Pieter van den Hombergh

Patient safety features are more present in larger primary care practices

OBJECTIVES This study aimed to explore whether specific characteristics of a general practice organization were associated with aspects of patient safety management. METHODS Secondary analysis of data from 271 primary care practices, collected in 10 European countries. These data were collected by a practice visitor and physician questionnaires. For this study we constructed 10 measures of patient safety, covering 45 items as outcomes, and 6 measures of practice characteristics as possible predictors for patient safety. RESULTS Eight of the 10 patient safety measures yielded higher scores in larger practices (practices with more than 2 general practitioners). Medication safety (B 0.64), practice building safety (B 0.49) and incident reporting items (B 0.47) showed the strongest associations with practice size. Also measures on hygiene (B 0.37), medical record keeping (B 0.30), quality improvement (B 0.28), professional competence (B 0.24) and organized patient feedback items (B 0.24) had higher scores in larger practices. CONCLUSION Larger general practice practices may have better safety management, although through our measurements no causal relationship could be established in this study.

Are family practice trainers and their host practices any better? comparing practice trainers and non-trainers and their practices

BackgroundFamily Physician (FP) trainees are expected to be provided with high quality training in well organized practice settings. This study examines differences between FP trainers and non-trainers and their practices to see whether there are differences in trainers and non-trainers and in how their practices are organized and their services are delivered.Method203 practices (88 non-training and 115 training) with 512 FPs (335 non-trainers and 177 trainers) were assessed using the “Visit Instrument Practice organization (VIP)” on 369 items (142 FP-level; 227 Practice level). Analyses (ANOVA, ANCOVA) were conducted for each level by calculating differences between FP trainees and non-trainees and their host practices.ResultsTrainers scored higher on all but one of the items, and significantly higher on 47 items, of which 13 remained significant after correcting for covariates. Training practices scored higher on all items and significantly higher on 61 items, of which 23 remained significant after correcting for covariates. Trainers (and training practices) provided more diagnostic and therapeutic services, made better use of team skills and scored higher on practice organization, chronic care services and quality management than non-training practices. Trainers reported more job satisfaction and commitment and less job stress than non-trainers.DiscussionThere are positive differences between FP trainers and non-trainers in both the level and the quality of services provided by their host practices. Training institutions can use this information to promote the advantages of becoming a FP trainer and training practice as well as to improve the quality of training settings for FPs.

De werkbelasting van de huisarts neemt af

SamenvattingEngels YMP, Mokkink HGA, Van den Hombergh P, Van den Bosch WJHM, Van den Hoogen HJM, Grol R. De werkbelasting van de huisarts neemt af. Huisarts Wet 2003;46(9):482-7.Doel Nagaan of de werkbelasting en werkdruk van huisartsen veranderd zijn tussen 1997/98 en 2002.Methode We onderzochten de verschillen tussen 1997/98 en 2002 in gerapporteerde werkbelasting, het aantal uren dat men minder zou willen werken en de subjectieve werkdruk van huisartsen.Hiervoor maakten we gebruik van data verzameld met het Visitatie Instrument Praktijkvoering (VIP).Resultaten De groep uit 2002 werkte 0,6 uur minder (na correctie) dan de groep uit 1997/98. Met name niet-solisten en huisartsen in de stad werkten minder uren in diensten. Het aantal uren dat men minder zou willen werken bleef nagenoeg gelijk, maar nam toe bij solisten en op het platteland. Zowel de beschikbare fulltime eenheden van huisartsen als van assistentes per 1000 patiënten namen enigszins toe. Huisartsen werkten in 2002 met wat meer plezier.Conclusie Wij vonden een lichte afname van de werkbelasting, waarschijnlijk door het groeiende aantal huisartsen, delegatie en de invoering van CHPs.AbstractEngels Y, Mokkink H, Van den Hombergh P, Van den Bosch W, Van den Hoogen H, Grol R. The GPs workload is decreasing. Huisarts Wet 2003;46(9):482-7.Introduction In recent years there have been many developments that have influenced workload and work stress of GPs in the Netherlands.There has been an overall increase in the number of GPs, but there has also been an increase in the percentages of female and part-time GPs.There has been a decrease in the percentage of single-handed practices.In the same period the responsibility of GPs has been expanded by the addition of many preventive tasks. In addition, the ageing population leads to a higher workload because older people require more and longer consultations.We were interested in the effect of these developments on the objective and subjective workload of GPs between 1997/98 (September 1997 – December 1998) and 2002 (January – November).Method We used data collected by the ‘VIP’ (an instrument used in practice visits to collect data on management) in 1997/98 (167 GPs in 116 general practices) and in 2002 (569 GPs in 308 practices). We used unpaired t-tests and stepwise multiple regression analyses to look for differences in reported workload, in the stated decreased number of hours GPs want to work, in full-time equivalent practitioners per 1000 patients and in work stress.Results In 2002 GPs reported a decrease in workload of 0.6 hours per week (after correction) as compared to their colleagues in 1997/98. GPs working in a single-handed practice and GPs working in a rural area reported no decrease in workload either for daytime or for out-of-hours work. In the same period the stated decrease in the number of hours GPs wanted to work also dropped. Consequently, the number of hours GPs wanted to work less stayed the same, and even increased for GPs in single-handed practices and those working in rural areas. The number of equivalent fulltime practitioners per 1000 patients increased slightly, as did the number of equivalent full-time practice assistants per 1000 patients. GPs in 2002 reported more pleasure in their work than did their colleagues in 1997/98.Conclusions Surprisingly, considering the above-mentioned developments, we did not find an increase in reported workload, but a decrease.We speculate that the increase in the number of GPs, the delegation of tasks and the implementation of a central organisation for out-of-hours care had caused this positive change.

