Email updates

Keep up to date with the latest news and content from BMC Health Services Research and BioMed Central.

Open Access Research article

Implementation evaluation of the Dutch national heat plan among long-term care institutions in Amsterdam: a cross-sectional study

Anton E Kunst* and Rieneke Britstra

Author Affiliations

Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO Box 22660, Amsterdam, 1100 DD, The Netherlands

For all author emails, please log on.

BMC Health Services Research 2013, 13:135  doi:10.1186/1472-6963-13-135

Published: 11 April 2013



In 2007, a national heat plan was introduced in the Netherlands to effectively protect vulnerable populations (such as institutionalised elderly people) against heatwaves. The aim of this study was to assess the extent to which the measures recommended in this heat plan had been implemented, and could be implemented, in long-term care institutions in Amsterdam three years on.


Questionnaires were sent to the care managers of all 54 eligible long-term care institutions in Amsterdam. This included questions on the presence of a heat protocol and cooling facilities in the building. Furthermore, the care managers were asked to judge the importance of 23 of the cooling measures recommended by the National Heat Plan in the event of a heatwave, and to report on practical problems that may affect the implementation of these cooling measures.


Of the 54 questionnaires sent, 27 were returned. Most institutions had a heat protocol, virtually all of which had been developed in the three years preceding the survey. Outdoor sunshades were used most often to protect residents against heat (93% of all institutions). Prevalence of cooling facilities such as air conditioning and rooftop cooling had increased, but remained low (41%). Care managers confirmed the importance of most of the 23 cooling measures recommended by the National Heat Plan, with some exceptions. Only 41% regarded consulting physicians on medication use to be ‘very important’. Most care managers did not foresee large problems with the implementation of the recommended cooling measures. Barriers mentioned related to shortage of and expertise among personnel, and residents’ independence.


The results suggest that a national heat plan could be implemented in long-term care institutions with few problems. Possible areas of improvement include cooling of buildings and staff training.

Heatwaves; Elderly; Institutions; Prevention; Nursing care