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Diekmann S, Schlierenkamp S, Walendzik A, Abels C, Zur Nieden P, Best D, Schaff C, Timmermann H, Klipker K, Marschall U, Wasem J, Neusser S. [Evaluating the reform of the psychotherapy guideline using a mixed-methods approach: a study protocol]. Gesundheitswesen 2023; 85:1066-1071. [PMID: 37473768 DOI: 10.1055/a-2011-6129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
INTRODUCTION In Germany, psychotherapy in outpatient statutory health care is regulated by the Psychotherapy Guideline (PT-GL). A discussion on waiting times and inadequate care for patients resulted in a structural reform of the PT-GL in 2017. The reform aims to improve access to psychotherapy and the entire course of care and treatment. The purpose of the present study was the evaluation of the new elements and identification of obstacles and barriers in their implementation. METHODS Quantitative and qualitative methods were used to evaluate the reform of the PT-GL. In a retrospective cohort-based analysis of anonymized administrative claim data from the statutory health insurances BARMER and AOK, the health care situation before and after the reform were compared. In addition, a cross-sectional questionnaire survey evaluated the implementation of the new care elements from the perspective of psychotherapists, general practitioners and patients. The questionnaires were developed based on focus groups with stakeholders and a literature search. The survey results provided the data basis for the cross-sectional analysis together with the routine data on the care situation after the reform of the PT-GL as well as aggregated, anonymized data from the National Association of Statutory Health Insurance Physicians on statutory health insurance care and on the use of the appointment service centers. CONCLUSION By combining quantitative and qualitative data, the effects of the structural reform of the PT-GL of 2016 can be analyzed at the individual and structural level as well as in relation to the entire care and treatment process. Based on this, proposals for a needs-oriented further development of the PT-GL will be prepared, considering the perspectives of various interest groups.
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Affiliation(s)
- Sandra Diekmann
- EsFoMed, Essener Forschungsinstitut für Medizinmanagement GmbH, Essen, Germany
| | - Sarah Schlierenkamp
- EsFoMed, Essener Forschungsinstitut für Medizinmanagement GmbH, Essen, Germany
| | - Anke Walendzik
- Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Essen, Germany
| | - Carina Abels
- Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Essen, Germany
| | - Pauline Zur Nieden
- EsFoMed, Essener Forschungsinstitut für Medizinmanagement GmbH, Essen, Germany
| | - Dieter Best
- Deutsche Psychotherapeuten Vereinigung (DPtV), Berlin, Germany
| | - Christa Schaff
- Berufsverband für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie in Deutschland e. V. (bkjpp), Mainz, Germany
| | - Helene Timmermann
- Vereinigung für analytische und tiefenpsychologisch fundierte Kinder- und Jugendlichen-Psychotherapie in Deutschland e.V. (VAKJP), Berlin, Germany
| | | | | | - Jürgen Wasem
- Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Essen, Germany
| | - Silke Neusser
- EsFoMed, Essener Forschungsinstitut für Medizinmanagement GmbH, Essen, Germany
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Diekmann S, Schlierenkamp S, Walendzik A, Abels C, Zur Nieden P, Best D, Schaff C, Timmermann H, Klipker K, Marschall U, Wasem J, Neusser S. [Correction: Evaluating the reform of the psychotherapy guideline using a mixed-methods approach: a study protocol]. Gesundheitswesen 2023; 85:e48. [PMID: 37972584 DOI: 10.1055/a-2167-0010] [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: 11/19/2023]
Affiliation(s)
- Sandra Diekmann
- EsFoMed, Essener Forschungsinstitut für Medizinmanagement GmbH, Essen, Germany