Praktijkvoering en kwaliteitsmanagement zijn hard nodig

Samenvatting‘Nascholing dient over de kern van het huisartsenvak te gaan en niet over praktijkvoering, kwaliteitsmanagement of andere niet-medische zaken. Dit soort niet-huisartsgeneeskundige zaken, alsook het toetsen ervan door middel van scharen tellen, moet je niet willen accrediteren.’ Dit betoogde Siep Thomas onlangs in een discussie over dilemma’s bij accreditering.1 Ook Joost Zaat, hoofdredacteur van dit tijdschrift, heeft weinig op met het aspect praktijkvoering en uit dit ook geregeld.2 Het dédain over praktijkvoering appelleert aan een ‘gesundes Hausarztempfinden’.

De Checklist Praktijkvoering

Een checklist is een belangrijk hulpmiddel om tekortkomingen en aandachtspunten op het spoor te komen en om dan de acties te prioriteren. Met voorbeelden wordt aanschouwelijk gemaakt wanneer en hoe een checklist ingezet kan worden voor kwaliteitsverbetering in de huisartsenpraktijk.

Hogere kwaliteit bij praktijken van huisartsopleiders

SamenvattingVan den Hombergh P, Schalk-Soekar S, Kramer A, Bottema B, Campbell S, Braspenning J. Hogere kwaliteit bij praktijken van huisartsopleiders. Huisarts Wet 2013;56(9):438-43.AchtergrondHuisartsen-in-opleiding mogen verwachten dat ze worden opgeleid door gekwalificeerde opleiders in modelpraktijken. Dit onderzoek kijkt naar de verschillen tussen huisartsopleiders en niet-opleiders op het gebied van kwaliteit van zorg (infrastructuur, team, informatie, kwaliteitsbeleid).MethodeWe toetsten 203 huisartsenpraktijken (115 opleidingspraktijken) met 512 huisartsen (177 opleiders), die vrijwillig deelnamen aan de NHG-Praktijkaccreditering®, met het Visitatie Instrument Praktijkvoering op 369 items (142 huisartsniveau; 227 praktijkniveau). Per niveau hebben we de verschillen geanalyseerd (ANOVA, ANCOVA).ResultatenOpleiders scoorden op alle items (behalve één) hoger en significant hoger op 47 items (13 items na covariatencorrectie). Opleidingspraktijken scoorden hoger op alle items en significant hoger op 61 items (23 items na covariatencorrectie). Het verschil met reguliere praktijken zit in een breder diagnostisch en therapeutisch aanbod, de ruimere inzet van teamkwaliteiten, een betere praktijkorganisatie, een groter aanbod voor mensen met chronische ziekten en kwaliteitsbeleid. Verder rapporteerden opleiders meer betrokkenheid en werkvreugde, en minder ervaren werkdruk dan reguliere huisartsen.ConclusieHuisartsenopleiders en hun praktijken onderscheiden zich positief van de reguliere huisartsenzorg in zowel de breedte van het aanbod als de kwaliteit ervan. Deelname aan de NHG-Praktijkaccreditering® helpt opleidingsinstituten de kwaliteit van de opleiding te monitoren en te borgen. Bij het promoten van het opleiderschap kan ook de werkvreugde worden ingebracht.

Is ‘practice size’ the key to quality of care?: Let us look for better clues than size

Imagine key stakeholders in primary care — managers, politicians, policy advisors, and patients — have gathered to draft an ideal primary care structure. Some argue for large group practices, others say smaller practices are better, others that team work or salary payment is the key. Is there evidence that would help them? Moreover, is there an optimum sized general practice in terms of delivering safe, quality care that is also highly rated by patients? Or is general practice, by its very nature, best served by practices of different sizes and contexts? The review in this Journal on ‘whether practice size matters for the quality of care in primary care’ does not resolve these questions.1 Many researchers have tried to find a relevant relationship between attributes of quality and practice size and it is interesting and sobering to see what is left after sifting the evidence. It isn’t a great deal. Defining the optimal size of a practice is a complex decision. There is conflicting evidence on the ability of small practices to deliver high-quality care and the views of physicians, patients, and health service managers can be at variance. …