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Brabers AEM, de Jong JD, Groenewegen PP, van Dijk L. Social support plays a role in the attitude that people have towards taking an active role in medical decision-making. BMC Health Serv Res 2016; 16:502. [PMID: 27655113 PMCID: PMC5031318 DOI: 10.1186/s12913-016-1767-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 09/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a growing emphasis towards including patients in medical decision-making. However, not all patients are actively involved in such decisions. Research has so far focused mainly on the influence of patient characteristics on preferences for active involvement. However, it can be argued that a patient's social context has to be taken into account as well, because social norms and resources affect behaviour. This study aims to examine the role of social resources, in the form of the availability of informational and emotional support, on the attitude towards taking an active role in medical decision-making. METHODS A questionnaire was sent to members of the Dutch Health Care Consumer Panel (response 70 %; n = 1300) in June 2013. A regression model was then used to estimate the relation between medical and lay informational support and emotional support and the attitude towards taking an active role in medical decision-making. RESULTS Availability of emotional support is positively related to the attitude towards taking an active role in medical decision-making only in people with a low level of education, not in persons with a middle and high level of education. The latter have a more positive attitude towards taking an active role in medical decision-making, irrespective of the level of emotional support available. People with better access to medical informational support have a more positive attitude towards taking an active role in medical decision-making; but no significant association was found for lay informational support. CONCLUSIONS This study shows that social resources are associated with the attitude towards taking an active role in medical decision-making. Strategies aimed at increasing patient involvement have to address this.
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Brabers AEM, van Dijk L, Groenewegen PP, de Jong JD. Do social norms play a role in explaining involvement in medical decision-making? Eur J Public Health 2016; 26:901-905. [PMID: 27161909 DOI: 10.1093/eurpub/ckw069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients' involvement in medical decision-making is crucial to provide good quality of care that is respectful of, and responsive to, patients' preferences, needs and values. Whether people want to be involved in medical decision-making is associated with individual patient characteristics, and health status. However, the observation of differences in whether people want to be involved does not in itself provide an explanation. Insight is necessary into mechanisms that explain people's involvement. This study aims to examine one mechanism, namely social norms. We make a distinction between subjective norms, that is doing what others think one ought to do, and descriptive norms, doing what others do. We focus on self-reported involvement in medical decision-making. METHODS A questionnaire was sent to members of the Dutch Health Care Consumer Panel in May 2015 (response 46%; N = 974). A regression model was used to estimate the relationship between socio-demographics, social norms and involvement in medical decision-making. RESULTS In line with our hypotheses, we observed that the more conservative social norms are, the less people are involved in medical decision-making. The effects for both types of norms were comparable. CONCLUSION This study indicates that social norms play a role as a mechanism to explain involvement in medical decision-making. Our study offers a first insight into the possibility that the decision to be involved in medical decision-making is not as individual as it at first seems; someone's social context also plays a role. Strategies aimed at emphasizing patient involvement have to address this social context.
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Brabers AEM, van Dijk L, Groenewegen PP, van Peperstraten AM, de Jong JD. Does a strategy to promote shared decision-making reduce medical practice variation in the choice of either single or double embryo transfer after in vitro fertilisation? A secondary analysis of a randomised controlled trial. BMJ Open 2016; 6:e010894. [PMID: 27154481 PMCID: PMC4861095 DOI: 10.1136/bmjopen-2015-010894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The hypothesis that shared decision-making (SDM) reduces medical practice variations is increasingly common, but no evidence is available. We aimed to elaborate further on this, and to perform a first exploratory analysis to examine this hypothesis. This analysis, based on a limited data set, examined how SDM is associated with variation in the choice of single embryo transfer (SET) or double embryo transfer (DET) after in vitro fertilisation (IVF). We examined variation between and within hospitals. DESIGN A secondary analysis of a randomised controlled trial. SETTING 5 hospitals in the Netherlands. PARTICIPANTS 222 couples (woman aged <40 years) on a waiting list for a first IVF cycle, who could choose between SET and DET (ie, ≥2 embryos available). INTERVENTION SDM via a multifaceted strategy aimed to empower couples in deciding how many embryos should be transferred. The strategy consisted of decision aid, support of IVF nurse and the offer of reimbursement for an extra treatment cycle. Control group received standard IVF care. OUTCOME MEASURE Difference in variation due to SDM in the choice of SET or DET, both between and within hospitals. RESULTS There was large variation in the choice of SET or DET between hospitals in the control group. Lower variation between hospitals was observed in the group with SDM. Within most hospitals, variation in the choice of SET or DET appeared to increase due to SDM. Variation particularly increased in hospitals where mainly DET was chosen in the control group. CONCLUSIONS Although based on a limited data set, our study gives a first insight that including patients' preferences through SDM results in less variation between hospitals, and indicates another pattern of variation within hospitals. Variation that results from patient preferences could be potentially named the informed patient rate. Our results provide the starting point for further research. TRIAL REGISTRATION NUMBER NCT00315029; Post-results.
