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Brettschneider C, Hajek A, Stein J, Luck T, Mamone S, Wiese B, Mösch E, Weeg D, Fuchs A, Pentzek M, Werle J, Weyerer S, Mallon T, van den Bussche H, Heser K, Wagner M, Scherer M, Maier W, Riedel-Heller SG, König HH. [Informal care for dementia according to type of service]. Nervenarzt 2018; 89:509-515. [PMID: 29637234 DOI: 10.1007/s00115-018-0511-7] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Dementia is a major challenge for society and its impact will grow in the future. Informal care is an essential part of dementia care. Previous studies considered informal care as a whole and not by its components. OBJECTIVE We aimed to assess the degree of association between specific informal care services and dementia. MATERIAL AND METHODS This analysis is based on data from the seventh wave of the AgeCoDe/AgeQualiDe study. Dementia was diagnosed based on the DSM-IV criteria. Severity of dementia was assessed and categorized by means of the Clinical Dementia Rating and eight individual informal care services were considered. Logistic regression models were used to assess associations. RESULTS Of the 864 participants 18% suffered from dementia (very mild: 4%; mild: 6%; moderate: 5%; severe: 3%). All informal care services were significantly associated with dementia, with an emphasis on "supervision", "regulation of financial matters" and "assistance in the intake of medication". Considering different degrees of dementia severity, similar results arose from the analyses. All three aforementioned services showed a pronounced association with all degrees of dementia severity, except for supervision and very mild dementia. CONCLUSION The provision of all types of informal care services is associated with dementia. The association is pronounced for services that can be more easily integrated into the daily routines of the informal caregiver. Policy makers who plan to integrate informal care into the general care arrangements for dementia should consider this.
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Affiliation(s)
- C Brettschneider
- Institut für Gesundheitsökonomie und Versorgungsforschung, Hamburg Center for Health Economics, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - A Hajek
- Institut für Gesundheitsökonomie und Versorgungsforschung, Hamburg Center for Health Economics, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - J Stein
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
| | - T Luck
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
| | - S Mamone
- Institut für Allgemeinmedizin, AG Medizinische Statistik und IT-Infrastruktur, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - B Wiese
- Institut für Allgemeinmedizin, AG Medizinische Statistik und IT-Infrastruktur, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - E Mösch
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - D Weeg
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - A Fuchs
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - M Pentzek
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - J Werle
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - S Weyerer
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - T Mallon
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - H van den Bussche
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - K Heser
- Klinik und Poliklinik für Psychiatrie/Psychotherapie, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland
| | - M Wagner
- Klinik und Poliklinik für Psychiatrie/Psychotherapie, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Deutschland
| | - M Scherer
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - W Maier
- Klinik und Poliklinik für Psychiatrie/Psychotherapie, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Deutschland
| | - S G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
| | - H-H König
- Institut für Gesundheitsökonomie und Versorgungsforschung, Hamburg Center for Health Economics, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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Abstract
ZusammenfassungIn wissenschaftlichen und berufspolitischen Aufsätzen der Neuropsychiatrie besteht weit gehende Einigkeit darüber, dass Acetylcholinesterase-Hemmer (AChEH) und Memantine bei Alzheimer-Demenz Präparate der ersten Wahl sind. Zwei gängige Thesen zur Arzneimittelversorgung werden in diesem Artikel untersucht: 1. Die einfache Dichotomisierung, nach der Hausärzte Ginkgo verschreiben, Neurologen und Psychiater hingegen AChEH und Memantine. 2. Die These der massiven Unterversorgung von dementen Patienten mit AChEH. Ergebnisse: Bezüglich der subjektiven Wahrnehmung der Wirksamkeit und Verschreibungshäufigkeit von AChEH und Memantine unterscheiden sich Hausärzte relativ wenig von niedergelassenen Neurologen und Psychiatern. Zwischen der subjektiven Wahrnehmung der Ärzte und der objektiven Verschreibungsrealität gibt es jedoch beträchtliche Unterschiede. Die These der massiven medikamentösen Unterversorgung von dementen Patienten mit AChEH muss bei differenzierter Betrachtung der Indikationsgruppe und Beachtung der kaum strittigen Erkenntnisse zur Wirksamkeit kritisiert werden. Als Fazit wird vorgeschlagen, die Verschreibung von AChEH in Deutschland klarer zu regeln und zu kontrollieren.
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Wiese B, van den Bussche H, Kaduszkiewicz H. Kompetenz, Grundeinstellung und professionelles Handlungskonzept von Hausärzten und Spezialisten in der Versorgung Demenzkranker. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1626913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungWenig ist bekannt, ob Ärzte sich für die Versorgung von dementen Patienten kompetent fühlen und ob eine fehlende Kompetenz die Einstellung zu Demenzkranken und das professionelle Verhalten beeinflusst. Noch weniger weiß man, ob Hausärzte und Spezialisten sich in dieser Hinsicht voneinander unterscheiden. Ziel dieser Studie war das Verhältnis zwischen Kompetenz, Grundeinstellung und professionellem Verhalten von Ärzten in der ambulanten Versorgung in Deutschland zu untersuchen. Methoden: Eine standardisierte postalische Befragung wurde an 389 Hausärzte und 239 Neurologen und Psychiater verschickt. Der Befragung bestand aus 49 Aussagen, zu denen die Ärzte auf einer 6-Punkte-Likert-Skala ihre Zustimmung oder Ablehnung angeben sollten. Die Rücklaufquote betrug 54% für die Hausärzte und 40% für die Spezialisten. Ergebnisse: Hausärzte und Spezialisten fühlen sich kompetent für die Versorgung Demenzkranker, bei den Spezialisten ist dieses Gefühl stärker. Kein Unterschied fand sich hinsichtlich der Grundeinstellung zur Versorgung Demenzkranker. In beiden Ärztegruppen hatten etwa 15% eine deutlich negative Einstellung. Insbesondere bei den Hausärzten zeigte sich ein Zusammenhang zwischen subjektiver Kompetenzeinschätzung, Grundeinstellung und professionellem Verhalten (z. B. Frühdiagnose und Fallsuche, therapeutisches Verhalten). Schlussfolgerung: Speziell für Hausärzte können Fortbildungsangebote, die die Kompetenz, aber auch die Grundeinstellung zur Versorgung Demenzkranker verbessern, einen direkten positiven Einfluss auf die alltägliche Versorgung dieser Patientengruppe haben.
