1
|
Stamer T, Herchenröder M, Klee MW, Götz K, Steinhäuser J. [Experience with orthopaedic insoles-a cross-sectional study]. Orthopadie (Heidelb) 2024; 53:291-296. [PMID: 38379032 PMCID: PMC10978688 DOI: 10.1007/s00132-024-04476-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Orthopaedic insoles (OI) are used to treat a variety of foot problems. OBJECTIVES The aim of this cross-sectional study was to investigate the perceptions of the treatment with OI among the manufacturers of the OIs, the orthopaedic technicians (OT). METHODS OT from the federal states of Schleswig-Holstein and Lower Saxony in Germany were invited to take part in a survey. The questions included, among others, the number of prescriptions for the production of an OI per month and the materials used. Descriptive statistics, subgroup analyses and a linear regression analysis were performed. RESULTS Of the 312 questionnaires distributed, 159 were completed (response rate 51%). Most of the respondents were male (80%). The average age of the participants was 50. On average, OT produced 290 OI per month, with plastic being the most commonly used material (73%). OT with less than 20 years of professional experience are more likely to follow the doctor's instructions when producing OI than OT with more than 20 years of professional experience. The latter are more likely to base their decisions regarding the manufacture and issuing of OI on their own experience. CONCLUSIONS The production and issuing process of OI differs among OT. The different professional perspectives of the OT could play a role here, as does the lack of a standardized procedure. The factors listed in this study represent potential starting points for future research projects that could contribute to the development of evidence-based standards.
Collapse
Affiliation(s)
- Tjorven Stamer
- Institut für Familienmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - Minettchen Herchenröder
- Institut für Familienmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Malte W Klee
- Institut für Familienmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Katja Götz
- Institut für Familienmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Jost Steinhäuser
- Institut für Familienmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| |
Collapse
|
2
|
Strumann C, Pfau L, Wahle L, Schreiber R, Steinhäuser J. Designing and Implementation of a Digitalized Intersectoral Discharge Management System and Its Effect on Readmissions: Mixed Methods Approach. J Med Internet Res 2024; 26:e47133. [PMID: 38530343 PMCID: PMC11005442 DOI: 10.2196/47133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/13/2023] [Accepted: 01/31/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Digital transformation offers new opportunities to improve the exchange of information between different health care providers, including inpatient, outpatient and care facilities. As information is especially at risk of being lost when a patient is discharged from a hospital, digital transformation offers great opportunities to improve intersectoral discharge management. However, most strategies for improvement have focused on structures within the hospital. OBJECTIVE This study aims to evaluate the implementation of a digitalized discharge management system, the project "Optimizing instersectoral discharge management" (SEKMA, derived from the German Sektorübergreifende Optimierung des Entlassmanagements), and its impact on the readmission rate. METHODS A mixed methods design was used to evaluate the implementation of a digitalized discharge management system and its impact on the readmission rate. After the implementation, the congruence between the planned (logic model) and the actual intervention was evaluated using a fidelity analysis. Finally, bivariate and multivariate analyses were used to evaluate the effectiveness of the implementation on the readmission rate. For this purpose, a difference-in-difference approach was adopted based on routine data of hospital admissions between April 2019 and August 2019 and between April 2022 and August 2022. The department of vascular surgery served as the intervention group, in which the optimized discharge management was implemented in April 2022. The departments of internal medicine and cardiology formed the control group. RESULTS Overall, 26 interviews were conducted, and we explored 21 determinants, which can be categorized into 3 groups: "optimization potential," "barriers," and "enablers." On the basis of these results, 19 strategies were developed to address the determinants, including a lack of networking among health care providers, digital information transmission, and user-unfriendliness. On the basis of these strategies, which were prioritized by 11 hospital physicians, a logic model was formulated. Of the 19 strategies, 7 (37%; eg, electronic discharge letter, providing mobile devices to the hospital's social service, and generating individual medication plans in the format of the national medication plan) have been implemented in SEKMA. A survey on the fidelity of the application of the implemented strategies showed that 3 of these strategies were not yet widely applied. No significant effect of SEKMA on readmissions was observed in the routine data of 14,854 hospital admissions (P=.20). CONCLUSIONS This study demonstrates the potential of optimizing intersectoral collaboration for patient care. Although a significant effect of SEKMA on readmissions has not yet been observed, creating a digital ecosystem that connects different health care providers seems to be a promising approach to ensure secure and fast networking of the sectors. The described intersectoral optimization of discharge management provides a structured template for the implementation of a similar local digital care networking infrastructure in other care regions in Germany and other countries with a similarly fragmented health care system.
Collapse
Affiliation(s)
- Christoph Strumann
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Lisa Pfau
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Laila Wahle
- Lacanja GmbH Health Innovation Port, Hamburg, Germany
| | - Raphael Schreiber
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| |
Collapse
|
3
|
Strumann C, Engler NJ, von Meissner WCG, Blickle PG, Steinhäuser J. Quality of care in patients with hypertension: a retrospective cohort study of primary care routine data in Germany. BMC Prim Care 2024; 25:54. [PMID: 38342910 PMCID: PMC10859029 DOI: 10.1186/s12875-024-02285-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/24/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Hypertension is a leading cause of morbidity and mortality if not properly managed. Primary care has a major impact on these outcomes if its strengths, such as continuity of care, are deployed wisely. The analysis aimed to evaluate the quality of care for newly diagnosed hypertension in routine primary care data. METHODS In the retrospective cohort study, routine data (from 2016 to 2022) from eight primary care practices in Germany were exported in anonymized form directly from the electronic health record (EHR) systems and processed for this analysis. The analysis focused on five established quality indicators for the care of patients who have been recently diagnosed with hypertension. RESULTS A total of 30,691 patients were treated in the participating practices, 2,507 of whom have recently been diagnosed with hypertension. Prior to the pandemic outbreak, 19% of hypertensive patients had blood pressure above 140/90 mmHg and 68% received drug therapy (n = 1,372). After the pandemic outbreak, the proportion of patients with measured blood pressure increased from 63 to 87%, while the other four indicators remained relatively stable. Up to 80% of the total variation of the quality indicators could be explained by individual practices. CONCLUSION For the majority of patients, diagnostic procedures are not used to the extent recommended by guidelines. The analysis showed that quality indicators for outpatient care could be mapped onto the basis of routine data. The results could easily be reported to the practices in order to optimize the quality of care.
Collapse
Affiliation(s)
- Christoph Strumann
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Luebeck, Schleswig-Holstein, Germany.
| | - Nicola J Engler
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Luebeck, Schleswig-Holstein, Germany
| | - Wolfgang C G von Meissner
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Luebeck, Schleswig-Holstein, Germany
- Hausärzte Am Spritzenhaus, Family Practice, Baiersbronn, Germany
| | - Paul-Georg Blickle
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Luebeck, Schleswig-Holstein, Germany
- Hausärzte Am Spritzenhaus, Family Practice, Baiersbronn, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Luebeck, Schleswig-Holstein, Germany
| |
Collapse
|
4
|
Goetz K, Oldenburg D, Strobel CJ, Steinhäuser J. The influence of fears of perceived legal consequences on general practitioners' practice in relation to defensive medicine - a cross-sectional survey in Germany. BMC Prim Care 2024; 25:23. [PMID: 38216861 PMCID: PMC10785451 DOI: 10.1186/s12875-024-02267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Medical decisions are influenced by a variety of factors also by legal requirements and feelings of uncertainty, which results in the term defensive medicine. The aim of the study was to evaluate the influence of fears of perceived legal consequences on the practice of defensive medicine from the perspective of German general practitioners (GPs). METHODS A cross-sectional study was performed from April to May 2022. GPs were invited via an e-mail newsletter of the Institute for Continuing Education in Family Medicine in the German Association of General Practitioners and via an online platform of the German College of General Practitioners and Family Physicians. The evaluation of legal fears, the general assessment of defensive medicine and reasons for and the frequency of defensive medical measures were surveyed in this study. Beside descriptive analyses, a stepwise linear regression analysis was used to explore potential associations between for the primary outcome variable 'fears of legal consequences' on the practice of defensive medicine. RESULTS 413 general practitioners with an average age of 50 years (51% female) responded. The majority rated their fears of legal consequences as low to average whereas for almost a third (27%, n = 113) the fears were strong to very strong. Regarding legal fears, the physician-patient-relationship played a fairly to very large role for 48% (n = 198) of the respondents. One third estimated the probability of being sued civilly in the next 10 years as rather high to very high. 47% (n = 193) of the participants assumed that the risk of being sued could mostly to very much be reduced by defensive medicine. Legal self-protection was for 38% of the responders (n = 157) quite frequently to very frequently a reason for acting defensively. Consequently, half of the respondents stated that they performed unnecessary laboratory tests at least once per week and 40% indicated that they referred patients for radiological diagnostics without medical indication once per month. CONCLUSIONS As legal fears have an influence on medical practice and legal self-protection being a frequent reason for defensive behaviour, understanding and knowledge of the law should be improved by legal education at university and further training of post-graduate trainees and practicing physicians should be implemented. Additionally, a more in-depth enlightenment of society about the phenomenon of Protective and Defensive Medicine and its consequences could be a possibility to decrease the perceived fears of legal consequences on the physicians' side.
Collapse
Affiliation(s)
- Katja Goetz
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - Dorothee Oldenburg
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christina Jana Strobel
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| |
Collapse
|
5
|
Cummerow J, Wienecke C, Engler N, Marahrens P, Gruening P, Steinhäuser J. Identifying Existing Evidence to Potentially Develop a Machine Learning Diagnostic Algorithm for Cough in Primary Care Settings: Scoping Review. J Med Internet Res 2023; 25:e46929. [PMID: 38096024 PMCID: PMC10755665 DOI: 10.2196/46929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/19/2023] [Accepted: 10/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Primary care is known to be one of the most complex health care settings because of the high number of theoretically possible diagnoses. Therefore, the process of clinical decision-making in primary care includes complex analytical and nonanalytical factors such as gut feelings and dealing with uncertainties. Artificial intelligence is also mandated to offer support in finding valid diagnoses. Nevertheless, to translate some aspects of what occurs during a consultation into a machine-based diagnostic algorithm, the probabilities for the underlying diagnoses (odds ratios) need to be determined. OBJECTIVE Cough is one of the most common reasons for a consultation in general practice, the core discipline in primary care. The aim of this scoping review was to identify the available data on cough as a predictor of various diagnoses encountered in general practice. In the context of an ongoing project, we reflect on this database as a possible basis for a machine-based diagnostic algorithm. Furthermore, we discuss the applicability of such an algorithm against the background of the specifics of general practice. METHODS The PubMed, Scopus, Web of Science, and Cochrane Library databases were searched with defined search terms, supplemented by the search for gray literature via the German Journal of Family Medicine until April 20, 2023. The inclusion criterion was the explicit analysis of cough as a predictor of any conceivable disease. Exclusion criteria were articles that did not provide original study results, articles in languages other than English or German, and articles that did not mention cough as a diagnostic predictor. RESULTS In total, 1458 records were identified for screening, of which 35 articles met our inclusion criteria. Most of the results (11/35, 31%) were found for chronic obstructive pulmonary disease. The others were distributed among the diagnoses of asthma or unspecified obstructive airway disease, various infectious diseases, bronchogenic carcinoma, dyspepsia or gastroesophageal reflux disease, and adverse effects of angiotensin-converting enzyme inhibitors. Positive odds ratios were found for cough as a predictor of chronic obstructive pulmonary disease, influenza, COVID-19 infections, and bronchial carcinoma, whereas the results for cough as a predictor of asthma and other nonspecified obstructive airway diseases were inconsistent. CONCLUSIONS Reliable data on cough as a predictor of various diagnoses encountered in general practice are scarce. The example of cough does not provide a sufficient database to contribute odds to a machine learning-based diagnostic algorithm in a meaningful way.
