Frans van der Horst

Provider-patient interaction in diabetes care: effects on patient self-care and outcomes. A systematic review.

A systematic review of the research literature using Medline, Embase, Psyclit/Psycinfo and the Cochrane Library files 1980 through 2001, identified only eight publications based on well-designed studies involving randomised controlled trials (RCTs)--testing the effects of modification of provider-patient interaction and provider consulting style on patient diabetes self-care and diabetes outcomes, in general practice or hospital outpatient settings. Review of these publications leads to the tentative conclusion that focusing on patient behaviour--directly enhancing patient participation i.e. by assistant-guided patient preparation for visits to doctors, empowering group education, group consultations, or automated telephone management--is more effective than focusing on provider behaviour to change their consulting style into a more patient-centred one. The latter proves hard to sustain, needs intensive support, and is not very effective in improving patient self-care and health outcomes when executed alone. Patient behaviour focused interventions show good efficacy and efficiency, and improve patient self-care and diabetes outcomes. More well-designed intervention studies focusing on enhancing patient participation in primary and hospital outpatient diabetes care are needed.

Review articleProvider–patient interaction in diabetes care: effects on patient self-care and outcomes: A systematic review

A systematic review of the research literature using Medline, Embase, Psyclit/Psycinfo and the Cochrane Library files 1980 through 2001, identified only eight publications based on well-designed studies involving randomised controlled trials (RCTs)--testing the effects of modification of provider-patient interaction and provider consulting style on patient diabetes self-care and diabetes outcomes, in general practice or hospital outpatient settings. Review of these publications leads to the tentative conclusion that focusing on patient behaviour--directly enhancing patient participation i.e. by assistant-guided patient preparation for visits to doctors, empowering group education, group consultations, or automated telephone management--is more effective than focusing on provider behaviour to change their consulting style into a more patient-centred one. The latter proves hard to sustain, needs intensive support, and is not very effective in improving patient self-care and health outcomes when executed alone. Patient behaviour focused interventions show good efficacy and efficiency, and improve patient self-care and diabetes outcomes. More well-designed intervention studies focusing on enhancing patient participation in primary and hospital outpatient diabetes care are needed.

Obstacles to adherence in living with type-2 diabetes: An international qualitative study using meta-ethnography (EUROBSTACLE)

Quantitative studies failed to determine variables which consistently explain adherence or non-adherence to treatment recommendations. Qualitative studies identified issues such as the quality of the health provider-health receiver relationship and the patients health beliefs. According to these findings, 39 focus groups of 246 people living with type-2 diabetes were conducted in seven European countries, assessing health beliefs, communication with caregivers and problems encountered in adhering to treatment regimens. Meta-ethnography was later applied to make a qualitative meta-analysis. Obstacles to adherence are common across countries, and seem to be related less to issues of the health-care system and more to patients knowledge about diabetes, beliefs and attitudes and the relationship with health-care professionals. The resulting key themes are course of diabetes, information, person and context, body awareness and relationship with the health care provider. Meta-ethnography is a feasible tool for the meta-analysis of multilingual qualitative data and leads to a richer account.

Determinants of patient satisfaction after cataract surgery in 3 settings

Purpose: To analyze the determinants of satisfaction and postoperative visual function after cataract surgery in 3 settings in The Netherlands. Setting: University Hospital Maastricht (outpatient care), Atrium Medical Center Heerlen (inpatient care), and Medical Center Maastricht Annadal (outpatient care), Maastricht, The Netherlands. Methods: This cross‐sectional study consisted of 150 patients of 50 years and older who had first‐eye phacoemulsification with intraocular lens implantation. Data were collected by a written questionnaire. The following parameters were measured: medical outcome, postoperative function, patient satisfaction with medical outcome and hospital care, and overall patient satisfaction. Results: In general, patients were very satisfied (mean score 8.43 on a 10‐point scale ranging from 1 = very bad to 10 = excellent). The 3 centers did not differ regarding the patient satisfaction (P = .092). However, postoperative visual function (P = .012), counseling (P = .010), and waiting time (P < .001) were different among the settings. Patient satisfaction with hospital care had a stronger correlation with overall satisfaction than patient satisfaction with the medical outcome (r = 0.669 versus r = 0.543, respectively). Conclusions: A causal model of patient satisfaction was tested, indicating that satisfaction was related to the patients preoperative expectations and the quality of care given during the hospital stay and follow‐up at the outpatient clinic. This emphasizes the relevance of patient education (to set realistic expectations) and counseling (need for care) by hospital staff in a cataract surgery setting.

Prevalence of habitual refractive errors and anisometropia among Dutch schoolchildren and hospital employees

Purpose:  Refractive error (RE) is suggested to cause not only visual impairment, but also functional problems such as aspecific health complaints and lower levels of school achievement. During the last few decades the prevalence of myopia has increased worldwide, especially in Asia. We investigated the prevalence of habitual RE and anisometropia in a Dutch population of children and employees.