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Hajek A, Brettschneider C, van den Bussche H, Kaduszkiewicz H, Oey A, Wiese B, Weyerer S, Werle J, Fuchs A, Pentzek M, Stein J, Luck T, Bickel H, Mösch E, Heser K, Bleckwenn M, Scherer M, Riedel-Heller SG, Maier W, König HH. Longitudinal Analysis of Outpatient Physician Visits in the Oldest Old: Results of the AgeQualiDe Prospective Cohort Study. J Nutr Health Aging 2018; 22:689-694. [PMID: 29806857 DOI: 10.1007/s12603-018-0997-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study was to identify determinants of outpatient health care utilization among the oldest old in Germany longitudinally. DESIGN Multicenter prospective cohort "Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" (AgeQualiDe). SETTING Individuals in very old age were recruited via GP offices at six study centers in Germany. The course of outpatient health care was observed over 10 months (two waves). PARTICIPANTS Primary care patients aged 85 years and over (at baseline: n=861, with mean age of 89.0 years±2.9 years; 85-100 years). MEASUREMENTS Self-reported numbers of outpatient visits to general practitioners (GP) and specialists in the past three months were used as dependent variables. Widely used scales were used to quantify explanatory variables (e.g., Geriatric Depression Scale, Instrumental Activities of Daily Living Scale, or Global Deterioration Scale). RESULTS Fixed effects regressions showed that increases in GP visits were associated with increases in cognitive impairment, whereas they were not associated with changes in marital status, functional decline, increasing number of chronic conditions, increasing age, and changes in social network. Increases in specialist visits were not associated with changes in the explanatory variables. CONCLUSION Our findings underline the importance of cognitive impairment for GP visits. Creating strategies to postpone cognitive decline might be beneficial for the health care system.
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Affiliation(s)
- A Hajek
- Dr. André Hajek, University Medical Center, Hamburg-Eppendorf, Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, Telephone +49 40 7410 52877; Fax +49 40 7410 40261, E-Mail:
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Heinen I, van den Bussche H, Koller D, Wiese B, Hansen H, Schäfer I, Scherer M, Schön G, Kaduszkiewicz H. [Morbidity differences according to nursing stage and nursing setting in long-term care patients: Results of a claims data based study]. Z Gerontol Geriatr 2016; 48:237-45. [PMID: 24509639 DOI: 10.1007/s00391-013-0556-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND We analyzed the differences in morbidity patterns of chronic diseases between long-term care dependent persons in nursing homes compared to those dwelling in the community. We also investigated morbidity differences between long-term care need stages in Germany. MATERIALS AND METHODS The study included claims data of one nationwide operating statutory health insurance in 2006. Inclusion criteria were age ≥ 65 years, minimum 1 out of 46 diagnoses in at least 3 quarters of the year (n = 8,670). A comparison population was formed with n = 114,962. Prevalences, relative risks, and odds ratios for the risk of nursing home care were calculated. RESULTS In the bivariate analysis, only three chronic diseases - dementia, urinary incontinence, and chronic heart failure - showed a higher risk for nursing home care. Regression analysis revealed that only dementia showed higher odds related to the stage of nursing needs. CONCLUSION Among the chronic diseases, only dementia shows a substantially elevated risk for nursing home care. Risk studies on other chronic diseases associated with higher risks of long-term care dependency and specific intervention strategies aiming at delaying or preventing nursing home admission should be developed.
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Affiliation(s)
- I Heinen
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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Freytag A, Quinzler R, Freitag M, Bickel H, Fuchs A, Hansen H, Hoefels S, König HH, Mergenthal K, Riedel-Heller SG, Schön G, Weyerer S, Wegscheider K, Scherer M, van den Bussche H, Haefeli WE, Gensichen J. [Use and potential risks of over-the-counter analgesics]. Schmerz 2015; 28:175-82. [PMID: 24718747 DOI: 10.1007/s00482-014-1415-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM We investigated the use of prescription and non-prescription (over-the-counter, OTC) analgesics and the associated risks in elderly patients with multiple morbidities. METHODS Pain medication use was evaluated from the baseline data (2008/2009) of the MultiCare cohort enrolling elderly patients with multiple morbidities who were treated by primary care physicians (trial registration: ISRCTN89818205). We considered opioids (N02A), other analgesics, and antipyretics (N02B) as well as nonsteroidal anti-inflammatory drugs (NSAIDs; M01A). OTC use, duplicate prescription, dosages, and interactions were examined for acetylsalicylic acid, diclofenac, (dex)ibuprofen, naproxen, and acetaminophen. RESULTS Of 3,189 patients with multiple morbidities aged 65-85 years, 1,170 patients reported to have taken at least one prescription or non-prescription analgesic within the last 3 months (36.7 %). Of these, 289 patients (24.7 % of 1,170) took at least one OTC analgesic. Duplicate prescription was observed in 86 cases; 15 of these cases took the analgesics regularly. In two cases, the maximum daily dose of diclofenac was exceeded due to duplicate prescription. In 235 cases, patients concurrently took a drug with a potentially clinically relevant interaction. In 43 cases (18.3 % of 235) an OTC analgesic, usually ibuprofen, was involved. DISCUSSION About one third of the elderly patients took analgesics regularly or as needed. Despite the relatively high use of OTC analgesics, the proportions of duplicate prescription, medication overdoses, and adverse interactions due to OTC products was low.
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Affiliation(s)
- A Freytag
- Institut für Allgemeinmedizin, Universitätsklinikum, Friedrich-Schiller-Universität, Bachstr. 18, 07743, Jena, Deutschland
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Birck S, Gedrose B, Robra BP, Schmidt A, Schultz JH, Stosch C, Wagner R, Janßen N, Scherer M, van den Bussche H. [Stability of long-term professional objectives of young physicians during postgraduate training. Results of a multicenter cohort study]. Dtsch Med Wochenschr 2014; 139:2173-7. [PMID: 25317646 DOI: 10.1055/s-0034-1387274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION We investigated persistences and changes of career preferences of medical residents in Germany after two years of postgraduate training with regard to future working place and position. The results are compared with those forwarded at graduation from medical school in a gender comparative perspective. METHODS The study is based on a standardized postal survey among the participants in the "KarMed" study, originally based on 1012 graduates of the medical faculties of Erlangen, Giessen, Hamburg, Heidelberg, Cologne, Leipzig and Magdeburg in 2009. 2107 persons were contacted. The return rate at baseline was 48 %, and the two surveys after the baseline reached return rates of 87 % and 89 % respectively. In all samples 2/3 were women as in actual medical undergraduate education. Descriptive statistics and regression analysis were performed. RESULTS After 2 years of residency, residents after 2 years of postgraduate training still preferred the hospital over private practice as their final workplace after postgraduate training. The attractiveness of leading positions in the hospital declined among men, whereas it was already low for women at graduation. A large proportion of those physicians preferring the ambulatory sector, especially women, wishes to work as employee instead of private practice. At the personal level, almost 60 % forwarded the same preferences as those at graduation. Gender, parenthood and region of study (East vs. West Germany) did not influence stability or change of preferences. CONCLUSION The results demonstrate the persistence of professional preferences regarding future sector and position of medical work during postgraduate training. These preferences do neither match with principles of gender equality nor with future workforce needs (e. g. in primary care).