Collapse
Affiliation(s)
- Julia Cummerow
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Christin Wienecke
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Nicola Engler
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Philip Marahrens
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Philipp Gruening
- Institute for Neuro- and Bioinformatics, University of Lübeck, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| |
Collapse
|
6
|
Adje M, Steinhäuser J, Laekeman M, Rogan S, Karstens S. Evaluation of a blended learning approach on stratified care for physiotherapy bachelor students. BMC Med Educ 2023; 23:545. [PMID: 37525131 PMCID: PMC10391990 DOI: 10.1186/s12909-023-04517-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Stratified models of care are valuable for addressing psychosocial factors which influence the outcome of patients with musculoskeletal disorders. Introducing such models in undergraduate training has the potential to propagate this knowledge with evidence and foster its implementation. The objective of this paper is to explore the perception and changes in the fear-avoidance beliefs of physiotherapy students participating in a developed blended learning course on stratified care. METHODOLOGY A mixed-methods with a convenient sample of two consecutive cohorts were given a blended learning course on stratified care for patients with low back pain. The blended learning course comprised scientific rudiments and application of stratified care in clinical practice conceptualised using the KERN' 6-step approach. The exam scores, perceptions, performance on self-reflection-tests and pre- and post-scores on The Tampa Scale for Kinesiophobia for Physiotherapists' (TSK-PT) were obtained. After gaining clinical experience, participants were invited to discuss their clinical experiences and perceptions in workshops. The quantitative data was analysed explorative-descriptively. The qualitative data was analysed following an inductive coding system with constant comparisons. RESULTS Ninety-one participants consented to the evaluation (mean age = 22.9 ± 1.6 years), 66% were female. Exam scores correlated with time spent in training (r = 0.30) and scores on self-reflection-tests 1 and 2 (r = 0.40 and r = 0.41). Participants in both cohorts described the learning resources as promoting their interest in the subject (72% and 94%), up-to-date (91% and 93%) and helpful (91% and 97%). The fear-avoidance scores for participants decreased from 53.5 (± 9.96) to 40.1 (± 12.4) with a large effect size (d = 1.18). The regression model [F (2, 49) = 1151.2, p < 0.001] suggests that pre-TSK-PT and the interest of participants in the training predicted post-TSK-PT. The workshop participants (n = 62) all worked in clinical practice. Emerging from the analysis were 4 categories (evolving to maturity in practice, perceiving determinants of stratified care, strategising for implementation and adopting an outlook for future practice). CONCLUSION The quality of engagement in learning, training strategy and interest in the subject contributes immensely to learning outcomes. This blended learning course was successful in reducing kinesiophobia and influencing the participants' attitude towards care with the potential of being translated into long-term practice.
Collapse
Affiliation(s)
- Mishael Adje
- Therapeutic Sciences, Department of Computer Science, Trier University of Applied Sciences, Trier, Germany.
- Institute of Family Medicine, University of Luebeck, Luebeck, Germany.
| | - Jost Steinhäuser
- Institute of Family Medicine, University of Luebeck, Luebeck, Germany
| | - Marjan Laekeman
- Department of Physiological Psychology, University of Bamberg, Bochum, Germany
| | - Slavko Rogan
- Division of Physiotherapy, School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Sven Karstens
- Therapeutic Sciences, Department of Computer Science, Trier University of Applied Sciences, Trier, Germany
| |
Collapse
|
7
|
Hellfritz MS, Waschkau A, Steinhäuser J. Experiences with the quality of telemedical care in an offshore setting - a qualitative study. BMC Health Serv Res 2023; 23:661. [PMID: 37340414 DOI: 10.1186/s12913-023-09664-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The evaluation and the improvement of the quality of telemedical care become increasingly important in times where this type of care is offered to a broad number of patients more and more. As telemedical care in an offshore setting has already been in use for decades, analyzing the extensive experience of offshore paramedics using telemedical care can help identify determinants of quality. Therefore, the aim of this study was to explore determinants of the quality of telemedical care using the experiences of experienced offshore paramedics. METHODS We conducted a qualitative analysis of 22 semi-structured interviews with experienced offshore paramedics. The results were categorized in a hierarchical category system using content analysis as described by Mayring. RESULTS All 22 participants were males, having a mean of 3.9 years of experience working with telemedicine support offshore. Generally, participants stated that for them telemedical interaction did not differ much from personal interaction. However, the offshore paramedics personality and way to communicate were mentioned to impact the quality of telemedical care as it influenced the way cases were presented. Furthermore, interviewees described it to be impossible to use telemedicine in cases of an emergency as it was too time-consuming, technically too complex, and lead to cognitive overload as other tasks with higher priority needed their attention. Three determinants of a successful consultation were mentioned: low levels of complexity in the reason for consultation, telemedical guidance training for the teleconsultant physician and for the delegatee. CONCLUSION Appropriate indications for telemedical consultation, communication training of consultation partners, and the impact of personality need to be addressed to enhance the quality of future telemedical care.
Collapse
Affiliation(s)
- Michael Stefan Hellfritz
- Universität zu Lübeck, Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - Alexander Waschkau
- Universität zu Lübeck, Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Jost Steinhäuser
- Universität zu Lübeck, Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| |
Collapse
|
8
|
Stamer T, Steinhäuser J, Flägel K. Artificial Intelligence Supporting the Training of Communication Skills in the Education of Health Care Professions: Scoping Review. J Med Internet Res 2023; 25:e43311. [PMID: 37335593 DOI: 10.2196/43311] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/10/2023] [Accepted: 04/26/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Communication is a crucial element of every health care profession, rendering communication skills training in all health care professions as being of great importance. Technological advances such as artificial intelligence (AI) and particularly machine learning (ML) may support this cause: it may provide students with an opportunity for easily accessible and readily available communication training. OBJECTIVE This scoping review aimed to summarize the status quo regarding the use of AI or ML in the acquisition of communication skills in academic health care professions. METHODS We conducted a comprehensive literature search across the PubMed, Scopus, Cochrane Library, Web of Science Core Collection, and CINAHL databases to identify articles that covered the use of AI or ML in communication skills training of undergraduate students pursuing health care profession education. Using an inductive approach, the included studies were organized into distinct categories. The specific characteristics of the studies, methods and techniques used by AI or ML applications, and main outcomes of the studies were evaluated. Furthermore, supporting and hindering factors in the use of AI and ML for communication skills training of health care professionals were outlined. RESULTS The titles and abstracts of 385 studies were identified, of which 29 (7.5%) underwent full-text review. Of the 29 studies, based on the inclusion and exclusion criteria, 12 (3.1%) were included. The studies were organized into 3 distinct categories: studies using AI and ML for text analysis and information extraction, studies using AI and ML and virtual reality, and studies using AI and ML and the simulation of virtual patients, each within the academic training of the communication skills of health care professionals. Within these thematic domains, AI was also used for the provision of feedback. The motivation of the involved agents played a major role in the implementation process. Reported barriers to the use of AI and ML in communication skills training revolved around the lack of authenticity and limited natural flow of language exhibited by the AI- and ML-based virtual patient systems. Furthermore, the use of educational AI- and ML-based systems in communication skills training for health care professionals is currently limited to only a few cases, topics, and clinical domains. CONCLUSIONS The use of AI and ML in communication skills training for health care professionals is clearly a growing and promising field with a potential to render training more cost-effective and less time-consuming. Furthermore, it may serve learners as an individualized and readily available exercise method. However, in most cases, the outlined applications and technical solutions are limited in terms of access, possible scenarios, the natural flow of a conversation, and authenticity. These issues still stand in the way of any widespread implementation ambitions.
Collapse
Affiliation(s)
- Tjorven Stamer
- Institute of Family Medicine, University Hospital Schleswig-Holstein Luebeck Campus, Luebeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein Luebeck Campus, Luebeck, Germany
| | - Kristina Flägel
- Institute of Family Medicine, University Hospital Schleswig-Holstein Luebeck Campus, Luebeck, Germany
| |
Collapse
|
9
|
Assing Hvidt E, Atherton H, Keuper J, Kristiansen E, Lüchau EC, Lønnebakke Norberg B, Steinhäuser J, van den Heuvel J, van Tuyl L. Low Adoption of Video Consultations in Post-COVID-19 General Practice in Northern Europe: Barriers to Use and Potential Action Points. J Med Internet Res 2023; 25:e47173. [PMID: 37213196 DOI: 10.2196/47173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023] Open
Abstract
In the wake of the COVID-19 pandemic, video consultation was introduced in general practice in many countries around the world as a solution to provide remote health care to patients. It was assumed that video consultation would find widespread adoption in post-COVID-19 general practice. However, adoption rates remain low across countries in Northern Europe, suggesting that barriers to its use exist among general practitioners and other practice staff. In this viewpoint, we take a comparative approach, reflecting on similarities and differences in implementation conditions of video consultations in 5 Northern European countries' general practice settings that might have created barriers to its use within general practice. We convened at a cross-disciplinary seminar in May 2022 with researchers and clinicians from 5 Northern European countries with expertise in digital care in general practice, and this viewpoint emerged out of dialogues from that seminar. We have reflected on barriers across general practice settings in our countries, such as lacking technological and financial support for general practitioners, that we feel are critical for adoption of video consultation in the coming years. Furthermore, there is a need to further investigate the contribution of cultural elements, such as professional norms and values, to adoption. This viewpoint may inform policy work to ensure that a sustainable level of video consultation use can be reached in the future, one that reflects the reality of general practice settings rather than policy optimism.
Collapse
Affiliation(s)
- Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Helen Atherton
- Unit of Academic Primary Care, Warwick Medical School, Coventry, United Kingdom
| | - Jelle Keuper
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg Universit, Tilburg, Netherlands
| | - Eli Kristiansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Elle Christine Lüchau
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | - Lilian van Tuyl
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| |
Collapse
|
10
|
Kötter T, Hoschek M, Pohontsch NJ, Steinhäuser J. [Planetary Health in the mandatory undergraduate medical curriculum - A qualitative study to evaluate a teaching/learning intervention]. Z Evid Fortbild Qual Gesundhwes 2023:S1865-9217(23)00057-0. [PMID: 37208274 DOI: 10.1016/j.zefq.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/16/2023] [Accepted: 03/26/2023] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Climate change is the greatest threat to human health and therefore has a direct impact on the work of physicians. At the same time, the health sector is also an originator of pollutants that burden the climate. The concept of Planetary Health describes, among other things, ways in which the health sector can counter the effects of climate change. Nevertheless, the inclusion of contents on sustainable action in the education of health professionals has not been made mandatory to date. The aim of this study is to answer the question of how an intervention has to be designed so that medical students specifically develop an interest in dealing with the topic on their own. METHODS The intervention consisted ofFor evaluation purposes, a qualitative study with guided focus group interviews of attendees was conducted. The fully transcribed focus group transcripts were analysed using Mayring's structuring qualitative content analysis. Additionally, we checked the semester evaluation for feedback on the intervention. RESULTS Four focus groups comprising n = 14 medical students (11 female, 3 male) were conducted. Dealing with Planetary Health as a topic during medical education was considered relevant. The partially restrained to negative reaction of the teaching practice staff involved to the checklist had a demotivating impact. A lack of time was given as a further reason for not dealing with the topic independently. Participants suggested integrating specific Planetary Health content in mandatory courses and considered environmental medicine to be especially suited. As a didactic method, case-based working in small groups seemed to be particularly appropriate. In the semester evaluation, we found both approving and critical commentaries. DISCUSSION Participants considered Planetary Health a relevant topic in the context of medical education. The intervention proved to be of limited use in motivating students to deal with the topic independently. A longitudinal integration of the topic in the medical curriculum seems to be appropriate. CONCLUSIONS From the students' perspective, it is important to teach and acquire knowledge and skills regarding to Planetary Health in the future. Despite a high level of interest, additional offers are not being utilised due to a lack of time and should therefore be made part of the mandatory curriculum, where possible.
Collapse
Affiliation(s)
- Thomas Kötter
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland.
| | - Mieke Hoschek
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Nadine Janis Pohontsch
- Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Jost Steinhäuser
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| |
Collapse
|
11
|
Wilfling D, Flägel K, Steinhäuser J, Balzer K. Specifics of and training needs in the inter-professional home care ofpeople with dementia. Pflege 2023; 36:67-76. [PMID: 35318856 DOI: 10.1024/1012-5302/a000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: Successful home care for people living with dementia (PLwD) allows them to live in their own home environment for as long as possible. Current findings indicate a need for further development of medical and nursing knowledge and skills in evidence-based collaborative care for these patients. Aim: To identify specifics of inter-professional care for PLwD and training needs of home care nurses and general practitioners involved in care. Method: A multi-perspective qualitative study was conducted, comprising focus groups as well as individual interviews. Focus groups and interviews followed a semi-structured topic guide. Interview data was digitally recorded and transcribed verbatim, followed by a thematic framework analysis. Results: The sample consisted of nine nurses, one medical assistant, three general practitioners and nine family caregivers of PLwD. Five themes related to inter-professional home care were inductively developed: challenges in outpatient dementia care, challenges in collaboration, insufficient healthcare infrastructure, competencies needed in dementia care, and training requirements. Challenges were a lacking flow of information as well as continuity and organization of care. Home care nurses and family caregivers complained about missing communication skills in health professionals involved in the care of PLwD. Conclusions: The interviews revealed heterogeneous training needs of home care nursing staff and general practitioners that can be addressed by an inter-professional training course.
