Suchergebnisse

This thesis is about how people support their health through the use of technology. It focuses on web-based information and communication technology (ICT). Many factors play a role in the interaction between people, technology and context. In five studies we have investigated a few of them. The central research question concerns the values eHealth technologies add to what people need for health in terms of information, communication and transformation. We have used a mixed-methods design to improve data collection and understanding of the issues concerned. The introduction depicts the context of pervasive and revolutionary ICTs in contemporary society. This influences how people perceive their health, the organization of health care and medical research. In the first chapter we examine the extent to which a so-called 'brain machine' affects relaxation among health professionals at risk for burn-out. Chapters 2-4 concern the Dutch government-funded health portal kiesBeter.nl. After a historical report of the policy context of New Public Management (accountability) and the transformation of the health care system (transparency) the portal is analyzed with regard to its original objectives. The next study analyses aspects of the portal's usability as perceived by patients with long-term conditions, followed by a study on the effect of a decision aid on the decision-making process of patients. Chapter 5 presents a study on the risks for patient safety and quality of care associated with eHealth technologies. The last study is an intellectual contribution to the international academic discourse on the impact of eHealth interventions in global health care. The studies have lead to a constructive perspective on 'iHealth' which is further elaborated in the 'Discussion'part. iHealth is the term introduced to denote persuasive health technologies in context, which implies that information and users are central to the development of technology. eHealth is a transitory concept in the progression towards fully integrated information and communication technologies in care: eHealth inside. Outcomes have been used to foster the extension of a 'holistic' framework to increase the uptake and impact of eHealth technologies. It is operationalized in a 'roadmap' that enables evidence-based design, implementation and evaluation of eHealth interventions.

AbstractAgainst a backdrop of New Public Management and healthcare system reform the Dutch Ministry of Health commissioned the National Institute for Public Health and the Environment (RIVM) to develop, host and manage an online public national health and care portal. The portal aims to facilitate consumer decision‐making behavior in health and healthcare and to contribute to transparency in order to improve the quality of care and the general functioning of the health markets. This article describes the policy context and uses a multi‐methods approach to evaluate the extent to which the portal, as an instrument of health policy, is meeting its original objectives. Four qualitative and quantitative methods of user data collection ‐ online survey, market monitoring, web analytics, and direct user feedback ‐ are used to estimate the impact of the portal with regard to user behavior and online health information needs over time. We find that the portal reaches a fair share of the Dutch health information market in quantitative and qualitative terms. However, while its exact contribution to the functioning of the health markets in terms of transparency remains undecided, it seems plausible that the portal's impact on choice behavior, choice awareness and empowerment is rather small.

In response to a 'temperance mentality' questionnaire, university students from Iran, Bulgaria, the United States, and Italy expressed more support for 'temperance moralism' than did students from Canada, Ireland, and the Netherlands. On the other hand, students from all seven countries generally supported 'non-moralistic drug prohibitionism,' an attitude that appears more compatible with the contemporary harm-reduction movement. In every sample, students expressed more support for temperance items that were directed towards drugs and alcohol than they did for items that were directed at alcohol alone. We argue that understanding the "temperance mentality" on a transnational level may help society to avoid repeating some of the drug policy excesses of the past.

OBJECTIVES: Dry powder inhalers (DPIs) and soft mist inhalers have a substantially lower global warming potential than pressurised metered-dose inhalers (pMDIs). To help mitigate climate change, we assessed the potential emission reduction in CO2 equivalents when replacing pMDIs by non-propellant inhalers (NPIs) in Dutch respiratory healthcare and estimated the associated cost. DESIGN: We performed a descriptive analysis of prescription data from two national databases of two independent governmental bodies. First, we calculated the number of patients with chronic obstructive pulmonary disease (COPD) and asthma that were using inhalation medication (2020). Second, we calculated the number and total of daily defined doses of pMDIs and NPIs including DPIs and soft mist inhalers, as well as the number of dispensed spacers per patient (2020). Third, we estimated the potential emission reduction in CO2 equivalents if 70% of patients would switch from using pMDIs to using NPIs. Fourth, we performed a budget impact analysis. SETTING: Dutch respiratory healthcare. PRIMARY AND SECONDARY OUTCOME MEASURES: The carbon footprint of current inhalation medication and the environmental and financial impact of replacing pMDIs with NPIs. RESULTS: In 2020, 1.4 million patients used inhalers for COPD or asthma treatment. A total of 364 million defined daily doses from inhalers were dispensed of which 49.6% were dispensed through pMDIs. We estimated that this could be reduced by 70% which would lead to an annual reduction in greenhouse gas emission of 63 million kg.CO2 equivalents saving at best EUR 49.1 million per year. CONCLUSIONS: In the Netherlands, substitution of pMDIs to NPIs for eligible patients is theoretically safe and in accordance with medical guidelines, while reducing greenhouse gas emission by 63 million kg.CO2 equivalents on average and saving at best EUR 49.1 million per year. This study confirms the potential climate and economic benefit of delivering a more eco-friendly respiratory care.