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Bomholt KB, Nebsbjerg MA, Burau V, Mygind A, Christensen MB, Huibers L. Task shifting from general practitioners to other health professionals in out-of-hours primary care - a systematic literature review on content and quality of task shifting. Eur J Gen Pract 2024; 30:2351807. [PMID: 38779917 PMCID: PMC11123461 DOI: 10.1080/13814788.2024.2351807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Task shifting from general practitioners (GPs) to other health professionals could solve the increased workload, but an overview of the evidence is lacking for out-of-hours primary care (OOH-PC). OBJECTIVES To evaluate the content and quality of task shifting from GPs to other health professionals in clinic consultations and home visits in OOH-PC. METHODS Four database literature searches were performed on 13 December 2021, and updated in August 2023. We included articles that studied content (patient characteristics, reason for encounter) and/or quality (patient satisfaction, safety, efficiency) of task shifting in face-to-face contacts at OOH-PC. Two authors independently screened articles for inclusion and assessed the methodological quality of included articles using the JBI critical appraisal checklist. Data was extracted and results were synthesised in a narrative summary. RESULTS The search identified 1,829 articles, resulting in the final inclusion of seven articles conducted in the UK or the Netherlands. Studies compared GPs with other health professionals (mainly nurses). These other health professionals saw patients with less urgent health problems, younger patients, and patients with less complex health problems than GPs. Most studies concluded that other health professionals provided safe and vastly efficient care corresponding to the level of GPs but findings about productivity were inconclusive. CONCLUSION The level of safety and efficiency of care provided by other health professionals in OOH-PC seems like that of GPs, although they mainly see patients presenting with less urgent and less complex health problems.
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Affiliation(s)
| | | | - Viola Burau
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anna Mygind
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Linda Huibers
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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Varagur K, Sullivan J, Chiang SN, Skolnick GB, Sacks JM, Christensen JM. Investigating Weekend Effect in the Management of Upper and Lower Extremity Degloving Injuries. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5345. [PMID: 37850199 PMCID: PMC10578671 DOI: 10.1097/gox.0000000000005345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 10/19/2023]
Abstract
Background Weekend presentation has been associated with adverse outcomes in emergent conditions, including stroke, myocardial infarction, and critical limb ischemia. We examine whether a weekend effect exists in the management of and outcomes after extremity degloving injuries. Methods The cohort included adults presenting with open extremity degloving injuries to a tertiary level one trauma center between June 2018 and May 2022. We collected demographics, comorbidities, injury information, interventions, and complications. Propensity score weighting was used to minimize confounding differences between those presenting on weekends (Sat-Sun) versus weekdays (Mon-Fri). Weighted regressions were used to examine differences in interventions by day of presentation. Multivariable weighted regressions accounting for differences in interventions received were used to examine whether weekend presentation was associated with amputation risk, complications, or functional deficits. Results Ninety-five patients with 100 open extremity degloving injuries were included. In total, 39% of injuries were weekend-presenting. There was a higher rate of noninsulin-dependent diabetes among patients presenting on weekends (P = 0.03). Weekend-presenting injuries had higher median Injury Severity Scores (P = 0.04). Propensity-weighted regression analysis revealed differences in interventions received on weekends, including lower rates of pedicled and free flaps and bone graft, and increased rates of negative-pressure wound therapy (P ≤ 0.02). Multivariable regression analysis revealed weekend presentation was a significant independent risk factor for amputation of the affected extremity [odds ratio 2.27, 95% CI (1.01-5.33), P = 0.05]. Conclusion Weekend presentation may impact interventions received and amputation risk in patients presenting with open extremity degloving injuries.
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Affiliation(s)
- Kaamya Varagur
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Janessa Sullivan
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Sarah N. Chiang
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Gary B. Skolnick
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Justin M. Sacks
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Joani M. Christensen
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
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3
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York R. Perceptions and beliefs about the regulation of advanced nurse practitioners. Nurs Manag (Harrow) 2021; 28:30-35. [PMID: 34060726 DOI: 10.7748/nm.2021.e1999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The role of the advanced nurse practitioner (ANP) is not regulated in the UK, which has led to wide variation in the skills, competencies and academic qualifications of nurses using this title. Urgent treatment centres (UTCs) require a broad and experienced knowledge base to meet the demand of patients presenting with undifferentiated illnesses and injuries, which can be stressful and challenging. AIM To examine the perceptions and beliefs about ANP regulation, and to explore and discuss any ideas about proposed regulation. METHOD The author used interpretative phenomenological analysis to uncover valuable insights into the experiences of two ANPs working in an UTC, and their beliefs around regulation of the ANP role. RESULTS Both ANPs had different backgrounds and qualifications yet still had similar perceptions and beliefs regarding the regulation of ANPs. Five main themes were developed from the interview transcripts. CONCLUSION This study identified the need to consider the importance of ANPs' identity and the complex regulatory process required to standardise the role.