Collapse
Affiliation(s)
- Denise Wilfling
- Institute of Social Medicine and Epidemiology, Nursing Research Group, University of Lübeck, Germany
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Kristina Flägel
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Katrin Balzer
- Institute of Social Medicine and Epidemiology, Nursing Research Group, University of Lübeck, Germany
| |
Collapse
|
12
|
Strobel CJ, Oldenburg D, Steinhäuser J. Factors influencing defensive medicine-based decision-making in primary care: A scoping review. J Eval Clin Pract 2023; 29:529-538. [PMID: 36433885 DOI: 10.1111/jep.13799] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Medical decision-making processes in primary care are influenced by defensive medical practice. This involves a high possibility for negative consequences on many levels, for example, patient's health, health care system costs and a crisis of trust in the patient-doctor relationship. Aim of this review was to identify factors of defensive medicine-based decision-making in primary care. METHODS This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR) guidelines and included systematic research on MEDLINE, Google Scholar and two German databases for additional grey literature. References provided further literature. Articles in English and German published from 1 January 1982 to 15 June 2022 were assessed. RESULTS From 911 publications screened, 13 publications [6 qualitative studies and 7 quantitative (3 cross-sectional) studies] were included. In these, four main categories of factors influencing defensive medical practice were identified: (social) media, patients adopting a consumer attitude, health care system based working conditions and physician's tolerance for uncertainty. Pressure deriving from these four different sources is exerted on the general practitioner and may result in a defensive medical decision behaviour. CONCLUSIONS Four categories on influencing factors of defensive medicine could be identified. Strategies to tolerate uncertainty should be trained in under- and postgraduate training.
Collapse
Affiliation(s)
- Christina J Strobel
- Institute of Family Medicine, University Medical Center Schleswig Holstein, Lübeck, Germany
| | - Dorothee Oldenburg
- Institute of Family Medicine, University Medical Center Schleswig Holstein, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Center Schleswig Holstein, Lübeck, Germany
| |
Collapse
|
13
|
Engler NJ, Steinhäuser J, Strumann C. Psychometric properties of the GP-Patient Relationship Questionnaire as an instrument for quality improvement in Germany. Z Evid Fortbild Qual Gesundhwes 2023; 177:41-47. [PMID: 36959066 DOI: 10.1016/j.zefq.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/27/2022] [Accepted: 12/08/2022] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Since the patient-doctor relationship (PDR) plays a crucial role in patient primary health care and management, the evaluation of the PDR from both, the patients' and primary care physicians', perspectives is an important approach to improve the quality of primary care. However, although there are a variety of questionnaires surveying the patients' view of the PDR, only few consider the physicians' perspective. The purpose of this study was to develop a questionnaire that adds the physicians' perspective to an existing PDR instrument and thus enables a mutual assessment of the relationship. METHODS This study was embedded in a German project aiming at enhancing the adherence in patients with hypertension. Patients and primary care physicians were asked to complete a questionnaire concerning their PDR. The Patient-Doctor Relationship Questionnaire (PDRQ-9) was used to assess the patients' perspective. For the physicians, the PDRQ-9 items were adapted to the physicians' perspective resulting in the GP-Patient Relationship Questionnaire (GPPR). The Helping Alliance Questionnaire (HAQ) was used for external validation. RESULTS A total of 60 physician questionnaires and 50 matched pairs of questionnaires from physicians and patients were included in the analyses. Within the analysis, notable deviations were found for one Item, nevertheless the calculated Cronbach's α of 0.89 showed a high internal consistency of the 9-item questionnaire. External validation showed a high correlation of the GPPR with the HAQ, confirming the good psychometric properties demonstrated for the overall instrument. DISCUSSION Overall, this initial validation study revealed good psychometric properties of the GPPR. A retest will be performed in the course of the overall project to confirm the reliability of the newly developed questionnaire. CONCLUSION A new questionnaire to assess the physicians' perspectives on the PDR was successfully developed to improve adherence depending processes of quality improving in primary care.
Collapse
Affiliation(s)
- Nicola Janine Engler
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
| | - Jost Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Christoph Strumann
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| |
Collapse
|
14
|
Stamer T, Essers G, Steinhäuser J, Flägel K. From summative MAAS Global to formative MAAS 2.0 - a workshop report. GMS J Med Educ 2023; 40:Doc9. [PMID: 36923316 PMCID: PMC10010769 DOI: 10.3205/zma001591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/10/2022] [Accepted: 11/23/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND The MAAS Global (Maastricht History-taking and Advice Scoring List) is an internationally widely-used instrument in under- and postgraduate medical education. The focus is on the assessment of medical communication and clinical skills. The assessment tool, which has also been used in Germany since 2015, has a high-quality design (e.g. comprehensible structure, appropriate complexity), good psychometric properties and is very user-friendly. An update of MAAS Global, MAAS 2.0, was published in March 2021 with a new and greater focus on context and the formative. METHOD The revised version of the MAAS 2.0 assessment sheet was translated into German with the authors' permission. Open questions were discussed with the revision process project manager. RESULTS The revision was carried out with a view to focusing on the patient's frame of reference, removing ambiguities identified previously while using MAAS Global, and closer alignment with the underlying Calgary-Cambridge model. Furthermore, the scale used for the evaluation was modified and now uses a formative evaluation range without grade-related classification. CONCLUSION With the content reorientation of MAAS Global to MAAS 2.0, and the associated focus on frame of reference, context, the formative, the revision presented here sets new priorities for future evaluations in the context of under- and postgraduate medical education and the assessment of medical patient communication in general.
Collapse
Affiliation(s)
- Tjorven Stamer
- University Hospital Schleswig-Holstein, Campus Lübeck, Institute of Family Medicine, Lübeck, Germany
| | - Geurt Essers
- Network of General Practice Training Institutes in the Netherlands, Utrecht, The Netherlands
| | - Jost Steinhäuser
- University Hospital Schleswig-Holstein, Campus Lübeck, Institute of Family Medicine, Lübeck, Germany
| | - Kristina Flägel
- University Hospital Schleswig-Holstein, Campus Lübeck, Institute of Family Medicine, Lübeck, Germany
| |
Collapse
|
15
|
Adje M, Steinhäuser J, Stevenson K, Mbada C, Alonge V, Karstens S. Developing tailored intervention strategies for implementation of stratified care to low back pain with physiotherapists in Nigeria: a Delphi study. BMC Health Serv Res 2023; 23:134. [PMID: 36759830 PMCID: PMC9909884 DOI: 10.1186/s12913-023-09123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Stratified care approach involving use of the STarT-Back tool to optimise care for patients with low back pain is gaining widespread attention in western countries. However, adoption and implementation of this approach in low-and-middle-income countries will be restricted by context-specific factors that need to be addressed. This study aimed to develop with physiotherapists, tailored intervention strategies for the implementation of stratified care for patients with low back pain. METHODS A two-round web-based Delphi survey was conducted among purposively sampled physiotherapists with a minimum of three years of clinical experience, with post-graduation certification or specialists. Thirty statements on barriers and enablers for implementation were extracted from the qualitative phase. Statements were rated by a Delphi panel with additional open-ended feedback. After each Delphi round, participants received feedback which informed their subsequent responses. Additional qualitative feedback were analysed using qualitative content analysis. The criteria for consensus and stability were pre-determined using percentage agreement (≥ 75%), median value (≥ 4), Inter-quartile range (≤ 1), and Wilcoxon matched-pairs test respectively. RESULTS Participants in the first round were 139 and 125 of them completed the study, yielding a response rate of 90%. Participants were aged 35.2 (SD6.6) years, and 55 (39.6%) were female. Consensus was achieved in 25/30 statements. Wilcoxon's test showed stability in responses after the 5 statements failed to reach consensus: 'translate the STarT-Back Tool to pidgin language' 71% (p = 0.76), 'begin implementation with government hospitals' 63% (p = 0.11), 'share knowledge with traditional bone setters' 35% (p = 0.67), 'get second opinion on clinician's advice' 63% (p = 0.24) and 'carry out online consultations' 65% (p = 0.41). Four statements strengthened by additional qualitative data achieved the highest consensus: 'patient education' (96%), 'quality improvement appraisals' (96%), 'undergraduate training on psychosocial care' (96%) and 'patient-clinician communication' (95%). CONCLUSION There was concordance of opinion that patients should be educated to correct misplaced expectations and proper time for communication is vital to implementation. This communication should be learned at undergraduate level, and for already qualified clinicians, quality improvement appraisals are key to sustained and effective care. These recommendations provide a framework for future research on monitored implementation of stratified care in middle-income countries.
Collapse
Affiliation(s)
- Mishael Adje
- Therapeutic Sciences, Trier University of Applied Sciences, Trier, Germany. .,Institute of Family Medicine, University of Luebeck, Luebeck, Germany.
| | - Jost Steinhäuser
- grid.4562.50000 0001 0057 2672Institute of Family Medicine, University of Luebeck, Luebeck, Germany
| | - Kay Stevenson
- grid.9757.c0000 0004 0415 6205The Impact Accelerator Unit, The Medical School Keele University, Keele, United Kingdom
| | - Chidozie Mbada
- grid.25627.340000 0001 0790 5329Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Victor Alonge
- Department of Physiotherapy, Exercise and Sports, LUNEX International University of Health, Differdange, Luxembourg
| | - Sven Karstens
- grid.434099.30000 0001 0475 0480Therapeutic Sciences, Department of Computer Science, Trier University of Applied Sciences, Trier, Germany
| |
Collapse
|
16
|
Wewetzer L, Held LA, Goetz K, Steinhäuser J. Determinants of the implementation of artificial intelligence-based screening for diabetic retinopathy-a cross-sectional study with general practitioners in Germany. Digit Health 2023; 9:20552076231176644. [PMID: 37274367 PMCID: PMC10233602 DOI: 10.1177/20552076231176644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Objective Diabetic retinopathy (DR) may lead to irreversible damage to the eye and cause blindness if diagnosed in its advanced stages. Artificial intelligence (AI) may support screening and contribute to a timely diagnosis. The aim of this study was to evaluate factors that might influence the success of implementing AI-supported devices for DR screenings in general practice. Methods A questionnaire with modules on attitudes toward digital solutions, technical factors, perceived patient perspectives, and sociodemographic data was constructed and 2100 general practitioners (GPs) in Germany were invited to participate via a personal letter. Results Two hundred nine physicians participated in the survey (10% response rate, mean age = 54 years, 46% women). Acquisition costs (mean = 1.37), remuneration (mean = 1.46), and running costs (mean = 1.40) were considered particularly relevant in the context of AI-based screening tools. GPs indicated that a mean of €27.00 (SD = 19) was considered to be an appropriate reimbursement for an AI-based screening for DR in their practice. Less relevant factors were availability of a smartphone used in the practice (mean = 2.53) and time until the examination result was available (mean = 2.29). Important technical factors were practicability of the device (mean = 1.27), unproblematic installation of any necessary software (mean = 1.34), and the integrability into the practice information system (mean = 1.44). Considering the patient welfare, physicians rated the accuracy of the examination, omission of pupil dilation, and the duration of the examination as the most important factors. Participants ranked the factors broadening the scope of care, strengthening the primary care (PC) range, and signs of modern medical practice as the most important factors for making an AI-based screening tool attractive for their practice. Conclusions These findings serve as a basis for a successful implementation of AI-assisted screening devices in PC and might facilitate early screenings for ophthalmological diseases in general practice. The most relevant barriers that need to be overcome for a successful implementation of such tools include clarification of the costs and reimbursement policies.
Collapse
Affiliation(s)
- Larisa Wewetzer
- Institute for Family Medicine, University Medical Center
Schleswig-Holstein, Lubeck Campus, Lubeck, Germany
| | - Linda A. Held
- Institute for Family Medicine, University Medical Center
Schleswig-Holstein, Lubeck Campus, Lubeck, Germany
| | - Katja Goetz
- Institute for Family Medicine, University Medical Center
Schleswig-Holstein, Lubeck Campus, Lubeck, Germany
| | - Jost Steinhäuser
- Institute for Family Medicine, University Medical Center
Schleswig-Holstein, Lubeck Campus, Lubeck, Germany
| |
Collapse
|
17
|
Strumann C, Blickle PG, von Meißner WCG, Steinhäuser J. The use of routine data from primary care practices in Germany to analyze the impact of the outbreak of SARS-CoV-2 on the utilization of primary care services for patients with type 2 diabetes mellitus. BMC Prim Care 2022; 23:327. [PMID: 36522736 PMCID: PMC9754999 DOI: 10.1186/s12875-022-01945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Routinely collected health data from ambulatory care providers offer a wide range of research opportunities. However, the access is often (e.g., technically) hindered, particularly in Germany. In the following, we describe the development of an infrastructure for the analysis of pseudonymized routine data extracted from primary care practices in Germany. Further, we analyze the impact of the outbreak of SARS-CoV-2 on the utilization of primary care services for patients with type 2 diabetes mellitus (DM type 2). METHODS In this retrospective cohort study, routine data were extracted from nine private primary care practices before and since the outbreak of SARS-CoV-2 in Germany. The sample consisted of patients who were treated between 2016 and 2022 in one of the participating practices. The effects of the outbreak on the frequency of practice visits and the disease course of DM type 2 patients were analyzed by means of bivariate and multivariate analyses. RESULTS The developed infrastructure offers an analysis of routine data from outpatient care within 24 h. In total, routine data of 30,734 patients could be processed for the analyses with 4182 (13.6%) patients having a diagnosed DM type 2 and 59.0% of these patients were enrolled in a disease management program (DMP). In the multivariate analysis, there was a significant negative effect of the SARS-CoV-2 outbreak on utilization of outpatient services of patients with DM type 2 disease. This decrease was less pronounced among DMP patients. The glycated haemoglobin level (HbA1c) has not changed significantly. CONCLUSIONS The study showed that the analysis of routine data from outpatient care in Germany is possible in a timely manner using a special developed electronic health record system and corresponding software. The significantly negative effect of the SARS-CoV-2 outbreak on utilization of outpatient services of patients with DM type 2 disease was less pronounced among DMP patients. Two years after the start of the Covid pandemic a significantly worsened course of illness cannot be observed. However, it must be taken into account that the observation period for clinically relevant outcomes is still relatively short.
