AnnuAl RepoRt 2012ReseARch centRe foR InnovAtIons In heAlthcARehu unIveRsIty of ApplIed scIences utRecht (hu)

the ReseARch centRe AIms to stimulate, motivate and support people’s self-RelIAnce And Independence

Research Centre for Innovations in Healthcare 04

The 2012 facts 05

New professional profiles for nurses 08

Lecturer Ad van Dooren, PhD, delivers inaugural speech 10

Inaugural speech Professor Helianthe Kort, , at TU Eindhoven 12

Awards won by the Research Centre 16

• CarolienSino,MA,winsPractice-orientedResearchAward2012 16

• MarianneSinoo,MA,winsHermanBoumaAward 18

• ProfessorMiaDuijnstee,,winsHUgenotenprijs 19

• JanPool,PhD,winsDavidLambAward 20

• RikEnsing,MA,winsZorginnovatieprijs 22

Healthcare and Technology Spearhead 24

Research and Education 28

New Studies 30

• Nursesandolderpeoplereducingstressstudy(NOPRESS) 30

• Improvedcommunicationbetweenolderpatientandcaregiver 32

• Complianceinpatientswithlimitedhealthliteracy(PREPGO) 34

• Increasedhealthincarehomes(BEZO) 37

Completed Studies 40

• Adviceonfuturepreventivespeechtherapy(PRIL) 40

• Languageproficiencytestformultilingualstudents 42

• E-Healththatworks(iKOP) 45

• Improvementofhealthliteracyinlowliteracypatients(Transfysa) 48

• Thehealinghospital(HEZO) 51

contents

The Research Centre for Innovations in Healthcare of the HU Faculty of Healthcare conducts research resulting in innovations that will help improve patient care, professional practice and education. In the Research Centre, five research groups are closely collaborating, based on a shared mission and vision.

Thegoaloftheseinnovationsistomaintainindependenceandselfrelianceforpatientswith(chronic)illnessofallages.ThevariousresearchgroupsoftheResearchCentreallworktowardsthisgoalandarecenteredaroundcarespecificallyforfragileolderadults,physicalactivityandhealth,speechandlanguagetherapy,pharmaceuticalinnovationsandcareandtechnology.Wecarryoutappliedresearchonbehalfofandincollaborationwithhealthcareprofessionals.TheinstallationoftheDisseminationofPharmaceuticalInnovationsResearchGrouphasincreasedexistingexpertisewithregardtodisseminationprocessesofinnovationsinpharmaceuticalcare.

TheResearchCentreisdoingresearchforandincollaborationwithprofessionalpractice.TeachingstaffandstudentsofHUareinvolvedintheCentre’sresearchprojects.

/ the ReseARch centRe foR InnovAtIons In heAlthcARe

2012 fActs • 5 ReseARch GRoups• 7 pRofessoRs• 50 ReseARcheRs• 19 phd students, • 73 scIentIfIc publIcAtIons• 34 AbstRActs• 35 publIcAtIons foR pRofessIonAls• 84 pResentAtIons foR pRofessIonAls• 60 pResentAtIons At scIentIfIc symposIA• 406 bAcheloR And mAsteR students

collAboRAted In ReseARch• 15 mAsteRclAsses,

vIsIted by oveR 1450 students

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/ pIeteRbAs lAllemAn nurse and organization sociologist

ReseARch GRoup foR nuRsInG And AllIed heAlthcARe foR people

wIth chRonIc Illnesses

‘foR my study of the woRk of nuRsInG mAnAGeRs And the Role of the nuRsInG hAbItus In mAnAGement sItuAtIons, I hAve lIved And woRked As A vIsItInG ReseARch scholAR In the unIted stAtes foR A yeAR. If you leARn AnythInG fRom doInG ReseARch In AnotheR countRy, It Is how to AmAze youRself AGAIn About thInGs thAt we In the netheRlAnds hAve AlwAys consIdeRed to be noRmAl.’

/ tAke ResponsIbIlIty

new professional profiles foR nuRses

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2On March 8th, professor Marieke Schuurmans, presented the new professional profiles for nurses and carers to Edith Schippers, Minister of Health, Welfare and Sport. Prof. Schuurmans did so on behalf of V&V2020, the steering group that has developed these new, future proof professional profiles.

Theprofilesconcerntheregisterednurse(bachelor),thespecialistnurse(master)andtheassociatedegreenurse.Itisproposed,from2020onward,thatnursesmustbeUniversityofAppliedSciencesgraduates,whereascareexpertswillbeeducatedatinstitutesforintermediatevocationaleducation.MariekeSchuurmans,PhD,professorofCareforOlderPeople,stateditwasahistoricday:‘ThedayonwhichcarersandnursestookResponsibilityforthefutureofhealthcare.Iamveryproudoftheseprofessionalprofilesfornursesandcarers.ItisanhonourtobeallowedtopresentthemtoMinisterSchippersandtoV&VNDutchNurses’Association.The new professional profilesSubstantialchangesinhealthcare,e.g.,therapidlyincreasingnumberofolderpeopleandchronicallyillpatientswithacomplexdemandforcare,requireafutureproofprofessionalstructureaswellasnewprofessionalprofiles.Adaptationoftheoldprofessionalprofilesalsoanswerstothecommission,setbytheMinisterofHealth,WelfareandSport,todifferentiatemoreclearlybetweennursestrainedatanintermediatevocationallevel(qualificationlevelnr.4),andthosetrainedatuniversitiesofAppliedSciencebachelorlevel(qualificationlevelnr.5).TheSteeringgroupV&V2020willdoeverythinginitspowertoseethatthisdifferentiationisimplemented:thenewprofessionalprofilesstatethatin2020allnurseswillhaveaUniversityofAppliedSciencebachelorcertificate,andthatinstitutesforintermediatevocationaleducationwilleducateassociatedegreenurses(level4).Bothprofessionalswillhaveclearlydifferentiated,complementarycompetencies.Oneoftheimplicationsoftheproposedprofessionalstructure,isthatassociatedegreenurseswillnolongerbesubjectedtothedisciplinaryrulescontainedintheIndividualHealthcareProfessionsact(WetBIG).Theprofilesshouldbeeffectuatedin2020.

