NIVEL

Utrecht, Netherlands
Utrecht, Netherlands

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Bensing J.,Nivel | Rimondini M.,University of Verona | Visser A.,Knowledge Center Innovation in Care
Patient Education and Counseling | Year: 2013

Objective: Although most health care professionals im- or explicitly will assume that they tend to use patient-centered communication strategies, there are reasons to believe that this might not always be a valid assumption. In everyday practice, professionals' own value system is often the dominant steering guide. This Special Issue aims to bring together ongoing research and reflections about the quality of health care communication from the patients' own perspective. In short: what do patients want? Methods: This introduction presents a comprehensive overview of the papers in the special issue of Patient Education and Counseling within a framework that describes the collected papers according to the six functions of medical consultations, taking account of the studies' applied methodologies: quantitative versus qualitative. Results: Two functions of the medical consultation are strongly represented in the collected papers on the quality of communication from the patients' perspective: 'fostering the relationship' and 'information giving'. There is a remarkable difference between the qualiative and quantitative studies, showing that if patients are not limited to prestructured questionnaires but completely free to express themselves, they tend to focus on 'fostering the relationship' with an emphasis on personal attention, warmth and empathy. Conclusions: Patients' needs and preferences for personalized and humane medical care cannot be overestimated. For the rest, patient diversity is striking, showing the limited usefulness of general communication guidelines for the other five functions of the medical consultation. Researchers should be aware that patients' views might be different dependent on the applied methodologies. © 2013.


Schafer W.,NIVEL
Health systems in transition | Year: 2010

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of health systems and of policy initiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems. They also describe the institutional framework, process, content, and implementation of health and health care policies, highlighting challenges and areas that require more in-depth analysis. Undoubtedly the dominant issue in the Dutch health care system at present is the fundamental reform that came into effect in 2006. With the introduction of a single compulsory health insurance scheme, the dual system of public and private insurance for curative care became history. Managed competition for providers and insurers became a major driver in the health care system. This has meant fundamental changes in the roles of patients, insurers, providers and the government. Insurers now negotiate with providers on price and quality and patients choose the provider they prefer and join a health insurance policy which best fits their situation. To allow patients to make these choices, much effort has been made to make information on price and quality available to the public. The role of the national government has changed from directly steering the system to safeguarding the proper functioning of the health markets. With the introduction of market mechanisms in the health care sector and the privatization of former sickness funds, the Dutch system presents an innovative and unique variant of a social health insurance system. Since the stepwise realization of the blueprint of the system has not yet been completed, the health care system in The Netherlands should be characterized as being in transition. Many measures have been taken to move from the old to the new system as smoothly as possible. Financial measures intended to prevent sudden budgetary shocks and payment mechanisms have been (and are) continuously adjusted and optimized. Organizational measures aimed at creating room for all players to become accustomed to their new role in the regulated market. As the system is still a "work in progress", it is too early to evaluate the effects and the consequences of the new system in terms of accessibility, affordability, efficiency and quality. Dutch primary care, with gatekeeping GPs at its core, is a strong foundation of the health care system. Gatekeeping GPs are a relatively unusual element in social health insurance systems. The strong position of primary care is considered to prevent unnecessary use of more expensive secondary care, and promote consistency and coordination of individual care. It continues to be a policy priority in The Netherlands. The position of the patient in The Netherlands is strongly anchored in several laws concerning their rights, their relation to providers and insurers, access to information, and possibilities to complain in case of maltreatment. In terms of quality and efficiency of the health care system, The Netherlands is, with some notable exceptions (e.g. implementation of innovations such as day surgery and electronic patient records), an average performer when compared to other wealthy countries. It is too early to tell whether efficiency and quality gains will occur as a result of the 2006 reform.


Victoor A.,NIVEL | Victoor A.,Institute for Health Services Research | Delnoij D.M.,University of Tilburg | Delnoij D.M.,Center for Consumer Experience in Health Care | And 5 more authors.
BMC Health Services Research | Year: 2012

Background: In several northwest European countries, a demand-driven healthcare system has been implemented that stresses the importance of patient healthcare provider choice. In this study, we are conducting a scoping review aiming to map out what is known about the determinants of patient choice of a wide range of healthcare providers. As far as we know, not many studies are currently available that attempt to draw a general picture of how patients choose a healthcare provider and of the status of research on this subject. This study is therefore a valuable contribution to the growing amount of literature about patient choice. Methods. We carried out a specific type of literature review known as a scoping review. Scoping reviews try to examine the breadth of knowledge that is available about a particular topic and therefore do not make selections or apply quality constraints. Firstly, we defined our research questions and searched the literature in Embase, Medline and PubMed. Secondly, we selected the literature, and finally we analysed and summarized the information. Results: Our review shows that patients choices are determined by a complex interplay between patient and provider characteristics. A variety of patient characteristics determines whether patients make choices, are willing and able to choose, and how they choose. Patients take account of a variety of structural, process and outcome characteristics of providers, differing in the relative importance they attach to these characteristics. Conclusions: There is no such thing as the typical patient: different patients make different choices in different situations. Comparative information seems to have a relatively limited influence on the choices made by many patients and patients base their decisions on a variety of provider characteristics instead of solely on outcome characteristics. The assumptions made in health policy about patient choice may therefore be an oversimplification of reality. Several knowledge gaps were identified that need follow-up research. © 2012 Victoor et al.; licensee BioMed Central Ltd.