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Affiliation(s)
- S Birck
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf
| | - B Gedrose
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf
| | - B-P Robra
- Institut für Sozialmedizin und Gesundheitsökonomie, Universität Magdeburg
| | - A Schmidt
- Medizinische Klinik, Universität Erlangen
| | | | - C Stosch
- Studiendekanat der Medizinischen Fakultät, Universität Köln
| | - R Wagner
- Studiendekanat der Medizinischen Fakultät, Universität Gießen
| | - N Janßen
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf
| | - M Scherer
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf
| | - H van den Bussche
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf
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Ketels G, Schön G, van den Bussche H, Barzel A. [Quo vadis Therapeutic Health Care Professionals--What do Occupational and Physical Therapists Think about their Future? Results of a Survey throughout Germany]. Gesundheitswesen 2014; 77:e172-8. [PMID: 25268413 DOI: 10.1055/s-0034-1387711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The introduction of occupational and physical therapy as academic disciplines is evidence of radical changes in the therapeutic health care professions. Therapists' professional associations are planning and negotiating both with health insurance companies and with other branches of the health care professions concerning future spheres of activity. In order to find out what the therapists in these professions think about their future, we conducted a survey of physical and occupational therapists through-out Germany. Our findings regarding professional life, job satisfaction, competition and cooperation have already been published. This article presents therapists' assessments of the future of their professions. METHOD From May until December 2008 we performed a cross-sectional survey, interviewing physical and occupational therapists throughout Germany. Statements were answered on a 6-step Likert scale; open questions were answered in free-text fields. The evaluation was performed quantitatively; the free texts were also evaluated qualitatively. RESULTS A total of 3,506 questionnaires were evaluated; 1,273 were completed by occupational therapists and 2,233 by physical therapists. Nearly half of the therapists (n=1,687; 48.4%) used the opportunity to emphasise the need for change. We identified 4,026 statements about 8 general topics: remuneration, employee co-determination, professional recognition, continuing education, cooperation, initial access to the professions, and their academic status. Therapists illustrated certain items in the questionnaire with examples from their professional experience, suggested additional topics, and proposed concrete changes. We document a broad range of opinions and concerns, especially in regard to such subjects concerning the future of the professions as their new academic status and initial access. CONCLUSION Physical and occupational therapists are concerned about the future development of their professions. They see a need for change in the following areas: remuneration, employee co-determination, initial access and cooperation as well as in the development of their profession as an academic discipline. Policy makers need to heed therapists' assessments of the state of their professions and their calls for its increased professionalisation.
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Affiliation(s)
- G Ketels
- Physiotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - G Schön
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - H van den Bussche
- ehem. Direktor Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - A Barzel
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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Schwarzbach M, Luppa M, Hansen H, König HH, Gensichen J, Petersen JJ, Schön G, Wiese B, Weyerer S, Bickel H, Maier W, van den Bussche H, Scherer M, Riedel-Heller SG. A comparison of GP and GDS diagnosis of depression in late life among multimorbid patients – Results of the MultiCare Study. Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1387020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sikorski C, Luppa M, Bickel H, Pentzek M, Weyerer S, Maier W, Wiese B, Scherer M, van den Bussche H, König H, Riedel-Heller SG. The role of spousal loss in the development of depressive symptoms in the elderly – implications for diagnostic systems. Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1387028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zimmermann T, Kaduszkiewicz H, van den Bussche H, Schön G, Brettschneider C, König HH, Wiese B, Bickel H, Mösch E, Luppa M, Riedel-Heller S, Werle J, Weyerer S, Fuchs A, Pentzek M, Hänisch B, Maier W, Scherer M, Jessen F. [Potentially inappropriate medication in elderly primary care patients : A retrospective, longitudinal analysis]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 56:941-9. [PMID: 23712323 DOI: 10.1007/s00103-013-1767-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Elderly people are often burdened by several diseases. This accounts for a higher medication intake and increases the risk of adverse drug events. To minimize this risk, several lists (Beers, PRISCUS) have been published of drugs that elderly patients should not take. We present a longitudinal analysis of the use of potentially inappropriate medication (PIM) over a period 4.5 years in a cohort of patients aged 75 years or more. METHODS Data were collected from the prospective, multicenter, observational study "German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe)," initially enrolling 3,327 patients. We investigated the prevalence of PIM by checking medications during visits to patients' homes. Furthermore, we analyzed the use of individual PIM agents over time. RESULTS At baseline, we found a PIM prevalence of 29 % according to the PRISCUS list, which decreased to 25.0 % 4.5 years later (χ(2): 7.87, p = 0.004). The Beers list yielded a prevalence of 21 % at baseline, decreasing after 4.5 years to 17.1 % (χ(2): 10.77, p = 0.000). A time-dependent multilevel model confirmed these results. Older age, depression, and the use of numerous prescribed agents are independent risk factors for using a PRISCUS-PIM. CONCLUSION Our results seem to support a trend toward a more rational drug therapy because fewer patients were prescribed PIM. Thus, for the individual patient, the risk of adverse effects and side effects is reduced as are the costs of these effects.
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Affiliation(s)
- T Zimmermann
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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van den Bussche H, Wonneberger C, Birck S, Schultz JH, Robra BP, Schmidt A, Stosch C, Wagner R, Scherer M, Pöge K, Rothe K, Gedrose B. [The professional and private situation of male and female physicians entering postgraduate medical education in Germany]. Gesundheitswesen 2013; 76:e1-6. [PMID: 23954987 DOI: 10.1055/s-0033-1343441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM This study investigated the professional and the private situation of medical interns at the onset of their postgraduate training in Germany. We analysed the contractual situation and the working hours in the hospital, the professional situation of the partner and the number of hours invested in private life with special reference to gender and children. METHOD A standardised postal survey was conducted among all last year medical students in the medical faculties of Erlangen, Giessen, Hamburg, Heidelberg, Cologne, Leipzig and Magdeburg after entering postgraduate training. 1 009 were contacted for a first follow-up one year later and 87% responded. Descriptive statistics and regression analysis were performed. RESULTS The analysis shows that female physicians are disadvantaged compared to males with regard to various professional and private conditions relevant for career development, especially when children are present. We found a large number of hints pointing towards a persistence of traditional role patterns within the couple relationship. These conditions differed substantially between the regions of former German Federal and former German Democratic Republic. CONCLUSIONS A growing number of children in the study population in the course of the longitudinal analysis will show if these gender-related differences persist in the course of the training period and which influences on career development can be observed.
