Browsing by Author "Wensing, M."

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Het sociale steunnetwerk van volwassenen met autisme: Een verkenning middels de Netwerk in Actie vragenlijst
Heuvel, R.M. van den ; Wensing, M. ; Geurts, H.M. ; Teunisse, J.P.W.M.
2021, Article in monograph or in proceedings (Nationaal Autisme Congres)
15 Organizational Implementation Strategies 263
Wensing, M. ; Grol, R. ; Laurant, M.G.H.
2020, Part of book or chapter of book (Grol, R.; Laurant, M.; Wensing, M. (ed.), Improving Patient Care: The Implementation of Change in Health Care, 3rd Edition, pp. 263-274)
Actions to influence the care network of home-dwelling elderly people: a qualitative study
Kemper, W. ; Adriaansen, M.J.M. ; Laurant, M.G.H. ; Wensing, M.
2019, Article / Letter to editor (Health & Social Care in the Community, vol. 27, iss. 4, (2019), pp. 973-981)
Symptoms of depression are associated with physical inactivity but not modified by gender or the presence of a cardiovascular disease; a cross-sectional study.
Achttien, R. ; Lieshout, J. van ; Wensing, M. ; Sanden, M.N. van ; Staal, J.B.
2019, Article / Letter to editor (BMC Cardiovascular Disorders, vol. 19, iss. 1, (2019), pp. 95)
The decline in physical activity in aging people is not modified by gender or the presence of cardiovascular disease.
Achttien, R. ; Lieshout, J.V. ; Wensing, M. ; Nijhuis-van der Sanden, M.W.G. ; Staal, J.B.
2019, Article / Letter to editor (European Journal of Public Health, (2019))
Developing a support program for care networks of home-dwelling older people
Kemper, W. ; Adriaansen, M.J.M. ; Laurant, M.G.H. ; Wensing, M.
2019, Article / Letter to editor (International Journal of Integrated Care (Ijic), vol. 19, iss. 4, (2019), pp. 425)
The effects of substitution of hospital ward care from medical doctors to physician assistants on non-adherence to guidelines on medication prescribing.
Bos, J.M. ; Timmermans, M.C.J. ; Kalkman, G.A. ; Bemt, P.M.L.A. van den ; Laurant, M.G.H. ; Smet, P. A. G. M. de ; Wensing, M.
2018, Article / Letter to editor (PLoS One, vol. 13, iss. 8, (2018))
Collaboration in teams with nurse practitioners and general practitioners during out-of-hours and implications for patient care; a qualitative study
Biezen, M. van der ; Wensing, M. ; Poghosyan, L ; Burgt, R. van der ; Laurant, M.G.H.
2017, Article / Letter to editor (BMC Health Services Research, vol. 17, (2017))Background: Increasingly, nurse practitioners (NPs) are deployed in teams along with general practitioners (GPs) to help meet the demand for out-of-hours care. The purpose of this study was to explore factors influencing collaboration between GPs and NPs in teams working out-of-hours. Methods: A descriptive qualitative study was done using a total of 27 semi-structured interviews and two focus group discussions. Data was collected between June, 2014 and October, 2015 at an out-of-hours primary care organisation in the Netherlands. Overall, 38 health professionals (GPs, NPs, and support staff) participated in the study. The interviews were audio-taped and transcribed verbatim. Two researchers conducted an inductive content analysis, involving the identification of relevant items in a first phase and clustering into themes in a second phase. Results: The following four themes emerged from the data: clarity of NP role and regulation, shared caseload and use of skills, communication concerning professional roles, trust and support in NP practice. Main factors influencing collaboration between GPs and NPs included a lack of knowledge regarding the NPs' scope of practice and regulations governing NP role; differences in teams in sharing caseload and using each other's skills effectively; varying support of GPs for the NP role; and limited communication between GPs and NPs regarding professional roles during the shift. Lack of collaboration was perceived to result in an increased risk of delay for patients who needed treatment from a GP, especially in teams with more NPs. Collaboration was not perceived to improve over time as teams varied across shifts. Conclusion: In out-of-hours primary care teams constantly change and team members are often unfamiliar with each other or other's competences. In this environment, knowledge and communication about team members' roles is continuously at stake. Especially in teams with more NPs, team members need to use each other's skills to deliver care to all patients on time.
