Biomedical subjects

A J Schrijvers

Publications and source records attributed to A J Schrijvers.

At least 19 recordsLinked to original sources

PubMed2001

Integration of care in The Netherlands: the development of transmural care since 1994.

BACKGROUND: integration of primary and hospital services has been the subject of health policy in The Netherlands in the 1990s. A bottom-up facilitating approach was chosen to stimulate development of 'transmural care' between traditionally separate sectors. Transmural care has been defined as, care, attuned to the needs of the patient, provided on the basis of co-operation and co-ordination between general and specialised caregivers with shared overall responsibility and the specification of delegated responsibilities'. We conducted a national survey to determine the success of the bottom-up policy and the extent of the development of transmural care. METHODS: a written questionnaire was distributed among members of two national networks of transmural care executives and project coordinators, which are representative for hospitals and home care organisations in The Netherlands. A total of 271 facilities were included in the study representing 71% of hospitals and 63% of the home care organisations in The Netherlands. The questionnaire covered topics as; type of care provided, participants, population, goals and type of evaluation. RESULTS: all hospitals in The Netherlands provide one or more of the seven types of transmural care, however, there is a great variation in the number of facilities per organisation. Most facilities cater to one or more groups of chronically ill patients. Project coordinators experience difficulties finding adequate financing options for the facilities. Evidence on the effects of transmural care on quality and efficiency is lacking. CONCLUSION: the bottom-up approach towards the development of transmural care has been successful but needs to be followed by top-down measures to insure adequate evaluation and encourage wide-spread implementation.

Delivery of Health Care, Integrated↗

PubMed2001

Organisational design for an integrated oncological department.

OBJECTIVE: The outcomes of a Strength, Weakness, Opportunities and Threat (SWOT) analysis of three Integrated Oncological Departments were compared with their present situation three years later to define factors that can influence a successful implementation and development of an Integrated Oncological Department in- and outside (i.e. home care) the hospital. RESEARCH DESIGN: Comparative Qualitative Case Study. METHODS: Auditing based on care-as-usual norms by an external, experienced auditing committee. RESEARCH SETTING: Integrated Oncological Departments of three hospitals. RESULTS: Successful multidisciplinary care in an integrated, oncological department needs broad support inside the hospital and a well-defined organisational plan.

Journal Article↗

PubMed2000

Can shared care deliver better outcomes for patients undergoing total hip replacement? A prospective assessment of patient outcomes and associated service use.

OBJECTIVES: To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. DESIGN: Prospective, observational cohort study. SETTING: Two regions in The Netherlands where different organisational health care models have been implemented: a shared care setting (experimental group) and a care as usual setting (control group). PATIENTS: One hundred and fifteen patients undergoing total hip replacement: 56 in the experimental group and 59 in the control group. MAIN MEASURES: Functional health status according to the sickness impact profile, hip function, patient satisfaction and use of health care services. RESULTS: Two weeks before hip replacement both groups were comparable concerning patient characteristics, hip function and health status. The mean improvement of the total sickness impact profile score between two weeks before hip replacement and six months after was -1.92 in the shared care group, compared to -5.11 in care as usual group, a difference in favour of the control group (p=0.02). The mean length of hospital stay was comparable in both settings: 12.8 days in the shared care group and 13.2 days in the care as usual group. After hip replacement, compared to care as usual, patients in the shared care group received more homecare, with a higher frequency, and for a longer period of time. No differences in patient satisfaction between the two groups were found. CONCLUSIONS: Six months after hip replacement, the health status of patients in the care as usual group, using significantly less home care, was better than the status of patients in the shared care group. DISCUSSION: The utilisation of home care after hip replacement should be critically appraised in view of the need to stimulate patients' independence.

Journal Article↗

PubMed2000

Management of type 2 diabetes: a challenge for patient and physician.

Type 2 diabetes mellitus is a chronic disease, associated with serious complications and co-morbidity and considerable costs. The number of people with diabetes mellitus is expected to increase with 40% in the next decade, due to prolonged life expectancy, the ageing of the population and developments in the health care sector, including more active screening strategies. The majority (40-60%) of type 2 diabetes patients in routine GP practice have a poor metabolic control (HbA1c > 8% or fasting blood glucose > 11 mmol/l). In this paper the obstacles in routine clinical practice for optimal type 2 diabetes care are discussed. Long-term complications are the major cause of morbidity and mortality in type 2 diabetes patients. Therefore, the primary aim of type 2 diabetes management is the prevention of complications, by lowering blood glucose levels and reducing the cardiovascular risk profile. An important component of type 2 diabetes management is an active role of the patient: diet, smoking habits, physical exercise and self-care behavior often need to change. In addition, the patient has to adhere to life long medical therapy. Motivating the patient for this active role is the challenge for health care providers. A complicating factor is that changes in lifestyle do not give immediate benefit for the patient, as the effects are seen in the reduction of the development of long-term complications. The cornerstones of health care to support active patient participation are: to guarantee the continuity of care, to integrate education in health care and to encourage the patient's attendance. It is the challenge for physicians to give type 2 diabetes patients the tools for active participation in the management of the disease.

