Stroke service in the Netherlands: an exploratory study on effectiveness, patient satisfaction and utilisation of healthcare

OBJECTIVE: To assess whether shared care for stroke patients results in better patient outcome, higher patient satisfaction and different use of healthcare services. DESIGN: Prospective, comparative cohort study. SETTING: Two regions in the Netherlands with different healthcare models for stroke patients: a shared care model (stroke service) and a usual care setting. PATIENTS: Stroke patients with a survival rate of more than six months, who initially were admitted to the Stroke Service of the University Hospital Maastricht (experimental group) in the second half of 1997 and to a middle sized hospital in the western part of the Netherlands between March 1997 and March 1999 (control group). MAIN OUTCOME MEASURES: Functional health status according to the SIP-68, EuroQol, Barthel Index and Rankin Scale, patient satisfaction and use of healthcare services. RESULTS: In total 103 patients were included in this study: 58 in the experimental group and 45 in the control group. Six months after stroke, 64% of the surviving patients in the experimental group had returned home, compared to 42% in the control group (p<0.05). This difference could not be explained by differences in health status, which was comparable at that time. Patients in the shared care model scored higher on patient satisfaction, whereas patients in the usual care group received a higher volume of home care. CONCLUSIONS: The Stroke Service Maastricht resulted in a higher number of patients who returned home after stroke, but not in a better health status. Since patients in the usual care group received a higher volume of healthcare in the period of rehabilitation, the Stroke Service Maastricht might be more efficient

Nursing home and nursing home physician: the Dutch experience.

Item does not contain fulltextDutch nursing home care today includes a broad range of institutional and outreaching care functions. Medical care is an essential part of this care. Nursing home medicine in The Netherlands has developed as an officially acknowledged medical specialty. This is unique because The Netherlands is the only country in which nursing home medicine is a specific medical discipline. Because of this, a continuum in the medical care for the elderly has been developed: the family physician for medical care in the community, the nursing home physician for the institutionalized elderly, and the clinical geriatrician plus other medical specialists for elderly who require hospital care. This article describes the characteristics of Dutch nursing home care and nursing home medicine and the advantages of this system. The article also shows that the combination of the medical knowledge of family physician and nursing home physician can be expected to increase the quality of medical care for the disabled elderly in institutions and in the community

Het co-assistentschap huisartsgeneeskunde: leerdoelen en voorwaarden

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Contacten tussen verpleeghuisarts en huisarts

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Educational objectives and requirements of an undergraduate clerkship in general practice : The outcome of a consensus procedure

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Lessons learned from a multidisciplinary fall-prevention programme: the occupational-therapy element

OBJECTIVE: To gain insight into the contribution of the occupational-therapy part of a multidisciplinary fall prevention programme towards the reduction of falls and functional decline. DESIGN: A descriptive and exploratory study. METHODS: Data were collected in the context of a randomized controlled trial that found no effect of a multidisciplinary fall prevention programme. The study population comprised 166 participants, two occupational therapists (OTs), and one official from each of the five participating municipalities. Data were collected on the recommendations arising from the OT part of the programme, the extent to which those recommendations were implemented and what OTs did to stimulate implementation of behaviour change. RESULTS: The occupational-therapy programme resulted in 457 recommendations; 65% of the recommendations regarding services and assistive devices were implemented. It took on average six months to implement recommended home modifications. Advice on behaviour change predominantly comprised recommendations to reduce risky behaviour. CONCLUSION: To improve the occupational-therapy programme more rapid implementation of recommendations is suggested. Second, participants should be supported to achieve recommended changes. Furthermore, occupational therapists should use theory-based techniques to stimulate behaviour change and use follow-up visits to promote maintenance of the desired behaviour

Failure of feedback to entrance self-assessment skills of general practitioners

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