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Gummersbach E, Fuchs A, Lubisch D, in der Schmitten J, Pentzek M, Leve V. Was motiviert Frauen zur Teilnahme am Mammographiescreening? Ergebnisse einer qualitativen Analyse von Interviews. Präv Gesundheitsf 2023. [DOI: 10.1007/s11553-023-01024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Zusammenfassung
Einleitung
Die Teilnahmerate am Mammographiescreening beträgt derzeit ca. 49 %. Über die Gründe für Frauen, am Screening teilzunehmen, ist bisher zu wenig bekannt.
Material und Methoden
Für eine qualitative Studie wurden aus den Teilnehmerinnen einer Fragebogenstudie zum Einfluss verschiedener Informationsbroschüren auf die Teilnahmebereitschaft 8 Frauen für Interviews ausgewählt. Die Frauen wurden nach den Kriterien Teilnahmebereitschaft (6 ja, 2 nein), Bildung (6 hoch, 2 niedrig) und Entscheidungssicherheit (6 hoch, 2 niedrig) ausgewählt und im Jahr 2014 in problemzentrierten Einzelinterviews befragt. Sequenzen der Interviewtranskripte wurden in multidisziplinären Teams inhaltsanalytisch ausgewertet.
Ergebnisse
Alle interviewten Frauen hatten Mammographieerfahrung. Es wurden übergreifende Themen in sechs Kategorien identifiziert: Pflichtgefühl, Autonomie, Zweifel, Unsicherheit, Arzt/Ärztin, Institution. Die Frauen sahen in der Screeningteilnahme die Chance, einer möglichen Bedrohung durch Brustkrebs zu entgehen. Erfahrungen mit Brustkrebs im Umfeld beeinflussten ihre Entscheidung. Einer selbstverantwortlichen Entscheidungsbildung wurde ein hoher Stellenwert zugesprochen, andererseits folgten sie dem Rat ihres Arztes/ihrer Ärztin. Bei der Durchführung des Screenings fühlten sie sich einer unpersönlichen und schmerzhaften Maschinerie ausgesetzt.
Schlussfolgerungen
Frauen treffen ihre Entscheidung, am Screening teilzunehmen oder nicht, eher auf der emotionalen Ebene. Um ihnen eine informierte Entscheidung zu ermöglichen, sollten in einem ärztlichen Gespräch neben sachlichen Informationen ihre Vorstellungen und Erfahrungen in Bezug auf das Mammographiescreening ergebnisoffen besprochen werden.
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Schüttig W, Flemming R, Mosler CH, Leve V, Reddemann O, Schultz A, Brua E, Brittner M, Meyer F, Pollmanns J, Martin J, Czihal T, von Stillfried D, Wilm S, Sundmacher L. Development of indicators to assess quality and patient pathways in interdisciplinary care for patients with 14 ambulatory-care-sensitive conditions in Germany. BMC Health Serv Res 2022; 22:1015. [PMID: 35945585 PMCID: PMC9364554 DOI: 10.1186/s12913-022-08327-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/13/2022] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND In settings like the ambulatory care sector in Germany, where data on the outcomes of interdisciplinary health services provided by multiple office-based physicians are not always readily available, our study aims to develop a set of indicators of health care quality and utilization for 14 groups of ambulatory-care-sensitive conditions based on routine data. These may improve the provision of health care by informing discussions in quality circles and other meetings of networks of physicians who share the same patients. METHODS Our set of indicators was developed as part of the larger Accountable Care in Deutschland (ACD) project using a pragmatic consensus approach. The six stages of the approach drew upon a review of the literature; the expertise of physicians, health services researchers, and representatives of physician associations and statutory health insurers; and the results of a pilot study with six informal network meetings of office-based physicians who share the same patients. RESULTS The process resulted in a set of 248 general and disease specific indicators for 14 disease groups. The set provides information on the quality of care provided and on patient pathways, covering patient characteristics, physician visits, ambulatory care processes, pharmaceutical prescriptions and outcome indicators. The disease groups with the most indicators were ischemic heart diseases, diabetes and heart failure. CONCLUSION Our set of indicators provides useful information on patients' health care use, health care processes and health outcomes for 14 commonly treated groups of ambulatory-care-sensitive conditions. This information can inform discussions in interdisciplinary quality circles in the ambulatory sector and foster patient-centered care.
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Affiliation(s)
- Wiebke Schüttig
- Chair of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany. .,Department for Health Services Management, Ludwig-Maximilian-University Munich, Munich, Germany.
| | - Ronja Flemming
- Chair of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany.,Department for Health Services Management, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Christiane Höhling Mosler
- AOK Health Insurance Rhineland / Hamburg, Kasernenstraße 61, 40213, Duesseldorf, Germany.,University Hospital Düsseldorf, Office of Quality Management and Patient Safety, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Verena Leve
- Institute of General Practice (ifam), Centre for Health and Society (chs), Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Olaf Reddemann
- Institute of General Practice (ifam), Centre for Health and Society (chs), Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Annemarie Schultz
- Regional Association of Statutory Health Insurance Physicians Hamburg, Humboldtstraße 56, 22083, Hamburg, Germany
| | - Emmanuelle Brua
- Regional Association of Statutory Health Insurance Physicians Hamburg, Humboldtstraße 56, 22083, Hamburg, Germany
| | - Matthias Brittner
- Regional Association of Statutory Health Insurance Physicians Westphalia Lip, Robert-Schimrigk-Straße 4-6, 44141, Dortmund, Germany
| | - Frank Meyer
- Regional Association of Statutory Health Insurance Physicians Westphalia Lip, Robert-Schimrigk-Straße 4-6, 44141, Dortmund, Germany
| | - Johannes Pollmanns
- Regional Association of Statutory Health Insurance Physicians North Rhine, Tersteegenstraße 9, 40474, Duesseldorf, Germany
| | - Johnannes Martin
- Regional Association of Statutory Health Insurance Physicians North Rhine, Tersteegenstraße 9, 40474, Duesseldorf, Germany
| | - Thomas Czihal
- Zentralinstitut für die Kassenärztliche Versorgung in der Bundesrepublik Deutschland, Salzufer 8, 10587, Berlin, Germany
| | - Dominik von Stillfried
- Zentralinstitut für die Kassenärztliche Versorgung in der Bundesrepublik Deutschland, Salzufer 8, 10587, Berlin, Germany
| | - Stefan Wilm
- Institute of General Practice (ifam), Centre for Health and Society (chs), Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany.,Department for Health Services Management, Ludwig-Maximilian-University Munich, Munich, Germany
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Flemming R, Schüttig W, Ng F, Leve V, Sundmacher L. Using social network analysis methods to identify networks of physicians responsible for the care of specific patient populations. BMC Health Serv Res 2022; 22:462. [PMID: 35395792 PMCID: PMC8991784 DOI: 10.1186/s12913-022-07807-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coordinating health care within and among sectors is crucial to improving quality of care and avoiding undesirable negative health outcomes, such as avoidable hospitalizations. Quality circles are one approach to strengthening collaboration among health care providers and improving the continuity of care. However, identifying and including the right health professionals in such meetings is challenging, especially in settings with no predefined patient pathways. Based on the Accountable Care in Germany (ACD) project, our study presents a framework for and investigates the feasibility of applying social network analysis (SNA) to routine data in order to identify networks of ambulatory physicians who can be considered responsible for the care of specific patients. METHODS The ACD study objectives predefined the characteristics of the networks. SNA provides a methodology to identify physicians who have patients in common and ensure that they are involved in health care provision. An expert panel consisting of physicians, health services researchers, and data specialists examined the concept of network construction through informed decisions. The procedure was structured by five steps and was applied to routine data from three German states. RESULTS In total, 510 networks of ambulatory physicians met our predefined inclusion criteria. The networks had between 20 and 120 physicians, and 72% included at least ten different medical specialties. Overall, general practitioners accounted for the largest proportion of physicians in the networks (45%), followed by gynecologists (10%), orthopedists, and ophthalmologists (5%). The specialties were distributed similarly across the majority of networks. The number of patients this study allocated to the networks varied between 95 and 45,268 depending on the number and specialization of physicians per network. CONCLUSIONS The networks were constructed according to the predefined characteristics following the ACD study objectives, e.g., size of and specialization composition in the networks. This study shows that it is feasible to apply SNA to routine data in order to identify groups of ambulatory physicians who are involved in the treatment of a specific patient population. Whether these doctors are also mainly responsible for care and if their active collaboration can improve the quality of care still needs to be examined.
