RESUMEN
About 25 years ago, concept mapping was introduced in the Netherlands and applied in different fields. A collection of concept mapping projects conducted in the Netherlands was identified, in part in the archive of the Netherlands Institute of Mental Health and Addiction (Trimbos Institute). Some of the 90 identified projects are internationally published. The 90 concept mapping projects reflect the changes in mental health care and can be grouped into 5-year periods and into five typologies. The studies range from conceptualizing the problems of the homeless to the specification of quality indicators for treatment programs for patients with cystic fibrosis. The number of concept mapping projects has varied over time. Growth has been considerable in the last 5 years compared to the previous 5 years. Three case studies are described in detail with 12 characteristics and graphical representations. Concept mapping aligns well with the typical Dutch approach of the "Poldermodel." A broad introduction of concept mapping in European countries in cooperation with other countries, such as the United States and Canada, would strengthen the empirical basis for applying this approach in health care policy, quality, and clinical work.
Asunto(s)
Análisis por Conglomerados , Investigación Empírica , Procesos de Grupo , Servicios de Salud Mental/organización & administración , Proyectos de Investigación , Conducta Cooperativa , Política de Salud , Humanos , Servicios de Salud Mental/normas , Países Bajos , Indicadores de Calidad de la Atención de SaludRESUMEN
OBJECTIVE: Depression research has resulted in knowledge about neurobiology, pharmacological strategies and short-term cost-effective treatments. However, more than two-thirds of all depressed patients experience insufficient improvement. Therefore, a better understanding of what patients, carers and professionals perceive as most helpful in the treatment of depression is needed. METHODS: Concept mapping, a mixed-method design, was used to identify the patients (n = 33), carers (n = 22) and professionals (n = 50) perspectives. In six brainstorm sessions, the patients, carers and professionals generated 795 ideas, which were condensed into 55 unique statements. Subsequently, 100 participants prioritized and sorted these statements, which were analysed by multidimensional scaling and cluster analysis and visualized as a two-dimensional map. RESULTS: The 55 statements were clustered in 10 factors and further grouped into four main-factors (meta-clusters): 'Professional therapist', 'Treatment content', 'Structured treatment process' and 'Treatment organisation'. Patients and carers prioritized 'Treatment organisation' higher than professionals, but overall there was considerable agreement about the factors of treatment the participants perceived as most helpful including factors related to the therapeutic relationship and the 'creation of hope'. CONCLUSIONS: Our study identified factors of depression treatment perceived as helpful according to patients, carers and professionals. Findings suggest that in a scientific era with emphasis on biological psychiatry, not only patients and carers, but also professionals consider aspecific factors the most helpful. Further studies might show that factors we found to be helpful in the treatment for depression, can be generalized to mental health treatment in general.
Asunto(s)
Cuidadores/psicología , Depresión/terapia , Personal de Salud/psicología , Participación del Paciente/psicología , Adulto , Actitud del Personal de Salud , Análisis por Conglomerados , Depresión/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: Self-management appears to be a promising approach in the case of depression, which helps to stimulate patients' autonomy. However, a good and systematic description of the concept self-management from the patients' perspective, to our knowledge, has not yet been performed. OBJECTIVE: To determine: (i) what strategies patients think they can use themselves to recover from depression, (ii) which main themes of self-management strategies can be detected, and (iii) which of these strategies patients perceive as being most helpful. METHODS: We used concept mapping to explore the experiences of patients who recently recovered from a depressive episode. Patients generated self-management strategies in focus group discussions. The strategies were clustered on a two-dimensional concept map by a hierarchical cluster analysis. RESULTS: Patients generated 50 strategies that formed eight clusters: (i) proactive attitude towards depression and treatment, (ii) daily life strategies and rules, (iii) explanation of disease to others, (iv) remaining socially engaged, (v) engaging in activities, (vi) structured attention to oneself, (vii) contact with fellow sufferers, and (viii) other. Behavioural and cognitive strategies and a proactive attitude towards treatment were considered as the most helpful. DISCUSSION AND CONCLUSION: From the patients' perspective, there is a wide range of self-management strategies that they can use - and perceive as helpful- to contribute to their own recovery. Professionals could encourage patients to take an active role in achieving recovery. Further research could open new roads to improve patients' active contributions to current treatments for depression.
