Browsing Han Publications by Author "Smits, M."

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.

Could Virtual Reality play a role in the rehabilitation after COVID-19 infection?

Smits, M. ; Staal, J.B. ; Goor, H. van

2020, Article / Letter to editor (BMJ Open Sport & Exercise Medicine, vol. 6, iss. 1, (2020), pp. e000943)Post-COVID-19 patients, particularly those who needed high care, are expected to have high needs for physical, psychological and cognitive rehabilitation. Yet, the resources needed to provide rehabilitation treatment are expected to be inadequate because healthcare systems faced a shortage of high-quality treatment of these symptoms already before the COVID-19 crisis emerged in patients with comparable needs. In this viewpoint, we discuss the potential of Virtual Reality (VR) administering fast, tailor-made rehabilitation at a distance, and offering a solution for the impending surge of demand for rehabilitation after COVID-19. VR consists of a head-mounted display (HMD) that can bring the user by computer-generated visuals into an immersive, realistic multi-sensory environment. Several studies on VR show its potential for rehabilitation and suggest VR to be beneficial in post-COVID-19. The immersion of VR may increase therapy adherence and may distract the patient from experienced fatigue and anxiety. Barriers still have to be overcome to easily implement VR in healthcare. We argue that embedding VR in virtual care platforms would assist in overcoming these barriers and would stimulate the spread of VR therapy, both for post-COVID-19 patients in the present and possibly for other patients with similar rehabilitation needs in the future.

EBP in het verpleeghuis: het EVIDENCE-project

Lovink, M.H. ; Huisman - de Waal, G. ; Smits, M. ; Vught, A.J.A.H. van

2019, Article / Letter to editor (TVZ : verpleegkunde in praktijk en wetenschap, vol. 2019, iss. 04, (2019), pp. 45-47)

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