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Affiliation(s)
- Ronja Flemming
- Chair of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, München, Germany. .,Department for Health Services Management, Ludwig-Maximilian-University Munich, Munich, Germany.
| | - Wiebke Schüttig
- Chair of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, München, Germany.,Department for Health Services Management, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Frank Ng
- Central Institute, for SHI Physician Care in Germany, Salzufer 8, 10587, Berlin, Germany
| | - Verena Leve
- Institute of General Practice (Ifam), Centre for Health and Society (Chs), Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, München, Germany.,Department for Health Services Management, Ludwig-Maximilian-University Munich, Munich, Germany
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Sundmacher L, Flemming R, Leve V, Geiger I, Franke S, Czihal T, Krause C, Wiese B, Meyer F, Brittner M, Pollmanns J, Martin J, Brandenburg P, Schultz A, Brua E, Schneider U, Dortmann O, Rupprecht C, Wilm S, Schüttig W. Improving the continuity and coordination of ambulatory care through feedback and facilitated dialogue-a study protocol for a cluster-randomised trial to evaluate the ACD study (Accountable Care in Germany). Trials 2021; 22:624. [PMID: 34526088 PMCID: PMC8441947 DOI: 10.1186/s13063-021-05584-z] [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: 11/27/2020] [Accepted: 08/31/2021] [Indexed: 12/12/2022] Open
Abstract
Background Patients in Germany are free to seek care from any office-based physician and can always ask for multiple opinions on a diagnosis or treatment. The high density of physicians and the freedom to choose among them without referrals have led to a need for better coordination between the multiple health professionals treating any given patient. The objectives of this study are to (1) identify informal networks of physicians who treat the same patient population, (2) provide these physicians with feedback on their network and patients, using routine data and (3) give the physicians the opportunity to meet one another in facilitated network meetings. Methods The Accountable Care Deutschland (ACD) study is a prospective, non-blinded, cluster-randomised trial comprising a process and economic evaluation of informal networks among 12,525 GPs and office-based specialists and their 1.9 million patients. The units of allocation are the informal networks, which will be randomised either to the intervention (feedback and facilitated meetings) or control group (usual care). The informal networks will be generated by identifying connections between office-based physicians using complete datasets from the Regional Associations of Statutory Health Insurance (SHI) Physicians in Hamburg, Schleswig Holstein, North Rhine and Westphalia Lip, as well as data from three large statutory health insurers in Germany. The physicians will (a) receive feedback on selected indicators of their own treatment activity and that of the colleagues in their network and (b) will be invited to voluntary, facilitated network meetings by their Regional Association of SHI physicians. The primary outcome will be ambulatory-care-sensitive hospitalisations at baseline, at the end of the 2-year intervention period, and at six months and at 12 months after the end of the intervention period. Data will be analysed using the intention-to-treat principle. A pilot study preceded the ACD study. Discussion Cochrane reviews show that feedback can improve everyday medical practice by shedding light on previously unknown relationships. Providing physicians with information on how they are connected with their colleagues and what the outcomes are of care delivered within their informal networks can help them make these improvements, as well as strengthen their awareness of possible discontinuities in the care they provide. Trial registration German Clinical Trials Register DRKS00020884. Registered on 25 March 2020—retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05584-z.
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Affiliation(s)
- Leonie Sundmacher
- Department of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, München, Germany.,Department of Health Services Management, Ludwig-Maximilians-University Munich, Geschwister-Scholl-Platz 1, 80539, München, Germany
| | - Ronja Flemming
- Department of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, München, Germany.,Department of Health Services Management, Ludwig-Maximilians-University Munich, Geschwister-Scholl-Platz 1, 80539, München, Germany
| | - Verena Leve
- Institute of General Practice of Heinrich-Heine University in Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Isabel Geiger
- Department of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, München, Germany.,Department of Health Services Management, Ludwig-Maximilians-University Munich, Geschwister-Scholl-Platz 1, 80539, München, Germany
| | - Sebastian Franke
- Department of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, München, Germany.,Department of Health Services Management, Ludwig-Maximilians-University Munich, Geschwister-Scholl-Platz 1, 80539, München, Germany
| | - Thomas Czihal
- Central Institute for SHI Physician Care in Germany (Zi), Salzufer 8, 10587, Berlin, Germany
| | - Clemens Krause
- Central Institute for SHI Physician Care in Germany (Zi), Salzufer 8, 10587, Berlin, Germany
| | - Birgitt Wiese
- Institute of General Practice, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Frank Meyer
- Regional Association of Statutory Health Insurance Physicians Westphalia Lip, Robert-Schimrigk-Str. 4-6, 44141, Dortmund, Germany
| | - Matthias Brittner
- Regional Association of Statutory Health Insurance Physicians Westphalia Lip, Robert-Schimrigk-Str. 4-6, 44141, Dortmund, Germany
| | - Johannes Pollmanns
- Regional Association of Statutory Health Insurance Physicians North Rhine, Tersteegenstraße 9, 40474, Düsseldorf, Germany
| | - Johannes Martin
- Regional Association of Statutory Health Insurance Physicians North Rhine, Tersteegenstraße 9, 40474, Düsseldorf, Germany
| | - Paul Brandenburg
- Regional Association of Statutory Health Insurance Physicians Schleswig Holstein, Bismarckallee 1-6, 23795, Bad Segeberg, Germany
| | - Annemarie Schultz
- Regional Association of Statutory Health Insurance Physicians Hamburg, Humboldtstraße 56, 22083, Hamburg, Germany
| | - Emmanuelle Brua
- Regional Association of Statutory Health Insurance Physicians Hamburg, Humboldtstraße 56, 22083, Hamburg, Germany
| | - Udo Schneider
- Techniker Krankenkasse, Bramfelder Straße 140, 22305, Hamburg, Germany
| | - Olga Dortmann
- AOK Health Insurance Rhineland/Hamburg, Kasernenstr. 61, 40213, Düsseldorf, Germany
| | - Christoph Rupprecht
- AOK Health Insurance Rhineland/Hamburg, Kasernenstr. 61, 40213, Düsseldorf, Germany
| | - Stefan Wilm
- Institute of General Practice of Heinrich-Heine University in Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Wiebke Schüttig
- Department of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, München, Germany. .,Department of Health Services Management, Ludwig-Maximilians-University Munich, Geschwister-Scholl-Platz 1, 80539, München, Germany.