Asunto(s)
Actitud Frente a la Salud , Trastorno Depresivo Mayor/terapia , Autocuidado/métodos , Adulto , Femenino , Grupos Focales , Conductas Relacionadas con la Salud , Política de Salud , Humanos , Masculino , Persona de Mediana Edad , Participación del Paciente/psicología , Autocuidado/psicología , Apoyo SocialRESUMEN
BACKGROUND: Internet interventions with and without therapist support have been found to be effective treatment options for harmful alcohol users. Internet-based therapy (IT) leads to larger and longer-lasting positive effects than Internet-based self-help (IS), but it is also more costly to provide. OBJECTIVE: To evaluate the cost effectiveness and cost utility of Internet-based interventions for harmful use of alcohol through the assessment of the incremental cost effectiveness of IT compared with IS. METHODS: This study was performed in a substance abuse treatment center in Amsterdam, the Netherlands. We collected data over the years 2008-2009. A total of 136 participants were included, 70 (51%) were female, and mean age was 41.5 (SD 9.83) years. Reported alcohol consumption and Alcohol Use Disorders Identification Test (AUDIT) scores indicated harmful drinking behavior at baseline. We collected self-reported outcome data prospectively at baseline and 6 months after randomization. Cost data were extracted from the treatment center's cost records, and sex- and age-specific mean productivity cost data for the Netherlands. RESULTS: The median incremental cost-effectiveness ratio was estimated at 3683 per additional treatment responder and 14,710 per quality-adjusted life-year (QALY) gained. At a willingness to pay 20,000 for 1 additional QALY, IT had a 60% likelihood of being more cost effective than IS. Sensitivity analyses attested to the robustness of the findings. CONCLUSIONS: IT offers better value for money than IS and might therefore be considered as a treatment option, either as first-line treatment in a matched-care approach or as a second-line treatment in the context of a stepped-care approach. TRIAL REGISTRATION: Netherlands Trial Register NTR-TC1155; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1155 (Archived by WebCite at http://www.webcitation.org/6AqnV4eTU).
Asunto(s)
Alcoholismo/terapia , Análisis Costo-Beneficio , Internet/economía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países BajosRESUMEN
OBJECTIVE: To investigate what patients themselves think they can contribute to recovery from depression, and what they find to be effective. The patients' perspective is necessary to improve treatment for depression. DESIGN: Qualitative, hypothesis-generating study. METHOD: The experiences and opinions of 20 patients who had recently recovered from a depressive episode were investigated using the 'concept mapping' method. In the first stage, patients generated statements during group discussions around the question: 'What can people themselves do to recover from depression?' In the second stage, patients individually graded the statements by relevance and grouped them by common characteristics. In the third stage, the statements were analysed and positioned in a concept map. RESULTS: In the first stage, the patients generated 50 statements which could be grouped into the following 8 clusters: active attitude towards depression and the assistance offered, regimen, explanation of the disease to acquaintances, social contacts, undertaking activities, structured attention for yourself, contact with fellow sufferers, and others. The common factor in statements that patients found the most important was that the focus for recovery should be on oneself. CONCLUSION: From the patients' perspective several methods were mentioned by which patients can contribute to their own recovery from depression. Practitioners could use these in their contact with the patient during treatment. This study also provides the basis for developing a self-management module for recovery from depression.
Asunto(s)
Actitud Frente a la Salud , Formación de Concepto , Depresión/psicología , Depresión/terapia , Autocuidado , Femenino , Humanos , Masculino , Participación del Paciente , AutoimagenRESUMEN
OBJECTIVE: The objective of this study is to identify the elements and clusters of a quality management model for integrated care. DESIGN: In order to develop the model a combination of three methods were applied. A literature study was conducted to identify elements of integrated care. In a Delphi study experts commented and prioritized 175 elements in three rounds. During a half-a-day session with the expert panel, Concept Mapping was used to cluster the elements, position them on a map and analyse their content. Multi-dimensional statistical analyses were applied to design the model. PARTICIPANTS: Thirty-one experts, with an average of 8.9 years of experience working in research, managing improvement projects or running integrated care programmes. RESULTS: The literature study resulted in 101 elements of integrated care. Based on criteria for inclusion and exclusion, 89 unique elements were determined after the three Delphi rounds. By using Concept Mapping the 89 elements were grouped into nine clusters. The clusters were labelled as: 'Quality care', 'Performance management', 'Interprofessional teamwork', 'Delivery system', 'Roles and tasks', 'Patient-centeredness', 'Commitment', 'Transparent entrepreneurship' and 'Result-focused learning'. CONCLUSION: The identified elements and clusters provide a basis for a comprehensive quality management model for integrated care. This model differs from other quality management models with respect to its general approach to multiple patient categories, its broad definition of integrated care and its specification into nine different clusters. The model furthermore accentuates conditions for effective collaboration such as commitment, clear roles and tasks and entrepreneurship. The model could serve evaluation and improvement purposes in integrated care practice. To improve external validity, replication of the study in other countries is recommended.
