Feedback based on patient evaluations: a tool for quality improvement?

Feedback regarding patient evaluations of health care is expected to be a tool for quality improvement. This study examined the response of general practitioners to such feedback in a randomised trial. Practitioners in the intervention group read and discussed the feedback report and then reported on a range of actions that can be undertaken to improve the quality of care.

From best evidence to best practice: effective implementation of change in patients' care.

Major difficulties arise when introducing evidence and clinical guidelines into routine daily practice. Data show that many patients do not receive appropriate care, or receive unnecessary or harmful care. Many approaches claim to offer solutions to this problem; which ones are as yet the most effective and efficient is unclear.

Fear of movement/(re)injury, disability and participation in acute low back pain.

Fear of movement/(re)injury and its associated avoidance behavior have shown to be strongly associated with functional disability in chronic low back pain. In acute low back pain disability, the role of pain-related fear has received little research attention so far. Measures of pain-related fear such as the Tampa Scale for Kinesiophobia (TSK) are increasingly being used in primary care.

[The measurement of sense of competence in caregivers of patients with dementia].

Background: In the context of a cohort study on the socio-economic consequences of dementia in Belgium, we evaluated the validity, reliability and feasibility of the French version of the Dutch Sense of Competence questionnaire (SCQ), and of its short version (the SSCQ), in caregivers of demented patients The questionnaire was based on Zarit's burden interview and on a theoretical family-crisis model.

Methods: Construct validity was evaluated by factor analysis and by comparison of the results with those of the original SCQ study. Reliability was evaluated by Cronbach's alpha and by item-total correlations.

Designing a quality improvement intervention: a systematic approach.

Most quality improvement or change management interventions are currently designed intuitively and their results are often disappointing. While improving the effectiveness of interventions requires systematic development, no specific methodology for composing intervention strategies and programmes is available. This paper describes the methodology of systematically designing quality of care improvement interventions, including problem analysis, intervention design and pretests.

Intensive support to improve clinical decision making in cardiovascular care: a randomised controlled trial in general practice.

Objective: To evaluate the effects of feedback reports combined with outreach visits from trained non-physicians on the clinical decision making of general practitioners (GPs) in cardiovascular care.

Design: Pragmatic cluster controlled trial with randomisation of practices to support (intervention group) or no special attention (control group); analysis after 2 years.

Setting: 124 general practices in The Netherlands.

Patient characteristics as predictors of primary health care preferences: a systematic literature analysis.

Objective: To identify associations between various cultural and demographic factors and patients' primary health care preferences.

Search Strategy: Searches were performed in MEDLINE (1966-December 2000), PsycINFO (1977-May 2001) and Sociological Abstracts (1963-December 2000). Identified papers were checked for more papers.

[International comparison of 19 clinical guideline programs--a survey of the AGREE Collaboration].

Clinical practice guidelines are being developed in many countries throughout the world to improve quality of patient care. However, the methods used to develop guidelines vary among organisations. Therefore an international task group, the AGREE (Appraisal Guideline Research and Evaluation Europe) Collaboration, started in 1998 to work on the harmonisation and coordination of guideline development.

Towards evidence-based clinical practice: an international survey of 18 clinical guideline programs.

Objective: To describe systematically the structures and working methods of guideline programs.

Design: Descriptive survey using a questionnaire with 32 items based on a framework derived from the literature. Answers were tabulated and checked by participants.

Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain.

The transition from acute to chronic low back pain (LBP) is influenced by many interacting factors. Pain-related fear, as measured by the Tampa Scale for Kinesiophobia (TSK) and the Fear-Avoidance Beliefs Questionnaire (FABQ), is one of these factors. The objectives of this study were to investigate, in a population with acute LBP, the reliability of TSK and FABQ through evaluation of the internal consistency, the test-retest reliability, and the concurrent validity between TSK and FABQ.

Interventions to improve medication compliance in older patients living in the community: a systematic review of the literature.

Noncompliance affects all age groups, but older patients have specific barriers against effective medication use and can be more vulnerable to the incorrect use of medication. Some age-related barriers are vision loss and cognitive impairment. In people aged 60 years or older, noncompliance with medication regimens varies from 26-59%.

Process evaluation on quality improvement interventions.