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Affiliation(s)
- H van den Bussche
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf
| | - C Wonneberger
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf
| | - S Birck
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf
| | - J-H Schultz
- Klinik für Allgemeine Internistische Medizin und Psychosomatik, Universität Heidelberg
| | - B-P Robra
- Institut für Sozialmedizin und Gesundheitsökonomie, Universität -Magdeburg
| | - A Schmidt
- Medizinische Klinik, Universität Erlangen
| | - C Stosch
- Studiendekanat der Medizinischen Fakultät, Universität Köln
| | - R Wagner
- Studiendekanat der Medizinischen Fakultät, Universität Gießen
| | - M Scherer
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf
| | - K Pöge
- Zentrum für Frauen- und Geschlechterforschung, Universität Leipzig
| | - K Rothe
- Zentrum für Frauen- und Geschlechterforschung, Universität Leipzig
| | - B Gedrose
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf
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Schwarzbach M, Luppa M, Sikorski C, Fuchs A, Maier W, van den Bussche H, Pentzek M, Riedel-Heller SG. The relationship between social integration and depression in non-demented primary care attenders aged 75 years and older. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1322097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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van den Bussche H, Jahncke-Latteck ÄD, Ernst A, Tetzlaff B, Wiese B, Schramm U. [Satisfied general practitioners and critical nursing staff - problems of interprofessional cooperation in the home care of dementia patients]. Gesundheitswesen 2012; 75:328-33. [PMID: 22932828 DOI: 10.1055/s-0032-1321754] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM OF THE STUDY Analysis of views of general practioners and nurses of interprofessional cooperation between general practititoners and nurses in the ambulatory care of dementia patients is presented. METHODS A survey was carried out among general practitioners and nurses caring for community dwelling dementia patients in Hamburg. RESULTS The majority of GPs and nurses consider interprofessional cooperation to be good and beneficial for their own work. GPs are generally more positive about the quality of cooperation than nurses. Joint sessions for planning and evaluation of care are seldom. Even so, more GPs than nurses evaluate the frequency of these meetings to be sufficient. Although nurses are more critical about the quality of the cooperation with the GPs, they seldom address the GP to express their criticism. CONSEQUENCES To make cooperation work, the matter should be part of the training of both physicians and nurses and the hierarchy between the 2 groups should be reduced.
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Affiliation(s)
- H van den Bussche
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
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Abstract
MultiCare is the acronym for a multidisciplinary and multicenter research network on multimorbidity and comorbidity in the primary care/family medicine setting, which is coordinated by the Institute of Primary Medical Care of the University Medical Center Hamburg-Eppendorf. Multimorbidity is one of the most difficult problems in primary medical care as little is known about the interaction of several diseases in a person with regard to etiology and disease progress. Also, guidelines for the treatment of multimorbid patients are largely lacking. Therefore, the aims of the MultiCare network include: the identification of multimorbidity patterns in the elderly primary care population, analysis of incidence and prevalence and of interactions within clusters, the investigation of severity and consequences for patients, as well as trials to improve physician-patient interaction in the case of multimorbidity. During the first funding period (2008-2010) the network consisted of two observational and two interventional studies. Their results as of summer 2011 are presented in the following article.
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Affiliation(s)
- H van den Bussche
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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van den Bussche H, Kromark K, Köhl-Hackert N, Robra B, Rothe K, Schmidt A, Stosch C, Wagner R, Wonneberger C, Scherer M, Alfermann D, Gedrose B. [General practitioner or specialist at home or abroad?]. Gesundheitswesen 2012; 74:786-92. [PMID: 22622844 DOI: 10.1055/s-0032-1311619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study investigated the career preferences of medical graduates in Germany with regard to discipline, place and position after the completion of postgraduate training. We also investigated differences in career options according to gender and region of study (former German Federal Republic vs. former German Democratic Republic).The study is based on a standardised postal survey among all last year medical students in the medical faculties of Erlangen, Giessen, Hamburg, Heidelberg, Cologne, Leipzig and Magdeburg in 2009. 2 107 persons were contacted and 1 012 (48%) participated in the survey.96% of participants stated their intention to pursue a postgraduate training in a medical discipline, and only 0.4% denied such an objective. 7% of the graduates preferred a career towards general practice, and a similar percentage preferred general internal medicine which usually also leads to a primary care activity. 84% aimed at becoming a medical specialist. In total, 28% intended to work in a specialist practice, and 10% in a general practice. Only one-fifth of the latter aimed at working in a countryside setting. 7% aimed at starting postgraduate training outside of Germany, and 8% preferred to work outside Germany after completion of the postgraduate training. In both cases, Switzerland was by far the most preferred country.The results contradict the thesis that young graduates are reluctant to enter clinical medicine. Working abroad is within the scope of less than 10% of the graduates. A dramatic difference between the demand for general practitioners and the career intentions of medical graduates is observed. Measures to increase the attractiveness of primary care, especially in the countryside, are urgently needed.
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Affiliation(s)
- H van den Bussche
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf.
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Leicht H, Heinrich S, Heider D, Bachmann C, Bickel H, van den Bussche H, Fuchs A, Luppa M, Maier W, Mösch E, Pentzek M, Rieder-Heller SG, Tebarth F, Werle J, Weyerer S, Wiese B, Zimmermann T, König HH. Net costs of dementia by disease stage. Acta Psychiatr Scand 2011; 124:384-95. [PMID: 21838738 DOI: 10.1111/j.1600-0447.2011.01741.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To estimate net costs of dementia by degree of severity from a societal perspective, including a detailed assessment of costs of formal and informal nursing care. METHOD In a cross-sectional study, costs of illness were analysed in 176 dementia patients and 173 matched non-demented control subjects. Healthcare resource use and costs were assessed retrospectively by means of a questionnaire. Dementia patients were classified into three disease stages, and linear regression models were applied to estimate net costs of dementia by degree of severity. RESULTS Annual net costs of dementia by stage were approximately €15 000 (mild), €32 000 (moderate) and €42 000 (severe), corresponding to US-$21 450, 45 760 and 60 060 respectively. Across disease stages, nursing care accounted for approximately three-quarters of total costs, of which half resulted from informal care. In sensitivity analyses using different valuation methods for nursing care, total costs decreased or increased by more than 20%. CONCLUSION Net costs more than double across stages of dementia. Informal care accounts for a considerable share of nursing care costs, and the approach to valuation of informal care has a large impact on cost-of-illness estimates.
