Browse by Lectorate "Organisatie van Zorg en Dienstverlening"

Now showing items 1-50 of 124

Zorgnetwerken van thuiswonende ouderen verbeteren
Kemper, W.
2022, Article / Letter to editor (Nieuwsbrief Zorg & innovatie, (2022))
Zinnige zorg dreigt utopie te worden
Jung, H.P. ; Laurant, M.G.H. ; Asten, C. van
2019, Article / Letter to editor (Medisch Contact, vol. 2019, iss. 47, (2019), pp. 18-20)
Worked based learning and improving in nursing homes
Meijers, J. ; Verbeek, F. ; Lierop, M. van ; Graas, R. van ; Muller-Schoof, I. ; Verbiest, M. ; Rutten, Johanna ; Backhaus, R. ; Snoeren, M. ; Gobbens, R. ; Vught, A.J.A.H. van et al. sine al.
2022, Article in monograph or in proceedings (Worked based learning and improving in nursing homes)
What does the nurse practitioner mean to you? A patient-oriented qualitative study in oncological/palliative care
Dusseldorp, L. van ; Groot, M. ; Adriaansen, M.J.M. ; Vught, A.J.A.H. van ; Vissers, K. ; Peters, J.
2018, Article / Letter to editor (Journal of Clinical Nursing, vol. 28, iss. 3-4, (2018), pp. 589-602)
We kunnen niet meer zonder de PA en VS
Brink, G.T.W.J. van den ; Laurant, M.G.H. ; Vught, A.J.A.H. van
2020, Article / Letter to editor (TVZ : verpleegkunde in praktijk en wetenschap, iss. 06, (2020), pp. 14-17)
De VS GGZ in de huisartsenpraktijk; ervaringen in de praktijk
Tordoir, A. ; Coolen, P. ; Vlerken, M. van ; Laurant, M.G.H. ; Vught, A.J.A.H. van
2020, Article / Letter to editor (De Eerstelijns, (2020))
Verpleegkundig specialist als regiebehandelaar ook buiten de ggz
Vught, A.J.A.H. van ; Kennis, E. ; Werf, M. van der ; Boeijen, E.R.K. ; Laurant, M.G.H.
2020, Article / Letter to editor (Dé Verpleegkundig Specialist, iss. jaargang 15, nr 1 maart 2020, (2020), pp. 36-39)
Verleiden tot het ondernemen van plezierige activiteiten
Bemmel, M.E.C. van ; Kemper, W. ; Adriaansen, M.J.M.
2020, Article / Letter to editor (Tijdschrift voor Gerontologie en Geriatrie, vol. 4, iss. 1, (2020), pp. 1-4)
Van baan naar baanmobiliteit bij laagopgeleide 45-plussers
Sanders, J.M.A.F. ; Wijk, E. van ; Boneschansker, O. ; Ybema, J.F.
2012, Article / Letter to editor (Tijdschrift voor Arbeidsvraagstukken, vol. 28, iss. 4, (2012), pp. 474-490)
Uit de hoek komen; samenwerkingsformules in een netwerk
Kemper, W. ; Zeist, M. van
2019, Book (monograph)
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))
Therapie: placebo und nocebo
Rutten, G.M.J.
2019, Article / Letter to editor (Physiopraxis, iss. 11-12, (2019), pp. 26-29)
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.
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.
The impact and organization of skill mix change in healthcare for older people
Lovink, M.H.
2019, Dissertation
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))
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))
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.
Taakverschuiving en toenemende verantwoordelijkheid
Vught, A.J.A.H. van ; Kemper, W.
2018, Part of book or chapter of book (Gezondheid Organiseren. Leerboek voor verpleegkundigen)
Taakherschikking op de huisartsenpost: een kwalitatief onderzoek
Klaasen, B. ; Aalderink-Nobel, M. ; Niet-van Middendorp, W. van der ; Vught, A.J.A.H. van
2018, Article / Letter to editor (Dé Verpleegkundig Specialist, vol. 2018, iss. 4, (2018), pp. 38-41)
Taakherschikking kan veilig en leidt tot betere zorg
Laurant, M.G.H.
2017, Article / Letter to editor (Nederlands Tijdschrift voor Evidence Based Practice, (2017), pp. 25-27)
Taakherschikking in verpleeghuizen: kansen, belemmeringen en effecten
Vught, A.J.A.H. van ; Lovink, M.H. ; Laurant, M.G.H.
