Biomedical subjects

E M Sluijs

Publications and source records attributed to E M Sluijs.

12 recordsLinked to original sources

PubMed2002

[Dentists and peer review: results of a descriptive study on perceived effects of peer review].

In the Netherlands over 20% of dentists participate in peer review groups. The peer review method is highly structured and consists of: setting standards for good dental care, measuring and evaluating performances against the standards and making improvements if necessary. An independent research institute (Nivel) investigated the perceived effects and advantages of and barriers to peer review. A postal questionnaire was sent tot 278 dentists who participate in peer review (response 60%). The results showed many effects of peer review. The most frequently reported effects were: more insight into the performances of colleagues, increased inter-professional contacts, a more critical attitude to performances, increased professional expertise and new inspiration and motivation. The respondents reported improvements in practice-organisation as well as in technical aspects of dental care. However, many dentists also mentioned some barriers to peer review. The method was evaluated as rather complex and it appeared to be difficult to reach consensus about standards for good dental care. In general, respondents perceived a positive balance between advantages and disadvantages of peer review, however many dentists were dissatisfied with the lack of financial compensation for participation in peer review.

Adult↗

PubMed2002

[Dentists and mutual practice visitation. Results of a descriptive study on the effects on mutual visitation by dentists].

In 1998 mutual practice visitation has been introduced in the Dutch dental practice as a method to improve quality of dental care. The method is called 'mutual visitation' because groups of three dentists visit and evaluate each others practices. An independent research institute (Nivel) investigated the perceived effects, advantages and barriers of visitation. A postal questionnaire was sent to all 235 dentists who, by that time, participated in visitation. The response was 57%. The results showed that the effects reported most frequently were: a more critical attitude to dental practice, more insight into practices of colleagues and actual improvements in dental care. The majority of the respondents considered visitation suitable to improve practice-organization. A minority considered visitation suitable to increase professional expertise. The mutuality of the visitation was highly valued by the participants. The main disadvantage of visitation appeared to be the time investment (a mean of three days per dentist). In general, the respondents held the view that the positive effects outweighed the time and efforts, however, many dentists regretted the lack of financial compensation for visitation.

Adult↗

PubMed2001

The impact of legislative versus non-legislative quality policy in health care: a comparison between two countries.

UNLABELLED: An important aim of the government's quality policy is to stimulate quality management (QM) in health care organizations. The relationship between the government's quality policy and QM in health care organizations is unknown. This article explores that relationship by comparing two countries with different quality policies, The Netherlands and Finland. In The Netherlands QM is required by law and health care is organized at national level. In Finland, QM is not required by law and the responsibilities for organizing health care are delegated to the municipalities. The question is whether or not these differences in national policy are reflected in the extent and effectiveness of QM in health care organizations in the two countries. A cross sectional survey was conducted in late 1999. Data about QM in both countries were gathered by questionnaire. The subsectors involved were hospitals, care for the disabled and care for the elderly. A total of 1172 health care organizations participated in the study (response rate 64%). The results show that-in keeping with our hypothesis-slightly more QM-activities and more patient participation were found in Dutch health care organizations compared with the Finnish ones. However, contrary to our expectations, the Finnish organizations reported more perceived effects of their QM-activities. Further analyses showed that some QM-activities are more closely related to the effectiveness of QM than others. In particular, cyclic quality improvement procedures, human resource management and the flexible attitude of employees showed the strongest relationship with the perceived effects of QM. The difference between the national approach in The Netherlands and the decentralized approach in Finland did not, as we had assumed, result in more regional variation in QM in Finland. CONCLUSIONS: a government's quality policy may have some influence on the extent of QM in health care organizations. However, more QM-activities do not necessarily imply more effects. RECOMMENDATIONS: since QM-activities differ in the degree to which they bring about changes and improvements in care, it is recommended that policy makers promote those QM-activities, which are the most potent, in order to improve the quality of care.

Aged↗

PubMed2001

[Decade of quality health care: dentists in comparison with other health professionals].

In 1990 the Dutch organisations for health care providers, patients-organizations and insurance companies agreed on the implementation of quality systems in health care. Ever since, the health care professions--including dentists--are being involved in the development of quality systems to assure and improve the quality of care. In 2000 a national survey has been conducted to investigate which quality systems already were developed by Dutch health care professions and a comparison between the professions has been made. It appeared that the quality systems of the professions are characterised by four pillars. 1. professional expertise; 2. evidence based guidelines for good practice; 3. peer review directed at continuous improvement; and 4. re-licensing or certification to guarantee the quality. The study showed that the professions differ in the quality policies they pursue and in the progress which has been made. In dental practice an accent in the quality policy is on peer review (whereas in general practice the accent is on guidelines). Ranking the professions in the degree in which the quality system are developed, medical doctors and pharmacists are front-runners, dentist are in the middle rank whereas nurses and psychologists are lagging behind. For the years to come, a priority has been set on further implementation of the quality systems.