| | - Sarah Schlierenkamp
- EsFoMed, Essener Forschungsinstitut für Medizinmanagement GmbH, Essen, Germany
| | - Anke Walendzik
- Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Essen, Germany
| | - Carina Abels
- Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Essen, Germany
| | - Pauline Zur Nieden
- EsFoMed, Essener Forschungsinstitut für Medizinmanagement GmbH, Essen, Germany
| | - Dieter Best
- Deutsche Psychotherapeuten Vereinigung (DPtV), Berlin, Germany
| | - Christa Schaff
- Berufsverband für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie in Deutschland e. V. (bkjpp), Mainz, Germany
| | - Helene Timmermann
- Vereinigung für analytische und tiefenpsychologisch fundierte Kinder- und Jugendlichen-Psychotherapie in Deutschland e.V. (VAKJP), Berlin, Germany
| | | | | | - Jürgen Wasem
- Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Essen, Germany
| | - Silke Neusser
- EsFoMed, Essener Forschungsinstitut für Medizinmanagement GmbH, Essen, Germany
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Schwarze K, Mathmann P, Schäfer K, Brannath W, Höhne PH, Altin S, Prein L, Naghipour A, Zielonkowski SM, Wasmuth S, Kanaan O, Am Zehnhoff-Dinnesen A, Schwalen AS, Schotenröhr A, Scharpenberg M, Schlierenkamp S, Stuhrmann N, Lang-Roth R, Demir M, Diekmann S, Neumann A, Gietmann C, Neumann K. Effectiveness and costs of a low-threshold hearing screening programme ( HörGeist) for individuals with intellectual disabilities: protocol for a screening study. BMJ Open 2023; 13:e070259. [PMID: 37202136 DOI: 10.1136/bmjopen-2022-070259] [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: 05/20/2023] Open
Abstract
INTRODUCTION Individuals with intellectual disabilities (ID) often suffer from hearing loss, in most cases undiagnosed or inappropriately treated. The implementation of a programme of systematic hearing screening, diagnostics, therapy initiation or allocation and long-term monitoring within the living environments of individuals with ID (nurseries, schools, workshops, homes), therefore, seems beneficial. METHODS AND ANALYSIS The study aims to assess the effectiveness and costs of a low-threshold screening programme for individuals with ID. Within this programme 1050 individuals with ID of all ages will undergo hearing screening and an immediate reference diagnosis in their living environment (outreach cohort). The recruitment of participants in the outreach group will take place within 158 institutions, for example, schools, kindergartens and places of living or work. If an individual fails the screening assessment, subsequent full audiometric diagnostics will follow and, if hearing loss is confirmed, initiation of therapy or referral to and monitoring of such therapy. A control cohort of 141 participants will receive an invitation from their health insurance provider via their family for the same procedure but within a clinic (clinical cohort). A second screening measurement will be performed with both cohorts 1 year later and the previous therapy outcome will be checked. It is hypothesised that this programme leads to a relevant reduction in the number of untreated or inadequately treated cases of hearing loss and strengthens the communication skills of the newly or better-treated individuals. Secondary outcomes include the age-dependent prevalence of hearing loss in individuals with ID, the costs associated with this programme, cost of illness before-and-after enrolment and modelling of the programme's cost-effectiveness compared with regular care. ETHICS AND DISSEMINATION The study has been approved by the Institutional Ethics Review Board of the Medical Association of Westphalia-Lippe and the University of Münster (No. 2020-843 f-S). Participants or guardians will provide written informed consent. Findings will be disseminated through presentations, peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER DRKS00024804.