Risk their necksAccordingtoministerSchippers,fewprofessionalgroupsshowasmuchinvolvementintheirprofessionasnursesandcarers.Duringthepresentationoftheprofiles,shesaid:‘Youhavereallystuckyournecksout,youhaveshownhowyoulookuponyourfuture,andyouhaveseriouslythoughtthingsthrough.Todayisagoodstart.Let’scontinuethis,onbehalfofpatients’bestinterestsandgoodqualityhealthcareinthefuture.’

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On February 9th, professor Ad van Dooren, delivered his inaugural speech, titled Panta Rhei: on the dissemination of pharmaceutical innovations. Health care in the Netherlands is increasingly concerned with innovation. However, as a rule of thumb only 1 in 70 innovations can be truly successful. Often, this is because insufficient attention is given to the implementation of innovations, encouraging the target group to actually use the innovation.

Taking into account different factorsAdvanDooren,PhD,professorofDisseminationofPharmaceuticalInnovations,deliveredhisinauguralspeechonbridgingthegapbetweenpharmaceuticalinnovationsandthepatient.TheDisseminationofPharmaceuticalInnovationsResearchGroupstudiesthefactorsthatplayapartinthepurposefuldisseminationofpharmaceuticalinnovations.AsProfessorAdvanDoorenpointsoutinhisinauguralspeech,bridgingthegapbetweenpharmaceuticalinnovationsandthetargetgroupthatissupposedtobenefitfromthese,isessentialforthesuccessofaparticularinnovation.Manyfactorsinfluencetheimplementationofinnovations.Thismakesitdifficulttopredicthowaninnovationwillbereceived.Makingplansinadvance,andtakingintoaccountthedifferentfactorsinfluencingit,shouldcontributetosuccessfulimplementation.Theresearchgroupwillconductresearchtoimprovethereceptionofinnovationprocesses,by demonstratingtheobviousneedforthem.

Implementing innovations sometimes takes too longSometimesittakesalongtimeforaninnovationtobeimplemented.Ad van Dooren:‘In1984,BarryMarshall,a32-year-oldAustralianphysician,drank acocktailofHelicobacterbacteria,obtainedfromthestomachofamanwhosufferedfromstomachache.Theeffectwasdramatic:hesufferedalotof pain,butsucceededtoprovethatgastriculcerswerecausedbyinfections.Afterwards,headmittedithadn’tbeenaverysensiblethingtodoforafatherofthree.Marshallcameupontheideawhenapatienttoldhimthathisgastriculcersymptomsdecreasedafterhewasadministeredatetracyclinecourseforathroat

/ pRofessoR Ad vAn dooRen,delIveRs InAuGuRAl speech

on the introduction of phARmAceutIcAl InnovAtIons

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infection.WhydidnoonebeforeMarshalleverthinkofthepossibilitythatcomplaintsduetoacidityofthestomachmightbecausedbybacteria?Itwasa wellknownfactthatgastriculcersinthepopulationusuallyoccurinwaves..However,mostscientistswereconvincedthatbacteriacouldnotsurviveintheacidenvironmentofthegastricjuices.Andwhydidittakeupto2005,whenMarshallandhiscolleagueWarrenreceivedtheNobelPrize,beforeallcriticismdiedaway?Didithaveanythingtodowiththefactthattheyoungdoctorwasnotconsideredanauthority,wasnotpartoftheestablishment,andwentagainstestablishedideas?Orwerestillotherfactorsplayingapart?

Precedingthisinauguralspeechandtocelebrateitstenthanniversary,theBachelorPharmaceuticalBusinessAdministrationprogrammeorganizedaconferenceonthefutureofpharmacyintheNetherlands.LecturesweregivenbyAdjiedBakas(trend watcher),CharlotteGroenhuizen(PharmaceuticalBusinessAdministrator),Jan Broeren,MA(VGZ),J.Smits,MA(chairmanKNMP),ProfessorBertLeufkens,PhD(CEG),andMichelDutree,PhD(chairmanNefarma).

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/ InAuGuRAl speech pRofessoR helIAnthe koRt, At the eIndhoven unIveRsIty of technoloGy

heAlthy BuildingsOn October 12th, professor Helianthe Kort, delivered her inaugural speech at the Eindhoven University of Technology. She was appointed part time professor of Building Healthy Environments for Future Users at the Department of Built Environment on August 1st, 2011. She is an authority on buildings and health. Helianthe Kort PhD is professor of Demand-driven Care at HU.

Buildingforhealthcareandhealthpreventsorreducestheriskofdisease.Also,ahealthybuildingallowsthosealreadyilltolivewiththeirdiseaseasindependentlyaspossible,andbecaredforintheirownenvironment.Healthybuildingsmonitor,followandinformusers.Theystimulatephysicalactivity,offersupportinactivitiesofdailyliving,andallowforself-careandfamilycare.Theyalsocontributetothequalityofprofessionalcare.

ChairinBuildingHealthyEnvironmentsforFutureUsersProfessorKortusesherchairinBuildingHealthyEnvironmentsforFutureUserstoeducatestudents.Thechairisalsousedtostudytheobviousneedofperformancerequirementsforthequalityoftheair,daylightandartificiallight,acoustics,heating,ventilationandairconditioning.Thisisdonefromahealthperspective.Itinvolvestheexperiencesofindividualusersandhealthcareprofessionals.Theperspectivesofboth”builders”and“carers”arealsoincluded.

ProfessorKort,:‘WiththischairIwanttostrengthenthepositionoftheunitwithknowledgeontheinterfacebetweenbuildingandhealth.Thiswillbereflectedintheperformancerequirementsofabuilding,andshouldresultinthedevelopmentofbuildingsthatallowforcomfortable,healthyliving,workingandrecreating.’

Readtheinauguralspeech(inDutch)>

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/ JAn JAAp montes y peRez pharmaceutical Business administration student

dIssemInAtIon of phARmAceutIcAl InnovAtIons ReseARch GRoup

‘I Am doInG A RevIew of the lIteRAtuRe on the pReventIon of type 2 dIAbetes. the ReseARch GRoup Is GoInG to use thIs RevIew And otheR studIes to develop A seRvIce thAt wIll enAble phARmAcy clIents to obtAIn AdvIce on how to pRevent type 2 dIAbetes.’

