Multiple medication safety recommendations to reduce preventable medication-related hospitalisations have been introduced in the Netherlands. Still, these hospitalisations remain prevalent. This might be due to suboptimal implementation in clinical practice. Therefore, more insight is needed into barriers and facilitators for the implementation of these medication safety recommendations across healthcare sectors. This study aimed to identify barriers and facilitators for implementing medication safety recommendations across healthcare sectors from the perspective of various stakeholders. A selection of 17 Dutch medication safety recommendations targeting medications responsible for a large proportion of medication-related hospitalisations was evaluated in focus groups to identify barriers and facilitators to their implementation. These included recommendations for: reducing fall risk in elderly; initiating prophylactic medication; monitoring patients at risk of electrolyte disorders; clarifying responsibilities for patient care; informing patients about alarm symptoms; and prescribing antithrombotics on strict indication. Stakeholders were selected through purposive sampling based on their profession and healthcare sector. Transcripts of audio-recordings were analysed inductively, after which implementation factors were categorised using the Consolidated Framework for Implementation Research. Thirty stakeholders were divided into five focus groups. These included community pharmacists (n = 9), general practitioners (n = 4), hospital pharmacists (n = 3), representatives from healthcare knowledge organisations (n = 3), patient representatives (n = 2), medical specialists (n = 2), nurses (n = 2), and other stakeholders (n = 5). Forty-nine barriers and facilitators were identified. Key themes were lack of specified responsibilities, limited information exchange, local collaboration and protocol adherence. Recommendations with a lower level of implementation often required collaboration with multiple healthcare providers, whereas recommendations with a higher level of implementation were frequently supported by clinical decision support systems. A broad range of barriers and facilitators to the implementation of medication safety recommendations was identified. Overall, the findings highlight the need for recommendations with specified responsibilities, improved information exchange, strengthened local collaboration, and increased protocol adherence.
E-consultation services between family physicians and hospital specialists may help manage rising healthcare costs and improve care accessibility. Yet, robust evaluations of e-consultation impact on hospital referral patterns remain scarce. To evaluate the effect of a multi-specialty e-consultation service between family physicians and medical specialists on hospital referral rates. An interrupted time series analysis was conducted in the Netherlands between 2015 and 2023, including family practices that submitted e-consultations to 11 specialties at a regional hospital. Family practices from a specific region in the Netherlands that used the e-consultation service were included as the exposed group, and a national sample of family practices from the Nivel Primary Care Database served as the control group. Implementation of a multi-specialty e-consultation service. Monthly referral rates for outpatient clinic visits were analyzed utilizing seasonal autoregressive integrated moving average (SARIMA) models and difference-in-differences analyses to evaluate trends before and after the introduction of the e-consultation service. Sensitivity analyses were performed using various lag periods, and subgroup analyses were conducted based on e-consultation volumes and family physician experience. There was a limited overall impact of e-consultations on hospital referral trends. Internal Medicine showed a regional reduction in referrals (−1.56
Improving the quality of care for people detained in police custody requires careful measurement and monitoring. However, a standardized and endorsed set of quality indicators for healthcare in police custody settings is lacking. This study aimed to develop a core set of quality indicators to monitor and evaluate police custody healthcare in the Netherlands. A four-phase modified Delphi process was conducted between February 2024 and September 2025: (1) identification of candidate quality indicators ethrough expert brainstorming; (2) rating of indicators on relevance and measurability in a self-administered questionnaire; (3) an in-person group consultation meeting to refine and prioritize the indicators; and (4) content validation of the core set by an advisory committee. A multidisciplinary pool of professionals from healthcare, police, justice, and adjacent sectors participated throughout. Brainstorming sessions with 14 experts yielded 185 candidate indicators, which were rated by 19 experts in the questionnaire. The group consultation meeting with 15 participants refined the list, and feedback from 8 advisory committee members informed the final selection. The resulting core set comprised 15 structure, 9–12 process (7 fixed and 2–5 variable), and 17 outcome indicators, covering all key domains of police custody healthcare quality. The first evidence-based set of indicators provides a foundation for the systematic assessment and continuous learning in police custody healthcare. Routine healthcare data may serve as a valuable measurement source, though their usefulness depends on data quality, accessibility, and system readiness.
BACKGROUND:Young children with respiratory syncytial virus (RSV) often have viral coinfections. This study assessed the impact of respiratory viral codetections on RSV disease burden in children < 5 years and whether this varies by specific codetected viruses. METHODS:Retrospective analyses were performed using data from the RSV ComNet study prior to implementation of passive immunisation. Children < 5 years with acute respiratory infection (ARI) were eligible for testing for RSV and other viruses (multiplex real-time Polymerase Chain Reaction). Primary care physicians completed a short report on day 1, and parents completed follow-up questionnaires (digital or by phone) on days 14 and 30. Disease burden was measured by healthcare resource utilisation, clinical course, and parental work absence. RESULTS:Of the 2637 children tested, 822 (31%) were RSV-positive, of which 585 (52%) had completed day 1 data. There were 378 (65%) children with RSV monoinfection and 207 (35%) with RSV codetection. Rhinovirus/enterovirus was most frequently codetected (60%). Healthcare resource utilisation, clinical course, and parental work absence did not significantly differ between children with RSV codetection and RSV monoinfection. Hospitalisation rate was 7% (CI: 5%-10%) versus 8% (CI: 5%-13%) and mean duration of illness 11 (CI: 10.6-11.9) versus 12 days (CI: 11.4-13.4), respectively. CONCLUSION:RSV-infections with viral codetections were generally not associated with increased healthcare resource utilisation, symptomatology, or parental work absence in children in primary care, suggesting that viral codetection alongside RSV disease does not impose a greater burden on patients or society. Further research is needed to determine whether specific RSV codetected viruses differentially impact disease burden.
Objective To assess the impact of the non-reimbursement policy on vitamin D therapy discontinuation in patients from the general and rheumatic populations.Design A cross-sectional study.Setting Research institute specialised in health research and two outpatient pharmacies in the Netherlands.Participants Patients from the general and rheumatic population with an active prescription for vitamin D supplementation therapy were included.Data collection and analysis Data were collected between April and May 2023 through self-reported questionnaires. Descriptive statistics and logistic regression were performed using STATA V. 17. P value <0.05 was considered statistically significant.Primary and secondary outcome measures The primary outcome was the proportion of patients who discontinued vitamin D supplementation therapy following the implementation of the non-reimbursement policy. Secondary outcomes included patient-reported reasons for therapy discontinuation and the association between patient-related characteristics and the risk of therapy discontinuation. In addition, the proportion of patients who switched to an alternative supplement and whether this switch had been made in consultation with a healthcare provider was examined.Results Of the 4800 patients, 302 (6.4%) patients discontinued their vitamin D therapy. The three most frequently reported reasons for therapy discontinuation were the inability to afford supplements without reimbursement, not willing to pay for supplements without reimbursement and being unaware of the alternative vitamin D supplements to switch to. Younger age, financial constraints and limited health literacy were significantly associated with vitamin D therapy discontinuation (p<0.05). Among the 1478 patients that switched to an alternative supplement, 706 (17.9%) patients indicated that they made the switch in consultation with a healthcare provider.Conclusion The implementation of the non-reimbursement policy resulted in a small proportion of patients discontinuing their vitamin D therapy. Elevated discontinuation rates were associated with specific patient-related characteristics including patients aged <50 years, those experiencing financial constraints and those with limited health literacy, suggesting the need for developing interventions and preventive strategies to support patients at risk of therapy discontinuation.