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van Dijk CE, de Jong JD, Verheij RA, Jansen T, Korevaar JC, de Bakker DH. Compliance with referrals to medical specialist care: patient and general practice determinants: a cross-sectional study. BMC FAMILY PRACTICE 2016; 17:11. [PMID: 26831125 PMCID: PMC4736608 DOI: 10.1186/s12875-016-0401-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/13/2016] [Indexed: 12/05/2022]
Abstract
Background In a gatekeeper system, primary care physicians and patients jointly decide whether or not medical specialist care is needed. However, it is the patient who decides to actually use the referral. Referral non-compliance could delay diagnosis and treatment. The objective of this study was to assess patient compliance with a referral to medical specialist care and identify patient and practice characteristics that are associated with it. Methods Observational study using data on 48,784 referrals to medical specialist care derived from electronic medical records of 58 general practices for the period 2008–2010. Referral compliance was based on claims data of medical specialist care. Logistic multilevel regression analyses were conducted to determine associations between patient and general practice characteristics and referral compliance. Results In 86.6 % of the referrals, patients complied. Patient and not practice characteristics were significantly associated with compliance. Patients from deprived urban areas and patients aged 18–44 years were less likely to comply, whereas patients aged 65 years and older were more likely to comply. Conclusion About 1 in 8 patients do not use their referral. These patients may not receive adequate care. Demographic and socio-economic factors appear to affect compliance. The results of this study may be used to make general practitioners more aware that some patients are more likely to be noncompliant with referrals.
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Huygens MW, Vermeulen J, Friele RD, van Schayck OC, de Jong JD, de Witte LP. Internet Services for Communicating With the General Practice: Barely Noticed and Used by Patients. Interact J Med Res 2015; 4:e21. [PMID: 26601596 PMCID: PMC4704911 DOI: 10.2196/ijmr.4245] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 06/25/2015] [Accepted: 07/12/2015] [Indexed: 11/13/2022] Open
Abstract
Background The Netherlands is one of the frontrunners of eHealth in Europe. Many general practices offer Internet services, which can be used by patients to communicate with their general practice. In promoting and implementing such services, it is important to gain insight into patients’ actual use and intention toward using. Objective The objective of the study is to investigate the actual use and intention toward using Internet services to communicate with the general practice by the general practice population. The secondary objective is to study the factors and characteristics that influence their intention to use such services. Methods There were 1500 members of the Dutch Health Care Consumer Panel, age over 18 years, that were invited to participate in this cross-sectional study. People who had contacted their general practitioner at least once in the past year were included. Participants were asked to fill out a questionnaire about the following services: Internet appointment planning, asking questions on the Internet, email reminders about appointments, Internet prescription refill requests, Internet access to medical data, and Internet video consultation. Participants indicated whether they had used these services in the past year, they would like to use them, and whether they thought their general practice had these services. For the first two services, participants rated items based on the unified theory of acceptance and use of technology complemented with additional constructs. These items were divided into six subscales: effort expectancy, performance expectancy, trust, attitude, facilitating conditions, and social influence. Results There were 546 participants that were included in the analyses out of 593 who met the inclusion criteria. The participants had a mean age of 53 years (SD 15.4), 43.6% (n=238) were male, and 66.8% (n=365) had at least one chronic illness. Actual use of the services varied between 0% (n=0, video consultation) and 10.4% (n=57, requesting prescription refill by Internet). The proportion of participants with a positive intention to use the service varied between 14.7% (n=80, video consultation) and 48.7% (n=266, Internet access to medical data). For each service, approximately half indicated that they did not know whether the service was available. Univariate logistic regression analyses revealed that all the constructs as well as age, level of education, and Internet usage had a significant association with intention toward using Internet appointment planning and asking questions by Internet. Conclusions Internet communication services to contact the general practice are not yet frequently used by this population. Although a substantial number of persons have a positive intention toward using such services, not all people who receive primary care seem willing to use them. The lack of awareness of the availability and functionality of such services might play an important role.
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Bouwman R, Bomhoff M, de Jong JD, Robben P, Friele R. The public's voice about healthcare quality regulation policies. A population-based survey. BMC Health Serv Res 2015; 15:325. [PMID: 26272506 PMCID: PMC4536787 DOI: 10.1186/s12913-015-0992-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 08/05/2015] [Indexed: 11/10/2022] Open
Abstract
Background In the wake of various high-profile incidents in a number of countries, regulators of healthcare quality have been criticised for their ‘soft’ approach. In politics, concerns were expressed about public confidence. It was claimed that there are discrepancies between public opinions related to values and the values guiding regulation policies. Although the general public are final clients of regulators’ work, their opinion has only been discussed in research to a limited extent. The aim of this study is to explore possible discrepancies between public values and opinions and current healthcare quality regulation policies. Methods A questionnaire was submitted to 1500 members of the Dutch Healthcare Consumer Panel. Questions were developed around central ideas underlying healthcare quality regulation policies. Results The response rate was 58.3 %. The regulator was seen as being more responsible for quality of care than care providers. Patients were rated as having the least responsibility. Similar patterns were observed for the food service industry and the education sector. Complaints by patients’ associations were seen as an important source of information for quality regulation, while fewer respondents trusted information delivered by care providers. However, respondents supported the regulator’s imposition of lighter measures firstly. Conclusions There are discrepancies and similarities between public opinion and regulation policies. The discrepancies correspond to fundamental concepts; decentralisation of responsibilities is not what the public wants. There is little confidence in the regulator’s use of information obtained by care providers’ internal monitoring, while a larger role is seen for complaints of patient organisations. This discrepancy seems not to exist regarding the regulator’s approach of imposing measures. A gradual, and often soft approach, is favoured by the majority of the public in spite of the criticism that is voiced in the media regarding this approach. Our study contributes to the limited knowledge of public opinion on government regulation policies. This knowledge is needed in order to effectively assess different approaches to involve the public in regulation policies.