Collapse
Affiliation(s)
- Christoph Strumann
- grid.412468.d0000 0004 0646 2097Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Paul-Georg Blickle
- grid.412468.d0000 0004 0646 2097Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany ,Hausärzte am Spritzenhaus, Family Practice, Baiersbronn, Germany
| | - Wolfgang C. G. von Meißner
- grid.412468.d0000 0004 0646 2097Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany ,Hausärzte am Spritzenhaus, Family Practice, Baiersbronn, Germany
| | - Jost Steinhäuser
- grid.412468.d0000 0004 0646 2097Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| |
Collapse
|
18
|
Waschkau A, Traulsen P, Steinhäuser J. Evaluation of Synchronous and Asynchronous Telemedical Applications in Primary Care in Rural Regions of Northern Germany-Results and Lessons Learned from a Pilot Study. Int J Environ Res Public Health 2022; 19:ijerph192214860. [PMID: 36429577 PMCID: PMC9690306 DOI: 10.3390/ijerph192214860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 05/30/2023]
Abstract
(1) Background: Telemedical applications (TAs) that are centered around General practitioners' (GP) practices could be beneficial for patients in rural areas in order to better their access to care. This could become more and more relevant as specialists favor practicing in more urban regions, leaving GPs as the first medical contact of patients in rural areas. (2) Methods: Three TAs, one synchronous, one asynchronous and one used in delegation were implemented and evaluated in ten GP practices and two specialists' practices in rural areas of northern Germany. (3) Results: Overall satisfaction with the TAs was generally high. GPs as well as specialists were especially satisfied with asynchronous TAs. A number of valuable "Lesson learned" were obtained and can be used as recommendations for further studies, e.g., taking time to identify market-ready technologies prior to implementation, developing dedicated trainings for users, and preparation of a technical support plan. Overall, the benefits of the TAs were rated high for the patients by the medical professionals. (4) Conclusion: Especially asynchronous TAs that are based on existing technology can be successfully implemented into a developing digital health care system such as the one in Germany. The impact on treatment of those TAs needs to be further investigated.
Collapse
|
19
|
Schmitt J, Warkentin N, Wilfling D, Steinhäuser J, Götz K. [A case management questionnaire for family caregivers of geriatric patients]. Z Gerontol Geriatr 2022; 55:406-411. [PMID: 33738608 PMCID: PMC9360053 DOI: 10.1007/s00391-021-01871-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/24/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND To ease the burden for family caregivers healthcare concepts are urgently needed. The healthcare concept continuous care in a regional network (RubiN) offers a care and case management in physician networks for geriatric patients and aims to relieve family caregivers. The aim of the study was to develop and to test the psychometric properties of a questionnaire that evaluates the satisfaction and acceptance of the healthcare provided by case management (CM) from the perspective of family caregivers. METHODS A mixed methods design was used to develop the questionnaire based on qualitative interviews, a literature search and own project experiences. After a pilot run the subsequent data acquisition took place in the participating RubiN physician networks from May to August 2020. Each of the 5 participating networks received a set of 50 questionnaires for family caregivers. The psychometric properties of the questionnaire were evaluated. RESULTS The questionnaire consisted of 11 items. A total of 137 family caregivers participated in the survey (response rate 55%). Overall, the family caregivers were very satisfied (78.1%) with the care offered. There were only a few missing values in the data. The 11 items in the questionnaire loaded on 2 factors. The first factor called effects from coordination showed an internal consistency of 0.843 and for the second factor called accessibility an internal consistency of 0.683 was observed. CONCLUSION The questionnaire with 11 items is characterized by its brevity and includes the acceptance and satisfaction of the care elements offered for family caregivers in a geriatric CM.
Collapse
Affiliation(s)
- Julian Schmitt
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Haus 50, 23538, Lübeck, Deutschland
| | - Nicole Warkentin
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Haus 50, 23538, Lübeck, Deutschland
| | - Denise Wilfling
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Haus 50, 23538, Lübeck, Deutschland
| | - Jost Steinhäuser
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Haus 50, 23538, Lübeck, Deutschland
| | - Katja Götz
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Haus 50, 23538, Lübeck, Deutschland.
| |
Collapse
|
20
|
Flägel K, Müller MT, Goetz K, Flum E, Schwill S, Steinhäuser J. Bridging the Gap Between Competencies and Uncertainties in Postgraduate Training in Family Medicine: Results and Psychometric Properties of a Self-Assessment Questionnaire. Adv Med Educ Pract 2022; 13:671-684. [PMID: 35811757 PMCID: PMC9266674 DOI: 10.2147/amep.s366786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE One of the reasons for postgraduate trainees not to choose working in a rural area is uncertainty related to the lack of competencies. The aim of this study was to investigate the concept of uncertainty by measuring competencies and to examine the psychometric properties of an instrument that measures competencies related to uncertainty in the self-assessment of postgraduate trainees in family medicine. PATIENTS AND METHODS A questionnaire was created based on pre-existing instruments. It was distributed to participants of postgraduate training seminars in the federal states of Baden-Württemberg and Schleswig-Holstein, Germany in 2016. Descriptive statistics and a partial correlation analysis were calculated for measuring the degree of association between year of postgraduate training and items' responses. Psychometric properties were assessed by calculating descriptive item analysis, factor analysis and internal consistency. RESULTS The response rate was 85% (105/124). More than one-fifth of the participants stated to show only seldom or sometimes the following skills: ability to balance work and life (N=25, 24%), letting a mild disorder run its own way (N=24, 23%) and ability to conduct interventions that decreased aggression from the patient (N=22, 21%). More than half of the participants felt (very) insecure in performing routine child check-ups, the application of a below elbow backslab and the partial removal of a toenail. Nine out of 21 items showed positive statistically significant correlation between level of competence and progress in training. Factor analysis led to a final instrument with 12 items (Cronbach's α=0.736) and a three-factor-structure: "doctor well-being and resilience", "communication" and "skills". CONCLUSION In order to reduce uncertainty with all its consequences, a focus on teaching of competencies regarding the physicians' well-being and resilience, communication and skills has to be continued in postgraduate training.
Collapse
Affiliation(s)
- Kristina Flägel
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Schleswig-Holstein, Germany
| | - Marie-Therese Müller
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Schleswig-Holstein, Germany
| | - Katja Goetz
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Schleswig-Holstein, Germany
| | - Elisabeth Flum
- Group Practice Dr. Katharina Mendler & Dr. Elisabeth Flum, Eppelheim, Baden-Württemberg, Germany
| | - Simon Schwill
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Schleswig-Holstein, Germany
| |
Collapse
|
21
|
Held LA, Wewetzer L, Steinhäuser J. Determinants of the implementation of an artificial intelligence-supported device for the screening of diabetic retinopathy in primary care - a qualitative study. Health Informatics J 2022; 28:14604582221112816. [PMID: 35921547 DOI: 10.1177/14604582221112816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diabetic retinopathy is a microvascular complication of diabetes mellitus that is usually asymptomatic in the early stages. Therefore, its timely detection and treatment are essential. First pilot projects exist to establish a smartphone-based and AI-supported screening of DR in primary care. This study explored health professionals' perceptions of potential barriers and enablers of using a screening such as this in primary care to understand the mechanisms that could influence implementation into routine clinical practice. Semi-structured telephone interviews were conducted and analysed with the help of qualitative analysis of Mayring. The following main influencing factors to implementation have been identified: personal attitude, organisation, time, financial factors, education, support, technical requirement, influence on profession and patient welfare. Most determinants could be relocated in the behaviour change wheel, a validated implementation model. Further research on the patients' perspective and a ranking of the determinants found is needed.
Collapse
Affiliation(s)
- Linda A Held
- Institute of Family Medicine, 54360University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Larisa Wewetzer
- Institute of Family Medicine, 54360University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, 54360University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| |
Collapse
|
22
|
Schricker C, Strumann C, Steinhäuser J. Identifying desired qualifications, tasks, and organizational characteristics of practice managers-a cross-sectional survey among group practice physicians in Germany. BMC Health Serv Res 2022; 22:821. [PMID: 35751083 PMCID: PMC9233318 DOI: 10.1186/s12913-022-08199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background The increase of centralization developments in primary and secondary care practices may cause the organizational needs to increase as well, as the practices grow in size. This continuous change is observed in different stages in various countries since, from the perspective of a physician, it is reinforced by the benefits it adds to flexible work configuration, professional exchange and specialization. However, in order to benefit from the joint practice system, the proper managerial skills of practice managers are required, as doctors are not naturally prepared to fulfill such tasks. This study thus aims to gain insight into physicians' views in group practices and acquire a greater understanding of expectations towards practice management and the emerging role of practice managers (PM). Methods A cross-sectional study design was employed which utilized an anonymous online questionnaire. In total, 3,456 physicians were invited to participate in the study between February 8th and March 17th 2021 by the Association of Statutory Health Insurance Physicians of Baden-Württemberg, Germany. Bivariate and multivariate analyses were applied to characterize the expectations of physicians towards practice management. Results The survey yielded 329 replies (9,5%). 50% of the participating practices already had a PM employed. In general, these practices were larger than practices without a PM. Most physicians (85%) considered a medical background to be essential for the task of a PM. While practices without a PM considered it important for PMs to have medical qualifications, practices with a PM favored qualifications in business administration. 77.2% of physicians preferred to educate and recruit PMs out of their current practice staff. Competence in organizational tasks, such as coordination of tasks and quality management, was considered to be an essential skill of a PM and had the highest agreement levels among those surveyed, followed by staff management of non-physicians, billing, bookkeeping, staff management of physicians and recruiting. Based on multivariate regression analysis, larger practices valued the role of a PM more and were more likely to employ a PM. Notably, the effect that size had on these items was more substantial for generalists than specialists. Conclusions The benefits and importance of PMs as well as the potential for delegation are recognized, in particular, by larger practices. The positive feelings that physicians who already employ PMs have towards their contribution to ambulatory care are even more significant. Pre-existing medical support staff has been identified to be the most desirable candidates for taking on the role of PM. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08199-5.
Collapse
Affiliation(s)
- Clemens Schricker
- University of Lübeck, Institute of Family Medicine, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - Christoph Strumann
- University of Lübeck, Institute of Family Medicine, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Jost Steinhäuser
- University of Lübeck, Institute of Family Medicine, Ratzeburger Allee 160, 23538, Lübeck, Germany
| |
Collapse
|
23
|
Adje M, Steinhäuser J, Stevenson K, Mbada CE, Karstens S. Patients' and physiotherapists' perspectives on implementing a tailored stratified treatment approach for low back pain in Nigeria: a qualitative study. BMJ Open 2022; 12:e059736. [PMID: 35725255 PMCID: PMC9214370 DOI: 10.1136/bmjopen-2021-059736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Stratified care has the potential to be efficient in addressing the physical and psychosocial components of low back pain (LBP) and optimise treatment outcomes essential in low-income countries. This study aimed to investigate the perceptions of physiotherapists and patients in Nigeria towards stratified care for the treatment of LBP, exploring barriers and enablers to implementation. METHODS A qualitative design with semistructured individual telephone interviews for physiotherapists and patients with LBP comprising research evidence and information on stratified care was adopted. Preceding the interviews, patients completed the Subgroups for Targeted Treatment tool. The interviews were recorded, transcribed and analysed following grounded theory methodology. RESULTS Twelve physiotherapists and 13 patients with LBP participated in the study (11 female, mean age 42.8 (SD 11.47) years). Seven key categories emerged: recognising the need for change, acceptance of innovation, resistance to change, adapting practice, patient's learning journey, trusting the therapist and needing conviction. Physiotherapists perceived stratified care to be a familiar approach based on their background training. The prevalent treatment tradition and the patient expectations were seen as major barriers to implementation of stratified care by the physiotherapists. Patients see themselves as more informed than therapists realise, yet they need conviction through communication and education to cooperate with their therapist using this approach. Viable facilitators were also identified as patients' trust in the physiotherapist and adaptations in terms of training and modification of the approach to enhance its use. CONCLUSION Key barriers identified are the patients' treatment expectations and physiotherapists' adherence to the tradition of practice. Physiotherapists might facilitate implementation of the stratified care by communication, hierarchical implementation and utilisation of patients' trust. Possibilities to develop a consensus on key strategies to overcome barriers and on utilisation of facilitators should be tested in future research.
