PubMed Health⌕ Search

Biomedical subjects

Richard Grol

Publications and source records attributed to Richard Grol.

At least 37 records · Page 2Linked to original sources
PubMed2005

Saying 'goodbye' to single-handed practices; what do patients and staff lose or gain?

BACKGROUND: The practice setting is, next to the GP and staff, an important determinant of the quality of care. Differences between single-handed practices and group practices in practice management and organization could therefore provide clues for improvement. An explorative, cross sectional survey was conducted in 766 general practices in The Netherlands comparing single-handed practices with group practices. OBJECTIVE: The study is looking for answers on aspects of the organization and management that are lost or gained when single-handed GPs and practices are replaced by group practices. METHODS: Between 1999 and 2003 GPs and their practices were assessed using a validated practice visit method (VIP) consisting of 303 indicators describing 56 dimensions of practice management. Instruments used consisted of questionnaires for patients, GPs, practice assistant and a direct observer in the practice. Single-handed practices (1 GP) were compared to group practices or health centres (>2.0 GPs) comparing raw scores on dimensions of practice management. In addition, data were analysed in a regression model with specific aspects of practice management as dependent variables using a general linear model procedure. Independent variables included 'single-handed/group practice', 'rural/ urban' 'part-time/full-time' and 'male/female'. RESULTS: Group practices scored better on nearly all aspects of infrastructure except those rated by patients. Patients gave single-handed practices higher marks for service, accessibility and even for the facilities. In single-handed practices GPs reported that they worked more and experienced higher levels of job stress. They delegated less of the medical technical tasks but there is no difference in delegation of preventive tasks/treatment of chronic diseases. Group practices had more computerized medical information and more quality assurance activities, but gave less patient information. Single-handed practices spent more hours on continuous medical education. DISCUSSION AND CONCLUSION: The quality of the practice infrastructure and the team scored better in group practices, but patients appreciated the single-handed practice better. The advantages of single-handed practices could be a challenge for group practices to give better personal, continuous care and to put the patient perspective before organizational considerations. This is underlined by the better score on patient information of single-handed practices. Single-handed practices can reduce their vulnerability and openness to high demand by opening up to the requirements of organised primary care.

Family Practice↗
PubMed2005

Familiarity with a GP and patients' evaluations of care. A cross-sectional study.

BACKGROUND: Personal continuity is considered a core feature of general practice care. Nowadays, another important concept for general practice may be patients' familiarity with a GP. OBJECTIVES: We studied the extent to which patients see a familiar GP, and how this matches their preferences. Furthermore we studied the impact of knowing the GP on patients' evaluations of consultations. METHODS: A cross-sectional design was used and 2400 patients visiting 17 general practices (30 GPs) in The Netherlands for a consultation were approached; 2152 patients completed the questionnaire. The main outcome measures were: i) the extent to which patients saw a familiar GP in relation to the reason for encounter, perceived seriousness of symptoms, and concern about symptoms; and ii) the impact of 'knowing the GP' on patients' overall satisfaction with the consultation, feeling of being helped to move forwards, trust in the GP, and perceived clearness of treatment plans. RESULTS: Patients saw a familiar GP to a high extent, regardless of the reason for encounter, perceived seriousness of symptoms and worries. Higher levels of familiarity with a GP were associated with higher levels of satisfaction, with increased feelings of being helped forward, with more trust in the GP, and with the perception of clearer treatment plans made. A multivariate model including the variable 'knowing the GP' explained 11% of the observed variance in patients' evaluations of consultations. CONCLUSION: Familiarity with a GP improves patients' assessment of general practice care. Also in the future, personal continuity should be promoted.

Adult↗
PubMed2005

Organizational assessment in general practice: a systematic review and implications for quality improvement.

