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ABSTRACT: To develop and pilot test a generic questionnaire to measure continuity of care from the patient's perspective across primary and secondary care settings.
We developed the Nijmegen Continuity Questionnaire (NCQ) based on a systematic literature review and analysis of 30 patient interviews. The questionnaire consisted of 16 items about the patient-provider relationship to be answered for five different care providers and 14 items each on the collaboration between four groups of care providers. The questionnaire was distributed among patients with a chronic disease recruited from general practice. We used principal component analysis (PCA) to identify subscales. We refined the factors by excluding several items, for example, items with a high missing rate.
In total, 288 patients filled out the questionnaire (response rate, 72%). PCA yielded three subscales: "personal continuity: care provider knows me," "personal continuity: care provider shows commitment," and "team/cross-boundary continuity." Internal consistency of the subscales ranged from 0.82 to 0.89. Interscale correlations varied between 0.42 and 0.61.
The NCQ shows to be a comprehensive, reliable, and valid instrument. Further testing of reliability, construct validity, and responsiveness is needed before the NCQ can be more widely implemented.
Journal of clinical epidemiology 06/2011; 64(12):1391-9. · 2.96 Impact Factor
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ABSTRACT: Objectives: To study the effects of outreach visits by trained nurses on cardiovascular risk-factor recording. This strategy was compared with a strategy composed of more commonly used methods to improve the quality of care in general practice such as written feedback. Methods: A controlled trial was conducted, in which 33 practices were visited by a trained nurse, 31 practices received written feedback and 31 other practices served as controls. To assess the level of risk-factor recording a chart audit was carried out before and after 18 months of intervention. A sample of medical records of patients aged 30 to 60 was evaluated looking for risk-factor entries: their presence, their combined presence, and their signal function to indicate a risk patient. Risk factors considered were: blood pressure, individual (medical) history as well as family history of cardiovascular diseases, smoking status, serum cholesterol, body weight and alcohol intake. Results: In practices visited by a trained nurse, a significant increase in the recording of most risk factors was found for the presence, the combined presence as well as the signal function. The increase in the presence of entries was consistent in all risk factors and independent of the baseline level. Changes in the group receiving written feedback were inconsistent and statistically not significant. Conclusions: Outreach visits by trained nurses is an effective tool to increase cardiovascular risk-factor recording in general practice.
07/2009; 3(3):90-95.
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ABSTRACT: Background. To explore unfavorable effects, health perception was assessed in patients enrolled in a cardiovascular program in general practice. Methods. A prospective questionnaire survey was conducted shortly after risk detection and after 1 year of intervention. Patients (n=413) with an elevated risk were selected from 27 practices in The Netherlands. The outcome measure was patients' perceptions of their general health status. Results. The response rate was 62%. Two thirds of the patients did not show any change in general health status at either point in time. Substantially more patients showed improvement after 1 year of intervention. Compared to reference data, no major differences were found. Conclusion. Enrollment in a cardiovascular risk detection and intervention program did not lead to unfavorable perceptions of general health status, either shortly after risk detection or after 1 year of intervention.
Preventive Cardiology 06/2007; 4(1):23 - 27.
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ABSTRACT: To determine to what extent participants in randomized controlled hypertension trials (RCTs) could be compared to patients with hypertension in general practices.
We analyzed RCTs that had been used in hypertension guidelines or were available for future hypertension guidelines. The characteristics of the participants of these RCTs were compared with those of the patients with hypertension in general practices. In addition, inclusion and exclusion criteria of the RCTs were applied to the hypertension patients in the general practices.
Twenty-one trials were analyzed. Participants' characteristics often differed from those of the patients with hypertension in general practices, in particular in the older trials where the participants showed lower cardiovascular risk. More recent trials showed participants' profiles that better reflected those of the patients under treatment in a general practice. Less than half of the patients undergoing treatment in a general practice would have been included in the hypertension trials.
Participants taking part in trials differed from patients with hypertension in a general practice in a number of important aspects. This hampers their external validity. Inclusion of participants with comorbidity and other general practice characteristics would improve translation of study findings to daily practice recommendations.