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Affiliation(s)
- Rachel York
- Health and Social Care, University of Derby, Derby, England
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Karacaoglu K, Leask CF. Staff views of a hospital at home model implemented in a Scottish care setting. AIMS Public Health 2021; 8:467-478. [PMID: 34395696 PMCID: PMC8334636 DOI: 10.3934/publichealth.2021036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose Demographic and financial challenges mean prioritising a shift in healthcare provision from acute to community settings. One well-evidenced model encapsulating this is 'hospital at home', however limited research has examined staffs' views on its implementation, which may inform service development and increase job satisfaction. The aim within was to explore the staff perspective of implementing a 'hospital at home' model in a Scottish care setting which can inform service provision and ultimately increase job satisfaction. Methods The 'Acute Care @ Home' (AC@H) service had a multi-disciplinary team. Referrals were predominantly received from a geriatric hospital ward. Inclusion criteria were older adults with geriatric syndromes and who required care input for a duration between one to seven days. In-depth staff interviews (N = 13) were conducted and analysed thematically to understand barriers and facilitators to implementation. These were supplemented with questionnaires assessing constructs of interest including training, communication and overall satisfaction. Results Several themes urged from our study: inter-team and intra-team collaboration, service development and operation, and scaling considerations. High job satisfaction was reported (mean score 73%), particularly due to a perceived non-hierarchical team structure and inclusive management style. Staff attributed positive outcomes through better identifying patients' needs at home compared to in hospital. Continuity of care facilitated rapport building. Recruitment challenges restricted the acuity and volume of patients the team were able to care for. Conclusions This qualitative methodology could be useful for future implementation of intermediate care resources for the future health and care system building. Patient assessments at home, as opposed to in hospital, in conjunction with care continuity by staff, may mitigate against hospital risks and better facilitate reablement. Where recruitment challenges are present, agile models of care delivery should be considered.
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Affiliation(s)
- Katherine Karacaoglu
- Aberdeen City Health and Social Care Partnership, Marischal College, Broad St, Aberdeen, UK.,Health Intelligence Department, NHS Grampian, Eday Rd, Aberdeen, UK
| | - Calum F Leask
- Aberdeen City Health and Social Care Partnership, Marischal College, Broad St, Aberdeen, UK.,Health Intelligence Department, NHS Grampian, Eday Rd, Aberdeen, UK
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Cassiani SHDB, Fernandes MNDF, Reveiz L, Filho JRF, da Silva FAM. [Skill mix of nurses and primary health care professionals: a systematic review]. Rev Panam Salud Publica 2020; 44:e82. [PMID: 32695147 PMCID: PMC7367406 DOI: 10.26633/rpsp.2020.82] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/11/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness of the strategy of skill mix of nurses and other health care professionals in primary health care. METHODS Systematic review of the literature aligned with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), including observational and intervention studies. No restrictions were established for period or country of publication; studies published in Spanish, English and Portuguese were included. The search was carried out in MEDLINE, CINAHL, LILACS, EMBASE and Web of Science electronic databases. RESULTS Eighteen studies were analyzed, including 6 from the United States; 3 from the Netherlands; 2 from the United Kingdom; 1 each from Australia, South Africa, South Korea, Scotland, Haiti and Japan; and 1 study with a prospective observational design from 8 countries. The studies reported that the skill mix among health professionals enables a better use of material resources; optimizes time spent on care; improves adhesion to treatment, quality of care and commitment and satisfaction with the work; and reduces the level of psychological distress in nursing professionals. CONCLUSIONS The expansion of tasks of nurses and other health care professionals, and the skill mix as well as the development of interprofessional teams, are strategies that help to face a scarcity and poor distribution of human resources in urban and non-urban areas with improvement of the health care of the population and satisfaction of professionals and clients.
