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1. Multimorbiditeit

Author

Schellevis, F. G., Visser, M., editor, Kok, A.A.L., editor, Spies, P.E., editor, and Buurman, B.M., editor

Published
2020
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7. Management of diabetes patients with comorbidity in primary care: a mixed-method study in Odisha, India.

Author

Pati, Sandipana, van den Akker, Marjan, Schellevis, F (François) G, Sahoo, Krushna Chandra, and Burgers, Jako S

Subjects
PEOPLE with diabetes, PRIMARY care, DISEASE management, PATIENTS' attitudes, COMORBIDITY
Abstract

Background Diabetes patients with comorbidities need regular and comprehensive care for their disease management. Hence, it is essential to assess the primary care preparedness for managing diabetes patients and the perspectives of the diabetes patients on the care received at the primary care facilities. Methods All 21 Urban Primary Health Centres (UPHCs) in Bhubaneswar city of Odisha, India, were assessed using the modified Primary Care Evaluation Tool and WHO Package of Essential Non-communicable disease interventions questionnaire. Additionally, 21 diabetes patients with comorbidities were interviewed in-depth to explore their perception of the care received at the primary care facilities. Results All the UPHCs had provisions to meet the basic requirements for the management of diabetes and common comorbidities like hypertension. There were few provisions for chronic kidney illness, cardiovascular disease, mental health, and cancer. Diabetes patients felt that frequent change in primary care physicians at the primary care facilities affected their continuity of care. Easy accessibility, availability of free medicines, and provisions of basic laboratory tests at the facilities were felt to be necessary by the diabetes patients. Conclusion Our study highlights the existing gaps in India's healthcare system preparedness and the needs of diabetes patients with comorbidity. The government of India's Health and Wellness (HWC) scheme aims to deliver comprehensive healthcare to the population and provide holistic care at the primary care level for NCD patients. It is imperative that there is an early implementation of the various components of the HWC scheme to provide optimal care to diabetes patients. [ABSTRACT FROM AUTHOR]

Published
2023
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12. Duizeligheid bij ouderen

Author

Maarsingh, O. R., Schellevis, F. G., van der Horst, H. E., Dros, J., Ter Riet, G., van Weert, H. C. P. M., Schellevis, F. G., and van der Windt, D. A. W. N

Published
2010
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27. Self-care of patients with type 2 diabetes mellitus over the course of illness: implications for tailoring support

Author

Puffelen, A. van, Kasteleyn, M., Vries, L. de, Rijken, M., Heijmans, M., Nijpels, G., Schellevis, F., Diacourse Study Grp, General practice, APH - Quality of Care, APH - Aging & Later Life, and APH - Health Behaviors & Chronic Diseases

Subjects
medicine.medical_specialty, Complications, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, 030209 endocrinology & metabolism, Type 2 diabetes, Logistic regression, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus type 2, Diabetes mellitus, Internal medicine, Internal Medicine, Medicine, 030212 general & internal medicine, business.industry, Insulin, Confounding, Course of illness, Distress, Type 2 Diabetes Mellitus, medicine.disease, Diabetes duration, Self-care, business, Research Article
Abstract

Purpose: Type 2 diabetes requires patients to make lifestyle changes and perform daily self-care. To determine at what stages patients may need particular self-management support, we examined (1) whether patients’ performance of self-care related to their diabetes duration, and (2) whether illness characteristics (treatment and complications) and diabetes-related distress influenced this relationship. Methods: Cross-sectional data from 590 type 2 diabetes patients were analysed through linear and logistic regression analysis. Self-care behaviours were assessed by the revised Summary of Diabetes Self-Care Activities (SDSCA) measure. Diabetes duration (model 1), treatment and complications (model 2), and distress, as assessed by the Problem Areas In Diabetes (PAID) scale (model 3), were stepwise included. Sociodemographic characteristics were added to all models to account for confounding. Results: Patients with a longer history of diabetes were less physically active, but monitored their blood glucose levels more frequently than more recently diagnosed patients. These relationships were mediated by the presence of complications and the use of insulin, with lower levels of physical activity being found among patients with macrovascular complications and higher frequencies of glucose monitoring among patients on insulin. All predictors together explained maximally 5% of the variance in self-care, except for glucose monitoring (37%) and smoking (11%). Conclusion: Type 2 diabetes patients’ self-care activity changes over the course of illness. To provide tailored self-management support, diabetes care providers should take into account patients’ phase of illness, including their treatment and complications, as well as their personal characteristics and distress level.

Published
2020

28. Application of the JA-CHRODIS Integrated Multimorbidity Care Model (IMCM) to a Case Study of Diabetes and Mental Health

Author

Forjaz, Maria J., Rodriguez-Blazquez, Carmen, Guerrero Fernández de Alba, Inmaculada, Gimeno-Miguel, Antonio, Bliek-Bueno, Kevin, Prados-Torres, Alexandra, Culig, J, Jureviciene, E, Maggini, M, Maguire, P, Mammarella, F, Moor, V, Navickas, R, Onder, G, Elorriaga, KP, Rijken, M, Rothe, U, Schellevis, F, Segovia, C, and Zaletel, J

Abstract

The Integrated Multimorbidity Care Model (IMCM), developed by the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS), proposes a set of 16 multidimensional components (i.e., recommendations) to improve the care of persons with multimorbidity in Europe. This study aimed at analyzing the potential applicability of the IMCM. We followed a qualitative approach that comprised two phases: (1) The design of a case study based on empirical clinical data, which consisted of a hypothetical woman with multimorbidity, type 2 diabetes mellitus, mental health, and associated social problems, and (2) the creation of a consensus group to gather the opinions of a multidisciplinary group of experts and consider the potential applicability of the IMCM to our case study. Experts described how care should be delivered to this patient according to each model component, suggested the use of specific rating scales and tools to assess her needs in a comprehensive and regular way, and pointed our crucial health and social resources to improve her care process. Experts also highlighted patient-centered, integrated and tailored care as one of the keystones of quality healthcare. Our results suggest that the IMCM is applicable in complex patients with multimorbidity.

