Is there a mismatch between the perspectives of patients and regulators on healthcare quality?:A survey study

Objectives: Internationally, healthcare quality regulators are criticized for failing to respond to patients' complaints. Patient involvement is, therefore, an important item on the policy agenda. However, it can be argued that there is a discrepancy between the patients' perspective and current regulatory approaches. This study examines whether a discrepancy exists between the perspectives of patients and regulators on healthcare quality. Methods: A questionnaire was sent to 996 people who had registered a complaint with the Dutch Healthcare Inspectorate to measure expectations of and experiences with the Inspectorate. A taxonomy was used to classify their complaints into the clinical, relationship, or management domains. Results: The response was 54%. More complaints about clinical issues (56%, P = 0.000) were investigated by the regulator than complaints about organizational (37%) and relational issues (51%). Patients with complaints about management issues less often indicated (13%, P = 0.002) that healthcare is improved by making their complaint than patients with complaints about clinical or relationship issues did (22%–23%). Patients who reported about relational issues with care providers attached more importance to issuing sanctions against the care provider than other patients (mean score 2.89 versus 2.62–2.68, P = 0.006). Conclusions: The predominant clinical approach taken by regulators does not match the patients' perspective of what is relevant for healthcare quality. In addition, patients seem to be more tolerant of what they perceive to be clinical or management errors than of perceived relational deficiencies in care providers. If regulators want to give patients a voice, they should expand their horizon beyond the medical framework

Recording of weight in electronic health records:An observational study in general practice

Background Routine weight recording in electronic health records (EHRs) could assist general practitioners (GPs) in the identification, prevention, and management of overweight patients. However, the extent to which weight management is embedded in general practice in the Netherlands has not been investigated. The purpose of this study was to evaluate the frequency of weight recording in general practice in the Netherlands for patients who self-reported as being overweight. The specific objectives of this study were to assess whether weight recording varied according to patient characteristics, and to determine the frequency of weight recording over time for patients with and without a chronic condition related to being overweight. Methods Baseline data from the Occupational and Environmental Health Cohort Study (2012) were combined with data from EHRs of general practices (2012–2015). Data concerned 3446 self-reported overweight patients who visited their GP in 2012, and 1516 patients who visited their GP every year between 2012 and 2015. Logistic multilevel regression analyses were performed to identify associations between patient characteristics and weight recording. Results In 2012, weight was recorded in the EHRs of a quarter of patients who self-reported as being overweight. Greater age, lower education level, higher self-reported body mass index, and the presence of diabetes mellitus, chronic obstructive pulmonary disease, and/or cardiovascular disorders were associated with higher rates of weight recording. The strongest association was found for diabetes mellitus (adjusted OR = 10.3; 95% CI [7.3, 14.5]). Between 2012 and 2015, 90% of patients with diabetes mellitus had at least one weight measurement recorded in their EHR. In the group of patients without a chronic condition related to being overweight, this percentage was 33%. Conclusions Weight was frequently recorded for overweight patients with a chronic condition, for whom regular weight measurement is recommended in clinical guidelines, and for which weight recording is a performance indicator as part of the payment system. For younger patients and those without a chronic condition related to being overweight, weight was less frequently recorded. For these patients, routine recording of weight in EHRs deserves more attention, with the aim to support early recognition and treatment of overweight

Factors influencing the impact of ex-post legislative evaluations:A scoping review

This article explores the factors that influence the impact of ex-post legislativeevaluations and suggests that these factors can be divided into three maincategories: context, research quality, and interaction. Contextual factors,including the evaluation’s initiation, it’s place in the legislative process, thevaried functions given by stakeholders, and the level of political or socialattention, are beyond researchers’ control. However, researchers caninfluence research quality and interaction with stakeholders, such as theevaluations’ commissioner, as well as the society at large, thereby increasingthe likelihood of achieving impactful results. They should engage with theevaluation context to improve impact, but must also maintain independencewhile being influenced by the context. These findings are in line with themuch broader literature on the impact of policy and programme evaluationswhich pays less attention to the policy instrument legislation. Therefore, bothdisciplines have an interest in a better exchange of knowledge

The impact of ex-post legislative evaluations:A scoping review

In various countries, laws are increasingly being evaluated by examining the effects in practice once a law enters into force. No systematic overview currently exists on the impact of these ex-post legislative evaluations. Therefore, this scoping review systematically examines the various types of impact of ex-post legislative evaluations. The studies we looked at demonstrate different types of impact that can be divided into the following seven categories: knowledge and understanding; confirmation of well-functioning legislation; legislative revision; influence on the legislative process; influence on the policy process; influence in the political sphere; and influence on society. The various types of impact are sometimes interrelated and can exist in various degrees. At the national and European levels, legislative revision and the tactical use of evaluation results in the political sphere, are the two most often mentioned categories. In contrast, the impact on society category is rarely mentioned

Is the perceived impact of disciplinary procedures on medical doctors’ professional practice associated with working in an open culture and feeling supported?:A questionnaire among medical doctors in the Netherlands who have been disciplined