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Affiliation(s)
- Silvia Helena De Bortoli Cassiani
- Organização Pan-Americana da SaúdeWashington, D.C.Estados Unidos de AméricaOrganização Pan-Americana da Saúde, Washington, D.C., Estados Unidos de América
| | | | - Ludovic Reveiz
- Organização Pan-Americana da SaúdeWashington, D.C.Estados Unidos de AméricaOrganização Pan-Americana da Saúde, Washington, D.C., Estados Unidos de América
| | | | - Fernando Antônio Menezes da Silva
- Organização Pan-Americana da SaúdeWashington, D.C.Estados Unidos de AméricaOrganização Pan-Americana da Saúde, Washington, D.C., Estados Unidos de América
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Heidet M, Canoui-Poitrine F, Revaux F, Perennou T, Bertin M, Binetruy C, Palazzi J, Tapiero E, Nguyen M, Reuter PG, Lecarpentier E, Vaux J, Marty J. Factors affecting medical file documentation during telephone triage at an emergency call centre: a cross-sectional study of out-of-hours home visits by general practitioners in France. BMC Health Serv Res 2019; 19:531. [PMID: 31362748 PMCID: PMC6668156 DOI: 10.1186/s12913-019-4350-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background In France, general practitioners (GPs) perform out-of-hours home visits (OOH-HVs) after physician-led telephone triage at the emergency call centre. The quality of a systematic physician-led triage has not been determined in France and may affect the efficiency of the OOH-HV process. The objectives of this study were first, to evaluate the quality of reporting in the electronic patient’s file after such triage and second, to analyse the factors associated with altered reporting. Methods Cross-sectional study in a French urban emergency call centre (district of Paris area) from January to December 2015. For a random selection of 30 days, data were collected from electronic medical files that ended with an OOH-HV decision. Missing key quality criteria (medical interrogation, diagnostic hypothesis or ruled-out severity criteria) were analysed by univariate then multivariate logistic regression, adjusted on patient, temporal and organizational data. Results Among 10,284 OOH-HVs performed in 2015, 748 medical files were selected. Reasons for the encounter were digestive tract symptoms (22%), fever (19%), ear nose and throat symptoms, and cardiovascular and respiratory problems (6% each). Medical interrogation was not reported in 2% of files (n = 16/748) and a diagnostic hypothesis in 58% (n = 432/748); ruled-out severity criteria were not reported in 60% (n = 449/748). On multivariate analysis, altered reporting was related to the work overload of triage assistants (number of incoming calls, call duration, telephone occupation rate; p < 0.03). Conclusion In the electronic files of patients requiring an OOH-HV by a GP in a French urban area, quality in medical reporting appeared to depend on organizational factors only, especially the triage assistants-related work factors. Corrective measures are needed to ensure good quality of triage and care. Electronic supplementary material The online version of this article (10.1186/s12913-019-4350-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthieu Heidet
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France. .,Université Paris-Est Créteil (UPEC), EA-4390 (Analysis of Risk in Complex Health Systems, ARCHeS), Créteil, France.
