Anne Brabers – NIVEL, the Netherlands Institute for Health Services Research

Currently, I am finishing my PhD-thesis titled “Patient involvement and medical practice variation” at the Netherlands Institute for Health Services Research (NIVEL), under supervision of prof. dr. Judith de Jong (Maastricht University) and prof. dr. Peter Groenewegen (Utrecht University). My PhD-trajectory is a bit different from a regular PhD-trajectory at university, as I perform my PhD-research next to several other research projects that I conduct at NIVEL. At NIVEL, we call this a “sprokkelpromotie”. The idea is that you write several articles about one topic, based on data that are mainly collected in the projects you work on. For instance, I work mainly as a researcher at the Dutch Health Care Consumer Panel, and in my PhD-thesis most of the studies are based on data collected in this panel. Writing a PhD-thesis in combination with performing several other research projects can be a struggle. One challenge is to create enough time to work on your thesis, especially when there are deadlines for other projects. On the other hand, I think, at the end, there are much more advantages. For instance, you learn to plan very well, you have a lot of variety in your work, you can use the experience of other research projects in your thesis, and you are more likely to involved in other research activities than when you do a regular PhD, like writing proposals to attract new research.

Patient involvement and medical practice variation
Medical practice variation is a well-known phenomenon that has been extensively described within the literature. Variation in medical treatment means that similar, or apparently similar, patients with a similar health status or medical condition do not receive the same treatment. In explaining this variation, current research mainly focuses on physicians and the organisations they work in. This approach might be adequate in the case that the physician decides on the treatment. In the past decades, however, this paternalistic model became questioned. At the same time, there is an increased emphasis towards including patients and their preferences into medical decision-making. Moreover, providing care that is respectful of, and responsive to an individual patient’s preferences is regarded as one aspect of good quality of care. As medical decision-making is decisive for practice variation, a question is whether patients can be ignored in theories about variation. This question was the central subject of my thesis. The findings of my thesis show that under certain circumstances patients indeed cannot be ignored in theories about variation.
Anne Brabers