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Affiliation(s)
- Katharina Schwarze
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Philipp Mathmann
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Karolin Schäfer
- Department of Special Education and Rehabilitation, Education and Aural Rehabilitation of People who are Deaf or Hard of Hearing, University of Cologne, Cologne, Germany
| | - Werner Brannath
- Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | | | | | - Lukas Prein
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Awa Naghipour
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | | | - Susanne Wasmuth
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Oliver Kanaan
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | | | - Anna Sophia Schwalen
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Anna Schotenröhr
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Martin Scharpenberg
- Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | - Sarah Schlierenkamp
- Essener Forschungsinstitut für Medizinmanagement - EsFoMed GmbH, Essen, Germany
| | - Nicole Stuhrmann
- Practice for Otolaryngology, Phoniatrics & Paediatric Audiology, Duesseldorf-Meerbusch, Germany
- Phoniatrics and Paediatric Audiology, Head and Neck Surgery, Helios HSK, Wiesbaden, Germany
| | - Ruth Lang-Roth
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Muhittin Demir
- Department of Otorhinolaryngology, Division of Phoniatrics and Paediatric Audiology, University Medicine Essen, Essen, Germany
| | - Sandra Diekmann
- Essener Forschungsinstitut für Medizinmanagement - EsFoMed GmbH, Essen, Germany
| | - Anja Neumann
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Corinna Gietmann
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
| | - Katrin Neumann
- Department of Phoniatrics and Paediatric Audiology, University Hospital Münster, Muenster, Germany
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Abels C, Diekmann S, Neusser S, Schlierenkamp S, Wasem J, Walendzik A. [Reform Implementation of the Psychotherapy Guideline 2017: Results from Focus Groups Within the Framework of the Innovation Fund Project EVA PT-RL]. Gesundheitswesen 2023. [PMID: 37044118 DOI: 10.1055/a-1976-1856] [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: 04/14/2023]
Abstract
BACKGROUND Mental illnesses cause both individual and social burdens. The main goal of the structural reform of the Psychotherapy Guideline of 2017 was to improve access to psychotherapeutic care. The focus groups, which were conducted as part of the research project "Evaluation of the Psychotherapy Guideline (Eva PT-RL)" funded by the Innovation Fund, address the implementation of the goals of the reform and the individual newly introduced care elements as well as hurdles to implementation from the perspective of service providers, patients and insurers. METHODS Six focus groups and five individual interviews were conducted with people from the three stakeholder groups mentioned above. The basis was a semistructured interview guide adapted to the respective group of people based on a structured literature research. The interviews were conducted by a team of moderators via video conference, recorded and transcribed. The analysis was carried out via a qualitative content analysis based on Mayring. RESULTS The initial psychotherapeutic consultation received a generally positive assessment particularly with regard to timely initial access to psychotherapeutic care. At the same time a delayed transition to subsequent guideline psychotherapy due to a lack of capacity was criticized by all participant groups. Beneficial effects of telephone accessibility as well as increased networking of psychotherapeutic care also with other psychosocial services were mentioned. However the implementation of acute treatment and relapse prophylaxis was found to be inadequate. The central finding was that the impulse for a paradigm shift aimed at by the reform was perceived and implemented differently by the psychotherapists - from a focus on individual therapy processes to a public mental health perspective with a commitment to care coordination. CONCLUSION Some elements of the reform were criticized by stakeholders, the transition from initial appointments to continuous treatment was considered as not timely enough, and the design of other elements (acute treatment and relapse prevention regulations) was assessed as improvable. There is a need for further research. The results of the focus groups serve as a basis for following project steps including a survey of psychotherapists, patients and GPs.
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Affiliation(s)
- Carina Abels
