Background In the Netherlands, general practitioners (GPs) play a key role in HIV testing. However, the proportion of people diagnosed with late-stage HIV remains high, and opportunities for earlier diagnosis are being missed. We implemented an educational intervention to improve HIV and STI testing in primary care in Amsterdam, the Netherlands. Methods GPs were invited to participate in an educational program between 2015 and 2020, which included repeat sessions using audit and feedback and quality improvement plans. Data on HIV, chlamydia and gonorrhoea testing by GPs were collected from 2011 through 2020. The primary outcome was HIV testing frequency, which was compared between GPs before and after participation using Poisson regression. Secondary outcomes were chlamydia and gonorrhoea testing frequencies, and positive test proportions. Additional analyses stratified by patient sex and age were done. Findings GPs after participation performed 7% more HIV tests compared to GPs before participation (adjusted relative ratio [aRR] 1.07, 95%CI 1.04–1.09); there was no change in the proportion HIV positive tests (aRR 0.87, 95%CI 0.63–1.19). HIV testing increased most among patients who were female and ≤19 or 50–64 years old. After participation, HIV testing continued to increase (aRR 1.02 per quarter, 95%CI 1.01–1.02). Chlamydia testing by GPs after participation increased by 6% (aRR 1.06, 95%CI 1.05–1.08), while gonorrhoea testing decreased by 2% (aRR 0.98, 95%CI 0.97–0.99). We observed increases specifically in extragenital chlamydia and gonorrhoea testing. Conclusions The intervention was associated with a modest increase in HIV testing among GPs after participation, while the proportion positive HIV tests remained stable. Our results suggest that the intervention yielded a sustained effect.
The purpose of the paper is to start a dialogue about differences between Western and Eastern cultures in the way they conceptualize knowledge and discuss the implications of these differences for a global intellectual capital (IC) theory and practice. A systematic metaphor analysis of the concept of knowledge and IC is used to identify common Western conceptualizations of knowledge in IC literature. A review of philosophical and religious literature was done to identify knowledge conceptualizations in the main streams of Asian philosophy. Fundamental differences were found in the way knowledge is conceptualized. In Western IC literature common metaphors for knowledge include knowledge as a thing and knowledge as capital. In Asian thought, knowledge is seen as unfolding truth based upon a unity of universe and human self and of knowledge and action. The research was performed on a limited sample of literature. More research is needed to identify how knowledge is conceptualized in the practice of doing business in Asia and to test the effects of introducing IC theories to Asian businessmen and managers. Moreover, it might be questionable whether different types of resources (Western management literature on IC and Asian cultural philosophies) can be put in a comparative perspective to extract conclusions out of it. This methodological starting point has its confinements, but is plausible partly as long as IC theories originating from an Asian background are still missing, partly as far as philosophical notions within Western IC publications are contrasted with Asian notions of knowledge. Despite this restriction we would like to emphasize that Western conceptualizations of knowledge, embedded in terms like intellectual capital and knowledge management, can not be transferred to Asian business without considering the local view on knowledge. Asian conceptualizations of knowledge should play an important role in the further development of a knowledge-based theory and practice of the firm. We choose deliberately to contrast Western philosophy with cultural and religious connotations in Asian philosophy, as the underlying paradigm is strongly influenced by these notions. This is clearly perceivable in revivalist and reformist tendencies in Buddhism, Hinduism and Islam. Religious notions within these traditions have a strong paradigmatic function in a cognitive and normative sense. Not only in anthropology but also in epistemology, contemporary Asian thought is dominated by a discourse deeply embedded in religious and cultural traditions, in which the dimensions of 'nature', 'subjectivity' and 'history' have well defined boundaries. Anthropologically and epistemologically, all spheres of human reality are analyzed and described within the perspective of an integral and monolithic unity, in which all dimensions and spheres of being are bound. In Western philosophy these spheres of being have been separated from religious notions because of a longstanding secularization due to which religion and culture, metaphysics and philosophy have become separate disciplines.(Boom, 1993)
Within large service organizations there are currently two trends visible. These trends seem to be diametrically opposed. On the one hand organizations face increasing price pressure and thus a pressure to cut costs. One of the consequences of this trend is that organizations are increasingly encouraging customers to make more use of digital communication channels. At the same time, companies find it important to know their customers in order to respond adequately to their needs. To do this, organizations must have a certain degree of personal involvement to their customers and they must have regular personal contact. It is assumed that both trends – digitisation and personalisation – will have a strong impact on customer experience and (perhaps) on the relational models customers use. If it is true that relational models - so the way in which people perceive and assess a relationship - play a role in the perception of the customer, it is also interesting to know if it is possible to influence these relational models. During the last fifty years much research has been done into the possibilities to influence customers by using subliminal priming techniques. In these techniques thoughts and feelings are unconsciously activated by showing people certain words or images (eg Bargh, Chen & Burrows, 1996; Dijksterhuis, 2005). In recent years a number of experiments were performed in which customers were unconsciously primed at some type of relationship (eg Aggarwal, 2004; McGraw & Tetlock, 2005; Tuk, Verlegh, Smidts & Wigboldus, 2009). These experiments showed that it is possible to activate a certain type of relationship. The experiments however the researchers used scenario’s based on an interpersonal relationship, and often to a fictitious relationship. The question is whether priming techniques also work for an already existing and more complex relationship between an organization and its customers. From 2010-2013 we conducted research for six large service providers in banking, insurance, utilities and social welfare to discover what the customer experience of these organisations, what role relational models played in customer experience and whether it was possible to influence these relational models. The research project has provided answers to the following questions: - Which relational models are used by customers and what is the influence of these models on customer experience? - What is the influence of digitisation in customer communication on relational models and customer experience? - What is the influence of personalisation in customer communication on relational models and customer experience? And finally, - Is it possible to influence relational models (and customer experience) by using specific words and images that are associated with relational models (relational framing)?
