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Biomedical subjects

H F Crebolder

Publications and source records attributed to H F Crebolder.

At least 19 recordsLinked to original sources
PubMed2003

A randomised controlled trial of joint consultations with general practitioners and cardiologists in primary care.

BACKGROUND: Joint consultation sessions of a small group of general practitioners (GPs) and a specialist in orthopaedics proved to be an effective way of decreasing the referral rate of orthopaedic patients. Cardiac complaints comprise an important category of health problems with high referral rates. AIMS: To study the effects of joint consultation on the quality of care and referrals for patients with cardiac complaints. DESIGN OF STUDY: Randomised controlled trial. SETTING: Forty-nine GPs participated in 16 consultation groups, each with one of 13 cardiologists, in monthly joint consultations over a period of about 18 months. METHOD: The GPs selected patients about whom they were uncertain, and those needing urgent referral were excluded. Patients were randomly assigned to joint consultation or to usual care. After a follow-up period all patients had a joint consultation for outcome assessment. Referral data were provided by two regional health insurance companies and questionnaires were given to the patients, GPs, and cardiologists to gauge their opinion of the trial. RESULTS: One hundred and forty-eight patients in the intervention group and 158 patients in the control group fulfilled the whole protocol. The quality of care was similar in both groups. In the intervention group, 34% of the patients were referred, compared with 55% in the control group (P = 0.001), and fewer patients underwent further diagnostic procedures (7% compared with 16%, P = 0.013). Referrals to cardiology as a proportion of all referrals decreased in the practices of the participating GPs, compared with their reference districts (P = 0.024). CONCLUSION: Joint consultation is an effective method that provides a quality of care that at least equals usual care and that contributes to a better selection of patients who need specialist care.

Adult↗
PubMed2000

Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial.

OBJECTIVE: To evaluate whether a programme of multifactorial home visits reduces falls and impairments in mobility in elderly people living in the community. DESIGN: Randomised controlled trial with 18 months of follow up. SETTING: Six general practices in Hoensbroek, the Netherlands. PARTICIPANTS: 316 people aged 70 and over living in the community, with moderate impairments in mobility or a history of recent falls. INTERVENTION: Five home visits by a community nurse over a period of one year. Visits consisted of screening for medical, environmental, and behavioural factors causing falls and impairments in mobility, followed by specific advice, referrals, and other actions aimed at dealing with the observed hazards. MAIN OUTCOME MEASURES: Falls and impairments in mobility. RESULTS: No differences were found in falls and mobility outcomes between the intervention and usual care groups. CONCLUSION: Multifactorial home visits had no effects on falls and impairments in mobility in elderly people at risk who were living in the community. Because falls and impairments in mobility remain a serious problem among elderly people, alternative strategies should be developed and evaluated.

Accidental Falls↗
PubMed2000

Effects of preventive home visits to elderly people living in the community: systematic review.

OBJECTIVE: To assess the effects of preventive home visits to elderly people living in the community. DESIGN: Systematic review. SETTING: 15 trials retrieved from Medline, Embase, and the Cochrane controlled trial register. MAIN OUTCOME MEASURES: Physical function, psychosocial function, falls, admissions to institutions, and mortality. RESULTS: Considerable differences in the methodological quality of the 15 trials were found, but in general the quality was considered adequate. Favourable effects of the home visits were observed in 5 out of 12 trials measuring physical functioning, 1 out of 8 measuring psychosocial function, 2 out of 6 measuring falls, 2 out of 7 measuring admissions to institutions, and 3 of 13 measuring mortality. None of the trials reported negative effects. CONCLUSIONS: No clear evidence was found in favour of the effectiveness of preventive home visits to elderly people living in the community. It seems essential that the effectiveness of such visits is improved, but if this cannot be achieved consideration should be given to discontinuing these visits.

Accident Prevention↗
PubMed2000

Patient autonomy during rehabilitation: the experiences of stroke patients in nursing homes.

This article describes the results of a grounded theory study among stroke patients (N=17, aged 50-85) in rehabilitation wards in nursing homes. Patient autonomy (dimensions: self-determination, independence and self-care) increases during rehabilitation due to patient factors (conditions and strategies of patient) and environmental factors (nursing home and strategies of health professionals and family). During rehabilitation patients are in a state of transition regarding autonomy: patients need support to enhance autonomy, gradually regain autonomy, and thereby need less support. Although facilitating environmental factors were discovered, patients also experienced constraining factors regarding patient autonomy. Health professionals should give more attention to self-determination and independence; the nursing home should offer stroke patients more opportunities to do familiar activities autonomously.

Aged↗
PubMed2000

Effects of transmural care on coordination and continuity of care.

