Search

There is a suggestion that the medical disciplinary committees (MDC) in the Netherlands are making more severe rulings on medical professionals. In a 10-year analysis of MDC rulings, it appears that complaints made by patients are more frequently being judged to be well-founded, and that the measures being taken are more severe. The authors conclude that there is a numerical basis for the increasing severity of the rulings. However, a numerical trend as such does not constitute proof of this, as the way in which the ruling is arrived at is unknown. A more thorough analysis of the patient complaints, the ruling and the underlying arguments is necessary. The authors also make some other statements that can be refuted. The importance of the possible influence of the increasing complexity of health care as a factor in the increase in complaints to the MDC is not addressed.

Scientific medical associations have made important steps in setting up integrated research agendas to narrow the huge knowledge gap about the effectiveness of accepted treatments. The ensuing care evaluations provide new insight into the value of different treatments; however, the implementation of the results of these care evaluations in practice continues to lag behind. In 2016 the Netherlands health insurers and the Netherlands patients' federation, supported by the Netherlands federation of medical specialists, started up the programme 'Leading the change'. As an integral part of this programme we held discussions with different parties to draw up measures to stimulate implementation. We advise having a comprehensive packet of measures to promote implementation. In this context it is important to make use of information-mirroring and to clarify the consequences of care evaluations for all parties involved. Implementation of new insights arising from care evaluations is in line with the responsibility associated with professional autonomy. Only if and when implementation lags behind despite stimulating measures will it be necessary to implement less voluntary measures.

In participatory action research (par), researchers, practitioners and the community engage in a research process together. This research approach has the potential to assist in bridging the research-practice gap by starting from practice needs and using joint expertise and experiences to enrich scientific knowledge, optimise clinical practice and empower stakeholders from different backgrounds.br/AIM: To discuss the potential benefits of par for clients, professionals and researchers in the field of mental healthcare.br/METHOD: Starting from the literature on par, fundamental characteristics and benefits of this research approach in the field of mental healthcare are described and illustrated with an example from practice.br/RESULTS: par in mental healthcare can contribute to enriching prepositional and practical knowledge, facilitate positive social change in care delivery, empower all stakeholders, and ultimately make a significant contribution to the integration of research and practice.br/CONCLUSION: par is valuable for clients, professionals and researchers in a variety of projects in mental healthcare.

Gain insight in questions adolescents have about their health.Cross-sectional questionnaire-based study.During the 2015-2016 school year, all grade 3 VMBO students and grade 4 MAVO/VMBO-T, HAVO or VWO (MHV) students in schools of the mid-Gelderland region were invited for the preventive health study 'Gezond leven? Check het even!' ['Living healthily? Do the check!']. In class, adolescents completed a digital questionnaire (the 'Check'), consisting of 70 questions about their health and well-being. For each topic, they could indicate if they had questions and whether they would have liked to have a conversation about them with a paediatrician or paediatric nurse or whether they would have liked to get digital information. The number of questions the adolescents had and the topics of these questions were described and compared with respect to gender, age, education level and ethnic background. Differences were analysed using logistic regression analysis.A total of 7057 (93.5%) of the 7544 adolescents who were invited completed the questionnaire (mean age: 15.1 years; 50.8% male). All 2561 VMBO students were invited for a consultation and 94.7% were seen. Of the 4496 MHV students, 25.5% were invited and 20.2% were seen. 27% of the adolescents had a question. The main themes were height, weight and lifestyle. Girls requested a consultation more often (23.0% vs 18.0%). Of the adolescents with a non-western background, 31.0% requested a consultation whereas 19.0% of the adolescents with a western background did so. MHV students wanted a digital response more often. Adolescents with psychological problems had more problems as well as more questions.The solution-oriented approach of the health study is a promising approach to reach adolescents in higher secondary education. As a result of this approach, many adolescents - including those from target groups that are usually difficult to reach - actively participated in the health study on their own initiative.