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Coppen R, Groenewegen PP, Hazes JMWM, de Jong JD, Kievit J, de Neeling JNDN, Reijneveld SAM, Verheij RA, Vroom E. [Re-use of medical data for research. What do the Dutch think of the requirement for explicit consent?]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2015; 160:A9868. [PMID: 27027208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE How do healthcare consumers perceive the use of medical data for scientific research, within the framework of protection of their personal data? DESIGN Survey among 731 members of the Healthcare Consumer Panel of the Netherlands Institute for Health Services Research (NIVEL). METHOD A written and online questionnaire was used, consisting of general questions and 4 cases per respondent. The questions concerned the degree of trust respondents have in the use of previously registered data for different kinds of healthcare research, and their willingness to make data available under various conditions without being asked for explicit consent. RESULTS Respondents showed a high degree of trust in scientific researchers and physicians concerning the re-use of medical data for research. A majority agreed that it is not necessary to be explicitly asked for consent for this kind of research, providing they are informed: one-third found their autonomy in being able to decide to be more important than scientific progress; three-quarters found explicit permission unnecessary as long as the data is well-protected and only used for scientific research. CONCLUSION Data protection in research should be proportional to the risks of misuse and the benefits of the use of the data for research. A large majority of healthcare users trust the researchers, and the existing codes of conduct protect data sufficiently. Therefore, we see no need for stricter requirements for the use of health data, which would unnecessarily limit healthcare research. We do consider greater transparency about the research process to be necessary, in order to maintain a proper balance between personal-data protection and the need to emphasise the necessity for learning in the healthcare system.
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van Dijk CE, Venema B, de Jong JD, de Bakker DH. Market competition and price of disease management programmes: an observational study. BMC Health Serv Res 2014; 14:510. [PMID: 25359224 PMCID: PMC4219132 DOI: 10.1186/s12913-014-0510-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 10/10/2014] [Indexed: 11/25/2022] Open
Abstract
Background Managed competition was introduced into the health care system in several countries including the Netherlands, although effects of competition of both providers and health insurers on the price of health care are inconclusive. We investigated the association between competition of both providers (care groups) and health insurers and the price of disease management programmes (DMPs). Methods Data from 76 DMP contractual agreements for type II diabetes mellitus in 2008, 2009 and 2010 were used to analyse the association between market competition and the price of DMPs. Market competition was calculated per municipal health services region (GGD). Insurer market competition was measured by the Herfindahl-Hirschman Index (HHI), care group competition by the number of care groups and the care group market share of GPs. The effect of competition was cross-sectionally studied with linear regression analyses. Results Insurer market concentration (HHI) and care group market share were not associated with the price of DMPs. The number of care groups in a GGD region was associated with a lower price (−€4.68; 95% CI: −8.36 - -1.00). The mean difference in the price of DMPs between health insurers was €58. Conclusions The price of DMPs seems to be more dependent on the particular health insurer than on market conditions. For competition among health insurers and provider groups to develop, preconditions such as selective contracting and option for patient to change provider should be in place.
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Victoor A, Hansen J, van den Akker-van Marle ME, van den Berg B, van den Hout WB, de Jong JD. Choosing your health insurance package: a method for measuring the public's preferences for changes in the national health insurance plan. Health Policy 2014; 117:257-65. [PMID: 24875333 DOI: 10.1016/j.healthpol.2014.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/14/2014] [Accepted: 04/26/2014] [Indexed: 10/25/2022]
Abstract
With rising healthcare expenditure and limited budgets available, countries are having to make choices about the content of health insurance plans. The views of the general population can help determine such priorities. In this article, we investigate whether preferences of the general population regarding the content of health insurance plans could be measured with the help of a stated preference method: the Basket Method (BM). In this method, people use an online tool to include or exclude healthcare interventions from their hypothetical insurance package; this then affects their monthly premium. The study was conducted in the Netherlands. In total, 1007 members of two panels managed by the NIVEL filled out an online questionnaire that included the BM. The suitability of the BM was tested with the help of five criteria, e.g. the BM's ability to distinguish between healthcare interventions. Our results suggest that the BM is suitable for measuring preferences of the general population regarding the content of the health insurance plan, as it performs well on most criteria. Policy makers can use these preferences when deciding the content of the health insurance plan. Its contents will then be more aligned to the population's needs and preferences.
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van Dijk CE, Korevaar JC, Koopmans B, de Jong JD, de Bakker DH. The primary-secondary care interface: does provision of more services in primary care reduce referrals to medical specialists? Health Policy 2014; 118:48-55. [PMID: 24816225 DOI: 10.1016/j.healthpol.2014.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 03/24/2014] [Accepted: 04/03/2014] [Indexed: 11/17/2022]
Abstract
Great variation in referral rates between primary care physicians has been the main reason to influence physician's referral behaviour, by for example, stimulating extra services. This study investigated the extent to which the number of therapeutic and diagnostic services performed by primary care physicians influenced referrals. Data was derived from electronic medical records of 70 general practices for the period 2006 until 2010. For the total patient population (N=651,089 patient years) and specific patients groups for whom specific services were performed mostly (28 groups; 10 services), logistic multilevel regression analyses were conducted to determine associations between the number of services performed in a practice and referrals to medical specialists. The total number of services performed in a practice was not associated with the referral rate (OR: 1.00). Only for two specific services was a significant association found: a lower referral rate for minor surgery for patient with sebaceous cysts (OR: 0.98) and a higher rate for Doppler diagnostic tests for patients with other peripheral arterial diseases (OR: 1.04). As the number of services in general practice was rarely associated with referrals, other measures might be more effective in changing referral behaviour. Another explanation for our results could be that certain preconditions have not been met.