/ AwARds won by the ReseARch centRe

cARolIen sIno, mA, wins practice-oriented research award 2012

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5‘Early recognition of medication-related problems in homecare’ is the title of a research report by the Research Group for Nursing and Allied Healthcare for People with Chronic Illnesses. This report has won the Practice-oriented Research of the Year 2012 Prize, on April 16th.

ProblemOlderpeopleusemoremedicationthantheaveragepersonintheNetherlands.Also,theirbodiesreactdifferentlytoprescriptiondrugs,whichcauseundesirableside-effects.Thisproblemisreinforcedbythefactthatolderpeopleoftenusedifferentdrugsatthesametime.Howcanweguaranteeearlyrecognitionoftheproblemsthatmayarisebecauseofthis?Manystepsweretakenoverthepastyearstolaydownrulestopreventthisproblem:doctorsprescribemedicines,whicharesubsequentlydistributedby pharmacies.Butthereisnowayofcontrollingwhathappensnext,behindthefrontdoor.

SolutionCarolienSino,MA,researcherattheResearchGroupforNursingandAlliedHealthcareforPeoplewithChronicIllnesses,andlecturerattheInstituteforNursingStudiesatHU,hasdevelopedachecklistinwhichmedication-relatedproblemsaremarkedwithredflags.Thisallowshomecareworkersto quicklyestablishwhetheramedicationproblemexists.ProfessorMariekeSchuurmans,professorofCareforOlderPeopleandCarolienSino’ssupervisor,explainswhyshewasnominated:‘Westartedthispracticeresearchbecauseofanextremelyrelevantpracticeproblemwithalargesocialimpact.Wecameupwithaninstrumentwithwhichtheproblemcanbetackledinstantly.’Thisinstrumentwasdevelopedincollaborationwith25UniversityofAppliedSciencesnursinggraduates.AlsostudentsofNursingScience,PharmacyandPharmaceuticalBusinessAdministrationparticipatedinthisstudy.TheprojectwasfundedbySIARaakPubliek.

PrizeThewinnerwasannouncedduringtheannualconferenceoftheNetherlandsAssociationofUniversitiesofAppliedSciences(HBO-raad),onApril16th.ThePractice-orientedResearchoftheYearPrizeconsistsof€3.000,-,tobespentatthediscretionofthewinner.

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Marianne Sinoo, MA, researcher at the Research Group Demand-driven Care, received the Herman Bouma Award for gerontechnology at the ISG*ISARC2012 on June 24th. She won this prize for her presentation of a study into ‘Visual functioning and visual comfort in care facilities for older adults’.

StudyFortypercentofnursinghomeresidentssufferfromimpairedvision.MarianneSinoostudiedthevisualfacultyofresidentsandthelightingconditionsin4nursinghomes.Basedontheoutcome,shemaderecommendationsontheorganizationofthesenursinghomes.Shefoundthatadequatelightingandadequateuseofcoloursandcontrastresultsinadecreaseoffallincidentsintheelderly.Addedtothis,lightinganduseofcolourareimportantforactivitiesofdailylivinginnursinghomeresidents.Sufficientlightingalsoresultsinadecreaseofthenumberoffallsbyolderpeoplewithvisualimpairments.SinooconductedherresearchincollaborationwithBartimeus(visualimpairmentknowledgecentre).TheuseoftechnologyinthecareforolderpeoplewasacentralthemeattheISG*ISARC2012conference.

mARIAnne sInoo, mA, wins herman Bouma award

6/ AwARds won by the ReseARch centRe

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During the ceremony at the start of the HU academic year on September 30th, Professor Mia Duijnstee, received the HUgenotenprijs, an award handed out by HU University of applied sciences, to lecturers, employees or students who have shown themselves to be inspiring, creative and involved, and have made a distinct contribution to our university of applied studies.

Development of practice-oriented researchProfessorMiaDuijnsteewaspraisedforhercommitmenttothedevelopmentofpractice-orientedresearchattheResearchCentreforInnovationsinHealthCare,andforhercontributiontotheUtrechtHealthcareAcademy,anetworkinwhichtheCentralNetherlandsRegionalEducationandTrainingCentre(ROCMiddenNederland),HU,andtheUniversityMedicalCentreUtrecht(UMCU)havesynchronizedtheireducationalfacilities.‘Wedonotcreateresearchers,wecreateuniversityofappliedsciencesgraduateswithaninquisitiveattitude,’Duijnsteeclaimed,inadiscussionwiththechairpersonabouthighervocationaleducationstudents.Earlierthisyear,ProfessorDuijnstee,leftHU.HerchairattheResearchGroupforNursingandAlliedHealthcareforpeoplewithchronicillnessesmainlyconcentratedonfamilycare.

pRofessoR mIA duIJnstee, wins hugenotenprijs

7/ AwARds won by the ReseARch centRe

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8On October 4th, Jan Pool, PhD, researcher at the Lifestyle and Health Research Group and lecturer in the Master Physiotherapy Programme, won the prestigious David Lamb Award at the international conference of the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) in Québec, Canada. This prize is presented once every four years, to the researcher who has made the most significant contribution to Manual Therapy.

What works best?Dr.Pool:‘Ihaveresearchedthedifferenceintermsofeffectsbetweenmanualtherapyandabehaviouralinterventioninpeoplewhosufferfromneckcomplaintsexistinglongerthan4weeks,butshorterthan12weeks(sub-acuteneckcomplaints).Iwaswonderingwhichofthetwoapproachesmightpreventneckcomplaintsfrombecomingchronic.Afterhavingresearched147patientswithneckcomplaints,itturnedoutthattherewasnosignificantdifference.Bothstrategiesareeffective.’

Manual Therapy versus behavioural interventionThemanualtherapistprovides‘hands-on’therapy.Heappliescertaintechniquestoallowthejointstofunctionbetter,e.g.,mobilization:themanualtherapistmovesthepatient’sjoints.Thepatientisnotrequiredtohelp.Duringabehaviouralintervention,thetherapistexclusivelyprovidesinformation,andtreatsthepatientaccordingtoastrictexerciseprotocol,basedonbehaviouralprinciples.This‘hands-off’therapyisespeciallyaimedatimprovingthepatient’slevelofactivity.Thetherapisttriestoignorepainbehaviour,andstimulateshealthybehaviour.