Collapse
Affiliation(s)
- Mishael Adje
- Therapeutic Sciences, Trier University of Applied Sciences, Trier, Germany
- Institute of Family Medicine, University of Lübeck, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University of Lübeck, Lübeck, Germany
| | - Kay Stevenson
- The Impact Accelerator Unit, The Medical School Keele University, Keele, UK
| | | | - Sven Karstens
- Therapeutic Sciences, Department of Computer Science, Trier University of Applied Sciences, Trier, Germany
| |
Collapse
|
24
|
Kötter T, Rose SI, Goetz K, Steinhäuser J. The predictive validity of admission criteria for the results of clinical competency assessment with an emphasis on family medicine in the fifth year of medical education: an observational study. BMC Med Educ 2022; 22:269. [PMID: 35413869 PMCID: PMC9003966 DOI: 10.1186/s12909-022-03293-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/14/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In many countries, the number of applicants to medical schools exceeds the number of available places. This offers the need, as well as the opportunity to medical schools to select those applicants most suitable for later work as a doctor. However, there is no generally accepted definition of a 'good doctor'. Clinical competencies may serve as surrogates. The aim of this study was to compare medical students in Germany selected based either on their pre-university grade point average alone or based on the result of a university-specific selection procedure regarding their clinical competencies with an emphasis on family medicine in the later years of training. METHODS We used the 'Allgemeinarztbarometer Ausbildung' (Undergraduate Family Medicine Barometer), an instrument developed to assess clinical competencies with an emphasis on family medicine, to compare students in the pre-university grade point average admission-quota and the university-specific selection procedure admission-quota in the fifth year of training. Students were judged by their supervising general practitioners after a two-week practical course. Competencies were rated on a five-point Likert-scale (1 = 'totally agree' i.e. the student is very competent to 5 = 'totally disagree' i.e. the student is not competent at all). RESULTS We included 94 students (66% female). Students in the university-specific selection procedure quota (n = 80) showed better mean scores in every item of the Undergraduate Family Medicine Barometer. We found a statistically significant difference between the two groups for the item assessing communication skills (M [university-specific selection procedure quota] = 1.81, SD = 0.84 vs. M [pu-GPA quota] = 2.38, SD = 0.96; t[91] = -2.23, p = .03; medium effect size). Logistic regression revealed no statistically significant age or gender contribution. CONCLUSIONS Despite the small sample-size, our results indicate, that students selected via an university-specific selection procedure show better communicative competencies in the later years of training.
Collapse
Affiliation(s)
- Thomas Kötter
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- Institute of Social Medicine and Epidemiology, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Silvia Isabelle Rose
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- Institute of Social Medicine and Epidemiology, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Katja Goetz
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| |
Collapse
|
25
|
Kötter T, Steinhäuser J. [Experiences with Video-Based Assessment under Pandemic-Related Contact Restrictions]. ZFA (Stuttgart) 2022; 98:386-389. [PMID: 37123508 PMCID: PMC10125252 DOI: 10.53180/zfa.2022.0386-0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/23/2022] [Indexed: 05/02/2023]
Abstract
Background Due to the COVID-19 pandemic, the Objective Structured Clinical Examination (OSCE) examinations were cancelled in the short term. This project described how to offer medical students an alternative assessment at Miller's competence level of "shows how". Methods Students produced videos in which they can be seen performing various physical examinations related to family medicine consultations. Trained assessors rated the videos uploaded to the learning platform and gave verbal feedback if requested. Results The grading (65 "very good" and 38 "good") was very mild. Twelve per cent of the students requested verbal feedback. Their evaluation of the procedure was mixed. The evaluators consistently assessed their task and the process as positive. Technically, the video-based assessment could be implemented without any problems. Conclusions The short-term implementation of a video-based assessment in the context of medical education proved to be feasible. It could serve not only as an emergency solution under a pandemic, but also as an additional opportunity for formative feedback in the future.
Collapse
Affiliation(s)
- Thomas Kötter
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
| | - Jost Steinhäuser
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
| |
Collapse
|
26
|
Strumann C, Steinhäuser J. Evaluation of a Direct-to-Patient Telehealth Service in Germany (docdirekt) Based on Routine Data. Dtsch Arztebl Int 2021; 118:872-873. [PMID: 35300786 PMCID: PMC8948339 DOI: 10.3238/arztebl.m2021.0378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 06/01/2023]
Affiliation(s)
- Christoph Strumann
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck;
| | - Jost Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck;
| |
Collapse
|
27
|
Hellfritz M, Waschkau A, Steinhäuser J. Quality indicators of telemedical care offshore-a scoping review. BMC Health Serv Res 2021; 21:1290. [PMID: 34856962 PMCID: PMC8638379 DOI: 10.1186/s12913-021-07303-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Offshore industries operate all around the world in diverse and remote environments. The use of telemedicine to ensure up-to-date medical care for thousands of people offshore has been common practice for decades. Thus, in this setting, extensive experiences with this type of health care delivery have already been gathered, while in other settings this is just beginning. However, the quality of telemedical care on offshore installations is rarely reported yet. The objective of this review was to explore published literature with regards to the following questions: Have any Quality Indicators (QIs) been published for measuring the quality of telemedical care on offshore installations or are there identifiable items that could be used as such QIs? METHODS We conducted a comprehensive Scoping Review (PRISMA-ScR) of the published literature using the databases MEDLINE, Cochrane Library, Web of Science (Core Collection), and Google Scholar. Search results were read and QIs or findings from which QIs could be derived were classified according to the dimensions of quality established by Donabedian (structure, process, or outcome QIs). RESULTS The search returned 10,236 non-recurring articles, 45 of which were full-text screened and 15 of which were included in this review. Types of publications were heterogenous. No QIs for the quality of telemedical care offshore have been published yet. Findings that could be the basis for QIs focused on structure quality (11 QIs) followed by process quality (11 QIs), while outcome quality was less common (1 QI). CONCLUSION Currently, although years of experience with telemedical care on offshore installations exist, there is a paucity of research on a solid data base regarding the quality of telemedical care offshore. The authors derived a list of 24 possible QIs from the findings of the publications for further validation. This could be the basis for implementation and definition of QIs in this and in similar remote settings.
Collapse
Affiliation(s)
- Michael Hellfritz
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - Alexander Waschkau
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| |
Collapse
|
28
|
Strumann C, von Meißner WCG, Blickle PG, Held L, Steinhäuser J. Experiences made by family physicians managing patients with SARS-CoV-2 infection during spring 2020 - a cross-sectional analysis. Z Evid Fortbild Qual Gesundhwes 2021; 165:35-42. [PMID: 34474994 PMCID: PMC8404987 DOI: 10.1016/j.zefq.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND In Germany, family physicians care for about 85% of the patients infected with SARS-CoV-2. The geographic distribution of the first wave in 2020 was heterogeneous, and each federal state experienced different percentages of patients that died from COVID-19. Each of the 16 federal states implemented its own regulation about medical care for SARS-CoV-2 infected patients. Against this background, the objective of this analysis was to gather experiences made by primary care physicians managing SARS-CoV-2 infected patients during the first wave in March 2020 and to clinically characterize these patients. METHODS In total, 5,632 physicians were invited to participate in an online questionnaire surveying routine data regarding the general care situation at the physician practice level and the care for patients infected with SARS-CoV-2. Bivariate and multivariate analyses were applied to characterize treatment experiences and to identify patient characteristics predicting the course of disease. RESULTS 132 family physicians from all German federal states (except from Berlin) participated in this analysis (response rate 2.3%) and provided routine care data for 1,085 patients. Information from 373 of these patients were provided in greater detail. On average, each physician treated 8.5 patients infected with SARS-CoV-2. About 15% of the physicians used video consultations to communicate with their infected patients. More than 82% made positive experiences with the exceptional regulation to provide a certificate of incapacity to work by telephone. Half of the physicians faced equipment insufficiencies due to a lack of protective gear, and in 10% of the practices, the staff themselves acquired SARS-CoV-2 infection. Greater numbers of SARS-CoV-2 cases treated in a practice translated into higher odds for members of the practice to get infected (odds ratio (OR) 1.03, 95% CI [1.01;1.06]). Older persons, males and patients in rural areas had higher odds of a severe course of disease. CONCLUSIONS Our results show that a large percentage of primary care physicians additionally managed their COVID-19 patients remotely by telephone or video during the outbreak, while also being at a higher risk for SARS-CoV-2 infection. Further, the increased severity in rural areas underlines the importance of strong primary health care in order to enable hospitals to concentrate on critically ill patients.
Collapse
Affiliation(s)
- Christoph Strumann
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus, Lübeck, Germany.
| | | | | | - Linda Held
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus, Lübeck, Germany
| |
Collapse
|
29
|
Weißenfeld MM, Goetz K, Steinhäuser J. Facilitators and barriers for the implementation of telemedicine from a local government point of view - a cross-sectional survey in Germany. BMC Health Serv Res 2021; 21:919. [PMID: 34488753 PMCID: PMC8419374 DOI: 10.1186/s12913-021-06929-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Telemedicine offers additional ways of delivering medical care, e.g., in primary care in rural areas. During the last decades, projects including telemedicine are being implemented worldwide. However, implementation of telemedicine is in some countries, e.g., Germany somewhat slower compared to northern European countries. One important part of successful implementation is to include the citizen perspective. The aims of this study were to explore the perception of representatives of the local government regarding telemedicine in the context of a perceived GP shortage and to tailor future telemedicine offers according to these perceived needs. METHODS Considering the multidisciplinary assessment suggested by the Model for Assessment of Telemedicine a questionnaire with 19 questions was developed by identifying determinants of telemedicine out the literature. After pre-testing, the questionnaire was sent to all 2199 mayors from the federal states of Schleswig-Holstein (North Germany) and Baden-Württemberg (South Germany) as representatives of the citizens (cross- sectional study; full population survey). The final questionnaire contained sections for socio-demographic data, telemedicine and perceived GP shortage. All responses from November 2018 until 2019 were included and analyzed descriptively. RESULTS The response rate was 32% (N = 699), of which 605 were included in the analysis. A majority of the participants stated they live in a rural area and 46% were in the office for up to 8 years. The mayors had predominantly a positive perception about telemedicine (60%) and 76% of them stated, their community would benefit from telemedicine. A GP shortage was reported by 39% of the participants. The highest risk of telemedicine was seen in misdiagnosing. In case of an emergency situation 291 (45%) of the participants considered data privacy as not as relevant. Mayors from a community with a perceived GP shortage had a more negative perception regarding telemedicine. CONCLUSION The acceptance of telemedicine is rapidly rising compared to former studies. Communities with a perceived GP shortage had a more negative perception. Barriers like data security concerns were seen as less important in case of an emergency. The highest risk of telemedicine was seen in misdiagnosing. These findings need to be considered in designing future telemedicine offers.
Collapse
Affiliation(s)
- Maja Maria Weißenfeld
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
| | - Katja Goetz
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| |
Collapse
|
30
|
Prill P, Steinhäuser J, Herchenröder M, Flägel K. Determinants of interprofessional collaboration in complementary medicine to develop an educational module "complementary and integrative medicine" for undergraduate students: A mixed-methods study. J Interprof Care 2021; 36:390-401. [PMID: 34328390 DOI: 10.1080/13561820.2021.1935810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
As use of complementary medicine (CM) is increasing, health professionals may require proper training in CM to offer evidence-based advice to their patients. The aim of this study was to explore interprofessional collaboration (IPC) in CM in order to gain a comprehensive overview of determinants and to facilitate the definition of objectives for an undergraduate interprofessional educational module. Pursuant to a sequential mixed-methods approach, focus groups and individual interviews with health professionals, who actively use CM in patient care, were conducted. All hospital employees at the University Hospital Lübeck, Germany, were asked to complete an online questionnaire that was based on the previously obtained qualitative results. The interviews with 20 participants revealed four main themes: profession-specific aspects, communication, health care system-associated factors, and the influence of CM on interprofessional dynamics. An analysis of the 157 responses in the online questionnaire showed that team meetings (n = 124, 79%) were most frequently stated as promoting IPC. In binary regression analyses, nursing (OR = 6.17 [2.02-18.84]) and medical professions (OR = 3.77 [1.27-11.18]) predicted evidence-based care as enabler for IPC. Hence, teaching professional competencies and an equal understanding of evidence-based medicine seems necessary to promote IPC within CM.
