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Blotenberg B, Seeling S, Büscher A. The health-related quality of life of older people through preventive home visits: A quantitative longitudinal study. Scand J Caring Sci 2023; 37:698-709. [PMID: 36755213 DOI: 10.1111/scs.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/06/2023] [Accepted: 01/14/2023] [Indexed: 02/10/2023]
Abstract
AIMS AND OBJECTIVES Preventive home visits are a low-threshold counselling and support approach. They have been reported to achieve heterogeneous effects. However, preventive home visits have the potential to reduce the risk of becoming dependent on long-term care. The aim of this study is to investigate the effect of preventive home visits as a nursing intervention on health-related quality of life of older people in a longitudinal survey and to develop recommendations for which target groups preventive home visits have the highest benefit. The sample consisted of 75 people, aged between 65 and 85, who were able to understand and speak German, had not yet been eligible for benefits from the long-term care insurance and lived in the municipality under study. METHODOLOGICAL DESIGN AND JUSTIFICATION A quantitative longitudinal study in order to investigate the effects of preventive home visits. ETHICAL ISSUES AND APPROVAL There were no ethical concerns. Accordingly, ethical approval was granted. RESEARCH METHODS, RESULTS AND CONCLUSIONS The health-related quality of life was recorded four times between 01/2017 and 08/2020 with the Short-Form-Health-Survey-12 and analysed using descriptive statistics. Results reveal that the physical health status cannot be easily influenced over a short period of time. The main effect, however, is that preventive home visits have a significant positive effect on the mental health status. The main topics during the home visits were mobility, nutrition and social participation. Increased knowledge and motivation for preventive behaviour extended the autonomy of older people. Accordingly, preventive home visits can support a self-determined life in a familiar environment. The results of the present study show that preventive home visits as a nursing intervention in rural areas are successful. In Germany, preventive home visits have not yet been implemented on a regular basis. In order to do so, a general definition of the concept is needed. Preventive home visits should be officially included in the regular health care services in Germany.
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Affiliation(s)
- Britta Blotenberg
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
- Faculty of Management, Culture and Technology, Osnabrück University of Applied Sciences, Lingen, Germany
| | - Stefanie Seeling
- Faculty of Management, Culture and Technology, Osnabrück University of Applied Sciences, Lingen, Germany
| | - Andreas Büscher
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
- Faculty of Business Administration and Social Sciences, Osnabrück University of Applied Sciences, Osnabrück, Germany
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Averbeck H, Litaker D, Fischer JE. Expanding the role of non-physician medical staff in primary care in Germany: protocol for a mixed-methods study exploring the perspectives of physicians in rural practices. BMJ Open 2022; 12:e064081. [PMID: 35882465 PMCID: PMC9330334 DOI: 10.1136/bmjopen-2022-064081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Primary care faces substantial challenges worldwide through an increasing mismatch in supply and demand, particularly in rural areas. One option to address this mismatch might be increasing efficiency by delegation of tasks to non-physician medical staff. Possible influencing factors, motives and beliefs regarding delegation to non-physician medical staff and the potential of an expanded role, as perceived by primary care physicians, however, remain unclear. The aim of this study is to assess these factors to guide development of potential interventions for expanding the role of non-physician medical staff in delivering primary care services in rural Germany. METHODS AND ANALYSIS This mixed-methods study based on the theoretical domains framework (TDF) consists of survey and interviews conducted sequentially. The survey, to be sent to all primary care physicians active in rural Baden-Wuerttemberg (estimated n=1250), includes 37 items: 15 assessing personal and practice characteristics, 15 matching TDF domains and 7 assessing opportunities for delegation. The interview, to be performed in a subsample (estimated n=12-20), will be informed by results of the survey. The initial interview guide consists of 11 questions covering additional TDF domains. Perspectives towards delegation will be maximised by comparing data emerging in either part of the study, seeking confirmation, disagreement or further details. ETHICS AND DISSEMINATION The Ethics Committee of Heidelberg University approved this study (approval number: 2021-530). Written informed consent will be obtained before each interview; consent for participation in the survey will be assumed when the survey has been returned. Results will be disseminated via publications in peer-reviewed journals and talks at conferences. By combining quantitative and qualitative methods, our results will support future research for crafting potential interventions to expand the role of non-physician medical staff in rural primary care.