Although health care in The Netherlands is of a high quality with strong emphasis on primary care and high accessibility to hospital care, care deficits may arise in patients with chronic complex health problems who need the attention of several caregivers. Because no regular coordinating centre or person exists, coordination of care may be deficient leading to a poor continuity of care. This may be particularly true for those patients being cared for by both primary and hospital care teams, as is the case for most terminal cancer patients. Therefore, a transmural home care intervention programme for terminal cancer patients was introduced which intended to optimize coordination of care and thereby improve continuity of care. This quasi-experimental study investigated the effects of this intervention (intervention group 79 patients) on indicators of coordination and continuity of care. When compared to standard care (control group 37 patients) moderate positive effects (mainly for the nursing disciplines) on the various indicators of coordination and continuity of care by the transmural home care intervention programme were found. Future prospective studies are needed to further elucidate the effects of transmural care on these aspects of care.

Continuity of Patient Care↗
PubMed2000

Effect of a short skills training course on competence and performance in general practice.

OBJECTIVES: Evaluation of the efficacy of a short course of technical clinical skills to change performance in general practice. DESIGN: Subjects were self-selected general practitioners (n=59) who were unaware of the study design. They were assigned to the intervention group (n=31) or control group (n=28) according to their preference for course date. The course covered four different technical clinical skills (shoulder injection technique, PAP-smear, laboratory examination of vaginal discharge, ophthalmoscopic control in diabetes mellitus). Main outcome measures used were pre- and post-training scores on a knowledge test of skills (60 multiple choice items), and pre- and post-training performance of procedures in practice using a log-diary covering 20 days. SETTING: University of Maastricht, The Netherlands. SUBJECTS: Self-selected general practitioners. RESULTS: Competence, as measured by the knowledge test of skills, improved significantly as a result of the training and skills test scores were satisfactory after training. A significant effect on performance in practice was found for PAP-smear and shoulder injection technique, whereas no effect could be demonstrated for examination of vaginal discharge and ophthalmoscopic control in diabetes mellitus. CONCLUSIONS: A good degree of competence is a necessary but not always sufficient condition for a physician to change his performance in practice. While some skills training seems adequate to bring about desired changes, for other skills more complex interventions are probably needed.

Education, Medical, Undergraduate↗
PubMed2000

The construction of a patient record-based risk model for recurrent falls among elderly people living in the community.

BACKGROUND: Predictive models of fall risk in the elderly living in the community may contribute to the identification of elderly at risk for recurrent falling. OBJECTIVES: Our aim was to investigate occurrence, determinants and health consequences of falls in a community-dwelling elderly population and the contribution of data from patient records to a risk model of recurrent falls. METHODS: A population survey was carried out using a postal questionnaire. The questionnaire on occurrence, determinants and health consequences of falls was sent to 2744 elderly persons of 70 years and over, registered in four general practices (n = 27 000). Data were analysed by bivariate techniques and logistic regression. RESULTS: A total of 1660 (60%) responded. Falls (> or =1 fall) in the previous year were reported by 44%: one-off falls by 25% and recurrent falls (> or =2 falls) by 19%. Women had significantly more falls than men. Major injury was reported by 8% of the fallers; minor injury by 49%. Treatment of injuries was by the GP in 67% of cases. From logistic regression, a risk model for recurrent falls, consisting of the risk factors female gender, age 80 years or over, presence of a chronic neurological disorder, use of antidepressants, problems of balance and sense organs and complaints of muscles and joints was developed. The model predicted recurrent falls with a sensitivity of 64%, a specificity of 71%, a positive predictive value of 42% and a negative predictive value of 86%. CONCLUSION: A risk model consisting of six variables usually known to the GP from the patient records may be a useful tool in the identification of elderly people living in the community at risk for recurrent falls.

Accidental Falls↗
PubMed2000

Facilitating and constraining factors on autonomy: the views of stroke patients on admission into nursing homes.

This article describes a model changing autonomy which was developed in a grounded theory study among stroke patients on admission into nursing homes for rehabilitation. Three dimensions of autonomy were identified: self-determination, independence, and self-care. On admission, patients' conditions (disabilities, multimorbidity, emotional state, and feeling like a layperson) and patients' strategies (waiting and seeing, and acting as a subordinate) constrain autonomy. Several environmental factors facilitate patient autonomy. The nursing home sustains patient autonomy by providing a hopeful atmosphere and room for autonomy. The health professionals facilitate autonomy by giving therapy, support and information, attentiveness and respect, paternalism and teamwork, Facilitating strategies of the family encompass emotional and instrumental support Care routines, lack of privacy, an unfamiliar environment, waiting periods, boredom, and lack of information were identified as constraining environmental factors. Developing guidelines and multidisciplinary courses regarding the approach to patient autonomy on admission is recommended.