Journal of Clinical Epidemiology 05/2007; 60(4):330-5. · 4.27 Impact Factor
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ABSTRACT: A pilot study aimed to determine the extent to which each of three data sources could provide complete and reliable data for valid assessment of clinical performance.
Clinical decisions taken in 168 consultations by seven family physicians were reviewed against guidelines for 15 clinical conditions. In total, 206 criteria were reviewed using three sources: medical records, observation in surgery, and structured self-recording by the physicians.
Seven family practices in the Netherlands.
Scores (%) of data recorded/total were obtained for each method. Kappa scores for the agreement between the three data sources were also obtained.
Medical record examination provided 40%, observation 72%, and physician self-recording 95% of the data required for the review against guidelines. Nine per cent of the clinical decisions could be reviewed when using medical records, 46% when using observation data, and 69% when using data from prospective self-recording. In particular, decisions in the area of patient education and diagnostic examinations could not be reviewed validly using medical records only. Kappa agreements between the data available from the three sources as well as between the review results appeared to be 0.79.
Medical records alone only supply sufficient information for the review of a very limited set of clinical decisions. Physician self-recording has significantly more potential for valid review of a broad range of clinical decisions. Furthermore, self-recording seems a reliable data collection method that deserves further research.
International Journal for Quality in Health Care 03/2004; 16(1):65-72. · 1.96 Impact Factor
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ABSTRACT: The use of clinical guidelines in general practice is often limited. Research on barriers to guideline adherence usually focuses on attitudinal factors. Factors linked to the guideline itself are much less studied.
To identify characteristics of effective clinical guidelines for general practice, and to explore whether these differ between therapeutic and diagnostic recommendations.
Analysis of performance data from an audit study of 200 general practitioners (GPs) in The Netherlands conducted in 1997.
Panel of 12 GPs in The Netherlands who were familiar with guideline methodology.
A set of 12 attributes, including six potential facilitators and six potential barriers to guideline use, was formulated. The panel assessed the presence of these attributes in 96 guideline recommendations formulated by the Dutch College of General Practitioners. The attributes of recommendations with high compliance rates (70% to 100%) were compared with those with low compliance rates (0% to 60%).
Recommendations with high compliance rates were to a lesser extent those requiring new skills (7% compared with 22% in recommendations with low compliance rates), were less often part of a complex decision tree (12% versus 25%), were more compatible with existing norms and values in practice (87% versus 76%), and more often supported with evidence (47% versus 31%). For diagnostic recommendations, the ease of applying them and the potential (negative) reactions of patients were more relevant than for therapeutic recommendations.
To bridge the gap between research and practice, the evidence as well as the applicability should be considered when formulating recommendations. If the recommendations are not compatible with existing norms and values, not easy to follow or require new knowledge and skills, appropriate implementation strategies should be designed to ensure change in daily practice.
British Journal of General Practice 02/2003; 53(486):15-9. · 1.83 Impact Factor
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ABSTRACT: Objective. To assess patients» views on the organization of (cardiovascular) preventive care. Design. Prospective questionnaire survey with measurements shortly after risk assessment (T<SUB>1</SUB>) and after 1 year of risk intervention (T<SUB>2</SUB>). Setting. Twenty-seven general practices participating in a project to enhance systematic cardiovascular disease prevention in two regions in The Netherlands. Study participants. Two-hundred and ninety-eight successive patients aged 3060 years identified with an elevated cardiovascular risk. Main outcome measures. Organizational aspects such as the acceptability of the care provider, practicality of special clinics, accessibility of the practice for routine care. Results. Most of the respondents (74%) had no preference for a care provider in cardiovascular preventive care and only a few patients (3%) reported having little confidence in the expertise of the practice assistant to provide such care. The vast majority (88%) considered special preventive clinics to be practical, especially at T<SUB> </SUB>. Most of the respondents (76%) did not report a decline in the accessibility of their practice for routine care. These outcome measures were not affected by age, sex, educational level or the number of risk factors measured during 1 year of risk intervention. Conclusion. Most patients did not have any major objections against the organization of preventive care through opportunistic case finding and risk monitoring in special preventive clinics managed by the practice assistant.
