Continuous versus intermittent data collection of health care utilization.

Background: In economic evaluations, participants have to report their health care utilization continuously during follow-up. To unburden participants, researchers often collect data intermittently (i.e.

Relationship between location and activity in injurious falls: an exploratory study.

Background: Knowledge about the circumstances under which injurious falls occur could provide healthcare workers with better tools to prevent falls and fall-related injuries. Therefore, we assessed whether older persons who sustain an injurious fall can be classified into specific fall types, based on a combination of fall location and activity up to the moment of the fall. In addition, we assessed whether specific injurious fall types are related to causes of the fall, consequences of the fall, socio-demographic characteristics, and health-related characteristics.

Lessons learned from a multidisciplinary fall-prevention programme: the occupational-therapy element.

Objective: To gain insight into the contribution of the occupational-therapy part of a multidisciplinary fall prevention programme towards the reduction of falls and functional decline.

Design: A descriptive and exploratory study.

Methods: Data were collected in the context of a randomized controlled trial that found no effect of a multidisciplinary fall prevention programme.

Process factors explaining the ineffectiveness of a multidisciplinary fall prevention programme: a process evaluation.

Background: Falls are a major health threat to older community-living people, and initiatives to prevent falls should be a public health priority. We evaluated a Dutch version of a successful British fall prevention programme. Results of this Dutch study showed no effects on falls or daily functioning.

Lack of effectiveness of a multidisciplinary fall-prevention program in elderly people at risk: a randomized, controlled trial.

Objectives: To assess whether a pragmatic multidisciplinary fall-prevention program was more effective than usual care in preventing new falls and functional decline in elderly people.

Design: A two-group, randomized, controlled trial with 12 months of follow-up.

Setting: University hospital and home-based intervention, the Netherlands.

A multidisciplinary fall prevention program for elderly persons: a feasibility study.

Falling is a common problem among elderly people and has many negative consequences. In the Netherlands, there is a need for effective fall prevention interventions aimed at elderly persons with an increased risk of falling. For this reason, we adapted a successful British fall prevention program comprising a medical occupational therapy assessment to the Dutch health care setting.

Cost-effectiveness of a multidisciplinary fall prevention program in community-dwelling elderly people: a randomized controlled trial (ISRCTN 64716113).

Objectives: Multidisciplinary and multifactorial interventions seem to be effective in preventing falls. We aimed to assess the cost-effectiveness of a multidisciplinary fall prevention program compared with usual Dutch healthcare in community-dwelling people 65 years of age or older who experienced a fall.

Methods: Cost-effectiveness and cost-utility analysis were performed from a societal perspective.

Is melatonin helpful in stopping the long-term use of hypnotics? A discontinuation trial.

Objective: To find out if administration of melatonin facilitates discontinuation of benzodiazepine (BD) therapy in patients with insomnia.

Method: A placebo controlled trial in nine general practices in the Netherlands. Long-term users of benzodiazepines were asked by their GP to participate in a discontinuation program in combination with melatonin or placebo.

Supporting stroke patients' autonomy during rehabilitation.

In a qualitative study, 22 stroke patients undergoing rehabilitation in three nursing homes were interviewed about constraints on and improvements in their autonomy and about approaches of health professionals regarding autonomy. The data were analysed using grounded theory, with a particular focus on the process of regaining autonomy. An approach by the health professionals that was responsive to changes in the patients' autonomy was found to be helpful for restoration of their autonomy.

Out-of-hours primary care. Implications of organisation on costs.

Background: To perform out-of-hours primary care, Dutch general practitioners (GPs) have organised themselves in large-scale GP cooperatives. Roughly, two models of out-of-hours care can be distinguished; GP cooperatives working separate from the hospital emergency department (ED) and GP cooperatives integrated with the hospital ED. Research has shown differences in care utilisation between these two models; a significant shift in the integrated model from utilisation of ED care to primary care.

The development of a multidisciplinary fall risk evaluation tool for demented nursing home patients in the Netherlands.

Background: Demented nursing home patients are at high risk for falls. Falls and associated injuries can have a considerable influence on the autonomy and quality of life of patients. The prevention of falls among demented patients is therefore an important issue.

Social support in diabetes: a systematic review of controlled intervention studies.

Systematic, computerized search in Medline, the Cochrane Library, Eric, PsychINFO and Embase files, 1980-2003, selecting descriptions of prospective intervention trials with good methodological design, testing effects of social support interventions on health outcomes in primary and outpatient care for type 2 diabetes. Six controlled trials were reviewed. They defined, modified, and measured social support in various ways, and scored outcomes with varying measures.

The impact of a primary care physician cooperative on the caseload of an emergency department: the Maastricht integrated out-of-hours service.

Objective: To determine the effect of an out-of-hours primary care physician (PCP) cooperative on the caseload at the emergency department (ED) and to study characteristics of patients utilizing out-of-hours care.

Design: A pre-post intervention design was used. During a 3-week period before and a 3-week period after establishing the PCP cooperative, all patient records with out-of-hours primary and emergency care were analyzed.

Follow-up care by patient's own general practitioner after contact with out-of-hours care. A descriptive study.

Background: Little is known about the care process after patients have contacted a GP cooperative for out-of-hours care. The objective of this study was to determine the proportion of patients who seek follow-up care after contact with a GP cooperative for out-of-hours care, and to gain insight into factors that are related to this follow-up care.

Methods: A total of 2805 patients who contacted a GP cooperative for out-of-hours care were sent a questionnaire.

General practitioners' satisfaction with and attitudes to out-of-hours services.

Background: In recent years, Dutch general practitioner (GP) out-of-hours service has been reorganised into large-scale GP cooperatives. Until now little is known about GPs' experiences with working at these cooperatives for out-of-hours care. The purpose of this study is to gain insight into GPs' satisfaction with working at GP cooperatives for out-of-hours care in separated and integrated cooperatives.

Effectiveness and cost-effectiveness of a multidisciplinary intervention programme to prevent new falls and functional decline among elderly persons at risk: design of a replicated randomised controlled trial [ISRCTN64716113].

Background: Falls are common among community-dwelling elderly people and can have a considerable impact on quality of life and healthcare costs. People who have sustained a fall are at greater risk of falling again.We replicated a British randomised controlled trial which demonstrated the effectiveness of a multidisciplinary intervention programme to prevent falls.

Learning in a clinical education programme in primary care: the Maastricht Adoption Programme.

Introduction: At Maastricht University, the integration of knowledge, skills and attitudes in preclinical medical education is promoted by an 'Adoption Programme', where students carry out assignments in a general practice setting. The assignments are explained and discussed in practical medical coaching groups. The aim of this study was to examine the relationships between the elements that affect learning in the programme.

Vulnerability of family caregivers in terminal palliative care at home; balancing between burden and capacity.

This paper reports on a grounded theory interview-based study with 13 family members aged 28-80 years caring for terminally ill people at home (with a life expectancy of 3 months or less) in the Netherlands. The project was approved by the ethics committee of the Maastricht University Hospital. The aim of this study was to explore the experiences of family caregivers, their needs for home care, and which health services they receive.

Process-evaluation of a home visit programme to prevent falls and mobility impairments among elderly people at risk.

This paper describes the results of a detailed evaluation of the intervention process of a multifactorial home visit programme aimed at preventing falls and mobility impairments among elderly persons living in the community. The aim of the study is to provide insight in factors related to the intervention process that may have influenced the effectiveness of this home visit programme. The programme consisted of five home visits performed by a community nurse over a period of 1 year.