Anneke van Dijk-de Vries

Effectiveness of Teamwork in an Integrated Care Setting for Patients with COPD: Development and Testing of a Self-Evaluation Instrument for Interprofessional Teams

Introduction: Teamwork between healthcare providers is conditional for the delivery of integrated care. This study aimed to assess the usefulness of the conceptual framework Integrated Team Effectiveness Model for developing and testing of the Integrated Team Effectiveness Instrument. Theory and methods: Focus groups with healthcare providers in an integrated care setting for people with chronic obstructive pulmonary disease (COPD) were conducted to examine the recognisability of the conceptual framework and to explore critical success factors for collaborative COPD practice out of this framework. The resulting items were transposed into a pilot instrument. This was reviewed by expert opinion and completed 153 times by healthcare providers. The underlying structure and internal consistency of the instrument were verified by factor analysis and Cronbach’s alpha. Results: The conceptual framework turned out to be comprehensible for discussing teamwork effectiveness. The pilot instrument measures 25 relevant aspects of teamwork in integrated COPD care. Factor analysis suggested three reliable components: teamwork effectiveness, team processes and team psychosocial traits (Cronbach’s alpha between 0.76 and 0.81). Conclusions and discussion: The conceptual framework Integrated Team Effectiveness Model is relevant in developing a practical full-spectrum instrument to facilitate discussing teamwork effectiveness. The Integrated Team Effectiveness Instrument provides a well-founded basis to self-evaluate teamwork effectiveness in integrated COPD care by healthcare providers. Recommendations are provided for the improvement of the instrument.

Lessons learnt from a cluster-randomised trial evaluating the effectiveness of Self-Management Support (SMS) delivered by practice nurses in routine diabetes care

Objective To evaluate the effectiveness of biopsychosocial Self-Management Support (SMS) delivered by practice nurses in routine diabetes care. Design A pragmatic cluster-randomised controlled trial within a hybrid effectiveness-implementation study design. Practice nurses were cluster-randomised. Setting A regional care group in the Netherlands consisting of 77 family practices. The study involved practice nurses (n=40) providing care to approximately 4000 patients with diabetes. Participants Patients with type 2 diabetes (n=264) selected by a self-administered questionnaire aimed at measuring emotional distress and diabetes-related reduced daily functioning. Intervention Practice nurses in the intervention arm (n=19) were trained to integrate SMS into their routine consultations. SMS included detection of patients with emotional distress and reduced daily functioning, and supporting them when needed through problem solving and reattribution techniques. Practice nurses in the control arm (n=21) provided usual care. Main outcome measures The primary outcome measure was a dichotomised score on a Visual Analogue Scale that measured the perceived effect of diabetes on daily functioning. Secondary measures included patients’ diabetes-related distress, quality of life, autonomy and participation, self-efficacy, self-management and glycaemic control. Outcomes were measured at baseline and at 4-month and 12-month follow-ups. Results Only 16 of the 117 patients in the intervention arm (14%) who were found eligible by the posted research-driven screening questionnaire were detected by their practice nurses. Extra consultations for the self-management support were delivered to only 11 study participants. In the control arm, 147 patients received usual care. Multilevel analyses showed no significant differences in outcomes between the intervention and control arms. Conclusions SMS in its present form was not effective. The research-driven screening to select trial participants appeared to be inconsistent with nurse-led detection in routine practice. Adequate follow-up moments need to be built in to overcome barriers resulting from tension between the implementation and effectiveness parts of hybrid studies. Trial registration number Current Controlled Trials NTR2764.

Sustainable interprofessional teamwork needs a team-friendly healthcare system: Experiences from a collaborative Dutch programme

ABSTRACT The significance of effective interprofessional teamwork to improve the quality of care has been widely recognised. Effective interprofessional teamwork calls on good collaboration between professionals and patients, coordination between professionals, and the development of teamwork over time. Effective development of teams also requires support from the wider organisational context. In a Dutch village, healthcare professionals work closely together, and mutual consultations as well as interprofessional meetings take place on a regular basis. The network was created as a precondition for sustainable interprofessional teamwork in elderly care. However, several external barriers were experienced regarding the supportive structure and cooperative attitude of the healthcare insurer and municipality. The aim of the article is to examine these experience-based issues regarding internal organisation, perspective, and definition of effective teamwork. Complicating factors refer to finding the right key figures, and the different perspectives on team development and team effectiveness. Our conclusion is that the organisation of healthcare insurance companies needs to implement fundamental changes to facilitate an interprofessional care approach. Furthermore, municipalities should work on their vision of the needs and benefits of a fruitful collaboration with interprofessional healthcare teams. The challenge for healthcare teams is to learn to speak the language of external partners. To support the development of interprofessional teams, external parties need to recognise and trust in a shared aim to provide quality of care in an efficient and effective way.The significance of effective interprofessional teamwork to improve the quality of care has been widely recognised. Effective interprofessional teamwork calls on good collaboration between professionals and patients, coordination between professionals, and the development of teamwork over time. Effective development of teams also requires support from the wider organisational context. In a Dutch village, healthcare professionals work closely together, and mutual consultations as well as interprofessional meetings take place on a regular basis. The network was created as a precondition for sustainable interprofessional teamwork in elderly care. However, several external barriers were experienced regarding the supportive structure and cooperative attitude of the healthcare insurer and municipality. The aim of the article is to examine these experience-based issues regarding internal organisation, perspective, and definition of effective teamwork. Complicating factors refer to finding the right key figures, and the different perspectives on team development and team effectiveness. Our conclusion is that the organisation of healthcare insurance companies needs to implement fundamental changes to facilitate an interprofessional care approach. Furthermore, municipalities should work on their vision of the needs and benefits of a fruitful collaboration with interprofessional healthcare teams. The challenge for healthcare teams is to learn to speak the language of external partners. To support the development of interprofessional teams, external parties need to recognise and trust in a shared aim to provide quality of care in an efficient and effective way.

