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22 februari 2023, Item does not contain fulltext, Aims: The aim of this study was to develop insights into how and why Dutch government policies on deployment and training of nurse practitioners and physician assistants have effect and under what circumstances. Design A realist analysis using qualitative interviews. Methods: Data analysis of 50 semi-structured interviews conducted in 2019 with healthcare providers, sectoral and professional associations, and training coordinators. Stratified purposive and snowball sampling were used. Results: Policies stimulated employment and training of nurse practitioners and physician assistants by: (1) contributing to the familiarity of participants in the decision-making process in healthcare providers with and medical doctors' trust in these professions; (2) contributing to participants' motivation in employment and training; and (3) eliminating barriers perceived by medical doctors, managers and directors. The extent to which policies affected employment and training was largely determined by sectoral and organizational circumstances, such as healthcare demand and complexity, and decision-makers in healthcare providers (medical doctors or managers/directors). Conclusion: Effectuating familiarity and trust among participants in the decision-making process is a crucial first step. Next, policymakers can motivate participants and lower their perceived barriers by extending the scope of practice, creating reimbursement opportunities and contributing to training costs. Theoretical insights into nurse practitioner and physician assistant employment and training have been refined. Impact The findings highlight how governments, health insurers, sectoral and professional associations, departments, councils, healthcare providers and professionals can facilitate and support nurse practitioner and physician assistant employment and training by contributing to familiarity, trust and motivation, and by clearing perceived barriers.

18 februari 2023, Item does not contain fulltext, Background: Medical residents work long, continuous hours. Working in conditions of extreme fatigue has adverse effects on the quality and safety of care, and on residents' quality of life. Many countries have attempted to regulate residents’ work hours. Objectives: We aimed to review residents' work hours regulations in different countries with an emphasis on night shifts Methods Standardized qualitative data on residents’ working hours were collected with the assistance of experts from 14 high-income countries through a questionnaire. An international comparative analysis was performed. Results: All countries reviewed limit the weekly working hours; North-American countries limit to 60-80 hours, European countries limit to 48 hours. In most countries, residents work 24 or 26 consecutive hours, but the number of long overnight shifts varies- ranging from two to ten. Many European countries face difficulties in complying with the weekly hour limit and allow opt-out contracts to exceed it. Conclusions: In the countries analyzed residents still work long hours. Attempts to limit the shift length or the weekly working hours resulted in modest improvements in residents’ quality of life with mixed effects on quality of care and residents' education.

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Contains fulltext : 293111.pdf (Publisher’s version ) (Open Access), Introduction: Despite policies aiming at universal health coverage by ensuring availability and accessibility of general practitioners (GPs), medically underserved areas are still present in Europe. This systematic review aims to summarize and compare literature on interventions and their potential effectiveness of GP recruitment and retention in these underserved areas ('medical deserts') from 2011 onwards. Methods: PubMed and Embase were used to identify publications, applying a two-stage selection process. All types of study designs, published in the past 10 years, were included if they discussed a possible intervention for GP recruitment or retention covering an underserved area in an EU-27/EEA/EFTA country (part of the European Union, the European Economic Area or the European Free Trade Association). Exclusion criteria were abstracts or full text not available, conference abstracts, poster presentations, books or overlapping secondary literature. Identified interventions were classified into four categories: 'education', 'professional and personal support', 'financial incentives' and 'regulation'. Eligible articles were critically appraisal by two authors (JB, LF), independently, by using the Joanna Briggs Institute checklist. Results: Of the 294 publications initially retrieved, 25 publications were included. Of them, 14 (56%) described educational interventions, 13 (52%) professional and personal support, and 11 (40%) financial or regulatory interventions. Overlapping categories were often described (56%). The effectiveness of educational or supportive interventions has mainly been evaluated crosssectionally, whereby causal inference on future GP availability cannot be implied. Few and mixed results were found for the effectiveness of financial and regulatory interventions, because period co-interventions were not taken into account during the study. Conclusion: In the past 10 years, educational and supportive interventions to improve GP recruitment and rete