Factors influencing decision of general practitioners and managers to train and employ a nurse practitioner or physician assistant in primary care: a qualitative study
Laurant, M.G.H. ; Biezen, M. van der ; Derckx, E. ; Wensing, M.
2017, Article / Letter to editor (BMC Family Practice, (2017))
The involvement of physician assistants in inpatient care in hospitals in the Netherlands: a cost-effectiveness analysis
Timmermans, M.C.J. ; Brink, G.T.W.J. van den ; Vught, A.J.A.H. van ; Adang, Eddy ; Berlo, C.L.H. van ; Boxtel, K.V. ; Braunius, W.W. ; Janssen, L. ; Venema, A. ; Wildenberg, F.J. ; Wensing, M. ; Laurant, M.G.H. et al. sine al.
2017, Article / Letter to editor (BMJ Open, (2017))
Towards an optimal composition of general practitioners and nurse practitioners in out-of-hours primary care teams: a quasi-experimental study
Laurant, M.G.H. ; Biezen, M. van der ; Wensing, M. ; Burgt, R.
2017, Article / Letter to editor (BMJ Open, (2017))
The impact of the implementation of physician assistants in inpatient care: A multicenter matched-controlled study
Timmermans, M.C.J. ; Vught, A.J.A.H. van ; Peters, Y ; Meermans, G ; Peute, JGM ; Postma, CT ; Smit, PC ; Verdaasdonk, E ; Reilingh, TSD ; Wensing, M. ; Laurant, M.G.H. et al. sine al.
2017, Article / Letter to editor (PLoS One, vol. 12, iss. 8, (2017))Background Medical care for admitted patients in hospitals is increasingly reallocated to physician assistants (PAs). There is limited evidence about the consequences for the quality and safety of care. This study aimed to determine the effects of substitution of inpatient care from medical doctors (MDs) to PAs on patients' length of stay (LOS), quality and safety of care, and patient experiences with the provided care. Methods In a multicenter matched-controlled study, the traditional model in which only MDs are employed for inpatient care (MD model) was compared with a mixed model in which besides MDs also PAs are employed (PA/MD model). Thirty-four wards were recruited across the Netherlands. Patients were followed from admission till one month after discharge. Primary outcome measure was patients' LOS. Secondary outcomes concerned eleven indicators for quality and safety of inpatient care and patients' experiences with the provided care. Results Data on 2,307 patients from 34 hospital wards was available. The involvement of PAs was not significantly associated with LOS (beta 1.20, 95% CI 0.99-1.40, p = .062). None of the indicators for quality and safety of care were different between study arms. However, the involvement of PAs was associated with better experiences of patients (beta 0.49, 95% CI 0.22-0.76, p = .001). Conclusions This study did not find differences regarding LOS and quality of care between wards on which PAs, in collaboration with MDs, provided medical care for the admitted patients, and wards on which only MDs provided medical care. Employing PAs seems to be safe and seems to lead to better patient experiences.
Strategies in primary healthcare to implement early identification of risky alcohol consumption: why do they work or not? A qualitative evaluation of the ODHIN study
Keurhorst, M. ; Heinen, M. ; Colom, J ; Linderoth, C ; Mussener, U ; Okulicz-Kozaryn, K ; Palacio-Vieira, J ; Segura, L. ; Silfversparre, F ; Slodownik, L ; Sorribes, E ; Laurant, M.G.H. ; Wensing, M. et al. sine al.
