J.E.W.C. van Gemert-Pijnen

Systematic literature analysis and review of targeted preventive measures to limit healthcare-associated infections by meticillin-resistant Staphylococcus aureus

Meticillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections in Europe. Many examples have demonstrated that the spread of MRSA within healthcare settings can be reduced by targeted infection control measures. The aim of this systematic literature analysis and review was to summarise the evidence for the use of bacterial cultures for active surveillance the benefit of rapid screening tests, as well as the use of decolonisation therapies and different types of isolation measures. We included 83 studies published between 2000 and 2012. Although the studies reported good evidence supporting the role of active surveillance followed by decolonisation therapy, the effectiveness of single-room isolation was mostly shown in non-controlled studies, which should inspire further research regarding this issue. Overall, this review highlighted that when planning the implementation of preventive interventions, there is a need to consider the prevalence of MRSA, the incidence of infections, the competing effect of standard control measures (e.g. hand hygiene) and the likelihood of transmission in the respective settings of implementation.

Towards Innovative Business Modeling for Sustainable eHealth Applications

Modern day healthcare is offering more and more treatment alternatives on the Internet, so-called eHealth. In order to reform the business logic of these organizations from the traditional healthcare services towards more eHealth in their services, an implementation strategy is needed to guide this reformation. A currently popular approach to guide these reformations and to come to an eventual implementation is by the use of business models. This paper describes what business models are and what their potential for designing and implementing eHealth applications can be. Also, three recent methods of business modeling that aimed to create sustainable eHealth applications will be described as an example, followed by some potential complications and their corresponding challenges that can appear when working on a business model for innovative eHealth applications.

Evaluating patient care communication in integrated care settings: application of a mixed method approach in cerebral palsy programs

OBJECTIVE In this study, we evaluated patient care communication in the integrated care setting of children with cerebral palsy in three Dutch regions in order to identify relevant communication gaps experienced by both parents and involved professionals. DESIGN A three-step mixed method approach was used starting with a questionnaire to identify communication links in which parents experienced gaps. In subsequent in-depth interviews with parents and focus group meetings with professionals underlying factors were evaluated. RESULTS In total, 197 parents completed the questionnaire (response 67%); 6% scored negative on parent-professional communication, whereas 17% scored negative on inter-professional communication, especially between the rehabilitation physician and primary care physiotherapy (16%) and (special) education/day care (15%). In-depth interviews among a subset of 20 parents revealed various sources of dissatisfaction such as lack of cooperation and patient centeredness, inappropriate amount of information exchange and professional use of parents as messenger of information. Focus group meetings revealed that professionals recognized these gaps. They attributed them to capacity problems, lack of interdisciplinary guidelines and clear definition of roles, but also a certain hesitance for contact due to unfamiliarity with involved professionals in the care network. CONCLUSIONS Parents particularly identified gaps in inter-professional communication between (rehabilitation) hospitals and primary care settings. Involved professionals recognized these gaps and primarily attributed them to organizational factors. Improvement initiatives should focus on these factors as well as facilitation of low-threshold contact across the patients care network.

eHealth Research, Theory and Development: A Multi-Disciplinary Approach

This is the first book to provide a comprehensive overview of the social and technological context from which eHealth applications have arisen, the psychological principles on which they are based, and the key development and evaluation issues relevant to their successful intervention. Integrating how eHealth applications can be used for both mental and physical health issues, it presents a complete guide to what eHealth means in theory, as well as how it can be used in practice. Inspired by the principles and structure of the CeHRes Roadmap, a multidisciplinary framework that combines and uses aspects from approaches such as human-centred design, persuasive technology and business modelling, the book first examines the theoretical foundations of eHealth and then assesses its practical application and assessment. Including case studies, a glossary of key terms, and end of chapter summaries, this ground-breaking book provides a holistic overview of one of the most important recent developments in healthcare. It will be essential reading for students, researchers and professionals across the fields of health psychology, public health and design technology.

Usage and Effect of a Web-Based Intervention for the Prevention of Overweight; a Randomized Controlled Trial

Web-based interventions can be effective in changing behaviour of people faced with health problems. However, it is unclear whether they are effective in preventing health problems like overweight. The aim of this study was to investigate usage and effectiveness of a web-based application to increase healthy behaviour in adults with a healthy weight or slight overweight (BMI 18-28 kg/m2) by means of a Randomized Controlled Trial. A total of 297 respondents were randomly assigned to the intervention (n=147) or the waiting list group (n=150). The intervention group received access to the intervention for 12 weeks. At pre- and post-test we measured dietary and physical activity behaviour (primary outcomes) and BMI, knowledge, attitude, self-efficacy, subjective behaviour and insight in behaviour (secondary outcomes). All participants, regardless of randomized group, show improvement in healthy behaviour and subjective assessment of healthy behaviour. People who are older, score higher on dietary behaviour and under-estimate their dietary behaviour are more likely to use the Healthy Weight Assistant (HWA). Using the HWA leads to improvement in physical activity behaviour and insight in this behaviour. Trial Registration: ISRCTN42687923

Evaluation of the Use of an Ask-the-Expert e-Consultation Service for Support on Health-Related Requests

E-consultation in health care can be used to respond to an increasing demand for care by offering support on health-related requests. In this study we evaluated the use of an Ask-the-expert e-consultation service in order to assess whether the service is efficient and useful. A content analysis of e-mail exchange between clients and online health professionals was performed to gain insight in the purposes of use of the service. Our findings show that the service was used for e-mails requests on not urgent, minor ailments. Clients asked for health information to increase knowledge on the cause of their injury or disease, its consequences, self-care solutions and treatment options. Decision support on assessing the necessity to visit a doctor for a certain health problem was another important reason to use the service. We believe that web-based triage systems could be used to more easily assess whether certain symptoms need to be investigated.