Introduction Disciplinary procedures can have a negative impact on the professional functioning of medical doctors. In this questionnaire study, doctors’ experience with open culture and support during a disciplinary procedure is studied to determine whether open culture and support are associated with perceived changes in the professional practice of doctors. Methods All doctors who received a warning or a reprimand from the Dutch Medical Disciplinary Board between July 2012 and August 2016 were invited to fill in a 60-item questionnaire concerning open culture, perceived support during the disciplinary procedure and the impact of the procedure on professional functioning as reported by doctors themselves. The response rate was 43% (n=294). Results A majority of doctors perceive their work environment as a safe environment in which to talk about and report incidents (71.2% agreed). Respondents felt supported by a lawyer or legal representative and colleagues (92.8% and 89.2%, respectively). The disciplinary procedure had effects on professional practice. Legal support and support from a professional confidant and a professional association were associated with fewer perceived changes to professional practice. Conclusion Our study shows that doctors who had been disciplined perceive their working environment as open. Doctors felt supported by lawyers and/or legal representatives and colleagues. Legal support was associated with less of a perceived impact on doctors’ professional practice

Intermediate weight changes and follow-up of dietetic treatment in primary healthcare:An observational study

Background Primary health care data have shown that most patients who were treated for overweight or obesity by a dietitian did not accomplish the recommended treatment period. It is hypothesised that a slow rate of weight loss might discourage patients from continuing dietetic treatment. This study evaluated intermediate weight changes during regular dietetic treatment in Dutch primary health care, and examined whether weight losses at previous consultations were associated with attendance at follow-up consultations. Methods This observational study was based on real life practice data of overweight and obese patients during the period 2013–2017, derived from Dutch dietetic practices that participated in the Nivel Primary Care Database. Multilevel regression analyses were conducted to estimate the mean changes in body mass index (BMI) during six consecutive consultations and to calculate odds ratios for the association of weight change at previous consultations with attendance at follow-up consultations. Results The total study population consisted of 25,588 overweight or obese patients, with a mean initial BMI of 32.7 kg/m2. The BMI decreased between consecutive consultations, with the highest weight losses between the first and second consultation. After six consultations, a mean weight loss of − 1.5 kg/m2 was estimated. Patients who lost weight between the two previous consultations were more likely to attend the next consultation than patients who did not lose weight or gained weight. Conclusions Body mass index decreased during consecutive consultations, and intermediate weight losses were associated with a higher attendance at follow-up consultations during dietetic treatment in overweight patients. Dietitians should therefore focus on discussing intermediate weight loss expectations with their patients

Patients at the centre after a health care incident:A scoping review of hospital strategies targeting communication and nonmaterial restoration

OBJECTIVE: This study aimed to provide an overview of the strategies adopted by hospitals that target effective communication and nonmaterial restoration (i.e., without a financial or material focus) after health care incidents, and to formulate elements in hospital strategies that patients consider essential by analysing how patients have evaluated these strategies. BACKGROUND: In the aftermath of a health care incident, hospitals are tasked with responding to the patients' material and nonmaterial needs, mainly restoration and communication. Currently, an overview of these strategies is lacking. In particular, a gap exists concerning how patients evaluate these strategies. SEARCH STRATEGY AND INCLUSION CRITERIA: To identify studies in this scoping review, and following the methodological framework set out by Arksey and O'Malley, seven subject‐relevant electronic databases were used (PubMed, Medline, Embase, CINAHL, PsycARTICLES, PsycINFO and Psychology & Behavioral Sciences Collection). Reference lists of included studies were also checked for relevant studies. Studies were included if published in English, after 2000 and as peer‐reviewed articles. MAIN RESULTS AND SYNTHESIS: The search yielded 13,989 hits. The review has a final inclusion of 16 studies. The inclusion led to an analysis of five different hospital strategies: open disclosure processes, communication‐and‐resolution programmes, complaints procedures, patients‐as‐partners in learning from health care incidents and subsequent disclosure, and mediation. The analysis showed three main domains that patients considered essential: interpersonal communication, organisation around disclosure and support, and desired outcomes. PATIENT CONTRIBUTION: This scoping review specifically takes the patient perspective in its methodological design and analysis. Studies were included if they contained an evaluation by patients, and the included studies were analysed on the essential elements for patients

Toezien op zorgkwaliteit door de ogen van patiënten:Andere werkwijze van inspectie nodig

De inspectie gezondheidszorg en Jeugd (ig J) wil het per- spectief van patiënten meer betrekken bij haar toezicht. Burgermeldingen geven de inspectie inzicht in dit patiën- tenperspectief. Patiënten die klachten melden willen dat het probleem dat zij melden zich niet herhaalt, maar het overgrote deel van die meldingen wordt niet nader onder- zocht door de inspectie. Daarnaast worden meldingen met een klinisch aspect veel vaker onderzocht dan organisatori- sche of communicatieve problemen. Bij meldingen van pati- enten gaat het niet noodzakelijkerwijs om het afwijken van de professionele richtlijnen met schade als gevolg. Als de inspectie kwaliteit van zorg door het perspectief van de patiënt wil bekijken, kan zij het beeld dat de patiënt hun aanreikt serieuzer nemen. Het patiëntenperspectief sugge- reert dat het voor de inspectie van belang is meer aandacht te besteden aan organisatorische factoren, relationele aspecten en andere aspecten van de gezondheidszorg, naast de medisch professionele normen