To design potentially successful quality improvement (QI) interventions, it is crucial to make use of detailed breakdowns of the implementation processes of successful and unsuccessful interventions. Process evaluation can throw light on the mechanisms responsible for the result obtained in the intervention group. It enables researchers and implementers to (1).

Characteristics of effective clinical guidelines for general practice.

Background: The use of clinical guidelines in general practice is often limited. Research on barriers to guideline adherence usually focuses on attitudinal factors. Factors linked to the guideline itself are much less studied.

Information for dementia patients and their caregivers: what information does a memory clinic pass on, and to whom?

This study assessed the information provided in a memory clinic and the patient and caregiver factors that influenced the provision of information. The study was part of a larger cross-sectional study of the diagnosis of dementia and satisfaction with information given. The participants were 51 elderly patients suspected of having dementia and living at home together with their caregivers.

Comparison of patients' and general practitioners' evaluations of general practice care.

Objectives: To compare patients' and general practitioners' (GPs') evaluations of the quality of general practice care.

Design: Written surveys among patients and GPs.

Setting: General practice in the Netherlands.

Patient characteristics determine differences in the influenza vaccination rate more so than practice features.

Background: World-wide each year 30-55% of the target population is vaccinated against influenza. Determinants of successful vaccination programs are not clear. This study was aimed at identifying practice- and patient-related factors that determine differences in vaccination rates.

Research on patients' views in the evaluation and improvement of quality of care.

The identification of methods for assessing the views of patients on health care has only developed over the last decade or so. The use of patients' views to improve healthcare delivery requires valid and reliable measurement methods. Four approaches are recognised: inclusion of patients' views in the information to those seeking health care, identification of patient preferences in episodes of care, patient feedback on delivery of health care, and patients' views in decision making on healthcare systems.

Lower urinary tract symptoms: social influence is more important than symptoms in seeking medical care.

Objective: To determine associations among lower urinary tract symptoms (LUTS), symptom severity, subjective beliefs and social influences when seeking primary medical care in men aged > or = 50 years.

Subjects And Methods: A population-based survey was conducted among 5052 men aged > or = 50 years, using patient registers of 22 general practitioners (GPs) in the Netherlands from November 1999 to May 2000. The questionnaire contained items concerning age, educational level, International Prostate Symptom Score (IPSS), bothersome score (BS), and questions from the Health Belief Model on attitude and social influences.

Inside guidelines: comparative analysis of recommendations and evidence in diabetes guidelines from 13 countries.

Objective: To compare guidelines on diabetes from different countries in order to examine whether differences in recommendations could be explained by use of different research evidence.

Research Design And Methods: We analyzed 15 clinical guidelines on type 2 diabetes from 13 countries using qualitative methods to compare the recommendations and bibliometric methods to measure the extent of overlap in citations used by different guidelines. A further qualitative analysis of recommendations and cited evidence for two specific issues in diabetes care explored the apparent discrepancy between recommendations and evidence.

Provision of information and advice in cardiovascular care: clinical performance of general practitioners.

The aim of this study was to assess the provision of information and advice by general practitioners (GPs) with respect to patients with hypertension, hypercholesterolaemia, or cardiovascular disease. The study relied on the prospective recording of patient encounters by GPs. Performance indicators were selected from the Dutch national guidelines for general practice.

Multifaceted support to improve clinical decision making in diabetes care: a randomized controlled trial in general practice.

Aims: To evaluate the effectiveness of a multifaceted intervention to improve the clinical decision making of general practitioners (GPs) for patients with diabetes. To identify practice characteristics which predict success.

Methods: Cluster randomized controlled trial with 124 practices and 185 GPs in The Netherlands.

Empowering patients: how to implement a diabetes passport in hospital care.

The purpose was to ascertain the views of patients with diabetes and patient care teams on the introduction of a recently developed diabetes passport in order to plan effective implementation. A semi-qualitative study by eight semi-structured focus group discussions with patient care teams and patients in four Dutch hospitals was organised. In total 29 patients participated (range five to nine per hospital).

Development of clinical practice guidelines for dentists: methods for topic selection.

Objectives: The aim of this study was to compare four methods for assessing the preferences of the dental profession for topics to be considered for the development of clinical practice guidelines.

Methods: The methods were: (1) a survey among dentists, (2) an analysis of topics discussed in dental peer groups, and (3) screening of dental journals. A fourth method was obtained from method number 3.