Patient satisfaction with home-birth care in The Netherlands.

One of the necessary elements in an obstetric system of home confinements is well-organized postnatal home care. In The Netherlands home care assistants assist midwives during home delivery, they care for the new mother as well as the newborn baby, instruct the family on infant health care and carry out household duties. The growing demand for postnatal home care is difficult to meet; this has resulted in a short supply of the most popular day care programme and a level of provision which does not result in adequate services. This study acknowledges the patient perspective of maternity home care in order to contribute to its organization. The majority (79%) of service centres were willing to participate. A total of 1812 (81%) women who recently gave birth to a child responded to a postal questionnaire addressing the quality of care according to five dimensions: availability, continuity, interpersonal relationships, outcome and assistant's expertise. Almost one-third of the new mothers rated the availability as inadequate while the assistant's expertise was rated positively. Postnatal maternity home care is personalized, small-scale, and recognizes childbirth as a life event. Furthermore, it is relatively inexpensive and contributes to the satisfaction of recipients. (aut. ref.

Ziekenhuiszorg voor AIDS/HIV -patiënten in Nederland van 1991 tot en met 2001.

De Stichting Aids Fonds heeft een abonnement op gegevens uit de Landelijke Medische Registratie (LMR) van Prismant (voorheen SIG-Zorginfomatie) met betrekking tot ziekenhuisopnamen en dagverpleging van personen met Aids of een daaraan gerelateerde diagnose. In 1996 heeft het Aids Fonds besloten de registratiegegevens van de LMR wat sterker op monitoring te richten. Dat betekent enerzijds dat de gegevens jaarlijks worden geactualiseerd en anderzijds dat er een bundeling komt met gegevens van andere infomatiebronnen op het terrein van HIV en AIDS. Het doel van dit hoofdstuk is daarom inzicht te geven in de laatste stand van zaken in de ontwikkelijng van ziekenhuiszorg van patiënten met AIDS/HIV. Het betreft de periode vanaf 1991 tot en met 2001 waarbij de nadruk in de tekst ligt op het meest recente jaar waarvan gegevens beschikbaar zijn -2001. Met uitzondering van één in kanker gespecialiseerd ziekenhuis werken alle Nederlandse ziekenhuizen mee aan de LMR. De dekkingsgraad is al jarenlang 99.2%. Dit hoofdstuk kent vier paragrafen. Na deze eerste paragraaf, waarin kort enkele vraagstellingen worden gepresenteerd., volgt een beschrijving van de gegevens en enige achtergrondinformatie over de herkomst ervan. Daarna volgen tabellen die betrekking hebben op de jaren 1991 tot en met 2001. (aut. ref.

Referrals to physiotherapy: the relation between the number of referrals, the indication for referral and the inclination to refer.

This article studies the relation between the referral rate and the type of patients general practitioners refer for physiotherapy. The study population consists of GPs participating in the Netherlands' Sentinel Stations Network, who recorded data on all referrals to physiotherapy during one year and filled in a questionnaire. Results show that the pattern of referral indications of high referring GPs does not differ systematically from that of low referring GPs. High referring GPs evaluate their patients complaints more as purely or mainly somatic. High referring GPs were no more inclined to give in to their patients demands, had busier practices, closer relations with physiotherapists and viewed their knowledge of physiotherapy as more satisfactory than low referring GPs. Some policy implications are discussed in respect to these results. (aut. ref.

Patient's evaluation of dietetic care: testing a cognitive-attitude approach.

The study of patients' attitudes is an important subject because the success of many medical programs is linked to it. We have used a cognitive attitude theory - the Elaboration Likelihood Model (ELM), to study how patients form an evaluation of dietetic care. Respondents answered one questionnaire before (46% response) and one questionnaire after (60% response) their first consultation with a primary care dietitian. Patients rated their pre-test quality expectations and post-test quality evaluations of each of 28 distinctive aspects of care. They also rated the relative importance of each aspect. According to the ELM, people of high motivation and capacity to process information do so in an elaborate way. From this model five hypotheses are derived. Patients who elaborate are assumed to show a more differentiated pattern in (1) their quality expectations, (2) their rating of importance and (3) their quality judgements of distinctive aspects of dietetic care than people who do not elaborate. Furthermore, they are expected to show (4) a weaker association between quality expectation and quality judgement, and (5) relatively more extreme quality judgements. The three first hypotheses are accepted, the evidence of the last two is still inconclusive. (aut.ref.

