Biomedical subjects

Antoinette de Bont

Publications and source records attributed to Antoinette de Bont.

4 recordsLinked to original sources

PubMed2007

Conditional reimbursement within the Dutch drug policy.

In The Netherlands, conditional reimbursement is considered to be a promising approach to achieving more effective and efficient pharmaceutical care. Because of its formal status and nationwide regulation, conditional reimbursement may allow governments to better control medical decision-making. To evaluate the effects of conditional reimbursement on medicine use and its performance as a policy tool, we compared observed volumes of medicine use with expected volumes. In addition, we mapped the annual growth by analysing trends in the volumes of use of all conditionally reimbursed drugs; starting with the year the drug entered the market (using macro-level data). Next we explored five cases in depth (using micro-level data) in order to explore what fraction of individual prescriptions met the requirements. We also performed qualitative research (document analysis, interviews (N=65)) in order to obtain the stakeholders' perspectives on how the measure functions, as well as to interpret the case studies data further. The findings suggest that conditional reimbursement may be an effective policy instrument, but that several changes are needed to optimize its impact. These changes are predominantly related to transparency (e.g. conditions are set following clear procedures and criteria), legitimacy (conditions should be consistent with criteria for prioritization), feasibility of procedures to control appropriate use, and timely and appropriate commitment of the stakeholders.

Interviews as Topic↗

PubMed2006

Coping with methodological dilemmas; about establishing the effectiveness of interventions in routine medical practice.

BACKGROUND: The aim of this paper is to show how researchers balance between scientific rigour and localisation in conducting pragmatic trial research. Our case is the Quattro Study, a pragmatic trial on the effectiveness of multidisciplinary patient care teams used in primary health care centres in deprived neighbourhoods of two major cities in the Netherlands for intensified secondary prevention of cardiovascular diseases. METHODS: For this study an ethnographic design was used. We observed and interviewed the researchers and the practice nurses. All gathered research documents, transcribed observations and interviews were analysed thematically. RESULTS: Conducting a pragmatic trial is a continuous balancing act between meeting methodological demands and implementing a complex intervention in routine primary health care. As an effect, the research design had to be adjusted pragmatically several times and the intervention that was meant to be tailor-made became a rather stringent procedure. CONCLUSION: A pragmatic trial research is a dynamic process that, in order to be able to assess the validity and reliability of any effects of interventions must also have a continuous process of methodological and practical reflection. Ethnographic analysis, as we show, is therefore of complementary value.

Adult↗

PubMed2006

Prioritisation by physicians in the Netherlands--the growth hormone example in drug reimbursement decisions.

Drug treatment and reimbursement is an area of ever growing complexity in health priority setting. This paper assesses the National Registry of Growth Hormone Treatment (LRG) responsible for making prioritisation decisions in the Dutch drug reimbursement system in the treatment of growth hormone, using the framework for fairness. We used qualitative research consisting of semi-structured interviews and focus group sessions combined with quantitative methods to audit the decisions of the forum. The rationing decisions of the forum demonstrate accountability for reasonableness by the conditions for transparency, relevance, and appeal. Most rationales for the decisions are public and transparent. The patients and paediatricians see decisions made by the LRG as clinical and therefore relevant decisions. They also refer to extensive appeal procedures. The case also raises important issues regarding the legitimacy of expert-based priority setting as the cyclic nature of guideline development conflicts with the need for maintaining strict rationing criteria. In 13% of the patients, the sick funds did cover treatment as the forum advised them to do, but according to guideline criteria it may be unlikely that these patients have growth hormone deficiency. According to the LRG, however, only 2% of the decisions are inconsistent with the guidelines, as some criteria on what to do in case of more uncertainty, shifted. For the forum, it seems rather unthinkable to go against the professional norms, in spite of formal national regulations. For the Health Care Insurance Board (CVZ), it was not considered possible to go against national regulations, especially as professional norms have shifted without informing policy makers and patient representatives.

Choice Behavior↗

PubMed2005

Looking for answers, constructing reliability: an exploration into how Dutch patients check web-based medical information.

INTRODUCTION: In the discussion about helping lay end users find reliable health-related information on the web, lay assessment practices of the reliability of information are often dismissed as insufficient. It is suggested that patients do not check important background information (authors, dates) for the medical content on websites. However, little effort has been made to understand how lay practices enable patients to assess information reliability in respect to their specific health situations. OBJECTIVE: This paper draws upon ethnographic research among Dutch patients to understand lay assessment practices. METHODS: We conducted qualitative interviews and observed patient search practices. Patients were asked to describe and then repeat the last searches they had conducted. They were also given standardized questions for searching for information. RESULTS: Patients did not utilize special user tools (checklists, seals, portals) to assist in searching for and evaluating information. However, we saw explicit strategies for checking information within their established patterns of searching, such as on and offline triangulation of information and checking information provider information and dates. CONCLUSION: Although patients do not follow standardized checklists, this is not to say that they are not assessing information. Their assessment processes are more extensive than current literature suggests.

Adult↗