Research studies into the implementation of clinical practice guidelines often reveal only modest effects. These studies could have greater relevance if the following pitfalls were to be considered in advance. Firstly, there is a lack of awareness of the fact that physicians are overloaded with guidelines and need time for implementation, particularly when the guideline involves additional effort. Secondly, there is a lack of ownership of guidelines that were developed with involvement of many stakeholders. Thirdly, there is a lack of tailored implementation strategies focusing on specific recommendations rather than the whole guideline. Fourthly, guideline adherence is used as an outcome measure while there may be legitimate reasons to deviate from the guideline in individual cases. The future challenge for research into guideline implementation is to study how guidelines really could assist physicians in delivering personalised care.

In the Netherlands and a number of other European countries general practitioners are the gatekeepers for specialist and hospital care. European health care systems with gatekeeping general practitioners, i.e. those with comprehensive, strong primary care, perform better on a number of health indicators and on equity. However, it is less clear if gatekeeping health care systems have lower health expenditure. There is ongoing debate on whether gatekeeping plays a role in diagnostic delay of cancers. At health care system level research is being hampered by small numbers and should be combined with in-depth research into health care mechanisms.

How do healthcare consumers perceive the use of medical data for scientific research, within the framework of protection of their personal data?Survey among 731 members of the Healthcare Consumer Panel of the Netherlands Institute for Health Services Research (NIVEL).A written and online questionnaire was used, consisting of general questions and 4 cases per respondent. The questions concerned the degree of trust respondents have in the use of previously registered data for different kinds of healthcare research, and their willingness to make data available under various conditions without being asked for explicit consent.Respondents showed a high degree of trust in scientific researchers and physicians concerning the re-use of medical data for research. A majority agreed that it is not necessary to be explicitly asked for consent for this kind of research, providing they are informed: one-third found their autonomy in being able to decide to be more important than scientific progress; three-quarters found explicit permission unnecessary as long as the data is well-protected and only used for scientific research.Data protection in research should be proportional to the risks of misuse and the benefits of the use of the data for research. A large majority of healthcare users trust the researchers, and the existing codes of conduct protect data sufficiently. Therefore, we see no need for stricter requirements for the use of health data, which would unnecessarily limit healthcare research. We do consider greater transparency about the research process to be necessary, in order to maintain a proper balance between personal-data protection and the need to emphasise the necessity for learning in the healthcare system.

The discussion on patient safety in the Netherlands appears to have reached an impasse. Healthcare professionals are feeling uncomfortable with the enormous increase in the numbers of norms and guidelines, the focus on error and the pressure from external parties. In this article, based on the conference Safety II and beyond - resilience meets regulation, held in Rotterdam, the Netherlands in June 2015, we discuss the underlying problems and propose an alternative approach to the concept of patient safety and to measures to guarantee this safety.

While the patients' perspective has been included in health care research, the participation of people with intellectual disabilities in research on their health has been limited, and considered to be difficult. However, they are vulnerable and experience more health problems than the general population. Legal issues regarding inclusion of people with intellectual disabilities are clarified in international and Dutch law, and should be respected. Aside from the legally responsible persons, various other stakeholders also play a role, which should be realized and considered when developing research plans. Inclusion of people with intellectual disabilities themselves in research, not only as subjects but also as advisors, researchers and decision-makers could make research more relevant and attractive for themselves, for health practice and for the research community.

Transferring responsibility for care from secondary to primary health services is a hot topic in Dutch health care. The theory is that this is cheaper, while providing the same quality of care, and practice guidelines have actually stimulated this process for many years. Researchers from the Netherlands Institute for Health Services Research (NIVEL) explored how this transfer of care has been accepted and how the process can be expanded. The fact that there is a great difference in referral rate between general practitioners led them to conclude that there is still room for more transfer of care. One problem is that general practitioners in the Netherlands have too many job responsibilities, and no single general practitioner can fulfil all requirements. Although further transfer would be cost effective the organisation of health care needs to be remodelled if more services are to be transferred. Physicians should be stimulated to collaborate more effectively and medical training should focus more on this competence.

