10 Innovations in Dutch Healthcare

10 Innovations in Dutch Healthcare

Elaborated by : D.J.M. van der Lee

Question: As part of my work for Evy , I was requested to deliver a report of ten innovations.

Method: During the period from week 38 (Sept. 16) to week 51 (Dec 16), I daily scanned two Dutch newspapers, De Volkskrant and Trouw, for healthcare innovations. When I found an innovation I searched for background information on the Internet. Every week I made a selection and posted a contribution to the Evy webpage on LinkedIn. From the total amount of innovations I have indicated ten categories: quality of life , healing environments , lifestyle , fertilization , individualized medicine , do nothing , end of life, technical innovations , organization of care and new treatments . Below I have worked out an example of each category. In some cases, I have also mentioned a second example .

Criteria for selecting innovations :
Relevance : Which issue(s) will be solved? How does it work? How do you use it ?
Impact: To what extent does the innovation provide in a need? To whom is this (all) a good idea?
Future-proof : How do you implement it in the short and long term?

Result :36 newspaper articles/posts , 10 categories, one example has been elaborated in each category.

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Quality of life

Source : De Visser, E. (17 september 2013). Haaruitval na chemokuur vaak niet nodig. De Volkskrant, p19.

R : Various cytotoxics cause severe hair loss ( alopecia ), it is estimated to affect more than 15,000 Dutch cancer patients per year. In half of all cancer patients receiving chemotherapy , hair loss can be prevented by cooling the scalp.

I: Hair loss has high impact on the majority of these patients, they describe it as stigmatizing and a constant reminder of cancer disease. The social costs for patients who received scalp cooling , could drop by an average of € 269 per patient compared to patients who do not receive scalp cooling.

F : Scalp cooling is applied in more and more Dutch hospitals (more than 75). Though, in many hospitals scalp cooling eligibility criteria are too restricted, inducing undertreatment of several patient groups.

Scientific background information: Van den Hurk, C. (2013). Safety and effectiveness of scalp cooling in cancer patients undergoing cytotoxic treatment. (Doctoral dissertation, Leiden University Medical Centre, the Netherlands ). Retrieved from: http://www.ikz.nl/bibliotheek/nieuwe_aanwinsten/index.php?id=3912

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Healing environments

Source: Van Limpt, C. (26 november 2013). Op consult in het groen. Natuur draagt bij aan gezondheid. Trouw, p8-9. Nature contributes to health: from that conviction ten young ‘pros’ designed the Green Treatment room. The mobile unit transparent competing for the 2013 Nature Price

R: Situations in health care are characterized by feelings of insecurity , anxiety and stress .

I: Healing environments provides needs as relaxation, comfort and well-being of patients. The example of the Green Treatment room contributes to the welfare of the client and therapist, to a faster recovery of patients and clients and, last but not least , at much lower treatment costs .

F : The Green Treatment room is a flexible, permanent or temporary -use, open, transparent speaking- and treatment area embedded in the green, where care provider and client can work in an inspiring natural setting. The design is developed into a turn-key space based on the ‘ portacabin system ‘ and is very easy to attach as module to an existing building. It can be placed as a construction area and also in temporary form (license free) .

Scientific background information: Dijkstra , K. (2009 ). Understandig healing environments : effects of physical environmental stimulation on patients’ health and well -being. (Doctoral dissertation, University of Twente, the Netherlands). Retrieved from: http://doc.utwente.nl/60753/1/thesis_K_Dijkstra.pdf

Another example of a healing environment :
Source: Dijksterhuis, K. (13 november 2013). Genezen in het stadse groen; Amersfoort krijgt luxe ziekenhuis met louter eenpersoonskamers. Trouw, p12.

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Lifestyle

Source : Lazal, M (25 oktober 2013). Ruby Wax zag psychiaters, werd zelf therapeut, maar alleen mindfulness hielp. Trouw, p9.