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Affiliation(s)
- H Leicht
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Barzel A, Ketels G, Schön G, van den Bussche H. Erste deutschlandweite Befragung von Physio- und Ergotherapeuten zur Berufssituation. physioscience 2011. [DOI: 10.1055/s-0031-1281827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- A. Barzel
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf
| | - G. Ketels
- Leitungsteam Physiotherapie, Universitätsklinikum Hamburg-Eppendorf
| | - G. Schön
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf
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Barzel A, Ketels G, Schön G, van den Bussche H. Erste deutschlandweite Befragung von Physio- und Ergotherapeuten zur Berufssituation. physioscience 2011. [DOI: 10.1055/s-0031-1273376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Barzel A, Ketels G, Schön G, Haevernick K, Lang H, Link K, Netzband A, Trenkner S, Wagner B, van den Bussche H. Erste deutschlandweite Befragung von Physio- und Ergotherapeuten zur Berufssituation. physioscience 2011. [DOI: 10.1055/s-0029-1246070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Papassotiropoulos A, Henke K, Stefanova E, Aerni A, Müller A, Demougin P, Vogler C, Sigmund JC, Gschwind L, Huynh KD, Coluccia D, Mondadori CR, Hänggi J, Buchmann A, Kostic V, Novakovic I, van den Bussche H, Kaduszkiewicz H, Weyerer S, Bickel H, Riedel-Heller S, Pentzek M, Wiese B, Dichgans M, Wagner M, Jessen F, Maier W, de Quervain DJF. A genome-wide survey of human short-term memory. Mol Psychiatry 2011; 16:184-92. [PMID: 20038948 PMCID: PMC3030750 DOI: 10.1038/mp.2009.133] [Citation(s) in RCA: 30] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Recent advances in the development of high-throughput genotyping platforms allow for the unbiased identification of genes and genomic sequences related to heritable traits. In this study, we analyzed human short-term memory, which refers to the ability to remember information over a brief period of time and which has been found disturbed in many neuropsychiatric conditions, including schizophrenia and depression. We performed a genome-wide survey at 909 622 polymorphic loci and report six genetic variations significantly associated with human short-term memory performance after genome-wide correction for multiple comparisons. A polymorphism within SCN1A (encoding the α subunit of the type I voltage-gated sodium channel) was replicated in three independent populations of 1699 individuals. Functional magnetic resonance imaging during an n-back working memory task detected SCN1A allele-dependent activation differences in brain regions typically involved in working memory processes. These results suggest an important role for SCN1A in human short-term memory.
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Affiliation(s)
- A Papassotiropoulos
- Division of Molecular Psychology, University of Basel, Basel, Switzerland. or
| | - K Henke
- Department of Psychology, University of Bern, Bern, Switzerland
| | - E Stefanova
- Institute of Neurology, CCS, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - A Aerni
- Division of Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - A Müller
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - P Demougin
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - C Vogler
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - J C Sigmund
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - L Gschwind
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - K-D Huynh
- Division of Molecular Psychology, University of Basel, Basel, Switzerland,Life Sciences Training Facility, Biozentrum, University of Basel, Basel, Switzerland
| | - D Coluccia
- Division of Psychiatry Research, University of Zurich, Zurich, Switzerland
| | - C R Mondadori
- Division of Neuropsychology, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - J Hänggi
- Division of Neuropsychology, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - A Buchmann
- Division of Psychiatry Research, University of Zurich, Zurich, Switzerland
| | - V Kostic
- Institute of Neurology, CCS, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - I Novakovic
- Institute of Biology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - H van den Bussche
- Institute of Primary Medical Care, University Medical Center, Hamburg-Eppendorf, Germany
| | - H Kaduszkiewicz
- Institute of Primary Medical Care, University Medical Center, Hamburg-Eppendorf, Germany
| | - S Weyerer
- Central Institute of Mental Health, Mannheim, Germany
| | - H Bickel
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - S Riedel-Heller
- Public Mental Health Research Unit, Department of Psychiatry, University of Leipzig, Leipzig, Germany
| | - M Pentzek
- Department of General Practice, Dusseldorf University Medical Center, Dusseldorf, Germany
| | - B Wiese
- Institute for Biometrics, Hannover Medical School, Hannover, Germany
| | - M Dichgans
- Department of Neurology, Klinikum Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - M Wagner
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - F Jessen
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - W Maier
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - D J-F de Quervain
- Division of Cognitive Neuroscience, University of Basel, Basel, Switzerland,Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland,Division of Cognitive Neuroscience, University of Basel, Birmannsgasse 8, Basel 4055, Switzerland. E-mail:
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Ehreke L, Luppa M, Luck T, Wiese B, Weyerer S, Weeg D, Olbrich J, van den Bussche H, Maier W, Pentzek M, König H, Riedel-Heller S. Is the Clock Drawing Test appropriate for screening for Mild Cognitive Impairment? Results of the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Koller D, Eisele M, Kaduszkiewicz H, Schön G, Steinmann S, Wiese B, van den Bussche H, Hoffmann F, Glaeske G. Gibt es Stadt-Land-Differenzen in der ambulanten Versorgung von Demenzpatienten in Deutschland? Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Zimmermann T, Kaduszkiewicz H, Schön G, van den Bussche H. Wie verlässlich sind hausärztliche Prävalenzangaben von KHK, Insult und Diabetes älterer Menschen? Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Eisele M, van den Bussche H, Koller D, Wiese B, Kaduszkiewicz H, Wegscheider K, Glaeske G, Schön G. Stationäre Versorgung: Gibt es Unterschiede in der Versorgung von Menschen mit Demenz im Vergleich zu einer nicht-dementen Kontrollgruppe? Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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van den Bussche H, Berger K, Kemper C, Barzel A, Glaeske G, Koller D. Inzidenz, Rezidiv, Pflegebedürftigkeit und Mortalität von Schlaganfall. Akt Neurol 2010. [DOI: 10.1055/s-0030-1248398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Luck T, Riedel-Heller SG, Luppa M, Wiese B, Wollny A, Wagner M, Bickel H, Weyerer S, Pentzek M, Haller F, Moesch E, Werle J, Eisele M, Maier W, van den Bussche H, Kaduszkiewicz H. Risk factors for incident mild cognitive impairment--results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Acta Psychiatr Scand 2010; 121:260-72. [PMID: 19824992 DOI: 10.1111/j.1600-0447.2009.01481.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To provide age- and gender-specific incidence rates of MCI among elderly general practitioner (GP) patients (75+ years) and to identify risk factors for incident MCI. METHOD Data were derived from the longitudinal German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Incidence was calculated according to the 'person-years-at-risk' method. Risk factors were analysed using multivariate logistic regression models. RESULTS During the 3-year follow-up period, 350 (15.0%) of the 2331 patients whose data were included in the calculation of incidence developed MCI [person-years (PY) = 6198.20]. The overall incidence of MCI was 56.5 (95% confidence interval = 50.7-62.7) per 1000 PY. Older age, vascular diseases, the apoE epsilon4 allele and subjective memory complaints were identified as significant risk factors for future MCI. CONCLUSION Mild cognitive impairment is frequent in older GP patients. Subjective memory complaints predict incident MCI. Especially vascular risk factors provide the opportunity of preventive approaches.
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Affiliation(s)
- T Luck
- Public Health Research Unit, Department of Psychiatry, University of Leipzig, Leipzig, Germany.