SpecialItisquiteextraordinarythatdoctorPoolhaswonthisprizeforthebestresearchinmanualtherapy,despitedemonstratingthatabehaviouralapproachandmanualtherapyareequallyeffective.

JAn pool, phd, wins david lamB award

/ AwARds won by the ReseARch centRe

Rik Ensing, MA, pharmacist at de Brug pharmacy in the Flevoziekenhuis, and member of the Dissemination of Pharmaceutical Innovations Research Group since October, has won the Healthcare Innovation Award at the KNMP conference, the conference of the professional and branch organization of pharmacists. Ensing has designed a new route for supplying medication to oncology patients, in an attempt to reduce the risk of people using the wrong medicines.

Oncologypatientsareusuallygivenrepeatprescriptionsformedicinestheyhavetotakebeforeandafterchemotherapy.Thiscanberathercomplicated.Itisalsoimportantforthepatienttovisitthepharmacyintime,withthecorrectprescription,becauseofthetimeneededtopreparethesemedicines.

One package in the treatment roomThankstothenewroute,oncologypatientsarenowreceivingmedicationinonepackage,atthedoctor’sofficeintheFlevoziekenhuis.Patientsbenefit,becausetheydonothavetovisitthepharmacyanymore,andbecausetheyareconfidentthatallnecessarymedicationiswaitingforthem.Atthesametime,physiciansandnursescanrestassuredthatthemedicationhasreachedthepatient.Medicationagainstnausea,e.g.,isputinspecialbags.Eachbagcontainstherightamountofmedicinesforthepatienttotakeinatdifferentmoments(e.g.,twopillsat08.00inthemorning).Thisway,thepatientnolongerneedstorememberwhentotakewhatmedicationinwhatquantity.

Patients and care professionals satisfiedEvaluationsessionswithpatientsshowgreatsatisfactionwiththenewprocedure.Also,oncologists,oncologynursesandpharmacyassistantsareenthusiastic.EnsingconductedhisresearchintoimprovementofthemedicationrouteincollaborationwithZühalEgirgen,PharmaceuticalBusinessAdministratorandHUalumnus.

RIk ensInG, mA, wins healthcare innovation award

/ AwARds won by the ReseARch centRe

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For the HU Healthcare and Technology Spearhead, 2012 has been the year of focusing, making visible and connecting with partners.

FocusTheHealthcareandTechnologySpearheadconcentratesonthreedomains:technologyforclients,technologyforprofessionals,andtechnologyforthebuiltenvironment.Thisfocuswasestablishedoverthepastyear.Asaresult,thespearheadhasbecomeastrategicHUtheme,andprovidesdirectionforrelevantresearchandeducation.Centralintheprogrammeistheuseofinnovativetechnologyineverydaypatientcare.Itisaimedatallowingpeoplewhoneedlongtermcaretofunctionandsociallyparticipateaslongaspossible,andasindependentlyaspossible.

Show expertise and activitiesThefirstHealthcareandTechnologyconference(#ZenT)wasaimedatmakingvisibletheexpertiseandactivitiesoftheHUspearhead.Forthis,aninformationplazawascreated,wheredifferenteducationprogrammesandresearchgroupsthatareactiveinthisfield,couldpresentthemselves.Thecommunitythatwasthuscreatedgatherseveryquarterlyinso-calledmeetups.Atthefirstmeetup,Co-DesigninHealthcareandTechnologywasthetopicofdiscussion.Inadditiontothemeetups,thereisaHealthcareandTechnologypublicationseries,whichislinkedtoameetupandhighlightsthethemeofthepreviousmeetup.

healthcare and technology speARheAd

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TheHealthcareandTechnologyspearheadalsobecomesmorevisibleinthecurricula:aHealthcareandTechnologyeducationaltrackisbeingdevelopedwithintheBachelorNursingProgramme,andatthesametime,amajorisbeingdevelopedintheBachelorHealthcareManagementProgramme.AminorPublicHealthEngineeringalreadyexistswithintheFacultyofHealthCare.

Connecting with partnersTheHealthcareandTechnologyprogrammeaimstoconnectwithpartners,suchastheUniversityMedicalCentreUtrecht(UMCU),MeanderMC,theUtrechtSciencePark,anumberofSmallandMediumEnterprises(SMEs),theCentralNetherlandsRegionalEducationandTrainingCentre(ROCMiddenNederland)andbranchorganizations.TheideaistojoinforcesandestablishanInnovationofHealthcareCentreofExpertise.

TheactualresearchsubjectsoftheHealthcareandTechnologyspearheadwillbeestablishedincollaborationwithallHUFaculties.TheFacultyofEconomyandManagementwillparticipateinresearchinge-Healthbusinessmodels.CollaborationwiththeFacultyofNatureandTechnologyrequirestheexpertiseoftheCo-DesignResearchGroup,whichareinvolvedindifferentprojects.StudentsoftheFacultyofCommunicationandJournalismareinvolvedinanumberofprojectsregardingthedevelopmentofknowledgebasesinthefieldofhealthcareandtechnology.FurtherorientationwiththeFacultyofEducationisnecessaryregardingtheuseofseriousgamesasatoolforeducatingstudentsontheinterfacebetweenhealthcareandtechnology.TheResearchCentreforSocialInnovationoftheFacultyofLaw&Societystudiestheuseoftechnologyforimprovingemploymentinhealthcare.

E-healthwillbecomeacentralthemefortheHealthcareandTechnologyspearheadin2013.Everyquarter,therewillbeameetupandapublicationintheHealthcareandTechnologyseries.

Moreinformation:www.zorgentechnologie.hu.nl

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‘I belIeve ReseARch Is ImpoRtAnt to A mAnAGeR In heAlth cARe: It pRovIdes new InsIGhts, And≈InfoRmAtIon of whAt Is GoInG on In the fIeld.’

In 2012, 406 students participated in research by the Research Centre. Among those was Anouk van der Vlies, a student of Healthcare Management. She and two other students, Rico Eysbroek and Eline Konijnenberg, participated in the Predictors project for use of e-Health by older people and healthcare professionals (PETZ).

