Background: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+. Conclusion: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.
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Purpose: Self-managed institutional homeless programmes started as an alternative to regular shelters. Using institutional theory as a lens, we aim to explore the experiences of stakeholders with the institutional aspects of a self-managed programs.Method: The data we analysed (56 interviews, both open and semi-structured) were generated in a longitudinal participatory case-study into JES, a self-managed homeless shelter. In our analysis we went back and forth between our empirical data and theory, using a combination of systematic coding and interpretation. Participants were involved in all stages of the research.Results: Our analysis revealed similarities between JES and regular shelters, stemming from institutional similarities. Participants shared space and facilities with sixteen people, which caused an ongoing discussion on (enforcement of) rules. Participants loathed lack of private space. However, participants experienced freedom of choice over both their own life and management of JES and structures were experienced more fluid than in regular care. Somestructures also appeared stimulated self-management.Conclusion: Our analysis showed how an institutional context influences self-management and suggested opportunities for introducing freedom and fluidity in institutional care.
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BACKGROUND: Limited research has examined what is actually done in the process of care by nursing staff in long-term institutional care. The applied instruments employed different terminologies, and psychometric properties were inadequately described. This study aimed to develop and test an observational instrument to identify and examine the amount of time spent on nursing interventions in long-term institutional care using a standardized language.METHODS: The Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC) is based on the conceptual framework of the Nursing Interventions Classification. Developmental, validation, and reliability stages of the GO-LTIC included: 1) item generation to identify potential setting-specific interventions; 2) examining content validity with a Delphi panel resulting in relevant interventions by calculating the item content validity index; 3) testing feasibility with trained observers observing nursing assistants; and 4) calculating inter-rater reliability using (non) agreement and Cohen's kappa for the identification of interventions and an intraclass correlation coefficient for the amount of time spent on interventions. Bland-Altman plots were applied to visualize the agreement between observers. A one-sample student T-test verified if the difference between observers differed significantly from zero.RESULTS: The final version of the GO-LTIC comprised 116 nursing interventions categorized into six domains. Substantial to almost perfect kappa's were found for interventions in the domains basic (0.67-0.92) and complex (0.70-0.94) physiological care. For the domains of behavioral, family, and health system interventions, the kappa's ranged from fair to almost perfect (0.30-1.00). Intraclass correlation coefficients for the amount of time spent on interventions ranged from fair to excellent for the physiological domains (0.48-0.99) and poor to excellent for the other domains (0.00-1.00). Bland Altman plots indicated that the clinical magnitude of differences in minutes was small. No statistical significant differences between observers (p > 0.05) were found.CONCLUSIONS: The GO-LTIC shows good content validity and acceptable inter-rater reliability to examine the amount of time spent on nursing interventions by nursing staff. This may provide managers with valuable information to make decisions about resource allocation, task allocation of nursing staff, and the examination of the costs of nursing services.
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The pressure on the European health care system is increasing considerably: more elderly people and patients with chronic diseases in need of (rehabilitation) care, a diminishing work force and health care costs continuing to rise. Several measures to counteract this are proposed, such as reduction of the length of stay in hospitals or rehabilitation centres by improving interprofessional and person-centred collaboration between health and social care professionals. Although there is a lot of attention for interprofessional education and collaborative practice (IPECP), the consortium senses a gap between competence levels of future professionals and the levels needed in rehabilitation practice. Therefore, the transfer from tertiary education to practice concerning IPECP in rehabilitation is the central theme of the project. Regional bonds between higher education institutions and rehabilitation centres will be strengthened in order to align IPECP. On the one hand we deliver a set of basic and advanced modules on functioning according to the WHO’s International Classification of Functioning, Disability and Health and a set of (assessment) tools on interprofessional skills training. Also, applications of this theory in promising approaches, both in education and in rehabilitation practice, are regionally being piloted and adapted for use in other regions. Field visits by professionals from practice to exchange experiences is included in this work package. We aim to deliver a range of learning materials, from modules on theory to guidelines on how to set up and run a student-run interprofessional learning ward in a rehabilitation centre. All tested outputs will be published on the INPRO-website and made available to be implemented in the core curricula in tertiary education and for lifelong learning in health care practice. This will ultimately contribute to improve functioning and health outcomes and quality of life of patients in rehabilitation centres and beyond.
The GeNEdu project aims to renew nursing curricula through building capacities of the Chinese partner institutions to develop gerontological nursing education for future health care professionals to meet the needs of the ageing society in China. It is financed from the Erasmus+ Programme, Key Action 2, Capacity Building in the Field of Higher Education 2019.
The ELLAN is a Lifelong Learning Programme project funded by the European Commission for the period September 2013 – September 2016. The consortium included 26 partners from 25 countries in Europe. The ELLAN project promotes European cooperation and exchange of innovation and good practice related to the ageing population and to the educational preparation of those professionals in health and social care that work with older people. The desired outcome of the ELLAN project is a better quality of higher education related to the care and services of people in later life. The project includes several research based workpackage with the main project result being the "European Core Competences Framework for health and social care professionals working with older people". The project directly targets educators and management staff at the partner organizations and other higher education institutions in Europe. The indirect target groups are the students, professional communities and older people themselves.
