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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Background: During hospitalization patients frequently have a low level of physical activity, which is an important risk factor for functional decline. Function Focused Care (FFC) is an evidencebased intervention developed in the United States to prevent functional decline in older patients. Within FFC, nurses help older patients optimally participate in functional and physical activity during all care interactions. FFC was adapted to the Dutch Hospital setting, which led to Function Focused Care in Hospital (FFCiH). FFCiH consists of four components: (1) ‘Environmental and policy assessment’; (2) ‘Education’; (3) ‘Goal setting with the patient’ and (4) ‘Ongoing motivation and mentoring’. The feasibility of FFCiH in the Dutch hospital setting needs to be assessed. Objective: Introduce FFCiH into Dutch hospital wards, to assess the feasibility of FFCiH in terms of description of the intervention, implementation, mechanisms of impact, and context. Design: Mixed method design Setting(s): A Neurological and a Geriatric ward in a Dutch Hospital. Participants: 56 Nurses and nursing students working on these wards. Methods: The implementation process was described and the delivery was studied in terms of dose, fidelity, adaptions, and reach. The mechanisms of impact were studied by the perceived facilitators and barriers to the intervention. Qualitative data were collected via focus group interviews, observations, and field notes. Quantitative data were collected via evaluation forms and attendance/participation lists. Results: A detailed description of FFCiH in terms of what, how, when, and by whom was given. 54 Nurses (96.4%) on both wards attended at least 1 session of the education or participated in bedside teaching. The nurses assessed the content of the education sessions with a mean of 7.5 (SD 0.78) on a 0–10 scale. The patient files showed that different short and long-term goals were set. Several facilitators and barriers were identified, which led to additions to the intervention. An important facilitator was that nurses experienced FFCiH as an approach that fits with the principles underpinning their current working philosophy. The experienced barriers mainly concern the implementation elements of the FFCiH-components ‘Education’ and ‘Ongoing motivation and mentoring’. Optimizing the team involvement, improving nursing leadership during the implementation, and enhancing the involvement of patients and their family were activities added to FFCiH to improve future implementation. Conclusions: FFCiH is feasible for the Dutch hospital setting. Strong emphasis on team involvement, nursing leadership, and the involvement of patients and their families is recommended to optimize future implementation of FFCiH in Dutch hospitals.
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Background and objective: Hospital and home care nurses and nursing assistants do not provide optimal nutritional care to older adults, which is due to several factors that influence their current behaviour. To successfully target these factors, we developed a microlearning intervention. The next step is to assess its feasibility to achieve the best fit with nursing practice. The aim of this study was to test the feasibility of the microlearning intervention about nutritional care for older adults provided by hospital and home care nurses and nursing assistants. Methods: In a multicentre study, we used a mixed-methods design. Feasibility was determined by assessing 1) recruitment and retention of the participants and 2) the acceptability, compliance and delivery of the intervention. Data about the use of the intervention (consisting of 30 statements), and data from a standardised questionnaire and two focus group interviews were used to measure the feasibility outcomes. Results: Fourteen teams with a total of 306 participants (response rate: 89.7%) completed the intervention and the median (Q1, Q3) score for completed statements per participant was 23 (12, 28). The mean proportion of correct answers was 72.2%. Participants were both positive and constructive about the intervention. They confirmed that they mostly learned from the intervention. Overall, the intervention was acceptable to the participants and compliance and delivery was adequate. Conclusions: The microlearning intervention is mostly feasible for hospital and home care nurses and nursing assistants. Based on participants’ constructive feedback, we consider that the intervention needs refinement to improve its feasibility.
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Veel ouderen ervaren tijdens en na ziekenhuisopname functieverlies. ‘Function Focused Care in Hospital’, ook wel bekend als bewegingsgerichte zorg, is een interventie gericht op het voorkomen en verminderen van functieverlies bij ouderen tijdens een ziekenhuisopname. Verpleegkundigen moedigen patiënten aan tot actieve betrokkenheid in de dagelijkse zorgmomenten.
Veel ouderen ervaren tijdens en na ziekenhuisopname functieverlies. ‘Function Focused Care in Hospital’, ook wel bekend als bewegingsgerichte zorg, is een interventie gericht op het voorkomen en verminderen van functieverlies bij ouderen tijdens een ziekenhuisopname. Verpleegkundigen moedigen patiënten aan tot actieve betrokkenheid in de dagelijkse zorgmomenten.Doel Doel van dit project is de effectiviteit bepalen van Function Focused Care in Hospital op het fysiek functioneren van patiënten die opgenomen zijn in de Nederlandse ziekenhuizen. Resultaten Nederlandstalig scholingsprogramma en handboek van de Function Focused Care in Hospital-benadering voor de ziekenhuissetting; Een evaluatie van het proces en de uitkomsten van de Function Focused Care-benadering. Looptijd 01 november 2020 - 31 oktober 2025 Aanpak Er is een haalbaarheidsstudie uitgevoerd, die uitwees dat de interventie geschikt is voor de Nederlandse praktijk. Op de neurologische en geriatrische afdelingen van drie ziekenhuizen is Function Focused Care in Hospital in de dagelijkse zorg geïmplementeerd en geëvalueerd op effectiviteit. Over de interventie Function Focused Care (FFC) is een zorgbenadering waarin verpleegkundigen patiënten actief betrekken bij alle zorgmomenten om hun fysiek functioneren te optimaliseren. Eerder onderzoek heeft laten zien dat FFC een positief effect heeft op fysieke activiteit, mobiliteit en ADL bij ouderen in de wijk en de langdurige zorg. Ook laten studies in de acute zorg belovende resultaten zien van FFC op fysieke activiteit en mobiliteit bij ouderen opgenomen in het ziekenhuis. Voorbeelden van zorg volgens de FFC-benadering zijn met de patiënt naar de badkamer lopen in plaats van wassen op bed, of de maaltijd aan tafel nuttigen in plaats van zittend in bed eten. De essentie van FFC is het behouden of, indien mogelijk, verbeteren van het fysieke functioneren. Tijdens de hele ziekenhuisopname wordt de patiënt aangemoedigd meer tijd te laten besteden aan fysieke activiteit op een op de patiënt aangepast niveau. Co-financiering Het project wordt mede gefinancierd door ZonMW, projectnummer 520002003.
In the Netherlands approximately 2 million inhabitants have one or more disabilities. However, just like most people they like to travel and go on holiday.In this project we have explored the customer journey of people with disabilities and their families to understand their challenges and solutions (in preparing) to travel. To get an understanding what ‘all-inclusive’ tourism would mean, this included an analysis of information needs and booking behavior; traveling by train, airplane, boat or car; organizing medical care and; the design of hotels and other accommodations. The outcomes were presented to members of ANVR and NBAV to help them design tourism and hospitality experiences or all.
Centre of Expertise, onderdeel van Hanze