BACKGROUND: Quality improvement of organizational aspects in general practice is receiving increasing attention. In particular, the impact of effective organization on preventative care has been recognized. Organizational assessments are typically used as part of professionally led accreditation schemes where there is a tension between externally led quality assurance and internally led quality improvement. The aim of this article is to inform the debate by reviewing the international-peer-reviewed literature on organizational assessments used in general practice settings. DESIGN: Systematic literature review. METHODS: The literature was searched for articles relating to organizational assessment. Titles and abstracts were examined by two independent reviewers and relevant articles obtained. Bibliographies were examined for follow-up references. Data were extracted on the development and use of assessment methods. RESULTS: Thirteen papers describing five organizational assessment instruments were included for detailed appraisal. CONCLUSION: This review discovered a developing field containing different approaches to the measurement of organizational aspects of general practice. Whilst professionally led accreditation is well-developed and dependent on externally led quality assurance, approaches to internally led quality improvement are less well-developed. There is a need for organizational assessment tools designed for the purpose of stimulating internal development.

Family Practice↗
PubMed2005

The OPTION scale: measuring the extent that clinicians involve patients in decision-making tasks.

OBJECTIVE: To examine the psychometric properties of a revised scale, named 'observing patient involvement in decision making' (OPTION), by analysing its reapplication to a sample of routine primary care consultations. The OPTION instrument assesses to what degree clinicians involve patients in decision making. DESIGN: Cross-sectional assessment of medical interaction by two calibrated raters. SETTING: Primary care. PARTICIPANTS: Twenty-one general practitioners provided 186 consultations for assessment. MEASUREMENTS: Observational score using the OPTION instrument. RESULTS: Compared with the first version of the OPTION scale, the revised scale that uses a magnitude instead of an attitude scale, when applied to the same data set, resulted in improvement in the scale's reliability and to lower scores for the levels of involvement achieved by the practitioners. Factor analysis confirms that it is acceptable to regard the scale as a single construct. Although there is moderate variability when raters are assessed on an item by item basis, the agreements between raters at the level of the overall OPTION score is high (the intraclass correlation coefficient scores for total OPTION score was 0.77), a level that is acceptable for the evaluation of a set of consultations per practitioner (e.g. between 5 and 10 consultations), where aggregate scores would be used for determining overall performance. CONCLUSIONS: We conclude that OPTION is sufficiently reliable to be used for formal assessment at the level of the whole instrument (all 12 items).

Cross-Sectional Studies↗
PubMed2005

A consultation leaflet to improve an older patient's involvement in general practice care: a randomized trial.

OBJECTIVE: To evaluate the effects of a programme to enhance the involvement of older patients in their consultations in general practice. DESIGN: Cluster randomized trial, in which data was collected from different cohorts. SETTING AND PARTICIPANTS: Twenty-five general practices in the south-east part of the Netherlands and their patients aged 70 years and over. INTERVENTION: Patients in the intervention group received a leaflet to help them prepare for the consultation. General practitioners (GPs) received an outreach visit to optimize older patients' involvement when visiting their GP. Patients in the control group received usual care. MAIN OUTCOME MEASURES: Questionnaires measuring involvement (COMRADE), enablement (Patient Enablement Index) and satisfaction with their care (EUROPEP). RESULTS: Pre-intervention 315 patients and post-intervention 263 patients were included. Subjects were satisfied with their involvement and the GP's behaviour during the consultation. No differences in effect as a result of the leaflet on involvement, enablement or satisfaction were found between the intervention and the control group. Of 318 patients who received the leaflet and visited their GP in the intervention period, 47 patients used the leaflet. These users were more accustomed to prepare themselves for consultations. Users reported more psychological problems than non-users. CONCLUSIONS: No relevant effects of the implementation programme on involvement, enablement or satisfaction were found. Other strategies are needed to enhance involvement of older patients in their care. Alternatively, older patients may perceive themselves sufficiently involved.

Aged↗
PubMed2005

Variation in requests for imaging investigations by general practitioners: a multilevel analysis.