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Greiner GG, Viehmann A, Linnenkamp U, Wilm S, Leve V, Neuenschwander M, Kuss O, Fehm T, Ensenauer R, Schumacher L, Lange U, Müller-Bößmann D, Lappe V, Ihle P, Adamczewski H, Kaltheuner M, Tamayo M, Gräfe V, Westerhoff B, Wallerich-Herf N, Schellhammer S, Kerres T, Schmitz-Losem I, Cramer S, Rupprecht CJ, Klüppelholz B, Meyer F, Koch-Schulte S, Jüngling U, Icks A. Study protocol for a mixed methods exploratory investigation of aftercare services for gestational diabetes in women to develop a new patient-centred model in Germany: the GestDiNa_basic study. BMJ Open 2021; 11:e046048. [PMID: 34341040 PMCID: PMC8330567 DOI: 10.1136/bmjopen-2020-046048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Women with gestational diabetes mellitus (GDM) have a higher risk of developing type 2 diabetes mellitus compared with women who never had GDM. Consequently, the question of structured aftercare for GDM has emerged. In all probability, many women do not receive care according to the guidelines. In particular, the process and interaction between obstetrical, diabetic, gynaecological, paediatric and general practitioner care lacks clear definitions. Thus, our first goal is to analyse the current aftercare situation for women with GDM in Germany, for example, the participation rate in aftercare diabetes screening, as well as reasons and attitudes stated by healthcare providers to offer these services and by patients to participate (or not). Second, we want to develop an appropriate, effective and patient-centred care model. METHODS AND ANALYSIS This is a population-based mixed methods study using both quantitative and qualitative research approaches. In various working packages, we evaluate data of the GestDiab register, of the Association of Statutory Health Insurance Physicians of North Rhine and the participating insurance companies (AOK Rheinland/Hamburg, BARMER, DAK Gesundheit, IKK classic, pronova BKK). In addition, quantitative (postal surveys) and qualitative (interviews) surveys will be conducted with randomly selected healthcare providers (diabetologists, gynaecologists, paediatricians and midwives) and affected women, to be subsequently analysed. All results will then be jointly examined and evaluated. ETHICS AND DISSEMINATION The study was approved by the ethics committee of the Faculty of Medicine, Heinrich-Heine-University Düsseldorf (Ethics Committee No.: 2019-738). Participants of the postal surveys and interviews will be informed in detail about the study and the use of data as well as the underlying data protection regulations before voluntarily participating. The study results will be disseminated through peer-reviewed journals, conferences and public information. TRIAL REGISTRATION NUMBER DRKS00020283.
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Affiliation(s)
- Gregory Gordon Greiner
- Institute for Health Services Research and Health Economics, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Anja Viehmann
- Institute for Health Services Research and Health Economics, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Ute Linnenkamp
- Institute for Health Services Research and Health Economics, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
- Department of Gynecology and Obstetrics, University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Stefan Wilm
- Institute of General Practice, Centre for Health and Society (chs), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Verena Leve
- Institute of General Practice, Centre for Health and Society (chs), Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Manuela Neuenschwander
- Institute for Biometrics and Epidemiology, German Diabetes Center Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Regina Ensenauer
- Institute of Child Nutrition, Max Rubner-Institute Federal Research Institute of Nutrition and Food, Karlsruhe, Baden-Württemberg, Germany
- Department of General Paediatrics, Neonatology, and Paediatric Cardiology, University Children's Hospital, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Liesa Schumacher
- Department of General Paediatrics, Neonatology, and Paediatric Cardiology, University Children's Hospital, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Ute Lange
- Department of Applied Heath Sciences, Bochum University of Applied Sciences, Bochum, Nordrhein-Westfalen, Germany
| | - Dorit Müller-Bößmann
- Department of Applied Heath Sciences, Bochum University of Applied Sciences, Bochum, Nordrhein-Westfalen, Germany
| | - Veronika Lappe
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Peter Ihle
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | | | | | - Miguel Tamayo
- Association of Statutory Health Insurance Physicians of North Rhine (KV Nordrhein), Düsseldorf, Nordrhein-Westfalen, Germany
| | - Viola Gräfe
- Association of Statutory Health Insurance Physicians of North Rhine (KV Nordrhein), Düsseldorf, Nordrhein-Westfalen, Germany
| | | | | | | | - Thomas Kerres
- DAK Gesundheit, Statutory Health Insurance, Hamburg, Germany
| | - Imke Schmitz-Losem
- pronova BKK, Statutory Health Insurance, Ludwigshafen, Rheinland-Pfalz, Germany
| | - Stefan Cramer
- pronova BKK, Statutory Health Insurance, Ludwigshafen, Rheinland-Pfalz, Germany
| | - Christoph J Rupprecht
- AOK Rheinland/Hamburg, Statutory Health Insurance, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Birgit Klüppelholz
- AOK Rheinland/Hamburg, Statutory Health Insurance, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Frank Meyer
- IKK classic, Statutory Health Insurance, Münster, Nordrhein-Westfalen, Germany
| | - Simone Koch-Schulte
- IKK classic, Statutory Health Insurance, Münster, Nordrhein-Westfalen, Germany
| | - Ute Jüngling
- Patient Representative, Dortmund, Nordrhein-Westfalen, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
- German Center for Diabetes Research, Neuherberg, Bayern, Germany
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Kastaun S, Leve V, Hildebrandt J, Funke C, Klosterhalfen S, Lubisch D, Reddemann O, McRobbie H, Raupach T, West R, Wilm S, Viechtbauer W, Kotz D. Training general practitioners in the ABC versus 5As method of delivering stop-smoking advice: a pragmatic, two-arm cluster randomised controlled trial. ERJ Open Res 2021; 7:00621-2020. [PMID: 34322552 PMCID: PMC8311138 DOI: 10.1183/23120541.00621-2020] [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: 08/28/2020] [Accepted: 10/10/2020] [Indexed: 11/05/2022] Open
Abstract
This study assessed the effectiveness of a 3.5-h training session for general practitioners (GPs) in providing brief stop-smoking advice and compared two methods of giving advice - ABC versus 5As - on the rates of delivery of such advice and of recommendations of evidence-based smoking cessation treatment during routine consultations. A pragmatic, two-arm cluster randomised controlled trial was carried out including a pre-/post-design for the analyses of the primary outcome in 52 GP practices in Germany. Practices were randomised (1:1) to receive a 3.5-h training session (ABC or 5As). In total, 1937 tobacco-smoking patients, who consulted trained GPs in these practices in the 6 weeks prior to or following the training, were included. The primary outcome was patient-reported rates of GP-delivered stop-smoking advice prior to and following the training, irrespective of the training method. Secondary outcomes were patient-reported receipt of recommendation/prescription of behavioural therapy, pharmacotherapy or combination therapy for smoking cessation, and the effectiveness of ABC versus 5As regarding all outcomes. GP-delivered stop-smoking advice increased from 13.1% (n=136 out of 1039) to 33.1% (n=297 out of 898) following the training (adjusted odds ratio (aOR) 3.25, 95% CI 2.34-4.51). Recommendation/prescription rates of evidence-based treatments were low (<2%) pre-training, but had all increased after training (e.g. behavioural support: aOR 7.15, 95% CI 4.02-12.74). Delivery of stop-smoking advice increased non-significantly (p=0.08) stronger in the ABC versus 5As group (aOR 1.71, 95% CI 0.94-3.12). A single training session in stop-smoking advice was associated with a three-fold increase in rates of advice giving and a seven-fold increase in offer of support. The ABC method may lead to higher rates of GP-delivered advice during routine consultations.
