Lidwien Lemmens

National Institute for Public Health and the Environment (RIVM) | RIVM · Centre for Prevention and Health Services Research (PZO)

Many initiatives integrating health and social care have been implemented in order to provide adequate care and support to older people living at home. Further development of existing initiatives requires iterative processes of developing, implementing and evaluating improvements to current practice. This case study provides insight into the proces...

Introduction: In several countries, initiatives to detect frailty among older citizens at an early stage are being implemented to enable proactive intervention and, consequently, to support independent living for as long as possible. Alignment and collaboration between the various actors are crucial. We aimed to provide insight in factors that imp...

Veel gemeenten bieden preventieve activiteiten voor ouderen aan. Maar hoe bereik je juist die groepen ouderen die het meeste baat hierbij hebben en die je met het reguliere aanbod nauwelijks bereikt? Wat zijn redenen dat deze groepen onvoldoende bereikt worden en wat zijn volgens professionals en ouderen elementen die zorgen dat deze groepen wel me...

Kwetsbare ouderen met polyfarmacie lopen een groter risico op vermijdbare medicatie-gerelateerde gezondheidsschade. Om medicatieveiligheid te verbeteren is door het zorgveld, in samenspraak met de IGZ, een aantal richtlijnen en veldnormen opgesteld met voorwaarden voor veilig voorschrijven. Volgens deze normen is het actief betrekken van patiënten...

Citizen science – the active participation of lay people in research – may yield crucial local knowledge and increase research capacity. Recently, there is growing interest to understand benefits for citizen scientists themselves. We studied the perceived impacts of participation in a public health citizen science project on citizen scientists in a...

Older people in the Netherlands are increasingly being stimulated to remain independent and live at home for as long as possible, with help from formal and informal caregivers. In-depth interviews were conducted with 36 older people and provided insight into what older people need with regard to health, wellbeing and aging in place. Mobility appear...

Many initiatives are developed aiming to proactively identify health and social problems in (frail) older people. Early detection and proactive delivery of care and support could help older people to age in place and remain independent. Previous research shows that these initiatives do not always meet the needs and preferences of older people with...

Background: A wide range of initiatives on early detection and intervention have been developed to proactively identify problems related to health and wellbeing in (frail) older people, with the aim of supporting them to live independently for as long as possible. Nevertheless, it remains unclear what the best way is to design such initiatives and...

Objective: To map initiatives in the Netherlands using a population-targeted approach to link prevention, care and welfare. Design: Descriptive investigation, based on conversations and structured interviews. Method: We searched for initiatives in which providers in the areas of prevention, care and welfare together with health insurers and/or...

Background More focus on patient-centeredness in care for patients with type 2 diabetes requests increasing attention to diabetes quality management processes on patient-centeredness by managers in primary care groups and outpatient clinics. Although patient-centered care is ultimately determined by the quality of interactions between patients and...

Background/aims: This study examines the feasibility of a preoperative exercise program to improve the physical fitness of a patient before gastrointestinal surgery. Methods: An outpatient exercise program was developed to increase preoperative aerobic capacity, peripheral muscle endurance and respiratory muscle function in patients with pancrea...

Objective: To describe comprehensive care programs targeting multimorbid and/or frail patients and to estimate their effectiveness regarding improvement of patient and caregiver related outcomes, healthcare utilization and costs. Methods: Systematic search in six electronic databases for scientific papers published between January 2011 and March...

Samenvatting Campmans-Kuijpers MJ, Baan CA, Lemmens LC, Klomp ML, Romeijnders AC, Rutten GE. Het diabeteskwaliteitsbeleid in zorggroepen. Huisarts Wet 2016;59(1):10-13. Achtergrond Om de ketenzorg voor diabetespatiënten te verbeteren, zijn in 2007 zorggroepen geïntroduceerd – er zijn er momenteel ongeveer honderd. Na 2007 is de kwaliteit van de dia...

In The Netherlands, standard diabetes care is provided either in diabetes care groups or outpatient clinics using a diabetes care program. The organisation of both care groups and outpatient clinics varies and is still under development. Quality of care indicators have been addressed enormously during the last years.