OBJECTIVES: To describe the variation in the numbers of imaging investigations requested by general practitioners (GPs) and to find likely explanations for this variation. METHODS: Cross-sectional survey of the use of eight imaging investigations by 229 GPs collaborating in 40 local GP groups from five regions in the Netherlands during 1997. A multivariable, multilevel regression analysis was used to link these data with survey data on professional characteristics such as knowledge about and attitude towards test ordering, and with data on contextual factors such as practice type or experience with feedback on test-ordering data. RESULTS: Data for 221 GPs (97%) were available. After adjustment for practice size and working time, the median number of imaging investigations ordered per GP was 148 (interquartile range 71 to 300), with large differences (up to twofold) between the regions (P<0.001). Overall, chest X-rays were the largest single category (median = 48 interquartile range 17 to 100). GPs working in a group practice requested, on average, 34% fewer investigations than their colleagues working in single-person practices (95% confidence interval 17 to 48%). CONCLUSIONS: Only practice type was found to be associated with the number of imaging investigations requested, adjusted for practice size and working time factor. No further explanations were found for the inter-regional differences. Future studies on the ordering of imaging investigations by GPs should attempt to delineate contextual from regional factors.

Diagnostic Imaging↗
PubMed2005

Interventions to improve management of anxiety disorders in general practice: a systematic review.

BACKGROUND: Anxiety disorders are common in general practice and are associated with several problems regarding recognition and management. AIM: To systematically evaluate the effectiveness of interventions aimed at improving recognition, diagnosis, and management of patients with anxiety disorders. DESIGN OF STUDY: Systematic review. METHOD: MEDLINE, EMBASE, PsychINFO, and the Cochrane Clinical Trials' Register were searched up until 2003. Randomised controlled trials, controlled before/after trials, and interrupted time series for professional, organisational, financial, and regulatory interventions were eligible. Primary effect measures consisted of anxiety outcomes, diagnosis, prescription, and referral. Two reviewers independently made eligibility judgments: eight out of 563 articles were found to be eligible. Two reviewers participated independently in the quality assessment and data extraction process using a standardised form based on the Effective Practice and Organisation of Care checklist. Relative risks or standardised mean differences were calculated when possible. RESULTS: Four professional interventions and three organisational interventions were examined. In general, the professional interventions seemed to increase recognition, referral, and prescription as well as improving anxiety outcomes. Two out of three organisational interventions showed a positive effect on anxiety outcomes. The one study that took prescription into account showed no effect. CONCLUSIONS: The quality of care for patients with anxiety can be improved. A combination of professional and organisational interventions in which an external expert is introduced seems to be most promising. Additional research is nevertheless necessary to determine the exact effects of such interventions using patient effect measures, economic evaluations, and feasibility studies.

Anxiety Disorders↗
PubMed2004

Effects of distance learning on clinical management of LUTS in primary care: a randomised trial.

AIM: To determine the effect of a distance learning programme on general practice management of men with lower urinary tract symptoms (LUTS). METHODS: A cluster randomised controlled trial was performed. General practitioners (GPs) were randomised to a distance learning programme accompanied with educational materials or to a control group only receiving mailed clinical guidelines on LUTS. Clinical management was considered as outcome. RESULTS: Sixty-three GPs registered care management of 187 patients older than 50 years attending the practice because of LUTS. The intervention group showed a lower referral rate to a urologist (OR: 0.08 (95% CI: 0.02-0.40)), but no effect on PSA testing or prescription of medication. PSA testing tended to be requested more frequently by intervention group GPs. Secondary analysis showed patients in the intervention group received more educational materials (OR: 75.6 (95% CI: 13.60-419.90)). CONCLUSIONS: The educational programme had impact on clinical management without changing PSA testing. Distance learning is an promising method for continuing education. PRACTICE IMPLICATIONS: Activating distance learning packages are a potentially effective method for improving professional performance. Emotional matters as PSA testing probably need a more complex approach.

Adult↗
PubMed2004

What drives change? Barriers to and incentives for achieving evidence-based practice.

To bridge the gap between scientific evidence and patient care we need an in-depth understanding of the barriers and incentives to achieving change in practice. Various theories and models for change point to a multitude of factors that may affect the successful implementation of evidence. However, the evidence for their value in the field is still limited. When planning complex changes in practice, potential barriers at various levels need to be addressed. Planning needs to take into account the nature of the innovation; characteristics of the professionals and patients involved; and the social, organisational, economic and political context.

