Workload, capacity for coping and psychological and physical outcomes amongst home helps in the Netherlands.

Owing to many developments and changes in home care in the Netherlands, a national study was carried out. One of the aims was to examine the differences between the six categories of home help in the Netherlands regarding workload, pressure of work and capacity for coping. A total of 474 home helps from six categories participated in the study.

A job profile of home helps in the Netherlands.

Owing to many developments and changes in home care in the Netherlands, a national study on home help services was carried out. One of the aims was to examine the job content of the six new categories of home help, the differences in their work and the correspondence of daily practice with formal job descriptions. Six home help categories were examined: alpha helps; A home helps; B caring helps; C and D carers; and specialized E carers - self-registration forms and weekly reports were used for data-collection.

Variation in home-birth rates between midwifery practices in The Netherlands.

Objective: To examine the reasons for the variation in home-birth rates between midwifery practices.

Method: Multi-level analysis of client and midwife associated, case-specific and structural factors in relation to 4420 planned and actual home or hospital births in 42 midwifery practices.

Findings: Women's choice of birth location and the occurrence of complications that lead to referral to specialist care before or during labour, were found to be the main determinants of the home-birth rate.

Introducing DRG-based financing in Hungary: a study into the relationship between supply of hospital beds and use of these beds under changing institutional circumstances.

Most hospital reforms carried out in Europe over the past few decades concern the supply of hospital beds and hospital financing systems. In Hungary, financing was not tied to hospital input or output until a Diagnosis-Related-Group system was introduced. This change provided an opportunity to study the effect of the new system, taking the supply of hospital beds into account.

Physician reimbursement and the medical encounter: an observational study in Dutch pediatrics.

Pediatrician reimbursement is shifting from fee-for-service to a fixed salary. In the Netherlands, as physicians working on a fee-for-service basis have a financial interest in talking less and in carrying out more diagnostic tests and investigations, it may be questioned whether this will influence the structure and content of medical visits. With use of 302 videotaped outpatient encounters with either salaried or fee-for-service pediatricians, differences were examined in visit length, number of requests for diagnostic tests and investigations (laboratory test, endoscopy, and radiography), pediatrician-parent communication behaviors, and patient satisfaction.

Doctor-patient communication in different European health care systems: relevance and performance from the patients' perspective.

Our aim is to investigate differences between European health care systems in the importance attached by patients to different aspects of doctor-patient communication and the GPs' performance of these aspects, both being from the patients' perspective. 3658 patients of 190 GPs in six European countries (Netherlands, Spain, United Kingdom, Belgium, Germany, Switzerland) completed pre- and post-visit questionnaires about relevance and performance of doctor-patient communication. Data were analyzed by variance analysis and by multilevel analysis.

Diffusion of a quality improvement programme among allied health professionals.

Objective: To assess the diffusion of a quality improvement (QI) programme among allied health professions in The Netherlands.

Design: Descriptive study, based on a questionnaire distributed to allied health professionals; response rate, 63%.

Settings And Participants: All subsectors in health care were covered, including primary care and institutional care.

Communication during gynecological out-patient encounters.

The intimate nature of women's health problems presented during gynecological encounters places great demands on gynecologists' communicative behavior. The present study examined what patients expect from their gynecologist, how gynecologists and patients actually communicate during out-patient encounters, and what factors shape the structure and process of the encounter. Twenty-one gynecologists (13 consultants and eight residents) videotaped 303 consecutive out-patient encounters.

Trends in HIV-related consultation in Dutch general practice.

New medicine against AIDS and a possible changing attitude towards AIDS will affect the role of the general practitioner (GP). We aim to explore and assess the changing role of the GP in preventing and detecting AIDS, which will be done by providing insight into the changing numbers and content of HIV-related consultations in the general practice. Since 1988 a representative sample of 63 Dutch GPs have participated in a network.

General practice in urban and rural Europe: the range of curative services.

The variation in the range of services provided by general practitioners (GPs) is not only related to personal characteristics and features of the country's health care system but also to the geographical circumstances of the practice location. In conurbations health services are more widely available than in the countryside, where GPs often are the only providers. With highly mobile populations and a plentiful supply of doctors, in cities the prevailing regulations for access and use of services are more difficult to maintain.

Home birth or short-stay hospital birth in a low risk population in The Netherlands.

In The Netherlands women with low risk pregnancies can choose whether they want to give birth at home or in hospital, under the care of their own primary caregiver. The majority of these women prefer to give birth at home, but over the last few decades an increasing number of low risk women have chosen a hospital birth, leaving hospital with their baby shortly after delivery. As both this trend and its effects have not been extensively investigated, a study was designed to examine the determinants of the choice for home or hospital birth.

Clinical experience of rehabilitation therapists with chronic diseases: a quantitative approach.

Objectives: To provide an overview of the numbers of patients with selected chronic diseases treated by rehabilitation therapists (physical therapists, occupational therapists, exercise therapists and podiatrists). The study was performed to get quantitative information on the degree to which rehabilitation therapists are experienced in the treatment of chronically ill patients.

Methods: Secondary analyses were performed on several databases containing representative data on patients treated by rehabilitation therapists.

Patient satisfaction with the general practitioner: a two-level analysis.

Objectives: The authors examine how patient satisfaction with health care providers relates to either the individual characteristics of respondents or the characteristics of health care providers and the structural setting in which they work.

Methods: Measures of three dimensions of patient satisfaction with the general practitioner (GP)--accessibility, interpersonal relationship, information given--were derived from an existing data set. Patients were nested with GPs.

Women's health care: for whom and why?

Differences are investigated between female practice populations of female general practitioners providing women's health care and of women and men general practitioners providing regular health care. Women's health care in the Netherlands is provided in the general practice "Aletta" and is based on the following principles: (1) consideration of the patient's gender identity and gender roles; (2) consideration of the patient's personal and social situation; (3) treating the patient respectfully; (4) encouraging the patient to cope with health problems and stimulating self-responsibility; and (5) avoidance of medicalization. Data were derived from an extensive health interview with 253 women Aletta patients (15 years or older) about socio-demographic characteristics, gender role, attitudes, somatic and mental health status, and medical consumption.

A comprehensive model of cooperation between caregivers related to quality of care.

Background: The system and delivery of health care tend to suffer from fragmentation, resulting in discontinuous and costly care. Local cooperation between caregivers is essential to achieve appropriate, timely, continuous and efficient care. The article develops a general comprehensive patient-centered model of quality of care related to local cooperation between caregivers.

'Burnout' among Dutch midwives.

Objective: to determine the effect of workload on 'burnout' having considered work capacity.

Design: cross-sectional study.

Setting: Dutch community midwives in independent practice.

Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in The Netherlands.

Objective: To investigate the relation between the intended place of birth (home or hospital) and perinatal outcome in women with low risk pregnancies after controlling for parity and social, medical, and obstetric background.

Design: Analysis of prospective data from midwives and their clients.

Setting: 54 midwifery practices in the province of Gelderland, Netherlands.

Factors influencing the type of health problems presented by women in general practice: differences between women's health care and regular health care.

Objective: Differences between health problems presented by women (aged 20-45) to female "women's health care" doctors and both female and male regular health care doctors were investigated. This article explores the relationship of patients' roles (worker, partner, or parent) and the type of health care, controlling for education, to the presentation of psychological, social, and purely somatic problems in general practice.

Method: Data was derived from a "women's health care" practice and twenty-one group practices providing regular care.