An Instrument to Assess the Needs of Patients with Type 2 Diabetes Mellitus for Health-Promotion Activities

AbstractBackground: Health promotion has become an integral part of primary healthcare for patients with chronic illness. A practical instrument to identify patient needs in health promotion will support patient-centered health counseling. Objective: The objective of the study was to develop and pilot test the ‘Health Promotion Diabetes’ (HEPRODIA) instrument, which aims to identify the needs of patients with diabetes mellitus for health-promoting activities with regard to their preferred lifestyle behavior change. Methods: Scale development of the instrument was guided by existing insights and expert opinion. Questionnaire data were collected in a sample of patients (n=221) from eight primary care practices in the southern part of the Netherlands.The resulting instrument comprised a fixed set of 14 items to elicit patients’ preferred lifestyle change, plus a variable set of 4–20 items concerning specific barriers and support needs regarding the chosen change. The instrument provides a starting point for discussion with a practice nurse about healthy lifestyle changes.Internal consistency (Cronbach’s α) and feasibility of the instrument, as well as experiences of the practice nurses using the instrument, were evaluated. Results: Cronbach’s α of the different scales ranged from 0.46 to 0.74. The practice nurses perceived the instrument as useful in daily practice and that it may be improved by further adjustment of patient segments. Conclusion: The HEPRODIA instrument is an aid to assess patient needs concerning health-promoting activities and to facilitate health counseling. Patients and practice nurses can benefit from using the instrument for patient-orientated health-promotion counseling. The psychometric properties of the instrument can be further improved.

Innovatieve geriatrische zorg

SamenvattingDoor vergrijzing zien vrijwel alle ziekenhuisafdelingen een toename van het percentage oudere patiënten. Zij hebben een forse kans op complicaties en op functieverlies. Reden voor het Zuyderland Medisch Centrum om sterk in te zetten op samenwerking met de eerstelijn.

Het meten van samenwerking in de zorg voor COPD-patiënten

SamenvattingOm de kwaliteit van zorg te verbeteren, is effectieve multidisciplinaire samenwerking in een team van zorgverleners van belang. Samenwerking is echter een abstract begrip en een instrument om de samenwerking tussen zorgverleners te evalueren ontbreekt. Deze studie beschrijft de totstandkoming van een dergelijk meetinstrument op basis van het Integrated (Health Care) Team Effectiveness Model (ITEM). De studie is toegepast op geïntegreerde COPD-zorg volgens een keten-DBC. Het ITEM is allereerst in focusgroepinterviews vanuit de praktijk ingevuld door vertegenwoordigers van de kerndisciplines in COPD-zorg. Hieruit is een meetinstrument afgeleid. Deze ‘ITEM-checklist’ is een checklist bestaande uit 25 stellingen over samenwerking. Zorgverleners kunnen dit gebruiken als basis voor een teamevaluatiegesprek. Het instrument is ter member check voorgelegd aan huisartsen, COPD-praktijkondersteuners, longverpleegkundigen en een longarts en vervolgens uitgetest onder zes leden van een COPD-samenwerkingsverband. Op basis van een Principal Component Analysis zijn drie intern consistente (α = 0.76-0.81) componenten onderscheiden, die teruggrijpen op de ITEM-domeinen ‘teameffectiviteit’, ‘teamproces’ en ‘teamkenmerken’. De combinatie van het theoretische ITEM-model met input vanuit het werkveld blijkt zo een bruikbare manier om een gefundeerd en in de praktijk toepasbaar meetinstrument te ontwikkelen. Deze studie bespreekt aanknopingspunten voor verfijning van het instrument.AbstractTeamwork assessment in multidisciplinary COPD teamsMultidisciplinary teams have become essential for chronic care. However, team effectiveness is a complex and multifaceted construct. This study describes the development and validation of a teamwork assessment instrument for multidisciplinary COPD teams. The instrument is based on the Integrated Health Care Team Effectiveness Model (ITEM), an overarching framework for conceptualizing the relationships between multiple dimensions of team context, structure, processes and outcomes in health care settings. Focus groups with caregivers in COPD were generated to apply ITEM into daily practice. Relevant aspects of teamwork, discussed in the focus groups, were transposed into an assessment instrument (a checklist of 25 topics). This ITEM-checklist was reviewed by expert opinion and tested in a COPD team. After that it was completed by health professionals involved in integrated COPD health care teams (N=153). Principal Component Analysis (PCA) and Cronbach’s alpha verified the underlying structure and internal consistency. ITEM turned out to be a comprehensible framework for discussing teamwork effectiveness. Health professionals perceived it as a helpful instrument to assess their collaborative practice and to structure a dialogue about teamwork. Factor analysis suggested 3 reliable components (Cronbach’s alpha between 0.76 and 0.81). These components refer to teamwork effectiveness, team processes and team psycho-social traits. Though the instrument needs further improvement, it already provides a well-founded basis for evaluating teamwork in integrated (COPD-) care.Keywords: teamwork, assessment instrument, COPD