Diabetes Mellitus, Type 2↗

PubMed1999

Use of resources and costs of palliative care with parenteral fluids and analgesics in the home setting for patients with end-stage cancer.

BACKGROUND: In 1992 a home care technology project was started in which infusion therapy in the home setting was made available for patients with end-stage cancer. Beside aspects of feasibility and quality of life the resource utilization and costs of this transition was studied. PATIENTS AND METHODS: We conducted a cost evaluation study, to determine the actual cost of managing patients with endstage cancer who require parenteral administration of fluid or analgesics in the home setting. A total of 128 patients were prospectively followed, with a detailed analysis of some aspects in a sample of 24 patients. RESULTS: The cost for each patient was found to be between $250.00 and $300.00 per day, half of which are for hospital charges, even with this active home care technology program. One-third of the costs can be attributed to primary health care activities, in particular those of the district nurses. A hypothetical control group (n = 25) was constructed based on current practice and chart review. Patients in this group would have cost around $750.00 per day. With a median treatment period of 16 days this means a saving of $8000.00 per patient. CONCLUSION: Our data suggest that significant savings can be obtained by implementing programs transferring palliative care technology to the home setting.

Adult↗

PubMed1999

Quality of life and the ICIDH: towards an integrated conceptual model for rehabilitation outcomes research.

OBJECTIVE: The development of the International Classification of Impairments, Disabilities and Handicaps (ICIDH) has led to the assessment of a wider range of re evant rehabilitation outcomes, but a need for a further broadening exists. In this article, a new proposal for an extended ICIDH is made. METHOD: Review of the literature on quality of life and of attempts to integrate the World Health Organization (WHO) biopsychosocial model and the ICIDH. RESULTS: Our review shows three operationalizations of the concept of quality of life: as health, as well-being and, preferably, as a superordinate construct. None of the attempts to integrate the WHO biopsychosocial model have been entirely successful. Our new proposal is characterized by (a) incorporation of the organ, person and social levels of the ICIDH, (b) distinction between objective and subjective aspects of quality of life as a second axis in the model, resulting in somatic sensations as the subjective part of the organ level, perceived hea th as the subjective part of the person level and domain-specific life satisfaction as the subjective part of the social level, and (c) separation of the concept of general well-being or happiness as being distinct from the ICIDH. The proposal mode is intended to serve as a framework in which different outcomes can be positioned in relation to each other. CONCLUSION: Our model is intuitively appealing and remains close to familiar concepts and models. However, it is as yet far from perfect, and we hope to provoke discussion to help further refinement.

Disability Evaluation↗

PubMed1998

[Total hip replacement arthroplasty in the Netherlands].

The total hip arthroplasty (THA) is an effective treatment of osteoarthritis of the hip joint. Each year, more than 16,000 THAs are performed in the Netherlands. The incidence of THA had doubled between 1980 and 1994. The medical indication has extended to younger and older patients. Due to the success of the THA the number of alternative treatments, such as arthrodesis and osteotomy decreased. The number of revision surgeries increased more than four folds, to 1,400 in 1994. Based on these data the increase of primary and revision hip arthroplasties is expected to continue, but it is unknown how much the exact increase will be. In view of the increased demand it is important to gain more insight into the numbers of primary and revision surgical procedures to be expected, so that a better estimation can be made of the health care capacity and financial resources required in the future.

Adolescent↗

PubMed1998

[An estimate of the intramural costs of the placement of a total hip prosthesis].

OBJECTIVE: Determining the intramural costs of the (re) placement of a total hip prostheses. DESIGN: Retrospective, descriptive. SETTING: Utrecht University Hospital (AZU) and the De Weezenlanden Hospital in Zwolle (ZWZ), the Netherlands. PATIENTS AND METHOD: From the records of 137 patients in whom an uncomplicated primary placement or revision of 151 total hip prostheses had taken place in the AZU or the ZWZ during the period 1990-93, data were collected on the number of days hospitalised, the length of the operation, the medical materials used, the number of radiological procedures, ECG's and laboratory determinations, and the visits to the outpatient clinic. The costs of a hip replacement were determined on the basis of the salary costs, tariffs and purchase prices. RESULTS: The average total cost was f 9381 for the placement of a cemented prosthesis, f 10,796 for the placement of a cement-free prosthesis, and f 17,879 for a revision operation. About 90% of the total costs were due to the price of hospitalization, surgery and prosthesis. With 14,000 primary placements and 1400 revisions annually, the cost is approximately 186 million guilders. An expected increase in the number of hip replacements and their cost should be taken into consideration.

