Illness in Children and Parental Response

Most children suffer from illnesses from time to time. In only a small part of these ill children parents decide to seek professional help. So, most child health care is carried out by parents. In general, this phenomenon is called the iceberg of symptoms. The part of the iceberg under the surface is the illness that is experienced but not brought to the attention of a health care provider. Often this illness is of a self-limiting nature and medical attention is not necessary. The part above the surface consists of the illnesses brought to the attention of a health care professional, which In The Netherlands is the general practitioner (GP) for adults as well as for children

Molluscum contagiosum in Dutch general practice

BACKGROUND: While molluscum contagiosum is considered to be a frequently encountered disease, few data on its incidence are known. AIM: The objective of this study was to describe the incidence of molluscum contagiosum in Dutch general practice and to assess the importance of venereal molluscum contagiosum. METHOD: Data were taken from the national survey of morbidity and interventions in general practice, drawn from 103 practices across the Netherlands, with a study population of 332300. RESULTS: The infection appeared to be common in childhood (cumulative incidence 17% in those aged under 15 years); the adult, sexually transmitted, form was rare. Incidence was higher between January and June than between July and December. Cases were unequally divided between recording practices, which is though to have been caused by the occurrence of small epidemics. CONCLUSION: The incidence of molluscum contagiosum in Dutch general practice was found to be 2.4 per 1000 person years. Molluscum contagiosum should still be considered as a mainly paediatric disease

Measuring morbidity of children in the community: a comparison of interview and diary data

BACKGROUND: Little is known about the validity of estimates of morbidity experienced at home. METHODS: In the Dutch National Survey of Morbidity and Interventions in General Practice mothers of 1630 children answered a health interview and kept a health diary for 3 weeks (only the first 2 weeks were used). Children's symptoms were recorded during the interview using a check list and monitored in the health diary through open-ended questions. RESULTS: In the interview parents reported symptoms for 65% of their children and in the diary for 54% of children. Ear problems, colds, fever and weakness and anxiety were reported more often in the interview. Mother's mental health was assessed by the General Health Questionnaire; those scoring >4 were assessed as having impaired mental health and these parents reported symptoms for more children in the interview (81%) than in the diary (65%). For similar reference periods, the least educated mothers reported fewer children with symptoms in the diary (45%) than in the interview (66%). More highly educated mothers reported similarly in the diary (67%) and the interview (70%). CONCLUSION: Both data collection methods yield different estimates of community morbidity. Explanations such as telescoping, the seriousness of the symptoms, the amount of psychological distress of the respondent, forgetfulness and literacy limitations are discussed. We recommend that diaries should not be used in less educated populations

Collaboration processes and perceived effectiveness of integrated care projects in primary care: A longitudinal mixed-methods study

Background: Collaborative partnerships are considered an essential strategy for integrating local disjointed health and social services. Currently, little evidence is available on how integrated care arrangements between professionals and organisations are achieved through the evolution of collaboration processes over time. The first aim was to develop a typology of integrated care projects (ICPs) based on the final degree of integration as perceived by multiple stakeholders. The second aim was to study how types of integration differ in changes of collaboration processes over time and final perceived effectiveness. Methods: A longitudinal mixed-methods study design based on two data sources (surveys and interviews) was used to identify the perceived degree of integration and patterns in collaboration among 42 ICPs in primary care in The Netherlands. We used cluster analysis to identify distinct subgroups of ICPs based on the final perceived degree of integration from a professional, organisational and system perspective. With the use of ANOVAs, the subgroups were contrasted based on: 1) changes in collaboration processes over time (shared ambition, interests and mutual gains, relationship dynamics, organisational dynamics and process management) and 2) final perceived effectiveness (i.e. rated success) at the professional, organisational and system levels. Results: The ICPs were classified into three subgroups with: 'United Integration Perspectives (UIP)', 'Disunited Integration Perspectives (DIP)' and 'Professional-oriented Integration Perspectives (PIP)'. ICPs within the UIP subgroup made the strongest increase in trust-based (mutual gains and relationship dynamics) as well as control-based (organisational dynamics and process management) collaboration processes and had the highest overall effectiveness rates. On the other hand, ICPs with the DIP subgroup decreased on collaboration processes and had the lowest overall effectiveness rates. ICPs within the PIP subgroup increased in control-based collaboration processes (organisational dynamics and process management) and had the highest effectiveness rates at the professional level. Conclusions: The differences across the three subgroups in terms of the development of collaboration processes and the final perceived effectiveness provide evidence that united stakeholders' perspectives are achieved through a constructive collaboration process over time. Disunited perspectives at the professional, organisation and system levels can be aligned by both trust-based and control-based collaboration processes

Exploring the success of an integrated primary care partnership:A longitudinal study of collaboration processes

Background: Forming partnerships is a prominent strategy used to promote integrated service delivery across health and social service systems. Evidence about the collaboration process upon which partnerships evolve has rarely been addressed in an integrated-care setting. This study explores the longitudinal relationship of the collaboration process and the influence on the final perceived success of a partnership in such a setting. The collaboration process through which partnerships evolve is based on a conceptual framework which identifies five themes: shared ambition, interests and mutual gains, relationship dynamics, organisational dynamics and process management. Methods: Fifty-nine out of 69 partnerships from a national programme in the Netherlands participated in this survey study. At baseline, 338 steering committee members responded, and they returned 320 questionnaires at follow-up. Multiple-regression-analyses were conducted to explore the relationship between the baseline as well as the change in the collaboration process and the final success of the partnerships. Results: Mutual gains and process management were the most significant baseline predictors for the final success of the partnership. A positive change in the relationship dynamics had a significant effect on the final success of a partnership. Conclusions: Insight into the collaboration process of integrated primary care partnerships offers a potentially powerful way of predicting their success. Our findings underscore the importance of monitoring the collaboration process during the development of the partnerships in order to achieve their full collaborative advantage