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Bes RE, Wendel S, Curfs EC, Groenewegen PP, de Jong JD. Acceptance of selective contracting: the role of trust in the health insurer. BMC Health Serv Res 2013; 13:375. [PMID: 24083663 PMCID: PMC3850712 DOI: 10.1186/1472-6963-13-375] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 09/27/2013] [Indexed: 11/24/2022] Open
Abstract
Background In a demand oriented health care system based on managed competition, health insurers have incentives to become prudent buyers of care on behalf of their enrolees. They are allowed to selectively contract care providers. This is supposed to stimulate competition between care providers and both increase the quality of care and contain costs in the health care system. However, health insurers are reluctant to implement selective contracting; they believe their enrolees will not accept this. One reason, insurers believe, is that enrolees do not trust their health insurer. However, this has never been studied. This paper aims to study the role played by enrolees’ trust in the health insurer on their acceptance of selective contracting. Methods An online survey was conducted among 4,422 people insured through a large Dutch health insurance company. Trust in the health insurer, trust in the purchasing strategy of the health insurer and acceptance of selective contracting were measured using multiple item scales. A regression model was constructed to analyse the results. Results Trust in the health insurer turned out to be an important prerequisite for the acceptance of selective contracting among their enrolees. The association of trust in the purchasing strategy of the health insurer with acceptance of selective contracting is stronger for older people than younger people. Furthermore, it was found that men and healthier people accepted selective contracting by their health insurer more readily. This was also true for younger people with a low level of trust in their health insurer. Conclusion This study provides insight into factors that influence people’s acceptance of selective contracting by their health insurer. This may help health insurers to implement selective contracting in a way their enrolees will accept and, thus, help systems of managed competition to develop.
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van Bodegom-Vos L, de Jong JD, Spreeuwenberg P, Curfs EC, Groenewegen PP. Are patients' preferences for shifting services from medical specialists to general practitioners related to the type of medical intervention? QUALITY IN PRIMARY CARE 2013; 21:81-95. [PMID: 23735689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND To improve the feasibility of shifting medical specialist to general practitioner (GP) services in patient-centred health care systems, it is important to know how this substitution is valued by patients. However, insight into patients' preferences is lacking. AIM This study aims to fill this gap by assessing whether patients' preferences for substitution are related to the type of medical intervention. METHODS Questionnaires were sent to 1000 members of the Dutch Insurants Panel (potential patients). Panel members were asked about their preferences for and use of medical specialist and GP services regarding 11 medical interventions. Six hundred and ninety-four members (69%) responded. We used multilevel multinomial regression to analyse the data. RESULTS Preferences were significantly related to medical intervention type. GP services were preferred for follow-up treatments (e.g. removing stitches) and non-complex invasive treatments (e.g. removal of lumps), and medical specialist services were preferred for complex invasive treatments (e.g. injection therapy for varicose veins), non-invasive treatments (e.g. start of insulin therapy) and diagnostic examinations (e.g. abdominal ultrasound). Age, effort required to visit a GP, perceived health status and previous treatment experiences also influenced preferences but did not confound the effects of medical intervention type. CONCLUSION This study provides strong indications that patients' preferences for substitution are influenced by the type of medical intervention. Therefore it seems important that health policy makers, purchasers and practitioners take the preferences of (potential) patients into account.
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Zwijnenberg NC, Hendriks M, Damman OC, Bloemendal E, Wendel S, de Jong JD, Rademakers J. Understanding and using comparative healthcare information; the effect of the amount of information and consumer characteristics and skills. BMC Med Inform Decis Mak 2012; 12:101. [PMID: 22958295 PMCID: PMC3483238 DOI: 10.1186/1472-6947-12-101] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 08/23/2012] [Indexed: 12/03/2022] Open
Abstract
Background Consumers are increasingly exposed to comparative healthcare information (information about the quality of different healthcare providers). Partly because of its complexity, the use of this information has been limited. The objective of this study was to examine how the amount of presented information influences the comprehension and use of comparative healthcare information when important consumer characteristics and skills are taken into account. Methods In this randomized controlled experiment, comparative information on total hip or knee surgery was used as a test case. An online survey was distributed among 800 members of the NIVEL Insurants Panel and 76 hip- or knee surgery patients. Participants were assigned to one of four subgroups, who were shown 3, 7, 11 or 15 quality aspects of three hospitals. We conducted Kruskall-Wallis tests, Chi-square tests and hierarchical multiple linear regression analyses to examine relationships between the amount of information and consumer characteristics and skills (literacy, numeracy, active choice behaviour) on one hand, and outcome measures related to effectively using information (comprehension, perceived usefulness of information, hospital choice, ease of making a choice) on the other hand. Results 414 people (47%) participated. Regression analysis showed that the amount of information slightly influenced the comprehension and the perceived usefulness of comparative healthcare information. It did not affect consumers’ hospital choice and ease of making this choice. Consumer characteristics (especially age) and skills (especially literacy) were the most important factors affecting the comprehension of information and the ease of making a hospital choice. For the perceived usefulness of comparative information, active choice behaviour was the most influencing factor. Conclusion The effects of the amount of information were not unambiguous. It remains unclear what the ideal amount of quality information to be presented would be. Reducing the amount of information will probably not automatically result in more effective use of comparative healthcare information by consumers. More important, consumer characteristics and skills appeared to be more influential factors contributing to information comprehension and use. Consequently, we would suggest that more emphasis on improving consumers’ skills is needed to enhance the use of comparative healthcare information.