In 2013, a dental practice without a website is almost unthinkable. Using a sample of309 dentists drawn from the list of members of the Dutch Dental Association in 2012, a study was carried out to find out whether the dental practice of the general dental practitioner had a website. The content of each website was subsequently inventoried using a questionnaire. Eighty-nine percent of the dental practices had a website. The content of the websites, however, varied enormously. An element such as the professional registration number with a reference to the professional register were absent in 73% of the websites and the date of the most recent update of the website was mentioned only once. The name of the dentist, his or her professional qualification and an email address were missing on respectively 9%, 20% and 9% of the websites. Contracts of the practice with insurance companies were rarely clearly indicated. The websites of many practices would benefit considerably from a significant improvement.

Attention to the role of art within healthcare is on the rise. Dutch hospitals are increasingly embracing the concept of the 'healing environment', which aims to create agreeable hospital surroundings for the well-being of employees and patients. The concept is being interpreted in diverse ways; irrespective of the specific outcome of this interpretation, the healing environment does have consequences for the healthcare facilities' policies related to art. Research at a few Dutch hospitals has revealed that the more stringently the guidelines on the healing environment are followed, the more emphasis is placed on the medical-functional approach to art and the lesser attention is paid to the intrinsic value of art. Hospitals that reject the concept of the healing environment, however, also clearly demonstrate defining art in terms of making the surroundings agreeable to the patient. The healing environment therefore cannot serve as a new legitimation of autonomous artworks in existing hospital collections, but it is congruent with the recent attention given to the societal role of art.

A good performance indicator reflects the quality of care and uses clinical outcomes. When outcomes are difficult to obtain, process and structure variables can provide a good picture of quality of care. A single performance indicator for the entire hospital is unattainable; efforts should focus on performance indicators for specific disorders. There are limitations to the use of performance indicators to compare hospitals; these include correction for case mix, the statistical reliability of the measurements and the validation of performance indicators. Well-considered performance indicators can be used to monitor trends and identify providers that perform below a certain benchmark, but not to rank them.

As a result of increased life expectancy of persons with intellectual disabilities, the number of ageing persons with intellectual disability has increased rapidly. As a result of changed attitudes in health care, the majority of people aged 50 years or more now live in the community and make use of the standard general and specialist healthcare services. Except in people with Down syndrome, primary ageing occurs at a normal age in this population. Nevertheless, an increased age-related vulnerability can be observed, occurring earlier than in the general population. Although scientific research is still scarce, the following factors threatening health can be distinguished: functional impairments, multimorbidity, unhealthy lifestyle, incomplete detection of risk factors for cardiovascular disease, insufficient participation in population screening, missed diagnoses as a result of lack of subjective symptoms. Reliable information on health status of ageing people with an intellectual disability will become available in the next few years based on current Dutch research. Following several changes in the rules of the Dutch Healthcare Authority (NZa) it is possible for general practitioners to refer those patients with an intellectual disability living in the community to a doctor specialised in intellectual disability medicine.

