Kijkend naar de ontwikkelingen in de medische en farmaceutische zorg, concludeer ik dat het belang van innovaties niet altijd in overeenstemming is met de snelheid waarmee die innovaties hun plek krijgen in het standaardhandelingsarsenaal van zorgverleners. Veranderingen in de zorg gaan vaak langzaam en doorbraken worden slecht herkend. De vraag is hoe dit komt. Er blijken vele factoren van invloed op het mogelijke succes van een innovatie. Van groot belang is het inzicht dat innoveren meer is dan iets bedenken en dan maar aannemen dat het wel zal worden opgepikt door de (potentiële) doelgroep. Het aan de man brengen (‘dissemineren’) van de innovatie is mede bepalend voor een succesvolle implementatie. In de farmaceutische zorg is voor deze overbruggingsfunctie een belangrijke rol weggelegd voor de farmakundige. Mijn lectoraat, dat is gekoppeld aan de opleiding Farmakunde, zal zich bezighouden met het onderzoek naar het proces om farmaceutische innovaties te dissemineren. In deze openbare les licht ik de context en consequenties van dit onderzoeksthema nader toe. Ik begin met een uitleg van de farmakundige en diens toegevoegde waarde in het werkveld (hoofdstuk 1), en vervolg met een korte beschrijving van recente veranderingen binnen de zorg (hoofdstuk 2). In het begeleiden van die veranderingen ligt een belangrijke meerwaarde van de farmakundige, en de missie van dit lectoraat. Daarna (hoofdstuk 3) beschouwen we het innoveren in de (farmaceutische) gezondheidszorg in meer detail. Hoofdstuk 4 geeft diverse handvatten voor het kiezen van de juiste interventies om de afstand tussen de innovator en de toekomstige gebruiker te overbruggen en zodoende de toegang voor de gebruiker tot de innovatie te verbeteren. De keuze van de onderzoekslijnen van mijn lectoraat, zoals in hoofdstuk 5 beschreven, is daarvan afgeleid
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Nieuwe wetgeving voor jeugdzorg in Nederland heeft geleid tot de implementatie van teams, die geïntegreerde eerstelijns jeugdzorg bieden. Belangrijke doelen van de nieuwe Jeugdwet waren meer geïntegreerde, tijdige zorg en minder gebruik van intensieve vormen van zorg. Het doel van dit onderzoek was het bestuderen van veranderingen in het gebruik van jeugdzorg in de tijd en de rol van nieuw ingevoerde wijkgerichte ondersteuningsteams hierin. Patronen van jeugdzorggebruik veranderden naar meer lokaal geleverde primaire jeugdzorg, iets minder gespecialiseerde en iets meer residentiële jeugdzorg. Bovendien nam het jeugdzorggebruik onder jongere kinderen toe in de tijd. Deze trends komen deels overeen met de trends die de Jeugdwet beoogt. Er is weinig bewijs gevonden voor de rol van specifieke teamkenmerken op veranderingen in jeugdzorggebruik in de tijd.
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The Internet is changing the way we organize work. It is shifting the requirement for what we call the ‘schedule push’ and the hierarchical organization that it implies, and therefore it is removing the type of control that is conventionally used to match resources to tasks, and customer demand to supplies and services. Organizational hierarchies have become too expensive to sustain, and in many cases their style of coordination is simply no longer necessary. The cost complexity of the industrial complex starts to outweigh the benefits and the Internet is making it redundant.
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Purpose: The increasing number of cancer survivors has heightened demands on hospital-based follow-up care resources. To address this, involving general practitioners (GPs) in oncological follow-up is proposed. This study explores secondary care providers’ views on integrating GPs into follow-up care for curatively treated breast and colorectal cancer survivors. Methods: A qualitative exploratory study was conducted using semi-structured interviews with Dutch medical specialists and nurse practitioners. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis by two independent researchers. Results: Fifteen medical specialists and nine nurse practitioners participated. They identified barriers such as re-referral delays, inexperience to perform structured follow-up, and worries about the lack of oncological knowledge among GPs. Benefits included the GPs’ accessibility and their contextual knowledge. For future organization, they emphasized the need for hospital logistics changes, formal GP training, sufficient case-load, proper staffing, remuneration, and time allocation. They suggested that formal GP involvement should initially be implemented for frail older patients and for prevalent cancer types. Conclusions: The interviewed Dutch secondary care providers generally supported formal involvement of primary care in cancer follow-up. A well-organized shared-care model with defined roles and clear coordination, supported by individual patients, was considered essential. This approach requires logistics adaptation, resources, and training for GPs. Implications for cancer survivors: Integrating oncological follow-up into routine primary care through a shared-care model may lead to personalized, effective, and efficient care for survivors because of their long-term relationships with GPs.