Activities of Daily Living↗
PubMed1999

Impact of gait problems and falls on functioning in independent living persons of 55 years and over: a community survey.

In a cross-sectional, population-based study among community-dwelling persons of 55 years and over the incidence of falls, risk indicators for falls, specifically age, and the impact of gait problems, falls and other risk factors on functioning was determined. A randomly age-stratified sample (n = 655) was taken from all independent living persons of 55 years and over (n = 2269) and registered in a primary health care centre. They received a mail questionnaire concerning demographic data, history of falls and injuries due to falls, physical and mental health status, gait problems, functional status, including social activities. The response rate was 62% (n = 405). Of the subjects aged 55 years and of those aged 65 years and over, 25% and 31% respectively fell at least once in the previous year. Half of the people reporting falls fell more than once. Serious injury occurred in 9% of the fallers, with 4% fractures. There is a significant association between falling and age and, even more clearly, between gait problems and age. The main risk factors of single and recurrent falls were female gender, physical health status and gait problems. Logistic regression analysis reveals that the main determinants of falling in general are gait problems and female gender and, of recurrent falling female gender, physical complaints and gait problems. Falls have some negative effect on functioning, i.e. mobility range and social activities, but this is overshadowed by mental status indicators and gait problems.

Accidental Falls↗
PubMed1998

Effectiveness of home care programmes for patients with incurable cancer on their quality of life and time spent in hospital: systematic review.

OBJECTIVE: To investigate whether for patients with incurable cancer comprehensive home care programmes are more effective than standard care in maintaining the patients' quality of life and reducing their "readmission time" (percentage of days spent in hospital from start of care till death). DESIGN: Systematic review. METHODS: A computer aided search was conducted using the databases of Medline, Embase, CancerLit, and PsychLit. The search for studies and the assessment of the methodological quality of the relevant studies were performed by two investigators, blinded from each other. Prospective, controlled studies investigating the effects of a home care intervention programme on patients' quality of life or on readmission time were included in the analyses. RESULTS: Only 9 prospective controlled studies were found; eight were performed in the United States and 1 in the United Kingdom. Their methodological quality was judged to be moderate (median rating 62 on a 100 point scale). None of the studies showed a negative influence of home care interventions on quality of life. A significantly positive influence on the outcome measures was seen in 2 out of the 5 studies measuring patients' satisfaction with care, in 3/7 studies measuring physical dimensions of quality of life, in 1/6 studies measuring psychosocial dimensions, and in 2/5 studies measuring readmission time. The incorporation of team members' visits to patients at home or regular multidisciplinary team meetings into the intervention programme seemed to be related to positive results. CONCLUSIONS: The effectiveness of comprehensive home care programmes remains unclear. Given the enormity of the problems faced by society in caring for patients with terminal cancer, further research is urgently needed.

Controlled Clinical Trials as Topic↗
PubMed1998

Care process and satisfaction analysis of a transmural home care program.

This study investigated both professional caregiver workload as well as the patients' and caregivers' satisfaction with a transmural home care program. Seventy-nine patients were included in the intervention program. The specialist nurse coordinator, general practitioner, community nurse providing 'intensive' community care, community nurses providing 'standard' community care, and the home helper spent in total an average of 7.5, 4.4, 55.6, 55.0, and 112.3 h, respectively, on each patient during the care process (mean survival of the 79 patients was 101.2 days). The 24 h telephone service and transmural home team were contacted in total 100 and 8 times, respectively. Patient and caregiver satisfaction with the care provided scored (very) high. Considering this acceptable workload and given that the program did not interfere with existing standard health care structures, it can be concluded that such care may easily be introduced by other hospitals and related primary care teams.

Attitude of Health Personnel↗
PubMed1998

Transmural care. A new approach in the care for terminal cancer patients: its effects on re-hospitalization and quality of life.

Despite their wishes, terminal cancer patients are frequently readmitted to hospitals. This appears in part to be due to poor communication amongst professional caregivers and/or the overburdening of their (informal) caregivers. This quasi-experimental study investigated the effects of a transmural home care programme on re-hospitalization, quality of life and place of death for terminal cancer patients. The programme intended to optimize communication, cooperation and coordination between intra- and extra-mural health care organizations (transmural care). Initial patient characteristics of the intervention group (n = 79) matched those of the control group (n = 37) well. When compared to the control group, which received the standard community care, patients in the intervention group underwent significantly less re-hospitalization during the terminal phase of their illness (5.8 versus 11.5 days; P < 0.01) while the intervention contributed significantly positive to the patients' "physical" quality of life 1 month after the start of the intervention. A higher, but not significant (P = 0.06) percentage of patients in the intervention group also died at home (81 versus 65%). The introduction of measures to enhance coordination and cooperation of intra- and extramural care, seems to be an improvement compared to standard community care.

