NVAG March 2015
Healthy Health Care
The integrated approach to lifestyle support in deprived urban areas, is, despite good initiatives, insufficient.
Geesje NijhofCoordinating/Specialist Senior Inspector
My background
• Medical doctor
• Specialised in public health• Worked for GGD, MOA, RIVM and now for the Dutch Health Care Inspectorate for six and half years• The first five years for public health topics with a focus on low SES and ethnic minorities and network inspection. Mainly stimulating inspection.• After a reduction of the public health department and a reorganisation I now work for elderly health care inspection.
Preliminary stage, research issue and goal
State of the healthcare 2012: Preconditions integrated approach to lifestyle support in deprived urban areas. Follow up research.
What is the view of the inspectorate on the cooperation of the joint health care providers in 20 deprived urban areas when looking at the preconditions for healthy health care?
Primary health care centres, community health services and home care institutions cooperate in all deprived urban areas according to the preconditions of healthy health care.
Method Selection 20 deprived urban areas were selected (NIVEL) 3 parties, if involved, an external director
QuestionnaireWeb based questionnaire with a 100% response rate
Visit1 conversation with the three parties involved and if needed anexternal director. Presence: 100%
20 area reports: assesment was based on the preconditions Present/not present = insufficient Operational/secured = sufficient
Preconditions on which the assesment is based
1. Joint problem analysis2. Joint goals3. Systematic evaluation and improvement4. Structured consultation of relevant care givers in the area5. Network control6. Involvement of the municipality and health insurance company
Results – total score per area
* * * * * * * * * * * * * *0
1
2
3
4
5
6
Totaal geborgd Totaal operationeel Totaal aanwezig Totaal afwezig
Wijken (N=20)* = LVG -lid
Aan
tal
ran
dvo
orw
aard
en
Results – overview of the preconditions
0 5 10 15 20
Gezamenlijke probleemstelling
Gezamenlijke doelstellingen
Systematische evaluatie en verbetering
Gestructureerd overleg
Netwerkregie
Betrokkenheid zorgverzekeraar-gemeente
Aantal wijken (N=20)
geborgd operationeel aanwezig afwezig
1. Joint problem analysis2. Joint goals
5 13 1Gezamenlijke doelstellingen
Aantal wijken (N=20)
operationeel aanwezig afwezig
2 5 12 1Gezamenlijke probleemanalyse
Aantal wijken (N=20)
geborgd operationeel aanwezig afwezig
3. Systematic evaluation and improvement4. Structured consultation
6 13 1Systematische evaluatie en verbetering
Aantal wijken (N=20)
operationeel aanwezig afwezig
1 5 11 3Gestructureerd overleg
Aantal wijken (N=20)
geborgd operationeel aanwezig afwezig
1 8 11Netwerkregie
Aantal wijken (N=20)
geborgd aanwezig afwezig
5. Network control 6. Involvement of the municipality and health insurance company
2 11 5 2Betrokkenheid zorgverzekeraar -gemeente
Aantal wijken (N=20)
geborgd operationeel aanwezig afwezig
Promoting factors, from the field
Knowing each other and who is in charge of what
Trusting each other
Grant each other things
Using each others expertise
Being enthousiastic
Taking the iniative
bottom-up, the patient should be the focal point
Conclusion Many lifestyle support activities, but no integrated approach
Little connection of universal prevention and lifestyle support activities of individuals
Active management of cohesion and cooperation of well structured primary health care centres
Convenants of the municipality and health care insurances are available, but there is inssuficient overall coordination with the health care providers
Consequences and continuation The focus of the of the Health Care Inspectorate shifted by order of the minister of Health, Welfare and Sport. The current focus: 1. Thematic Inspection Research on hold and reduction for the future.
2. An emphasis on the risk to patient safety. Consequences for the practice: Monitoring of incidents Risk based supervision Incentive supervision has been put on hold We are waiting for better times for this subject.
Impact of this project in Dutch healthcare
The ministry of Health, Welfare and Sport is using the results of this research for the development of the National Prevention Programme
Parties of the Agenda of Health care is using the preconditions
15
Challenge for (public) healthcare in the Netherlands
Focus on integrated care in low SES neighbourhoods Awareness of the influence of different ehtnic backgrounds in healhtcare Attention for and action on health illiteracy
NVAG March 2015
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