GPs' assessment of cooperation with other health care providers involved in cancer care-a cross-sectional study

Cancer is a complex disease requiring the involvement of several health care providers. A possible constant in the cancer care process is the general practitioner (GP). The aim of this project was to evaluate GPs' satisfaction with cooperation with other health care providers in the cancer care process of their patients and to explore which variables are associated with higher satisfaction with cooperation with other health care providers. We considered the following health care providers: outpatient oncology specialists, physicians in relatively small hospitals (≤400 beds), physicians in relatively large hospitals (>400 beds), home care services, outpatient psycho(onco)logists/psychotherapists, hospice/palliative care units and specialised palliative home care. The cross-sectional study was carried out as a postal survey all over Germany. Data were analysed descriptively and by means of logistic regression. Overall satisfaction with cooperation with other health care providers involved in cancer care was rather high. Only cooperation with outpatient psycho(onco)logists/psychotherapists was rated as not assessable/irrelevant by a majority of GPs. For all other health care providers under review, both communication and the transfer of sufficient information in good time were associated with overall satisfaction with cooperation. Little association was found between GP and practice variables and overall satisfaction with cooperation with the considered health care providers.

Physician cooperation in outpatient cancer care. An amplified secondary analysis of qualitative interview data

The importance of outpatient cancer care services is increasing due to the growing number of patients having or having had cancer. However, little is known about cooperation among physicians in outpatient settings. To understand what inter- and multidisciplinary care means in community settings, we conducted an amplified secondary analysis that combined qualitative interview data with 42 general practitioners (GPs), 21 oncologists and 21 urologists that mainly worked in medical practices in Germany. We compared their perspectives on cooperation relationships in cancer care. Our results indicate that all participants regarded cooperation as a prerequisite for good cancer care. Oncologists and urologists mainly reported cooperating for tumour-specific treatment tasks, while GPs' reasoning for cooperation was more patient-centred. While oncologists and urologists reported experiencing reciprocal communication with other physicians, GPs had to gather the information they needed. GPs seldom reported engaging in formal cooperation structures, while for specialists, participation in formal spaces of cooperation, such as tumour boards, facilitated a more frequent and informal discussion of patients, for instance on the phone. Further research should focus on ways to foster GPs' integration in cancer care and evaluate if this can be reached by incorporating GPs in formal cooperation structures such as tumour boards.

[How Patients View and Accept Health Care Services Provided by Health Care Assistants in the General Practice: Survey of Participants of the GP-centered Health Care Program in Baden-Wuerttemberg]

BACKGROUND

In recent years, models for the delegation of GP tasks to non-physician medical staff have been tested, implemented in a general practice setting and, to some extent, funded by health insurance companies.

AIM

How were changes in the spectrum of tasks performed by non-physician staff viewed and accepted by patients?

METHODS

Between October 2014 and January 2015, a written survey was conducted among chronically ill patients (≥ 65 years of age) receiving health care from health care assistants (HCA) with or without the additional "health care assistant in the family practice", or VERAH qualification. Using a self-developed survey, based on a previous collection of data, patients were asked about various aspects of health care provided by HCAs.

RESULTS

77 practices participated and a total of 1 266 patients were surveyed. The patients said the HCAs had a role to play in many aspects of their health care. More than half the patients said HCAs could take responsibility for some of the home visits and contacts in the practice. Almost without exception, patients regarded the organisational, healthcare and other supporting services performed by the HCAs as very good. The results were more heterogeneous for specific consulting services. While consultations on vaccinations, preventive services, medical examinations and medication adherence were well accepted, this was much less often the case with advice on lifestyle. Many patients see HCAs as additional and competent persons they can trust, and could well imagine HCAs taking on responsibility for further delegable services.

CONCLUSION

At least among GP-centered health care programme participants, many healthcare services delegated to HCAs were appreciated and accepted by patients. Home visits and case management, in the sense of structured individual health care for patients with special needs, are further services that may be well suited for delegation. This should be investigated in further studies (including qualitative studies).

[Qualitative Research in Health Services Research - Discussion Paper, Part 3: Quality of Qualitative Research]

The third and final discussion paper of the German Network of Health Services Research's (DNVF) "Qualitative Methods Working Group" demonstrates methods for the evaluation and quality of qualitative research in health services research. In this paper we discuss approaches described in evaluating qualitative studies, including: an orientation to the general principles of empirical research, an approach-specific course of action, as well as procedures based on the research-process and criteria-oriented approaches. Divided into general and specific aspects to be considered in a qualitative study quality evaluation, the central focus of the discussion paper undertakes an extensive examination of the process and criteria-oriented approaches. The general aspects include the participation of relevant groups in the research process as well as ethical aspects of the research and data protection issues. The more specific aspects in evaluating the quality of qualitative research include considerations about the research interest, research questions, and the selection of data collection methods and types of analyses. The formulated questions are intended to guide reviewers and researchers to evaluate and to develop qualitative research projects appropriately. The intention of this discussion paper is to ensure a transparent research culture, and to reflect on and discuss the methodological and research approach of qualitative studies in health services research. With this paper we aim to initiate a discussion on high quality evaluation of qualitative health services research.