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van den Bussche H, Du Moulin M. Berufseinstiegsprobleme und Berufsausstiegstendenzen bei Absolventen und Absolventinnen des Medizinstudiums in Deutschland und in anderen OECD-Ländern. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Eisele M, Kaduszkiewicz H, Schön G, Koller D, Wiese B, Hoffmann F, Glaeske G, van den Bussche H. Inanspruchnahmeverhalten von ambulanten Gesundheitsleistungen vor, während und unmittelbar nach Diagnosestellung einer Demenz – Inwiefern unterscheiden sich Demenzkranke von nicht demenziell Erkrankten? Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gedrose B, Kromark K, Köhl N, Robra B, Rothe K, Schmidt A, Stosch C, Wagner R, Alfermann D, van den Bussche H. Karriereplanung von Absolventen und Absolventinnen des Medizinstudiums vor Beginn der Facharztweiterbildung. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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van den Bussche H, Ernst A, Jahncke-Latteck Ä, Schramm U. Kooperation zwischen Hausärzten und Pflegediensten bei Demenzpatienten – Erste Ergebnisse der Interventionsstudie KOVERDEM. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Barzel A, Eisele M, Bussche HVD. [Outpatient management of stroke patients from the viewpoint of general practitioners in Hamburg--an exploratory study]. Gesundheitswesen 2008; 70:170-6. [PMID: 18415925 DOI: 10.1055/s-2008-1062731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Stroke is the archetype of a chronic disease, with a considerable burden on ambulatory care. After discharge from hospital or inpatient rehabilitation, stroke patients are attended primarily by general practitioners (GPs). Little is known about the quality of outpatient care for stroke patients, so this study focused on the views of professionals involved in outpatient care. METHODS A postal survey of 443 general practitioners from Hamburg, Germany was undertaken. Results were compared with a parallel survey carried out with physiotherapists and occupational therapists. RESULTS 89 questionnaires were analysed. Based on a response rate of 28% the results cannot be seen as representative, but they do provide important information. As it seems, problems in ambulatory care do not start after discharge from hospital, but are partly caused by inpatient care. GPs see therapeutic benefits in ambulatory care for only half of their chronic stroke patients. They assess their own therapeutic efforts as effective in terms of medication, but they are less successful in changing their patients' behaviour with regard to lifestyle. Estimations of the prevalence of post-stroke depression vary substantially, with a mean of 47%. With regard to their daily practice, 60% of GPs do not find guidelines to be helpful. All in all, respondents describe the situation of chronic stroke patients and their families to be complex and difficult to manage. In addition to their professional performance, GPs carry out duties related to case management - as do the therapists. CONCLUSION The care of stroke patients is not only the responsibility of a single group of professionals, but is a rather complex task involving different health-care professionals. The rehabilitation process and the interdisciplinary cooperation need to be further analysed to ensure a good cooperation between health-care professionals and to improve the quality of ambulatory care for stroke patients.
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Affiliation(s)
- A Barzel
- Wissenschaftliche Mitarbeiterin, Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf.
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Barzel A, Eisele M, van den Bussche H. Ambulante Versorgung von Schlaganfallpatienten aus der Sicht Hamburger Physio- und Ergotherapeuten. physioscience 2007. [DOI: 10.1055/s-2007-963640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kothe R, Sommerfeldt D, Morfeld M, Quellmann C, Weidtmann K, Fuhrhop I, van den Bussche H, Gawad KA. [The new curriculum for surgery in Hamburg, Germany]. Chirurg 2006; 77:622-9. [PMID: 16786341 DOI: 10.1007/s00104-006-1180-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In October 2004, the medical faculty of Hamburg University started a program to restructure completely clinical teaching according to new state regulations of June 2002. In this new curriculum design, the surgical disciplines were horizontally and vertically interconnected and integrated, with a focus on practical training and problem-based teaching. This study describes the concept of clinical teaching and presents the student evaluation results of the first four blocks with a focus on performance in surgical disciplines. There was high student satisfaction with the new program, compared with results before October 2004 and also with respect to other disciplines within the new curriculum. This was especially true for the practical courses in the newly established skills lab. Future developments in e-learning and practical teaching in the skills lab are necessary to overcome restrictions on medical education due to changes in the German health care system.
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Affiliation(s)
- R Kothe
- Interdisziplinäres Wirbelsäulenzentrum Klinikum Dortmund, Beurhausstrasse 40, 44137 Dortmund.
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Abstract
AIM The disease management programme for diabetes mellitus type 2 (DMP) is joined by many General Practitioners. Aim of the study is to compare patients included in this programme with patients not included and to explore reasons for the selection. METHODS 10 GPs in Hamburg participated. From each patient list 10 participants in the DMP and the same number of non-participants were randomly selected. HbA1c before start of the programme, presence of insulin therapy, comorbidity and language skills were documented. GPs reported their estimation of the compliance and their reasoning in the selection process. The hypothesis for the primary endpoint was: Diabetics not included have a worse HbA1c value than those included in the DMP. RESULTS The hypothesis was not confirmed. In both groups similarly good HbA1c values were observed (7.0 in DMP participants, 7.3 in non-participants). The included participants differed from those not included with respect to age (statistically significantly younger) and a better compliance. In the subgroup of patients younger than 70 years the patients included have a better HbA1c and get insulin more frequently (both n. s.). CONCLUSIONS One part of the patients seems to be not included into the DMP for good reasons. Two questions should be further evaluated: To what extent are patients included although they already have a good metabolic situation? And to what extent are patients with a poor compliance not included, although they might benefit from participation?
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Affiliation(s)
- S Dunkelberg
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg.
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Dunkelberg S, Noack A, Sperber S, Zingel D, van den Bussche H, Kaduszkiewicz H. [Disease Management Program for diabetes mellitus type 2: cooperation or resistance of the general practitioner]. Gesundheitswesen 2006; 68:26-31. [PMID: 16463242 DOI: 10.1055/s-2006-926483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM of the study was to seize the attitudes of General Practitioners (GPs) towards the disease management program (DMP) for type 2 diabetes implemented in summer 2003 in Germany. Moreover we were interested in the way GPs realise the program in daily practice, e. g. how many patients and which patients they include. METHOD A postal questionnaire was sent twice to all GPs in the region of Hamburg (n = 1.230), in November 2003 and in December 2004. Response rate without reminder was 20 respective 16 percent. RESULTS In 2004 81 percent of the GPs taking part in the survey participate in the DMP. These doctors include a third of their patients with type 2 diabetes into the program. 65 percent of the GPs nevertheless do not believe, that the patients will benefit from the program. 47 percent of the participating GPs object to DMP in general. Only 66 percent say they follow the DMP guidelines for pharmacotherapy. Half of the doctors state they actively canvass patients for the program, while one fifth says they advice patients against participation. The GPs participate in first line to supply the demand of the patients and because of the public pressure less because they think the DMP is good in respect of content. In 2003 critics and pessimism regarding benefit for patients were even stronger than in 2004. CONCLUSIONS GPs participate in the DMP diabetes half-heartedly and with doubts. The results suggest selections in the inclusion of patients. Further research should find out whether patients being likely to profit from the DMP are systematically not included.