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Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Verena Leve
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jaqueline Hildebrandt
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christian Funke
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Stephanie Klosterhalfen
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Diana Lubisch
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Olaf Reddemann
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hayden McRobbie
- University of New South Wales, National Drug and Alcohol Research Centre, Randwick, Australia.,Lakes District Health Board, Rotorua, New Zealand
| | - Tobias Raupach
- Dept of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.,Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Robert West
- Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Stefan Wilm
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Viechtbauer
- Dept of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Daniel Kotz
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.,Dept of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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7
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Kastaun S, Viechtbauer W, Leve V, Hildebrandt J, Funke C, Klosterhalfen S, Lubisch D, Reddemann O, Raupach T, Wilm S, Kotz D. Quit attempts and tobacco abstinence in primary care patients: follow-up of a pragmatic, two-arm cluster randomised controlled trial on brief stop-smoking advice - ABC versus 5As. ERJ Open Res 2021; 7:00224-2021. [PMID: 34322551 PMCID: PMC8311137 DOI: 10.1183/23120541.00224-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/23/2021] [Indexed: 11/14/2022] Open
Abstract
We developed a 3.5-h training for general practitioners (GPs) in delivering brief stop-smoking advice according to different methods (ABC, 5As). In a pragmatic, cluster randomised controlled trial our training proved effective in increasing GP-delivered rates of such advice (from 13% to 33%). In this follow-up analysis we examined the effect of the training and compared ABC versus 5As on patient-reported quit attempts and point prevalence abstinence at weeks 4, 12 and 26 following GP consultation. Follow-up data were collected in 1937 smoking patients - independently of the receipt of GP advice - recruited before or after the training of 69 GPs. At week 26, ∼70% of the patients were lost to follow-up. All 1937 patients were included in an intention-to-treat analysis; missing outcome data were imputed. Quit attempts and abstinence rates did not differ significantly from pre- to post-training or between patients from the ABC versus the 5As group. However, ancillary analyses showed that patients who received GP advice compared to those who did not had two times higher odds of reporting a quit attempt at all follow-ups and abstinence at week 26. We reported that our training increases GP-delivered rates of stop-smoking advice, and the present analysis confirms that advice is associated with increased quit attempts and abstinence rates in patients. However, our training did not further improve these rates, which might be related to patients' loss to follow-up or to contextual factors, e.g. access to free evidence-based cessation treatment, which can hamper the transfer of GPs' advice into patients' behaviour change.
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Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Viechtbauer
- Dept of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Verena Leve
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jaqueline Hildebrandt
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christian Funke
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Stephanie Klosterhalfen
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Diana Lubisch
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Olaf Reddemann
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Tobias Raupach
- Institute for Medical Education, University Hospital Bonn, Bonn, Germany
- Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Stefan Wilm
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Daniel Kotz
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
- Dept of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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8
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Pohontsch NJ, Meyer T, Eisenmann Y, Metzendorf MI, Leve V, Lentsch V. Study protocol of a systematic review and qualitative evidence synthesis using two different approaches: Healthcare related needs and desires of older people with post-stroke aphasia. BMJ Open 2021; 11:e039348. [PMID: 35175215 PMCID: PMC8039218 DOI: 10.1136/bmjopen-2020-039348] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 03/05/2021] [Accepted: 03/17/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Stroke is a frequent disease in the older population of Western Europe with aphasia as a common consequence. Aphasia is known to impede targeting treatment to individual patients' needs and therefore may reduce treatment success. In Germany, the postacute care of patients who had stroke is provided by different healthcare institutions of different sectors (rehabilitation, nursing and primary care) with substantial difficulties to coordinate services. We will conduct two qualitative evidence syntheses (QESs) aiming at exploring distinct healthcare needs and desires of older people living with poststroke aphasia. We thereby hope to support the development of integrated care models based on needs of patients who are very restricted to communicate them. Since various methods of QESs exist, the aim of the study embedding the two QESs was to determine if findings differ according to the approach used. METHODS AND ANALYSIS We will conduct two QESs by using metaethnography (ME) and thematic synthesis (ThS) independently to synthesise the findings of primary qualitative studies. The main differences between these two methods are the underlying epistemologies (idealism (ME) vs realism (ThS)) and the type of research question (emerging (ME) vs fixed (ThS)).We will search seven bibliographical databases. Inclusion criteria comprise: patients with poststroke aphasia, aged 65 years and older, studies in German/English, all types of qualitative studies concerning needs and desires related to healthcare or the healthcare system. The protocol was registered in the International Prospective Register of Systematic Reviews, follows Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines and includes three items from the Enhancing Transparency in Reporting the synthesis of Qualitative Research checklist. ETHICS AND DISSEMINATION Ethical approval is not required. Findings will be published in a peer-reviewed journal and presented on national conferences.