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van Dijk L, de Jong JD, Westert GP, de Bakker DH. Variation in formulary adherence in general practice over time (2003-2007). Fam Pract 2011; 28:624-31. [PMID: 21788374 DOI: 10.1093/fampra/cmr043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To study trends and variation in adherence to the main national formulary for the 20 most prevalent health problems in Dutch general practice over a 5-year period (2003-07). METHODS Routine electronic medical records from a pool of 115 representative general practices were linked to the main national formulary. Analyses included over 2 million prescriptions for 246 391 patients. The outcome variable was whether or not the prescribed medication was congruent with recommendations in the national formulary. Trends and variation were analysed using three-level multilevel logistic regression analyses (general practice, patient, and prescription). RESULTS The percentage of formulary adherent prescriptions for the 20 most prevalent health problems was 73-76% between 2003 and 2007. The percentage varied considerably between guidelines. Lowest adherence rates were found for acute bronchitis and acute upper respiratory infection. Interpractice variation was constant over time. CONCLUSIONS General practice information networks are useful for monitoring general patterns of formulary on a year-to-year basis. Formulary adherence is stable over time but varies across diagnoses, patients and general practices. In the past decade, efforts have been made to increase the level of formulary adherent prescribing. These general efforts managed to stabilize (variation in) adherence in a field where many other initiatives (e.g. by pharmaceutical companies) are undertaken to influence prescribing behaviour.
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Wendel S, de Jong JD, Curfs EC. Consumer evaluation of complaint handling in the Dutch health insurance market. BMC Health Serv Res 2011; 11:310. [PMID: 22085762 PMCID: PMC3250957 DOI: 10.1186/1472-6963-11-310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 11/15/2011] [Indexed: 11/26/2022] Open
Abstract
Background How companies deal with complaints is a particularly challenging aspect in managing the quality of their service. In this study we test the direct and relative effects of service quality dimensions on consumer complaint satisfaction evaluations and trust in a company in the Dutch health insurance market. Methods A cross-sectional survey design was used. Survey data of 150 members of a Dutch insurance panel who lodged a complaint at their healthcare insurer within the past 12 months were surveyed. The data were collected using a questionnaire containing validated multi-item measures. These measures assess the service quality dimensions consisting of functional quality and technical quality and consumer complaint satisfaction evaluations consisting of complaint satisfaction and overall satisfaction with the company after complaint handling. Respondents' trust in a company after complaint handling was also measured. Using factor analysis, reliability and validity of the measures were assessed. Regression analysis was used to examine the relationships between these variables. Results Overall, results confirm the hypothesized direct and relative effects between the service quality dimensions and consumer complaint satisfaction evaluations and trust in the company. No support was found for the effect of technical quality on overall satisfaction with the company. This outcome might be driven by the context of our study; namely, consumers get in touch with a company to resolve a specific problem and therefore might focus more on complaint satisfaction and less on overall satisfaction with the company. Conclusions Overall, the model we present is valid in the context of the Dutch health insurance market. Management is able to increase consumers' complaint satisfaction, overall satisfaction with the company, and trust in the company by improving elements of functional and technical quality. Furthermore, we show that functional and technical quality do not influence consumer satisfaction evaluations and trust in the company to the same extent. Therefore, it is important for managers to be aware of the type of consumer satisfaction they are measuring when evaluating the handling of complaints within their company.
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Reitsma-van Rooijen M, de Jong JD, Rijken M. Regulated competition in health care: switching and barriers to switching in the Dutch health insurance system. BMC Health Serv Res 2011; 11:95. [PMID: 21569225 PMCID: PMC3112070 DOI: 10.1186/1472-6963-11-95] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 05/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2006, a number of changes in the Dutch health insurance system came into effect. In this new system mobility of insured is important. The idea is that insured switch insurers because they are not satisfied with quality of care and the premium of their insurance. As a result, insurers will in theory strive for a better balance between price and quality. The Dutch changes have caught the attention, internationally, of both policy makers and researchers. In our study we examined switching behaviour over three years (2007-2009). We tested if there are differences in the numbers of switchers between groups defined by socio-demographic and health characteristics and between the general population and people with chronic illness or disability. We also looked at reasons for (not-)switching and at perceived barriers to switching. METHODS Switching behaviour and reasons for (not-)switching were measured over three years (2007-2009) by sending postal questionnaires to members of the Dutch Health Care Consumer Panel and of the National Panel of people with Chronic illness or Disability. Data were available for each year and for each panel for at least 1896 respondents - a response of between 71% and 88%. RESULTS The percentages of switchers are low; 6% in 2007, 4% in 2008 and 3% in 2009. Younger and higher educated people switch more often than older and lower educated people and women switch more often than men. There is no difference in the percentage of switchers between the general population and people with chronic illness or disability. People with a bad self-perceived health, and chronically ill and disabled, perceive more barriers to switching than others. CONCLUSION The percentages of switchers are comparable to the old system. Switching is not based on quality of care and thus it can be questioned whether it will lead to a better balance between price and quality. Although there is no difference in the frequency of switching among the chronically ill and disabled and people with a bad self-perceived health compared to others, they do perceive more barriers to switching. This suggests there are inequalities in the new system.
