Research into the heart of the health care system is directed towards the process of interaction between carer and patient. The quality, efficiency and safety of this care process are high on the agendas of the Health Ministry, the Federation of Patients and Consumer Organizations in the Netherlands (NPCF), the Dutch College of General Practitioners (NHG), the Dutch Health Care Inspectorate (IGZ), the Dutch Institute for rational use of medicine (DGV), the Royal Dutch Pharmaceutical Society (KNMP) and patient associations. Guidelines, both geared towards medical procedures and towards communication, are an important instrument in this respect. Recently, care standards have been added to these guidelines for different groups of chronically ill patients. These standards do not just describe the (multidisciplinary) care needed for a certain condition, but also the role of self-management and the desired outcomes in concrete indicators. The demand for the implementation of multidisciplinary guidelines and care standards in the care process is an important element.
ICT is another important way of improving quality and patient safety. The Electronic Patient Record (EPR) is about to be introduced. With the EPR health care professionals will be able to see all the patient’s medical details at a consultation. Quality gains can also be made for the patient. A considerable number of patients do not follow the therapy agreed on with the person treating them. At the moment there are several initiatives to improve this. Better communication between health care professional and patient is an important element. Various parties, including the Council for Public Health and Health Care (RVZ), have called for greater attention to the – supposed –ability of patients to speak up for themselves, but also to the way e-health and group consultations can be given a place in Dutch health care, traditionally focused primarily on personal one-on-one interaction.
Prevention deserves to be mentioned separately here, especially the link between prevention and care, between public and curative health care. The Public Health ministry aims to make prevention a more obvious component of regular care, with primary care as a natural entry point. In this field, therefore, more and more attention will be given to prevention. Prevention features emphatically in the previously mentioned care standards and in the introduction of preventive consultations for people with a higher risk of cardiovascular diseases. An assessment of the Cardiovascular Risk Management Programme [Programma Cardiovasculair Risicomanagement] is scheduled for 2010.
A number of experimental projects in which the therapeutic and non-specific components of communication in health care are being deciphered, have been made possible by the Spinoza Prize awarded to former NIVEL Director Professor Jozien Bensing in 2006. The outcomes of these projects could give a more evidence-based character to the importance of good communication.
Complementary to this is the line of research with the patient perspective at its core. Research into health care innovations, such as the added value of the collective medical consultation; the effects of tailored information via the Internet; or situational feedback by means of pocket computers, is being done more and more by NIVEL. Within the therapy compliance study practical instruments are being developed to improve the communication process around therapy compliance. ICT solutions feature more and more in the research into the furthering of therapy compliance as well. ICT is also important in the research into the quality of the care process and medical technical procedures. More and more health care files are being linked together. This offers opportunities to further enrich the research into procedures within the GP’s practice, such as the research into guideline compliance.
Enrichment like this can be managed through the primary care information system about health and illness, in which registration systems oriented in a monodisciplinary way will be integrated into a multidisciplinary primary care system, incorporating the activities of various health care professionals, amongst other things. What’s more, the care process of LINEL-GPs has already been charted by videoing different care professionals’ consultations. Within LINEL, great attention will be given to the linking of prevention and health care.