Diffusion of Innovation↗
PubMed2004

The effect of a distance-learning programme on patient self-management of Lower Urinary Tract Symptoms (LUTS) in general practice: a randomised controlled trial.

OBJECTIVE: To determine whether a distance-learning programme on LUTS provided to the general practitioner affected patient self-management. METHODS: A randomised trial was performed to examine the effects of the distance-learning programme (an educational package for the GP and a patient information leaflet) compared with written guidelines on LUTS mailed to the GP. In 63 general practices (32 intervention and 31 control) across the Netherlands all patients older than 50 years presenting LUTS for the first time were invited to participate. Main outcome measures were patient evaluation of quality of care received and perceptions of enablement. RESULTS: A total of 151 patients was included. The intervention increased patient enablement regarding maintenance of independence (OR = 3.14) and coping with illness (OR = 2.21). Overall enablement scores were not changed. Patients in the intervention group had more positive evaluations of general practice care received (OR = 2.28 to 3.95). An explorative analysis suggested that the effects of the intervention were mediated in particular by handing out of patient information leaflets. CONCLUSIONS: A distance-learning programme on LUTS for general practitioners had positive effects on patient self-management. Handing out leaflets appeared to be a crucial mediating factor.

Aged↗
PubMed2004

Impact of national health care systems on patient evaluations of general practice in Europe.

OBJECTIVE: To examine associations between patient evaluations of general practice and characteristics of national health care systems. METHODS: International comparative study in 17 countries, using international patient survey data (n= 25052) and data-bases for health care system characteristics. Dependent variable was patients' evaluation of general practice care. Five independent factors were examined: GP density, physician density, fee for service reimbursement, gatekeeper role, and first-contact role. RESULTS: None of the associations were statistically significant. CONCLUSIONS: Patients were highly satisfied with general practice in different national health care systems. Descriptive tables on international variations may lead to misleading conclusions.

Europe↗
PubMed2004

Health education on self-management and seeking health care in older adults: a randomised trial.

The aim of this randomised trial was to determine the effects of a health education strategy for older adults living at home on GP attendance. The health education comprised a written booklet on five frequently by GP unnoticed, highly prevalent and potentially treatable health problems: hearing impairment, visual impairment, urinary incontinence, depression and Lower Urinary Tract Symptoms (LUTS). The information comprised structured guidance to enhance decision-making on seeking health care by their GP and contained advice on self-management. The control group did not receive any intervention. Primary outcome was GP attendance of patients regarding the five health problems within 3 months. At this point we expected an increase of GP attendance. Six hundred and eighty-seven subjects completed the study. We can conclude that the health education strategy did not change the GP attendance of older adults. The results suggest that the health education was being appreciated as being useful and informative.

Activities of Daily Living↗
PubMed2004

Patients' ideas, fears and expectations of their coronary risk: barriers for primary prevention.

The application of cardiovascular guidelines and risk tables may be impeded by many barriers. In the present paper, we explored the role of patients in the feasibility of cardiovascular preventive care in general practice. Patient-related barriers were examined by means of a qualitative study. Fifteen GPs audio-taped one or two consultations on primary cardiovascular preventive care. The tapes were used to guide the subsequent semi-structured in-depth interviews with patients. Twenty-two patients were interviewed. Patients' understanding of prevention of cardiovascular disease (CVD) was often insufficient. The risk table and the multi-factorial approach were difficult to understand. Risk perception was often unrealistic and dichotomous, and mainly based on personal experiences. There was a demand for more information and cholesterol tests. At the patient level, many barriers impede effective prevention of cardiovascular diseases. In particular, the highly individualized high-risk approach needs to be explained to patients. Educational patient materials, intended to support both the GP and the patient, should take into account the ideas, fears and expectations of patients.

Adult↗
PubMed2004

GPs' views on involvement of older patients: an European qualitative study.