Asunto(s)
Formación de Concepto , Prestación Integrada de Atención de Salud/normas , Técnica Delphi , Modelos Organizacionales , Garantía de la Calidad de Atención de Salud , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: An assessment of the EFQM excellence model was carried out in Italy's Udine Hospital, aimed at evaluating how first and second-level managers perceived their hospital and individual departments. The study objectives also included identifying strengths and areas requiring improvement and stimulating a quality culture. DESIGN/METHODOLOGY/APPROACH: Udine's S. Maria della Misericordia Hospital is a large specialised unit in North East Italy and similar to many regional hospitals throughout the country. The survey is a single case study of the hospital and its ten clinical departments. A 153-item questionnaire was completed by 201 experienced respondents. FINDINGS: Leadership, policy and strategy, partnership and resources were rated highly, whereas people, society and customer results received lower ratings. Several improvement actions were planned, primarily with regard to the results criteria. PRACTICAL IMPLICATIONS: A two-level self-assessment was successfully carried out in a hospital, giving insight into the organisation's strengths and areas requiring improvement. Through the study, a systemic approach was introduced and quality awareness was heightened. ORIGINALITY/VALUE: The findings are useful for other hospitals conducting EFQM self-assessment.
Asunto(s)
Hospitales Especializados/normas , Garantía de la Calidad de Atención de Salud/métodos , Encuestas y Cuestionarios , Estudios Transversales , Hospitales Públicos , Italia , Programas Nacionales de SaludRESUMEN
OBJECTIVE: To evaluate a treatment process redesign programme implementing evidence-based treatment as part of a total quality management in a Dutch addiction treatment centre. METHOD: Quality management was monitored over a period of more than 10 years in an addiction treatment centre with 550 professionals. Changes are evaluated, comparing the scores on the nine criteria of the European Foundation for Quality Management (EFQM) Excellence Model before and after a major redesign of treatment processes and ISO certification. RESULTS: In the course of 10 years, most intake, care, and cure processes were reorganized, the support processes were restructured and ISO certified, 29 evidence-based treatment protocols were developed and implemented, and patient follow-up measuring was established to make clinical outcomes transparent. Comparing the situation before and after the changes shows that the client satisfaction scores are stable, that the evaluation by personnel and society is inconsistent, and that clinical, production, and financial outcomes are positive. The overall EFQM assessment by external assessors in 2004 shows much higher scores on the nine criteria than the assessment in 1994. CONCLUSION: Evidence-based treatment can successfully be implemented in addiction treatment centres through treatment process redesign as part of a total quality management strategy, but not all results are positive.
Asunto(s)
Protocolos Clínicos/normas , Modelos Organizacionales , Gestión de la Calidad Total/organización & administración , Humanos , Países Bajos , Centros de Tratamiento de Abuso de Sustancias , Trastornos Relacionados con Sustancias/terapiaRESUMEN
AIM: To identify and specify the structure and the elements of a quality framework for addiction treatment programs. METHOD: Concept mapping strategy was applied. In brainstorm sessions, 70 statements were generated and rated by 90 representatives of three stakeholder groups. Using multivariate statistical analyses, the statements were positioned on a map. RESULTS: Two dimensions 'Best Practice' and 'Performance' and nine clusters were identified. The three most important clusters were 'Attitude of staff', 'Client orientation' and 'Treatment practice'. The most important statement was effectiveness. CONCLUSION: The specific quality framework identified has some similarity with existing non-specific frameworks.
Asunto(s)
Servicios de Salud Mental/normas , Calidad de la Atención de Salud , Trastornos Relacionados con Sustancias/rehabilitación , Benchmarking , Humanos , Análisis Multivariante , Evaluación de Programas y Proyectos de SaludRESUMEN
OBJECTIVE: The objective of this study is to determine an indicator framework for addiction treatment centres based on the demands of stakeholders and in alignment with the European Foundation for Quality Management (EFQM) Excellence Model. SETTING: The setting is the Jellinek Centre based in Amsterdam, the Netherlands, which serves as a prototype for an addiction treatment centre. METHOD: Concept mapping was used in the construction of the indicator framework. During the 1-day workshop, 16 stakeholders generated, prioritized and sorted 73 items concerning quality and performance. Multidimensional scaling and cluster analysis was applied in constructing a framework consisting of two dimensions and eight clusters. RESULTS: The horizontal axis of the indicator framework is named 'Organization' and has two poles, namely, 'Processes' and 'Results'. The vertical axis is named ' Task' and the poles are named 'Efficient treatment' and 'Prevention programs'. The eight clusters in the two-dimensional framework are arranged in the following, prioritized sequence: 'Efficient treatment network', 'Effective service', ' Target group', 'Quality of life', 'Efficient service', 'Knowledge transfer', 'Reducing addiction related problems', and 'Prevention programs'. The most important items in the framework are: 'patients are satisfied with their treatment', 'early interventions', and 'efficient treatment chain'. CONCLUSION: The indicator framework aligns with three clusters of the results criteria of the EFQM Excellence Model. It is based on the stakeholders' perspectives and is believed to be specific for addiction treatment centres. The study demonstrates that concept mapping is a suitable strategy for generating indicator frameworks.