Published
2020

29. Socioeconomic inequalities in out-of-hours primary care use: An electronic health records linkage study

Author

Jansen, T., Hek, K., Schellevis, F. G., Kunst, A. E., Verheij, R. A., Jansen, T., Hek, K., Schellevis, F. G., Kunst, A. E., and Verheij, R. A.

Abstract

Background Low socioeconomic position (SEP) is related to higher healthcare use in out-of-hours primary care services (OPCSs). We aimed to determine whether inequalities persist when taking the generally poorer health status of socioeconomically vulnerable individuals into account. To put OPCS use in perspective, this was compared with healthcare use in daytime general practice (DGP). Methods Electronic health record (EHR) data of 988 040 patients in 2017 (251 DGPs, 27 OPCSs) from Nivel Primary Care Database were linked to socio-demographic data (Statistics, The Netherlands). We analyzed associations of OPCS and DGP use with SEP (operationalized as patient household income) using multilevel logistic regression. We controlled for demographic characteristics and the presence of chronic diseases. We additionally stratified for chronic disease groups. Results An income gradient was observed for OPCS use, with higher probabilities within each lower income group [lowest income, reference highest income group: odds ratio (OR) = 1.48, 95% confidence interval (CI): 1.45–1.51]. Income inequalities in DGP use were considerably smaller (lowest income: OR = 1.17, 95% CI: 1.15–1.19). Inequalities in OPCS were more substantial among patients with chronic diseases (e.g. cardiovascular disease lowest income: OR = 1.60, 95% CI: 1.53–1.67). The inequalities in DGP use among patients with chronic diseases were similar to the inequalities in the total population. Conclusions Higher OPCS use suggests that chronically ill patients with lower income had additional healthcare needs that have not been met elsewhere. Our findings fuel the debate how to facilitate adequate primary healthcare in DGP and prevent vulnerable patients from OPCS use.

Published
2020

39. Developments in mental health care in Dutch general practices:An overview of recent studies

Author

Magnée, T., de Beurs, D. P., Schellevis, F. G., Verhaak, P. F., APH - Quality of Care, APH - Aging & Later Life, and General practice

Abstract

BACKGROUND Dutch policy aims to strengthen mental health care in general practices, to keep health care affordable. Recently, a new function (mental health nurses) and a new referral model for patients with mental health problems were introduced. AIM To explore to what extent the volume of mental health care in Dutch general practices has increased and to what extent the content changed in the period 2010-2015. METHOD This study employed: 1. analyses of medical records, and 2. a case study in a primary health care centre. RESULTS The number of general practices with at least one mental health nurse increased from 20% in 2010 to almost 90% in 2015. In the period 2010-2014, general practitioners (gps) and mental health nurses treated increasing numbers of patients with mental health problems. No task shifting from gps to mental health nurses was observed. In the period 2011-2015, the number of antidepressant prescriptions increased slightly. In 2014, gps in a well-prepared primary care centre allocated 87% of their patients with mental health problems to a treatment setting in line with the referral model. CONCLUSION Dutch general practices have recently provided more mental health care, thereby emphasising their important role in the mental health care system.

Published
2019

45. Attitude toward livestock farming does not influence the earlier observed association between proximity to goat farms and self-reported pneumonia

Author

Borlée, F., Yzermans, C Joris, Oostwegel, Floor S.M., Schellevis, F., Heederik, D., Smit, L.A., Borlée, F., Yzermans, C Joris, Oostwegel, Floor S.M., Schellevis, F., Heederik, D., and Smit, L.A.

Abstract

Background: Attitudes toward environmental risks may be a source of bias in environmental health studies because concerns about environmental hazards may influence self-reported outcomes. Objective: The main aim was to assess whether earlier observed associations between proximity to goat farms and self-reported pneumonia were biased by participants’ attitude toward farming. Methods: We developed an attitude-score for 2,457 participants of the Dutch Livestock Farming and Neighbouring Residents’ Health Study (veehouderij en gezondheid omwonenden) by factor analysis of 13 questionnaire items related to attitude toward livestock farming. Linear regression analysis was used to assess associations between attitude and potential determinants. The effect of attitude on the association between goat farm proximity and pneumonia was analyzed by evaluating (1) misclassification of the outcome, (2) effect modification by attitude, and (3) exclusion of participants reporting health problems due to farms in their environment. Results: In general, the study population had a positive attitude toward farming, especially if participants were more familiar with farming. Older participants, females, ex-smokers, and higher-educated individuals had a more negative attitude. Both self-reported respiratory symptoms and exposure to livestock farms were associated with a more negative attitude. Misclassification of self-reported pneumonia was nondifferential with regard to participants’ attitude. Furthermore, no indication was found that the association between proximity to goat farms and pneumonia was modified by attitude. Excluding subjects who attributed their health symptoms to livestock farms did also not change the association. Conclusions: The association between goat farm proximity and pneumonia was not substantially biased by study participants’ attitude toward livestock farming.

Published
2019

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