Arthroplasty, Replacement, Hip↗

PubMed1998

Predictors of health status and life satisfaction in spinal cord injury.

OBJECTIVE: To analyze relationships between injury-related variables, demographic variables, functional health status, and life satisfaction of people with spinal cord injury (SCI). DESIGN: Cross-sectional survey. SETTING: A community in the Netherlands. SUBJECTS: Three hundred eighteen people with SCI, aged 18 to 65 years. Mean age was 39.4 years and mean time after injury was 3.6 years. MAIN OUTCOME MEASURES: Health status was measured with the SIP68. Its six scales were aggregated to three dimensions, measuring physical, psychologic, and social functioning. Life satisfaction was measured with the Life Satisfaction Questionnaire. Data were analyzed by path analysis using LISREL V8. RESULTS: Obtained scores showed that respondents suffered from serious limitations in physical functioning and social functioning, had only a few limitations in psychologic functioning, and were satisfied with their lives in general and with most life domains. Physical functioning was accurately predicted by injury-related variables, but psychologic functioning was not. Next to level and completeness of the injury, the number of secondary complications turned out to be a predictor of functional health. In a path model that had a close fit with the data, injury-related variables were related to health status but not to life satisfaction. Social functioning (-.48), marital status (-.38), psychologic functioning (-.19), and age (-.16) were significant predictors of life satisfaction (total R2=.44). CONCLUSIONS: This study points out the high prevalence of secondary complications and their importance to the health status of people with SCI. Level of social and psychologic functioning are more important predictors of life satisfaction than the seriousness of the injury.

Adolescent↗

PubMed1998

Life satisfaction of persons with spinal cord injury compared to a population group.

Life satisfaction is thought to be the subjective part of quality of life, i.e. the feelings of the persons concerned about their functioning and circumstances. In this study, life satisfaction of spinal cord-injured persons living in the community is compared to life satisfaction of a population group. Respondents were a nationwide sample of 318 persons with spinal cord injury (response 60%) and 507 inhabitants of a large city in The Netherlands (response 42%). Life satisfaction was measured using the Life Satisfaction Questionnaire, containing one question about general life satisfaction and eight questions about domain-specific life satisfaction. Mean scores of general life satisfaction and of satisfaction with self-care ability, leisure situation, vocational situation and sexual life were lower in persons with spinal cord injury than in the population group, but satisfaction with family life was higher. However, differences in general life satisfaction, satisfaction with leisure situation and with vocational situation could be attributed to differences in the composition of both groups. Satisfaction with self-care ability was lower in persons with tetraplegia than in persons with paraplegia, but we found no differences in other questions. Several relationships between life satisfaction and age and marital status existed, but they were more pronounced in the population group than in the group of persons with spinal cord injury. Time after injury and cause of injury were not related to life satisfaction variables. Uniformity in measurement instruments would facilitate comparisons between studies.

Adolescent↗

PubMed1998

Direct cost of rheumatoid arthritis during the first six years: a cost-of-illness study.

The objective was to estimate the annual direct disease-related cost of rheumatoid arthritis (RA) during the first 6 yr and to determine which socio-demographic and clinical characteristics relate to these costs. The study population consisted of 424 RA patients who had participated in a (population-based) trial on therapeutic strategies for early RA since 1990 and were not lost to follow-up in April 1996. A questionnaire on costs due to RA was sent to these patients; 363 (86%) completed questionnaires were analysed. The total annual direct cost per patient was estimated by adding up the costs of health care workers, days admitted to care facilities, medication, monitoring for side-effects, alternative medicine, adaptations in the home, devices, and other direct costs such as travelling expenses. The mean annual direct cost due to RA was estimated to be Dfl. 11,550 per patient. An obvious increase in direct cost with increasing disease duration was not found. Patients with higher disease activity exhibited significantly higher costs compared to patients with lower disease activity. A multiple logistic regression model showed that greater disability and lower age increased the odds for high costs. The annual direct cost of RA averaged out at Dfl. 11,550 per patient (i.e. Pound Sterling 3680). A high total direct cost in the first 6 yr of disease is related to severe functional disability and lower age.