[Importance of complementary medicine approaches for patients with prostate cancer]

BACKGROUND

In Germany, many prostate cancer patients use complementary medicine (CM) or have an interest in these treatment approaches; however, the information and consultation situation of cancer patients is insufficient and therefore the Competence Network Complementary Medicine in Oncology (COCON) was launched by the German Cancer Aid Society. One of the projects of the COCON examines the use of CM and the information and counseling needs regarding these topics in various groups of cancer patients. The focus of this article is on the qualitative study reporting selected results for the subgroup of prostate cancer patients.

STUDY DESIGN AND STUDY METHODS

A total of 19 semi-structured qualitative interviews with prostate cancer patients were conducted regarding the use of CM as well as their information and consultation needs.

RESULTS

It was found that the patients interviewed discussed various issues surrounding nutrition, particularly a healthy diet, the selective use of certain foods and the use of dietary supplements. Additional themes mentioned by interviewees were physical exercise, psychological well-being, mistletoe therapy, homeopathy and traditional Chinese medicine. Patients indicated that they wanted more information and counseling opportunities with regards to CM. They also expressed a desire for more holistic care.

CONCLUSION

The results show that prostate cancer patients use a range of CM and have a need for information about CM. Prostate cancer patients are in a special situation because of a regular feedback on the prostate-specific antigen (PSA) value. This should be taken into consideration in consultation with prostate cancer patients regarding CM.

[Qualitative research in health services research - discussion paper, Part 1: What is the idea?]

In this first part of a 3-part discussion paper the working group "Qualitative Methods" in the German Network of Health Services Research (DNVF) identifies the potentials and opportunities qualitative research methods provide for health services research. Many research questions relevant for health services research require the use of qualitative methods. However, the potential of and need for qualitative research in health services research has not yet received sufficient attention from funding bodies. We discuss the applicability and importance of qualitative research for the field of health services research. We then move on to describe the key characteristics of qualitative research that need to be taken into account in health services research. We discuss characteristics such as open-ended (qualitative) data, interpretation of meanings, the search for contradictions, closeness to everyday life, openness towards change or modification of the research question and processes in the context of health services research. To ensure a high-quality approach in qualitative methods for the health services research, sufficient competency in methods and appropriate settings that account for the peculiarities of qualitative methods need to be developed. These include an appropriate time frame and sufficient and qualified personnel to conduct qualitative research. Qualitative research is not a research paradigm in itself rather it comprises of many different and diverging approaches. The goal of this paper is to show the diversity of qualitative research methods, its importance for health services research, and to open up the discussion on strategies for integrating qualitative methods into health services research.

Practice-based depression case management in primary care: a qualitative study on family doctors' perspectives

BACKGROUND

Case management provided by health care assistants (HCAs) is effective in improving primary care for depressive patients. Little is known on the implementation-related aspects of case management performed in small family practices.

OBJECTIVE

To explore family doctors' perspectives on clinical and organizational aspects of implementation of case management and perceived practice-related aspects associated with patient care after 1 year's experience of HCAs providing case management for depressive patients in their practices.

METHODS

This qualitative study was nested in a cluster-randomized trial on case management provided by practice-based HCAs for patients with major depression in Germany. We used semi-structured interview guides and performed audio-taped interviews with family doctors. Full transcription and thematic content analysis were carried out.

RESULTS

Twenty-three family doctors were interviewed. The family doctors perceived case management as beneficial to patients and reported that it improved their consultation styles and doctor-patient relationships. They implemented case management elements into their everyday day work using 'concrete', 'subsumed' or 'progressive' implementation styles.

CONCLUSIONS

Family doctors perceived practice-based case management by HCAs as beneficial for patient care. Different implementation styles may be appropriate, depending on the health care setting, and this requires further evaluation.

Effects of acupuncture and homeopathy: prospective documentation. Interim results

OBJECTIVE

To evaluate the overall effectiveness in general practice of homeopathy and acupuncture, and to estimate costs.

METHOD

Prospective documentation of all patients insured with an insurance company who are provided with free treatment of acupuncture and homeopathy. 4000 patients treated by acupuncture and 1000 patients by homeopathy will be enrolled. All patients will be followed up from the beginning of treatment for another 4 years. Doctors will provide data on each visit (diagnosis, treatment, change of symptoms, etc.), patients will fill in questionnaires at the beginning and at the end of treatment, as well as each year after the end of treatment (complaints, current treatment, general health status as measured by the MOS-SF 36). Insurance data on workdays lost will be provided by the insurance company.

RESULTS

Data acquisition and entry is continuing. Up to now data from the first questionnaire of 1453 patients have been entered and 951 patients have returned the follow-up questionnaire. Doctors' ratings of the change of the main diagnosis shows improvement of around 80% with only 2% deteriorated. This impression is vindicated by the patients' follow-up questionnaire. 36% patients rated the therapy as efficacious, 47% as partially efficacious. Quality of life as measured by the SF 36 questionnaire improved significantly in all dimensions. Data on workdays off will be presented.

CONCLUSION

Homeopathy and acupuncture are clinically effective in a variety of medical problems.