Suchergebnisse

Local public networks can be governed in many different ways. Among scholars as well as among practitioners, there is some debate about the best approach. Based on literature, this article examines the relationship between local public network governance roles, contingency factors, and network performance in a theoretically informed way. Governance roles are positioned on a continuum from top-down (commissioner) to bottom-up (facilitator), with an intermediate area (coproducer). How governance roles influence the performance of local public networks is assumed to depend on contingency factors, which might explain the inconsistent results of studies examining this influence. An integrated model of local public network governance is presented that includes four contingency factors: the number of network participants, diversity of network members, degree of customizability of service demands, and the number of new network participants. The model can be applied to the heterogeneous contexts that local governments encounter when governing local public networks.

<p>Currently, 4% of older adults reside in long-term care facilities in the Netherlands. Nursing home residents tend to have multimorbidity that is associated with considerable disabilities and a high level of care dependency. In the Dutch adult population the highest estimated prevalence (&gt;40%) of visual impairment (low vision and blindness) was found in the subgroup of residents in nursing homes (NHs). The aim of this study is to describe the current practice of eye care by Dutch nursing home physicians (NHPs).</p><p>A digital online survey was developed to describe the eye care activities of nursing home physicians and their cooperation in this perspective with other professionals.</p><p>Of 1573 NHPs present in the Netherlands, 125 (8%) responded.</p><p>Results show that more than 50% of the NHPs regularly examine 'distant vision', 'near vision' and 'the visual field'. However, 23%, 33% and 45% almost never or never examine the 'visual field', 'near vision' and 'distant vision', respectively. Data regarding eye care, regularly recorded in the client files by more than 50% of the NHPs, are medical data involving 'use of eye medication', 'eye disease', and 'eye surgery in the past'. Less commonly recorded is 'the use of reading glasses' as well as 'eye pain'.</p><p>Inside of the NH, (head) nurses and ward nurses (chi² = 309, df = 5, p = 0.000), and outside of the NH, ophthalmologists and low vision specialists are most frequently contacted about eye related issues (chi² = 224, df = 4, p = 0.000). Opticians are rarely contacted, and optometrists and orthoptists are 'never' contacted by more than 50% of the NHPs. Moreover, 50% of the NHPs noted that collaboration with external eye care professionals is 'not structural'.</p><p>This study shows that, according to NHPs, relevant visual aspects are not structurally examined and recorded in the client files. Outside of the NH, NHPs tend to have a less frequent collaborative relationship with optometrists, orthoptists and opticians compared to ophthalmologists and low vision specialists. The NHP's role in providing eye care can be improved by development of guidelines for structural eye screening, improvement of recording in client files, and exploring plus undertaking collaboration with other eye care professionals.</p>

To improve continuity and coordination of care in geriatric rehabilitation, an integrated care pathway was developed in the south of the Netherlands. This study aims to reach nationwide consensus on the content and structure of this locally developed pathway using a two-round Delphi study with specialized elderly care physicians (n = 37) as experts. In the first round, experts indicated their level of agreement on 65 statements representing the pathway on a 5-point Likert-type scale. Statements that did not gain consensus (interquartile range > 1) were redistributed to participants in Round 2. Consensus was reached on 56 statements (86%) after Round 1 and on 60 statements (92%) after Round 2. In total, 53 statements were assessed as relevant, seven statements were considered irrelevant, and five statements did not reach consensus. We conclude that there is broad nationwide consensus on the pathway, which therefore has the potential to be disseminated and implemented on a wider scale.