Teneinde te kunnen beschikken over een instrument om de mondgezondheid (en de daaraan verbonden aspecten van financiering en organisatie van zorgverlening) van de Belgische bevolking te kunnen opvolgen, bestaat de nood om een systeem van dataregistratie met betrekking tot de mondgezondheid op te starten. De interuniversitaire werkgroep ICE (Interuniversitaire Cel voor Epidemiologie) werd de opdracht toevertrouwd om een Dataregistratiesysteem voor de Mondgezondheid van de Belgische bevolking te ontwikkelen. Om de implementatie van dit 'Dataregistratiesysteem Mondgezondheid' voor te bereiden, werd een haalbaarheidsstudie opgestart. Het doel hiervan was een validatie uit te voeren van de voorgestelde meetinstrumenten en een procesevaluatie uit te voeren. Deze bundel vormt het eindverslag van de haalbaarheidsstudie. 1.2. TAKEN VAN DE ICE De haalbaarheidsstudie bevatte enkele voorbereidende stappen teneinde het 'Dataregistratiesysteem Mondgezondheid' te kunnen uitvoeren gekoppeld aan de Gezondheidsenquête 2008, georganiseerd door het WIV (Wetenschappelijk Instituut Volksgezondheid). Deze stappen waren: a) Voorbereiden van aanvragen en overeenkomsten b) Ontwikkelen en valideren van de verschillende meetinstrumenten voor het onderzoek c) Exploratie van de databank geregistreerde zorgconsumptie d) Uitvoeren van een procesevaluatie (veldwerk) Voor een specifieke omschrijving van de opdracht verwijzen we naar de "Overeenkomst tussen het Comité van de verzekering voor geneeskundige verzorging bij de dienst voor geneeskundige verzorging van het RIZIV enerzijds en Ugent, optredend in naam van het interuniversitair onderzoeksteam ICE" van 17 juli 2006. 1.3. INHOUD VAN HET EINDVERSLAG Dit eindverslag omvat * een stand van zaken wat betreft de afspraken met de verschillende partners, * een omschrijving van het klinische registratiesysteem, de definitieve vragenlijsten en documenten voor de registratie van de mondgezondheidsgegevens (mondgezondheidsenquête), * een selectie van voorbeelden van resultaten bekomen op basis van de proefenquête * een evaluatie en discussie van de hele procedure

To describe and calculate Home Care Quality Indicators from data of the European Aged in Home Care (ADHOC) project. With due regard for risk factors, home care agencies at country level have been compared with each other on quality of care.The indicators of Home Care quality of care (HCQIs) are calculated based on methods that have been developed in the US and Canada. The values of these QIs are risk adjusted on the basis of odds ratios of covariates resulting from logistic regression analysis on the ADHOC sample. To enhance the comparison of QIs between countries we have used the method of percentile thresholds and QI aggregate sum measure related to those.Risk adjusted values of 22 Home Care Quality Indicators differed considerably between home care agencies in the eleven European countries that participated in ADHOC. The QI aggregate showed which countries probably had the best home care and which had the worst.There are quality indicators available, derived from data of the Resident Assessment Instrument for Home Care, with which quality of care between home care agencies in and across nations can be adequately compared. Examples of this type of indicator are: social isolation, inadequate pain control, failure to improve in impaired locomotion in the home.

v, 151 p. ill.

VI, 157 p. ill.

ix, 125 p. ill.

viii, 93 p. ill.

In an evidence-based review of the relationship between volume and quality of care, the independent Dutch Institute for Healthcare Improvement (CBO) concluded that volume appears to be related to outcome for certain surgical procedures (case fatality after pancreatic and oesophageal cancer) and that quality of care might be improved by centralisation. The Dutch Institute for Healthcare Improvement also identified conditions required for centralisation, particularly acceptance by professionals and hospitals. In the USA, programmes to improve quality ofcare initiated by the Leapfrog Group using volume criteria or, more recently, using 'public reporting' and 'pay for performance' principles have led to improvements in quality. In Canada, the Surgical Oncology programme within the Cancer System Quality Index programme has reduced case fatality following pancreatic resection. The Canadian programme was based not only on volume but also on standards, guidelines, rapid access strategies and publicly available performance assessments. In The Netherlands, the Dutch Health Care Inspectorate is introducing the so-called performance indicators of care. Other initiatives are underway to develop a system with multiple quality criteria as in Canada. These programmes should not be restricted to surgical procedures but should include complex procedures in other specialties as well.

Viii, 196 p. ill.