Introduction: Despite the expected beneficial effects on quality of care, patient involvement in diabetes care groups, which deliver a bundled paid integrated care programme for diabetes type 2, seems to be limited. The aim of this study was to gain insight into levels and methods of patient involvement, into facilitators and barriers, and into th...

Objective: Presently, little is known about the characteristics and impact of integrated care programs for patients with psychological comorbidity. The aim was to provide an overview of these integrated care programs and their effectiveness. Methods: Systematic literature review including papers published between 1995 and 2014. An integrated car...

Problems related to medication use by frail elderly patients Many frail elderly patients take five or more different medicines on a daily basis (polypharmacy) and make frequent hospital visits. Hospital admissions and discharges can lead to medication-related problems, ranging from unsuitable medication to harmful interactions and undertreatment o...

Farmacotherapeutische zorg voor ouderen en mensen met een psychiatrische aandoening is complex en risicovol, omdat deze groepen vaak te maken hebben met polyfarmacie, dat wil zeggen het chronisch gebruik van vijf of meer verschillende geneesmiddelen. Polyfarmacie is een risicofactor voor geneesmiddelgerelateerde ziekenhuisopnames. Voor de IGZ zijn...

To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management migh...

To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. This before-and-after study with a 1-year follow-up surveyed quality managers on six domains of quality management. Questionnaires measured organization of care, multidisciplinary teamwork, patient centered...

Background In recent years, most Dutch general practitioners started working under the umbrella of diabetes care groups, responsible for the organisation and coordination of diabetes care. The quality management of these new organisations receives growing interest, although its association with quality of diabetes care is yet unclear. The best way...

Patient participation in organisational decision-making in care groups In 2010, the Ministry of Health, Welfare and Sport introduced a new funding system for the care for people with a chronic disease such as diabetes. The purpose of this so-called bundled payment scheme is to improve the quality of care and to facilitate cooperation between healt...

Improving medication safety for the elderly; some bottlenecks Many people aged 65 years and over take five or more different medicines (polypharmacy) on a daily basis. Especially in the frail elderly, polypharmacy may entail risks such as avoidable hospitalizations. There are several guidelines and protocols that aim to improve the safe use of medi...

Background Worldwide, the organisation of diabetes care is changing. As a result general practices and diabetes teams in hospitals are becoming part of new organisations in which multidisciplinary care programs are implemented. In the Netherlands, 97 diabetes care groups and 104 outpatient clinics are working with a diabetes care program. Both type...

Systematic evaluation of the effectiveness of innovative care concepts for diabetes, taking into account heterogeneity of study results. Systematic review, meta-analysis and meta-regression analysis. Medline, CINAHL and PsycINFO were searched for reviews and empirical studies into adult patients with diabetes in whom interventions were used that co...

Since 2007 it is possible to purchase chronic diabetes care by bundled payments. The effects of this payment reform on the health care delivery process and quality of care are described in this report. Several changes in the health care delivery process were observed. For instance, many tasks of GPs were delegated to practice nurses. Eye examinatio...

Rationale, aims and objectives: Self-management support (SMS) is a crucial element in the treatment of diabetes and a key component of person-centered care. Widely introduced disease management programs are assumed to improve SMS. Hence, new organizations, such as care groups and accountable care organizations, are introduced to implement disease m...

Background Multimorbidity is increasingly recognized as a major public health challenge of modern societies. However, knowledge about the size of the population suffering from multimorbidity and the type of multimorbidity is scarce. The objective of this study was to present an overview of the prevalence of multimorbidity and comorbidity of chronic...

To provide insight into the characteristics of comprehensive care programs for patients with multiple chronic conditions and their impact on patients, informal caregivers, and professional caregivers. Systematic literature search in multiple electronic databases for English language papers published between January 1995 and January 2011, supplement...

Achtergrond: De zorgstandaard diabetes type 2 van de Nederlandse Diabetes Federatie (NDF) beschrijft de zorginhoudelijke en organisatorische eisen aan diabeteszorg. Hij is functioneel omschreven, waardoor taakherschikking mogelijk wordt. De zorgstandaard diende eerst alleen als basis voor het vormgeven van het zorgprogramma, maar met de komst van i...

Bundled payments of diabetes care: effects on care delivery process and quality of care at three-year follow-up. Since 2007 it has been possible to purchase chronic diabetes care by bundled payments. The effects of this payment reform on the health care delivery process and quality of care are described in this report. Several changes in the health...