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Affiliation(s)
- Heiner Averbeck
- Division of General Medicine, Center for Preventive Medicine and Digital Health (CPD), Heidelberg University, Mannheim, Germany
| | - David Litaker
- Division of General Medicine, Center for Preventive Medicine and Digital Health (CPD), Heidelberg University, Mannheim, Germany
| | - Joachim E Fischer
- Division of General Medicine, Center for Preventive Medicine and Digital Health (CPD), Heidelberg University, Mannheim, Germany
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Kis A, Augustin J. [Access to health care throughout the country]. Hautarzt 2021; 73:40-46. [PMID: 34846553 DOI: 10.1007/s00105-021-04916-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/24/2022]
Abstract
The legal basis for describing the regional care situation is based on the adjusted supply rate of the 'demand planning guideline'. However, it provides only limited information about the accessibility of medical care which is crucial for the reality of patients' lives. The aim of this review is to present geographic approaches that spatially measure access to dermatological care in its physical and digital dimension. Here, on the one hand, the classical geographic parameter 'accessibility' is addressed, and on the other hand, data from the Federal Ministry of Transport and Digital Infrastructure (BMVI) on broadband coverage are presented as access parameters of teledermatological applications. In addition to the methodological approach, limitations and potentials in the interpretation of the results, minimum standards are also considered. The access parameters presented here make it possible to investigate spatial disparities and to present them clearly via cartographic representations. While the example of accessibility with a car shows almost area-wide access to the nearest dermatology practice (≤ 30 min), investigations on public transport accessibility reveal rather heterogeneous accessibility. Particularly in the identification of 'dual care gaps', sub-areas with poor physical and digital accessibility, these approaches could support and advance the application of alternative care models. However, the approaches presented here focus on potential accessibility. Further dimensions on actual physician utilisation or availability-also with regard to minimum standards-should be the subject of future research.
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Affiliation(s)
- A Kis
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland.
| | - J Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland
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Schröder L, Flägel K, Goetz K, Steinhäuser J. Mobility concepts and access to health care in a rural district in Germany: a mixed methods approach. BMC Fam Pract 2018; 19:47. [PMID: 29720091 PMCID: PMC5932842 DOI: 10.1186/s12875-018-0733-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 04/09/2018] [Indexed: 02/07/2023]
Abstract
Background Western countries are facing the challenges of an imminent shortage of physicians, especially general practitioners. As a consequence longer travel times to doctors’ practices may arise. This study aimed to investigate the mobility behavior of a rural population in terms of medical consultations. Methods An exploratory mixed-methods design was conducted in the Waldshut district of the federal state Baden-Württemberg in Germany. Focus groups and a single telephone-interview with representatives, occupationally affiliated with mobility in the district (e.g. representatives of public transport, nursing-services or the District Office Waldshut), were performed in 2016 and analyzed using Mayring’s structuring content analysis. A questionnaire based on the collected qualitative data was subsequently distributed to a random sample of 1000 adult inhabitants living in the Waldshut district. Quantitative data were analyzed employing descriptive statistics. Results Qualitatively, four focus groups and one single telephone-interview with a total of 20 participants were performed. Therein the necessity of reaching a nearby general practitioner and the importance of individual motor traffic was emphasized. Novel mobility modes of ride sharing and telemedicine were controversially discussed as future transport and consultation options, respectively. Quantitatively, 277 questionnaires (27.7%) were valid and included in our analysis. Mean age was 51 years (SD = 18.5) and 58% (n = 160) were female. Irrespective of the mode of transport 60% (n = 166) expected to reach their general practitioner within 15 min. Using the possibility of multiple answers 47% (n = 192) stated to use a car in order to reach their general practitioner, public transport was used by 5% (n = 19). Nearly 80% (n = 220) could imagine sharing a car with well-known persons for consultations. Turning to a general practitioner via telemedicine was imaginable for 32% (n = 91). Conclusions Individual motor car traffic seems to be an important factor in providing accessibility to rural medical care. As a supplementation, web based ride sharing has economic and structural potential for reaching a doctor’s practice. However, familiarity and trustworthiness need to be guaranteed within this flexible transport mode. Furthermore, telemedicine may be a future approach in order to reduce travel time to a doctor’s practice.
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Affiliation(s)
- Lisa Schröder
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23552, Lübeck, Germany.
| | - Kristina Flägel
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23552, Lübeck, Germany
| | - Katja Goetz
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23552, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23552, Lübeck, Germany
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Nowossadeck E, Prütz F. [Regional differences in the development of hospitalizations : An effect of different demographic trends?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:358-366. [PMID: 29374298 DOI: 10.1007/s00103-018-2695-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Population aging and population decline in many regions of the Federal Republic of Germany are key elements of demographic change. In the regions concerned there is a rising number of older people and, simultaneously, a declining population. So far, the consequences of regional shrinkage and growth for inpatient care don't seem to have been analysed very well. This paper analyses the influence of population aging and declining/increasing population (demographic factors) as well as other, non-demographic factors on the number of hospitalizations in Germany and the Federal States since 2000.One result of the analysis is that there are major differences between the Federal States. The analysis shows, for example, an increase of hospitalizations in Berlin while in Saxony-Anhalt the number of hospitalizations declines. The increase in Berlin was the result of population aging and, to a lower extent, an increase in population. In Saxony-Anhalt the declining population resulted in a decreasing number of hospitalizations. Population aging and non-demographic factors were not able to compensate this trend.Overall, the effect of demographic factors on the number of hospitalizations remains constant over time. Short-term changes of hospitalizations are due to non-demographic factors, such as epidemiological trends, (for example trends of incidence or prevalence), or structural changes of health care service (for example patients shifting between different sectors of health care or the introduction of new reimbursement systems).