2016, Article / Letter to editor (BMC Family Practice, vol. 17, (2016))Background: Screening and brief interventions (SBI) in primary healthcare are cost-effective in risky drinkers, yet they are not offered to all eligible patients. This qualitative study aimed to provide more insight into the factors and mechanisms of why, how, for whom and under what circumstances implementation strategies work or do not work in increasing SBI. Methods: Semi-structured interviews were conducted between February and July 2014 with 40 GPs and 28 nurses in Catalonia, the Netherlands, Poland, and Sweden. Participants were purposefully selected from the European Optimising Delivery of Healthcare Interventions (ODHIN) trial. This randomised controlled trial evaluated the influence of training and support, financial reimbursement and an internet-based method of delivering advice on SBI. Amongst them were 38 providers with a high screening performance and 30 with a low screening performance from different allocation groups. Realist evaluation was combined with the Tailored Implementation for Chronic Diseases framework for identification of implementation determinants to guide the interviews and analysis. Transcripts were analysed thematically with the diagram affinity method. Results: Training and support motivated SBI by improved knowledge, skills and prioritisation. Continuous provision, sufficient time to learn intervention techniques and to tailor to individual experienced barriers, seemed important T&S conditions. Catalan and Polish professionals perceived financial reimbursement to be an additional stimulating factor as well, as effects on SBI were smoothened by personnel levels and salary levels. Structural payment for preventive services rather than a temporary project based payment, might have increased the effects of financial reimbursement. Implementing e-BI seem to require more guidance than was delivered in ODHIN. Despite the allocation, important preconditions for SBI routine seemed frequent exposure of this topic in media and guidelines, SBI facilitating information systems, and having SBI in protocol-led care. Hence, the second order analysis revealed that the applied implementation strategies have high potential on the micro professional level and meso-organisational level, however due to influences from the macro-level such as societal and political culture the effects risks to get nullified. Conclusions: Essential determinants perceived for the implementation of SBI routines were identified, in particular for training and support and financial reimbursement. However, focusing only on the primary healthcare setting seems insufficient and a more integrated SBI culture, together with meso- and macro-focused implementation process is requested.
Substitution of general practitioners by nurse practitioners in out-of-hours primary care: a quasi-experimental study
Biezen, M van der ; Schoonhoven, Lisette ; Wijers, N. ; Burgt, R. van der ; Wensing, M. ; Laurant, M.G.H.
2016, Article / Letter to editor (Journal of Advanced Nursing, vol. 72, iss. 8, (2016), pp. 1813-1824)AimTo provide insight into the impact of substituting general practitioners with nurse practitioners in out-of-hours services on: (1) the number of patients; and (2) general practitioners' caseload (patient characteristics, urgency levels, types of complaints). BackgroundGeneral practitioners' workload during out-of-hours care is high, and the number of hours they work out-of-hours has increased, which raises concerns about maintaining quality of care. One response to these challenges is shifting care to nurse practitioners. DesignQuasi-experimental study comparing differences between and within out-of-hours teams: experimental, one nurse practitioner and four general practitioners; control, five general practitioners. MethodsData of 12,092 patients from one general practitioners cooperative were extracted from medical records between April 2011 and July 2012. ResultsThe number of patients was similar in the two study arms. In the experimental arm, the nurse practitioner saw on average 163% of the patients and each general practitioner on average 209% of the patients. General practitioners treated more older patients; higher urgency levels; and digestive, cardiovascular and neurological complaints. Nurse practitioners treated more patients with skin and respiratory complaints. Substitution did not lead to a meaningful increase of general practitioners' caseload. ConclusionThe results show that nurse practitioners can make a valuable contribution to patient care during out-of-hours. The patients managed and care provided by them is roughly the same as general practitioners. In areas with a shortage of general practitioners, administrators could consider employing nurses who are competent to independently treat patients with a broad range of complaints to offer timely care to patients with acute problems.
The impact of substituting general practitioners with nurse practitioners on resource use, production and health-care costs during out-of-hours: a quasi-experimental study
Biezen, M van der ; Adang, Eddy ; Burgt, R. van der ; Wensing, M. ; Laurant, M.G.H.
2016, Article / Letter to editor (BMC Family Practice, vol. 17, (2016))Background: The pressure in out-of-hours primary care is high due to an increasing demand for care and rising health-care costs. During the daytime, substituting general practitioners (GPs) with nurse practitioners (NPs) shows positive results to contribute to these challenges. However, there is a lack of knowledge about the impact during out-of-hours. The current study aims to provide an insight into the impact of substitution on resource use, production and direct health-care costs during out-of-hours. Methods: At a general practitioner cooperative (GPC) in the south-east of the Netherlands, experimental teams with four GPs and one NP were compared with control teams with five GPs. In a secondary analysis, GP care versus NP care was also examined. During a 15-month period all patients visiting the GPC on weekend days were included. The primary outcome was resource use including X-rays, drug prescriptions and referrals to the Emergency Department (ED). We used logistic regression to adjust for potential confounders. Secondary outcomes were production per hour and direct health-care costs using a cost-minimization analysis. Results: We analysed 6,040 patients in the experimental team (NPs: 987, GPs: 5,053) and 6,052 patients in the control team. There were no significant differences in outcomes between the teams. In the secondary analysis, in the experimental team NP care was associated with fewer drug prescriptions (NPs 37.1 %, GPs 43 %, p < .001) and fewer referrals to the ED (NPs 5.1 %, GPs 11.3 %, p = .001) than GP care. The mean production per hour was 3.0 consultations for GPs and 2.4 consultations for NPs (p < .001). The cost of a consultation with an NP was (sic)3.34 less than a consultation with a GP (p = .02). Conclusions: These results indicated no overall differences between the teams. Nonetheless, a comparison of type of provider showed that NP care resulted in lower resource use and cost savings than GP care. To find the optimal balance between GPs and NPs in out-of-hours primary care, more research is needed on the impact of increasing the ratio of NPs in a team with GPs on resource use and health-care costs.