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Item does not contain fulltext, Background: Patients' web-based access to their medical records is expected to promote their role and responsibility in managing their own health and treatments and supporting shared decision-making. As of July 2020, general practices in the Netherlands are legally obliged to provide their patients access to their electronic medical records. Web-based access provision is facilitated and stimulated through a national support program named OPEN. Objective: We aimed to investigate general practice staff experiences with providing web-based access; investigate its impact on patient consultations, administrative actions, and patient inquiries; and investigate how it affects routine general practice workflow processes. Methods: In October 2021, a total of 3813 general practices in the Netherlands were invited to complete a web-based survey that included questions regarding their experiences with the provision of web-based access to medical records and how it affects routine general practice workflow. Responses of general practices that started providing web-based access before 2020, in 2020, or in 2021 were analyzed to identify trends. Results: Of 3813 invited general practices, 523 (13.72%) completed the survey. Approximately all responding general practices (487/523, 93.1%) indicated that they provide web-based access. Experiences with patients' web-based access were diverse, with 36.9% (178/482) primarily positive, 8.1% (39/482) primarily negative, 42.3% (204/482) neutral, and 12.7% (61/482) could not (yet) indicate how they experienced web-based access. Of the total, two-thirds (311/473, 65.8%) reported an increase in e-consultations and a similar percentage (302/474, 63.7%) indicated an increase in administrative actions associated with web-based access provision. A small proportion of the practices (≤10%) experienced a decrease in patient contacts. Earlier adoption of web-based access was associated with a more positive attitude toward web-based access and more posi

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Contains fulltext : 296289.pdf (Publisher’s version ) (Open Access), Background: General practices have adapted the practice organisation to the circumstances of the COVID-19 pandemic. In this article we describe several adjustments in general practices in the field of patient flow management, appointments, triage, referral and infection prevention. We also examined how practices relate to the policy of the government and of the professional organisations during the pandemic. Methods: A cross-sectional online survey was conducted among a sample of 893 general practitioners (GPs) during February and March 2021. The response rate was 17%. Because the questionnaire concerns practices and not individual GPs, one practice owner per practice received an invitation with a link to the online questionnaire. One reminder has been sent. Results: General practices adapted their organisation during the corona pandemic, partly based on information and advice from their professional organisations. The adjustments were necessary to ensure that patient care continued as much and as safely as possible, often remotely. The use of video consultations quickly increased from 6% to 65% of the practices. The cooperation with neighbouring practices improved and practices felt supported by the professional organisations. Conclusions: The pandemic itself, remote care and stricter patient flow management have put pressure on the quality of care and patient safety. The accessibility of the practices was sometimes limited. In the perception of patients, this was stronger than in reality.

06 juni 2023, Contains fulltext : 296287.pdf (Publisher’s version ) (Closed access)

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Contains fulltext : 296288.pdf (Publisher’s version ) (Closed access), Background: Medical deserts are considered a problematic issue for many Western countries which try to employ multitude of policies and initiatives to achieve a better distribution of their health workforce (HWF). The aim of this study was to systematically map research and provide an overview of definitions, characteristics, contributing factors and approaches to mitigate medical deserts within the European Union (EU)-funded project "ROUTE-HWF" (a Roadmap OUT of mEdical deserts into supportive Health WorkForce initiatives and policies). Methods: We performed a scoping review to identify knowledge clusters/research gaps in the field of medical deserts focusing on HWF issues. Six databases were searched till June 2021. Studies reporting primary research from Western countries on definitions, characteristics, contributing factors, and approaches were included. Two independent reviewers assessed studies for eligibility, extracted data and clustered studies according to the four defined outcomes. Results: Two-hundred and forty studies were included (n = 116, 48% Australia/New Zealand; n = 105, 44% North America; n = 20, 8% Europe). All used observational designs except for five quasi-experimental studies. Studies provided definitions (n = 171, 71%), characteristics (n = 95, 40%), contributing factors (n = 112, 47%), and approaches to mitigate medical deserts (n = 87, 36%). Most medical deserts were defined by the density of the population in an area. Contributing factors to HWF issues in medical deserts consisted in work-related (n = 55, 23%) and lifestyle-related factors (n = 33, 14%) of the HWF as well as sociodemographic characteristics (n = 79, 33%). Approaches to mitigate them focused on training adapted to the scope of rural practice (n = 67, 28%), HWF distribution (n = 3, 1%), support/infrastructure (n = 8, 3%) and innovative models of care (n = 7, 3%). Conclusion: Our study provides the first scoping review that presents and categorizes definitions, characterist

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Contains fulltext : 296285.pdf (Publisher’s version ) (Open Access), Primary health care (PHC) is essential for all of the healthcare systems. The main purpose of the PHC is the prevention of health problems. Secondary, tertiary, and quaternary health care system is based on primary health care. PHC is accessible for every person in a community, and it’s also plays a key role for environmental health. Primary health care is responsible for the organization and integration of the health care system. In other words, primary health care provides a comprehensive health system and coordinates it with the other sectors. According to the principle of PHC, the health service must be equitable, accessible, and sustainable. Primary health care is the building blocks of the public health. PHC is mainly organizing public health services according to people’s need for better health in the society. In a personal level, PHC prevents and reduces health problems and thus promotes human health. Therefore, health care policy must be constituted to support primary health care in all county.