To investigate how often and why people with dementia and their partners have contact with the general practitioner (GP) before and after the diagnosis of dementia. Retrospective cohort study. Patients given the diagnosis of 'dementia' in the period 2006-2011 were selected from patient records of GP practices participating in the NIVEL Primary Care Database; data were also collected from the patients' partners. Patients and their partners were compared with a reference group. The number of GP contacts from 2 years before until 1 year after diagnosis were analysed. There were data on 823 patients with dementia and 184 partners. People with dementia had more frequent GP contacts from 4 months before diagnosis until 8 months thereafter. The mean number of GP contacts was 21.5 for people with dementia versus 17.4 for people without dementia in the total 3-year period. Reasons for more frequent contact were depression, abrasions/scratches/blisters and memory/concentration/orientation disorders before diagnosis. After diagnosis, memory/concentration/orientation disorders and general decline were more common reasons for contact than in the reference group. The frequency of GP contacts for partners was not significantly higher. People with dementia have more contact with their GP than people without dementia. From 1.5 years before diagnosis they visit the GP with specific complaints more often. Their partners also have regular contact with their GP, especially in the year after diagnosis.


Netjes J.E.,NIVEL | Rijken M.,NIVEL
Inflammatory Bowel Diseases | Year: 2013

Background: The aims of the present study are twofold. First, to describe labor participation rates of people with inflammatory bowel disease (IBD) in the Netherlands compared with the total Dutch population and to people with chronic illness in general. Second, to explore differences in labor participation among IBD patients and assess the potential impact of a number of characteristics of IBD patients on labor participation. Methods: Data were obtained from a nationwide survey of individuals with IBD in the Netherlands. In all, 1115 respondents completed the survey. Univariate, bivariate, and multinomial logistic regression analysis were conducted to identify factors predicting the number of hours worked by IBD patients. Results: People with IBD do not participate less often in the labor market compared with the total Dutch population age 15 to 64. However, male patients age 45 to 64 less often have a fulltime job compared with age- and gender-matched reference groups from the general population. People with IBD are more likely to participate in the labor market than people with chronic illness in general. Gender, age, duration of illness, having a stoma or pouch, comorbidity, vitality, pain, and perceived personal control appear to be significant predictors of the number of hours worked. Conclusions: People with IBD in the Netherlands are as often employed as the general population, but among some gender/age categories fewer people work fulltime. Besides sociodemographic and illness characteristics, the perception of personal control over the illness explains differences in the number of hours worked. Strengthening IBD patients' control perceptions deserves attention. Copyright © 2013 Crohn's & Colitis Foundation of America, Inc.


Brugman M.,University of Maine, United States | Caron S.L.,University of Maine, United States | Rademakers J.,NIVEL
International Journal of Sexual Health | Year: 2010

The United States has the highest rates of teen pregnancy, births, and abortions of all industrialized countries. On the contrary, The Netherlands has the lowest rates. Using qualitative and quantitative methods, this retrospective study investigated American and Dutch college women's sexual behavior, attitudes, and comfort to better understand the factors that lead to the disparity between these two countries. Survey results revealed that the American sample experienced sexual behaviors at a younger age and with more partners, whereas the Dutch sample showed a better use of contraceptives during high school, more talk with their parents, and greater sexuality education. Several distinctly different themes emerged between the U.S. and Dutch women from the in-depth interviews. Themes about U.S. girls included: driven by hormones and peers; unprepared; satisfying him; and uncomfortable and silent parents. Some themes about Dutch girls were: motivated by love; control of my own body; parents as supporters and educators; and books at young ages. Implications for what the United States could be doing to promote sexual health are discussed. © Taylor & Francis Group, LLC.


Kuchinke W.,Heinrich Heine University Düsseldorf | Ohmann C.,Heinrich Heine University Düsseldorf | Verheij R.A.,NIVEL | van Veen E.-B.,MedLawConsult | And 3 more authors.
International Journal of Medical Informatics | Year: 2014

To develop a model describing core concepts and principles of data flow, data privacy and confidentiality, in a simple and flexible way, using concise process descriptions and a diagrammatic notation applied to research workflow processes. The model should help to generate robust data privacy frameworks for research done with patient data. Methods: Based on an exploration of EU legal requirements for data protection and privacy, data access policies, and existing privacy frameworks of research projects, basic concepts and common processes were extracted, described and incorporated into a model with a formal graphical representation and a standardised notation. The Unified Modelling Language (UML) notation was enriched by workflow and own symbols to enable the representation of extended data flow requirements, data privacy and data security requirements, privacy enhancing techniques (PET) and to allow privacy threat analysis for research scenarios. Results: Our model is built upon the concept of three privacy zones (Care Zone, Non-care Zone and Research Zone) containing databases, data transformation operators, such as data linkers and privacy filters. Using these model components, a risk gradient for moving data from a zone of high risk for patient identification to a zone of low risk can be described. The model was applied to the analysis of data flows in several general clinical research use cases and two research scenarios from the TRANSFoRm project (e.g., finding patients for clinical research and linkage of databases). The model was validated by representing research done with the NIVEL Primary Care Database in the Netherlands. Conclusions: The model allows analysis of data privacy and confidentiality issues for research with patient data in a structured way and provides a framework to specify a privacy compliant data flow, to communicate privacy requirements and to identify weak points for an adequate implementation of data privacy. © 2014 Elsevier Ireland Ltd.


