HIV nursing consultants: patients' preferences and experiences about the quality of care.

AIM AND OBJECTIVES: We were interested to find out how human immunodeficiency virus (HIV)-patients judge the quality of care received from their HIV nursing consultants, compared with the care delivered by HIV specialists and general practitioners. Furthermore, we were interested in how the opinions of HIV patients on the HIV nursing consultant compared with the opinions of patients with rheumatic diseases on the care they receive from their specialized nurses. BACKGROUND: The role of nurses has changed over the years. For patients with chronic diseases there seems to be an increasing role for nursing consultants in the delivery of care. In evaluating quality of care, patients' views are considered important especially for the chronically ill who can be seen as experts by experience. METHODS: Between February 1999 and June 2000, 250 patients, receiving care from both general practitioner and specialist, received a questionnaire [Quality of Care Through the Patient's Eyes (QUOTE)-HIV] to assess HIV-related quality of care, as perceived by them. Aspects were formulated as "importance" and "performance" statements. Items were scored on 4-point scales. A ratio score (R(ij) = P(ij)/I(ij)) was calculated by dividing the perceived performance score (P) of an individual patient (i), on a health service (j) by his importance score (I). A comparison was made with patients with rheumatic diseases by using data from the QUOTE-Rheuma. RESULTS: Patients judged the quality of care from the HIV nursing consultant as predominantly good. Five aspects showed an unfavourable ratio score (R < 1.0) which indicates room for improvement. On the dimensions "professional performance" and "attitude of the professional" the HIV nursing consultant scores between the general practitioner and the HIV specialist. Patients with rheumatic diseases seemed to be more satisfied than HIV patients with the care from their nurse consultant. CONCLUSIONS: The HIV nursing consultants have an important role in the care of patients infected with HIV. The HIV nursing consultants are judged as good and are ranked in between the general practitioner and the HIV specialist. Given the orientation towards a more integrated care for chronically ill patients, there should be more attention paid to the position of the HIV nursing consultant. RELEVANCE TO CLINICAL PRACTICE: In the Netherlands and in the United Kingdom there is a tendency to a greater degree of differentiation of tasks in health care. This study shows that there is room for a position like the nursing consultant and that this is highly valued by patients. (aut.ref.

Assessment model for the justification of intrusive lifestyle interventions: literature study, reasoning and empirical testing: Bmc Medical Ethics

Background: In many countries health insurers, employers and especially governments are increasingly using pressure and coercion to enhance healthier lifestyles. For example by ever higher taxes on cigarettes and alcoholic beverages, and ever stricter smoke-free policies. Such interventions can enhance healthier behaviour, but when they become too intrusive, an unfree society can emerge. Which lifestyle interventions that use pressure or coercion are justifiable and which are not? We tried to develop an assessment model that can be used for answering this question, on a generally acceptable way, for all sorts of lifestyle interventions. Methods: The intended assessment model was developed in three phases. In the first phase the model was theoretically developed on the basis of literature study and reasoning. In the second phase the model was empirically tested by assessing two detailed cases from everyday practice using the model. The model was improved again and again. In the third phase (publication phase) the 10th version of the model was developed while writing this article. Results: An assessment model for the justification of intrusive lifestyle interventions. It comprises three components: (1) 12 assessment criteria (necessity, causality, responsibility, appropriate design, effectiveness, intrusiveness, burdens-benefits-ratio, fairness, support, complementary policies, verifiability, implementation capacity); (2) an assessment structure with three filters (design logic, effects and side effects, implementation); (3) a way of assessing (based on reasonableness and transparency). Conclusions: We have developed an assessment model for the justification of lifestyle interventions that use pressure or coercion to promote health. The correctness, completeness and practicality of the model are likely. Important principles for the justification are the logic and completeness of the underlying argumentation and the proper use of the available scientific information. Parties for and against a particular intervention could use the model to test and strengthen their argumentation and to improve the quality of the intervention

Botsingen in de spreekkamer: publiek en artsen oordelen over vraaggestuurde inrichting van de zorg.

Onder het publiek overheerst de opvatting dat de inrichting van de zorg moet worden gekenmerkt door aandacht voor keuzevrijheid en keuze-informatie; kortom: meer marktwerking. Onder artsen overheerst het streven naar goed hulpverlenerschap, zoals dat voor een deel gecodificeerd is in wetgeving. Onvoldoende mondigheid van patiënten wordt door bijna tweederde van het publiek genoemd als een belangrijke belemmering voor goede zorg; artsen vinden dat dit geen rol speelt. De meerderheid van het publiek vindt dat goede zorg wordt belemmerd doordat patiënten te weinig informatie hebben om hun keus op te baseren. Artsen vinden dat veel minder. Het is tijd voor diepgaand overleg tussen artsen- en patiëntenorganisaties om deze verschillen te analyseren en zo mogelijk op te lossen. Tijdens de medische opleiding en tijdens de beroepsuitoefening moet structureel aandacht worden besteed aan het ontwikkelen van onderhandelings- en communicatievaardigheden. (aut. ref.