Zorgdiagnose bij thuiswonende, dementerende patiënten. Een nieuw concept?

Inleiding: De zorg voor dementerende patiënten is een belangrijke maatschappelijke uitdaging. Naast de ziektediagnostiek is de vaststelling van de zorgbehoefte van de patiënt van groot belang. In dit artikel wordt op basis van literatuur en expertadvies een werkdocument opgesteld om de zorgdiagnose bij thuiswonende dementerenden in kaart te brengen. Methode: Via een systematisch literatuuronderzoek werden de componenten van zorgdiagnose geïnventariseerd. Vervolgens werd na semigestructureerde interviews bij zestien zorgverleners en twee mantelzorgers de inventaris verder ontwikkeld en een werkdocument opgesteld. Resultaten: De literatuur over zorgdiagnose is recent en er zijn slechts weinig studies met eenduidige resultaten. Alle auteurs zijn het er echter over eens dat het inventariseren van de zorgbehoefte leidt tot een betere zorgplanning en een hogere levenskwaliteit van zowel patiënt als mantelzorger. Als synthese van het literatuuronderzoek en semigestructureerde interviews wordt een werkdocument voorgesteld om tijdens een multidisciplinair overleg (MDO) de zorgbehoefte bij een thuiswonende, dementerende patiënt en zijn mantelzorger te inventariseren. Besluit: Het in kaart brengen van de zorgbehoefte van een thuiswonende, dementerende patiënt en zijn mantelzorger is belangrijk. Het voorgestelde document kan dienen als leidraad tijdens een multidisciplinair overleg

Integrated Care Models for Older Adults with Depression and Physical Comorbidity: A Scoping Review

Objective: Multimorbidity is a growing challenge in the care for older people with mental illness. To address both physical and mental illnesses, integrated care management is required. The purpose of this scoping review is to identify core components of integrated care models for older adults with depression and physical comorbidity, and map reported outcomes and implementation strategies. Methods: PubMed, EMBASE, CINAHL and Cochrane Library were searched independently by two reviewers for studies concerning integrated care interventions for older adults with depression and physical comorbidity. We used the SELFIE framework to map core components of integrated care models. Clinical and organisational outcomes were mapped. Results: Thirty-eight studies describing thirteen care models were included. In all care models, a multidisciplinary team was involved. The following core components were mainly described: continuity, person-centredness, tailored holistic assessment, pro-activeness, treatment interaction, individualized care planning, and coordination tailored to complexity of care needs. Twenty-seven different outcomes were evaluated, with more attention given to clinical than to organisational outcomes. Conclusion: The core components that comprise integrated care models are diverse. Future studies should focus more on implementation aspects of the intervention and describe financial parts, e.g., the cost of the intervention for the healthcare user, more transparently

Facilitating guideline implementation in primary health care practices

Introduction: Many patients continue to receive suboptimal services, inappropriate, unsafe, and costly care. Underutilization of research by health professionals is a common problem in the primary care setting. Although many theoretical frameworks can be used to help address such evidence-practice gaps, health care professionals may not be aware of the benefits of frameworks or of the most appropriate ones for their context and thus, may be faced with the challenge of selecting and using the most relevant one. Aim: The aim of this article was to describe the process used to adapt a knowledge translation framework to meet the local needs of health professionals working in one large primary care setting. Methods: The authors developed a 5-step approach for guideline implementation. This approach was informed by prior research and the authors’ experiences in supporting multidisciplinary teams of health care professionals during the implementation of evidence-based clinical guidelines into primary care practices. To ensure that the 5-step approach was practical and suitable for the context of guideline implementation by multidisciplinary teams in primary health care, the implementation team adapted the “knowledge-to-action” framework using a multistep process. Results: The implementation approach consisted of the following 5 steps: identification, context analysis, development of implementation plan, evaluation, and sustainability. All 5 steps were described alongside details about a national low back pain project. Discussion: This article describes a collaborative, grassroots process that addressed an identified need in one complex context by adapting a knowledge translation framework to meet the local needs of health professionals working in primary care settings. Existing implementation frameworks may be too complex or abstract for use in busy clinical contexts. The 5-step approach presented in this paper resulted in practical steps that are more readily understood by health care professionals and staff on “the ground”. © The Author(s) 2020

Spiritualiteit aan het levenseinde: kunst of wetenschap?