Local networks of community and healthcare organisations: a mixed methods study
Kemper, W. ; Koetsenruijter, J. ; Rogers, A. ; Laurant, M.G.H. ; Wensing, M.
2016, Article / Letter to editor (BMC Research Notes, vol. 9, (2016))
Impact of primary healthcare providers' initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial
Keurhorst, M. ; Anderson, P. ; Heinen, M. ; Bendtsen, P. ; Baena, B ; Brzozka, K ; Colom, J ; Deluca, P. ; Drummond, C ; Kaner, E. ; Kloda, K. ; Mierzecki, A. ; Newbury-Birch, D. ; Okulicz-Kozaryn, K ; Palacio-Vieira, J ; Parkinson, K. ; Reynolds, J. ; Ronda, G ; Segura, L. ; Slodownik, L ; Spak, F ; van Steenkiste, B ; Wallace, P ; Wolstenholme, A ; Wojnar, M. ; Gual, A. ; Laurant, M.G.H. ; Wensing, M. et al. sine al.
2016, Article / Letter to editor (Implementation Science, vol. 11, (2016))Background: Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation. Methods: In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. Results: Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups. Conclusions: The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners' attitudes, their actual behaviour and care improvement strategies to enhance implementation science.
The effectiveness of substitution of hospital ward care from medical doctors to physician assistants: a study protocol (vol 14, 43, 2014)
Timmermans, M.C.J. ; Vught, A.J.A.H. van ; Wensing, M. ; Laurant, M.G.H.
2016, Article / Letter to editor (BMC Health Services Research, vol. 16, (2016))
Determinants of the sustained employment of physician assistants in hospitals: a qualitative study
Timmermans, M.C.J. ; Vught, A.J.A.H. van ; Maassen, I.T.H.M ; Draaijer, L ; Hoofwijk, AGM ; Spanier, M ; Unen, W. van ; Wensing, M. ; Laurant, M.G.H.
2016, Article / Letter to editor (BMJ Open, vol. 6, iss. 11, (2016))Objectives: To identify determinants of the initial employment of physician assistants (PAs) for inpatient care as well as of the sustainability of their employment. Design: We conducted a qualitative study with semistructured interviews with care providers. Interviews continued until data saturation was achieved. All interviews were transcribed verbatim. A framework approach was used for data analysis. Codes were sorted by the themes, bringing similar concepts together. Setting: This study was conducted between June 2014 and May 2015 within 11 different hospital wards in the Netherlands. The wards varied in medical speciality, as well as in hospital type and the organisational model for inpatient care. Participants: Participant included staff physicians, residents, PAs and nurses. Results: The following themes emerged to be important for the initial employment of PAs and the sustainability of their employment: the innovation, individual factors, professional interactions, incentives and resources, capacity for organisational change and social, political and legal factors. Conclusions: 10 years after the introduction of PAs, there was little discussion among the adopters about the added value of PAs, but organisational and financial uncertainties played an important role in the decision to employ and continue employment of PAs. Barriers to employ and continue PA employment were mostly a consequence of locally arranged restrictions by hospital management and staff physicians, as barriers regarding national laws, PA education and competencies seemed absent.
Physician assistants in medical ward care: a descriptive study of the situation in the Netherlands
Timmermans, M.C.J. ; Vught, A.J.A.H. van ; Van den Berg, M ; Ponfoort, ED ; Riemens, F ; Unen, J. van ; Wobbes, T ; Wensing, M. ; Laurant, M.G.H.