Determinants of doctor consultation for micturition problems in an elderly male population

Objective: To study which factors influence doctor consultation when a subject has micturition problems. Methods: Postal questionnaire in an open population of older men (n = 1,695), followed by investigations in 10 general practices, including uroflowmetry. Results: 25% of the men had micturition problems, of which 10–30% presented their symptoms to a doctor. Almost 60% experienced an influence of their micturition habits on activities of daily living. More than 85% of the men were not able to compare their micturition pattern with others. In multiple logistic regression, presentation to a doctor was independently associated with obstructive symptoms, dysuria, men defining their situation as a complaint, depressive mood, more frequent sexual desire and smoking. Many other factors which might play a role in diagnosis and timing of treatment were not found to influence consultation. Conclusion: Most men deal with micturition problems without consulting, although symptoms have a substantial impact on daily life. Consultation was associated with symptoms, psychological factors and smoking.

Relationship between habitual refractive errors and headache complaints in schoolchildren.

Purpose. Refractive error (RE) is considered to be a possible cause for headaches. We aimed to gain insight into the relation between habitual RE (sphere and astigmatism) and headache complaints. Methods. In a cross-sectional study the habitual refractive state of 487 children, aged between 11 and 13 years, was measured using an autorefractometer (Topcon, RM-8000B). Headache complaints were measured using a questionnaire. Data were analyzed using Pearson correlation coefficients, bivariate analysis, and multiple logistic regression analysis. Results. For right eyes we found 15% habitual myopia <−0.50 D and 12% habitual hyperopia >+0.50 D; habitual astigmatism >0.25 D was found in 33% of children. Pearson R between right and left eyes was 0.76 for the spherical component and 0.42 for the cylindrical. In the total group of children 70% reported the occurrence of headache in the last year. These headaches were reported as “often or frequent” by 37% of children, “severe” by 15%, “with long duration” by 45%, and “with severe burden” by 27%. In the total sample we found various associations between gender, sphere/cylinder components of habitual RE, and headache complaints. Headache was reported more in girls than in boys. Of the total variance of headache complaints in girls, the sphere component of habitual RE explained 4% of frequency, 6% of intensity, 2% of duration, and 2% of amount of burden. Of the total variance of headache complaints in boys the cylinder component of habitual RE explained 3% of frequency, and 4% in amount of burden. Conclusion. Habitual RE and headache complaints are relatively common conditions in schoolchildren aged between 11 and 13 years. Headache complaints showed a small but statistically significant association with the sphere component of habitual RE in girls and the cylinder component of habitual RE in boys. The associations found between habitual RE and headache complaints indicate that habitual RE might be a risk factor for headache in children.

Barriers and facilitating factors in the professional careers of international medical graduates

Medical Education 2010: 44: 795–804

Identifying Experiential Expertise to Support People With Diabetes Mellitus in Applying for and Participating Effectively in Paid Work A Qualitative Study

Objective: Identifying and describing successful diabetes-related (SDR) behaviors from reports by experiential experts to support people with diabetes in applying for and participating effectively in paid work. Methods: Data were collected by conducting in-depth interviews with experiential experts with diabetes (N = 47). Results: A comprehensive set of SDR behaviors that can help people with diabetes apply for and participate in paid work. The most important factors were reported to be the ability to anticipate problems in job applications, effective self-management activities to prevent and/or respond to hypoglycemia and hyperglycemia at work, informing relevant others in the workplace, and successfully negotiating with employers about adjustments to work conditions. Conclusions: A set of work-related SDR behaviors was identified. After validation by experiential experts and professionals, these could be translated into recommendations and tested in experiments in self-management programs.

Potential barriers and facilitators for implementation of an integrated care pathway for hearing-impaired persons: an exploratory survey among patients and professionals.

BackgroundBecause of the increasing costs and anticipated shortage of Ear Nose and Throat (ENT) specialists in the care for hearing-impaired persons, an integrated care pathway that includes direct hearing aid provision was developed. While this direct pathway is still under investigation, in a survey we examined expectations and potential barriers and facilitators towards this direct pathway, of patients and professionals involved in the pathway.MethodsTwo study populations were assessed: members of the health professions involved in the care pathway for hearing-impaired persons (general practitioners (GPs), hearing aid dispensers, ENT-specialists and clinical audiologists) and persons with hearing complaints. We developed a comprehensive semi-structured questionnaire for the professionals, regarding expectations, barriers, facilitators and conditions for implementation. We developed two questionnaires for persons with hearing complaints, both regarding evaluations and preferences, and administered them after they had experienced two key elements of the direct pathway: the triage and the hearing aid fitting.ResultsOn average GPs and hearing aid dispensers had positive expectations towards the direct pathway, while ENT-specialists and clinical audiologists had negative expectations. Professionals stated both barriers and facilitators towards the direct pathway. Most professionals either supported implementation of the direct pathway, provided that a number of conditions were satisfied, or did not support implementation, unless roughly the same conditions were satisfied. Professionals generally agreed on which conditions need to be satisfied. Persons with hearing complaints evaluated the present referral pathway and the new direct pathway equally. Many, especially older, participants stated however that they would still visit the GP and ENT-specialist, even when this would not be necessary for reimbursement of the hearing aid, and found it important that the ENT-specialist or Audiological Centre evaluated their hearing aid.ConclusionThis study identified professional concerns about the direct pathway for hearing-impaired persons. Gaps exist in expectations amongst professions. Also gaps exist between users of the pathway, especially between age groups and regions. Professionals are united in the conditions that need to be fulfilled for a successful implementation of the direct pathway. Implementation on a regional level is recommended to best satisfy these conditions.