Diabetes quality management in Dutch care groups and outpatient clinics:A cross-sectional study

BACKGROUND: In recent years, most Dutch general practitioners started working under the umbrella of diabetes care groups, responsible for the organisation and coordination of diabetes care. The quality management of these new organisations receives growing interest, although its association with quality of diabetes care is yet unclear. The best way to measure quality management is unknown and it has not yet been studied at the level of outpatient clinics or care groups. We aimed to assess quality management of type 2 diabetes care in care groups and outpatient clinics. RESULTS: Quality management was measured with online questionnaires, containing six domains (see below). They were divided into 28 subdomains, with 59 (care groups) and 57 (outpatient clinics) questions respectively. The mean score of the domains reflects the overall score (0-100%) of an organisation. Two quality managers of all Dutch care groups and outpatient clinics were invited to fill out the questionnaire. Sixty care groups (response rate 61.9%) showed a mean score of 59.6% (CI 57.1-62.1%). The average score in 52 outpatient clinics (response rate 50.0%) was 61.9% (CI 57.5-66.8%). Mean scores on the six domains for care groups and outpatient clinics respectively were: ‘organisation of care’ 71.9% (CI 68.8-74.9%), 76.8% (CI 72.8-80.7%); ‘multidisciplinary teamwork’ 67.1% (CI 62.4-71.9%), 71.5% (CI 65.3-77.8%); ‘patient centeredness’ 46.7% (CI 42.6-50.7%), 62.5% (CI 57.7-67.2%); ‘performance management’ 63.3% (CI 61.2-65.3%), 50.9% (CI 44.2-57.5%); ‘quality improvement policy’ 52.6% (CI 49.2-56.1%), 50.9% (CI 44.6-57.3%); and ‘management strategies’ 56.0% (CI 51.4-60.7%), 59.0% (CI 52.8-65.2%). On subdomains, care groups scored highest on ‘care program’ (83.3%) and ‘measured outcomes’ (98.3%) and lowest on ‘patient safety’ (15.1%) and ‘patient involvement’ (17.7%). Outpatient clinics scored high on the presence of a ‘diabetic foot team’ (81.6%) and the support in ‘self-management’ (81.0%) and low on ‘patient involvement’ (26.8%) and ‘inspection of medical file’ (28.0%). CONCLUSIONS: This nationwide assessment reveals that the level of quality management in diabetes care varies between several subdomains in both diabetes care groups and outpatient clinics

Collaborating on Early Detection of Frailty; a Multifaceted Challenge

Introduction: In several countries, initiatives to detect frailty among older citizens at an early stage are being implemented to enable proactive intervention and, consequently, to support independent living for as long as possible. Alignment and collaboration between the various actors are crucial. We aimed to provide insight in factors that impede or facilitate collaboration at a local level as perceived by the different actors and we explore their experiences. Methods: Semi-structured interviews were conducted with 37 representatives of three groups active in proactive elderly care in the Netherlands: (i) commissioners, (ii) service providers, and (iii) other stakeholders (e.g. public health advisors, academics). The Framework Method was used to analyse data. Results: Interviewees perceived many factors hampering or facilitating collaboration. Overall, the factors mentioned were quite similar for the different groups. Facilitators and barriers were related to culture and professionals (e.g. knowledge of early detection approaches, mutual trust), organizations (e.g. shared vision or patient information system) and context (e.g. financing). Discussion and conclusion: Collaborating on early detection appears to be a multifaceted challenge. However, as different stakeholders hold similar views, there seem to be several starting-points to improve collaboration. First steps shall include getting to know each other and developing a shared vision on early detection