2018, Article / Letter to editor (Dé Verpleegkundig Specialist, vol. 2018, iss. 1, (2018), pp. 30-33)
Taakherschikking in de ouderenzorg
Lovink, M.H. ; Persoon, A. ; Laurant, M.G.H.
2015, Article / Letter to editor (Dé Verpleegkundig Specialist, iss. 9, (2015))
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.
Substitution of general practitioners by nurse practitioners in out-of-hours primary care home visits: A quasi-experimental study
Smits, M. ; Peters, Y ; Ranke, S ; Plat, E ; Laurant, M.G.H. ; Giesen, P
2020, Article / Letter to editor (International Journal of Nursing Studies, vol. 104, (2020))Background: General practitioners experience a high workload during out-of-hours care. A possible solution is the shifting of care to nurse practitioners. Objectives: To provide insight into patient- and care characteristics, safety, efficiency, and patient satisfaction of substituting general practitioners with nurse practitioners for home visits by out-of-hours primary care services. Design: Quasi-experimental non-randomised study comparing home visits by nurse practitioners (intervention group; one out-of-hours care service) with home visits by general practitioners (control group; two out-of-hours care services) for 24 protocolised health problems. Setting: Three out-of-hours primary care services in the East of the Netherlands. Participants: 1601 patients who received a home visit by a nurse practitioner (N=386) or a general practitioner (N = 1215). Of these patients, 639 gave informed consent to be included in the protocol adherence assessment and follow-up record review (nurse practitioner: N=358; general practitioner: N=281). Methods: Five nurse practitioners with experience in ambulance care were recruited and trained. From September 2016 to March 2017 the nurse practitioners took over home visits under supervision of a general practitioners. This was evaluated using: (1) data-extraction from the patient registration system, (2) follow-up record review in the patients' general practices, and (3) patient satisfaction survey. Two general practitioners independently assessed protocol adherence based on the extracted registration data. Results: Nurse practitioners prescribed medication significantly less often than general practitioners (19.9% versus 30.6%), and referred patients significantly more often to the hospital (24.1% versus 15.9%). The mean length of the home visit was significantly longer for nurse practitioners (34.1 versus 21.1 min). Nurse practitioners adhered to the protocol significantly more often than general practitioners (84.9% versus 76.2%) and their medication prescribing was significantly more often appropriate (93.7% versus 79.5%). There were no differences in the number of missed diagnoses and complications. The number of follow-up contacts was also similar in both groups. Patient satisfaction was generally high and significantly higher for nurse practitioners on several items. Conclusions: Nurse practitioners with experience in ambulance care can safely, efficiently, and satisfactorily perform low complex out-of-hours primary care home visits. It is recommended to study the safety and efficiency of nurse practitioners' home visits in other regions and with nurse practitioners with different educational levels and different specialisations. In addition, we recommend to evaluate the cost-effectiveness and if it leads increased quality of care. (C) 2019 Elsevier Ltd. All rights reserved.
Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study.
Lovink, M.H. ; Vught, A.J.A.H. van ; Laurant, M.G.H. ; Schoonhoven, Lisette ; Koopmans, R.T.
2017, Article / Letter to editor (BMJ Open, (2017))
Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: a realist evaluation case study
Lovink, M.H. ; Laurant, M.G.H. ; Vught, A.J.A.H. van ; Maassen, I.T.H.M ; Schoonhoven, Lisette ; Persoon, A. ; Koopmans, R.T.C.M.
2019, Article / Letter to editor (BMJ Open, vol. 9, iss. 5, (2019))
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.
Sterk Wijknetwerk; verkennen, vormgeven, verdiepen, verankeren
Laurant, M.G.H. ; Derckx, E.
2020, Article / Letter to editor (De Eerstelijns, iss. 5, (2020), pp. 36-37)
Solo emergency care by a physician assistant versus an ambulance nurse: a cross-sectional document study
Bloemhoff, A. ; Schoonhoven, Lisette ; Kreek, A.J.L. de ; van Grunsven, PM ; Laurant, M.G.H. ; Berben, S.A.A.
