Process evaluation of a multidisciplinary care program for patients undergoing gynaecological surgery.
OBJECTIVE
This study describes the process evaluation of an innovative multidisciplinary care program for patients undergoing benign gynaecologic surgery. This care program aims at improving recovery and preventing delayed return to work and consists of two steps: (1) an interactive e-health intervention for all participants, and (2) integrated clinical and occupational care management for those participants whose sick leave exceeds 10 weeks.


METHODS
Eligible for this study were employed women aged between 18-65 years scheduled for a laparoscopic adnexal surgery and/or hysterectomy. Data were collected from patients, their supervisors and their gynaecologists, by means of electronic questionnaires during a 6 month follow-up period and an automatically generated, detailed weblog of the patient web portal ( www.ikherstel.nl ). Investigated process measures included: reach, dose delivered, dose received, and fidelity. In addition, attitudes towards the intervention were explored among all stakeholders.


RESULTS
215 patients enrolled in the study and accounted to a reach of 60.2 % (215/357). All intervention group patients used their account at least once and total time spent on the patient web portal was almost 2 h for each patient (median 118 min, IQR 64-173 min). Most patients visited the website several times (median 11 times, IQR 6-16). Perceived effectiveness among patients was high (74 %). In addition, gynaecologists (76 %) and employers (61 %) were satisfied with the web portal as well. Implementation of the second step of the intervention was suboptimal. Motivating patients to consent to additional guidance and developing an accurate return-to-work-prognosis were two important obstacles.


CONCLUSIONS
The results of this study indicate good feasibility for implementation on a broad scale of the e-health intervention for patients undergoing benign gynaecological surgery. To enhance the implementation of the second step of the perioperative care program, adaptations in the integrated care protocol are needed.
Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands, ev.bouwsma@vumc.nl.
E V A
EV
Bouwsma
A
A
Vonk Noordegraaf
Z
Z
Szlávik
H A M
HA
Brölmann
M H
MH
Emanuel
J P
JP
Lips
W
W
van Mechelen
A
A
Mozes
A L
AL
Thurkow
J A F
JA
Huirne
J R
JR
Anema
D000290:Adnexa Uteri / Q000601:surgery*; D000328:Adult; D003289:Convalescence; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy; D009426:Netherlands; D009787:Occupational Medicine; D010348:Patient Care Team; D017060:Patient Satisfaction; D015397:Program Evaluation; D020127:Recovery of Function; D012017:Referral and Consultation; D062707:Return to Work; D018582:Sick Leave; D017216:Telemedicine