Agenda kwaliteitsstandaarden in de wijkverpleging

Het ZonMw-programma ‘Ontwikkeling Kwaliteitsstandaarden 2019-2022: Wijkverpleging’ draagt bij aan het ontwikkelen, implementeren en evalueren van kwaliteitsstandaarden voor verpleegkundigen en verzorgenden. Het is belangrijk om te weten voor welke onderwerpen en patiëntproblemen mogelijk een knelpuntanalyse of een kwaliteitsstandaard nodig is, of waar een kwaliteitsstandaard geactualiseerd dient te worden. Om dit helder te krijgen wordt in 2020-2021 de ‘Programmeringsstudie Ontwikkeling Kwaliteitsstandaarden 2019-2022: Wijkverpleging’ uitgevoer

The effectiveness of the Allen Carr smoking cessation training in companies tested in a quasi-experimental design

Background: The Allen Carr training (ACt) is a popular one-session smoking cessation group training that is provided by licensed organizations that have the permission to use the Allen Carr method. However, few data are available on the effectiveness of the training. Methods: In a quasi-experimental design the effects of the existing practice of providing the ACt to smokers (n = 124) in companies on abstinence, were compared to changes in abstinence in a cohort of similar smokers in the general population (n = 161). To increase comparability of the smokers in both conditions, smokers in the control condition were matched on the group level on baseline characteristics (fourteen variables) to the smokers in the ACt. The main outcome measure was self-reported continuous abstinence after 13 months, which was validated using a CO measurement in the Act condition. Results: Logistic regression analyses showed that when baseline characteristics were comparable, significantly more responding smokers were continuously abstinent in the ACt condition compared to the control condition, Exp(B) = 6.52 (41.1% and 9.6%, respectively). The all-cases analysis was also significant, Exp(B) = 5.09 (31.5% and 8.3%, respectively). Conclusion: Smokers following the ACt in their company were about 6 times more likely to be abstinent, assessed after 13 months, compared to similar smokers in the general population. Although smokers in both conditions did not differ significantly on 14 variables that might be related to cessation success, the quasi-experimental design allows no definite conclusion about the effectiveness of the ACt. Still, these data support the provision of the ACt in companies

Programmering van ontwikkeling, implementatie en actualisatie van kwaliteitsstandaarden voor de wijkverpleging: Eindrapportage

Het is voor de kwaliteit van zorg van groot belang dat verpleegkundigen en verzorgenden hun handelen baseren op actuele kennis en inzichten. Om dit te faciliteren worden onder meer vanuit het ZonMw-programma ‘Ontwikkeling Kwaliteitsstandaarden 2019-2022: Wijkverpleging’ kwaliteitsstandaarden ontwikkeld. Onder de koepelterm kwaliteitsstandaarden vallen richtlijnen die vooral de inhoudelijke elementen van zorg beschrijven, evenals zorgstandaarden die vooral gaan over het perspectief van zorggebruiker en de organisatie van zorg. Het is belangrijk om te weten voor welke onderwerpen en patiëntproblemen mogelijk een knelpuntanalyse of een kwaliteitsstandaard nodig is, of waar een kwaliteitsstandaard geactualiseerd dient te worden. Om dit helder te krijgen wordt in 2020-2021 de ‘Programmeringsstudie Ontwikkeling Kwaliteitsstandaarden 2019-2022: Wijkverpleging’ uitgevoerd. Het doel van deze programmeringsstudie is bijdragen aan een systematische en breed gedragen programmering voor het ZonMw-programma ‘Ontwikkeling Kwaliteitsstandaarden 2019- 2022: Wijkverpleging’. De programmeringsstudie bestond uit vier deelstudies. Het voorliggende rapport heeft betrekking op de vierde en laatste deelstudie. Dit onderdeel had als doel om een advies uit te brengen aan V&VN om de programmeringsagenda voor de ontwikkeling én implementatie van kwaliteitsstandaarden voor de wijkverpleging actueel te houden. Hiervoor werden als eerste knelpunten en wensen ten aanzien van het actueel houden van de programmeringsstudie opgehaald tijdens advies- en klankbordgroepen bijeenkomsten. Aanvullend werden gesprekken met andere beroepsorganisaties gevoerd om meer inzicht te krijgen in hoe zij hun programmeringsagenda’s actueel houden. Daarnaast werden resultaten uit de eerdere drie deelstudies vertaald naar aanbevelingen om de programmeringsagenda actueel te houden. Tot slot is gezocht naar aanvullende literatuur om de aanbevelingen waar mogelijk te onderbouwen

The Influencing Contexts and Potential Mechanisms Behind the Use of Web-Based Self-management Support Interventions: Realistic Evaluation

Background: Self-management can increase self-efficacy and quality of life and improve disease outcomes. Effective self-management may also help reduce the pressure on health care systems. However, patients need support in dealing with their disease and in developing skills to manage the consequences and changes associated with their condition. Web-based self-management support programs have helped patients with cardiovascular disease (CVD) and rheumatoid arthritis (RA), but program use has been low.   Objective: This study aimed to identify the patient, disease, and program characteristics that determine whether patients use web-based self-management support programs or not.   Methods: A realistic evaluation methodology was used to provide a comprehensive overview of context (patient and disease characteristics), mechanism (program characteristics), and outcome (program use). Secondary data of adult patients with CVD (n=101) and those with RA (n=77) were included in the study. The relationship between context (sex, age, education, employment status, living situation, self-management [measured using Patient Activation Measure-13], quality of life [measured using RAND 36-item health survey], interaction efficacy [measured using the 5-item perceived efficacy in patient-physician interactions], diagnosis, physical comorbidity, and time since diagnosis) and outcome (program use) was analyzed using logistic regression analyses. The relationship between mechanism (program design, implementation strategies, and behavior change techniques [BCTs]) and outcome was analyzed through a qualitative interview study.   Results: This study included 68 nonusers and 111 users of web-based self-management support programs, of which 56.4% (101/179) were diagnosed with CVD and 43.6% (78/179) with RA. Younger age and a lower level of education were associated with program use. An interaction effect was found between program use and diagnosis and 4 quality of life subscales (social functioning, physical role limitations, vitality, and bodily pain). Patients with CVD with higher self-management and quality of life scores were less likely to use the program, whereas patients with RA with higher self-management and quality of life scores were more likely to use the program. Interviews with 10 nonusers, 10 low users, and 18 high users were analyzed to provide insight into the relationship between mechanisms and outcome. Program use was encouraged by an easy-to-use, clear, and transparent design and by recommendations from professionals and email reminders. A total of 5 BCTs were identified as potential mechanisms to promote program use: tailored information, self-reporting behavior, delayed feedback, providing information on peer behavior, and modeling.   Conclusions: This realistic evaluation showed that certain patient, disease, and program characteristics (age, education, diagnosis, program design, type of reminder, and BCTs) are associated with the use of web-based self-management support programs. These results represent the first step in improving the tailoring of web-based self-management support programs. Future research on the interaction between patient and program characteristics should be conducted to improve the tailoring of participants to program components.This study was funded by ZonMw, the Netherlands Organization for Health Research and Development (grant 520001001). The authors would like to thank all the patients with cardiovascular disease (CVD) and rheumatoid arthritis (RA) who contributed to this study. </p