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Inclusive communication in a diverse and complex health system: a patient - doctor partnership
No full textPrimary care aims to provide people an equal opportunity to reach their full
potential of health. By providing an easy access to the most appropriate, high
quality care, primary care professionals support people in managing and coping
with their health problems. To organize the most suitable care and support,
primary care professionals and patients need to work together. Effectively
managing health problems requires sufficient knowledge and skills. Faced with
major challenges: a shift in care towards the community, the increasing number
of people with long-term illnesses and disabilities, as well as the shifting role with
patients increasingly expected to take on responsibility for maintaining, protecting
and improving their health, primary care is in need for effective communication
and collaboration between primary care professionals and patients.
In the present dissertation, primary care professionals’, i.e. GPs and PCNs,
responsiveness to people’s health and communication needs is studied.
In the first part, we explored GPs’ responsiveness to patients’ HL needs and the
relation with the quality of GP care, as evaluated by patients. To ensure personcentred, equitable care, it is of utmost importance that GPs are able to effectively
communicate with patients of varying health literacy levels. Being responsive to
patients’ HL needs is not only crucial to ensure patients can engage in shared
decision-making, it also serves to provide patients with the necessary support to
self-manage their health. To get a better understanding of the interrelation
between GPs’ estimates of patients’ HL and patient satisfaction and patients’ postconsultation enablement, we assessed the (in)accuracy of GPs’ intuitive
assessments of their patients’ HL. Our study demonstrated that GPs tend to
overestimate patients’ HL. These patients, whose HL was overestimated by their
GP, were less likely to feel satisfied about the relation and communication with;
and the information and support provided by their GP. We did not found a
correlation between patients’ improved ability to manage or cope with their health
problems after having consulted with their GP, on the one hand, and patients’ HL,
GPs’ ((in)correct) estimations thereof. Post-consultation enablement did correlate
with increasing age. Our research on HL-responsiveness was conducted within 41
general practices, without on-site guidance. To maximize participation, we
feasibility tested the HLS-EU-Q16 in people at risk of low HL, prior to our research in general practices. The cognitive interviews showed that, overall, this
questionnaire was comprehensible. The questionnaire would benefit from some
contextual information.
In the second part of this thesis, we focused on the care for people with a
disability. Primary care professionals are increasingly expected to address the
health needs of this population. Given the specific and often complex health needs,
we wanted to explore to what extent GPs’ and PCNs’ are knowledgeable about the
care that is available to people with a disability within the community. Moreover,
we asked GPs and PCNs to self-report about the quality of their interprofessional
communication, within the context of the care they provide to people with a
disability. Our study revealed that few GPs and PCNs are knowledgeable about
tools to support communication, which is problematic, given the communication
difficulties people with a disability experience. GPs and PCNs have complementary
expertise on the care available to people with a disability. Both groups were most
knowledgeable about supportive measures related to housing adaptations and
mobility. In contrast to previous research, GPs and PCNs’ communication with
home care and residential care was perceived as (very) well. However, quality did
vary, depending on the type of professional and the context in which GPs or PCNs
provided care to PDs.
To ensure the quality and safety of care, 'customization' is important. Whether it
concerns primary care professionals or patients: in order to provide the necessary
support in the decisions they make or the actions they take, it is important to tap
into their motivation, knowledge and skills to obtain, process and apply health
information. In the partnership with patients, it is especially important to tap into
people’s competencies. Not only from a patient safety perspective, to guarantee
the quality of (self-)care, but also from an empowerment-perspective, to support
people, especially those with reduced self-reliance or communication disorders, to
be in control over their health. This dissertation is a plea to move away from the
'one size' communication, to inclusive communication.De eerstelijnszorg is erop gericht mensen gelijke kansen te bieden op een
optimale gezondheid. Door een gemakkelijke toegang te bieden tot de meest
geschikte, kwalitatieve zorg, bieden eerstelijnszorgverleners de nodige
ondersteuning opdat mensen zelf kunnen instaan voor het managen van en
omgaan met hun gezondheidsproblemen.