Collapse
Affiliation(s)
- Paula Prill
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Minettchen Herchenröder
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.,Department of Orthopaedics and Trauma Surgery, Division Physiotherapy Research, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Kristina Flägel
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| |
Collapse
|
31
|
Strumann C, Möller B, Steinhäuser J. [Assessing Electronic Prescription: A Cross-sectional Study of Pharmacists in Germany]. Gesundheitswesen 2021; 84:961-967. [PMID: 34161985 PMCID: PMC9525142 DOI: 10.1055/a-1498-1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hintergrund
Mit dem Modellprojekt GERDA („Geschützter
e-Rezept-Dienst der Apotheken“) wurde von der Landesapothekerkammer
(LAK) und dem Landesapothekerverband (LAV) in Baden-Württemberg die
Möglichkeit geschaffen, Rezepte im Rahmen von Online-Sprechstunden
über das von der Kassenärztlichen Vereinigung
Baden-Württemberg betriebene telemedizinische Portal
„docdirekt“, zu verordnen. Vor diesem Hintergrund war das Ziel
der Studie, Barrieren und fördernde Faktoren aufseiten der Apotheken
für die Beteiligung an einer Versorgung, die eine elektronische
Verordnung von Rezepten beinhaltet, zu explorieren und zu priorisieren. Auf
Basis dieser Determinanten wurden Empfehlungen zur Optimierung einer
erfolgreichen Implementierung ähnlicher Versorgungsangebote
abgeleitet.
Methode
Es wurde ein Mixed-Methods-Design gewählt, um die
Determinanten zu explorieren und zu priorisieren. Im ersten Schritt wurden
Determinanten für die Beteiligung an einem System, welches die
elektronische Verordnung von Rezepten ermöglicht mithilfe von
Einzelinterviews mit an docdirekt beteiligten Teleärzten,
niedergelassenen Hausärzten und Apothekern exploriert.
Anschließend wurden diese Determinanten in einem zweiten Schritt durch
eine quantitative Befragung von Apothekern priorisiert.
Ergebnisse
Von den 523 an der Umfrage teilgenommenen Apothekern war mehr
als die Hälfte bereit sich an einem E-Rezept-System zu beteiligen,
8,5% schließen eine zukünftige Beteiligung aus.
Insgesamt konnten 18 Determinanten für die Beteiligung an einem System,
welches die elektronische Verordnung von Rezepten ermöglicht, exploriert
werden. Der Schutz der freien Apothekenwahl wurde als wichtigster Aspekt
für eine Beteiligung identifiziert. Gefolgt von der Möglichkeit
einer Korrekturfunktion bei E-Rezepten (um z. B. Retaxierungen oder
Medikationsfehlern zu vermeiden), der Integration des E-Rezepts in die
bestehende Apotheken-EDV sowie dem gesetzlichen Ausschluss von direkten
Verträgen mit Versandapotheken. Zeitersparnisse und eine ggf.
höhere Vergütung wurden dagegen als weniger relevant
bewertet.
Schlussfolgerung
Insgesamt gab über die Hälfte der
befragten Apotheken an, sich an einem E-Rezept-System beteiligen zu wollen.
Für die ab Januar 2022 geplante flächendeckende
Einführung von E-Rezepte kann der Einbezug der identifizierten
fördernden Faktoren vonseiten der Politik, Softwareentwickler und
Verbände eine wichtige Rolle bei der Implementierung spielen.
Collapse
Affiliation(s)
- Christoph Strumann
- Institute of Family Medicine, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Lübeck, Deutschland
| | - Birger Möller
- Institute of Family Medicine, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Lübeck, Deutschland
| | - Jost Steinhäuser
- Institute of Family Medicine, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Lübeck, Deutschland
| |
Collapse
|
32
|
Hötker EDV, Ring MM, Steinhäuser J. Determinants of the Implementation of Telemedicine in the German Navy-A Mixed Methods Study. Mil Med 2021; 187:e726-e734. [PMID: 33647979 PMCID: PMC9071090 DOI: 10.1093/milmed/usab080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/02/2021] [Accepted: 02/12/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction The history of the use of telemedicine in maritime medicine dates back to the 1930s. In the early 2000s, the German Navy built up a telemedicine network which today is installed in all ships and provides a connection to the medical infrastructure ashore. The objective of this study was to optimize the implementation of telemedicine based on the experience gained in the German Navy. For this purpose, qualitative and quantitative methods were used to identify determinants which affect the use of telemedicine in order to determine whether there is any need for optimization. Methods The study was conducted using a mixed methods design. First, guideline-based interviews were conducted with Navy medical officers who had been recruited via various email distribution lists. The interviews were then transcribed and coded. In an analysis, deductive and inductive categories were derived from the codes. Hypotheses were deduced from the interviews, too, and used to develop a questionnaire. Besides the medical officers, other Navy medical personnel with experience in the field of telemedicine took part in the survey. The study was concluded by a descriptive analysis of the quantitative data. Results The analysis of the interviews revealed that a regular use of telemedicine workstations increased the users’ confidence and, in their opinion, improved medical treatment. Technical and organizational problems posed obstacles, which increased the use of partly insecure alternatives. A proper technical support was regarded as a precondition for effectively using telemedicine. The results of the quantitative analysis showed that consultation was mainly sought for dermatological (46%), surgical (24%), and internal (22%) conditions. Conclusion The study revealed determinants for the use of telemedicine in the German Navy. Factors improving the motivation of the users should be strengthened in order to optimize the use of telemedicine. Furthermore, it can be assumed that a successful implementation will be supported by reducing or eliminating obstacles. The findings on the main reasons for seeking medical advice could be taken into account in the further planning of specific training.
Collapse
Affiliation(s)
- Ensign Daniel Valentin Hötker
- Institute of Family Medicine, University Medical Center Lübeck, Lübeck 23562, Schleswig-Holstein, Germany.,Regional Medical Support Command Kiel, Bundeswehr Medical Service, Kiel 24106, Schleswig-Holstein, Germany
| | - Markus Matthias Ring
- Medical Information Technology Section, Navy Medical Service Directorate, Rostock 18057, Mecklenburg-Vorpommern, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Center Lübeck, Lübeck 23562, Schleswig-Holstein, Germany
| |
Collapse
|
33
|
Weier L, Steinhäuser J, Träder JM, Deck R. [General Practitioner Centered Rehabilitation Aftercare for Chronic Back Pain]. REHABILITATION 2021; 60:195-203. [PMID: 33477195 DOI: 10.1055/a-1286-2595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
BACKGROUND Back pain is one of the most common and costly health disorders in Germany. Rehabilitation measures for back pain often show a lack of long-term effects after rehabilitation treatment. The "Neues Credo" aftercare concept has proven to be promising in increasing the long-term effects. In the current study, it was piloted and evaluated in general practitioners' practices. METHODS A prospective observational study was carried out. Nine orthopedic rehabilitation clinics and N=178 general practitioners were involved in the aftercare. The intervention was evaluated by means of written surveys of 85 rehabilitation patients with chronic back pain at 3 points in time. The outcomes were functional capacity and participation; the secondary outcomes were subjective health and physical activity. The long-term effects were evaluated by analyses of variance with repeated measurements. RESULTS At the end of the rehabilitation, the main outcome functional capacity shows a significant improvement of small magnitude, all secondary outcomes show significant medium to large effects. During the follow-up period, the participants were able to significantly increase their physical activity. Especially with respect to endurance training and workout. Twelve months after rehabilitation, significant improvements can still be seen in all outcomes. The range of parameters describing effect size are below the usual thresholds for clinically important changes. CONCLUSION Rehabilitation aftercare like the program "Neues Credo" shows similar lasting effects when supported by the general practitioner instead of the rehabilitation clinic. The successes decrease somewhat 12 months after the rehabilitation, but we still see significant differences in all outcomes compared to baseline. There is a high satisfaction with the program by rehabilitants and general practitioners. Since general practitioners are the first contact after rehabilitation a transfer of the program into routine care would be promising.
Collapse
Affiliation(s)
- Lisa Weier
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck
| | | | | | - Ruth Deck
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck
| |
Collapse
|
34
|
Weinmayr LM, Zwierlein R, Steinhäuser J. Modifiable determinants for the success or failure of inter-physician collaboration in group practices in Germany - a qualitative study. BMC Fam Pract 2020; 21:276. [PMID: 33349242 PMCID: PMC7754572 DOI: 10.1186/s12875-020-01349-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022]
Abstract
Background A growing demand for physicians exists worldwide. Due to political changes, economic incentives and new workplace expectations a trend from single-handed practices to group practices has been noticed in many countries over the last years. In view of this background, our study aimed to identify determinants for success or failure of inter-physician collaboration in order to positively influence future collaboration in anticipation of the important role group practices may play in future health care delivery. Methods We chose a qualitative study design, using semi-structured phone interviews to collect data from physicians and non-physician consultants with experience in inter-physician collaboration that were analysed using content analysis. Eleven physicians with experience in collaborative working and fourteen non-physician consultants specializing in advice to health care professionals participated. Results Education in entrepreneurial skills as well as implementation of good practice management in preparation for collaboration are crucial modifiable facilitators for successful inter-physician collaboration. Furthermore, open communication and realistic insight into the mode of acquaintance, moral concept and degree of specialisation of the colleagues involved play major roles for the success of inter-physician collaboration in group practices. Conclusions There are several underlying themes beyond clinical expertise concerning success or failure of group practices. To influence future collaboration positively, it is important to focus on management and communication skills as well as to address basic understanding of economics.
Collapse
Affiliation(s)
- Lisa-Marie Weinmayr
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Ruben Zwierlein
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
| |
Collapse
|
35
|
Naumenko K, Steinhäuser J, Niebuhr F, Goetz K. Short report: coaching as an intervention to treat mild form of fear of flying. PSYCHOL HEALTH MED 2020; 27:1205-1212. [PMID: 33275446 DOI: 10.1080/13548506.2020.1856391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Fear of flying can lead to restrictions in private but also in professional life. Different treatment approaches are available to handle fear of flying. Of these, coaching could be one possible treatment method. However, evidence is rare and the aim of this study was to evaluate descriptive effect of wingwave® coaching on a mild form of fear of flying. Coaching was delivered twice before the first flight and once after the first flight. The interventions were conducted between December 2016 and May 2017. Four people with fear of flying participated in the study. As measurement tools, satisfaction with life scale and 'Fear of Flying Scale' (FFS) were used at each of the measurement points. The measurement of fear of flying using the FFS measures showed a reduction in all four individuals. The participants also revealed a benefit in the sub-scales Anticipation, Flying and Turbulence. Our study indicates a positive impact of wingwave® coaching on dealing with a mild form of fear of flying.
Collapse
Affiliation(s)
- Kristina Naumenko
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Frank Niebuhr
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Katja Goetz
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| |
Collapse
|
36
|
Mosler T, Flägel K, Steinhäuser J. [Reasons for Encounter in Out-of-Hours Care in Emergency Departments and Emergency Practices - A Mixed Methods Trial]. Gesundheitswesen 2020; 83:432-442. [PMID: 33096581 DOI: 10.1055/a-1236-3570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Since 2006, with the opening of emergency practices (EP) in Germany, out-of-hours patient care has been carried out by general practitioners. Additionally, emergency departments (ED) of the hospitals ensure acute care. Thus, optimal coordination of care is a much discussed subject. The aim of this study was to provide reasons for encounter and subjective reasons to visit each of these institutions. METHODS In a mixed method trial, patients with non-urgent conditions (Manchester Triage System level 4 and 5) were interviewed in 2 ED in Schleswig-Holstein and 2 EP in Baden-Württemberg regarding their reasons for encounter from July 2015 to August 2016 during the out of hours primary care practices. Data collection was carried out using a paper-based questionnaire and a semi-structured interview. The statistical program SPSS was used for descriptive analysis, text data analysis was carried out with the method of qualitative content analysis. RESULTS In total, 398 patients were interviewed. Most frequently, reasons for encounter in ED and EP were related to musculoskeletal complaints (39%, n=116 and 23%, n=23, respectively). Within technical examination services, the laboratory diagnostics were used as a priority in ED (59%, n=175). In the EP, one patient (2%) underwent laboratory diagnostics. The main reasons for encounter in both facilities were increasing complaints (50%, n=147 in ED; 70%, n=70 in EP) and a desire for quick diagnosis (73%, n=217 in ED; 48%, n=48 in EP). In total, 112 patients (28%) had a medication plan, and 67 (60%) brought it into the facility. Two-thirds of ED patients (n=197) were handed over to outpatient care. In EP, 89% (n=89) continued as outpatient. Qualitative content analysis revealed similar complaint categories in both facilities, but with significant differences in the severity and experienced urgency. In both facilities, patients expected to have their symptoms clarified. In ED, the desire for a rapid and specific diagnosis was expressed more frequently. CONCLUSION Indications for medical treatment were seen in most consultations in both care facilities. There was a distinction between the ED and EP in the urgency of the consultations.