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Wendel S, Bes RE, de Jong JD, Schellevis FG, Friele RD. [The fat doctor and the fat patient--can a doctor also be allowed to transgress?]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2010; 154:A2897. [PMID: 21211080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Evaluation of opinions of patients with regard to an unhealthy lifestyle of the doctor and assessment as to whether or not this is dependent on the patient's own lifestyle (healthy or unhealthy). DESIGN Descriptive questionnaire study. METHOD An online questionnaire was sent to 1000 members of a panel. They were asked to score a set of statements about their trust in a doctor who smokes, drinks or is overweight and the willingness to follow the advice of such a doctor. The items were scored on a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree). RESULTS The respondents found it very important that doctors should serve as a role model. A striking finding was that two-thirds would follow the advice of a doctor who does not serve as a role model. Furthermore, smoking, drinking and overweight respondents were shown to have more trust in a smoking, drinking or overweight doctor than non-smokers, non-drinkers or respondents who are not overweight. Regarding the willingness to follow a doctor's advice, we found that drinking and overweight respondents were more likely to follow the advice of a drinking or overweight doctor than non-drinkers or respondents who are not overweight. We did not find a significant difference between smokers and non-smokers and their willingness to follow the advice from a smoking doctor. CONCLUSION Respondents found it important that doctors serve as a role model. Yet, a majority of the respondents would follow the advice of a doctor who does not serve as a role model. Respondents who struggle with the same unhealthy lifestyle habits as their doctor reported that they are more likely to follow his or her advice than respondents who do not have these unhealthy lifestyle habits.
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Hendriks M, de Jong JD, van den Brink-Muinen A, Groenewegen PP. The intention to switch health insurer and actual switching behaviour: are there differences between groups of people? Health Expect 2009; 13:195-207. [PMID: 19906212 DOI: 10.1111/j.1369-7625.2009.00583.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Several western countries have introduced managed competition in their health care system. In the Netherlands, a new health insurance law was introduced in January 2006 making it easier to switch health insurer each year. OBJECTIVE The objective was to measure people's intention to switch health insurer and actual switching behaviour. We also examined whether some groups were less inclined to switch health insurer and/or had more difficulty to exert their intention to switch. DESIGN In October 2006, members of three Dutch panels indicated whether they intended to switch health insurer during that year's open enrollment period. In the beginning of 2007, the same people were asked whether they indeed switched health insurer. RESULTS Only 1% intended to switch health insurer. Women, older people, lower educated people, people who were insured for a longer period and people who reported a bad or moderate health were less inclined to switch health insurer. The amount of switching was higher among individuals who intended to switch (31%) than among individuals who did not know whether they would switch (7%) and individuals with no intention to switch (2%). Among those who intended to switch health insurer, women and people who reported a good health switched health insurer more often. The years of enrollment were also associated with actual switching behaviour. DISCUSSION AND CONCLUSIONS We might have to temper the optimistic expectations on enhanced choice. Future research should determine why people do not switch health insurer when they intend to and which barriers they experience.
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de Jong JD, Groenewegen PP, Spreeuwenberg P, Schellevis F, Westert GP. Do guidelines create uniformity in medical practice? Soc Sci Med 2009; 70:209-16. [PMID: 19879028 DOI: 10.1016/j.socscimed.2009.10.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Indexed: 10/20/2022]
Abstract
This article aimed to test the general hypothesis that guidelines create uniformity, or reduce variation, in medical practice. Medical practice variation has policy interest and is one of the reasons for developing guidelines. The development and implementation of guidelines was considered in the broader context of processes of rationalization. We focused on the influence of voluntary guidelines developed by the professional organization for family physicians in the Netherlands on variation in drug prescription. Data were used from the First and Second Dutch National Survey of General Practice (DNSGP1 and DNSGP2), collected in 1987 and 2001 respectively. DNSGP1 consisted of 103 practices and 161 GPs serving 335.000 patients. DNSGP2 consisted of 104 practices and 195 GPs serving 390.000 patients. Two groups of diagnoses were created, one containing all diagnoses for which guidelines were introduced and one containing all other diagnoses. For both groups a measure of concentration, Herfindahl-Hirschman Index (HHI), was used to represent variation. This measure of concentration was compared between both groups using multilevel analysis. Results showed that although there was an overall increase in variation (a significantly lower HHI) in prescription, the increase was less in the cases of diagnoses for which guidelines were introduced. Guidelines, primarily, had an effect on variations in single-handed practices. The overall conclusion is that the introduction of guidelines, although it probably tempered the increase in variation, did not reduce variation.