Van Dillen S.M.E.,Wageningen University | Noordman J.,NIVEL | Van Dulmen S.,NIVEL | Van Dulmen S.,Radboud University Nijmegen | And 2 more authors.
European Journal of Clinical Nutrition | Year: 2014

Background/Objective: To examine the content of Dutch practice nurses' (PNs') advices about weight, nutrition and physical activity to overweight and obese patients. Subjects/Methods: A 100 videotaped real-life PN consultations (The Netherlands, 2010/2011) with overweight or obese patients were selected. An observational checklist was developed to assess frequency and content. Personalization of advices was scored, as also the guidelines on which PNs based their advices. Content analysis was used to identify different categories of advices. Results: About one quarter of advices concerned weight, over two-thirds nutrition and one-third physical activity. Lose weight, eat less fat and be more physically active in general were the main categories for each type of advice. Despite high clarity of advices, lower scores were found for specificity and personalization. Very few nutrition advices were provided in combination with physical activity advices. Conclusions: Weight advices often related to the patient's complaint. PNs seldom set a concrete weight goal. Although benefits of physical activity were discussed, often no practical advices were provided about how to achieve this. Integrated lifestyle advice was not common: advices about nutrition and physical activity were fragmented throughout the consultation. Obesity prevention needs more emphasis in PNs' educational programs. © 2014 Macmillan Publishers Limited. All rights reserved.


De Boer D.,NIVEL | Delnoij D.,University of Tilburg | Rademakers J.,University of Tilburg
Health Expectations | Year: 2010

Background Patient-given global ratings are frequently interpreted as summary measures of the patient perspective, with limited understanding of what these ratings summarize. Global ratings may be determined by patient experiences on priority aspects of care. Objectives (i) identify patient priorities regarding elements of care for breast cancer, hip- or knee surgery, cataract surgery, rheumatoid arthritis and diabetes, (ii) establish whether experiences regarding priorities are associated with patient-given global ratings, and (iii) determine whether patient experiences regarding priorities are better predictors of global ratings than experiences concerning less important aspects of care. Setting and participants Data collected for the development of five consumer quality index surveys - disease-specific questionnaires that capture patient experiences and priorities - were used. Results Priorities varied: breast cancer patients for example, prioritized rapid access to care and diagnostics, while diabetics favoured dignity and appropriate frequency of tests. Experiences regarding priorities were inconsistently related to global ratings of care. Regression analyses indicated that demographics explain 2.4-8.4% of the variance in global rating. Introducing patient experiences regarding priorities increased the variance explained to 21.1-35.1%; models with less important aspects of care explained 11.8-23.2%. Conclusions Some experiences regarding priorities are strongly related to the global rating while others are poorly related. Global ratings are marginally dependent on demographics, and experiences regarding priorities are somewhat better predictors of global rating than experiences regarding less important elements. As it remains to be fully determined what global ratings summarize, caution is warranted when using these ratings as summary measures. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.


Wiegers T.A.,NIVEL | Boerma W.G.W.,NIVEL | de Haan O.,NSPOH
Sexual and Reproductive Healthcare | Year: 2010

Objective: To assess a baseline level of maternity care knowledge of the population and of care providers in rural areas in Kyrgyzstan and Tajikistan (Central Asia). Methods: Interviews with pregnant women and with men about their knowledge of key danger signs, serious health problems during pregnancy, labour and childbirth, and knowledge of basic infant care. Questionnaires about maternity care knowledge for providers, and checklists about providers' communication and counselling skills and about facilities completed by observers. Results: Level of knowledge among the population about possible complications during pregnancy and the postpartum period was low. Physicians in Kyrgyzstan scored an average of 55.2% correct answers on 52 knowledge questions about maternity care. Midwives and nurses in Kyrgyzstan, physicians and midwives in Tajikistan, scored on average less than 50% correct answers. In Kyrgyzstan, in seven out of 15 facilities (47%) staff was permanently available for treatment and referral of patients (24. h a day, 7. days a week). In Tajikistan this was the case in only 2 of 17 facilities (12%). Conclusion: Kyrgyz and Tajik women and men have limited knowledge about possible complications during pregnancy, childbirth, and the period after childbirth. Service providers do not have an adequate professional level of knowledge of perinatal health issues and lack basic skills to monitor their work. © 2010 Elsevier B.V.

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