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Affiliation(s)
- S Dunkelberg
- Institut für Allgemeinmedizin, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf.
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von dem Knesebeck O, Döhner H, Kaduszkiewicz H, van den Bussche H, von Renteln Kruse W. Forschung zur Versorgung im höheren Lebensalter. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2006; 49:167-74. [PMID: 16416109 DOI: 10.1007/s00103-005-1213-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Three examples serve to highlight challenges for health care that stem from population ageing and the health situation of the elderly. The first challenge is to develop and evaluate prevention and health promotion programmes for the elderly. Two promising interventions are outlined: 'preventive home visits' and 'active health promotion in old age'. The second challenge is to improve the coordination of health and social care measures. Case management is presented as one adequate approach in this regard. The third challenge stems from the increasing prevalence of age-specific diseases. In terms of dementia it is pointed out that it is important to improve early diagnosis and to integrate self-help groups and counselling services into therapy.
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38
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Behnke M, Moulin M, Taube K, Lehmann K, van den Bussche H. Evaluation eines häuslichen Gehtrainings als Form der strukturierten Rehabilitationsnachsorge bei Patienten mit chronisch-obstruktiver Lungenerkrankung (COPD). Gesundheitswesen 2005. [DOI: 10.1055/s-2005-920690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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39
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von Renteln-Kruse W, Dieckmann P, Anders J, Rösler A, Krause T, van den Bussche H. [Medicine in old age and in the elderly. Educational concepts in area Q7 of the accreditation requirements and its first evaluation by students]. Z Gerontol Geriatr 2005; 38:288-92. [PMID: 16133758 DOI: 10.1007/s00391-005-0274-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2004] [Accepted: 11/18/2004] [Indexed: 11/25/2022]
Abstract
Until very recently, medicine in old age was not an obligatory part of the medical students' education in Germany. This has been changed by an educational reform. However, there are no obliging recommendations or procedures on which issues of medicine in old age should be taught. Therefore, we describe the development of a new curriculum, first experiences with the teaching, and the results of its evaluation by the students at the University of Hamburg. As a result, the subjects and the didactic teaching were both well accepted by the students and judged as interesting and instructive.
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Affiliation(s)
- W von Renteln-Kruse
- Medizinisch-Geriatrische Klinik, Albertinen-Haus, Zentrum für Geriatrie und Gerontologie, Wiss. Einrichtung an der Universität Hamburg, Sellhopsweg 18-22, 22459 Hamburg, Germany.
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Abstract
The paper reviews the evidence for the recommendation of cholinesterase inhibitors and asks critical questions concerning the reasons for the discrepancy between the weak evidence and the recommendation of these drugs in therapy guidelines. Furthermore, the argument of the severe underuse of these drugs is examined.
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Affiliation(s)
- H van den Bussche
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg
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41
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Li GL, de Vries JJ, van Steeg TJ, van den Bussche H, Maas HJ, Reeuwijk HJEM, Danhof M, Bouwstra JA, van Laar T. Transdermal iontophoretic delivery of apomorphine in patients improved by surfactant formulation pretreatment. J Control Release 2005; 101:199-208. [PMID: 15588905 DOI: 10.1016/j.jconrel.2004.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Accepted: 09/16/2004] [Indexed: 11/28/2022]
Abstract
The objective of the present study is to evaluate the efficacy and the safety of transdermal iontophoretic delivery of R-apomorphine, a potent dopamine agonist, in combination with surfactant pretreatment in patients with advanced Parkinson's disease. Iontophoresis patches were applied in 16 patients for 3.5 h, with 0.5 h of passive delivery followed by 3 h of current application at a current density of 250 microA/cm2. Eight of these patients were treated with a surfactant formulation prior to iontophoresis. The pharmacokinetics, pharmacodynamic effects, systemic and local side effects of R-apomorphine were assessed. The plasma concentration vs. time profiles upon iontophoresis of R-apomorphine were described successfully by a novel pharmacokinetic model. The model suggests that only 1.9% of the dose that has been released from the patch accumulated in the skin. The patients treated with the surfactant formulations showed a statistically significant increase of bioavailability (from 10.6+/-0.8% to 13.2+/-1.4%) and of the steady state input rate (from 75.3+/-6.6 to 98.3+/-12.1 nmol/cm2 h) compared to the control patients (iontophoresis without absorption enhancers). In five out of eight patients in the study group and in three out of eight patients in the control group, clinical improvement was observed.
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Affiliation(s)
- G L Li
- Department of Pharmaceutical Technology, Leiden Amsterdam Centre for Drug Research, University of Leiden, P.O. Box 9502, 2300 RA, Leiden, The Netherlands
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42
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van den Bussche H, Steinberg B, von Brandis S, Sperber S, Zimmermann T. [Effectiveness of an outpatient disease management programme for chronic heart insufficiency patients]. Gesundheitswesen 2004; 66:656-60. [PMID: 15499509 DOI: 10.1055/s-2004-813593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The effectivity of a disease management programme (DMP) for outpatients suffering from chronic heart insufficiency (CHI) in primary care is presented. The programme is predominantly based on a weekly telephone monitoring by a case manager using a standardised questionnaire that scores CHI-relevant information of the patient. If the score exceeds a predefined limit the patient's general practitioner is alarmed. An observational study including a total of 115 patients indicates a significant decline of the hospital admission rate (p < 0.0001), as the primary outcome measure, whereas the total length of hospitalization remained constant. The findings are compared with other studies' results and the aims of a randomised controlled trial on the efficacy of DMP on patients with chronic heart failure are discussed.
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Affiliation(s)
- H van den Bussche
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf.
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43
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Kaduszkiewicz H, Beck-Bornholdt HP, van den Bussche H, Zimmermann T. Fragliche Evidenz für den Einsatz des Cholinesterasehemmers Donepezil bei Alzheimer-Demenz - eine systematische Übersichtsarbeit. Fortschr Neurol Psychiatr 2004; 72:557-63. [PMID: 15472779 DOI: 10.1055/s-2004-830077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Objective of this systematic review is to determine the level of scientific evidence for the use of Donepezil in Alzheimer's Disease. METHODS Ten randomised controlled double-blind trials testing Donepezil versus Placebo were identified in MEDLINE and EMBASE. All ten trials were included in this systematic review. Following a detailed catalogue of criteria the methodological standard of the ten trials was assessed. RESULTS The authors of eight trials postulated statistically significant differences in favour of Donepezil. Unfortunately, the methodological standard of all studies was insufficient. The methodological shortcomings are discussed in detail. CONCLUSION With regard to severe methodological deficiencies the evidence for the use of Donepezil in moderate to severe Alzheimer's Disease is lacking. But even if the trials had been conducted in a methodologically correct way the clinical relevance of the postulated positive results would have to be questioned.
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Affiliation(s)
- H Kaduszkiewicz
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf.
