Maartje J. van der Aa

Bio: Maartje J. van der Aa is an academic researcher from Maastricht University. The author has contributed to research in topics: Health care & Solidarity. The author has an hindex of 4, co-authored 10 publications receiving 58 citations. Previous affiliations of Maartje J. van der Aa include Public Health Research Institute & University of Amsterdam.

Patients with multimorbidity and their experiences with the healthcare process: a scoping review

Abstract: Background : The number of patients with multimorbidity (two or more conditions) is increasing. Observational research has shown that having multiple health problems is associated with poorer outcomes in terms of health, quality of care, and costs. Thus, it is imperative to understand how patients with multimorbidity experience their healthcare process. Insight into patient experiences can be used to tailor healthcare provision specifically to the needs of patients with multimorbidity. Objective : To synthesize self-reported experiences with the healthcare process of patients with multimorbidity, and identify overarching themes. Design : A scoping literature review that evaluates both qualitative and quantitative studies published in PubMed, Embase, MEDLINE, and PsycINFO. No restrictions were applied to healthcare setting or year of publication. Studies were included if they reported experiences with the healthcare process of patients with multimorbidity. Patient experiences were extracted and subjected to thematic analysis (interpretative), which revealed overarching themes by mapping their interrelatedness. Results : Overall, 22 empirical studies reported experiences of patients with multimorbidity. Thematic analysis identified 12 themes within these studies. The key overarching theme was the experience of a lack of holistic care. Patients also experienced insufficient guidance from healthcare providers. Patients also perceived system-related issues such as problems stemming from poor professional-to-professional communication. Conclusions : Patients with multimorbidity experience a range of system- and professional-related issues with healthcare delivery. This overview illustrates the diversity of aspects that should be considered in designing healthcare services for patients with multimorbidity. Journal of Comorbidity 2017;7(1):11–21

Varying Opinions on Who Deserves Collectively Financed Health Care Services: A Discrete Choice Experiment on Allocation Preferences of the General Public.

Abstract: In Europe, health insurance arrangements are under reform. These arrangements redistribute collectively financed resources to ensure access to health care for all. Allocation of health services is ...

Solidarity in insuring financial risks of illness: a comparison of the impact of Dutch policy reforms in health insurance and disability insurance since the 1980s

Abstract: Solidarity is the “moral infrastructure” of social insurance arrangements that protect citizens against financial risks of illness: costs of medical care (health insurance) and loss of income (disability insurance). Although these arrangements have both met reforms, the effects of these reforms on the two forms of insurance have not yet been compared. This article presents a comparative analysis of these reforms’ impact on solidarity since the 1980s in the Netherlands. It develops an analytical framework, distinguishing coverage and financing dimensions, and concludes that the reforms affected several solidarity dimensions and that the effects were partly different in health insurance and disability insurance.

Measuring renewed expertise for integrated care among health- and social-care professionals: Development and preliminary validation of the ICE-Q questionnaire.

Abstract: Accumulations of health and social problems challenge current health systems. It is hypothesized that professionals should renew their expertise by adapting generalist, coaching, and population health orientation capacities to address these challenges. This study aimed to develop and validate an instrument for evaluating this renewal of professional expertise. The (Dutch) Integrated Care Expertise Questionnaire (ICE-Q) was developed and piloted. Psychometric analysis evaluated item, criterion, construct, and content validity. Theory and an iterative process of expert consultation constructed the ICE-Q, which was sent to 616 professionals, of whom 294 participated in the pilot (47.7%). Factor analysis (FA) identified six areas of expertise: holistic attitude towards patients (Cronbach's alpha [CA] = 0.61) and considering their social context (CA = 0.77), both related to generalism; coaching to support patient empowerment (CA = 0.66); preventive action (CA = 0.48); valuing local health knowledge (CA = 0.81); and valuing local facility knowledge (CA = 0.67) point at population health orientation. Inter-scale correlations ranged between 0.01 and 0.34. Item-response theory (IRT) indicated some items were less informative. The resulting 26-item questionnaire is a first tool for measuring integrated care expertise. The study process led to a developed understanding of the concept. Further research is warranted to improve the questionnaire.

Funding Health Care: Options for Europe

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Multimorbidity

Abstract: Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual’s carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient’s values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed. Multimorbidity (two or more coexisting conditions in an individual) has substantial effects on individuals, carers and society. This Primer by Skou and colleagues summarizes the epidemiology, mechanisms, diagnosis and treatment of multimorbidity. Moreover, this Primer summarizes the effect of multimorbidity on quality of life and discusses open research questions for this condition.

Effects of substituting nurse practitioners, physician assistants or nurses for physicians concerning healthcare for the ageing population: a systematic literature review

Abstract: Aims To evaluate the effects of substituting nurse practitioners, physician assistants or nurses for physicians in long-term care facilities and primary healthcare for the ageing population (primary aim) and to describe what influences the implementation (secondary aim). Background Healthcare for the ageing population is undergoing major changes and physicians face heavy workloads. A solution to guarantee quality and contain costs might be to substitute nurse practitioners, physician assistants or nurses for physicians. Design A systematic literature review. Data sources PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL, Web of Science; searched January 1995–August 2015. Review methods Study selection, data extraction and quality appraisal were conducted independently by two reviewers. Outcomes collected: patient outcomes, care provider outcomes, process of care outcomes, resource use outcomes, costs and descriptions of the implementation. Data synthesis consisted of a narrative summary. Results Two studies used a randomized design and eight studies used other comparative designs. The evidence of the two randomized controlled trials showed no effect on approximately half of the outcomes and a positive effect on the other half of the outcomes. Results of eight other comparative study designs point towards the same direction. The implementation was influenced by factors on a social, organizational and individual level. Conclusion Physician substitution in healthcare for the ageing population may achieve at least as good patient outcomes and process of care outcomes compared with care provided by physicians. Evidence about resource use and costs is too limited to draw conclusions.