Towards a "FAIR University

<p>Ambition:<br> <strong> </strong><br> <strong>Maastricht </strong><strong>University </strong><strong>is </strong><strong>to become  </strong><strong>a </strong><strong>‘FAIR’ </strong><strong>university</strong><br> <strong> </strong><br> by 2025 or even 2023</p

Preference for a general practitioner and patients' evaluations of care: a cross-sectional study

Personal continuity is no longer always evident in general practice. Changes in society and in general practice seem to have shifted away from an emphasis on personal patient–doctor relationships. We studied how patients' lack of preference for a particular general practitioner (GP) or preference for a different GP is related to patients' evaluations of care. Patients who were indifferent to the GP seen, and patients who would have preferred another GP, evaluated consultations significantly less positively than patients who saw their GP of preference. Developments towards less personal doctoring in general practice should, therefore, be considered carefully

Patients’ Needs for Contact With Their GP at the Time of Hospital Admission and Other Life Events: A Quantitative and Qualitative Exploration

PURPOSE Our goal was to explore patients’ anticipated needs for contact with their general practitioner (GP) at the time of hospital admissions and other life events. METHODS We undertook a questionnaire survey of 875 patients from 35 general practices spread throughout the Netherlands and a qualitative interview study with 30 patients. RESULTS Most patients expected to need contact with their GP if admitted to a hospital for a serious condition, such as a malignancy (98%) or a heart attack (97%). For minor conditions, such as a minor foot operation, contact was considered less important (33%). At the time of major life events, many patients anticipated needing contact as well: 81% in the case of a birth within the family, 90% in the case of a death in the family. In the quantitative analysis patients’ wants were related only to a minor extent to patient characteristics. The qualitative analysis, however, distinguished categories of patients with different needs. Some patients were more technical in their needs, others focussed primarily on the relationship. CONCLUSION Patients appear to have considerable need for contact with their physician at the time of hospital admission and other life events. The profession should reflect on this underexplored field and attempt to take a policy-making position toward initiating patient contact

The effects of a team-based continuous quality improvement intervention on the management of primary care: a randomised controlled trial

Item does not contain fulltextAIM: To study the effects of a team-based model for continuous quality improvement (CQI) on primary care practice management. DESIGN OF STUDY: Randomised controlled trial. SETTING: Twenty-six intervention and 23 control primary care practices in the Netherlands. METHOD: Practices interested in taking part in the CQI project were, after assessment of their practice organisation, randomly assigned to the intervention or control groups. During a total of five meetings, a facilitator helped the teams in the intervention group select suitable topics for quality improvement and follow a structured approach to achieve improvement objectives. Checklists completed by an outreach visitor, questionnaires for the GPs, staff and patients were used to assemble data on the number and quality of improvement activities undertaken and on practice management prior to the start of the intervention and 1 year later. RESULTS: Pre-test and post-test data were compared for the 26 intervention and 23 control practices. A significant intervention effect was found for the number of improvement objectives actually defined (93 versus 54, P<0.001) and successfully completed (80 versus 69% of the projects, P<0.001). The intervention group also improved on more aspects of practice management, as measured by our practice visit method, than the control group but none of these differences proved statistically significant. CONCLUSION: The intervention exerted a significant effect on the number and quality of improvement projects undertaken and self-defined objectives met. Failure of the effects of the intervention on the other dimensions of practice management to achieve significance may be due to the topics selected for some of the improvement projects being only partly covered by the assessment instrument

Continuity of care in general practice: a survey of patients' views.

BACKGROUND: It is not known how patients value continuity for different health problems. In addition, it is not clear how different types of patients value continuity. It has been argued, for example, that young and healthy individuals have different ideas about continuity from older people with chronic illnesses. More extensive exploration of patients' views and expectations on personal continuity is important as this may help to organise general practice better in the future. AIM: To explore patients' views on continuity of care in general practice and their relations to patient characteristics. DESIGN OF STUDY: Postal questionnaire survey. SETTING: Thirty-five general practices throughout The Netherlands. METHOD: A sample of 25 patients from each practice was sent a questionnaire. RESULTS: The response rate was 644/875 (74%). The percentage of patients feeling that it was important to see their personal doctor varied, from 21% for a splinter in the eye, to 96% for discussing the future when seriousy ill. The main reasons for preference of their own general practitioners (GPs) were the GP's assumed better medical knowledge of the patient and understanding of the personal and family background. Multiple linear regression analysis (GLM) showed that patient characteristics could explain 10% to 12% of the variance in these views on personal continuity. CONCLUSION: The importance that patients attach to continuity of care depends on the seriousness of the conditions/facing them. Patients in The Netherlands desire a high level of personal care for serious conditions. Patient characteristics, such as age, sex, and frequency of visits to the GP influence views on continuity of care only to a minor extent

