A person-centred segmentation study in elderly care: towards efficient demand-driven care.

Providing patients with more person-centred care without increasing costs is a key challenge in healthcare. A relevant but often ignored hindrance to delivering person-centred care is that the current segmentation of the population and the associated organization of healthcare supply are based on diseases. A person-centred segmentation, i.e., based on persons' own experienced difficulties in fulfilling needs, is an elementary but often overlooked first step in developing efficient demand-driven care. This paper describes a person-centred segmentation study of elderly, a large and increasing target group confronted with heterogeneous and often interrelated difficulties in their functioning. In twenty-five diverse healthcare and welfare organizations as well as elderly associations in the Netherlands, data were collected on the difficulties in biopsychosocial functioning experienced by 2019 older adults. Data were collected between March 2010 and January 2011 and sampling took place based on their (temporarily) living conditions. Factor Mixture Model was conducted to categorize the respondents into segments with relatively similar experienced difficulties concerning their functioning. First, the analyses show that older adults can be empirically categorized into five meaningful segments: feeling vital; difficulties with psychosocial coping; physical and mobility complaints; difficulties experienced in multiple domains; and feeling extremely frail. The categorization seems robust as it was replicated in two population-based samples in the Netherlands. The segmentation's usefulness is discussed and illustrated through an evaluation of the alignment between a segment's unfulfilled biopsychosocial needs and current healthcare utilization. The set of person-centred segmentation variables provides healthcare providers the option to perform a more comprehensive first triage step than only a disease-based one. The outcomes of this first step could guide a focused and, therefore, more efficient second triage step. On a local or regional level, this person-centred segmentation provides input information to policymakers and care providers for the demand-driven allocation of resources.

Job satisfaction and job content in Dutch dental hygienists.

OBJECTIVES: This study compares the scope of practice of Dutch dental hygienists (DHs) educated through a 2- or 3-year curriculum ('old-style DHs') with that of hygienists educated through a new extended 4-year curriculum leading to a bachelor's degree ('new-style DHs'), with the aim to investigate whether an extended scope of practice positively affects perceived skill variety, autonomy and job satisfaction. METHODS: The questionnaires were obtained from old- and new-style DHs (n = 413, response 38%; n = 219, response 59%, respectively), in which respondents had recorded their dental tasks, perceived skill variety, autonomy and job satisfaction. T -tests were used to analyse differences between old- and new-style DHs, and regression analyses were performed to assess the relation between scope of practice and skill variety, autonomy and job satisfaction. RESULTS: New-style DHs have a more extended scope of practice compared with old-style DHs. Despite their more complex jobs, which are theoretically related to higher job satisfaction, new-style DHs perceive lower autonomy and job satisfaction (P < 0.05). Skill variety is the strongest predictor for DHs' job satisfaction (ß = 0.462), followed by autonomy (ß = 0.202) and caries decisive tasks, the last affecting job satisfaction negatively (ß = -0.149). Self-employment is the strongest significant predictor for autonomy (ß = 0.272). CONCLUSIONS: The core business of DHs remains the prevention and periodontology services. New-style DHs combine these tasks with extended tasks in the caries field, which can lead to comparatively less job satisfaction, because of a lower experienced autonomy in performing these extended tasks.

Changes in the professional domain of Dutch dental hygienists.

OBJECTIVE: This study's purpose was to compare the scope of practice of Dutch dental hygienists educated through a two- or three-year curriculum ('old curriculum dental hygienists' [OCDHs]) with that of hygienists educated through a new extended four-year curriculum leading to a bachelor's degree ('new curriculum dental hygienists' [NCDHs]). METHODS: In 2005 and 2007, we obtained surveys from 320 OCDHs and the first 67 NCDHs, respectively, in which respondents were asked to complete a questionnaire and score how often they performed certain dental tasks. By means of factor analysis, these tasks were grouped into nine activity groups and 5 remaining single activities. T-tests and Mann-Whitney U-tests were used to compare the scope of practice between OCDHs and NCDHs. RESULTS: NCDHs worked more often in dental offices (instead of being self-employed) and generally worked more hours per week than OCDHs. They performed more often tasks dealing with caries diagnosis and treatment and less often tasks dealing with prevention and periodontology. These differences were statistically significant. However, in dental offices the differences between OCDHs en NCDHs were far less pronounced. In those practices OCDHs performed dental sealants, small corrections of dentures and/or restoration and caries diagnosis during dental check-up no less frequently than NCDHs. CONCLUSIONS: Although prevention remains the core domain (or role) of all Dutch dental hygienists surveyed, the scope of practice substantially differed. This, however, depended not only on education, but also on type of practice. The new curriculum answers to and legitimates an already developed practice of task delegation.

[Task redistribution in Dutch dental care in relation to dental hygienists' job satisfaction]. / Taakherschikking in de Nederlandse mondzorg en de werktevredenheid van mondhygiënisten.

In research into a professional cross-section of dental hygienists, we studied the extent to which task redistribution has an influence on job satisfaction. The research among randomly chosen dental hygienists consisted of questions about organizational and personal characteristics, the set of assigned tasks, task characteristics and job satisfaction. The respondents were divided into 3 clusters which differed in the breadth of their sets of tasks. Although prevention and periodontology services remain the core tasks in dental hygienists' jobs, the degree of task redistribution differed strongly from cluster to cluster. Respondents with a considerable degree of task redistribution experienced the most task variation, but scored significantly lower on the task characteristics autonomy, feedback, task identity and task importance. This explains why redistribution does not directly correspond with a greater degree of job satisfaction. Moreover, it is precisely the dental hygienists with a broad set of tasks who are significantly less satisfied with their salary than those with a traditional set of tasks.