To support decision making on how to best redesign chronic care by studying the heterogeneity in effectiveness across chronic care management evaluations for heart failure. Reviews and primary studies that evaluated chronic care management interventions. A systematic review including meta-regression analyses to investigate three potential sources o...

Purpose The study aims to support decision making on how best to redesign diabetes care by investigating three potential sources of heterogeneity in effectiveness across trials of diabetes care management. Methods Medline, CINAHL and PsycInfo were searched for systematic reviews and empirical studies focusing on: (1) diabetes mellitus; (2) adult pa...

Rationale, aims and objectives Clinical diversity and methodological heterogeneity exists between studies on chronic care management. This study aimed to examine the effectiveness of chronic care management in chronic obstructive pulmonary disease (COPD) while taking heterogeneity into account, enabling the understanding of and the decision making...

Evaluating the impact of disease management programs on healthcare expenditures for patients with diabetes, depression, heart failure or COPD. Systematic Pubmed search for studies reporting the impact of disease management programs on healthcare expenditures. Included were studies that contained two or more components of Wagner's chronic care model...

To present an overview of the prevalence of multimorbidity and comorbidity of chronic diseases in the Dutch population. Data analysis. Data from the Netherlands Information Network of General Practice (LINH), a large representative network of general practices over a period of 7 years (2002-2008) were analysed. Multimorbidity was defined as a patie...

Oncology surgery of the gastrointestinal tract is complex and infamous for its high complication rates. One of the methods for implementing interventions to optimize the patients' condition and to enhance postoperative outcome is the development and implementation of a clinical pathway. The aim of this study was to analyze the content, i.e. the int...

The contents and organization of the preoperative care have gained increasing attention over the past decade. Several strategies have emerged to evaluate and optimize patients before surgery, aiming to minimize the risk of complications. In this thesis two different strategies for preoperative evaluation and optimization were studied: outpatient pr...

A systematic review on clinical pathways for gastrointestinal surgery was performed. The aim was to study indicators that are used to evaluate these clinical pathways and to study which effects of clinical pathways are reported. A search was performed for the period from January 2000 to November 2006 in MEDLINE, EMBASE and CINAHL. The Leuven Clinic...

Several studies have shown that outpatient preoperative evaluation by anaesthetists increases quality of care and is cost-effective. The aim of this study was to gain insight into the factors that positively or negatively influence the implementation of outpatient preoperative evaluation clinics (OPE clinics). After an extensive literature study an...

Preoperative evaluation performed by anaesthesiologists primarily aims to estimate the risk of perioperative complications and to create opportunities to optimize the patients' condition before surgery. In this study an inventory was made of the current practice of preoperative evaluation in Dutch hospitals. It was estimated how many hospitals had...

Despite the (qualitatively and quantitatively) proven cost-effectiveness of timely outpatient preoperative evaluation (OPE), leading to improved preoperative care, many Dutch hospitals have not (yet) implemented an OPE clinic. Hence, a large study among all Dutch hospitals has recently been started to determine which factors facilitate or limit the...

De cardioloog en de hartfalenverpleegkundige kunnen gezien worden als de centrale zorgverleners. In de thuissituatie spelen de huisarts en de thuiszorg een belangrijke rol. Er zijn recent twee landelijke afstemmingsafspraken gepubliceerd: de Multidisciplinaire richtlijn Chronisch Hartfalen en het Protocol Multidisciplinaire Voorlichting Hartfalen....

Doelstelling: Door de vergrijzing van de populatie en verbeterde overleving zal het aantal mensen met chronische aandoeningen toenemen, en daarmee ook het aantal mensen met multimorbiditeit. Multimorbiditeit verwijst naar het tegelijkertijd voorkomen voorkomen van ziekten en de term comorbiditeit naar het voorkomen van extra ziekten bij een specifi...

Chronisch zieken hebben steeds vaker contact met praktijkondersteuners in de huisartsenpraktijk (POH) of gespecialiseerd verpleegkundigen. Tien jaar geleden werd de chronische zorg nog vrijwel uitsluitend door huisartsen en medisch specialisten verleend, tegenwoordig komen veel chronisch zieken voor controle bij een verpleegkundige. Multidiscipli...