2016, Article / Letter to editor (Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 24, (2016))Background: This study compares the assessment, treatment, referral, and follow up contact with the dispatch centre of emergency patients treated by two types of solo emergency care providers in ambulance emergency medical services (EMS) in the Netherlands: the physician assistant (PA), educated in the medical domain, and the ambulance registered nurse (RN), educated in the nursing domain. The hypothesis of this study was that there is no difference in outcome of care between the patients of PAs and RNs. Methods: In a cross-sectional document study in two EMS regions we included 991 patients, treated by two PAs (n = 493) and 23 RNs (n = 498). The inclusion period was October 2010-December 2012 for region 1 and January 2013-March 2014 for region 2. Emergency care data were drawn from predefined and free text fields in the electronic patient records. Data were analysed using descriptive statistics. We used chi(2) and Mann-Whitney U tests to analyse for differences in outcome of care. Statistical significance was assumed at a level of P < 0.05. Results: Patients treated by PAs and RNs were similar with respect to patient characteristics. In general, diagnostic measurements according to the national EMS standard were applied by RNs and by PAs. In line with the medical education, PAs used a medical diagnostic approach (16 %, n = 77) and a systematic physical exam of organ tract systems (31 %, n = 155). PAs and RNs provided similar interventions. Additionally, PAs consulted more often other medical specialists (33 %) than RNs (17 %) (chi(2) = 35.5, P < 0.0001). PAs referred less patients to the general practitioner or emergency department (50 %) compared to RNs (73 %) (chi(2) = 52.9, P < 0.0001). Patient follow up contact with the dispatch centre within 72 h after completion of the emergency care on scene showed no variation between PAs (5 %) and RNs (4 %). Conclusions: In line with their medical education, PAs seemed to operate from a more general medical perspective. They used a medical diagnostic approach, consulted more medical specialists, and referred significantly less patients to other health care professionals compared to RNs. While the patients of the PAs did not contact the dispatch centre more often afterwards.
Skills of Physician Assistants and residents tested with simulated Intensive Care Patients
Oers, J.A.H. van ; Hilkens, M. ; Brink, G.T.W.J. van den ; Vught, A.J.A.H. van
2018, Article / Letter to editor (Netherlands Journal of Critical Care, (2018))
Skill mix, roles and remuneration in the primary care workforce: Who are the healthcare professionals in the primary care teams across the world?
Freund, T ; Everett, C ; Griffiths, P ; Hudon, C ; Naccarella, L ; Laurant, M.G.H.
2015, Article / Letter to editor (International Journal of Nursing Studies, vol. 52, iss. 3, (2015), pp. 727-743)World-wide, shortages of primary care physicians and an increased demand for services have provided the impetus for delivering team-based primary care. The diversity of the primary care workforce is increasing to include a wider range of health professionals such as nurse practitioners, registered nurses and other clinical staff members. Although this development is observed internationally, skill mix in the primary care team and the speed of progress to deliver team-based care differs across countries. This work aims to provide an overview of education, tasks and remuneration of nurses and other primary care team members in six OECD countries. Based on a framework of team organization across the care continuum, six national experts compare skill-mix, education and training, tasks and remuneration of health professionals within primary care teams in the United States, Canada, Australia, England, Germany and the Netherlands. Nurses are the main non-physician health professional working along with doctors in most countries although types and roles in primary care vary considerably between countries. However, the number of allied health professionals and support workers, such as medical assistants, working in primary care is increasing. Shifting from 'task delegation' to 'team care' is a global trend but limited by traditional role concepts, legal frameworks and reimbursement schemes. In general, remuneration follows the complexity of medical tasks taken over by each profession. Clear definitions of each team-member's role may facilitate optimally shared responsibility for patient care within primary care teams. Skill mix changes in primary care may help to maintain access to primary care and quality of care delivery. Learning from experiences in other countries may inspire policy makers and researchers to work on efficient and effective teams care models worldwide. (C) 2014 The Authors. Published by Elsevier Ltd.
Skill mix change between physicians, nurse practitioners, physician assistants, and nurses in nursing homes: A qualitative study
Lovink, M.H. ; Vught, A.J.A.H. van ; Persoon, A. ; Koopmans, R.T.C.M. ; Laurant, M.G.H. ; Schoonhoven, Lisette
2019, Article / Letter to editor (Nursing & Health Sciences, vol. 2019, iss. september, (2019), pp. 282-290)
Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study
Lovink, M.H. ; Vucht, A.J.A.H. van ; Persoon, A. ; Schoonhoven, Lisette ; Koopmans, R.T.C.M. ; Laurant, M.G.H.
2018, Article / Letter to editor (BMC Family Practice, vol. 19, iss. 1, (2018))
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.