2016, Article / Letter to editor (Journal of Evaluation in Clinical Practice, vol. 22, iss. 3, (2016), pp. 395-402)Rationale, aims and objectivesMedical ward care has been increasingly reallocated from medical doctors (MDs) to physician assistants (PAs). Insight into their roles and tasks is limited. This study aims to provide insight into different organizational models of medical ward care, focusing on the position, tasks and responsibilities of the involved PAs and MDs. MethodsIn this cross-sectional descriptive study 34 hospital wards were included. Characteristics of the organizational models were collected from the heads of departments. We documented provider continuity by examination of work schedules. MDs and PAs in charge for medical ward care (n=179) were asked to complete a questionnaire to measure workload, supervision and tasks performed. ResultsWe distinguished four different organizational models for ward care: medical specialists in charge of admitted patients (100% MS), medical residents in charge (100% MR), PAs in charge (100% PA), both MRs and PAs in charge (mixed PA/MR). The wards with PAs had the highest provider continuity. PAs spend relatively more time on direct patient care; MDs spend relatively more time on indirect patient care. PAs spend more hours on quality projects (P=0.000), while MDs spend more time on scientific research (P=0.030). ConclusionAcross different organizational models for medical ward care, we found variations in time per task, time per bed and provider continuity. Further research should focus on the impact of these differences on outcomes and efficiency of medical ward care.
Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis
Keurhorst, M. ; Glind, I. van de ; do Amaral-Sabadini, MB ; Anderson, P. ; Kaner, E. ; Newbury-Birch, D. ; Braspenning, J ; Wensing, M. ; Heinen, M. ; Laurant, M.G.H.
2015, Article / Letter to editor (Addiction, vol. 110, iss. 12, (2015), pp. 1877-1900)Background and AimsScreening and brief interventions (SBI) delivered in primary health care (PHC) are cost-effective in decreasing alcohol consumption; however, they are underused. This study aims to identify implementation strategies that focus on SBI uptake and measure impact on: (1) heavy drinking and (2) delivery of SBI in PHC. MethodsMeta-analysis was conducted of controlled trials of SBI implementation strategies in PHC to reduce heavy drinking. Key outcomes included alcohol consumption, screening, brief interventions and costs in PHC. Predictor measures concerned single versus multiple strategies, type of strategy, duration and physician-only input versus that including mid-level professionals. Standardized mean differences (SMD) were calculated to indicate the impact of implementation strategies on key outcomes. Effect sizes were aggregated using meta-regression models. ResultsThe 29 included studies were of moderate methodological quality. Strategies had no overall impact on patients' reported alcohol consumption [SMD=0.07; 95% confidence interval (CI)= -0.02 to 0.16], despite improving screening (SMD=0.53; 95% CI=0.28-0.78) and brief intervention delivery (SMD=0.64;95% CI=0.27-1.02). Multi-faceted strategies, i.e. professional and/or organizational and/or patient-orientated strategies, seemed to have strongest effects on patients' alcohol consumption (P<0.05, compared with professional-orientated strategies alone). Regarding SBI delivery, combining professional with patient-orientated implementation strategies had the highest impact (P<0.05). Involving other staff besides physicians was beneficial for screening (P<0.05). ConclusionsTo increase delivery of alcohol screening and brief interventions and decrease patients' alcohol consumption, implementation strategies should include a combination of patient-, professional- and organizational-orientated approaches and involve mid-level health professionals as well as physicians.
GPs' role security and therapeutic commitment in managing alcohol problems: a randomised controlled trial of a tailored improvement programme
Keurhorst, M. ; Beurden, I. van ; Anderson, P. ; Heinen, M. ; Akkermans, R.P. ; Wensing, M. ; Laurant, M.G.H.
2014, Article / Letter to editor (BMC Family Practice, vol. 15, (2014))Background: General practitioners with more positive role security and therapeutic commitment towards patients with hazardous or harmful alcohol consumption are more involved and manage more alcohol-related problems than others. In this study we evaluated the effects of our tailored multi-faceted improvement implementation programme on GPs' role security and therapeutic commitment and, in addition, which professional related factors influenced the impact of the implementation programme. Methods: In a cluster randomised controlled trial, 124 GPs from 82 Dutch general practices were randomised to either the intervention or control group. The tailored, multi-faceted programme included combined physician, organisation, and patient directed alcohol-specific implementation strategies to increase role security and therapeutic commitment in GPs. The control group was mailed the national guideline and patients received feedback letters. Questionnaires were completed before and 12 months after start of the programme. We performed linear multilevel regression analysis to evaluate effects of the implementation programme. Results: Participating GPs were predominantly male (63%) and had received very low levels of alcohol related education before start of the study (0.4 h). The programme increased therapeutic commitment (p = 0.005; 95%-CI 0.13 - 0.73) but not role security (p = 0.58; 95%-CI -0.31 - 0.54). How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs' reported proportion of patients asked about alcohol consumption at baseline, contributed to the effect of the programme on therapeutic commitment. Conclusions: A tailored, multi-faceted programme aimed at improving GP management of patients with hazardous and harmful alcohol consumption improved GPs' therapeutic commitment towards patients with alcohol-related problems, but failed to improve GPs' role security. How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs' reported proportion of patients asked about alcohol consumption at baseline, both increased the impact of the programme on therapeutic commitment. It might be worthwhile to monitor proceeding of role security and therapeutic commitment throughout the year after the implementation programme, to see whether the programme is effective on short term but faded out on the longer term.
