184 research outputs found
Pay-for-performance in health care:Effects are uncertain
No full textA British pay-for-performance scheme to improve medical care has attracted the attention of Dutch health authorities. An extensive pay-for-performance policy was introduced in general practices in the UK in 2004. In British patients with hypertension, however, financial incentives for healthcare providers did not appear to improve the quality of patient care. A temporary effect was seen among patients with asthma and diabetes. Unintended consequences were detected. The quality of care for patients in general practice was already improving before the change in policy. Based on these results, careful consideration is needed before the introduction of extensive pay-for-performance in Dutch general practice. Quality of care has been an issue for Dutch GP's for many years. General practitioners and health insurance companies should cooperate to identify those aspects of care needing further improvement. More can probably be gained from trust in GPs and the facilitating role of health insurance companies than from a pay-for-performance scheme.</p
Prestatiefinanciering in de zorg: Onzeker of het werkt
No full textA British pay-for-performance scheme to improve medical care has attracted the attention of Dutch health authorities. An extensive pay-for-performance policy was introduced in general practices in the UK in 2004. In British patients with hypertension, however, financial incentives for healthcare providers did not appear to improve the quality of patient care. A temporary effect was seen among patients with asthma and diabetes. Unintended consequences were detected. The quality of care for patients in general practice was already improving before the change in policy. Based on these results, careful consideration is needed before the introduction of extensive pay-for-performance in Dutch general practice. Quality of care has been an issue for Dutch GP's for many years. General practitioners and health insurance companies should cooperate to identify those aspects of care needing further improvement. More can probably be gained from trust in GPs and the facilitating role of health insurance companies than from a pay-for-performance scheme
Vitamine D:Wat moeten we er mee?
No full textEvidence of a beneficial effect of supplementation on vitamin D deficiency is limited. Since 2008, the Health Council of the Netherlands has recommended a daily vitamin D supplement for women of 50 years and older and both men and women of 70 years and older. This advice is poorly implemented in the general population. General practitioners are increasingly requesting a vitamin D blood level in lowrisk patients with nonspecific complaints. A primary healthcare laboratory measured vitamin D levels in random blood samples. They concluded that low vitamin D levels are highly prevalent in primary care patients. These results suggest that there is no added value in vitamin D blood level measurement. Discussion is still ongoing as to whether vitamin D supplementation is really beneficial. Trials are under way but the results are not yet known. Supplementation that is necessary on the basis of individual risk assessment, or preferred by an individual can be started without a blood level measurement.</p
Vitamine D:Wat moeten we er mee?
No full textEvidence of a beneficial effect of supplementation on vitamin D deficiency is limited. Since 2008, the Health Council of the Netherlands has recommended a daily vitamin D supplement for women of 50 years and older and both men and women of 70 years and older. This advice is poorly implemented in the general population. General practitioners are increasingly requesting a vitamin D blood level in lowrisk patients with nonspecific complaints. A primary healthcare laboratory measured vitamin D levels in random blood samples. They concluded that low vitamin D levels are highly prevalent in primary care patients. These results suggest that there is no added value in vitamin D blood level measurement. Discussion is still ongoing as to whether vitamin D supplementation is really beneficial. Trials are under way but the results are not yet known. Supplementation that is necessary on the basis of individual risk assessment, or preferred by an individual can be started without a blood level measurement.</p
Pay-for-performance in health care:Effects are uncertain
No full textA British pay-for-performance scheme to improve medical care has attracted the attention of Dutch health authorities. An extensive pay-for-performance policy was introduced in general practices in the UK in 2004. In British patients with hypertension, however, financial incentives for healthcare providers did not appear to improve the quality of patient care. A temporary effect was seen among patients with asthma and diabetes. Unintended consequences were detected. The quality of care for patients in general practice was already improving before the change in policy. Based on these results, careful consideration is needed before the introduction of extensive pay-for-performance in Dutch general practice. Quality of care has been an issue for Dutch GP's for many years. General practitioners and health insurance companies should cooperate to identify those aspects of care needing further improvement. More can probably be gained from trust in GPs and the facilitating role of health insurance companies than from a pay-for-performance scheme.</p
Home-based palliative care for children with incurable cancer: long-term perspectives of and impact on general practitioners
Get PDFContext: although a large percentage of children with advanced-stage cancer die at home, remarkably little information is available regarding the experience of general practitioners (GPs) with respect to providing home-based palliative care to children with incurable cancer.Objectives: to explore the perspectives of GPs who care for children with advanced-stage cancer in a home-based setting.Methods: in this cross-sectional study, 144 GPs who provided home-based palliative care to 150 children with incurable cancer from 2001 through 2010 were invited to complete a questionnaire addressing their perspectives regarding: 1) symptom management, 2) collaboration with other health care professionals, 3) the child’s death and care after death and 4) impact of having provided palliative care, scored on distress thermometer (range 0-10).Results: a total of 112 GPs (78%) responded, and 91 GPs completed the questionnaire for 93 patients. The median interval between the child’s death and completing the questionnaire was 7 years. The most prevalent symptoms reported in the patients were fatigue (67%) and pain (61%). Difficulties with communicating with (14%), coordinating with (11%), collaborating with (11%), and contacting (2%) fellow members of the multidisciplinary treatment team were rare. Hectic (7%) and shocking (5%) situations and panic (2%) around the child’s death were rare. GPs reported feelings of sadness (61%) and/or powerlessness (43%) around the time of the patient’s death, and they rated their own distress level as relatively high during the terminal phase (median score: 6, range: 0-9.5). The majority of GPs (94%) reported that they ultimately came to terms with the child’s death.Conclusion: in general, GPs appear to be satisfied with the quality of home-based palliative care that they provide pediatric patients with incurable cancer. Communication among healthcare professionals is generally positive and is considered important. Finally, although the death of a pediatric patient has a profound impact on the GP, the majority of GPs eventually come to terms with the child’s deat
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