R : Medically unexplained symptoms are symptoms for which no clear biomedical cause
has been identified. Mindfulness training can contribute to accept the symptoms as a part of life and improve self-care.
I: often feel strongly impaired by their symptoms and they have a relatively high health care use, they receive many medical investigations and interventions. This leads to a high risk for adverse effects. The high healthcare use also leads to considerable healthcare costs. An intervention directed at this specific group of patients has the potential to have large societal and individual impact.
F: Mindfulness is increasingly used, particularly in mental health care .

Scientific background information: Van Ravesteijn, H. ( 2013). Minding the Body , Mindfulness – based cognitive therapy for patients with medically unexplained symptoms. (Doctoral dissertation , Radboud University Nijmegen Medical Centre , the Netherlands). Retrieved from : http://www.radboudcentrumvoormindfulness.nl/media/onderzoek/Minding_the_Body_Proefschrift_Hiske_van_Ravesteijn.pdf

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Fertilization

Source : N.N. (4 november 2013). Spanning stijgt voor lustpil. De Volkskrant, p3.

R: Sexual dysfunction is more common in women than in men. A combination preparation with testosterone and a PDE-5 – inhibitor increases the female libido . The same applies to women who are testosterone were given in combination with a 5HT1a agonist.
I: Relations often end or dismiss when the desire disappears . Life gets in the rut. The attention to each other slowly disappears . Sex is out of the question whether it is because it ‘ should ‘, but without feeling . A pill that increases desire can save relationships.
F: Perhaps there will soon be a desire pill for women on the market that can screw up the sex life of the woman.

Scientific background information: Bloemers J, van Rooij K, Poels S, Goldstein I, Everaerd W, Koppeschaar H, Chivers M, Gerritsen J, van Ham D, Olivier B, Tuiten A.Toward Personalized Sexual Medicine (Part 1): Integrating the “Dual Control Model” into Differential Drug Treatments for HSDD and FSAD. Journal of Sexual Medicine 2013;10 (3):791-809.

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Person-centered Medicine

Source : Algra, W. (31 september 2013). Genentest voorspelt nut chemokuur bij borstkanker. Trouw, p1.

R : For drugs that are registered on the market, efficacy was proven on a population level. However, on an individual level, most drugs have a different effect in different patients. They may fail to work in some patients or cause serious side effects. Pharmacogenetic research studies the contribution of genetic variation to interindividual variability in response to medication. The aim is to optimize drug response for an individual patient by using his genetic profile in treatment decisions.
I: Strict regulation of drugs can have a negative impact on innovation in the sector and thus can exponentially increase the cost of new drugs .
F: Ideally, knowledge of the genetic profile of a patient can guide the best choice for its treatment. We call this ‘geneesmiddelen op maat’ (customized medicine): the choice of the drug and the dose are as much as possible adapted to the individual patient .

Scientific background information: Van der Baan, F. (2012). Personalized Medicine: Pharmacogenetic Testing in Drug Development and Clinical Practice. ( Doctoral dissertation , University of Utrecht , the Netherlands ) . Retrieved from: http://dspace.library.uu.nl/handle/1874/242204

Another example of personalized medicine :
N.N. (13 november 2013). Kanker wordt op een andere wijze aangepakt; Tumorcellen in een kweekbakje laten groeien en daar alle bestaande geneesmiddelen op testen zodat duidelijk wordt welke behandeling effectief is. De Volkskrant, p19.

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Do Nothing

Source : N.N. (26 november 2013). ‘Preventief controleren ontwricht de markt en maakt mensen bang’, Trouw, p1.

R : There are several providers of preventive medical examination in people without symptoms. There is often no increased risk of disease. However, meaningless deviations could be found at the screening.
I: Not

testing could prevent anxiety, stress and possibly follow-up study.
F: The Dutch College of General Practitioners ( NHG ) is not in favor of preventive screening and recommends it off . There are some exceptions , such as screening for breast and cervical cancer and colorectal cancer ( from 2014 ) .