ReseARch & educAtIon

11PETZInthisprojectthepredictivefactorswerestudiedregardingtheuseofe-Healthtechnologybyolderpeopleandcareprofessionals,especiallyinthefieldoftelehealth.TheResearchGroupDemand-drivenCarewillsubsequentlydevelopspecificcoursesforolderpeopleandhealthcareprofessionals.TheprojectispartlyfundedbySIARAAK.

Tasks for studentsThestudentshavereviewedtheliterature,andcontributedtothedevelopmentofpreliminaryquestionnairesforolderpeopleandcareprofessionals.Theyalsocontributedtothedevelopmentofobservationquestionnaires.Subsequently,thepreliminaryquestionnaireswerepresentedtoolderpeopleandhealthcareprofessionals.Theoutcomewasanalysedbythestudentsandtheirresearchteachers,allowingthemtofurtheroptimizethequestionnaires.

International collaborationOneofthecollaboratingpartnersinthePETZprojectisFloridaStateUniversity,Tallahassee.‘WhenwewereonaworkingvisittoAmerica,wetookminutesduringthemeetings,andgainednewinsights.’Everyday,thestudentssummarizedconclusions,andpresentedthesetothepeopleattendingthemeetings.

Research and educationForthreemonths,Anouk,RicoandElinecollaboratedinthisstudy,fulfillingtheirsecondyearpracticaltrainingrequirementintheHealthcareManagementeducationprogramme.TheResearchCentreisnottheonlyunitthatofferspracticalresearchtrainingjobs.Practice-orientedresearchisalsopartofsomeoftheparticipatingminors.ThereisalsoroomforSiriusstudents(studentswhoarelookingforextrachallengesbesidetheirstudies)toparticipateintheresearchbytheResearchCentre.

Studentsgetacquaintedwithresearchnotjustbyparticipatinginaparticularresearchstudy.Conductingresearchisalsoastructuralpartwithinthecurriculumofthehealthcareeducationprogrammes.DuringtheResearchandPracticeeducationaltrack(LOEP),studentsacquireacademicskills,learntopracticeevidencebased,refreshknowledgeontheirownaccordanddevelopaninnovative,professionalattitude.

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new ReseARch / no pRess

nurses and older people ReducInG stRess study

12The Research Group for Nursing and Allied Healthcare for people with chronic illnesses is developing a method for measuring the knowledge and attitudes of nurses regarding older people, in order to be able - where necessary - to offer specific training. Thus, the Research Group supports nurses to improve the care they are giving to older people.

Hospitalnursesarefacedwithanincreasingnumberofolderpatients.Caringforthispatientgroupproducesalotofstress.Often,nursesareunawareoftheproblemsthatbeingillpresenttoolderpeople,andtheyexperiencethemtoberathertroublesome.Agingmaycauseolderpeopletodevelopspecificproblems,andhospitaladmissionmayincreasetheriskofcomplications,e.g.,decubitus,dehydration,malnourishment,deliriumandfallaccidents.Also,olderpeopleoftenrequiremoretime.Manynursesexperiencetensionbetweennursingaccordingtoprotocolswithinacertaintimeframe,andthespecificcarerequiredbyolderpeople.

Look beyond the medical problemInhospitals,attentionisusuallyfocusedonthemedicalproblemforwhichapatientisadmitted.Initself,thatisagoodthing,butinthecaseofolderpeopleprofessionalsneedtotakeabroaderperspective,becausemanythingscangowrong.Inthisproject,theResearchGroupaimstodevelopinstrumentsformeasuringtheknowledgeandattitudesofhospitalnursesregardingolderpeople.Subsequently,thehospitalshouldbeabletoestablishwhatparticulartrainingwouldbenefitthenurse.Thiswilleventuallyleadtoimprovedcareforolderpatients.

CollaborationForthisproject,HUcollaborateswiththreeregionalhospitals(Diakonessenhuishospital,theUniversityMedicalCentreUtrecht(UMCU),andSt.Antoniushospital).Inaddition,HUalsocollaborateswithUtrechtUniversity(NursingScience),V&VNDutchNurses’Association,twouniversitiesinAmericaandoneinSouthAfrica.ThisstudyisfundedbySIARAAKinternational,foraperiodoftwoyears.

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Researcher Esther du Pon, MA, is developing a personalized application for older people, enabling them to formulate questions and acquire relevant information before consulting with their general practitioner. This allows them to be better prepared.

Patient not more emancipatedItisoftenclaimedthatpatientsintheNetherlandshavebecomemoreemancipated.However,researchhasshownthatoverthepastyearsgeneralpractitionersarebeingaskedlessquestionsratherthanmore.Whenapatientfeelsillorhashadtowaitalongtimebeforetreatment,emancipationseemstobenolongertheirmainconcern.Duringconsultation,importantthemessuchasuseofmedicationandpatientcompliancearehardlydiscussedatall.SincetheintroductionofthenewHealthInsuranceBill(2006),moreisexpectedfromthepatient.Patientshavebeengivenaresponsibilityoftheirown.Especiallyolderpeople(65yearsandover)whoarechronicmedicationusers,experienceproblemsduringconsultationwithageneralpractitionerorpharmacist.Manyolderpeopleusedifferentprescriptiondrugsatthesametime.Thisincreasestheriskofsideeffectsandinteractionwithothermedications.Also,depression,relativelyfrequentinolderpeople,makesithardertocommunicate.Asaresult,questionsmayremainunansweredandpatientsmaynotknowjustwhattoexpect.Theymaybeunnecessarilyworriedordissatisfieduponleavingtheconsultationroom.

Better prepared for consultationThisproject,bytheDisseminationofPharmaceuticalInnovationsResearchGroup,ismeanttoprovideolderpatientswithameanstopreparethemselvesfortakingamoreactivepartduringconsultationswiththeirgeneralpractitioner,practicesupporterorpharmacist.Byusingapersonalizedapplication,developedbytheResearchGroup,olderpeoplecanacquirealltherelevantinformationandformulatequestionsinadvance,whichallowthemtopreparethemselvesbetter.Asaresult,patientswillaskmorequestions,gettheinformationtheyneedandgohomesatisfied.Intheendthiswillbenefitthepatient’smedicationbehaviourandconsequentlyalsotheirqualityoflife.

improved communication Between oldeR pAtIent And cAReGIveR

/ new studIes

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patient compliance In pAtIents wIth lImIted heAlth lIteRAcy who ARe GoInG thRouGh chronic pain rehaBilitation

new studIes / pRepGo

14The Lifestyle and Health Research Group has started a project to stimulate patient compliance in people who are less able to read, understand and apply information regarding their health.

