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Okuyama A.,Osaka University | Wagner C.,VU University Amsterdam | Wagner C.,NIVEL Netherlands Institute for Health Services Research | Bijnen B.,VU University Amsterdam | Bijnen B.,Medical Center Alkmaar
BMC Health Services Research | Year: 2014

Background: Speaking up is important for patient safety, but often, health care professionals hesitate to voice concerns. Understanding the influencing factors can help to improve speaking-up behaviour and team communication. This review focused on health care professionals' speaking-up behaviour for patient safety and aimed at (1) assessing the effectiveness of speaking up, (2) evaluating the effectiveness of speaking-up training, (3) identifying the factors influencing speaking-up behaviour, and (4) developing a model for speaking-up behaviour. Methods. Five databases (PubMed, MEDLINE, CINAHL, Web of Science, and the Cochrane Library) were searched for English articles describing health care professionals' speaking-up behaviour as well as those evaluating the relationship between speaking up and patient safety. Influencing factors were identified and then integrated into a model of voicing behaviour. Results: In total, 26 studies were identified in 27 articles. Some indicated that hesitancy to speak up can be an important contributing factor in communication errors and that training can improve speaking-up behaviour. Many influencing factors were found: (1) the motivation to speak up, such as the perceived risk for patients, and the ambiguity or clarity of the clinical situation; (2) contextual factors, such as hospital administrative support, interdisciplinary policy-making, team work and relationship between other team members, and attitude of leaders/superiors; (3) individual factors, such as job satisfaction, responsibility toward patients, responsibility as professionals, confidence based on experience, communication skills, and educational background; (4) the perceived efficacy of speaking up, such as lack of impact and personal control; (5) the perceived safety of speaking up, such as fear for the responses of others and conflict and concerns over appearing incompetent; and (6) tactics and targets, such as collecting facts, showing positive intent, and selecting the person who has spoken up. Conclusions: Hesitancy to speak up can be an important contributing factor to communication errors. Our model helps us to understand how health care professionals think about voicing their concerns. Further research is required to investigate the relative importance of different factors. © 2014 Okuyama et al.; licensee BioMed Central Ltd.

Heiligers P.J.M.,NIVEL Netherlands Institute for Health Services Research | Heiligers P.J.M.,University Utrecht
BMC Medical Education | Year: 2012

Background: The main subject is the influence of gender and the stage of life on the choice of specialty in medical education. In particular we looked at the influence of intrinsic and external motives on this relationship. The choice of specialty was divided into two moments: the choice between medical specialties and general practice; and the preference within medical specialties. In earlier studies the topic of motivation was explored, mostly related to gender. In this study stage of life in terms of living with a partner -or not- and stage of education was added. Methods. A questionnaire concerning career preferences was used. The online questionnaire was sent to all student members of the KNMG (Royal Dutch Medical Association). 58% of these students responded (N = 2397). Only 1478 responses could be used for analyses (36%). For stipulating the motives that played a role, principal components factor analysis has been carried out. For testing the mediation effect a set of regression analyses was performed: logistic regressions and multiple regressions. Results: Although basic findings about gender differences in motivations for preferred careers are consistent with earlier research, we found that whether or not living with a partner is determinant for differences in profession-related motives and external motives (lifestyle and social situation). Furthermore living with a partner is not a specific female argument anymore, since no interactions are found between gender and living with a partner. Another issue is that motives are mediating the relationship between, living with a partner, and the choice of GP or medical specialty. For more clarity in the mediating effect of motives a longitudinal study is needed to find out about motives and changing circumstances. Conclusions: The present study provides a contribution to the knowledge of career aspirations of medical students, especially the impact of motivation. Gender and living with a partner influence both choices, but they are not interacting, so living with a partner is similarly important for male and female students in choosing their preferences. Moreover, external and intrinsic motives mediate this relationship to a greater of lesser degree. First stage students are influenced by life-style and intrinsic motives in their choice of general practice. For second stage students, the results show influences of life-style motives next to profession-related motives on both moments of choice. © 2012 Heiligers; licensee BioMed Central Ltd.