- Lehrstuhl für Medizinmanagement, Universität Duisburg Essen Lehrstuhl für Medizinmanagement, Essen, Germany
| | - Sandra Diekmann
- EsFoMed, Essener Forschungsinstitut für Medizinmanagement GmbH, Essen, Germany
| | - Silke Neusser
- EsFoMed, Essener Forschungsinstitut für Medizinmanagement GmbH, Essen, Germany
| | - Sarah Schlierenkamp
- EsFoMed, Essener Forschungsinstitut für Medizinmanagement GmbH, Essen, Germany
| | - Jürgen Wasem
- Lehrstuhl für Medizinmanagement, Universität Duisburg Essen Lehrstuhl für Medizinmanagement, Essen, Germany
| | - Anke Walendzik
- Lehrstuhl für Medizinmanagement, Universität Duisburg Essen Lehrstuhl für Medizinmanagement, Essen, Germany
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Neusser S, Neumann A, zur Nieden P, Speckemeier C, Schlierenkamp S, Walendzik A, Karbach U, Andreica I, Vaupel K, Baraliakos X, Kiltz U. Facilitators and barriers of vaccine uptake in patients with autoimune inflammatory rheumatic disease: a scoping review. RMD Open 2022; 8:rmdopen-2022-002562. [PMID: 36562767 PMCID: PMC9748992 DOI: 10.1136/rmdopen-2022-002562] [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: 07/06/2022] [Accepted: 09/01/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Patients with autoimmune inflammatory rheumatic diseases (AIRD) often have lower vaccination coverage rates compared with the general population, despite being disproportionately affected by infectious complications. We aim to systematically review the literature regarding vaccination willingness and hesitancy in AIRD. METHODS A scoping review was conducted in PubMed, EMBASE and the Cochrane Library in June 2021. Study selection was performed by two independent reviewers and data were extracted using a standardised form. Risk of bias was assessed using instruments from McMaster University. Identified barriers were categorised into the WHO's measuring behavioural and social drivers (BeSD) of vaccination conceptual model. RESULTS The search yielded 1644 hits of which 30 publications were included (cross-sectional studies based on interviews (n=27) and intervention studies (n=3)). The majority of studies reported barriers to influenza and pneumococcal vaccination only (n=9) or in combination with another vaccination (n=8) from the patients' perspective. Only one study assessed the view of rheumatologists. Coverage of domains matched to the BeSD model suggests a lack of awareness of infection risk by both patients and physicians. Patients mainly mentioned behavioural and social factors that negatively influenced their willingness to be vaccinated while physicians mentioned organisational deficits as major barriers. CONCLUSIONS The view on vaccination in patients with AIRD diverges between patients and rheumatologists. Our results show that in-depth counselling on vaccines is important for patients, whereas physicians need support in implementing specific immunisation recommendations. The themes identified provide a starting point for future interventions to improve vaccine rates in patients with AIRD.
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Affiliation(s)
- Silke Neusser
- Essener Forschungsinstitut für Medizinmanagement, Essen, Germany
| | - Anja Neumann
- Essener Forschungsinstitut für Medizinmanagement, Essen, Germany
| | | | | | | | - Anke Walendzik
- Essener Forschungsinstitut für Medizinmanagement, Essen, Germany
| | - Ute Karbach
- Institute for Medical Sociology Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Ioana Andreica
- Faculty of Medicine, Ruhr Universität Bochum, Bochum, Germany,Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Kristina Vaupel
- Faculty of Medicine, Ruhr Universität Bochum, Bochum, Germany,Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany
| | | | - Uta Kiltz
- Faculty of Medicine, Ruhr Universität Bochum, Bochum, Germany,Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany
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Schwarze K, Neumann A, Schäfer K, Brannath W, Altin S, Höhne PH, Schlierenkamp S, Diekmann S, Mathmann P, Gietmann C, Wasmuth S, Matulat P, Prein L, Neumann K. „HörGeist – Ein Programm zur
niedrigschwelligen Identifikation und Behandlung von
Hörstörungen bei Menschen mit geistiger Behinderung“
– Studienprotokoll. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753797] [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: 12/12/2022]
Affiliation(s)
- K Schwarze
- Universität Duisburg-Essen, Lehrstuhl für
Medizinmanagement, Essen, Deutschland
| | - A Neumann
- Universität Duisburg-Essen, Lehrstuhl für
Medizinmanagement, Essen, Deutschland
| | - K Schäfer
- Universität zu Köln, Lehrstuhl für
Audiopädagogik, Köln, Deutschland
| | - W Brannath