Adult↗

PubMed1998

Effects of rheumatoid arthritis on employment and social participation during the first years of disease in The Netherlands.

OBJECTIVE: To study the effect of rheumatoid arthritis (RA) on working capabilities and social participation, including non-paying jobs, during the first 6 yr of disease. DESIGN: Cross-sectional study. METHODS: In April 1996, a self-reporting questionnaire was sent to 424 participants of a population-based clinical trial of therapeutic strategies for early RA initiated in 1990. RESULTS: A total of 363 completed questionnaires were returned (response = 86%). Disease duration varied from < 1 to 6 yr (mean 2.8 yr). The employment rate was low in the RA population compared to the Dutch population. In the male 45- to 64-yr-old group, 63% of RA patients were not employed compared to 32% of the Dutch population (P < 0.01). In the female 45- to 64-yr-old group, 76% of the RA population vs 67% of the Dutch were not employed (P < 0.05). Of the employed patients, 59% reported that RA affected their working capabilities, e.g. they worked an average of 21 h per week less due to RA. Of the patients without a paying job, 41% believed that this was (partly) due to RA. In addition, fewer RA patients had non-paying jobs and they performed fewer household activities compared to the general Dutch population. CONCLUSION: RA already has a negative influence on the working capabilities, social participation and household activities of these patients during the first 6 yr of disease.

Adult↗

PubMed1997

Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair.

BACKGROUND: Inguinal hernias can be repaired by laparoscopic techniques, which have had better results than open surgery in several small studies. METHODS: We performed a randomized, multicenter trial in which 487 patients with inguinal hernias were treated by extraperitoneal laparoscopic repair and 507 patients were treated by conventional anterior repair. We recorded information about postoperative recovery and complications and examined the patients for recurrences one and six weeks, six months, and one and two years after surgery. RESULTS: Six patients in the open-surgery group but none in the laparoscopic-surgery group had wound abscesses (P=0.03), and the patients in the laparoscopic-surgery group had a more rapid recovery (median time to the resumption of normal daily activity, 6 vs. 10 days; time to the return to work, 14 vs. 21 days; and time to the resumption of athletic activities, 24 vs. 36 days; P<0.001 for all comparisons). With a median follow-up of 607 days, 31 patients (6 percent) in the open-surgery group had recurrences, as compared with 17 patients (3 percent) in the laparoscopic-surgery group (P=0.05). All but three of the recurrences in the latter group were within one year after surgery and were caused by surgeon-related errors. In the open-surgery group, 15 patients had recurrences during the first year, and 16 during the second year. Follow-up was complete for 97 percent of the patients. CONCLUSIONS: Patients with inguinal hernias who undergo laparoscopic repair recover more rapidly and have fewer recurrences than those who undergo open surgical repair.

Activities of Daily Living↗

PubMed1997

Services for spinal cord injured: availability and satisfaction.

This article discusses service delivery for Spinal Cord Injured (SCI) in the Netherlands. In this wealthy country, almost everyone has access to domestic adaptations and other equipment, regardless of income and with low, or without user contributions. However, satisfaction with this system of its products is rarely examined. Subjects in this research are 318 SCI individuals between 18 and 65 years of age, living in the community at a mean time of 3.6 years after injury. Availability of accessible housing, domestic adaptations, wheelchairs and outdoor transportation is investigated. Satisfaction with available services and satisfaction with service delivery procedures is measured by self-developed questionnaires. Relationships between these satisfaction scores and measures for functional health status (SIP68) and life satisfaction (LSQ) are analyzed. The presence of domestic adaptations is high, and 78.3% said their houses were sufficiently adapted at the time of the interview. Wheelchairs were generally available and most respondents had more than one. However, many users had complaints about their wheelchairs: 35.9% about their manual wheelchairs and 47.5% about their electric wheelchairs. Public transport was rarely used, 51.1% of respondents had an adapted car. Having an adapted car was significantly related to the ability to drive independently. Satisfaction with available services was acceptable, but satisfaction with service delivery procedures was very low. Satisfaction with available services did have a significant relationship with functional health status when the influence of the type of injury was taken into account. Satisfaction with available services also had a significant relationship with life satisfaction, after the influence of functional health status was taken into account. Further research on this topic is recommended.

Activities of Daily Living↗

PubMed1997

Cost-effectiveness of extraperitoneal laparoscopic inguinal hernia repair: a randomized comparison with conventional herniorrhaphy. Coala trial group.