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Affiliation(s)
- Nadine Janis Pohontsch
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Meyer
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Yvonne Eisenmann
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
| | - Maria-Inti Metzendorf
- Institute of General Practice, Centre for Health and Society, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Verena Leve
- Institute of General Practice, Centre for Health and Society, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Veronika Lentsch
- Berufsakademie Nord, University of Cooperative Education, Hamburg, Germany
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9
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Niesten D, Gerritsen AE, Leve V. Barriers and Facilitators to integrate Oral Health care for Older Adults in General (Basic) Care in East Netherlands. Part 2 Functional Integration. Gerodontology 2021; 38:289-299. [PMID: 33386759 PMCID: PMC8451897 DOI: 10.1111/ger.12525] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/05/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE to synthesise a framework of barriers and facilitators in the functional integration of oral health care (OHC) into general health care for frail older adults at macro (system), meso (organisation and interprofessional integration) and micro (clinical practice) levels. BACKGROUND Identification of these barriers and facilitators is expected to promote better and more appropriate care. METHODS For this qualitative study, comprising 41 participants, representatives of 10 different groups of (professional) care providers, and OHC receivers (home-dwelling and nursing-home patients) were interviewed. Transcripts of the in-depth, topic-guided interviews were thematically analysed. In a subsequent workshop with 52 stakeholders, results and interpretations were discussed and refined. RESULTS Two themes were identified: (1) compartmentalised care systems and (2) poor interprofessional and communication infrastructure. Barriers related to (1) included lack of integrative policies and compartmentalised healthcare education (macro level); poor embedding of OHC in care procedures, instruments and guidelines (meso level); and poor interprofessional skills (micro level). Barriers related to (2) included poor financial incentives for collaborative practices (macro level) and badly connected ICT systems (meso level). Identified facilitators included integration of an OHC professional into care teams, and interdisciplinary consultations (meso level); and integration of OHC in individual care plans (micro level). CONCLUSION In The Netherlands, OHC for older people is at best poorly integrated into general care practices. Barriers and facilitators are interconnected across macro-, meso- and micro levels and between normative and functional domains and are mainly related to compartmentalisation at all levels and to poor interprofessional and communication infrastructure.
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Affiliation(s)
- D Niesten
- College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A E Gerritsen
- College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - V Leve
- Institut für Allgemeinmedizin, Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Germany
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10
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Niesten D, Gerritsen AE, Leve V. Barriers and facilitators to integrate oral health care for older adults in general (basic) care in East Netherlands. Part 1: Normative integration. Gerodontology 2020; 38:154-165. [PMID: 33274776 DOI: 10.1111/ger.12507] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/05/2020] [Accepted: 10/17/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE to synthesise a framework of barriers and facilitators in the normative integration of oral health care (OHC) into general health care for frail older adults at macro (system), meso (organisation and interprofessional integration) and micro (clinical practice) levels. BACKGROUND Identification of these barriers and facilitators is expected to promote better and more appropriate care. METHODS For this qualitative study, comprising 41 participants, representatives of 10 different groups of (professional) care providers, and OHC receivers (home-dwelling, and nursing home patients) in East Netherlands were interviewed. Transcripts of the in-depth, topic-guided interviews were thematically analysed. In a subsequent workshop with 52 stakeholders, results and interpretations were discussed and refined. RESULTS Two main themes were identified: (1) a compartmentalised care culture in which OHC and general health care are seen as two separate realms, and (2) prioritisation, awareness and attitude regarding OHC integration. Subthemes such as low political attention (macro level); unclear responsibilities, hierarchical relations and the lack of vision of organisations (meso level); and poor awareness and low prioritisation by care providers and patients (micro level) were identified as potential barriers. Subthemes such as leadership (meso level), and the supportive personality of individual caregivers and ownership of patients (micro level) were identified as facilitators. CONCLUSION Barriers and facilitators in normative OHC integration in The Netherlands are interrelated and apparent at macro-, meso- and micro levels. They are mainly related to (a) a compartmentalised care culture, and (b) related low prioritisation, and poor awareness of and attitude towards (integration of) oral health (care).
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Affiliation(s)
- Dominique Niesten
- College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anneloes E Gerritsen
- College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Verena Leve
- Institut für Allgemeinmedizin, Heinrich-Heine-Universität, Düsseldorf, Germany
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11
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Linnenkamp U, Greiner G, Fehm T, Adamczewski H, Bizjak G, Borgmeier F, Dortmann O, Ensenauer R, Gräfe V, Hollmann T, Ihle P, Jüngling U, Kaltheuner M, Kerres T, Kuß O, Lange U, Lappe V, Leve V, Meier-Stiegen F, Meyer F, Müller-Bößmann D, Neuenschwander M, Ruckhäberle E, Rupprecht C, Schellhammer S, Schmitz-Losem I, Schneider M, Schumacher L, Tamayo M, Viehmann A, Westerhoff B, Wilm S, Icks A. GestDina – Analysis of the current aftercare situation for gestational diabetes. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- U Linnenkamp
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf
| | - G Greiner
- IVG, Heinrich-Heine-Universität Düsseldorf/DDZ
| | - T Fehm
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf
| | | | - G Bizjak
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf
| | - F Borgmeier
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf
| | | | - R Ensenauer
- Kinderklinik, Universitätsklinikum Düsseldorf
| | - V Gräfe
- Kassenärztliche Vereinigung Nordrhein
| | | | - P Ihle
- pmv Forschungsgruppe, Universität zu Köln
| | | | | | | | | | - U Lange
- Studienbereich Hebammenwissenschaft, HSG Bochum
| | - V Lappe
- pmv Forschungsgruppe, Universität zu Köln
| | - V Leve
- ifam, Heinrich-Heine-Universität Düsseldorf
| | - F Meier-Stiegen
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf
| | | | | | | | - E Ruckhäberle
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf
| | | | | | | | | | | | - M Tamayo
- Kassenärztliche Vereinigung Nordrhein
| | - A Viehmann
- IVG, Heinrich-Heine-Universität Düsseldorf/DDZ
| | | | - S Wilm
- ifam, Heinrich-Heine-Universität Düsseldorf
| | - A Icks
- IVG, Heinrich-Heine-Universität Düsseldorf/DDZ
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12
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Kastaun S, Leve V, Hildebrandt J, Funke C, Becker S, Lubisch D, Viechtbauer W, Reddemann O, Hempel L, McRobbie H, Raupach T, West R, Kotz D. Effectiveness of training general practitioners to improve the implementation of brief stop-smoking advice in German primary care: study protocol of a pragmatic, 2-arm cluster randomised controlled trial (the ABCII trial). BMC Fam Pract 2019; 20:107. [PMID: 31351460 PMCID: PMC6660716 DOI: 10.1186/s12875-019-0986-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/27/2019] [Indexed: 11/10/2022]
Abstract
Background The German clinical guideline on tobacco addiction recommends that general practitioners (GPs) provide brief stop-smoking advice to their patients according to the “5A” or the much briefer “ABC” method, but its implementation is insufficient. A lack of training is one barrier for GPs to provide such advice. Moreover, the respective effectiveness of a 5A or ABC training regarding subsequent delivery of stop-smoking advice has not been investigated. We developed a training for GPs according to both methods, and conducted a pilot study with process evaluation to optimize the trainings according to the needs of GPs. This study aims at evaluating the effectiveness of both trainings. Methods A pragmatic 2-arm cluster randomised controlled trial with a pre-post data collection will be conducted in 48 GP practices in North Rhine-Westphalia (Germany). GPs will be randomised to receive a 3.5-h-training in delivering either 5A or ABC, including peer coaching and intensive role plays with professional actors. The patient-reported primary outcome (receipt of GP advice to quit: yes/no) and secondary outcomes (recommendation rates of smoking cessation treatments, group comparison (5A versus ABC): receipt of GP advice to quit) will be collected in smoking patients routinely consulting their GP within 4 weeks prior, and 4 weeks following the training. Additional secondary outcomes will be collected at 4, 12 and 26 weeks following the consultation: use of cessation treatments during the last quit attempt (if so) since the GP consultation, and point-prevalence abstinence rates. The primary data analysis will be conducted using a mixed-effects logistic regression model with random effects for the cluster variable. Discussion If the training increases the rates of delivery of stop-smoking advice, it would offer a low-threshold strategy for the guideline implementation in German primary care. Should one method prove superior, a more specific guideline recommendation can be proposed. Trial registration German Clinical Trials Register (DRKS00012786); registered on 22th August 2017, prior to the first patient in. Electronic supplementary material The online version of this article (10.1186/s12875-019-0986-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany.