Collapse
|
37
|
Wilfling D, Hinz A, Steinhäuser J. Big data analysis techniques to address polypharmacy in patients - a scoping review. BMC Fam Pract 2020; 21:180. [PMID: 32883227 PMCID: PMC7472702 DOI: 10.1186/s12875-020-01247-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 08/17/2020] [Indexed: 11/10/2022]
Abstract
Background Polypharmacy is a key challenge in healthcare especially in older and multimorbid patients. The use of multiple medications increases the potential for drug interactions and for prescription of potentially inappropriate medications. eHealth solutions are increasingly recommended in healthcare, with big data analysis techniques as a major component. In the following we use the term analysis of big data as referring to the computational analysis of large data sets to find patterns, trends, and associations in large data sets collected from a wide range of sources in contrast to using classical statistics programs. It is hypothesized that big data analysis is able to reveal patterns in patient data that would not be identifiable using conventional methods of data analysis. The aim of this review was to evaluate whether there are existing big data analysis techniques that can help to identify patients consuming multiple drugs and to assist in the reduction of polypharmacy in patients. Methods A computerized search was conducted in February 2019 and updated in May 2020, using the PubMed, Web of Science and Cochrane Library databases. The search strategy was defined by the principles of a systematic search, using the PICO scheme. All studies evaluating big data analytics about patients consuming multiple drugs were considered. Two researchers assessed all search results independently to identify eligible studies. The data was then extracted into standardized tables. Results A total of 327 studies were identified through the database search. After title and abstract screening, 302 items were removed. Only three studies were identified as addressing big data analysis techniques in patients with polypharmacy. One study extracted antipsychotic polypharmacy data, the second introduced a decision support system to evaluate side-effects in patients with polypharmacy and the third evaluated a decision support system to identify polypharmacy-related problems in individuals. Conclusions There are few studies to date which have used big data analysis techniques for identification and management of polypharmacy. There may be a need to further explore interdisciplinary collaboration between computer scientists and healthcare professionals, to develop and evaluate big data analysis techniques that can be implemented to manage polypharmacy.
Collapse
Affiliation(s)
- D Wilfling
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - A Hinz
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - J Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| |
Collapse
|
38
|
Waschkau A, Flägel K, Goetz K, Steinhäuser J. Evaluation of attitudes towards telemedicine as a basis for successful implementation: A cross-sectional survey among postgraduate trainees in family medicine in Germany. Z Evid Fortbild Qual Gesundhwes 2020; 156-157:75-81. [PMID: 32859557 DOI: 10.1016/j.zefq.2020.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND By comparison with other countries of the European Union Germany is only middle-ranking in terms of telemedicine usage. There is a relevant gap between the legal framework and the actual state of implementation. Healthcare providers play an important role in this implementation process as they are increasingly confronted with the application of telemedical scenarios. Therefore, the aim of this survey was to determine attitudes towards telemedicine of postgraduate trainees in Family Medicine (FM) in Germany. METHODS A cross-sectional survey was conducted between July and October 2016 among postgraduate trainees in FM throughout Germany. The questionnaire covered four topics: attitudes towards telemedicine, barriers for the implementation of telemedicine, assessment of useful telemedical applications and telemedicine scenarios. A descriptive approach was used to analyze the data in order to derive determinants for the implementation of telemedicine. RESULTS In total, 388 postgraduate trainees from 13 of the 16 federal states in Germany answered the survey. Seventy-eight percent were female. Participants' mean age was 36 years. The majority of participants believed that only a fraction of the already existing technology in telemedicine is being used (70 %). The largest perceived barrier to telemedicine was data safety concerns. More than half of the participants (54 %) believed that telemedicine would change the doctor-patient relationship. 51 % of the participants were interested in training in telemedicine. In this respect, it is important to note that 27 % of the postgraduate trainees said their willingness to practice in rural areas might be facilitated through the availability of telemedical backup for family physicians. CONCLUSIONS Participating trainees in FM in Germany think that the potential for telemedicine is not yet fully exploited. Based on the results of this survey the next steps to be taken for the implementation of telemedicine applications can be addressed.
Collapse
Affiliation(s)
- Alexander Waschkau
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany.
| | - Kristina Flägel
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Katja Goetz
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| |
Collapse
|
39
|
Waschkau A, Götz K, Steinhäuser J. [Fit for the Future: Development of a seminar on aspects of digitization of healthcare as a contribution of Medical Sociology]. Z Evid Fortbild Qual Gesundhwes 2020; 155:48-53. [PMID: 32798192 PMCID: PMC7832042 DOI: 10.1016/j.zefq.2020.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/16/2020] [Accepted: 06/15/2020] [Indexed: 11/22/2022]
Abstract
Hintergrund Im Bereich der Ausbildung von Humanmedizinern wurden Themen der Digitalisierung des Gesundheitssystems bisher kaum adressiert, auch wenn seit 2015 im Nationalen Kompetenzbasierten Lernzielkatalog Medizin (NKLM) hierzu Kompetenzen als Lernziele definiert sind. Zeitgleich nimmt in der öffentlichen Wahrnehmung Telemedizin, als ein Bereich dieser Digitalisierung der einen ergänzenden Zugang zur medizinischen Versorgung bietet, einen zunehmend größeren Raum ein. Ziel war es, Medizinstudierenden im vierten vorklinischen Semester einen ersten Einblick in Telemedizin und weitere Aspekte der Digitalisierung im Gesundheitswesen im Rahmen eines Seminars zu vermitteln. Methode Auf der Basis der vorhandenen Literatur wurde ein inhaltlich-didaktisches Konzept für das Seminar „Die Arzt-Patienten-Beziehung im Spannungsfeld technischer Entwicklungen“ im Fach Medizinische Soziologie für Studierende der Humanmedizin der Universität zu Lübeck entwickelt. In Anlehnung an das vier Stufen Modell von Kirkpatrick wurden die Studierenden zu Beginn des Seminars zu Themenwünschen zum Thema Digitalisierung und Telemedizin und zum Abschluss des Seminars zu Einstellungen und Erfahrungen mit Telemedizin befragt. Ergebnisse Insgesamt besuchten 184 Studierende aus dem vierten vorklinischen Semester das Seminar. Die Rücklaufquote der Befragungen lag bei 32%. Die am häufigsten gewünschten Themen von Studierenden lauteten „Rechtliche Rahmenbedingungen“, „elektronische Patientenakte“ und „Fernsprechstunde“. Das Thema Digitalisierung des Gesundheitswesens wurde von 85% der Studierenden als sehr relevant für ihren späteren Beruf eingeschätzt. Ebenfalls 85% der Studierenden wünschten sich eine einfache Bedienung von Geräten, die im Rahmen von Telemedizin eingesetzt werden. Eine größere Unsicherheit wurde von gut einem Drittel der Studierenden mit Bezug auf die Einschätzung des Nutzens von Gesundheits-Apps angegeben. Schlussfolgerung Die Inhalte des Seminars treffen auf eine große Nachfrage seitens der Studierenden. Zukünftig sollten Themen rund um die Digitalisierung des Gesundheitssystems vermehrt in der Ausbildung integriert werden. Die identifizierten Unsicherheiten der Studierenden bei der Einschätzung verschiedener telemedizinischer Anwendungen sollten zukünftig adressiert werden.
Collapse
Affiliation(s)
- Alexander Waschkau
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Deutschland.
| | - Katja Götz
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Deutschland
| | - Jost Steinhäuser
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Deutschland
| |
Collapse
|
40
|
Kötter T, Rose SI, Götz K, Steinhäuser J. [The "Allgemeinarztbarometer A" - an instrument to assess primary care competencies during medical education and training]. Z Evid Fortbild Qual Gesundhwes 2020; 155:34-39. [PMID: 32798191 DOI: 10.1016/j.zefq.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/07/2020] [Accepted: 06/24/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The primary goal of medical education and training is to develop clinical competencies. Competency-based curricula exist for both medical education which - once the current reform is implemented - will be geared more towards primary care, and specialty training for General Practice. The "Allgemeinarztbarometer" is a German-language instrument to assess primary care competencies during specialty training and has so far been mainly used as a self-assessment tool. The aim of this study was (i) to test the application of the "Allgemeinarztbarometer" in the context of medical education as an external assessment tool (in its "Allgemeinarztbarometer A [ABA]" version) and (ii) to evaluate its basic psychometric properties. METHODS Physicians involved in teaching were asked to assess medical students after a two-week internship in General Practice during their fifth year of study using the ABA (9-item external assessment version). After data processing and displaying basic distributions, we conducted exploratory factor analysis, followed by confirmatory factor analysis. The detected factor structure was then tested for internal consistency. RESULTS A total of 150 completed questionnaires were included in the analysis. One item showed a high number of missing values (response option "Not assessable"). Exploratory factor analysis indicated a two-factor structure ("Patient-oriented skills" and "General Practice decision-making"). Three items were not unambiguously assignable and hence erased. Confirmatory factor analysis validated the identified factor structure. The two factors showed a Cronbach's α of 0.73 and 0.84 (moderate to very good internal consistency). DISCUSSION Our study provides a first analysis of the ABA in the context of medical education. The detected two-dimensional structure shows a high goodness-of-fit when giving up three items still used in this survey. The analysis of missing data showed a high number of "I can't say" answers when assessing the development of strategies against burnout. CONCLUSIONS The ABA (6-item version) seems to be a suitable tool for the external assessment of General Practice competencies in the context of medical education. Further studies are needed to evaluate both the completeness of the assessment and the external assessability of certain items in the context of medical education.
Collapse
Affiliation(s)
- Thomas Kötter
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland; Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland.
| | - Silvia Isabelle Rose
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland; Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Katja Götz
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Jost Steinhäuser
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| |
Collapse
|
41
|
von Solodkoff M, Strumann C, Steinhäuser J. [Acceptance of Care Offers for exclusive Remote Treatment Illustrated by the Telemedical Model Project "docdirekt" with a Mixed-Methods Design]. Gesundheitswesen 2020; 83:186-194. [PMID: 32615623 PMCID: PMC7979317 DOI: 10.1055/a-1173-9903] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Current telemedical services, such as the "docdirekt" project in Baden-Württemberg (BW), are evaluated for optimizing their implementation. Based on the results of this evaluation, strategies for adapting these services for exclusive remote treatment are identified that enable their integration in regular medical care. METHODS In the first part of the study, citizens from BW were individually interviewed on their expectations regarding such a project, and the advantages and barriers in the use of services for exclusive remote treatment. Determinants were explored by means of Mayring's qualitative content analysis. In the second part of the study, these determinants were prioritized by using a quantitative survey of randomly selected citizens from BW. RESULTS A total of 27 subjects (mean age 51 years, min: 23 years, max: 86 years) participated in the interviews. Most importantly, they found the direct accessibility of healthcare professionals a great advantage. A "24/7" hotline was found to be beneficial, as well as the possibility to get electronic prescriptions or medical sickness certificates. Privacy and a missing physical examination were perceived as barriers. In the questionnaire, the participants (n=217, return 10.9%, mean age: 53 years, min: 19 years, max: 88 years) rated a "direct medical contact" as the most important, followed by the "possibility to get a specialist" and to receive "a first therapy suggestion". In total, n=71 (34.6%) rejected the future use of such a service. The willingness to use the service decreased with increasing age and decreasing digital skills. CONCLUSION The study shows that there is an interest in the use of services for exclusive remote treatment. People who intend to use telemedical service prioritize the fast-initial medical assessment and the comfort aspects and, among other things, consider the inclusion of additional services as beneficial. The next step is to incorporate these determinants into the existing telemedical service.
Collapse
Affiliation(s)
- Michail von Solodkoff
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - Christoph Strumann
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - Jost Steinhäuser
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| |
Collapse
|
42
|
Abstract
BACKGROUND In recent years, the motivation of the new generation of general practitioners to set up their own practice is decreasing. Knowledge of factors that promote and inhibit the process of setting up a practice can enable developing strategies to support this process. The aim of this study was to explore these determinants. METHODS Between April and October 2016, self-employed general practitioners from Baden-Württemberg were invited to participate in a qualitative interview study. Stratification of 553 physicians, who participated in a general practice support program between 2008 and 2011 and set up a practice in 2008 to 2014, was based on the agglomeration in rural areas, the peripheral zones around the agglomeration and the urban agglomerations themselves. The transcripts of the interviews were analyzed by two authors with the content analysis according to Mayring and summarized. In a second step, a consensus version was elaborated. RESULTS A total of 23 general practitioners were recruited, 57% female and 42 years on average, and mostly working in group practices. The main motivation to set up a practice was the desire to improve the situation in relation to the daily clinical routine. These included a lower duty load and more family-friendly working hours. Relevant supportive factors during setting up a practice were family support, participation in a postgraduate training rotation network program and professional counseling. Inhibiting factors were fears of recourse and indebtedness, a complicated accounting system and a bureaucratic process of admission. CONCLUSIONS On the one hand, the study shows that the many advantages of working as a general practitioner, such as its being family friendly, need to be better communicated to the doctors and their financial concerns alleviated. On the other hand, the need for courses on management of one's practice has also become clear. A standardized and optimized process of setting up a practice with an improved overview and a collegial contact person can facilitate the decision for and implementing the setting up a medical practice as a general practitioner.