What went and what came? Morbidity trends in general practice from the Netherlands

Background: Fourty years of morbidity registration in general practice is a milestone urging to present an overview of outcomes. This paper provides insight into the infrastructure and methods of the oldest practice-based research network in the Netherlands and offers an overview of morbidity in a general practice population. Changes in morbidity and some striking trends in morbidity are presented. Methods:The CMR (Continuous Morbidity Registration) collects morbidity data in four practices, in and around Nijmegen, the Netherlands. The recording is anchored in the Dutch healthcare system, which is primary care based, and where every citizen is listed with a personal GP. Trends over the period 1985-2006 are presented as a three year moving average. As an indicator for 20-year prevalence trends we used the annual percentage change (APC). We restricted ourselves to morbidity, which is presented to the family physician on a frequent basis (overall prevalence rates <1.0/1000/year). Results: The age distribution of the CMR population is comparable to the general Dutch population. Overall incidence figures vary between 1500/ 1000 ptyrs (men) and 2000/1000 ptyrs (women). They are quite stable over the years, whereas overall prevalence figures are rising gradually to 1500/2500 ptyrs (men) and 2000/3500 ptyrs (women). Increase in prevalence rates for chronic conditions is diffuse and gradual with a few striking exceptions. Conclusion: For morbidity patterns, the CMR database serves as a mirror of general practice. Practice-based research networks are indispensable for the development and maintenance of general practice as an academic discipline

Male and female health problems in general practice: The differential impact of social position and social roles

Sex, social position and social roles have been identified as important health predictors. Moreover, various social variables have been found to bear differently upon female as compared to male health. This study analyses data from a large-scale registration project in general practice (the Continuous Morbidity Registration), pertaining to the medical diagnoses of nearly 10,000 patients over a five year period. The effects of sex, social class, marital and parental status on a number of distinct categories of health problems were established, and a possible differential impact of social position and social roles on male and female health was explored. Categories of health problems studied were 'overall health problems', 'sex specific conditions', 'symptoms without disease', 'prevention and diagnostics' and 'trauma'. Sex and, above all, social class were identified as important predictors of most categories of health problems, especially during the reproductive period of life. Marital status and parental status did not contribute substantially to most types of health problems. Rates of prevention and diagnostics, sex specific conditions and total number of health problems could to a certain extent be predicted by the four sociodemographic variables, as opposed to trauma rates and symptoms without disease rates. Social class appeared the only variable with a substantially different effect on male vs female rates of sex specific conditions, prevention and diagnostics and trauma, but not so for overall health problems and symptoms without disease. Marital status and parental status did not differ significantly in their effect on male vs female health. Results illustrate that differentiation of the health variable into categories of health problems elucidates the relationship between sex, social variables and health.general practice health inequalities social roles sex differences

Screening for depression in high-risk groups is not effective

Inleiding De reguliere huisartsgeneeskundige zorg ontdekt ongeveer de helft van de patiënten met een depressieve stoornis (DS). Screening van hoogrisicogroepen zou de andere helft kunnen achterhalen.Methode We onderzochten de effectiviteit van selectief screenen op een DS in drie hoogrisicogroepen in de huisartsenpraktijk: patiënten met psychosociale problemen, patiënten met lichamelijk onverklaarde klachten en patiënten die vaak de huisarts bezoeken. We voerden het onderzoek uit in drie gezondheidscentra in Nederland.Resultaten Van de 2005 geïdentificeerde hoogrisicopatiënten konden wij er 1687 uitnodigen voor de screening. Van deze groep deden 780 patiënten mee. Wij ontdekten 71 patiënten met een DS; van hen waren er 36 (51%) al onder behandeling, weigerden 14 behandeling en wilden er 4 niet aan ons onderzoek meedoen. Als resultaat van de screening startten 17 patiënten (1% van de 1687) aan een behandeling voor een DS.Conclusie Screening op depressie in hoogrisicogroepen blijkt niet effectief: slechts 1 op de 5 ontdekte patiënten met een DS was bereid deel te nemen aan een behandeling