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44
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van den Bussche H, Dunkelberg S. [Who should decide on applications for medical rehabilitation? A critical reappraisal of the proposals of the Advisory Board on Concerted Action in Health Care]. REHABILITATION 2003; 42:350-3. [PMID: 14677106 DOI: 10.1055/s-2003-812544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Summary. In Germany the allocation of rehabilitation services depends on a decision of one of the social insurance funds. This decision is taken on the basis of an assessment of the application file by a physician of the fund. The general practitioner who may be the best informed professional as to the patients' disability, has no decision power in this allocation process. In 2001, however, the prestigious Advisory Board to the Ministry of Health proposed to leave the allocation to the general practitioner or another physician in office practice, thus restricting the role of the fund to verifying the appropriateness of the decision of the GP. This proposal is reviewed on the basis of the results of a survey among all general practitioners in the four Länder of Hamburg, Schleswig-Holstein, Mecklenburg-Vorpommern and Sachsen-Anhalt (n = 2110; response rate of 46%) done between 1999 and 2001. Furthermore, several steps and measures are proposed in view of increasing the involvement of the GP in the allocation process and of improving the communication between the funds and the general practitioners.
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Affiliation(s)
- H van den Bussche
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg.
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45
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Bullinger M, Morfeld M, Kohlmann T, Nantke J, van den Bussche H, Dodt B, Dunkelberg S, Kirchberger I, Krüger-Bödecker A, Lachmann A, Lang K, Mathis C, Mittag O, Peters A, Raspe HH, Schulz H. [SF-36 Health Survey in Rehabilitation Research. Findings from the North German Network for Rehabilitation Research, NVRF, within the rehabilitation research funding program]. Rehabilitation (Stuttg) 2003; 42:218-25. [PMID: 12938044 DOI: 10.1055/s-2003-41645] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The SF-36 Health Survey and its 12-item abridged form is an instrument for the assessment of health related quality of life that can be used with healthy persons and patient populations. Its use has been recommended within a large German multicentre rehabilitation research programme. The paper examines missing data across all five study projects of the North German Network for Rehabilitation Research (NVRF) as well as psychometric properties of the instrument. In addition, data were compared to representative norm data using the SF-36 (SF-12) in the German National Health Survey. Results showed that there were few missing data in the SF-36. Examining the impact of age, gender and health status yielded effects of higher age and female gender on missing data. Psychometric analyses showed good to excellent results of the instrument in terms of scale fit and reliability. In terms of convergent validity, medium to high correlation of the SF-36 subscales with comparable instruments (e. g. SCL-90-R) could be found. Summarizing, the SF-36/SF-12 can be recommended for use in rehabilitation research. Analyses regarding sensitivity should be conducted in future studies.
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Affiliation(s)
- M Bullinger
- Arbeitsgruppe Lebensqualitätsforschung bei Erwachsenen und Kindern, Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf.
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Lemke R, Peter M, Tirre A, van den Bussche H, Alpers E, Defaire F, Grasselli M, Haupt G, Leuschner C, Meißner U, Stephan U, Wolf M, Breitbart E. Training of Patients with Atopic Dermatitis and Psoriasis vulgaris in an Ambulant Neighborhood Rehabilitation Program: Presentation of a Pilot Project. ACTA ACUST UNITED AC 2001. [DOI: 10.1159/000057972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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47
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van den Bussche H, Kilbinger C. [General medicine in France and in Germany: current situation and future trends]. Cah Sociol Demogr Med 2001; 41:81-102. [PMID: 11433960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The health care system has been built up, both in France and Germany, on the same Bismarckian model: health insurance is financed by contributions from employers and employees, ambulatory care is provided by GPs and specialists in private practice ... etc... Since the 90's, in both countries, there has been a move to strengthen the prestige of GPs and broaden their functions in view of lowering the cost of the health system. However, cost containment has not been the single objective. Several laws have been voted for initiating the gatekeeping function of GPs, controlling the installation of specialists in ambulatory care (private practice), reducing the free choice of care providers by the patients... At the same time, post-graduate training in general practice has been strengthened. Due to historical and cultural reasons, several differences appear in the two countries. For example, confidentiality is strictly observed in Germany and health ID appears only in the French system. We are at the start of a long process. Its success will depend on two conditions: the generalization of the gatekeeping function (which should be entrusted to GPs) and the separation of physicians' income level from the amount of the services they provide to the patients.
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Affiliation(s)
- H van den Bussche
- Unité de Recherche sur les Soins Primaires et les Systèmes de Santé, Faculté de Médecine, Université de Hambourg
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48
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Dunkelberg S, van den Bussche H, Verbeck A, Niemann D. [Comparison of two different educational concepts in general practice]. Z Arztl Fortbild Qualitatssich 2000; 94:765-72. [PMID: 11127785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
In a postgraduate training course in general practice in Hamburg two different educational concepts were used and compared with each other. One was oriented more towards problem-based learning, the other more towards lectures. The participants were asked to fill in a written questionnaire after each day (n = 970) and at the end of the course (n = 26). Both courses achieved good results. On a five point scale the median of the general satisfaction was 4. The problem oriented course, however, was judged better than the other in many respects.
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Affiliation(s)
- S Dunkelberg
- Allgemeinmedizin und Gesundheitssystemforschung, Universität Hamburg.
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49
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Niemann D, van den Bussche H, Dunkelberg S, Becker-Philipps K. [Problem-based learning in graduate general practice education: the why and how]. Z Arztl Fortbild Qualitatssich 2000; 94:143-7. [PMID: 10782511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
This paper describes the experiences with different concepts of problem oriented learning in a postgraduate training course in general practice in Hamburg. It is argued that for postgraduate training of general practitioners a four-step-model is more adequate than the "classical" seven-step-model.
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Affiliation(s)
- D Niemann
- Universitätskrankenhaus Eppendorf, Arbeitsschwerpunkt Allgemeinmedizin und Gesundheitssystemforschung, Hamburg
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50
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Lachmann A, van den Bussche H, Dunkelberg S, Ehrhardt M. [Need for rehabilitation from the viewpoint of the general practitioner]. Rehabilitation (Stuttg) 1999; 38 Suppl 2:S148-53. [PMID: 10652713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
In Germany, the general practitioner plays an important role in the allocation process of rehabilitative measures. A survey concerning the questions of need, demand and effectiveness of medical rehabilitation measures as seen from the general practitioner's perspective in Hamburg, Schleswig-Holstein und Halle/Saale (n = 956) in 1999 shows that general practitioners have a rather positive attitude towards rehabilitation in general. With regard to the different measures within the rehabilitation system they show a differentiated opinion. As they see a large percentage of over- and underuse of rehabilitation they would appreciate that their information on the patient would be more intensively taken into account in the allocation process.
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Affiliation(s)
- A Lachmann
- Arbeitsschwerpunkt Allgemeinmedizin und Gesundheitssystemforschung, Universitätskrankenhaus Eppendorf, Hamburg
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