SCIENTIFIC CHALLENGES OF EUROPEAN IMPLEMENTATION RESEARCH - EXPERIENCES FROM THE ODHIN FIVE COUNTRY STUDY ON IMPLEMENTING BRIEF INTERVENTIONS FOR HEAVY DRINKING IN PRIMARY HEALTH CARE
Anderson, P. ; Gual, A. ; Spak, F ; Bendtsen, P. ; Keurhorst, M. ; Segura, L. ; Colom, J ; Reynolds, J. ; Drummond, C ; Deluca, P. ; van Steenkiste, B ; Mierzecki, A. ; Kloda, K. ; Wallace, P ; Newbury-Birch, D. ; Kaner, E. ; Laurant, M.G.H. ; Wojnar, M. et al. sine al.
2013, Article / Letter to editor (Alcohol and Alcoholism, vol. 48, (2013), pp. 59)
Samenwerken met informele zorg
Kemper, W.
2019, Part of book or chapter of book (Effectief verplegen)
Samenwerken met burgers, hoe doe je dat? Sterk wijknetwerk
Laurant, M.G.H.
2020, Article / Letter to editor (De Eerstelijns, iss. mei 2020, (2020), pp. 40-41)
Samenwerken doe je zo
Laurant, M.G.H.
2020, Article / Letter to editor (Zorg en Welzijn, (2020))
Ruimte voor physician assistants en verpleegkundig specialisten in anderhalvelijnszorg
Vught, A.J.A.H. van ; Erp, R.M.A. van ; Laurant, M.G.H. ; Brink, G.
2019, Book (monograph)
Pulling out all the stops: what motivates 65+ year olds with depressive symptoms to participate in an outreaching preference-led intervention programme?
Beljouw, I.M.J. van ; Heerings, M ; Abma, TA ; Laurant, M.G.H. ; van't Veer-Tazelaar, PJ ; Baur, VE ; Stek, ML ; Marwijk, H.W.J. van ; Exel, E. van
2015, Article / Letter to editor (Aging & Mental Health, vol. 19, iss. 5, (2015), pp. 453-463)Objectives: Many older adults have significant depressive symptoms but few people access care for these. This study explores which personal, clinical and need factors facilitate or hinder acceptance of a new outreaching preference-led intervention programme. Methods: From a sample of 9661 community-dwelling 65+ year olds, 244 persons with depressive symptoms according to the Patient Health Questionnaire-9 were included. Data on programme effectiveness in terms of care utilisation were collected. Associations between programme acceptance and personal, clinical and need factors were studied using quantitative (logistic regression analyses) and qualitative methods (semi-structured interviews with 26 subjects, who accepted (n = 20) or declined (n = 6) the programme). Results: Fifty-six per cent (n = 137) took part in the interventions. Quantitative logistic regression analyses showed that participants were more often female, suffered from more severe depressive symptoms and perceived more loneliness. Qualitative analyses revealed that people accepting the intervention programme felt that medical terms as having a depressed mood were applicable to their situation, more often perceived their symptoms as hindering, felt lonely and more often perceived a need for care. They were more often advised by their general practitioner to participate than individuals who refused the interventions. Many participating individuals did not see a match between the intervention programme and their needs, especially with respect to meeting new people. Conclusion: Many older persons with depressive symptoms did not feel the need to take part in the programme. Providing support in alleviating loneliness and further adaptation to older adults' illness representations and perceptions when discussing depressive symptoms might enhance care utilisation.
Profielen Physician Assistant en Verpleegkundig Specialist in de praktijk. Convergeren of divergeren?
Vught, A.J.A.H. van ; Laurant, M.G.H.
2018, Book (monograph)
Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN Study
Bendtsen, P. ; Anderson, P. ; Wojnar, M. ; Newbury-Birch, D. ; Mussener, U ; Colom, J ; Karlsson, N ; Brzozka, K ; Spak, F ; Deluca, P. ; Drummond, C ; Kaner, E. ; Kloda, K. ; Mierzecki, A. ; Okulicz-Kozaryn, K ; Parkinson, K. ; Reynolds, J. ; Ronda, G ; Segura, L. ; Palacio, J ; Baena, B ; Slodownik, L ; van Steenkiste, B ; Wolstenholme, A ; Wallace, P ; Keurhorst, M. ; Laurant, M.G.H. ; Gual, A. et al. sine al.
