[Limited change in the quality of the social medical guidance and in the satisfaction of sick-listed patients, after collaborative projects between general practitioners and occupational physicians].
ABSTRACT To evaluate whether regional projects for collaboration between general practitioners (GPs) and occupational physicians (OPs) improved the quality of their social medical guidance (SMG) and the satisfaction of their patients.
Evaluation study with before and after measurements with respect to the same GPs and OPs.
Structured interviews were conducted with 58 GPs and 83 OPs regarding the SMG of their sick-listed patients. Before the project, the SMG of 1109 sick-listed patients was assessed and after the project, 1 or 1.5 years later, the SMG of 1121 sick-listed patients. These patients were sent a questionnaire by means of which their satisfaction could be assessed.
After the projects, the quality ofthe diagnosis by the OPs was improved and they also more often adhered to the official guidelines of the KNMG (Royal Netherlands Medical Association) when contacting the GP about a patient. The GPs more often contacted the OP if they needed more information about a patient after reaching a diagnosis. Nevertheless, in half to three-quarters of the patients for whom contact between GPs and OPs was indicated, this contact did not take place. There was no significant increase in patient satisfaction. Before the projects, patients gave their GP a grade of 8.2 on a 10-point scale and after the projects this was 8.5; the OPs were given a grade of 7.5 both times. Further analysis showed that there was no significant relation between the quality ofthe SMG and the patient's satisfaction with the doctor.
Although there was some improvement in the quality of the SMG, there was still insufficient cooperation between GPs and OPs compared to the guidelines. An increase in patient satisfaction was not demonstrated.
- The European Journal of General Practice 02/2006; 12(3):138-41. DOI:10.1080/13814780600881201 · 0.81 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Research in different fields of medicine suggests that communication is important in physician-patient encounters and influences satisfaction with these encounters. It is argued that this also applies to the non-curative tasks that physicians perform, such as sickness certification and medical disability assessments. However, there is no conceptualised theoretical framework that can be used to describe intentions with regard to communication behaviour, communication behaviour itself, and satisfaction with communication behaviour in a medical disability assessment context. The objective of this paper is to describe the conceptualization of a model for the communication behaviour of physicians performing medical disability assessments in a social insurance context and of their claimants, in face-to-face encounters during medical disability assessment interviews and the preparation thereof. CONCEPTUALIzATION: The behavioural model, based on the Theory of Planned Behaviour (TPB), is conceptualised for the communication behaviour of social insurance physicians and claimants separately, but also combined during the assessment interview. Other important concepts in the model are the evaluation of communication behaviour (satisfaction), intentions, attitudes, skills, and barriers for communication. The conceptualization of the TPB-based behavioural model will help to provide insight into the communication behaviour of social insurance physicians and claimants during disability assessment interviews. After empirical testing of the relationships in the model, it can be used in other studies to obtain more insight into communication behaviour in non-curative medicine, and it could help social insurance physicians to adapt their communication behaviour to their task when performing disability assessments.BMC Public Health 10/2009; 9:375. DOI:10.1186/1471-2458-9-375 · 2.32 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: We wanted to measure adherence to the guideline for depression in disability assessments. The research questions we addressed were: How can we develop performance indicators (PIs) for adherence to the Dutch guideline for disability assessment of patients with depression and how can we measure the quality of the scores? What is the inter-rater reliability of these PIs? What is the quality of the PI scores? PIs, developed by the researchers, were reviewed on various aspects, by a panel of seven experts in several consulting rounds. After adjustments, senior insurance physicians (IPs) attended two training sessions and scored the PIs on 10 different simulated case reports. Two researchers developed proxy 'gold standard' scores for these 10 case reports. To assess the inter-rater reliability and the quality of the scores, we calculated the intra-class correlations (ICC) and 95% confidence intervals (CI) of the PI scores and of the PI scores compared to the proxy 'gold standard', respectively. Six specific and relevant PIs resulted from the consultation of the panel of experts. The PI scores for the 10 case reports, rated by seven (of the eight) senior IPs who completed both training sessions, showed that the PIs were not reliable at individual level (ICC = 0.543; 95% CI 0.426-0.642). However, the ICC became more reliable as an average of two raters was calculated (ICC = 0.704). The ICC of the PI scores with the proxy 'gold standard' was 0.538 (95% CI 0.419-0.640), but the quality was higher when calculated as an average of two raters (ICC = 0.700). The PIs for adherence to the guideline were sufficiently reliable, and the quality of their scores was adequate if at least two well-trained raters were involved. The senior IPs evaluated the feasibility of the PIs as good, with a prerequisite of sufficient training. This method may be interesting for measuring guideline adherence and quality of disability assessments in general.Disability and Rehabilitation 05/2011; 33(25-26):2535-43. DOI:10.3109/09638288.2011.579222 · 1.84 Impact Factor