| | - Verena Leve
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Jaqueline Hildebrandt
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Christian Funke
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Stephanie Becker
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Diana Lubisch
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Olaf Reddemann
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Linn Hempel
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hayden McRobbie
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,The Dragon Institute for Innovation, Auckland, New Zealand
| | - Tobias Raupach
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.,Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Robert West
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany.,Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.,Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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13
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Hajek A, Brettschneider C, Eisele M, van den Bussche H, Wiese B, Mamone S, Weyerer S, Werle J, Leve V, Pentzek M, Röhr S, Stein J, Bickel H, Mösch E, Heser K, Wagner M, Scherer M, Maier W, Riedel-Heller SG, König HH. Prevalence and determinants of driving habits in the oldest old: Results of the multicenter prospective AgeCoDe-AgeQualiDe study. Arch Gerontol Geriatr 2019; 82:245-250. [PMID: 30877986 DOI: 10.1016/j.archger.2019.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/12/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 12/01/2022]
Abstract
AIM To present data on the prevalence of driving habits and to identify the determinants of driving habits among the oldest old in Germany. METHODS Cross-sectional data were used from the "Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" (AgeQualiDe), including primary care patients aged 85 years and above (n = 549 at FU 9, mean age was 90.3 years; 86-101 years). Driving habits were measured (driving a car; frequency of driving a car and driving duration). Correlates were quantified using widely established scales (e.g., Geriatric Depression Scale, Instrumental Activities of Daily Living Scale). Multiple regression models were used to identify the determinants of driving habits. RESULTS Sixteen percent (87 out of 549) drove a car. Among the car-drivers, about 80% drove at least several times a week and about two-thirds drove longer distances (>15 min). Multiple logistic regressions showed that among the oldest old being a male was more likely to be a current driver compared to being a female. Other significant factors were subjective memory impairment, severe visual impairment, functional and cognitive impairment. Correlates of frequency of driving a car and driving duration were further identified. CONCLUSION About one in six very old Germans is still a regular car driver. Several determinants of driving habits among the oldest old were identified. Future longitudinal studies are required to clarify the factors leading to changes in driving habits.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marion Eisele
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hendrik van den Bussche
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt Wiese
- Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Silke Mamone
- Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Verena Leve
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Michael Pentzek
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Horst Bickel
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Edelgard Mösch
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Kathrin Heser
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Michael Wagner
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany; DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Maier
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany; DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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14
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Santos S, Lessing C, Schrappe M, Vollmar H, Leve V, Zschocke B, Lux R. Entwicklung, Anwendung und Evaluation eines Konzeptes zur sicheren Patientenidentifikation im Krankenhaus – Wie kann der Wissenstransfer gelingen? Gesundheitswesen 2017. [DOI: 10.1055/s-0035-1555922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S. Santos
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | | | | | - H. Vollmar
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
- Institut für Allgemeinmedizin und Familienmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten
| | - V. Leve
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - B. Zschocke
- Qualitätsmanagement, Vivantes Klinikum im Friedrichshain, Berlin
| | - R. Lux
- Zentrum für Medizinische Lehre (ZML), Ruhr-Universität Bochum (RUB), Bochum
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Leve V, Ilse K, Ufert M, Wilm S, Pentzek M. [Driving and dementia : An issue for general practice?!]. Z Gerontol Geriatr 2017; 50:55-62. [PMID: 28432419 DOI: 10.1007/s00391-017-1234-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/10/2017] [Accepted: 03/30/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND With most forms of dementia, the risk of road traffic accidents increases with disease progression. Addressing the issue of fitness to drive at an early stage can help to reduce driving-related risks and simultaneously preserve mobility. General practitioners (GPs) are central contact persons for dementia patients and their relatives in medical and psychosocial matters, and also play a key role in addressing the issue of driving safety. OBJECTIVE Identification of relevant aspects of managing fitness to drive in dementia, as well as of support requirements for German general practice. MATERIALS AND METHODS Seven focus groups with dementia patients, family caregivers and GPs were conducted in order to define the different requirements for counselling in the general practice setting. The transcribed discussions were analysed by a multiprofessional research team using content analysis. RESULTS For people with dementia, declining mobility and driving cessation is related to a loss of autonomy. Addressing fitness to drive in dementia is thus a subject of conflict and uncertainty for both family caregivers and GPs. The difficulties include the assessment of fitness to drive in the general practice setting, concerns about compromising the patient-physician relationship by raising the issue of driving fitness, as well as uncertainties about the GP's own role. GPs consider the involvement of caregivers to be important to successfully address the topic of driving safety and organise alternative transport. Support is required in the form of criteria defining the time point at which fitness to drive should be assessed, information on compensation possibilities and mobility alternatives. CONCLUSION Resource-oriented and patient-centred development of management strategies for limited mobility is needed in general practice. Finding the correct balance between documentation, adequately informing the patient and establishing patient-centred strategies represents a challenge.