Bell B.G.,University of Nottingham | Schellevis F.,NIVEL Netherlands Institute for Health Services Research | Schellevis F.,VU University Amsterdam | Stobberingh E.,Maastricht University | And 2 more authors.
BMC Infectious Diseases | Year: 2014

Background: Greater use of antibiotics during the past 50 years has exerted selective pressure on susceptible bacteria and may have favoured the survival of resistant strains. Existing information on antibiotic resistance patterns from pathogens circulating among community-based patients is substantially less than from hospitalized patients on whom guidelines are often based. We therefore chose to assess the relationship between the antibiotic resistance pattern of bacteria circulating in the community and the consumption of antibiotics in the community.Methods: Both gray literature and published scientific literature in English and other European languages was examined. Multiple regression analysis was used to analyse whether studies found a positive relationship between antibiotic consumption and resistance. A subsequent meta-analysis and meta-regression was conducted for studies for which a common effect size measure (odds ratio) could be calculated.Results: Electronic searches identified 974 studies but only 243 studies were considered eligible for inclusion by the two independent reviewers who extracted the data. A binomial test revealed a positive relationship between antibiotic consumption and resistance (p < .001) but multiple regression modelling did not produce any significant predictors of study outcome. The meta-analysis generated a significant pooled odds ratio of 2.3 (95% confidence interval 2.2 to 2.5) with a meta-regression producing several significant predictors (F(10,77) = 5.82, p < .01). Countries in southern Europe produced a stronger link between consumption and resistance than other regions.Conclusions: Using a large set of studies we found that antibiotic consumption is associated with the development of antibiotic resistance. A subsequent meta-analysis, with a subsample of the studies, generated several significant predictors. Countries in southern Europe produced a stronger link between consumption and resistance than other regions so efforts at reducing antibiotic consumption may need to be strengthened in this area. Increased consumption of antibiotics may not only produce greater resistance at the individual patient level but may also produce greater resistance at the community, country, and regional levels, which can harm individual patients. © 2014 Bell et al.; licensee BioMed Central Ltd.

Groenewegen P.P.,NIVEL Netherlands Institute for Health Services Research | Jurgutis A.,Klaipeda University
Quality in Primary Care | Year: 2013

Background Greece is hit hard by the state debt Conclusions The authors recommend the develcrisis.This calls for comprehensive reforms to restore opment of a clear vision and development strategy sustainable and balanced growth. Healthcare is one for strengthening primary care. Stepped access to of the public sectors needing reform. The European secondary care should be realised through the Union (EU) Task Force for Greece asked the authors introduction of mandatory referrals. Primary care to assess the situation of primary care and to make should be accessible through the lowest possible recommendations for reform. Primary healthcare is out-of-pocket payments. The roles of purchaser and especially relevant in that it might increase the provider of care should be split. Quality of care efficiency of the healthcare system, and improve should be improved through development of cliniaccess to good quality healthcare. cal guidelines and quality indicators. The education Approach Assessment of the state of primary care of health professionals should put more emphasis in Greece was made on the basis of existing on primary care and medical specialists working in literature, site visits in primary care and consul- primary care should be (re-)trained to acquire the tations with stakeholders. necessary competences to satisfy the job descripResults The governance of primary care (and health- tions to be developed for primary care procare in general) is fragmented. There is no system of fessionals. The advantages of strong primary care gatekeeping or patient lists. Private payments for- should be communicated to patients and the wider mal and informal) are high. There are too many public,physicians, but too few general practitioners and nurses, and they are unevenly spread across the As a consequence, there are problems of primary care access, continuity, co-ordination and comprehensiveness of primary care. © 2013 Radcliffe Publishing.

Reitsma-van Rooijen M.,NIVEL Netherlands Institute for Health Services Research
BMC health services research | Year: 2011

In 2006, a number of changes in the Dutch health insurance system came into effect. In this new system mobility of insured is important. The idea is that insured switch insurers because they are not satisfied with quality of care and the premium of their insurance. As a result, insurers will in theory strive for a better balance between price and quality. The Dutch changes have caught the attention, internationally, of both policy makers and researchers. In our study we examined switching behaviour over three years (2007-2009). We tested if there are differences in the numbers of switchers between groups defined by socio-demographic and health characteristics and between the general population and people with chronic illness or disability. We also looked at reasons for (not-)switching and at perceived barriers to switching. Switching behaviour and reasons for (not-)switching were measured over three years (2007-2009) by sending postal questionnaires to members of the Dutch Health Care Consumer Panel and of the National Panel of people with Chronic illness or Disability. Data were available for each year and for each panel for at least 1896 respondents - a response of between 71% and 88%. The percentages of switchers are low; 6% in 2007, 4% in 2008 and 3% in 2009. Younger and higher educated people switch more often than older and lower educated people and women switch more often than men. There is no difference in the percentage of switchers between the general population and people with chronic illness or disability. People with a bad self-perceived health, and chronically ill and disabled, perceive more barriers to switching than others. The percentages of switchers are comparable to the old system. Switching is not based on quality of care and thus it can be questioned whether it will lead to a better balance between price and quality. Although there is no difference in the frequency of switching among the chronically ill and disabled and people with a bad self-perceived health compared to others, they do perceive more barriers to switching. This suggests there are inequalities in the new system.

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