Although the agenda of the European Union (EU) does not directly provide for it, it seems reasonable to assume that due to the process of European social and economic integration there will be mounting pressure on the presently widely differing systems for primary care to move towards a more uniform orientation. In 2004, during its rotating presidency of the EU, the Dutch government asked its Health Council for advice on the current level of knowledge with regard to the organisation and significance of primary care. The Council formulated a set of key recommendations for the future development of primary care in Europe. The Council defines primary care as: generalist care, consisting of general medical, paramedical and pharmaceutical care, nursing and supportive care and non-specialised mental and social health care together with preventive and health educational activities linked to these forms of care. This care is for all health problems, is aimed at ambulatory patients, and is delivered close to the patients' homes. It is easily accessible to all, and provides emergency care when necessary. The main differences in the provision of primary care between countries in Europe concern the presence or absence of registration with a general practitioner and the gate-keeper role of primary care. International comparative research has identified the presence of precisely these features as predictors of better health outcomes in terms of morbidity and mortality. They therefore form a prominent role in the key recommendations, which state, among other things, that a patient should choose a primary-care team in the context of an integrated care circuit, thereby giving up his or her freedom to select care givers outside that circuit, in the interest of quality continuity and the efficiency of care. Other key recommendations are: close cooperation between primary-care teams, preventive services and public health and occupational health, a transparent provision on information between all providers of care, and the creation of a European Center for primary-care development.

In 1983 a ministerial decree based on Section 18 of the Hospital Provisions Act came into force, under which a number of top clinical centres could only give certain specialised care if they obtained a permit from the minister of Health, Welfare and Sport. Following the Health Council's report 'The Limits of Care' published in 1986, the government instructed the Health Council in 1989 to develop a policy for regularly reporting the status of certain section-18-activities and to put forward proposals for investigative medical research. This led to the Health Council's so-called annual reports, which have played a pivotal role in the balanced introduction and dissemination of special provisions. In 1995 the Health Council stopped issuing its annual report due to the ambiguity which arose concerning the implementation of a number of proposals it had made. In 1997 all top clinical activities were made subject to section 2 of the Specific Medical Procedures Act. This meant that there was no longer a statutory obligation to advise the government. However, under the Specific Medical Procedures Act, the Health Council has been able to continue its important advisory role. For example, the Health Council's advice was taken into consideration when the practice of in-vitro fertilisation was evaluated and during the drafting of the Embryo Act.

In drawing up a new coalition agreement in the Netherlands, public health and health care will be important issues. The government now has the opportunity, by planning well, to correct the negative image of public health care (expensive and inefficient) and to cope with major problems, such as long waiting lists and unequal access to care. Requirement are agreement on a realistic percentage of volume growth, based on demographic trends, good agreement on conditions of employment efficient use of funds which citizens can understand, limiting drug prices and outlining a health care system for the future that is transparent and universally accessible, with collective responsibilities clearly delineated. Furthermore research on public health and health care should be stimulated.

As a part of the SGO Health Research Promotion Programme, programme section Health Care Research, an experimental core training was instituted for general practitioners. The aim of the training was to provide a small number of family physicians with clinical and medical expertise relevant to general practice that would enable them to play a leading role in the development of academic general practice medicine. Seven general physicians followed a self-composed training programme of 2 to 3 years, consisting of active participation in patient care in Dutch clinics and clinics in other countries. The experiences gained during the SGO programme were used by the Dutch College of General Practitioners to develop a nationwide superior professional training course.

Medical and pharmaceutical research leads to a collection of data that are presented in the form of tables. Examples from several fields in the medical and pharmaceutical sciences show that principal component analysis allows to visualise the information, present in the tables, and thereby to more easily interpret this information. The method is explained algebraically and geometrically. The possibility to apply principal components to develop models, and thereby relate certain measurable quantities, is shortly indicated.

The care needs, utilization of care and the wish to be admitted on a short or long term basis of 135 applicants to homes for the aged are presented and their interrelations considered. The care needs of the applicants to and 207 residents of homes for the aged are compared. With an increasing number of housekeeping disabilities, depressive complaints, memory disorders and, as expected, the use of formal and informal care increased. The care needs of the applicants were at least as large as those of the residents. They had (nearly) as much housekeeping and ADL disabilities and even more feelings of loneliness and depressive complaints. Yet, for those applicants with few housekeeping disabilities the necessity of admission to a home for the aged can be questioned. That is, the wish to be admitted on short term was strongly associated with depressive complaints and feelings of loneliness. Provided that these mental problems can be handled effectively, (more) home care may be an alternative for them.