Background : NHG ( 2013). Medical check ups in people without symptoms . Retrieved from : https://www.nhg.org/standpunten/medische-check-ups-bij-mensen-zonder-klachten

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End of life

Source : N.N. (15 oktober 2013), Voor het eerst orgaandonatie na euthanasie, Trouw, p8.

R : In countries where active euthanasia by a physician is allowed under law – Belgium and the Netherlands – physicians are sometimes confronted with patients who want to donate organs after active euthanasia has been performed. This combination of procedures has been reported in Belgium, and this article is the first description of such a case in the Netherlands. It concerns a patient with a neurodegenerative disease who donated organs after euthanasia.
I: The combination of two complex and controversial procedures – active euthanasia and organ donation – raises important ethical, legal and practical issues.
F: It is suggested that with a thorough preparation and a strict separation of both procedures, organ donation after active euthanasia can strengthen patient autonomy and increase the number of donated organs.

Background information: Ned Tijdschr Geneeskd. 2013 157: A6548

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Technical innovations

Source : N.N. (28 oktober 2013). Chirurg met Google Glass laat collega’s live meekijken. De Volkskrant, p17.

R : During an operation, surgeons have to deal with lots of information. As a result, sometimes important signals saying it’s going wrong with the patient are missed.
I: By making use of the Google Glass another surgeon can easily watch elsewhere with the operation and provide advice. Google Glass can also provide a

probing signal to the surgeon when the patient is likely to go wrong and the surgeon can search all kinds of protocols and manuals on the internet that are projected before the nose through the glasses. The Google glass can be controlled using “voice actions”, so the surgeon does not need to walk to a computer or a book.
F: Google Glass is tested in the operating room of RUNMC to find out the additional value of this technology .

Background information: http://www.linkedin.com/today/post/article/20130815203138-19886490-google-glas-in-or?trk=mp-reader-card#sthash.6i1pqSL7.dpuf

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Organisation of care

Source : Kuiken, A (25 oktober 2013). Voor 17 euro per uur: een mantelzorger. Trouw, p3.

R : Because of budget cuts, many (Dutch) people lose their home care in 2015 . Many family caregivers are overloaded . Organizations such as the Mantelaar jump into that hole with cheaper homecare delivered by medicine and nursing students .
I: Because of their background, students will quickly identify health problems. But they also get a special course developed by affiliated physicians. Some clients will be visited every week a few times. To others only when the family cannot.
F: ?
Background information : WHO Regional Office for Europe ( 2013). Home care across Europe . Retrieved from : http://www.euro.who.int/__data/assets/pdf_file/0008/181799/e96757.pdf

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New Treatments

Source : N.N. (7 oktober 2013). Komst nieuwe kankercentra onzeker; Zorgverzekeraars zijn niet overtuigd van werking nieuwe protonentherapie en weigeren vergoeding. Trouw, p1 and 13.

R: In head and neck cancer patients, target volumes are often complex shaped, large and surrounded by many critical and vital structures (e.g. the spinal cord, salivary glands, the hearing organ, the optic structures, the voice producing organ and structures involved in swallowing). Therefore, radiotherapy of the head and neck region is frequently associated with a variety of radiation-induced acute and late side effects that adversely affect quality of life. Xerostomia (the sense of a dry mouth) and swallowing dysfunction are the two most important radiation-induced late side effects that significantly affect patients’ quality of life.
I: More sophisticated radiation therapy techniques, such as proton therapy, may help to further improve the dose reduction in the relevant risk organs, and reduce the risk of xerostomia and swallowing problems, and then to improve the quality of life during and after radiation therapy.
F: Minister Schippers has granted a license for the use of proton therapy at UMC Groningen and a partnership of the LUMC , Erasmus MC and TU Delft . In two other centers further information is required before the Minister can decide.

Scientific background information: Van de Water , T (2013). Potential benefits of intensity-modulated proton therapy in head and neck cancer. (Doctoral dissertation, University of Groningen, the Netherlands ). Retrieved from: http://irs.ub.rug.nl/ppn/35504806X

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