Farmacotherapeutische zorg voor kwetsbare groepen met polyfarmacie moet beter

Farmacotherapeutische zorg voor ouderen en mensen met een psychiatrische aandoening is complex en risicovol, omdat deze groepen vaak te maken hebben met polyfarmacie, dat wil zeggen het chronisch gebruik van vijf of meer verschillende geneesmiddelen. Polyfarmacie is een risicofactor voor geneesmiddelgerelateerde ziekenhuisopnames. Voor de IGZ zijn ‘het verbeteren van zorg voor ouderen’ en ‘het verhogen van de medicatieveiligheid’ speerpunten. Om het IGZ-beleid verder vorm te geven, heeft het Rijksinstituut voor Volksgezondheid en Milieu (RIVM) onderzocht welke risico’s patiënten met polyfarmacie lopen en welke maatregelen beschikbaar zijn om deze risico’s te beperken. Uit dit onderzoek bleek dat over- en onderbehandeling vaak voorkomen. Dit kan veroorzaakt worden doordat voorschrijvers soms niet van elkaar weten wat ze voorschrijven, wijzigen of stoppen. Verder bleek dat bij mensen met een psychiatrische aandoening sprake kan zijn van bijwerkingen of interacties die specifiek optreden bij psychiatrische medicatie, soms vanwege combinatie met somatische geneesmiddelen. Er zijn diverse richtlijnen die de medicatieveiligheid kunnen verbeteren, maar bij de implementatie is een aantal knelpunten gesignaleerd, niet alleen op het terrein van samenwerking, regie en medicatieoverdracht, maar ook omdat ICT onvoldoende faciliterend is en voorschrijvers nog te weinig kennis hebben over polyfarmacie bij kwetsbare groepen. Het zorgveld probeert de gesignaleerde knelpunten aan te pakken. De IGZ zal vanaf 2015 in alle domeinen van de gezondheidszorg de focus leggen op vier richtlijnen die belangrijke voorwaarden vormen voor verantwoord voorschrijven aan kwetsbare groepen met polyfarmacie

Multimorbidity and comorbidity in the Dutch population - data from general practices

<p>Abstract</p> <p>Background</p> <p>Multimorbidity is increasingly recognized as a major public health challenge of modern societies. However, knowledge about the size of the population suffering from multimorbidity and the type of multimorbidity is scarce. The objective of this study was to present an overview of the prevalence of multimorbidity and comorbidity of chronic diseases in the Dutch population and to explore disease clustering and common comorbidities.</p> <p>Methods</p> <p>We used 7 years data (2002–2008) of a large Dutch representative network of general practices (212,902 patients). Multimorbidity was defined as having two or more out of 29 chronic diseases. The prevalence of multimorbidity was calculated for the total population and by sex and age group. For 10 prevalent diseases among patients of 55 years and older (N = 52,014) logistic regressions analyses were used to study disease clustering and descriptive analyses to explore common comorbid diseases.</p> <p>Results</p> <p>Multimorbidity of chronic diseases was found among 13% of the Dutch population and in 37% of those older than 55 years. Among patients over 55 years with a specific chronic disease more than two-thirds also had one or more other chronic diseases. Most disease pairs occurred more frequently than would be expected if diseases had been independent. Comorbidity was not limited to specific combinations of diseases; about 70% of those with a disease had one or more extra chronic diseases recorded which were not included in the top five of most common diseases.</p> <p>Conclusion</p> <p>Multimorbidity is common at all ages though increasing with age, with over two-thirds of those with chronic diseases and aged 55 years and older being recorded with multimorbidity. Comorbidity encompassed many different combinations of chronic diseases. Given the ageing population, multimorbidity and its consequences should be taken into account in the organization of care in order to avoid fragmented care, in medical research and healthcare policy.</p

Towards an integrative approach of healthcare: implementing positive health in three cases in the Netherlands

Abstract Background The healthcare system is under tremendous pressure. One possible solution towards relieving some of this pressure is to use Positive Health, which takes ‘health’ as a starting point, rather than ‘illness’. Positive Health provides opportunities for stimulating integrated care. Methods Three cases in the Netherlands are studied in this paper. Their way of working with Positive Health is investigated through semi-structured and narrative interviews, using realist-evaluation and thematic analyses. Results Seven ‘working elements’ are identified that enhance the chances of successfully implementing Positive Health in practice (part 1). The interviews show that healthcare professionals have noticed that people adopt a healthier lifestyle and gain a greater degree of control over their own health. This boosts job satisfaction for healthcare professionals too. The organisations and professionals involved are enthusiastic about working with Positive Health, but still experience barriers (part 2). Conclusions The results of this study imply that implementing Positive Health in practice can facilitate collaboration between organisations and professionals from different disciplines, such as healthcare, welfare, and municipal health services. Operating from the perspective of a shared goal, professionals from different disciplines will find it easier to jointly organise activities to foster citizens’ health. Additionally, more attention is paid to non-medical problems affecting people’s well-being, such as loneliness or financial problems