Background: The World Health Organization defines palliativecare as encompassing the control of pain and other symptoms and psychological, social, and spiritual care. Most patients experiencing life-threatening illness want the medical team to address their spirituality. Nevertheless, the provision of spiritual care in everyday practice remains difficult. Health care providers face many obstacles, such as discomfortwith the subject, inability to find the right words or a lack of specific training. line-height:115%">Aim: Calibri" lang="EN-GB">The overall aim of this thesis was to study spirituality in palliative home care from different perspectives. We aimed to answer the following questions: how do general practitioners (GPs) perceive their role in spiritual care (RQ1)? What are the key elements of spiritual care in palliative home care (RQ 2)? What are the key outcome measures for spiritual care in palliative home care (RQ 3)? What are GPs views on the use of the FICA tool for spiritual history taking (RQ 4)? How do GPs, nurses, and their patients experience thears moriendi model (AMM) as a tool for spiritual history taking (RQ 5)?What is the effect of structured spiritual history taking on the spiritual well-being of palliative patients (RQ 6)? What challenges need to beovercome to recruit patients with an incurable, life-threatening illness for research in home care (RQ 7)? line-height:115%">Methods: Firstly we carried out a qualitative synthesis of the evidence (RQ 1). We then organised an invitational conference involving experts in palliative and spiritual care to reach a consensus on key elements and outcome measures for spiritual care in palliative home care (RQ 2 & 3). For this we used the nominal group technique, followed by atwo-stage web-based Delphi process. In a third stage we conducted semi-structured interviews with GPs to investigate their views about the FICAtool (RQ 4). We piloted the AMM and subsequently interviewed health care providers and palliative patients to investigate their experiences with the model (RQ 5). Afterwards we carried out a cluster randomised controlled trial (RCT) to investigate the effect of structured spiritual history taking on the spiritual well-being of palliative patients (RQ 6). The health care providers assigned to the intervention arm of the RCT completed a survey immediately after taking the history and participated in a semi-structured interview a few weeks later to investigate their experience with the AMM (RQ 5). Finally, we described the challenges we met in the recruitment of health care providers and palliative patients for the RCT (RQ 7).line-height:115%">Results: Many GPssee it as their role to identify and assess patients spiritual needs despite perceived barriers such as lack of time and lack of specific training (RQ 1). The experts attending the invitational conference reached consensus about 14 key elements and three key outcome measures for spiritual care (RQ 2 & 3). The FICA tool seems to be a usable tool for spiritual history taking, provided that certain substantive and linguisticadjustments are made (RQ 4). Guided by the AMM, health care providers can gather information about the context, life story, and meaningful connections of their patients, enabling them to organise person-centred palliative care with respect for the spiritual dimension (RQ 5). Spiritual history taking was not found to have any effect on patient scores for spiritual well-being, quality of life, health care relationship trust,or pain (RQ 6). Finally, recruitment of GPs, early identification of palliative care patients, and patient-provider communication about end-of-life issues were major difficulties in our trial (RQ 7).line-height:115%">Conclusions: Health care providers generally perceive a palliative care process that focuses attention on the patient s spirituality as a tough but rewarding experience. The FICA tool and the AMM are usable for the clinical assessment of spirituality, provided that they are used in a spontaneous way, according to the individual needs of the patient. These tools furnish greater insights into patients spiritual needs and resources and help caregivers to establish person-centred end-of-life care. More research is needed to better understand the role of the GP as spiritual caregiver, to design an interdisciplinarymodel for spiritual care in palliative home care and to develop and evaluate outcome measures for spiritual interventions.nrpages: 173status: publishe

Rapid Recommendations: snelle vertaling van wetenschappelijke resultaten naar de praktijk.

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Improving care for heart failure patients in primary care, GPs' perceptions: a qualitative evidence synthesis

General practitioners (GPs) play a key role in heart failure (HF) management. Despite multiple guidelines, the management of patients with HF in primary care is suboptimal. Therefore, all the qualitative evidence concerning GPs' perceptions of managing HF in primary care was synthesised to identify barriers and facilitators for optimal care, and ideas for improvement.status: publishe

The Ars Moriendi Model for Spiritual Assessment: A Mixed-Methods Evaluation

To explore nurses' and physicians' experiences with the ars moriendi model (AMM) for spiritual assessment.
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Vulnerability of wives of Nepalese labor migrants to HIV infection: a socio-epidemiological study

The vulnerability paradigm accounts for women’s susceptibility to HIV infection being a consequence of socio-economic and cultural factors, and there is a strong need for socio-epidemiological analysis to understand and address vulnerability of Nepalese women to HIV infection. Therefore, to assess the risk factors and vulnerability of the wives of Nepalese labor migrants to HIV infection, we conducted a mixed-methods study in which a descriptive case study was embedded within a case-control study. A total of 224 wives of labor migrants were interviewed in the case-control study and two focus group discussions were conducted in the descriptive case study. Data was analyzed using hierarch- ical conditional logistic regression analysis in the case-control study and thematic analysis in the descriptive case study. We found that illiteracy, low socio-economic status and gender inequality contributed to poor knowledge and poor sexual negotiation among the wives of labor migrants and increased their risk of HIV through unprotected sex. Among male labor migrants, illiteracy, low socio-economic status, migration to India before marriage and alcohol consumption contributed to visit female sex workers and increased the risk of HIV in their wives through unprotected sex. Both labor migrants and their wives feared disclosure of positive HIV status due to HIV stigma and thus were less likely to be tested for HIV. Interventions targeting the general population, such as access to basic education, income generation and mass awareness, and interventions targeting specific subpopu- lations, such as gender-related training and involving men in HIV-related programs, should be combined to reduce vulnerability of Nepalese women to HIV infection.no isbnstatus: publishe

Vulnerability of Wives of Nepalese Labor Migrants to HIV Infection: Integrating Quantitative and Qualitative Evidence

HIV risk is determined by the interaction between social and individual risk factors, but information about such factors among Nepalese women is not yet understood. Therefore, to assess the risk factors and vulnerability of the wives of Nepalese labor migrants to HIV infection, the authors conducted a mixed-methods study in which a descriptive qualitative study was embedded within a case-control study. Two hundred twenty-four wives of labor migrants were interviewed in the case-control study, and two focus group discussions (n = 8 and 9) were conducted in the qualitative study. The authors found that illiteracy, low socio-economic status, and gender inequality contributed to poor knowledge and poor sexual negotiation among the wives of labor migrants and increased their risk of HIV through unprotected sex. Among male labor migrants, illiteracy, low socio-economic status, migration to India before marriage, and alcohol consumption contributed to liaisons with female sex workers, increasing the risk of HIV to the men and their wives through unprotected sex. Both labor migrants and their wives feared disclosure of positive HIV status due to HIV stigma and thus were less likely to be tested for HIV. HIV prevention programs should consider the interaction among these risk factors when targeting labor migrants and their wives.peerreview_statement: The publishing and review policy for this title is described in its Aims & Scope. aims_and_scope_url: http://www.tandfonline.com/action/journalInformation?show=aimsScope&journalCode=wwah20status: publishe