Aged↗
PubMed1998

Cost analysis of transmural home care for terminal cancer patients.

The economic implications of home care service programmes for oncology patients remain unclear. This quasi-experimental study investigated the costs of a transmural home care programme for terminal cancer patients and compared them to those of the standard care available. The programme intended to optimize communication, cooperation and coordination between the intra- and extra- mural health care organizations (transmural care). Complete sets of data could be retrieved for 57 of the 79 patients in the intervention group, and for 29 of the 37 patients in the control group. Comparison of the intervention and control group revealed significantly lower pharmaceutical and rehospitalization costs in the intervention group, whilst community nursing and home help costs were significantly higher. However, no significant difference could be found for total health care costs between the groups. In view of this, and that the programme has proved to have significantly positive effects on both the patient's and direct caregiver's quality of life, the installation of such programmes in every hospital with a multidisciplinary oncology unit is recommended.

Aged↗
PubMed1998

Autonomy in the rehabilitation of stroke patients in nursing homes. A concept analysis.

This article presents a concept analysis of autonomy in relation to the rehabilitation of stroke patients. Analysis of the results of a literature survey provided three important concepts of autonomy in the field of biomedical ethics: self-governance, self-realization and actual autonomy. These concepts are compared with concepts from caring sciences and summarized in a table. The results indicate the importance of the social environment (formal and informal caregivers) for the restoration of autonomy. Because of the patient's condition and context, a social concept of autonomy makes more sense in the rehabilitation of stroke patients in nursing homes than does an individual concept. The concept analysis sheds light on the fact that the majority of studies regarding patient autonomy are primarily based on theoretical reflections, not on empirical studies. More research is warranted to gather information on how patients themselves consider and appreciate autonomy during rehabilitation, to explore the views of stroke patients' formal and informal caregivers and to investigate whether a social concept of autonomy is suitable for all phases of rehabilitation. Concerning the practice of rehabilitation, no definite conclusion can be given as yet.

Aged↗
PubMed1998

[Nursing home day-care: a growing function for a rather stable patient group].

This article is a descriptive study of the characteristics of nursing home day-care patients in the Netherlands in 1995 at first admission and at discharge. Data were derived from the National Nursing Home Registration System (SIVIS), in which in 1995 over 85% of Dutch nursing homes participated. Newly admitted day-care patients are characterized by high age (89% older than 65 years), a distribution with (only!) 9% more women than men and a morbidity pattern of chronic somatic (cerebrovascular disease 45%) and psychogeriatric (dementia 80%) disorders. This morbidity pattern was associated with a considerable degree of disability, in particular regarding the activities of daily living and mobility. Most patients (78%) come from their own homes. The average length of stay from admittance to discharge, for both somatic and psychogeriatic day-care patients was nine months. For about 10% of the somatic patients and 40% of the psychogeriatic ones ambulatory day-care resulted in (subsequent) admission to the nursing home itself. In the last decade nursing home day-care capacity has increased rapidly and parallel to this also the number of day-care patients. Remarkably the average level of disability and the average period of treatment of nursing home day-care patients has remained approximately the same in this period.

Activities of Daily Living↗
PubMed1997

Educational objectives and requirements of an undergraduate clerkship in general practice. The outcome of a consensus procedure.

OBJECTIVES: The main aim of this study was to reach consensus between students, faculty and general practice teachers on the educational objectives and requirements of the clerkship in general practice. METHOD: The consensus procedure consisted of four steps and all active general practice teachers (n = 116) were asked to participate in the study. RESULTS: We identified 189 educational objectives: 127 complaints (problems, symptoms, syndromes), 29 clinical skills and 37 objectives concerning the theoretical dimensions of general practice. Educational requirements crystallized to 16 essential preconditions of a teaching practice and 35 didactic activities to be performed by the general practice teachers. CONCLUSIONS: These consensus results will be used to structure the medical curriculum and as guidelines for the educational process during the clerkship.

Australia↗
PubMed1997

Prevalence and incidence of health problems in people with intellectual disability.

The objective of this study was to determine the prevalence and incidence of the most frequent chronic health problems in relation to age in people with intellectual disabilities living in residential facilities in the Netherlands. A prospective cohort study was done with four data collections, each with an interval of one year. Data were collected by means of questionnaires which were completed by each person's physician. Striking results included the reported high prevalence and incidence of visual and hearing impairment, which was even more pronounced in people with Down's syndrome than in people with intellectual disability resulting from other causes. Gastrointestinal problems also appeared to have high incidence rates. Dementia was frequently reported in people with Down's syndrome aged 40 years and older. The results reflect the need for a more predictive policy which can anticipate health problems in people with intellectual disability.

Adolescent↗