Om de meest gepaste zorg en ondersteuning te kunnen organiseren, moeten
eerstelijnsprofessionals en patiënten samenwerken. Een doeltreffende aanpak van
gezondheidsproblemen vereist kennis en vaardigheden. De eerstelijnszorg wordt
geconfronteerd met grote uitdagingen: een verschuiving van zorg richting de
vertrouwde omgeving, naar de gemeenschap; het toenemend aantal mensen met
langdurige aandoeningen; evenals een veranderende rol ten aanzien van
patiënten, die steeds vaker geacht worden verantwoordelijkheid op te nemen voor
het behouden, beschermen en verbeteren van hun gezondheid; waardoor de
behoefte aan effectieve communicatie en samenwerking tussen
eerstelijnszorgprofessionals en patiënten toeneemt.
Binnen dit doctoraatsproefschrift onderzoeken we in welke mate
eerstelijnsprofessionals, huisartsen en eerstelijnsverpleegkundigen kunnen
inspelen op de gezondheids- en communicatiebehoeften van mensen.
In het eerste deel onderzochten we de mate waarin huisartsen tegemoet komen
aan de behoeften van patiënten wat hun gezondheidsvaardigheden betreft en de
relatie hiervan met de kwaliteit van
Om persoonsgerichte, billijke zorg te garanderen, is het van het grootste belang
dat huisartsen effectief kunnen communiceren met patiënten van verschillende
niveaus op vlak van gezondheidsvaardigheden. Inspelen op de
gezondheidsvaardigheden-behoeften van patiënten is niet alleen cruciaal om
ervoor te zorgen dat patiënten kunnen deelnemen aan gedeelde besluitvorming,
het laat ook toe om patiënten de nodige ondersteuning te bieden om zelf hun
gezondheid te onderhouden, verbeteren of beschermen. We trachtten een beter
inzicht te krijgen op de onderlinge relatie tussen de inschattingen van huisartsen
van hun patiënten hun gezondheidsvaardigheden en: patiënttevredenheid, enerzijds, en het verbeterd vermogen van patiënten om na het consult voor hun
gezondheid te zorgen, anderzijds. Daartoe onderzochten we de
(on)nauwkeurigheid van huisartsen hun intuïtieve inschattingen van de
gezondheidsvaardigheden van hun patiënten. Onze studie toonde aan dat de
meeste huisartsen de gezondheidsvaardigheden van hun patiënten overschatten.
Deze patiënten, van wie de gezondheidsvaardigheden door de huisarts overschat
werd, hadden een minder grote kans om tevreden te zijn over de relatie en
communicatie met; en de informatie en ondersteuning die ze kregen van hun
huisarts. We vonden geen correlatie tussen het verbeterde vermogen van
patiënten om hun gezondheidsproblemen te onderhouden of ermee om te gaan
na het consult met hun huisarts, enerzijds, en de (in)correcte inschattingen van
patiënten hun gezondheidsvaardigheden door huisartsen. Het verbeterd
vermogen om z’n gezondheidsproblemen aan te pakken na het consult correleerde
wel met een toenemende leeftijd van patiënten. Ons onderzoek naar het
beantwoorden van de behoeften op vlak van gezondheidsvaardigheden, werd
uitgevoerd binnen 41 huisartsenpraktijken, zonder begeleiding ter plaatse. Om de
deelname te maximaliseren, hebben we – voorafgaand aan ons onderzoek in
huisartsenpraktijken – de haalbaarheid van de HLS-EU-Q16 getest, en dit bij
mensen met een risico op een lage gezondheidsvaardigheden. Uit de cognitieve
interviews bleek dat deze vragenlijst over het algemeen begrijpelijk was. De
vragenlijst heeft wel baat bij wat contextuele informatie.