| | - Florence Canoui-Poitrine
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, Département de Santé Publique, Créteil, France.,Université Paris-Est Créteil (UPEC), EA-7376 (Clinical Epidemiology and Ageing, CEpiA), Créteil, France
| | - François Revaux
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Thomas Perennou
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Maeva Bertin
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Charles Binetruy
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Julien Palazzi
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Eric Tapiero
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Michel Nguyen
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Paul-Georges Reuter
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Raymond Poincaré, SAMU 92, Garches, France
| | - Eric Lecarpentier
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Julien Vaux
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France.,Université Paris-Est Créteil (UPEC), EA-4390 (Analysis of Risk in Complex Health Systems, ARCHeS), Créteil, France
| | - Jean Marty
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France.,Université Paris-Est Créteil (UPEC), EA-4390 (Analysis of Risk in Complex Health Systems, ARCHeS), Créteil, France
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Kelly SJ, Piercy H, Ibbotson R, Fowler Davis SV. Who attends out-of-hours general practice appointments? Analysis of a patient cohort accessing new out-of-hours units. BMJ Open 2018; 8:e020308. [PMID: 29886444 PMCID: PMC6009516 DOI: 10.1136/bmjopen-2017-020308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This report describes the patients who used additional out-of-hours (OOH) appointments offered through a UK scheme intended to increase patient access to primary care by extending OOH provision. DESIGN Cohort study and survey data. SETTING OOH appointments offered in four units in one region in England (October 2015 to November 2016). METHODS Unidentifiable data on all patients were abstracted from a bespoke appointment system and the responses to a patient opinion questionnaire about this service. Descriptive analysis of the appointment data was conducted. Multivariate analysis of the opinion survey data examined the characteristics of the patients who would have gone to the emergency department (ED) had the OOH appointments not been available. RESULTS There were 24 448 appointments for 19 701 different patients resulting in 29 629 service outcomes. Women dominated the uptake and patients from the poorest fifth of the population used nearly 40% of appointments. The patient survey found OOH appointments were extremely popular-93% selecting 'extremely likely' or 'likely' to recommend the service. Multivariate analysis of patient opinion survey data on whether ED would have been an alternative to the OOH service found that men, young children, people of Asian heritage and the most deprived were more likely to have gone to ED without this service. CONCLUSIONS The users of the OOH service were substantially different from in-hours service users with a large proportion of children under age 5, and the poor, which support the idea that there may be unmet need as the poor have the least flexible working conditions. These results demonstrate the need for equality impact assessment in planning service improvements associated with policy implementation. It suggests that OOH need to take account of patients expectations about convenience of appointments and how patients use services for urgent care needs.
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Affiliation(s)
- Shona J Kelly
- Department of Social Work, Social Care and Community Studies, Sheffield Hallam University, Sheffield, UK
| | - Hilary Piercy
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK
| | - Rachel Ibbotson
- Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - Sally V Fowler Davis
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield Hallam University, Sheffield, UK
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van der Biezen M, Wensing M, Poghosyan L, van der Burgt R, Laurant M. Collaboration in teams with nurse practitioners and general practitioners during out-of-hours and implications for patient care; a qualitative study. BMC Health Serv Res 2017; 17:589. [PMID: 28830410 PMCID: PMC5568365 DOI: 10.1186/s12913-017-2548-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasingly, nurse practitioners (NPs) are deployed in teams along with general practitioners (GPs) to help meet the demand for out-of-hours care. The purpose of this study was to explore factors influencing collaboration between GPs and NPs in teams working out-of-hours. METHODS A descriptive qualitative study was done using a total of 27 semi-structured interviews and two focus group discussions. Data was collected between June, 2014 and October, 2015 at an out-of-hours primary care organisation in the Netherlands. Overall, 38 health professionals (GPs, NPs, and support staff) participated in the study. The interviews were audio-taped and transcribed verbatim. Two researchers conducted an inductive content analysis, involving the identification of relevant items in a first phase and clustering into themes in a second phase. RESULTS The following four themes emerged from the data: clarity of NP role and regulation, shared caseload and use of skills, communication concerning professional roles, trust and support in NP practice. Main factors influencing collaboration between GPs and NPs included a lack of knowledge regarding the NPs' scope of practice and regulations governing NP role; differences in teams in sharing caseload and using each other's skills effectively; varying support of GPs for the NP role; and limited communication between GPs and NPs regarding professional roles during the shift. Lack of collaboration was perceived to result in an increased risk of delay for patients who needed treatment from a GP, especially in teams with more NPs. Collaboration was not perceived to improve over time as teams varied across shifts. CONCLUSION In out-of-hours primary care teams constantly change and team members are often unfamiliar with each other or other's competences. In this environment, knowledge and communication about team members' roles is continuously at stake. Especially in teams with more NPs, team members need to use each other's skills to deliver care to all patients on time.
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Affiliation(s)
- Mieke van der Biezen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, IQ Healthcare, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Michel Wensing
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, IQ Healthcare, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- Department of General Practice and Health Services Research, Health Services Research and Implementation Science, Heidelberg University, Marsilius Arkaden-Turm West, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Lusine Poghosyan
- Columbia University School of Nursing, 168th St., Suite 219, New York, NY 10032 USA
| | - Regi van der Burgt
- Foundation for Development of Quality Care in General Practice, Tilburgseweg-West 100, 5652 NP, Eindhoven, The Netherlands
| | - Miranda Laurant
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, IQ Healthcare, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- HAN University of Applied Sciences, Faculty of Health and Social Studies, P.O. BOX 6960, Nijmegen, 6503 GL The Netherlands
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