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Affiliation(s)
- Verena Leve
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Deutschland.
| | - Katharina Ilse
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Deutschland
| | - Marie Ufert
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Deutschland
| | - Stefan Wilm
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Deutschland
| | - Michael Pentzek
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Deutschland
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16
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Pentzek M, Vollmar HC, Wilm S, Leve V. Putting dementia awareness into general practice : The CADIF approach. Z Gerontol Geriatr 2017; 50:44-47. [PMID: 28315047 DOI: 10.1007/s00391-017-1206-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/19/2017] [Accepted: 02/17/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND International studies show that dementia is often recognized at later stages in general practice. Pure knowledge-sharing interventions could not change this in a sustainable manner. Concepts for changing attitudes of general practitioners (GPs) are required. OBJECTIVES What barriers affect GPs' recognition of and diagnostic approach to dementia? What recommendations for a GP-specific diagnostic procedure can be derived from this? METHODS Metasynthesis of qualitative studies with GPs on barriers to dementia recognition, explication of the "frailty" concept and the diagnostic approach described therein and the development of an approach in cases of suspected cognitive decline in a multiprofessional team. RESULTS A metasynthesis of qualitative studies revealed a lack of a general practice framework in the diagnostic approach of GPs, characterized by poor patient-centeredness and confusion of early detection, diagnostics and disclosure. The embedding of cognitive decline into the geriatric triad is intended to promote the focus on everyday function and quality of life, i.e. on caring instead of curing. The proposed concept for a transfer into practice emphasizes increased awareness for cognitive warning signs among practice personnel, a geriatric and personal approach to the patient, as well as follow-up assessment and monitoring. CONCLUSION In contrast to early recognition, awareness initially does not imply an active search for cognitive deficits with questions and tests but a vigilance for red flags. The described scheme is a component of a complex intervention for attitude change among GPs towards dementia.
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Affiliation(s)
- Michael Pentzek
- Institute of General Practice (ifam) and Centre for Health and Society (chs), Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.,Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Stefan Wilm
- Institute of General Practice (ifam) and Centre for Health and Society (chs), Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Verena Leve
- Institute of General Practice (ifam) and Centre for Health and Society (chs), Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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Santos S, Lessing C, Schrappe M, Vollmar HC, Leve V, Zschocke B, Lux R. [Development, Application and Evaluation of a Concept for Safe Patient Identification in Hospital - How can Knowledge Transfer Succeed?]. Gesundheitswesen 2015; 79:506-513. [PMID: 26110245 DOI: 10.1055/s-0035-1549988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aim of the Study: In order to minimise the risk of patient misidentification in clinical settings, the German Coalition for Patient Safety published recommendations for safety patient identification in 2008. The aim of this study was to develop, implement and evaluate a theoretical framework of knowledge transfer. The purpose of the framework was to enhance hospital staff's ability to apply the recommendations for safe patient identification in the daily routine of patient care. Method: A data bank-based research and literature review have been conducted. Research topics were: knowledge transfer, change management and implementation science. Within the application of the concept group interviews were held with hospital staff and the interview material was evaluated using content analysis. On this basis a tailored multifaceted implementation strategy has been developed and applied in 8 hospital wards of 4 hospitals belonging to a communal hospital concern. The evaluation of the developed knowledge transfer concept was conducted 4 weeks after the concept application with a written questionnaire. Results: The developed framework concept of knowledge translation consisted of 4 phases built on top of each other: initiation phase; analysis phase; implementation phase; evaluation phase. The multifaceted implementation strategy included 3 interventions: a poster, a computer-based training and a guideline for team meetings. The survey yielded responses from 56 individuals: 96% declared that they know about the existence of the recommendations for safe patient identification; 86% said that they know about the content of the recommendations; 91% have striven to apply the recommendations in the daily routine of patient care; 71% stated that the recommendations for safe patient identification have become integral part in the daily routine of patient care. To become aware of the recommendations and its content the respondents have used on average 2.3 interventions, however the effect of the CBS was relatively small. Conclusion: The developed theoretical framework concept for knowledge transfer provides a way to integrate the recommendations for safe patient identification in the daily routine of patient care and to counteract risk factors promoting misidentification. Therefore a multifaceted implementation strategy is promising.
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Affiliation(s)
- S Santos
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | | | | | - H C Vollmar
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf.,Institut für Allgemeinmedizin und Familienmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten
| | - V Leve
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - B Zschocke
- Qualitätsmanagement, Vivantes Klinikum im Friedrichshain, Berlin
| | - R Lux
- Zentrum für Medizinische Lehre (ZML), Ruhr-Universität Bochum (RUB), Bochum
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Vollmar HC, Thyrian JR, LaMantia MA, Alder CA, Guerriero Austrom MM, Callahan C, Leve V, Hoffmann W, Boustani M. [Aging Brain Care Program from Indianapolis: Transferability to the German healthcare system]. Z Gerontol Geriatr 2015; 49:32-6. [PMID: 26014477 DOI: 10.1007/s00391-015-0904-1] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND New and innovative concepts of care management have been developed to improve the health of older adults with dementia and depression. AIM This article describes the American aging brain care (ABC) program and the possible transfer to the German healthcare system is discussed. MATERIAL AND METHODS The ABC medical home model in Indianapolis incorporates a specialized geriatric healthcare center which is affiliated to the Eskenazi Hospital as well as a program involving home-based domestic visits by healthcare personnel to affected people. The diagnoses are made in the geriatric center where therapy and treatment are also planned. These stages are carried out in a multiprofessional team, which identifies the individual needs of the patients and relatives and discusses these in family conferences as well as in close consultation with the primary care center of the hospital. The care, diagnosis and therapy are coordinated using a self-developed software for the program and via predetermined pathways and procedural instructions on the approach in the healthcare center and in the domestic visit program. RESULTS AND CONCLUSION From the perspective of the authors the core elements of the program include not only the use of a home-based care model but also the selection and training of a new type of front-line care provider. Models like the program presented here show great promise for meeting the demands of a rapidly expanding population of vulnerable older adults.