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de Jong JD, Groenewegen PP, Spreeuwenberg P, Westert GP, de Bakker DH. Do decision support systems influence variation in prescription? BMC Health Serv Res 2009; 9:20. [PMID: 19183464 PMCID: PMC2662826 DOI: 10.1186/1472-6963-9-20] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 01/30/2009] [Indexed: 11/16/2022] Open
Abstract
Background Translating scientific evidence into daily practice is problematic. All kinds of intervention strategies, using educational and/or directive strategies, aimed at modifying behavior, have evolved, but have been found only partially successful. In this article the focus is on (computerized) decision support systems (DSSs). DSSs intervene in physicians' daily routine, as opposed to interventions that aim at influencing knowledge in order to change behavior. We examined whether general practitioners (GPs) are prescribing in accordance with the advice given by the DSS and whether there is less variation in prescription when the DSS is used. Methods Data were used from the Second Dutch National Survey of General Practice (DNSGP2), collected in 2001. A total of 82 diagnoses, 749811 contacts, 133 physicians, and 85 practices was included in the analyses. GPs using the DSS daily were compared to GPs who do not use the DSS. Multilevel analyses were used to analyse the data. Two outcome measures were chosen: whether prescription was in accordance with the advice of the DSS or not, and a measure of concentration, the Herfindahl-Hirschman Index (HHI). Results GPs who use the DSS daily prescribe more according to the advice given in the DSS than GPs who do not use the DSS. Contradictory to our expectation there was no significant difference between the HHIs for both groups: variation in prescription was comparable. Conclusion We studied the use of a DSS for drug prescribing in general practice in the Netherlands. The DSS is based on guidelines developed by the Dutch College of General Practitioners and implemented in the Electronic Medical Systems of the GPs. GPs using the DSS more often prescribe in accordance with the advice given in the DSS compared to GPs not using the DSS. This finding, however, did not mean that variation is lower; variation is the same for GPs using and for GPs not using a DSS. Implications of the study are that DSSs can be used to implement guidelines, but that it should not be expected that variation is limited.
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Heiligers PJM, de Jong JD, Groenewegen PP, Hingstman L, Völker B, Spreeuwenberg P. Is networking different with doctors working part-time? Differences in social networks of part-time and full-time doctors. BMC Health Serv Res 2008; 8:204. [PMID: 18834545 PMCID: PMC2583974 DOI: 10.1186/1472-6963-8-204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 10/04/2008] [Indexed: 11/18/2022] Open
Abstract
Background Part-time working is a growing phenomenon in medicine, which is expected to influence informal networks at work differently compared to full-time working. The opportunity to meet and build up social capital at work has offered a basis for theoretical arguments. Methods Twenty-eight teams of medical specialists in the Netherlands, including 226 individuals participated in this study. Interviews with team representatives and individual questionnaires were used. Data were gathered on three types of networks: relationships of consulting, communication and trust. For analyses, network and multilevel applications were used. Differences between individual doctors and between teams were both analysed, taking the dependency structure of the data into account, because networks of individual doctors are not independent. Teams were divided into teams with and without doctors working part-time. Results and Discussion Contrary to expectations we found no impact of part-time working on the size of personal networks, neither at the individual nor at the team level. The same was found regarding efficient reachability. Whereas we expected part-time doctors to choose their relations as efficiently as possible, we even found the opposite in intended relationships of trust, implying that efficiency in reaching each other was higher for full-time doctors. But we found as expected that in mixed teams with part-time doctors the frequency of regular communication was less compared to full-time teams. Furthermore, as expected the strength of the intended relationships of trust of part-time and full-time doctors was equally high. Conclusion From these findings we can conclude that part-time doctors are not aiming at efficiency by limiting the size of networks or by efficient reachability, because they want to contact their colleagues directly in order to prevent from communication errors. On the other hand, together with the growth of teams, we found this strategy, focussed on reaching all colleagues, was diminishing. And our data confirmed that formalisation was increasing together with the growth of teams.
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de Jong JD, van den Brink-Muinen A, Groenewegen PP. The Dutch health insurance reform: switching between insurers, a comparison between the general population and the chronically ill and disabled. BMC Health Serv Res 2008; 8:58. [PMID: 18366678 PMCID: PMC2287167 DOI: 10.1186/1472-6963-8-58] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 03/19/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND On 1 January 2006 a number of far-reaching changes in the Dutch health insurance system came into effect. In the new system of managed competition consumer mobility plays an important role. Consumers are free to change their insurer and insurance plan every year. The idea is that consumers who are not satisfied with the premium or quality of care provided will opt for a different insurer. This would force insurers to strive for good prices and quality of care. Internationally, the Dutch changes are under the attention of both policy makers and researchers. Questions answered in this article relate to switching behaviour, reasons for switching, and differences between population categories. METHODS Postal questionnaires were sent to 1516 members of the Dutch Health Care Consumer Panel and to 3757 members of the National Panel of the Chronically ill and Disabled (NPCD) in April 2006. The questionnaire was returned by 1198 members of the Consumer Panel (response 79%) and by 3211 members of the NPCD (response 86%). Among other things, questions were asked about choices for a health insurer and insurance plan and the reasons for this choice. RESULTS Young and healthy people switch insurer more often than elderly or people in bad health. The chronically ill and disabled do not switch less often than the general population when both populations are comparable on age, sex and education. For the general population, premium is more important than content, while the chronically ill and disabled value content of the insurance package as well. However, quality of care is not important for either group as a reason for switching. CONCLUSION There is increased mobility in the new system for both the general population and the chronically ill and disabled. This however is not based on quality of care. If reasons for switching are unrelated to the quality of care, it is hard to believe that switching influences the quality of care. As yet there are no signs of barriers to switch insurer for the chronically ill and disabled. This however could change in the future and it is therefore important to monitor changes.