Involvement of older patients in general practice care is regarded as important, but is not widespread. To determine specific barriers to the involvement of older patients in general practice care and to identify variations between countries, we performed an international comparative study based on qualitative interviews with 233 general practitioners (GPs) in 11 countries. Most GPs thought that involving older patients had positive outcomes. GPs saw patient involvement as a process taking place solely during consultations. The main barrier for GPs was lack of time. Barriers related to older patients were their feelings of respect for doctors, their lack of experience in being involved and possible mental and physical impairments. To conclude, increasing involvement of older patients is not easy and will only be effective when GPs have adopted a more developed concept of patient involvement and are supported with the different methods for achieving this. The range of appropriate interventions may be similar in all countries.

Adult↗
PubMed2004

Barriers to implementing cardiovascular risk tables in routine general practice.

DESIGN: Qualitative study. GPs were interviewed after analysing two audiotaped cardiovascular consultations. SETTING: Primary health care. SUBJECTS: A sample of 15 GPs who audiotaped 22 consultations. MAIN OUTCOME MEASURES: Barriers hampering GPs from following the guideline. RESULTS: Data saturation was reached after about 13 interviews. The 25 identified barriers were related to the risk table, the GP or to environmental factors. Lack of knowledge and poor communication skills of the GP, along with pressure of work and demanding patients, cause GPs to deviate from the guideline. GPs regard barriers external to themselves as most important. CONCLUSION: Using the risk table as a key element of the high-risk approach in primary prevention encounters many barriers. Merely incorporating risk tables in guidelines is not sufficient for implementation of the guidelines. Time-efficient implementation strategies dealing in particular with the communication and presentation of cardiovascular risk are needed.

Adolescent↗
PubMed2004

Use of prescribed and non-prescribed medication for dyspepsia.

OBJECTIVE: To explore patient factors related to the use of prescribed and non-prescribed drugs for dyspepsia in The Netherlands. DESIGN: Patient survey study. SETTING AND SUBJECTS: Questionnaires sent to patients who had a prescription for dyspepsia medication from their general practitioner. MAIN OUTCOME MEASURES: Patient factors related to the on-demand use of prescribed medication and the use of non-prescribed medication for dyspepsia. RESULTS: 74% of the (n=518) patients had been receiving prescribed medication for dyspepsia for more than one year. A quarter of the patients were using the prescribed medication "on demand" instead of adhering to the instructions on the prescription. PPI prescriptions reduced the probability of using the medication on demand, compared with other prescribed drugs (OR 0.39). Some 19% of the patients were using non-prescribed drugs for dyspepsia. More of the patients who had visited their general practitioner in the previous 12 months were using their drugs on demand (OR 2.27) and were using non-prescribed drugs (OR 2.40) than the patients who had not visited their GP. CONCLUSION: Clear information for patients on how to use their medication for dyspepsia may contribute to decreasing unnecessary drug use. Communication about (in)appropriate use of drugs "on demand", non-prescribed drugs, and health education should be addressed to all patient groups. Further studies on these topics should aim to improve medical care based on shared decision-making for patients with dyspepsia.

Adult↗
PubMed2004

A multidisciplinary guideline for the acute phase of stroke: barriers perceived by Dutch neurologists.

RATIONALE, AIMS AND OBJECTIVES: Guidelines for stroke management should improve quality of care. Dissemination of guidelines, however, does not guarantee guideline adherence. The aim of this paper is to investigate barriers for guideline adherence to bring about suggestions for possible implementation strategies. METHOD: Questionnaire survey among all Dutch neurologists working on neurology wards in general hospitals during the year 2000 in The Netherlands. RESULTS: The neurologists expressed a high degree of agreement with the diagnostic and preventive recommendations, but expressed doubts with regard to the therapeutic recommendations, especially for the recombinant tissue plasminogen activator therapy. In general, barriers at the organizational and the multidisciplinary team level were most prominent. CONCLUSIONS: Active implementation of the guidelines seems necessary. Implementation strategies should be focused on the different sources of barriers: the caregiver, the patient and the organization of care.

Acute Disease↗