In het tweede deel van dit doctoraatsproefschrift hebben we ons gericht op de
zorg voor mensen met een beperking. Eerstelijnsprofessionals worden geacht om
de gezondheidsbehoeften van deze populatie te kunnen beantwoorden. Gezien de
specifieke en vaak complexe gezondheidsbehoeften van deze populatie,
onderzochten we in hoeverre huisartsen en eerstelijnsverpleegkundigen kennis
hebben van de zorg die beschikbaar is voor mensen met een beperking, binnen
de gemeenschap. Daarnaast vroegen we huisartsen en
eerstelijnsverpleegkundigen om te rapporteren over de kwaliteit van hun
communicatie, zoals zij die ervaren. Op die manier krijgen we inzicht in hun
samenwerking in het kader van de zorg voor mensen met een beperking. Uit ons
onderzoek bleek dat zowel huisartsen, als eerstelijnsverpleegkundigen beperkte
kennis hebben over hulpmiddelen om communicatie te ondersteunen. Dit is
problematisch, gezien de communicatieproblemen die mensen met een beperking ervaren. Huisartsen en eerstelijnsverpleegkundigen hebben complementaire
expertise over de zorg die beschikbaar is voor mensen met een beperking. Beide
groepen waren het meest op de hoogte van ondersteunende maatregelen met
betrekking tot woningaanpassingen en mobiliteit. In tegenstelling tot eerder
onderzoek werd de communicatie van huisartsen en eerstelijnsverpleegkundigen
met zorgverleners in de thuiszorg en in de residentiële zorg over het algemeen
als (zeer) goed ervaren. Dit varieerde echter, afhankelijk van het type professional
en de context waarin huisartsen of eerstelijnsverpleegkundigen zorg verleenden
aan mensen met een beperking.
Om de kwaliteit en veiligheid van zorg te waarborgen is 'maatwerk' belangrijk. Of
het nu gaat om eerstelijnszorgprofessionals of patiënten: om de nodige
ondersteuning te bieden bij de beslissingen die ze nemen of de acties die ze
ondernemen, is het belangrijk om hun motivatie, kennis en vaardigheden aan te
boren om gezondheidsinformatie te verkrijgen, te verwerken en toe te passen. In
de samenwerking met patiënten is het vooral belangrijk om de competenties van
mensen aan te boren. Niet alleen vanuit patiëntveiligheidsperspectief, om de
kwaliteit van (zelf)zorg te waarborgen, maar ook vanuit een empowermentperspectief, om mensen, met name mensen met verminderde zelfredzaamheid of
communicatiestoornissen, te ondersteunen om controle te hebben over hun
gezondheid. Dit doctoraatsproefschrift is een pleidooi om af te stappen van de
'one size' communicatie, naar inclusieve communicatie
General practitioners' predictions of their own patients' health literacy: a cross-sectional study in Belgium
No full textOBJECTIVES: To support patients in their disease management, providing information that is adjusted to patients' knowledge and ability to process health information (ie, health literacy) is crucial. To ensure effective health communication, general practitioners (GPs) should be able to identify people with limited health literacy. To this end, (dis)agreement between patients' health literacy and GPs' estimations thereof was examined. Also, characteristics impacting health literacy (dis)agreement were studied. DESIGN: Cross-sectional survey of general practice patients and GPs undertaken in 2016-17. SETTING: Forty-one general practices in two Dutch-speaking provinces in Belgium. PARTICIPANTS: Patients (18 years of age and older) visiting general practices. Patients were excluded when having severe impairments (physical, mental, sensory). MAIN OUTCOME MEASURES: Patients' health literacy was assessed with 16-item European Health Literacy Survey Questionnaire. GPs indicated estimations on patients' health literacy using a simple scale (inadequate; problematic; adequate). (Dis)agreement between patients' health literacy and GPs' estimations thereof (GPs' estimations being equal to/higher/lower than patients' health literacy) was measured using Kappa statistics. The impact of patient and GP characteristics, including duration of GP-patient relationships, on this (dis)agreement was examined using generalised linear logit model. RESULTS: Health literacy of patients (n=1375) was inadequate (n=201; 14.6%), problematic (n=299; 21.7%), adequate (n=875; 63.6%). GPs overestimated the proportion patients with adequate health literacy: adequate (n=1241; 90.3%), problematic (n=130; 9.5%) and inadequate (n=4; 0.3%). Overall, GPs' correct; over-/underestimations of health literacy occurred for, respectively, 60.9%; 34.2%; 4.9% patients, resulting in a slight agreement (κ=0.033). The likelihood for GPs to over-/underestimate patients' health literacy increases with decreasing educational level of patients; and decreasing number of years patients have been consulting with their GP. CONCLUSIONS: Intuitively assessing health literacy is difficult. Patients' education, the duration of GP-patient relationships and GPs' gender impact GPs' perceptions of patients' health literacy.status: Publishe
Implementing an electronic medication overview in Belgium
No full textBackground
An accurate medication overview is essential to reduce medication errors. Therefore, it is essential to keep the medication overview up-to-date and to exchange healthcare information between healthcare professionals and patients. Digitally shared information yields possibilities to improve communication. However, implementing a digitally shared medication overview is challenging. This articles describes the development process of a secured, electronic platform designed for exchanging medication information as executed in a pilot study in Belgium, called “Vitalink”.