Noncompliance more frequentPatientswithlimitedhealthliteracy(whoarelessabletoread,understandandapplyinformationregardingtheirhealth)aremoreoftennoncompliantthanotherpeople.Patientcomplianceimproveswhenpatientsreceivecontinuouseducationabouttheirdiseaseandtreatment.However,peoplewithlimitedhealthliteracyfinditmoredifficulttounderstandtheinformationprovidedbytheircaregivers.Therefore,itisimportanttoadapthealtheducationtothelevelofunderstandingofeachindividualpatient.ThePREPGOpracticeprojectisdevelopingsolutionsforpatientswithlimitedhealthliteracyandchronicpain.

CollaborationTheprojectteamcollaborateswiththechronicpainrehabilitationteamsofHeliomareanddeHoogstraat,withPharosNationalKnowledgeandAdvisoryCentreonMigrants,RefugeesandHealthCareIssues,withCBO/NIGZ,TNO,theNetherlandsinstituteforhealthservicesresearch(NIVEL),theUniversityofAmsterdamandtheRoyalDutchSocietyforPhysicalTherapy(KNGF).ThisprojectissupervisedbyProfessorHarriëtWittink,andfundedbySIARAAK.

TheknowledgethatisgainedinthePREPGOprojectwillbeusedinpractice(bymeansofpracticaltraining,intercollegiateconsultationandphysiotherapyandpainassociations),forthedevelopmentofguidelines,andcontributetoscientificknowledgeonreasonsfordrop-outinrehabilitationprogrammes.

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15The Research Group for Demand-driven Care is currently studying adaptations in care homes that bear a positive influence on the health and well-being of older people. Also, the effects of these adaptations on work perception of the nursing staff are subject of study. The project was called: BEZO (Inspiring environment in the care for older people).

Light, quality of the air and acousticsResearchersstudytheinfluenceoflight:Whateffectdodaylightandartificiallighthaveonboththequalityoflivingofresidentsandthejobsatisfactionofstaff?Andwhataretheeffectsonmedicationusebyresidents?Researchersexpectthat,withappropriatelighting,residentswillneedlesssleepmedication,becausetheywillbemorerelaxed.Addedtothat,adecreaseinfallaccidentsisexpected.Attentionisalsopaidtoacousticsandaudibility,andtothequalityoftheairinsidethebuilding.Itisassumedthatadaptationofthesetwowillbearapositiveinfluenceonthehealthandwell-beingofresidents,aswellasonprofessionals’jobsatisfaction.

Expected effectsIfolderpeoplearemorerelaxedandthenumberoffallaccidentsdrop,itisexpectedthatcarestaffwillhavemoretimetogiveresidentsspecialattention.Furthermore,itisexpectedthatresultsfromtheBEZOprojectwillhelpcarersreassessthehealthcareprocess.Theprojectalsoprovidesdirectionforthedevelopmentofguidelinesregardingthebuildingaspectsofcarehomes.

Follow-up of the HEZO projectThisprojectisfundedbySIARAAK,andisafollow-upoftheHEZOproject,inwhichresearchwasdoneintowhichspecificbuildingadaptationsinhospitalscouldhavehadahealinginfluence.

healthier cARe homes

new studIes / bezo

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/ lIeke kuIpeRsspeech therapist at KoninKlijKe auris group and Knowledge circle memBer of the research group speech and language therapy

ReseARch GRoup speech And lAnGuAGe theRApy

ReseARch GRoup speech And lAnGuAGe theRApy ‘scIence And close contAct wIth chIldRen Is A GReAt combInAtIon; I cAn ImmedIAtely obseRve the effects of the studIes.’

Speechtherapistsmustremaininvolvedintheearlyrecognitionoflanguagedeficienciesinchildren.Itisveryimportanttotakeauniform,nationwideapproach,inordertomissasfewchildrenwithlanguagedeficienciesaspossible.Bymakingpreventivespeechtherapymoretransparentandbydemonstratingtheeffects,therecognitionandacknowledgementoftheroleofthepreventivespeechtherapistwillincrease.

TheseconclusionsaredrawnbyMiekeBeers,PhD,EsthervanNiel,MA,andEllenGerrits,PhD,inthePRIL(PreventioninSpeechTherapy)researchreport.TheResearchGroupSpeechandLanguageTherapyhasstudiedthedesiresandpossibilitiesforpreventivespeechtherapybymeansofinterviewingmanagersandspeechtherapistsinareahealthauthorities(GGD’en)intheNetherlands.ThisstudywascommissionedbytheAssociationofSpeechTherapistsintheNetherlands(NVLF).

Current situationManyhealthcentresintheNetherlandsscreentwo-year-oldchildrenforpossiblelanguagedeficiencies.Usually,languagescreeningispartofacomprehensivedevelopmentscreening,performedbypaediatriciansorpaediatricnurses.Afterscreening,speechtherapistsplayanimportantroleifthechild’slanguagedevelopmentappearstobe‘notokay’.Thereisnoclarityaboutthequestionwhatthisaftercareisabout,exactly.‘Speechtherapyconsultation’isorganizeddifferentlyinthedifferentregions.Cutbackshaveresultedinfurtherfragmentationandlimitationsonpreventivespeechtherapytasks.

More uniformityResearchoutcomesshowthatbothmanagersandspeechtherapistsinareahealthauthorities(GGD’en)argueinfavourofuniformlanguagescreeningattheageoftwo,followedbypreventivespeechtherapy.Followingthescreeningprocedure,andduringspeechtherapyconsultation,itispossibletodofurtherdiagnosticresearch,explaintheneedoflanguagestimulationtoparents,andadvisethem

completed ReseARch pRoJects / pRIl

advice on future pReventIve speech theRApy

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aboutsubsequentstepstotake,e.g.treatment.Itisalsorecommendedtokeepa possibilityforrecognitionofproblemswhenachildisinelementaryschool.