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Background: To improve the effectiveness of community-based care programs, especially those targeting the oldest-old population (80+), data are needed that elucidate those factors associated with a successful response to the intervention. Two comparable nurse-led care programs have been evaluated in two large randomized controlled trials (RCTs), one in Switzerland and one in the Netherlands. Aims: To identify common patient characteristics that are related to a successful response to proactive nurse-led care, we explored if and to what extent, identical factors were present in both study populations. Methods: A secondary data analysis using trial data from the intervention group of both RCTs was conducted. The study sample consisted 461 older adults, 230 from the U-PROFIT trial (the Netherlands) and 231 from the HPC trial (Switzerland). The mean age of the total sample was 85.1 years (SD 3.7). The UPROFIT intervention, delivered by registered nurses, included a frailty assessment and a comprehensive geriatric assessment (CGA) at home followed by an individualized evidence-based care plan, care coordination, and follow-up. The HCP intervention was delivered by advanced practice nurses consisting of four home visits and three phone calls, and was guided by the principles of health promotion, empowerment, partnership, and family-centeredness. A successful response was defined as “stable” or “no decline” in daily functioning at follow-up. Daily functioning was measured with 13 items of activities of daily living and instrumental activities of daily living. Multivariate logistic regression models were applied to calculate the association between individual characteristics and a successful response.
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Aim. To report the expectations and experiences of general practitioners and practice nurses regarding the U-CARE programme, to gain a better understanding of the barriers and facilitators in providing proactive, structured care to frail older people and to determine whether implementation is feasible. Background. Care for older patients with complex care needs in primary care is fragmented, reactive and time consuming. A structured, proactive care programme was developed to improve physical functioning and quality of life in frail older patients. Design. An explanatory mixed-methods study nested in a cluster-randomized trial. Methods. The barriers to and needs for the provision of structured, proactive care, and expectations regarding the U-CARE programme were assessed with prequestionnaires sent to all participating general practitioners (n = 32) and practice nurses (n = 21) in October 2010. Postquestionnaires measured experiences with the programme after 5 months. Twelve months later, focus group meetings were conducted. Results. Practice nurses and general practitioners reported that it was difficult to provide proactive and structured care to older patients with multi-morbidity, different cultural backgrounds and low socioeconomic status. Barriers were a lack of time and financial compensation. Most general practitioners and practice nurses indicated that the programme added value for the coordination of care and allowed them to provide structured care. Conclusion. This explanatory mixed-methods study showed that general practitioners and practice nurses perceived the U-CARE programme as feasible in general practice. A transition was made from reactive, ad hoc care towards a proactive and preventive care approach
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Senior co-housing communities offer an in-between solution for older people who do not want to live in an institutional setting but prefer the company of their age peers. Residents of co-housing communities live in their own apartments but undertake activities together and support one another. This paper adds to the literature by scrutinizing the benefits and drawbacks of senior co-housing, with special focus on the forms and limits of social support and the implications for the experience of loneliness. Qualitative fieldwork was conducted in eight co-housing communities in the Netherlands, consisting of document analysis, interviews, focus groups, and observations. The research shows that co-housing communities offer social contacts, social control, and instrumental and emotional support. Residents set boundaries regarding the frequency and intensity of support. The provided support partly relieves residents’ adult children from caregiving duties but does not substitute formal and informal care. Due to their access to contacts and support, few residents experience social loneliness. Co-housing communities can potentially also alleviate emotional loneliness, but currently, this happens to a limited degree. The paper concludes with practical recommendations for enhancing the benefits and reducing the drawbacks of senior co-housing. Original article at MDPI; DOI: https://doi.org/10.3390/ijerph16193776
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Het voorliggende rapport doet verslag van het onderzoek naar verdienmodellen van preventie. De centrale vraag die met het onderzoek beantwoord is, luidt: Wat zijn mogelijke barrières bij potentiële verdienmodellen voor preventie, die samenwerking tussen actoren in de weg kunnen staan? De algemene uitkomst is dat er zeker verdienmodellen van preventie te identificeren en te ontwerpen zijn temeer daar preventie vanuit een economisch perspectief als een soort investeringsbeslissing kan worden beschouwd. Er zijn echter wel verschillende barrières te onderkennen voor de ontwikkeling van een effectieve verdienmodellen. In het licht van de onderzoeksvraag leidt dit tot volgende conclusies: - Preventie is belangrijk maar komt nog onvoldoende van de grond; - Actoren kunnen worden ingedeeld in vier helixen en hebben verschillende salience; - Preventie is een maatschappelijk verdienmodel; - Verdienmodellen van preventie zijn technologisch, datagedreven en schaalbaar; - Barrieres voor preventie zijn bedrijfskundig van aard.
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Hoofdstuk 20 Part II in Understanding Penal Practice van Ioan Durnescu en Fergus McNeill Criminological and penological scholarship has in recent years explored how and why institutions and systems of punishment change – and how and why these changes differ in different contexts. Important though these analyses are, this book focuses not so much on the changing nature of institutions and systems, but rather the changing nature of penal practice and practitioners The first part of the book focuses on understanding practice and practitioners, exploring how changing social, cultural, political, and organisational contexts influence practice, and how training, development, professional socialisation and other factors influence practitioners. The second part is concerned with how practitioners can be best supported to develop the skills and approaches that seem most likely to generate positive impacts. It contains accounts of new practice models and approaches, as well as reports of research projects seeking both to discover and to encourage effective practices
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