OBJECTIVE: To determine the cost-effectiveness of laparoscopic inguinal hernia repair. SUMMARY BACKGROUND DATA: Laparoscopic inguinal hernia repair seems superior to open techniques with respect to short-term results. An issue yet to be studied in depth remains the cost-effectiveness of the procedure. As part of a multicenter randomized study in which >1000 patients were included, a cost-effectiveness analysis from a societal point of view was performed. METHODS: After informed consent, all resource costs, both in and outside the hospital, for patients between August 1994 and July 1995 were recorded prospectively. Actual costs were calculated in a standardized fashion according to international guidelines. The main measures used for the evaluation of inguinal hernia repair were the number of averted recurrences and quality of life measured with the Short Form 36 questionnaire. RESULTS: Resource costs were recorded for 273 patients, 139 in the open and 134 in the laparoscopic group. Both groups were comparable at baseline. Average total hospital costs were Dfl 1384.91 (standard deviation: Dfl 440.15) for the open repair group and Dfl 2417.24 (standard deviation: Dfl 577.10) for laparoscopic repair, including a disposable kit of Dfl 676. Societal costs, including costs for days of sick leave, were lower for the laparoscopic repair and offset the hospital costs by Dfl 780.83 (75.6%), leaving the laparoscopic repair Dfl 251.50 more expensive (Dfl 4665 versus Dfl 4916.50). At present, the recurrence rate is 2.6% lower after laparoscopic repair. Thus, 38 laparoscopic repairs, costing an additional Dfl 9,557, prevent the occurrence of one recurrent hernia. Quality of life was better after laparoscopic repair. CONCLUSION: A better quality of life in the recovery period and the possibility of replacing parts of the disposable kit with reusable instruments may result in the laparoscopic repair becoming dominantly better--that is, less expensive and more effective from a societal perspective.

Cost-Benefit Analysis↗

PubMed1996

Lifetime hospitalization profiles for symptomatic, HIV-infected persons.

We explored the relationship between the incidence of hospitalization and disease progression in a group of 140 symptomatic, HIV infected patients by linking hospitalizations to the time of diagnosis, the time of death, or both. The relationship could best be described by positively skewed U-patterns or (weak) J-patterns with a high use of resources immediately following diagnosis and preceding death. The lifetime hospitalization profiles differed according to the type of insurance, age, the initial diagnosis in the CDC-IV stage and the length of survival. The results not only confirm general hypotheses posed by other research groups, but also demonstrate the existence of variations among subgroups of patients. The results can be used to improve economic assessments of the impact of AIDS in The Netherlands and the European Union. The method used has the advantage of being based on a bottom-up approach to resource utilization, involving the use pf prospective data for the patients' full lifespans, and can easily be applied to other areas of health services research.

Adult↗

PubMed1996

[Intravenous sedation with propofol in dental treatment. Experience in mentally handicapped patients].

Simple dental procedures in mentally handicapped patients can be facilitated by the use of intravenous sedation. This article describes our experiences with eleven such patients undergoing a total of eighteen procedures in 1994-1995. Sedation was administered by a consultant anesthetist using propofol in 'Sterrenberg'--a home for the mentally handicapped in the Netherlands. The article describes the organization of the patients selection and pre- per- and post-sedation care using a management protocol. It is concluded that the technique is effective and safe for simple dental procedures such as examination, removal of tartar, radiography and the treatment of cavities, provided that patients selection and care are meticulous.

Adult↗

PubMed1995

[Dutch interview version of the Barthel Index evaluated in patients with spinal cord injuries].

OBJECTIVE: Clinimetric evaluation of a Dutch questionnaire version of the Barthel Index (BI). DESIGN: Survey. SETTING: Eight Dutch rehabilitation centres. METHODS: Interviews with 318 spinal cord injured (SCI) patients living in the community, who were between 18 and 65 years of age at the time of the interview and who were admitted for the first time after injury to a specialized rehabilitation unit between 1986 and 1992. Validity, reliability and discriminant validity of the BI were determined. RESULTS: This Dutch questionnaire version of the BI had good reliability (Cronbach's alpha: 0.87; all item-total correlations > or = 0.30). In case of persons with a complete SCI a strong and statistically significant relationship was found between BI score and the level of the lesion (Spearman-Brown correlation: 0.69; p < 0.0001). Patients with more serious lesions had significantly higher BI scores than patients with less serious lesions. CONCLUSIONS: This Dutch questionnaire version of the BI was a sufficiently reliable and valid measure for assessing ability to cope in activities of daily living. Further research should be done on the test-retest reliability and responsiveness of this BI version.

Activities of Daily Living↗