Certification↗

PubMed1999

Educating patient educators: enhancing instructional effectiveness in physical therapy for low back pain patients.

The objective of this research project was to study the effectiveness of a training program for the enhancement of patient education skills in physical therapy. In this paper the improvement of five of these skills is tested. These skills are aimed at a better monitoring of adherence problems during the treatment and at enhancing self-efficacy of the patient after treatment. In order to test the effectiveness of the program, complete treatments of 19 physiotherapists have been assessed before (1142 sessions, 130 patients) and after (775 sessions, 88 patients) the training program. Information on the instructions and solutions given to the patients was obtained with a registration form, completed after each session by the physiotherapist. The patient's perception of the effectiveness and feasibility of instructions was obtained from questionnaires, completed by the patient on three occasions. After the training only a minority of the trained skills appeared to be improved. All in all, the training program was not very effective. More effort is needed to develop training programs aimed at promoting patients' self-efficacy as well as measurement instruments to assess the effects of such programs.

Attitude of Health Personnel↗

PubMed1999

Diffusion of a quality improvement programme among allied health professionals.

OBJECTIVE: To assess the diffusion of a quality improvement (QI) programme among allied health professions in The Netherlands. DESIGN: Descriptive study, based on a questionnaire distributed to allied health professionals; response rate, 63%. SETTINGS AND PARTICIPANTS: All subsectors in health care were covered, including primary care and institutional care. The participants were either salaried or self-employed in private practice. INTERVENTION: The governing boards of the professional associations developed a QI policy. This study reports the evaluation of the diffusion of this policy. MAIN OUTCOME MEASURE: Respondents' knowledge of the QI programme and their opinions with respect to the relevance of 15 QI activities. Respondents were asked whether they were currently taking part in QI activities and, if not, whether they intended to participate in them in the near future. In addition, the advantages of the QI programme and the barriers to further implementation which respondents perceived were assessed. RESULTS: Most of the health professionals were familiar with the QI programme. The relevance of the QI activities for the profession was rated. Continuing education was ranked highest in priority. The respondents perceived the advantages of many of the QI activities. At the time of the study, less than one-third of the respondents were taking part in peer review, or complying with national guidelines. Respondents listed a number of barriers to further implementation. CONCLUSIONS: The perceived advantages and barriers related to implementation appear to differ per QI activity. Consequently, implementation strategies should differ per QI activity and be tailored to the specific advantages and barriers of each one.

Allied Health Personnel↗

PubMed1999

Back care instructions in physical therapy: a trend analysis of individualized back care programs.

BACKGROUND AND PURPOSE: The treatment of people with low back pain often includes giving a variety of instructions about back care. The objective of our study was to explore the content and sequence of these instructions. SUBJECTS: Our database contained information on 1,151 therapy sessions for 132 patients who were treated by 21 therapists. METHODS: Hierarchical linear modeling was used to establish trends in instructions during the course of treatment. Instructions were measured by means of a registration form. RESULTS: Pain management instructions were given at the start of treatment and then decreased in later sessions. Instructions about taking care of the back in daily activities followed the same course. Exercise instructions were introduced after the start of treatment and were spread evenly across the visits. The number of recommendations about general fitness decreased during treatment. CONCLUSION AND DISCUSSION: The majority of back care instructions were spread evenly across therapy visits. Relatively little variation in instructions among patients was seen, which may indicate a lack of individualization of the back care programs.

Activities of Daily Living↗

PubMed1997

Quality systems in Dutch health care institutions.

The implementation of quality systems in Dutch health care was supervised by a national committee during 1990-1995. To monitor the progress of implementation a large survey was conducted in the beginning of 1995. The survey enclosed all subsectors in health care. A postal questionnaire--derived from the European Quality Award--was sent to 1594 health care institutions; the response was 74%. The results showed that in 13% of the institutions a coherent quality system had been implemented. These institutions reported, among other effects, an increase in staff effort and job satisfaction despite the increased workload; 59% of the institutions had implemented parts of a quality system. It appeared that management pay more attention to human resource management compared to documentation of the quality system. The medical staff pay relatively more attention to protocol development than to quality-assurance procedures. Patients were hardly involved in these quality activities. The research has shown that it is possible to monitor the progress of implementation of quality systems on a national level in all subsectors of health care. The results play an important role in the discussions and policy on quality assurance in health care.