Collapse
Affiliation(s)
- Ruben Zwierlein
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig Holstein - Campus Lübeck, Lübeck
| | - Frank Portenhauser
- Kassenärztliche Vereinigung Baden-Württemberg, Koordinierungsstelle Allgemeinmedizin Baden-Württemberg, Stuttgart
| | - Kristina Flägel
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig Holstein - Campus Lübeck, Lübeck
| | - Jost Steinhäuser
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig Holstein - Campus Lübeck, Lübeck
| |
Collapse
|
43
|
Strumann C, Emcke T, Flägel K, Steinhäuser J. [Regional differences between general practitioners and general internal medicine physicians in primary care]. Z Evid Fortbild Qual Gesundhwes 2020; 150-152:88-95. [PMID: 32115385 DOI: 10.1016/j.zefq.2020.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In many places in Germany, the need for primary care physicians has been steadily increasing for several years, especially in rural areas. It is hypothesized that physicians are more likely to practice in rural areas if they have received a broad education and vocational training. Differences between general practitioners (GPs) and physicians in general internal medicine (GIM) in the breadth of their vocational training are created by the underlying distinct training schemes. The aim of the analysis was to test whether GPs and GIM physicians differ in their distribution between urban and rural regions of Schleswig-Holstein and whether there are differences in the rate and frequency of performing home visits. METHODS Based on invoicing data of the Association of Statutory Health Insurance Physicians in the federal state of Schleswig-Holstein (Northern Germany) covering the years 2015 up to the third quarter (Q3) of 2018, we analysed differences between GPs and GIM physicians in their regional distribution. Furthermore, we looked at differences between both specialties regarding the application rate and the number of home visits performed and unforeseen physician visits. In addition to bivariate approaches, we also used multivariate regression analysis. RESULTS Between 2017 (Q4) and 2018 (Q3), 1,378 GPs and 585 GIM physicians provided medical services in Schleswig-Holstein. While 27.5 % of the GPs had practices in rural areas, the share of GIM physicians was 14.5 % (p < 0.001). Home visits were performed by 97.8 % of the GPs and 93.2 % of the GIM physicians (p < 0.001). This difference was even more pronounced in rural areas (99.5 % vs. 94.1 % (p = 0.002)). Significant differences have also been found in the number of billed home visits. GPs made 36 % more home visits than GIM physicians. In rural areas, the difference was 60 %. CONCLUSION The analysis revealed significant differences between GPs and GIM physicians regarding the type of region where they work, the application rate and the number of performed home visits. The findings could foster a discussion about how GIM physicians can be better prepared to provide primary care, especially in rural areas.
Collapse
Affiliation(s)
- Christoph Strumann
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Institut für Allgemeinmedizin, Lübeck, Deutschland.
| | - Timo Emcke
- Kassenärztliche Vereinigung Schleswig-Holstein, Bad Segeberg, Deutschland
| | - Kristina Flägel
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Institut für Allgemeinmedizin, Lübeck, Deutschland
| | - Jost Steinhäuser
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Institut für Allgemeinmedizin, Lübeck, Deutschland
| |
Collapse
|
44
|
Kötter T, Rose SI, Waldmann A, Steinhäuser J. Do Medical Students in Their Fifth Year of Undergraduate Training Differ in Their Suitability to Become a "Good Doctor" Depending on Their Admission Criteria? A Pilot Study. Adv Med Educ Pract 2020; 11:109-112. [PMID: 32104132 PMCID: PMC7013149 DOI: 10.2147/amep.s235529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/24/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND In Germany, the pre-university grade point average (pu-GPA) has to be the main criterion for medical school applicant selection. This is also mandatory in the university-specific selection procedures (Auswahlverfahren der Hochschulen [AdH]). The admission framework has now been reworked following a judgement by the German Federal Constitutional Court. From 2020, more students will be admitted based solely on the pu-GPA and at least two selection criteria independent of the pu-GPA have to be considered in the AdH. However, the question whether an AdH (the core of the AdH at Lübeck Medical School [LMS], Germany, is a 30-mins panel interview led by two faculty members and one student) leads to better doctors as compared to pu-GPA-based selection, remains unanswered. OBJECTIVE To compare students selected based either on their pu-GPA alone ("pu-GPA-students") or based on the result of the AdH at LMS ("AdH-students") regarding their suitability to become a good doctor. DESIGN We conducted a cross-sectional observational pilot study at LMS. Students were judged regarding their overall suitability to become a good doctor by their supervising general practitioners after a two-week internship in their last year of theoretical medical education. The scores were matched to the selection procedure and compared between the pu-GPA-students and AdH-students. RESULTS In all, 79% of the AdH-students were rated as "absolutely suitable" for the medical profession, as compared to 42% of the pu-GPA-students (p = 0.01, odds ratio 5.17, 95% confidence interval = 1.41, 18.99). We did not find any association between gender or age and the suitability rating. CONCLUSION Despite the small sample size, our results indicate that it could be favourable to select medical students not only based on their pu-GPA but also using additional selection criteria.
Collapse
Affiliation(s)
- Thomas Kötter
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
- Correspondence: Thomas Kötter Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Lübeck23562, GermanyTel +49 451 3101 8006Fax +49 451 3101 8004 Email
| | - Silvia Isabelle Rose
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Annika Waldmann
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| |
Collapse
|
45
|
Flägel K, Galler B, Steinhäuser J, Götz K. [The "National Aeronautics and Space Administration-Task Load Index" (NASA-TLX) - an instrument for measuring consultation workload within general practice: evaluation of psychometric properties]. Z Evid Fortbild Qual Gesundhwes 2019; 147-148:90-96. [PMID: 31759889 DOI: 10.1016/j.zefq.2019.10.003] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 09/23/2019] [Accepted: 10/23/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aims of the study were the translation and a first reflection of the psychometric properties of the Aeronautics and Space Administration-Task Load Index (NASA-TLX), a multidimensional instrument to measure workload in general practice. METHODS During April and September 2015, the NASA-TLX was translated and evaluated. For this purpose, a questionnaire composed of the NASA-TLX items and others items related to demographic data, was developed. Postgraduate family medicine trainees and family physicians were then asked to assess patient consultations by applying the questionnaire. The psychometric properties of the NASA-TLX were identified using explorative and confirmatory factor analysis. Reliability was assessed using Cronbach's α. RESULTS Overall, 16 participants completed 769 surveys after a single patient consultation. The highest average was observed for the item 'mental demand' (mean 6.9 ± 5.4), followed by the item 'effort' (mean 6.6 ± 5.5). Factor analysis revealed a one-factor solution with an explained variance of 56.9 %. The German version of NASA-TLX demonstrated a high internal consistency (Cronbach's α = 0.84). Confirmatory factor analysis showed that there was an acceptable consistency between the expected unidimensional structure and the data. CONCLUSIONS The German version of NASA-TLX provides preliminary indications of psychometric properties and presents an important tool to evaluate family physicians' workload in direct patient contact.
Collapse
Affiliation(s)
- Kristina Flägel
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, 23562 Lübeck, Deutschland.
| | - Britta Galler
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, 23562 Lübeck, Deutschland.
| | - Jost Steinhäuser
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, 23562 Lübeck, Deutschland
| | - Katja Götz
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, 23562 Lübeck, Deutschland.
| |
Collapse
|
46
|
Allner R, Wilfling D, Kidholm K, Steinhäuser J. Corrigendum zu "Telemedizinprojekte im ländlichen Raum Deutschlands. Eine systematische Bewertung mit dem "Modell zur Evaluation von telemedizinischen Anwendungen"": [Z. Evid. Fortbild. Qual. Gesund. wesen 2019;141-142:89-95]. Z Evid Fortbild Qual Gesundhwes 2019; 144-145:102. [PMID: 31399390 DOI: 10.1016/j.zefq.2019.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Raphael Allner
- Institut für Telematik, Universität zu Lübeck, Lübeck, Germany.
| | - Denise Wilfling
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Jost Steinhäuser
- Institut für Allgemeinmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| |
Collapse
|
47
|
|
48
|
Feindel A, Rosenberg G, Steinhäuser J, Mozr C, Goetz K. Primary care practice assistants' attitudes towards tasking shifting and their perceptions of the challenges of task shifting - Development of a questionnaire. Health Soc Care Community 2019; 27:e323-e333. [PMID: 30834640 DOI: 10.1111/hsc.12736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 01/18/2019] [Accepted: 02/09/2019] [Indexed: 06/09/2023]
Abstract
Shifting tasks from medical staff to non-medical staff is a common practice for promoting the efficient use of healthcare resources. The aim of this study was to develop and pilot test a questionnaire that evaluates practice assistants' attitudes towards task shifting and their perceptions of the challenges of task shifting (acronym: ACD questionnaire) and to assess the psychometric properties of the questionnaire. The development and pilot testing of the questionnaire occurred from March 2016 to March 2017 and was based on guided and cognitive interviews with practice assistants. Then, an online survey was conducted throughout Germany from June to August 2017 to determine the questionnaire's psychometric properties. A factorial analysis was conducted via principal component analysis, and reliability was assessed using Cronbach's α. The questionnaire included four themes: "working conditions and job satisfaction", "confidence to execute delegated tasks", "excessive demands associated with executing delegated tasks" and "relevance of task shifting for patient care". A total of 274 practice assistants with an average age of 38.2 years participated in the online survey. Each theme included components that showed good to very good reliability (Cronbach's α 0.64-0.91). The ACD questionnaire provides a way, for the first time, to evaluate delegable tasks, including practice assistants' attitudes towards task shifting and their perceptions of the challenges generated by these tasks. The questionnaire also indicates which components of practice assistants' professional training should be intensified.
Collapse
Affiliation(s)
- Andrea Feindel
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Gerrit Rosenberg
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Cornelia Mozr
- Medical Association of Schleswig-Holstein, Edmund-Christiani-Seminar, Bad Segeberg, Germany
| | - Katja Goetz
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany
| |
Collapse
|
49
|
Hahn K, Steinhäuser J, Wilfling D, Goetz K. Quality of health care for refugees - a systematic review. BMC Int Health Hum Rights 2019; 19:20. [PMID: 31196192 PMCID: PMC6567514 DOI: 10.1186/s12914-019-0205-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 06/06/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this systematic review was to identify quality indicators (QI) developed for health care for refugees. METHODS We conducted a systematic review of international QI databases such as the Agency for Health care Research and Quality in addition to a systematic search in PubMed, Cochrane library and Web of Science, using the terms "refugee" and "quality indicator", complemented by a search in reference lists and grey literature. All papers which included QIs for refugees, especially for health care were included. In a first step all existing QIs were screened for their relevance to refugees. In a second step, all health care QIs were extracted. In a final step, these health care QIs were classified into process, structure and outcome indicators. RESULTS Of 474 papers, 23 were selected for a full-text review. Of these 23 publications, 6 contained 115 QIs for health and health care for refugees. The main health care topics identified were reproductive health, health care service and health status. CONCLUSIONS Most indicators were indicators for outcome and structure quality, the smallest group were process indicators. Within the area of refugee health care, most QIs that have been found were QIs regarding reproductive health. QI databases do not yet include indicators specifically related to refugees.
Collapse
Affiliation(s)
- Karolin Hahn
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Denise Wilfling
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Katja Goetz
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
| |
Collapse
|
50
|
Hahn K, Steinhäuser J. Strategies for rural areas: The development of and initial experiences with a training course for physicians from third countries to prepare them for medical practice in Germany. GMS J Med Educ 2019; 36:Doc25. [PMID: 31211220 PMCID: PMC6545610 DOI: 10.3205/zma001233] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 06/09/2023]
Abstract
Aim: In Germany there is an increasing shortage of physicians, especially in rural areas. Strategies that make use of medical doctors from non-EU member states could effectively counteract this problem more rapidly than other strategies, including those that focus on education. Physicians from third countries must first demonstrate evidence of their professional qualifications on an exam. The failure rate in Schleswig-Holstein is approximately 50%. The specific aim of the 80-hour training course is to prepare third-country physicians for the practice of medicine in Germany and to provide exposure to the rural setting, regardless of whether or not these physicians have already taken an exam to receive formal recognition of their professional qualifications. Method: The need for post-licensure training courses was discerned in interviews with third-country physicians and examiners. The course was also evaluated using different instruments and then revised accordingly. Results: The training program has been held four times with a total of 52 third-country physicians; the program was given the very good rating of 1.4 on the traditional German academic grading scale. In addition to the 10-day training course, the participants had access to an online medical learning platform. Moreover, information on working in rural setting and a field trip to a variety of medical institutions in a rural region was integrated into the course. The majority of the participants used the course as additional preparation for the exam. Their willingness to later practice medicine in a rural setting was high with 89% of participants. Conclusion: The evaluation results suggest that such an intensive training program is suitable to prepare third-country physicians for medical practice in Germany and in particular in rural regions.
Collapse
Affiliation(s)
- Karolin Hahn
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Institut für Allgemeinmedizin, Lübeck, Germany
| | - Jost Steinhäuser
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Institut für Allgemeinmedizin, Lübeck, Germany
| |
Collapse
|