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Item does not contain fulltext, Information and communication technologies (ICT) are the engine of competitiveness and innovation of the twenty-first century. The advances in ICT specifically enable digital transformation in (extended) enterprises. Yet, successfully leveraging ICT is a complex challenge, particularly when mobile technology with its many advantages and specific singularities is involved. Careful preparation before development and implementation is needed. We present an integrative framework that supports organizations in preparing their mobile technology-enabled digital transformation. It consists of seven activities that are categorized by three pillars of the framework: (1) internal analysis, (2) economic analysis, and (3) integrative analysis. We demonstrate the validity and applicability of the framework through a multimethod validation. First, by a retrospective case study about the introduction of a mobile app in a hospital, we show that most aspects of the framework are relevant and covered. Second, by qualitative semi-structured expert interviews, we conclude that the need for each of the activities of the framework is underwritten. Third, by successfully applying one key activity of the framework—definition of the target system—on the implementation of an electronic learning environment at a fire brigade.

Item does not contain fulltext, Background: Nursing competency frameworks describe the competencies; knowledge, skills and attitudes nurses should possess. Countries have their own framework. Knowledge of the content of professional competency frameworks in different countries can enhance the development of these frameworks and international collaborations. Objective: This study examines how competencies and task divisions are described in the current professional competency frameworks for registered nurses (RNs with a Bachelor's degree) in the Netherlands, Belgium, the United Kingdom (UK), Canada and the United States (US). Methods: Qualitative document analysis was conducted using the most recently published professional competency frameworks for registered nurses in the above-mentioned five countries. Results: All the competency frameworks distinguished categories of competencies. Three of the five frameworks explicitly mentioned the basis for the categorization: an adaptation of the CanMEDS model (Netherlands), European directives on the recognition of professional qualifications (Belgium) and an adapted inter-professional framework (US). Although there was variation in how competencies were grouped, we inductively identified ten generic competency domains: (1) Professional Attitude, (2) Clinical Care in Practice, (3) Communication and Collaboration, (4) Health Promotion and Prevention, (5) Organization and Planning of Care, (6) Leadership, (7) Quality and Safety of Care, (8) Training and (continuing) Education, (9) Technology and e-Health, (10) Support of Self-Management and Patient Empowerment. Country differences were found in some more specific competency descriptions. All frameworks described aspects related to the division of tasks between nurses on the one hand and physicians and other healthcare professionals on the other hand. However, these descriptions were rather limited and often imprecise. Conclusions: Although ten generic domains could be identified when analysing and comparing, 11 p.

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Item does not contain fulltext, Huisartsenpraktijken pasten tijdens de coronapandemie hun organisatie aan, mede op basis van informatie en adviezen van hun beroepsorganisaties. De aanpassingen waren noodzake-lijk om de zorg voor patiënten zo veel en zo veilig mogelijk doorgang te laten vinden, vaak op afstand. De pandemie zelf, de zorg op afstand en de strakkere geleiding van de patiëntenstroom zetten de kwaliteit van zorg en de patiëntveiligheid onder druk. De toegankelijkheid van de praktijken was soms beperkt, in de beleving van patiënten was dat sterker dan in werkelijkheid.

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EQUIP 2022: 60th Conference of the European Society for Quality and Patient Safety in General Practice/Family Medicine (GP/FM) (11-12 March 2022), Item does not contain fulltext

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Item does not contain fulltext, The first outbreak of the COVID-19 pandemic led to the introduction of the more extensive use of e-health in Dutch general practices. The objective of this study was to investigate the experiences of general practitioners (GPs) regarding this change. In addition, the necessary conditions for e-health technology to be of added value to general practices were explored. In April 2020, 30 GPs were recruited for in-depth interviews via a web survey which contained questions regarding the use of e-health during the first wave of the pandemic. While most GPs intend to keep using e-health applications more extensively than before the pandemic, the actual use of e-health depends on several factors, including the characteristics of the application’s users. The following conditions for successful and sustainable implementation of e-health were identified: (1) integration of e-health technology in the organization of GP care, (2) sufficient user-friendliness of applications as well as digital skills of professionals and patients, and (3) adequate technological and financial support of e-health services. GPs clearly recognize the benefits of using e-health, and most GPs intend to keep using e-health applications more extensively than before the pandemic. However, improvements are needed to allow widespread and sustainable adoption of e-health technology in general practices.

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