Tot hier ... en nú verder - behoeften van ouderen tijdens de coronapandemie in Nederland

Begin 2020 bereikte het coronavirus Nederland. Hoewel we nu een stuk meer weten over het coronavirus SARS-CoV-2, was er in het begin vooral heel veel onbekend. Ouderen werden in één keer als ‘kwetsbaar’ bestempeld.1 De coronamaatregelen waren gericht op het beschermen van ouderen tegen COVID-19 infectie, maar zorgden ook voor minder participatie en meer angst en eenzaamheid bij ouderen.3 4 1 5 Bovendien kwam de autonomie van ouderen onder druk te staan.6 Hoewel ouderenparticipatie aan een opmars bezig is, wordt de mening van ouderen niet altijd meegenomen in beleid over ouderen. Deze periode heeft nog eens benadrukt hoe belangrijk het is om niet alleen te spreken over ouderen, maar om vooral ook in gesprek te blijven met ouderen. Dit is een van de belangrijkste lessen uit ons onderzoek naar welzijn en ondersteuning van ouderen tijdens de coronaperiode. We blikken hier terug op de situatie van twee jaar corona, en kijken ook vooruit naar wat er nodig is in de toekomst

Tot hier … en nú verder – behoeften van ouderen tijdens de coronapandemie in Nederland

Begin 2020 bereikte het coronavirus Nederland. Hoewel we nu een stuk meer weten over het coronavirus SARS-CoV-2, was er in het begin vooral heel veel onbekend. Ouderen werden in één keer als ‘kwetsbaar’ bestempeld.1 De coronamaatregelen waren gericht op het beschermen van ouderen tegen COVID-19 infectie, maar zorgden ook voor minder participatie en meer angst en eenzaamheid bij ouderen.3 4 1 5 Bovendien kwam de autonomie van ouderen onder druk te staan.6 Hoewel ouderenparticipatie aan een opmars bezig is, wordt de mening van ouderen niet altijd meegenomen in beleid over ouderen. Deze periode heeft nog eens benadrukt hoe belangrijk het is om niet alleen te spreken over ouderen, maar om vooral ook in gesprek te blijven met ouderen. Dit is een van de belangrijkste lessen uit ons onderzoek naar welzijn en ondersteuning van ouderen tijdens de coronaperiode. We blikken hier terug op de situatie van twee jaar corona, en kijken ook vooruit naar wat er nodig is in de toekomst

Change in quality management in diabetes care groups and outpatient clinics after feedback and tailored support

Objective  To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. Research design and methods This before-and-after study with a 1-year follow-up surveyed quality managers on six domains of quality management. Questionnaires measured organization of care, multidisciplinary teamwork, patient centeredness, performance results, quality improvement policy, and management strategies (score range 0–100%). Based on the scores, responders received feedback and a benchmark and were granted access to a toolbox of quality improvement instruments. If requested, additional support in improving quality management was available, consisting of an elucidating phone call or a visit from an experienced consultant. After 1 year, the level of quality management was measured again. Results Of the initially 60 participating care groups, 51 completed the study. The total quality management score improved from 59.8% (95% CI 57.0–62.6%) to 65.1% (62.8–67.5%; P < 0.0001). The same applied to all six domains. The feedback and benchmark improved the total quality management score (P = 0.001). Of the 44 participating outpatient clinics, 28 completed the study. Their total score changed from 65.7% (CI 60.3–71.1%) to 67.3% (CI 62.9–71.7%; P = 0.30). Only the results in the domain multidisciplinary teamwork improved (P = 0.001). Conclusions Measuring quality management and providing feedback and a benchmark improves the level of quality management in care groups but not in outpatient clinics. The questionnaires might also be a useful asset for other diabetes care groups, such as Accountable Care Organizations