Generalist-Specialist Collaboration in Primary Care for Frail Older Persons: A Promising Model for the Future

Utilisation of nursing home care before and after the 2015 Dutch national reform: an interrupted time series analysis

BACKGROUND

The Netherlands introduced abrupt, large-scale, long-term care (LTC) reforms in 2015 that promoted ageing-in-place. However, there has been no comprehensive population-level study evaluating how these reforms have impacted nursing home (NH) utilisation. This study examines the association between the 2015 reforms with national monthly rates of NH admissions and survival time amongst newly admitted older adults.

METHODS

We analysed population data from Statistics Netherlands (2011-2019), conducting an interrupted time-series analysis to compare monthly NH admission rates before and after the 2015 reforms amongst adults aged 65 and older (N = 402 350). A Cox proportional hazards model was used to assess the reform's impact on mortality risk amongst newly admitted residents.

RESULTS

The adjusted NH admission rate before the reform was 88.80 per 100 000 older adults (95% CI (confidence interval): 82.36-95.83), compared to 69.82 per 100 000 after the reform (95% CI: 65.91-73.78), indicating a significant reduction (incident rate ratio: 0.80, 95% CI: 0.74-0.86). Over a 3-year follow-up, the average survival time for those admitted after the reform was 608 days (95% CI: 608.72-610.74), compared to 622.52 days (95% CI: 620.59-624.45) for those admitted before the reform. The reform was associated with a slightly increased mortality risk (hazard ratio: 1.05, 95% CI: 1.02-1.07).

CONCLUSIONS

The 2015 Dutch LTC reform is associated with a reduction in national NH admissions and a decrease in average survival time of 2 weeks.

Doing the Right Thing? General Practitioners' Considerations in Achieving a Timely Dementia Diagnosis

OBJECTIVES

Timely detection and diagnosis of dementia are beneficial for providing appropriate, anticipatory care and preventing acute situations. However, initiating diagnostic testing is a complex and dynamic process that requires general practitioners (GPs) to balance competing priorities. Previously identified barriers, such as a lack of time, knowledge, and resources, may not fully represent the challenges involved in this process. Therefore, this study aimed to examine GPs' more implicit considerations on starting the diagnostic trajectory for dementia.

METHODS

A qualitative study was conducted using semi-structured interviews with 14 Dutch GPs who were purposively selected through maximum variation sampling. The interview transcripts were inductively analyzed in multiple rounds by a multidisciplinary research team using thematic analysis.

RESULTS

GPs' considerations on starting the diagnostic trajectory for dementia can be summarized in three main themes that are interconnected: (1) 'the presumed patient's willingness', that is, facing a dilemma of wanting to respect patient autonomy in cases of denial or an absence of a diagnostic request, while at the same time identifying a problem and feeling the urgency to act; (2) 'the GP's attempt not to harm', that is, balancing between not wanting to harm the patient and/or relatives with the burdensome label of dementia and with the possible negative consequences of a late diagnosis; and (3) 'time, trust, and interprofessional collaboration influence timeliness of diagnostic work-up', that is, time available for consultations, time as a diagnostic factor, GP's diagnostic confidence, and trustful physician-patient relationship.

CONCLUSIONS

This study revealed that important ethical dilemmas regarding patient autonomy and the principle of doing no harm lie behind practical GP barriers to initiating diagnostic testing for dementia. Time, trust, and interprofessional collaboration were found to facilitate GPs in determining the right decision and timing with each individual patient and their relatives. Future research could explore the value of diagnostic decision aids that explicitly involve patients and their relatives in this balancing act.

A systematic literature review of the relationship between sustainable human resources management and spiritual leadership

BACKGROUND: The process of involving sustainability in the Human Resources (HR) area, which is still a major challenge to be faced, will only occur when the leadership shares the values that influence ethics at work and have a more involved relationship with all business stakeholders. OBJECTIVE: The objective of this study was to verify the relationship between the dimensions of Spiritual Leadership, the functional and competitive dimensions of Human Resources and Organizational Sustainability. METHODS: Through the Systematic Review Method, the available literature has been categorized based on the thematic alignment of the topics. Content analysis of 49 articles included predetermined codes verifying the most recurrent dimensions of each thematic axis. RESULTS: Among the HR functional dimensions, the one represented by training and development, assumes an intermediate role between the achievement of the intended cultural management, which can be through communication and teamwork, until reaching the organizational sustainability actions, which is the main purpose of this thematic relationship. CONCLUSIONS: This article makes a unique contribution to the existing literature on spiritual leadership and sustainable human resources management as well as reveals new avenues of in-depth research focusing specifically on the relationship of the thematic axes uncovered in the study.