2015, Article / Letter to editor (Alcohol and Alcoholism, vol. 50, iss. 4, (2015), pp. 430-437)To determine the relation between existing levels of alcohol screening and brief intervention rates in five European jurisdictions and role security and therapeutic commitment by the participating primary healthcare professionals. Health care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psychologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities as part of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment. The only significant but small relationship was found between role security and screening rate in a multilevel logistic regression analysis adjusted for occupation of the provider, number of eligible patients and the random effects of jurisdictions and primary health care units (PHCU). No significant relationship was found between role security and brief intervention rate nor between therapeutic commitment and screening rate/brief intervention rate. The proportion of patients screened varied across jurisdictions between 2 and 10%. The findings show that the studied factors (role security and therapeutic commitment) are not of great importance for alcohol screening and BI rates. Given the fact that screening and brief intervention implementation rate has not changed much in the last decade in spite of increased policy emphasis, training initiatives and more research being published, this raises a question about what else is needed to enhance implementation.
Physician substitution by NPs, PAs and/or nurses in healthcare for older people
Lovink, M.H. ; Persoon, A. ; Koopmans, R.T.C.M. ; Schoonhoven, Lisette ; Vught, A.J.A.H. van ; Laurant, M.G.H.
2016, Article / Letter to editor (Journal of Advanced Nursing, vol. 72, (2016), pp. 96)
Physician substitution by mid-level providers in primary healthcare for older people and long-term care facilities: protocol for a systematic literature review
Lovink, M.H. ; Persoon, A. ; Vught, A.J.A.H. van ; Koopmans, R.T.C.M. ; Schoonhoven, Lisette ; Laurant, M.G.H.
2015, Article / Letter to editor (Journal of Advanced Nursing, vol. 71, iss. 12, (2015), pp. 2998-3005)Aim. This protocol describes a systematic review that evaluates the effects of physician substitution by mid-level providers (nurse practitioners, physician assistants or nurses) in primary healthcare for older people and long-term care facilities. The secondary aim is to describe facilitators and barriers to the implementation of physician substitution in these settings. Background. Healthcare for older people is undergoing major changes, due to population ageing and reforms that shift care to the community. Besides, relatively few medical students are pursuing careers in healthcare for older people. Innovative solutions are needed to guarantee the quality of healthcare and to contain costs. A solution might be shifting care from physicians to mid-level providers. To date, no systematic review on this topic exits to guide policymaking. Design. A quantitative systematic literature review using Cochrane methods. Methods. The following databases will be searched for original research studies that quantitatively compare care provided by a physician to the same care provided by a mid-level provider: PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL and Web of Science. Study selection, data extraction and quality appraisal will be conducted independently by two reviewers. Data synthesis will consist of a qualitative analysis of the data. Funding of the review was confirmed in August 2013 by the Ministry of Health, Welfare and Sport of the Netherlands. Discussion. This review will contribute to the knowledge on effects of physician substitution in healthcare for older people and factors that influence the outcomes. This knowledge will guide professionals and policy administrators in their decisions to optimize healthcare for older people.
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.
Physician Assistants en Verpleegkundig Specialisten; we kunnen niet meer zonder
Brink, G.T.W.J. van den ; Laurant, M.G.H. ; Vught, A.J.A.H. van
2020, Article / Letter to editor (TVZ : verpleegkunde in praktijk en wetenschap, (2020))
Physician assistants and nurse practitioners in primary care plus: a systematic review
Erp, R.M.A. van ; Doorn, A.L. van ; Brink, G.T.W.J. van den ; Peters, J. ; Laurant, M.G.H. ; Vught, A.J.A.H. van
2021, Article / Letter to editor (International Journal of Integrated Care (Ijic), vol. 21, iss. 1, (2021))
Physician Assistants (PA) en Verpleegkundig Specialisten (VS) in verpleeghuizen
Vught, A.J.A.H. van ; Lovink, M.H. ; Koopmans, R.T.C.M. ; Persoon, A. ; Laurant, M.G.H.
2019, Article / Letter to editor (Tijdschrift voor Ouderengeneeskunde, vol. 2019, iss. 3, (2019))
Physician assistant voor de somatische zorg binnen de ggz
Vught, A.J.A.H. van ; Heijden, F.M.M.A van der
2019, Article / Letter to editor (Tijdschrift voor Psychiatrie, vol. 61, iss. februari 2019, (2019), pp. 81-83)https://www.napa.nl/2019/02/opinieartikel-in-de-psychiater-over-pa-binnen-ggz/

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