More clearly defined role speech therapist as expertProfessionalswhowereinterviewedthinkthatspeechtherapistsshouldhavea moreclearlydefinedrolewithregardtotherecognitionandsupportofchildrensufferingfromlanguagedeficiencies.Speechtherapistsshouldmoreoftenparticipateasteachersincontinuingeducationprogrammesorascoachesforotherprofessionalsinvolvedwiththechild,suchasplaygroupleaders,teachers,paediatriciansandcommunitynurses.Forthisroletoo,anationwide,uniform‘bestpractice’shouldbeestablished.

More transparent speech therapyDuetocutbacks,futurefundingofpreventivespeechtherapywillnotcomefromareahealthauthorities(GGD’en)only,butalsofromeducationfundsfor,e.g.,projectsinthefieldofpre-schoolandearlyschooleducation(VVE).Speechtherapistsshouldstresstheimportanceofpreventivespeechtherapy,andbetransparentabouttheirproductandthecostsinvolved.Thistransparencyshouldoffermoreinsightinthevalueofpreventivespeechtherapyfortheagenciesthatspeechtherapistscollaboratewith,e.g.,childandadolescenthealthcare,educationinstitutesand(local)government.

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lAnGuAGe pRofIcIency test for multilingual students

/ completed ReseARch pRoJects

17UniqueThenewtestisunique,becauseexistinglanguagetestsarepredominantlyaimedatchildren.Furthermore,thetestmonitorsbothwrittenandspokenlanguage,suchasvocabulary,syntaxandgrammar.Mosttestsforgrownupsonlymeasurewrittenlanguage.

Improve language proficiencyThetestwasdevelopedaspartoftheG5project.TheMinistryofEducation,CultureandScienceprovidesfundingforthisproject,andcommissionsthefiveuniversitiesofappliedsciencesintheRandstadregiontoimprovethestudysuccessofmultilingualstudentswhospeakDutchasasecondlanguage.Withinthisproject,moneywasreservedforimprovingthelanguageproficiencyofthesestudents.EllenGerrits,professorofspeech&languagetherapy:‘Beforedoinganintervention,firstyouhavetoknowwhattheproblemis.Thetestshouldobjectifythis.’

Students projectThefirstpartoftheprojectcontainedastandardizationstudyforthelanguageproficiencytest,incollaborationwithspeechtherapystudents.Fiftythreestudentsweretested,forwhomDutchwastheirmothertongue.

Inthesecondpart,speechtherapystudentstestedmultilingualstudentswhoareexperiencingproblemswiththeDutchlanguage(NT2).Thesestudentshadmuchlowerscoresonmostlanguageaspects,comparedtostudentswithDutchasamothertongue.Dutchvocabularyinmultilingualstudentswasclearlybelowaverage,andtheymademanygrammaticalmistakeswhilespeaking.Multilingualstudentsindicatedthattheirlanguageproficiencypresentedanobstacleforstudying.ResearcherGerdaBruinsma:‘Thetestisafirststeptohelpingmultilingualstudentswithlanguageproficiencyproblemsstudysuccessfully.’

ThestudywasexecutedintheHUSpeechTherapyClinic.

In collaboration with speech therapy students, Gerda Bruinsma, MA, researcher at the Research Group Speech and Language Therapy, has developed a language proficiency test for university of applied sciences students. The test enables early detection of language deficiencies in students for whom Dutch is a second language so that specific language training can be offered.

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The Research Group for Demand-Driven Care studied the requirements that have to be met in order to enable the target group to successfully use e-health. Although the iKOP project was completed, HU continues to research this theme within the Healthcare and Technology spearhead.

E-health-healthcarebymeansofmodern,digitalmedia-willbeappliedmoreandmoretolessentheburdenofcare.Tobeabletomakegooduseofe-health,differentSmallandMediumEnterprises(SMEs)haveaskedtheResearchGroupforDemand-DrivenCaretoinvestigatewhatkindofenvironmentisneededtoallowadequateuseofe-health,andwhatspecificneedsolderpeopleandtheirfamilycaregivershave.TheseissueswereresearchedwithintheiKOP(ExpandingE-Healthknowledge)project.

Sensor systemTheuseofasensorsystemwasstudied,amongotherthings.Inthissystemmultiplemovementsensorsarepositionedinthehouseofanindependentlylivingolderperson.Thesensorsmeasurehowoftentheolderpersonentersacertainroom(doorsensor)orperformsacertainaction(e.g.,registeredbyabedsensor,asensoronalightswitchoronarefrigerator).Thesignalofthesensorsystemcanbepassedontofamilycaregiversviatheinternet.Thesystemisoftenusedinolderpeoplesufferingfromdementia.Thisway,itispossibletoobservefromadistanceifadementedolderpersoniswanderinginthehouse,whichmakestimelyinterventionbyfamilycaregiverspossible.Thesensorsystemcanalsobeusedasanautomaticswitch,e.g.,forlightsorautomaticcentrallockingsystems.Thestudyshowsthatfamilycaregiversappreciatethebenefitsofasensorsystemmostwhentheyarelivingatlessthanonehourdistancefromtheolderpersontheyarecaringfor.Also,thesystemisespeciallybeneficialforolderpeoplewhosementalcapacitiesaredeclining.Iftheseconditionsaremet,botholderpeopleandfamilycaregiversshowgreatenthusiasmforthesensorsystem.

Continuation within the Healthcare and Technology spearheadTheiKOPproject,fundedbySIARAAK,wascompleted.HUcontinuestodoresearchone-healththatworks,iscomprehensibletousers,lessenstheburdenofcareandproducesbreakthroughsinSMEs.ThisresearchisdonewithinthescopeoftheHUHealthcareandTechnologyspearhead.

e-heAlth that worKs18 completed ReseARch pRoJects / Ikop

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/ Ilse toppeRassistant researcher and physiotherapy student

lIfestyle And heAlth ReseARch GRoup

‘the ReseARch I Am pARtIcIpAtInG In Is cleARly RelevAnt foR pRActIce. physIotheRApIsts pARtIcIpAtInG In ouR study cAn hARdly wAIt to stARt woRkInG wIth the pRototype questIonnAIRe. thAt Is GReAt.’