The effectiveness of substitution of hospital ward care from medical doctors to physician assistants: a study protocol
Timmermans, M.C.J. ; Vught, A.J.A.H. van ; Wensing, M. ; Laurant, M.G.H.
2014, Article / Letter to editor (BMC Health Services Research, vol. 14, (2014))Background: Because of an expected shrinking supply of medical doctors for hospitalist posts, an increased emphasis on efficiency and continuity of care, and the standardization of many medical procedures, the role of hospitalist is increasingly allocated to physician assistants (PAs). PAs are nonphysician clinicians with medical tasks. This study aims to evaluate the effects of substitution of hospital ward care to PAs. Methods/Design: In a multicenter matched controlled study, the traditional model in which the role of hospitalist is taken solely by medical doctors (MD model) is compared with a mixed model in which a PA functions as a hospitalist, contingent with MDs (PA/MD model). Twenty intervention and twenty control wards are included across The Netherlands, from a range of medical specialisms. Primary outcome measure is patients' length of hospital stay. Secondary outcomes include indicators for quality of hospital ward care, patients experiences with medical ward care, patients health-related quality of life, and healthcare providers' experiences. An economic evaluation is conducted to assess the cost implications and potential efficiency of the PA/MD model. For most measures, data is collected from medical records or questionnaires in samples of 115 patients per hospital ward. Semi-structured interviews with healthcare professionals are conducted to identify determinants of efficiency, quality and continuity of care and barriers and facilitators for the implementation of PAs in the role of hospitalist. Discussion: Findings from this study will help to further define the role of nonphysician clinicians and provides possible key components for the implementation of PAs in hospital ward care. Like in many studies of organizational change, random allocation to study arms is not feasible, which implies an increased risk for confounding. A major challenge is to deal with the heterogeneity of patients and hospital departments.
Shifting Cardiovascular Care to Nurses Results in Structured Chronic Care
Nouwens, E ; van Lieshout, J ; Hombergh, P. van den ; Laurant, M.G.H. ; Wensing, M.
2014, Article / Letter to editor (American Journal of Managed Care, vol. 20, iss. 7, (2014), pp. E278-U145)Objectives To explore nurse involvement in cardiovascular risk management (CVRM) in primary care and how this involvement was associated with the degree of structured chronic illness care. Study Design A cross-sectional observational study in 7 European countries. Methods Five aspects of nurse involvement in CVRM and 35 specific components of structured chronic illness care were documented in 202 primary care practices in Austria, Belgium, Germany, the Netherlands, Slovenia, Spain, and Switzerland. An overall measure for chronic care management, range 0 to 5, was constructed, derived from elements of the Chronic Care Model (CCM). Random coefficient regression modeling was used to explore associations. Results A majority of practices involved nurses for organization of CVRM in administrative tasks (82.2 %), risk factor monitoring (78.5%) and patient education (57.1%). Fewer practices involved nurses in defining protocol and the organization for CVRM (45%) or diagnosis and treatment (34.6%). With an increasing number of tasks handled by nurses, overall median adoption of CCM increased from 2.7 (95% CI, 1.5-3.6) to 4.2 (95% CI, 3.8-4.1), When the number of nurse tasks increased by 1, the adoption of CCM increased by 0.13 (P < .05; 95% CI, 0.03-0.22). Some practices with low nurse involvement had high adoption of CCM, while variation of adoption of CCM across practices reduced substantially with an increasing level of nurse involvement. Conclusions Nurses were involved in the delivery of CVRM in varying degrees. Higher involvement of nurses was associated with higher degree of structured chronic illness care, with less variation.

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