Findings
The goal of “Vitalink” is to improve the exchange of medication information between professionals working in healthcare and patients in order to achieve a more efficient cooperation and better quality of care. Healthcare professionals of primary and secondary health care and patients of four Belgian regions participated in the project. In each region project groups coordinated implementation and reported back to the steering committee supervising the pilot study. The electronic medication overview was developed based on consensus in the project groups. The steering committee agreed to establish secured and authorized access through the use of electronic identity documents (eID) and a secured, eHealth-platform conform prior governmental regulations regarding privacy and security of healthcare information.
Discussion
A successful implementation of an electronic medication overview strongly depends on the accessibility and usability of the tool for healthcare professionals. Coordinating teams of the project groups concluded, based on their own observations and on problems reported to them, that secured and quick access to medical data needed to be pursued. According to their observations, the identification process using the eHealth platform, crucial to ensure secured data, was very time consuming. Secondly, software packages should be adapted to daily activities of healthcare professionals. Moreover, software should be easy to install and run properly. The project would have benefited from a cost analysis executed by the national bodies prior to implementation
Implementing an electronic medication overview in Belgium
No full textBackground
An accurate medication overview is essential to reduce medication errors. Therefore, it is essential to keep the medication overview up-to-date and to exchange healthcare information between healthcare professionals and patients. Digitally shared information yields possibilities to improve communication. However, implementing a digitally shared medication overview is challenging. This articles describes the development process of a secured, electronic platform designed for exchanging medication information as executed in a pilot study in Belgium, called “Vitalink”.
Findings
The goal of “Vitalink” is to improve the exchange of medication information between professionals working in healthcare and patients in order to achieve a more efficient cooperation and better quality of care. Healthcare professionals of primary and secondary health care and patients of four Belgian regions participated in the project. In each region project groups coordinated implementation and reported back to the steering committee supervising the pilot study. The electronic medication overview was developed based on consensus in the project groups. The steering committee agreed to establish secured and authorized access through the use of electronic identity documents (eID) and a secured, eHealth-platform conform prior governmental regulations regarding privacy and security of healthcare information.
Discussion
A successful implementation of an electronic medication overview strongly depends on the accessibility and usability of the tool for healthcare professionals. Coordinating teams of the project groups concluded, based on their own observations and on problems reported to them, that secured and quick access to medical data needed to be pursued. According to their observations, the identification process using the eHealth platform, crucial to ensure secured data, was very time consuming. Secondly, software packages should be adapted to daily activities of healthcare professionals. Moreover, software should be easy to install and run properly. The project would have benefited from a cost analysis executed by the national bodies prior to implementation
Implementing an electronic medication overview in Belgium
No full textAbstract: Background An accurate medication overview is essential to reduce medication errors. Therefore, it is essential to keep the medication overview up-to-date and to exchange healthcare information between healthcare professionals and patients. Digitally shared information yields possibilities to improve communication. However, implementing a digitally shared medication overview is challenging. This articles describes the development process of a secured, electronic platform designed for exchanging medication information as executed in a pilot study in Belgium, called Vitalink. Findings The goal of Vitalink is to improve the exchange of medication information between professionals working in healthcare and patients in order to achieve a more efficient cooperation and better quality of care. Healthcare professionals of primary and secondary health care and patients of four Belgian regions participated in the project. In each region project groups coordinated implementation and reported back to the steering committee supervising the pilot study. The electronic medication overview was developed based on consensus in the project groups. The steering committee agreed to establish secured and authorized access through the use of electronic identity documents (eID) and a secured, eHealth-platform conform prior governmental regulations regarding privacy and security of healthcare information. Discussion A successful implementation of an electronic medication overview strongly depends on the accessibility and usability of the tool for healthcare professionals. Coordinating teams of the project groups concluded, based on their own observations and on problems reported to them, that secured and quick access to medical data needed to be pursued. According to their observations, the identification process using the eHealth platform, crucial to ensure secured data, was very time consuming. Secondly, software packages should meet the needs of their users, thus be adapted to daily activities of healthcare professionals. Moreover, software should be easy to install and run properly. The project would have benefited from a cost analysis executed by the national bodies prior to implementation
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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