Patient preference for genders of health professionals

Preferences for physicians' gender is an obvious and well documented example of considerations of patients' attitudes. But research carried out in this field is rather limited to the domain of family medicine. This article describes preferences for 13 different health professions: surgeons, neurologists, anaesthetists, internists, general practitioners, psychiatrists, psychologists, social workers, hospital and district nurses, home helps, gynaecologists and midwives. Our investigation also concerns the reasons for people's preferences. In February 1993 a self-administered survey was completed and returned by 961 out of 1113 (response 86%) participants of the Dutch Health Care Consumers Panel, a panel resulting from a random sample of Dutch households. On a range of different health professions a varying minority of patients prefer a care provider of a particular gender. There are virtually no sex preferences for the more "instrumental" health professions (e.g. surgeons, anaesthetists). Gender preferences are stronger for those health professions more likely engaged in intimate and psychosocial health problems (e.g. gynaecologists and GPs). Preferences expressed do not relate to sex stereotypes of gender differences in instrumentality, expertise, efficiency, consultation length, and personal interest. The majority of persons who prefer female health professionals indicate that they talk more easily to females than to males, and feel more at ease during (internal) examination by females than by males. Persons who prefer male health professionals use the same reasons in favour of males. The discussion relates to gender differences in the communication style of male and female physicians

Health problems in children and adolescents before and after a man-made disaster.

OBJECTIVE:: The aims of this study were to examine health problems of children (4-12 years old at the time of the disaster) and adolescents (13-18 years old at the time of the disaster) before and after exposure to a fireworks disaster in the Netherlands (May 2000), to compare these health problems with a control group, and to identify risk factors for postdisaster psychological problems. METHOD:: Because the electronic medical records of family practitioners were used, longitudinal monitoring of health problems from 1 year predisaster until 2 years postdisaster for both victims (N = 1,628) and controls (N = 2,856) was possible. Health problems were classified according to the International Classification of Primary Care. RESULTS:: Postdisaster increases were significantly larger in victims than in controls for psychological problems, musculoskeletal problems, stress reactions, and symptoms of the extremities. Children 4-12 years old presented larger increases in sleep problems compared with controls, whereas children 13-18 years old showed larger increases in anxiety problems than their controls. Significant predictors for postdisaster psychological problems included being relocated, presenting predisaster psychological problems, and a low to medium socioeconomic status. CONCLUSIONS:: Children and adolescents exposed to a disaster are at risk of long-lasting increases in both psychological and physical health problems. Postdisaster interventions should focus on those who were relocated and presented predisaster psychological problems. (aut.ref.

Prevalence of symptoms in a case-control study before and after a disaster.

Background: Individuals exposed to trauma report poorer health status and more physical symptoms than do similar non-exposed individuals while it is generally assumed that posttraumatic psychological symptoms precede physical symptoms. Aim: This study’s objective is to explore the prevalence of health symptoms after a man made disaster: the explosion of a firework depot in a residential area in Enschede, the Netherlands. Ten percent of the victims had to be relocated because their houses were destroyed. Methods: Design: Pre-disaster baseline symptoms compared with post-disaster symptoms by monitoring in general practice using medical records of 9392 victims and 7392 controls. Outcome measures: Psychological symptoms and medically unexplained physical symptoms (MUPS) were registered using the International Classification of Primary Care (ICPC). Prevalence rates in four weeks periods were calculated as the number of individuals presenting symptoms divided by the numbers at risk, taking into account the amount of person-time during which events were counted as well as the time elapsed before health symptoms were presented. Results: Prevalence rates for pre-disaster psychological symptoms were 26 per 1000 per 4 weeks for both victims and controls. Immediately after the disaster the prevalence rate increased to 181 for victims and than gradually decreased to 41 in de last 4 weeks of the study-period. Relocated victims showed much higher prevalence rates for psychological symptoms than non-relocated victims. Prevalence rates for MUPS were 77 per 1000 per 4 weeks for victims and 67 for controls. Immediately after the disaster the prevalence rate increased to 84 for victims but rapidly fell back to the pre-disaster rate. However, relocated victims showed slowly increasing post-disaster rates for MUPS. Post-disaster psychological symptoms preceded MUPS in 50% of the victims presenting both symptoms, compared to 32% in the period before the explosion (p< .001). Conclusions: Immediately after the disaster a lot of psychological problems and physical symptoms were presented to general practitioners but even two and a half years later an excess of psychological symptoms wasobserved. Furthermore, individuals presenting psychological symptoms had an increased risk for developing medically unexplained physical symptoms