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Affiliation(s)
- Enno Nowossadeck
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland.
| | - Franziska Prütz
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
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Kuhn B, Kleij KS, Liersch S, Steinhäuser J, Amelung V. Which strategies might improve local primary healthcare in Germany? An explorative study from a local government point of view. BMC Fam Pract 2017; 18:105. [PMID: 29262798 PMCID: PMC5738820 DOI: 10.1186/s12875-017-0696-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/12/2017] [Indexed: 11/23/2022]
Abstract
Background Facing rising inequities and poorer accessibility of physicians in rural areas, new healthcare delivery structures are being considered to support local healthcare in German communities. To better understand perspectives on and attitudes towards different supplementary models, we examined attitudes among local politicians in the German federal state of Lower Saxony towards the suitability of supplementary care models. Methods As part of a cross-sectional study, we surveyed local politicians in Lower Saxony at the local authority and district levels (n = 449) by mail questionnaire. We asked for an assessment of four potential supplementary healthcare models at the local level: the use of trained medical assistants, patients’ buses, mobile physicians’ offices, and telemedicine. Results The response rate was 71.0% for mayors (n = 292) and 81.6% (n = 31) for county administrators. In summary, 72.4% of respondents supported the use of trained medical assistants, 48.9% voted for patients’ buses, 22.0% for mobile physicians’ offices, and 13.9% for telemedicine. Except for telemedicine, the politicians’ approval of the supplementary models in rural areas was higher than in urban areas. The assessment regarding the suitability of each model was not significantly connected with indicators of a positively or negatively assessed local healthcare situation. The analyses showed that the use of trained medical assistants was associated with the positive effects of division of labor and potential to relieve physicians. In contrast, there was skepticism about technical support via telemedicine, mostly due to concerns about its unsuitability for elderly people and the potential lower quality of healthcare delivery. Conclusion Local politicians widely accept the use of trained medical assistants, whereas the applicability of technical solutions such as telemedicine is perceived with skepticism. Therefore, the knowledge gap between evidence for and prejudices against telemedicine needs to be addressed more effectively. Reasons for the assessments of the presented models are more likely traceable to personal views than to assessments of the actual estimated local primary care situation. Electronic supplementary material The online version of this article (10.1186/s12875-017-0696-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bertolt Kuhn
- Medical School Hannover, Institute for Epidemiology, Social Medicine and Health Systems Research, OE 5410, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany.
| | - Kim-Sarah Kleij
- Medical School Hannover, Institute for Epidemiology, Social Medicine and Health Systems Research, OE 5410, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany
| | - Sebastian Liersch
- Medical School Hannover, Institute for Epidemiology, Social Medicine and Health Systems Research, OE 5410, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany
| | - Jost Steinhäuser
- University Hospital of Schleswig-Holstein, Campus Lübeck, Institute of Family Medicine, Lübeck, Germany
| | - Volker Amelung
- Medical School Hannover, Institute for Epidemiology, Social Medicine and Health Systems Research, OE 5410, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany
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Kis A, Augustin M, Augustin J. Regionale fachärztliche Versorgung und demographischer Wandel in Deutschland - Szenarien zur dermatologischen Versorgung im Jahr 2035. J Dtsch Dermatol Ges 2017; 15:1199-1210. [PMID: 29228477 DOI: 10.1111/ddg.13379_g] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/27/2017] [Indexed: 12/01/2022]
Abstract
HINTERGRUND Mithilfe der Bedarfsplanungsrichtlinie des Gemeinsamen Bundesausschusses soll die medizinische Versorgung in Deutschland flächendeckend sichergestellt werden. Kalkulatorische Größe zur Abbildung der räumlichen Versorgungssituation ist der "korrigierte Versorgungsgrad". Vor dem Hintergrund des demographischen Wandels und bereits heute existenter Wiederbesetzungsschwierigkeiten steht die Frage, wie sich die dermatologische Versorgung kleinräumig entwickeln wird. METHODIK Mit bundesweiten Daten zu Hautarztstandorten sowie aktuellen und prognostizierten Bevölkerungszahlen auf Kreisebene wurde auf Basis der aktuellen Bedarfsplanungsrichtlinie der korrigierte Versorgungsgrad in drei Wiederbesetzungsszenarien (Szenario 1: 100%ige Wiederbesetzung, Szenario 2: Wegfall eines Arztsitzes je Planungsbereich, Szenario 3: Wegfall von zwei Arztsitzen in ländlichen Planungsbereichen) für das Prognosejahr 2035 exemplarisch berechnet. ERGEBNISSE Während sich in Szenario 1 die Versorgungssituation von 2014 auf 2035 in einigen Teilräumen sogar verbessern würde (n = 3 nicht mehr unterversorgt), zeigen die wahrscheinlicheren Szenarien 2 und 3 mit dem Wegfall einzelner Arztstandorte und dem altersselektiven Wanderungsverhalten, dass ganze Regionen in die Unterversorgung gelangen könnten. SCHLUSSFOLGERUNGEN Es ist davon auszugehen, dass die räumliche Heterogenität der dermatologischen Versorgung unter Berücksichtigung des demographischen Wandels zunehmen wird. Weitere Anstrengungen in der Bedarfsplanung, aber auch hinsichtlich kreativer Versorgungsmodelle und interkommunaler Kooperation sind erforderlich, um die Versorgung dem demographischen Wandel sowie veränderten Lebensentwürfen junger Mediziner anzupassen.