ImpRovement of heAlth lIteRAcy In pAtIents wIth limited health literacy On August 29th the final conference of the Transparency of Healthcare in Disadvantaged Neighbourhoods project (TransFysA) was held. The insights and results of this project were presented at this conference.

completed ReseARch pRoJects / tRAnsfysA

ThisprojectoftheLifestyleandHealthResearchGroupcontributestotheimprovementof(physiotherapy)caretoboththenativeDutchandimmigrantswhoaresufferingfromlimitedhealthliteracy.Itdoessobymakinglimitedhealthliteracymorevisibleandbyprovidingsupporttoincreasethehealthliteracyofthesepatients.Theprojectwasinitiatedfollowingarequestfromanumberofphysiotherapypracticesindisadvantagedareas,wheremanypeoplewithlimitedhealthliteracylive.

Limited literacy and health skillsOneandahalfmillionpeoplesufferfromlimitedliteracyintheNetherlands.Twothirdsofthosearenativeand1/3areimmigrants.Peoplewithlimitedliteracyhaveproblemswithreading,writing,arithmetic,speakingandunderstanding,andoftenlackknowledgeofthehumanbody.Theyalsofinditdifficulttoabstract(haveanoverallview,anticipateorlookback,summarize,distinguishmainissuesfromside-issues).Thismakesitmoredifficultforthemtofunctionwellinsociety.Forimmigrantswithlimitedliteracytherecanbeextrabarriers.TheymayhavelessinformationconcerningthehealthcaresystemintheNetherlands,differentattitudestowardscaregiversordifferentviewsonthecausesoftheirowndiseases.Caregiversmustpossessadifferentsetofskillstohandlethiswell.Explicitcommunication,mutualunderstandingandopennessareveryimportantduringtreatment.

Limited literacy in physiotherapy practiceDifferentfactorsareimportantforexperiencinghealthandfortheappeal

19(immigrant)peoplewithlimitedliteracymakeon(amongotherthings)physiotherapy,e.g.,socioeconomicstatus,education,ethnicity.Duringtheconference,attentionwasgiventorecognizinglimitedliteracyinphysiotherapypractice.Limitedliteracyisnotsomethingthatcanbeobservedinpeople’souterappearance.Thesymptomsareoftendisguised.However,thenumberofyearsspentinschoolisoftenareliableindicator.Ifaphysiotherapistsuspectsthatcertaininformationwasnotunderstood,hemightaskthepatienttotellinhisownwordswhatwasdiscussedduringtreatment(talkback).

Talking Touch ScreenWithintheTransFysAprojectasolutionwassoughtforproblemsthatphysiotherapistsexperienceduringtheintakeofpatientswithlimitedliteracy.ThePSKquestionnaire(PatientSpecificComplaintsquestionnaire,whichisusedinmanyphysiotherapypracticesduringintake)wasconvertedintoatalkingtouchscreen(TTS).PreliminaryresultsshowthattheTTSiseasiertofillinthanthepaperversionofthePSKforpatientsfromalllevelsofeducation.

Continuation within the Healthcare and Technology spearheadTheTransFysaproject,fundedbySIARAAK,wascompleted.HUcontinuestodoresearchlimitedhealthliteracy.ThisresearchisdonewithinthescopeoftheHUHealthcareandTechnologyspearhead.

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SMEs have asked the Research Group for Demand-Driven Care to investigate what requirements are needed to create a Healing Environment and to make this knowledge applicable for SMEs. This resulted in a DVD, a website for smart phones, a survey of the relevant literature, a practice document translating the theoretical framework into practice and a documentary.Healing EnvironmentsThereisashiftinhowwelookuponthehospitalasabuilding,likethereisashiftinhowwelookuponhealthcareasawhole.Thearchitectureanddesignarechangingfromauniform,standardizedbuildingtoaso-calledHealingEnvironment(HE).DifferentsourcesclaimthattheHealingEnvironmentconceptisbeneficialforthehealingandwell-beingofpeople,andthatitreducesstress.Importantitemsaretheuseof(day)light,naturalcolours,plantsandart.Ahealingenvironmentisalsodesignedtoofferpeoplethepossibilitytobeactiveanddothingsindependently.

Applicable for SMEsWithintheHEZOproject,knowledgewasdevelopedtoscientificallysubstantiatetheHealingEnvironmentsconceptandmakeitapplicableforSMEswithregardtosafety,privacy,comfort,supportoffamilyandsurroundings(location)ofthebuilding.ThenewlybuiltMeanderMedicalCentrewasusedasanexperimentalcentre.

Combined knowledgeInformationonhowSMEsmayusetheHealingEnvironmentsconceptintheirdesignscanbefoundintheHEZOKnowledgeBase(mobilewebsite).ThisinformationisalsoavailableonDVD,withrecordingsoftheentireprocess,frominitiativetoinsightintheHEconcept(DVDtrailer),apracticedocumentcontainingatranslationofthetheoreticalframeworkintopracticesituations,anoverviewoftheliteratureandtheHealingHospitalEnvironmentDocumentary.TheprojectwasfundedbySIARAAK.

the heAlInG hospital completed ReseARch pRoJects / hezo

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/ RodeRIck udo lecturer and researcher

ReseARch GRoup foR demAnd-dRIven cARe ‘the only wAy to meet the GRowInG need foR e-heAlth pRoducts Is A multIdIscIplInARy AppRoAch: heAlthcARe pRofessIonAls cAnnot do wIthout compAnIes thAt mAke the pRoducts, And compAnIes RequIRe knowledGe About the needs And desIRes of useRs, And of the deGRee of AcceptAnce. theRefoRe, As An economIst, I Am ReseARchInG the dynAmIcs of e-heAlth busIness models, In collAboRAtIon wIth compAnIes And ReseARcheRs fRom dIffeRent dIscIplInes: nuRsInG, psycholoGy, mAnAGement And technoloGy.’

‘the research centre is aBout research foR pRActIce, In collAboRAtIon wIth pRActIce’

HU University of Applied Sciences UtrechtBolognalaan 1013584 CJ Utrecht

www.innovationsinhealthcare.research.hu.nlsecretariaatlectoraat.fg@hu.nl

Design: Raak Grafisch OntwerpText: Stijntje VogelaarTranslation: Fritz Boeringa, Harriet WittinkPhotography: Femke van den Heuvel, Erik Kottier, Shutterstock, HU beeldbankIllustrations: Studio Vrijdag