NHLDP Netherlands:Applying Ophelia in Rheumatology care

Mark Bakker Dr. Polina PutrikProf. dr. Annelies Boonen

Key staff

Dr. Polina Putrik Prof. dr. Annelies Boonen Mark Bakker

Partner Organisations

Dr. Marc KokHanneke Voorneveld

Prof. dr. Mart van der LaarDr. Harald Vonkeman

Alliantie Gezondheidsvaardigheden, ReumaZorg Nederland

Background- One in three people in The

Netherlands face challenges related to health literacy (Heijmans, Brabers & Rademakers, 2018)

- Rheumatic and Musculoskeletal diseases account for over 20% of the global years lived with disability (Vos et al., 2012)

- Musculoskeletal diseases are more prevalent among the lower educated (Putrik et al., 2018)

- Prescription of biologicalDMARDs at a later stage, at higher disease activity(Putrik et al., 2016)

- Possible explanation forthe gap: health literacy

Background

Cum

ulat

ive

HR

Time

Aims

• To address health literacy needs and co-design a “health literate” rheumatology clinic

Sub-aims:• To increase awareness about the importance of

health literacy• To disseminate our lessons learned

Context & focus

- Patients with rheumatic conditions in specialised (outpatient) care:- Spondyloarthritis (SpA) - Rheumatoid Arthritis (RA)- Gout

Needs assessment population

(HLQ)

Generate patient profiles

Discuss profiles and perceptions

Co-design, develop and implement

interventionsPerception healthcare providers

• OPtimising HEalth LIteracy and Access (Ophelia) approach (Osborne et al., 2013; Batterham et al., 2014)

• Design as inclusive as possible

Method

Address needs before, during, and after care moment

Method

• Perception of healthcare providers

Current status and timeline

Prep

arations

First data

Prep

arationsSpA

RA

Lessons learnedStrengths

Minimised selection biasInclusive, personal, supportive

Enhanced heterogeneity / transferability

A diverse patient population, within and between centres

Expert partners

Innovation

Close contact with data & context

Weaknesses

Small-scaled with a small research team

Setup for data collection is time-consuming

Time investment needed by medical staff

Lessons learnedOpportunities

Increasing awareness at policy level

Scaling up & partnerships

Further engaging with patients

Threats

“What’s the use?”

Cost of investment vs. expected outcomes

Time investment & commitment by medical staff

Future partnerships & scaling up potential

• Sponsors• Other departments in current hospitals• NVZ / NFU: Dutch hospital federations• Expand current partnerships

Conclusions

• Successful first steps – energy to move further!

• Workshops are coming up in 2019 – finding solutions

• Eager to collaborate with other specialties

m.vandort@maastrichtuniversity.nl

References

Batterham, R.W., Buchbinder, R., Beauchamp, A., Dodson, S., Elsworth, G.R., & Osborne, R.H. (2014). The OPtimising HEalth LIterAcy (Ophelia) process: study protocol for using health literacy profiling and community engagement to create and implement health reform. BMC Public Health 14:694.

Heijmans, M., Brabers, A., & Rademakers, J. (2018). Health Literacy in Nederland. Utrecht, Netherlands: Nivel Osborne, R.H., Batterham, R.W., Elsworth, G.R., Hawkins, M., & Buchbinder, R. (2013). The grounded psychometric

development and initial validation of the Health Literacy Questionnaire (HLQ). BMC Public Health. 13:658. Putrik, P., Ramiro, S., Lie, E., Keszei, A.P., Kvien, T.K., . . . van der Heijde, D. (2016). Less educated and older

patients have reduced access to biologic DMARDs even in a country with highly developed social welfare (Norway): results from Norwegian cohort study NOR-DMARD. Rheumatology (Oxford)

Putrik, P., Ramiro, S., Chorus, A. M., Keszei, A. P., & Boonen, A. (2018). Socio-economic gradients in the presence of musculoskeletal and other chronic diseases: results from a cross-sectional study in the Netherlands. Clinical Rheumatology, 37(12), 3173-3182. doi:10.1007/s10067-018-4158-3

Vos, T., Flaxman, A. D., Naghavi, M., Lozano, R., Michaud, C., Ezzati, M., . . . Murray, C. J. L. (2012). Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859), 2163-2196. doi:https://doi.org/10.1016/S0140-6736(12)61729-2

m.vandort@maastrichtuniversity.nl

Thank you!

Contact: mark.bakker@mumc.nl