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Affiliation(s)
- Anne Kis
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Matthias Augustin
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Jobst Augustin
- Competenzzentrum Versorgungsforschung in der Dermatologie (CVderm), Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
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Kis A, Augustin M, Augustin J. Regional healthcare delivery and demographic change in Germany - scenarios for dermatological care in 2035. J Dtsch Dermatol Ges 2017; 15:1199-1209. [DOI: 10.1111/ddg.13379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Anne Kis
- German Center for Health Services Research in Dermatology (CVderm); Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm); Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Jobst Augustin
- German Center for Health Services Research in Dermatology (CVderm); Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
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Radzimanowski M, Gallowitz C, Müller-Nordhorn J, Rieckmann N, Tenckhoff B. Physician specialty and long-term survival after myocardial infarction - A study including all German statutory health insured patients. Int J Cardiol 2017; 251:1-7. [PMID: 29092757 DOI: 10.1016/j.ijcard.2017.10.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/25/2017] [Accepted: 10/13/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND With a mortality rate above European average, myocardial infarction (MI) is the second most common cause of death in Germany. Data about post-MI ambulatory care and mortality is scarce. We examined the association between ambulatory treating physicians' specialty and the mortality of post-MI patients. METHODS Medical claims data of all 17 German regional Associations of Statutory Health Insurance physicians were analyzed, which cover approximately 90% of the German population. Patients with a new diagnosis of a MI in 2011 were divided into treatment groups with and without ambulant cardiology care within the first year after MI diagnosis. Propensity-score matching based on socio-demographic and clinical variables was performed to achieve comparability between groups. The 18-month mortality rate was derived employing a validated method. RESULTS 158,494 patients with a new diagnosis of MI had received post-MI ambulatory care in 2011. Half of them (51%) had at least one ambulatory contact with a cardiologist within the first year. During a follow-up of 18months, the mortality rate before and after propensity-score matching was 19% and 14% in patients without cardiology care and 6%, respectively, in patients with cardiology care (χ2=666.7; P<0.000 after propensity adjustment). Patients who only saw a cardiologist and had no additional contact to an ambulant general practitioner (GP)/internist within the first year did not have increased survival rates. CONCLUSIONS Outpatient follow-up care by a cardiologist in combination with consultations of GP/internists within the first year may be of importance for the prognosis of MI patients.
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Affiliation(s)
- Maria Radzimanowski
- Kassenärztliche Bundesvereinigung (KBV), National Association of Statutory Health Insurance Physicians, Herbert-Lewin-Platz 2, 10623 Berlin, Germany; Charité Universitätsmedizin Berlin, Institute of Public Health, Seestr. 73, Haus 10, 13347 Berlin, Germany.
| | - Christian Gallowitz
- Kassenärztliche Bundesvereinigung (KBV), National Association of Statutory Health Insurance Physicians, Herbert-Lewin-Platz 2, 10623 Berlin, Germany
| | - Jacqueline Müller-Nordhorn
- Charité Universitätsmedizin Berlin, Institute of Public Health, Seestr. 73, Haus 10, 13347 Berlin, Germany
| | - Nina Rieckmann
- Charité Universitätsmedizin Berlin, Institute of Public Health, Seestr. 73, Haus 10, 13347 Berlin, Germany
| | - Bernhard Tenckhoff
- Kassenärztliche Bundesvereinigung (KBV), National Association of Statutory Health Insurance Physicians, Herbert-Lewin-Platz 2, 10623 Berlin, Germany
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