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Affiliation(s)
- H C Vollmar
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5/Geb. 14.97, 40225, Düsseldorf, Deutschland. .,Institut für Allgemeinmedizin und Familienmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Herdecke, Deutschland.
| | - J R Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Rostock/Greifswald, Greifswald, Deutschland
| | - M A LaMantia
- Indiana University Center for Aging Research (IU-CAR), Indiana University School of Medicine (IUSM), Indianapolis, USA.,Regenstrief Institute, Inc., Indianapolis, USA
| | - C A Alder
- Regenstrief Institute, Inc., Indianapolis, USA.,Eskenazi Health, Indianapolis, USA
| | - M M Guerriero Austrom
- Indiana University Center for Aging Research (IU-CAR), Indiana University School of Medicine (IUSM), Indianapolis, USA.,Department of Psychiatry, IUSM, Indianapolis, USA.,Indiana Alzheimer Disease Center, IUSM, Indianapolis, USA
| | - C Callahan
- Indiana University Center for Aging Research (IU-CAR), Indiana University School of Medicine (IUSM), Indianapolis, USA
| | - V Leve
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5/Geb. 14.97, 40225, Düsseldorf, Deutschland
| | - W Hoffmann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Rostock/Greifswald, Greifswald, Deutschland.,Institute for Community Medicine, University of Greifswald, Greifswald, Deutschland
| | - M Boustani
- Indiana University Center for Aging Research (IU-CAR), Indiana University School of Medicine (IUSM), Indianapolis, USA.,Regenstrief Institute, Inc., Indianapolis, USA.,Center for Health Innovation and Implementation Science (CHIIS), IUSM, Indianapolis, USA
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19
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Pentzek M, Michel JV, Ufert M, Vollmar HC, Wilm S, Leve V. [Fitness to drive in dementia - theoretical framing and design of a recommendation for German general practice]. Z Evid Fortbild Qual Gesundhwes 2015; 109:115-23. [PMID: 26028448 DOI: 10.1016/j.zefq.2015.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/20/2015] [Accepted: 03/24/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND General practitioners (GPs) are among the first to be contacted by persons with dementia and their relatives. Fitness to drive in dementia is a subject of uncertainty and conflict for GPs. OBJECTIVE Development of recommendations for German general practice on managing fitness to drive in dementia. METHODS Specification of problem areas by using relevant parts of a metasynthesis of international qualitative dementia research with GPs; literature review on evidence regarding the pre-defined problem areas; deduction of a preliminary design for a recommendation in a multi-professional team. RESULTS The difficulties include the assessment of fitness to drive in the office setting, concerns about damaging the patient-physician relationship by raising the issue of driving fitness, and uncertainties about the GP's own legal role. A diagnosis of dementia does not per se preclude driving. The majority of elderly people would accept discussing fitness to drive with their GP. In Germany, GPs are not obliged to assess fitness to drive, or to report unsafe drivers to the Licensing Agency, but under certain conditions they do have the right to report. Addressing the issue of driving and dementia early with the patient seems to be a prerequisite for a resource-oriented and patient-centred management. DISCUSSION The distinction between medical, ethical-communicative, and legal aspects enabled us to break down this complex problem and thus provide the informative basis to draft tailored recommendations. In an ongoing project, this framework will be further developed and informed by the expertise of patients, family caregivers, and professionals from various fields.
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Affiliation(s)
- Michael Pentzek
- Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Institut für Allgemeinmedizin (ifam).
| | | | - Marie Ufert
- Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Institut für Allgemeinmedizin (ifam)
| | - Horst Christian Vollmar
- Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Institut für Allgemeinmedizin (ifam); Universität Witten/Herdecke, Fakultät für Gesundheit, Institut für Allgemeinmedizin und Familienmedizin
| | - Stefan Wilm
- Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Institut für Allgemeinmedizin (ifam)
| | - Verena Leve
- Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Institut für Allgemeinmedizin (ifam)
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Wilm S, Leve V, Santos S. [Is it quality of life that patients really want? Assessment from a general practitioner's perspective]. Z Evid Fortbild Qual Gesundhwes 2014; 108:126-9. [PMID: 24780710 DOI: 10.1016/j.zefq.2014.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The multidimensional, complex construct of 'quality of life' as a patient-reported outcome is used in medicine as a measurable indicator of health and illness. But do we know what we do when we measure 'quality of life'? Can we grasp how the patient with his individual concept of disease really feels when we use instruments that were designed, administered and analysed by professionals? Do we know the meaning of what we have measured? Is it not shortsighted to focus on health-related quality of life? And is it really quality of life that patients actually want? From a general practitioner's perspective, these questions will be asked of three patients.
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Affiliation(s)
- Stefan Wilm
- Institut für Allgemeinmedizin (ifam), Fakultät für Medizin, Heinrich-Heine-Universität Düsseldorf.
| | - Verena Leve
- Institut für Allgemeinmedizin (ifam), Fakultät für Medizin, Heinrich-Heine-Universität Düsseldorf
| | - Sara Santos
- Institut für Allgemeinmedizin (ifam), Fakultät für Medizin, Heinrich-Heine-Universität Düsseldorf
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Wilm S, Santos S, Leve V. [The role of non-pharmaceutical and non-technical therapeutic interventions in patient care]. Z Evid Fortbild Qual Gesundhwes 2013; 107:200-205. [PMID: 23790693 DOI: 10.1016/j.zefq.2013.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A clear definition of the broad field of non-pharmaceutical and non-technical therapeutic interventions in patient care does not exist, making the discussion more difficult. Here, the relationship between patient and professional, contextual factors, and the influence of the patient play a more prominent role than with drug therapy and technical interventions. The vast majority of non-pharmaceutical and non-technical procedures consist of complex and nearly always communication-based interventions. It is difficult to describe their role, since reliable data on criteria like frequency, time required, costs, quality, number of professionals involved and the importance for the patient are sparse. These therapeutic interventions may well form the core and biggest part of therapy in patient care. (As supplied by publisher).
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Affiliation(s)
- Stefan Wilm
- Institut für Allgemeinmedizin (ifam), Fakultät für Medizin, Heinrich-Heine-Universität Düsseldorf, Moorenstrasse 5, Düsseldorf.
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Leve V, Naegele G, Sporket M. ["Retirement at 67": prerequisites for the ability of older female jobholders to continue working]. Z Gerontol Geriatr 2009; 42:287-91. [PMID: 19618227 DOI: 10.1007/s00391-009-0054-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 06/21/2009] [Indexed: 11/28/2022]
Abstract
The new Retirement Age Adjustment Act, enacted by the Federal Government in spring 2007 to raise the statutory retirement age to 67 years in Germany, poses a challenge for the jobholders concerned as well as for the companies. Especially older female jobholders are exposed to particular risks regarding their ability to continue working due to the cumulative concurrence of age-specific but also additional gender-specific employment patterns and risks. Their employment situation is influenced by age discrimination in terms of recruitment and human resource management. Furthermore, women were and are confronted with specific obstacles in the course of their working lives, such as, the problem of reconciling work and family life and care giving, lesser opportunities for development and advancement due to sectoral and work organizational circumstances and lower incomes. There has been an increase in part-time arrangements, marginal employment, and temporary jobs, which are all predominantly filled by women. If women do not manage to stay in gainful employment, they do not only individually face an insufficient old-age income but the national economy is also in danger of losing valuable human resources and social security contributions.
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Affiliation(s)
- V Leve
- Institut für Gerontologie an der Technischen Universität Dortmund, Dortmund, Germany
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