Data Collection↗

PubMed1993

Correlates of exercise compliance in physical therapy.

BACKGROUND AND PURPOSE: This correlational study describes factors that are related to patient compliance with exercise regimens during physical therapy. We investigated whether patient compliance was related to characteristics of the patient or the patient's illness, to the patient's attitude, or to the physical therapist's behavior. SUBJECTS AND METHODS: Of a random sample of 300 physical therapists in private practice in the Netherlands, 222 therapists responded to a questionnaire survey. Eighty-four respondents also made audio recordings. Materials of the study were 1,931 registration forms, 1,837 audio-recorded sessions of physical therapy sessions, and 1,681 patient questionnaires. RESULTS: The results show that the three main factors related to noncompliance were (1) the barriers patients perceive and encounter, (2) the lack of positive feedback, and (3) the degree of helplessness. The first factor, the barriers patients perceive and encounter, shows the strongest relation with noncompliance. The results also show that noncompliance is more strongly related to the characteristics of the illness than to the illness, a bad prognosis is negatively related to compliance, and much hindrance of the complaint is positively related to compliance. There was no difference between men and women with regard to patient compliance, but less educated patients were slightly more compliant than more highly educated patients. CONCLUSION AND DISCUSSION: These correlational findings can be used to formulate hypotheses of cause and effect in future clinical research. Future research should take into account the type and efficacy of therapeutic exercise for different diseases. For physical therapy practice, it seems important that physical therapists carefully explore which problems patients encounter in their efforts to comply and that they seek solutions to those problems in mutual cooperation with their patients.

Adult↗

PubMed1991

A checklist to assess patient education in physical therapy practice: development and reliability.

Patient education in physical therapy is gaining attention because it can contribute to patient compliance and prevention. This article describes the development of an assessment tool for investigating patient education in physical therapy. A checklist of 65 educational activity items was constructed. The investigators tested the applicability of the checklist using 227 audiotaped treatment sessions involving patients from various private practices in the Netherlands. The 227 audiotaped sessions covered the entire period of treatment for 25 patients, each of whom participated in an average of 9 treatment sessions. The results showed that all except 1 of the 65 educational activities occurred in the 227 treatment sessions and that no educational activities occurred that could not be rated in the checklist. These findings may indicate that the checklist covers the entire range of educational activities currently applied by physical therapists. The reliability of the checklist was tested using a subsample of the treatments. The average scores for interrater and intrarater reliability, as determined by the use of the Cramer's V coefficient of association for ordinal data, were .76 and .81, respectively. The checklist can be used to investigate the current educational activities in physical therapy practice. In addition, the checklist can be used in peer review and can contribute to the development of standards for the quality of care. [Sluijs EM. A checklist to assess patient education in physical therapy practice: development and reliability.

Educational Measurement↗

PubMed1985

Evaluation of an interview training course for general practitioners.

This article describes the evaluation of an experimental training in doctor-patient communication for general practitioners. The training was based on Rogerian theory and accommodated to the specific situation of the general practitioner. The main concept of this theory is the notion of 'unconditional positive regard'. It was expected that doctors would change their communication behaviour and that as a result patients would talk more about their psychosocial problems. The training was restricted to the diagnostic process, no therapeutic interventions were taught. The effects of this training have been measured by comparing video-tapes of live doctor-patient consultations, before and 3 months after the training. The most important result of this evaluation study turned out to be the change of the doctor's behaviour in the expected direction, but surprisingly the outcome of the consultation did not change at all: the doctors were empathically listening, but the patients did not talk more about their problems. Creating room for patients is not sufficient to induce them to discuss their personal problems with their doctors. Perhaps they do not feel like discussing their personal problems with them at all.

Communication↗

PubMed1984

Byrne and Long: a classification for rating the interview style of doctors.

In order to assess the doctor's verbal behaviour in the consultation, a classification instrument is needed that will enable us to summarize the doctor's interview style. Such an instrument, developed by Byrne and Long, is evaluated in this study. After presenting the procedure as it has been worked out by Byrne and Long, some points of criticism are formulated. On account of our criticism, some changes have been introduced into the instrument. To test the relevance and reliability of the instrument, 36 consultations have been classified according to the adjusted system. This procedure showed that it was possible to represent a consultation with the 45 categories the system consisted of (although only 15 categories occurred in more than half of the consultations). Those categories that occurred often enough, could be measured with sufficient reliability, with inter-observer reliability coefficients mostly above 0.70. An example shows that the procedure is extremely useful to indicate certain differences between doctors and types of consultations.

Disease↗