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Lugtenberg M, Heiligers PJM, de Jong JD, Hingstman L. Internal medicine specialists' attitudes towards working part-time: a comparison between 1996 and 2004. BMC Health Serv Res 2006; 6:126. [PMID: 17026741 PMCID: PMC1617100 DOI: 10.1186/1472-6963-6-126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Accepted: 10/06/2006] [Indexed: 11/27/2022] Open
Abstract
Background Although medical specialists traditionally hold negative views towards working part-time, the practice of medicine has evolved. Given the trend towards more part-time work and that there is no evidence that it compromises the quality of care, attitudes towards part-time work may have changed as well in recent years. The aim of this paper was to examine the possible changes in attitudes towards part-time work among specialists in internal medicine between 1996 and 2004. Moreover, we wanted to determine whether these attitudes were associated with individual characteristics (age, gender, investments in work) and whether attitudes of specialists within a partnership showed more resemblance than specialists' attitudes from different partnerships. Methods Two samples were used in this study: data of a survey conducted in 1996 and in 2004. After selecting internal medicine specialists working in general hospitals in The Netherlands, the sample consisted of 219 specialists in 1996 and 363 specialists in 2004. They were sent a questionnaire, including topics on the attitudes towards part-time work. Results Internal medicine specialists' attitudes towards working part-time became slightly more positive between 1996 and 2004. Full-time working specialists in 2004 still expressed concerns regarding the investments of part-timers in overhead tasks, the flexibility of task division, efficiency, communication and continuity of care. In 1996 gender was the only predictor of the attitude, in 2004 being a full- or a part-timer, age and the time invested in work were associated with this attitude. Furthermore, specialists' attitudes were not found to cluster much within partnerships. Conclusion In spite of the increasing number of specialists working or preferring to work part-time, part-time practice among internal medicine specialists seems not to be fully accepted. The results indicate that the attitudes are no longer gender based, but are associated with age and work aspects such as the number of hours worked. Though there is little evidence to support them, negative ideas about the consequences of part-time work for the quality of care still exist. Policy should be aimed at removing the organisational difficulties related to part-time work and create a system in which part-time practice is fully integrated and accepted.
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de Jong JD, Westert GP, Lagoe R, Groenewegen PP. Variation in hospital length of stay: do physicians adapt their length of stay decisions to what is usual in the hospital where they work? Health Serv Res 2006; 41:374-94. [PMID: 16584454 PMCID: PMC1702523 DOI: 10.1111/j.1475-6773.2005.00486.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To test the hypothesis that physicians who work in different hospitals adapt their length of stay decisions to what is usual in the hospital under consideration. DATA SOURCES Secondary data were used, originating from the Statewide Planning and Research Cooperative System (SPARCS). SPARCS is a major management tool for assisting hospitals, agencies, and health care organizations with decision making in relation to financial planning and monitoring of inpatient and ambulatory surgery services and costs in New York state. STUDY DESIGN Data on length of stay for surgical interventions and medical conditions (a total of seven diagnosis-related groups [DRGs]) were studied, to find out whether there is more variation between than within hospitals. Data (1999, 2000, and 2001) from all hospitals in New York state were used. The study examined physicians practicing in one hospital and physicians practicing in more than one hospital, to determine whether average length of stay differs according to the hospital of practice. Multilevel models were used to determine variation between and within hospitals. A t-test was used to test whether length of stay for patients of each multihospital physician differed from the average length of stay in each of the two hospitals. PRINCIPAL FINDINGS There is significantly (p<.05) more variation between than within hospitals in most of the study populations. Physicians working in two hospitals had patient lengths of stay comparable with the usual practice in the hospital where the procedure was performed. The proportion of physicians working in one hospital did not have a consistent effect for all DRGs on the variation within hospitals. CONCLUSION Physicians adapt to their colleagues or to the managerial demands of the particular hospital in which they work. The hospital and broader work environment should be taken into account when developing effective interventions to reduce variation in medical practice.
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de Jong JD, Heiligers P, Groenewegen PP, Hingstman L. Part-time and full-time medical specialists, are there differences in allocation of time? BMC Health Serv Res 2006; 6:26. [PMID: 16515698 PMCID: PMC1409779 DOI: 10.1186/1472-6963-6-26] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Accepted: 03/03/2006] [Indexed: 11/10/2022] Open
Abstract
Background An increasing number of medical specialists prefer to work part-time. This development can be found worldwide. Problems to be faced in the realization of part-time work in medicine include the division of night and weekend shifts, as well as communication between physicians and continuity of care. People tend to think that physicians working part-time are less devoted to their work, implying that full-time physicians complete a greater number of tasks. The central question in this article is whether part-time medical specialists allocate their time differently to their tasks than full-time medical specialists. Methods A questionnaire was sent by mail to all internists (N = 817), surgeons (N = 693) and radiologists (N = 621) working in general hospitals in the Netherlands. Questions were asked about the actual situation, such as hours worked and night and weekend shifts. The response was 53% (n = 411) for internists, 52% (n = 359) for surgeons, and 36% (n = 213) for radiologists. Due to non-response on specific questions there were 367 internists, 316 surgeons, and 71 radiologists included in the analyses. Multilevel analyses were used to analyze the data. Results Part-time medical specialists do not spend proportionally more time on direct patient care. With respect to night and weekend shifts, part-time medical specialists account for proportionally more or an equal share of these shifts. The number of hours worked per FTE is higher for part-time than for full-time medical specialists, although this difference is only significant for surgeons. Conclusion In general, part-time medical specialists do their share of the job. However, we focussed on input only. Besides input, output like the numbers of services provided deserves attention as well. The trend in medicine towards more part-time work has an important consequence: more medical specialists are needed to get the work done. Therefore, a greater number of medical specialists have to be trained. Part-time work is not only a female concern; there are also (international) trends for male medical specialists that show a decline in the number of hours worked. This indicates an overall change in attitudes towards the number of hours medical specialists should work.
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