Using Different Cutoffs to Define Tinnitus and Assess Its Prevalence—A Survey in the Dutch General Population

Introduction: Tinnitus prevalence numbers in the literature range between 5 and 43%, depending on the studied population and definition. It is unclear when tinnitus becomes pathologic.Objectives: To assess the tinnitus prevalence in the Dutch general population with different cutoffs for definition.Methods: In this cross-sectional study, a questionnaire was sent to a sample (n = 2,251) of the Nivel (Netherlands Institute for Health Services Research) Dutch Health Care Consumer Panel. Three questions were asked to assess the presence of tinnitus, duration, and frequency of the complaint. We classified people as having pathologic tinnitus when participants experienced it for 5–60 min (daily or almost daily or weekly), or tinnitus for >60 min or continuously (daily or almost daily or weekly or monthly), so tinnitus impact on daily life was measured with the Tinnitus Functional Index (TFI) and a single-item question. Answers were stratified to mid-decade years of age. Prevalence numbers were weighted by gender and age to match the Dutch population.Results: Nine hundred thirty-two of 2,251 participants (41%) filled out the questionnaire. The median age was 67.0 (IQR 17) years. Three hundred thirty-eight of 932 (36%) experienced tinnitus for an undefined amount of time during the last year. Two hundred sixteen of 932 (23%) met our definition of having pathologic tinnitus (21% when weighted for age and gender). The median TFI score for all pathologic tinnitus participants was 16.6 (IQR 21.8). A percentage of 50.4% of the pathologic tinnitus participants had a TFI in the range 0–17, which can be interpreted as not a problem.Conclusion: Twenty-three percent (unweighted) or 21% (weighted) of our sample met our definition of pathologic tinnitus, which was based on a combination of duration and frequency over the last year. The TFI score of 47.7% of the pathologic tinnitus participants is ≥18. This indicates that they consider the tinnitus to be at least “a small problem” [11.1% (unweighted) or 8.9% (weighted) of the total study group]. This study illustrates the difficulties with defining pathologic tinnitus. In addition, it demonstrates that tinnitus prevalence numbers vary with different definitions and, consequently, stresses the importance of using a uniform definition of tinnitus.

The Patient as a Mobile Health Care Consumer

Many believe that digital health will be a catalyst to enable health care to become more market-centric and consumer-driven. Indeed, the Covid-19 pandemic has essentially redefined the concept of “elective” procedures based almost entirely on patient preference and behaviors, much of which was unexpected. Although the concept of educated and empowered patient consumers paints a compelling vision, many fear the unintended consequences of removing or minimizing trusted caregiver guidance from the equation. What are the risks and unintended consequences of self-managed care? Will patients properly prioritize? Will the benefits, risks, and potential trade-offs be understood? How will fact be separated from hype, misinformation and confirmation bias? In this chapter the opportunities and hazards of patients as mobile health consumers are detailed with a specific focus on potential harms and corresponding mitigations.

Health Care Consumer Shopping Behaviors and Sentiment: Qualitative Study

Background Although some health care market reforms seek to better engage consumers in purchasing health care services, health consumer behavior remains poorly understood. Objective This study aimed to characterize the behaviors and sentiment of consumers who attempt to shop for health care services. Methods We used a semistructured interview guide based on grounded theory and standard qualitative research methods to examine components of a typical shopping process in a sample size of 54 insured adults. All interviews were systematically coded to capture consumer behaviors, barriers to shopping behavior, and sentiments associated with these experiences. Results Participants most commonly described determining and evaluating options, seeking value, and assessing or evaluating value. In total, 83% (45/54) of participants described engaging in negotiations regarding health care purchasing. The degree of positive sentiment expressed in the interview was positively correlated with identifying and determining the health plan, provider, or treatment options; making the decision to purchase; and evaluating the decision to purchase. Conversely, negative sentiment was correlated with seeking value and making the decision to buy. Conclusions Consumer shopping behaviors are prevalent in health care purchasing and can be mapped to established consumer behavior models.

Are we using the right tools to manage variation, errors and omissions?

In all processes, there is an inherent risk of variability to occur. In the process of delivering healthcare, variability can occur as a result of an error or omission and compromise the quality of care or affect the safety of the health care consumer. Even though incident reporting, root cause analysis, use of checklists and other quality improvement methods are in wide-spread use, we may not be using these tools appropriately and therefore we are losing an opportunity to improve the quality of care.

Health Care Consumer Shopping Behaviors and Sentiment: Qualitative Study (Preprint)

BACKGROUND Although some health care market reforms seek to better engage consumers in purchasing health care services, health consumer behavior remains poorly understood. OBJECTIVE This study aimed to characterize the behaviors and sentiment of consumers who attempt to shop for health care services. METHODS We used a semistructured interview guide based on grounded theory and standard qualitative research methods to examine components of a typical shopping process in a sample size of 54 insured adults. All interviews were systematically coded to capture consumer behaviors, barriers to shopping behavior, and sentiments associated with these experiences. RESULTS Participants most commonly described determining and evaluating options, seeking value, and assessing or evaluating value. In total, 83% (45/54) of participants described engaging in negotiations regarding health care purchasing. The degree of positive sentiment expressed in the interview was positively correlated with identifying and determining the health plan, provider, or treatment options; making the decision to purchase; and evaluating the decision to purchase. Conversely, negative sentiment was correlated with seeking value and making the decision to buy. CONCLUSIONS Consumer shopping behaviors are prevalent in health care purchasing and can be mapped to established consumer behavior models.

Community participation in primary care: willingness to participate, a web survey in the Netherlands

AimThe aim of the study is to explore to what extent members of the community are willing to participate in the way their primary care practice is organized and which characteristics of people and community are associated with this willingness.BackgroundCommunity participation in primary care refers to involvement of community members in the organization, governance and policy making of primary care facilities. Due to demographic changes and changes in the role of patients and the community concerning health care, it becomes important to include the social environment of patients into healthcare. Community participation may help GPs to improving their practice and providing care according to the needs of the population. Interpreted this way, it may be an important contributor to quality of care.MethodsIn 2016, a web questionnaire was send to 800 members of the Dutch Health Care Consumer Panel. The response rate was 34%. Willingness to participate was divided into perceived readiness, ability and time to participate. The data were analysed using frequency tables and linear regression analysis.FindingsHalf of the participants were ready to give their opinion on primary care and one-third reported willingness to participate in decision making. Participants were less optimistic about their ability to participate and the time they have available for participation. Readiness and perceived ability were mainly determined by the importance that the respondents attributed to participation. Participants with previous experience in volunteering appeared more willing to spend time on participation.ConclusionsThis study showed that half of the respondents are willing to participate, but they are less sure about their ability to do so and that finding time to participate is seen as problematic. Future research should focus on which characteristics influence willingness. This knowledge might help primary care facilities to recruit people more easily and successfully.

Strategies for Implementing the National Standards for Culturally and Linguistically Appropriate Services in Home Health Care

This article is an abridged version of a book chapter, Culturally and Linguistically Appropriate Services, published in the Handbook of Home Health Care Administration, Sixth Edition (Marilyn Harris, editor). The article describes the importance of culturally and linguistically competent care for the success of home health agencies. It uses the 15 standards of the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards) as an outline for identifying strategies that home health leaders can incorporate into their agencies’ practices to enhance their care to culturally and linguistically diverse patients. Providing services that produce equitable outcomes for diverse patients is likely to enhance agency Home Health Compare and HHCAHPS (Home Health Care Consumer Assessment of Healthcare Providers and Systems) scores, Star Ratings, and reimbursement in a value-based reimbursement model.