- Universität Bremen, Kompetenzzentrum für Klinische
Studien, Bremen, Deutschland
| | - S Altin
- AOK Rheinland-Hamburg – Die Gesundheitskasse.,
Düsseldorf, Deutschland
| | - P-H Höhne
- AOK Rheinland-Hamburg – Die Gesundheitskasse.,
Düsseldorf, Deutschland
| | - S Schlierenkamp
- Essener Forschungsinstitut für Medizinmanagement GmbH, Essen,
Deutschland
| | - S Diekmann
- Essener Forschungsinstitut für Medizinmanagement GmbH, Essen,
Deutschland
| | - P Mathmann
- Universitätsklinikum Münster, Klinik für
Phoniatrie und Pädaudiologie, Münster, Deutschland
| | - C Gietmann
- Universitätsklinikum Münster, Klinik für
Phoniatrie und Pädaudiologie, Münster, Deutschland
| | - S Wasmuth
- Universitätsklinikum Münster, Klinik für
Phoniatrie und Pädaudiologie, Münster, Deutschland
| | - P Matulat
- Universitätsklinikum Münster, Klinik für
Phoniatrie und Pädaudiologie, Münster, Deutschland
| | - L Prein
- Universitätsklinikum Münster, Klinik für
Phoniatrie und Pädaudiologie, Münster, Deutschland
| | - K Neumann
- Universitätsklinikum Münster, Klinik für
Phoniatrie und Pädaudiologie, Münster, Deutschland
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Schlierenkamp S, Diekmann S, zur Nieden P, Lux G, Walendzik A, Abels C, Wasem J, Best D, Klipker K, Marschall U, Schaff C, Timmermann H, Neusser S. Arztkontakte vor und nach der Strukturreform der
Psychotherapie-Richtlinie: eine Analyse von Routinedaten der gesetzlichen
Krankenversicherung im Projekt Eva PT-RL (Evaluation der
Psychotherapie-Richtlinie). Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753660] [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: 12/12/2022]
Affiliation(s)
- S Schlierenkamp
- Essener Forschungsinstitut für Medizinmanagement GmbH, Essen,
Deutschland
| | - S Diekmann
- Essener Forschungsinstitut für Medizinmanagement GmbH, Essen,
Deutschland
| | - P zur Nieden
- Essener Forschungsinstitut für Medizinmanagement GmbH, Essen,
Deutschland
| | - G Lux
- Essener Forschungsinstitut für Medizinmanagement GmbH, Essen,
Deutschland
| | - A Walendzik
- Universität Duisburg-Essen, Lehrstuhl für
Medizinmanagement, Essen, Deutschland
| | - C Abels
- Universität Duisburg-Essen, Lehrstuhl für
Medizinmanagement, Essen, Deutschland
| | - J Wasem
- Universität Duisburg-Essen, Lehrstuhl für
Medizinmanagement, Essen, Deutschland
| | - D Best
- Deutsche Psychotherapeuten Vereinigung, Berlin,
Deutschland
| | - K Klipker
- AOK-Bundesverband GbR, Berlin, Deutschland
| | | | - C Schaff
- Berufsverband für Kinder- und Jugendpsychiarie, Psychosomatik
und Psychotherapie in Deutschland e.V. (BKJPP), Mainz, Deutschland
| | - H Timmermann
- Vereinigung Analytischer Kinder- und Jugendlichen-Psychotherapeuten in
Deutschland e.V. (VAKJP), Berlin, Deutschland
| | - S Neusser
- Essener Forschungsinstitut für Medizinmanagement GmbH, Essen,
Deutschland
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Neusser S, Neumann A, Speckemeier C, Zur Nieden P, Schlierenkamp S, Walendzik A, Karbach U, Andreica I, Vaupel K, Baraliakos X, Kiltz U. AB1402 FACILITATORS AND BARRIERS OF VACCINE UPTAKE IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASE: A SCOPING REVIEW. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2730] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with chronic inflammatory rheumatic diseases (CIRD) remain underrepresented in receiving vaccinations despite being disproportionately affected by infectious complications.ObjectivesTo systematically review the literature regarding vaccination willingness and vaccination hesitancy in CIRD patients with focus on the perspective of patients and physicians.MethodsA scoping review was conducted in PUBMED, EMBASE and the Cochrane Library through 2021. Study selection was performed by two independent reviewers, data were extracted using a standardized form and risk of bias was assessed using instruments from the McMaster University. Identified barriers and hurdles were synthesized by categorizing them into the WHO’s Measuring Behavioural and Social Drivers of Vaccination (BeSD) conceptual model.ResultsThe search yielded 1,644 hits, of which 30 were included (cross-sectional studies (n=27) based on interviews and 3 intervention studies). The majority of studies reported barriers to influenza and pneumococcal vaccination (n=11), or influenza vaccination only (n=9) from the patients perspective. Two studies assessed the attitudes towards COVID-19 vaccinations. Only one study assessed the view of rheumatologists. Patients mainly mentioned behavioral and social factors that negatively influence their willingness to be vaccinated while physicians see deficits in the organization and lack of time as a major barrier. Coverage of domains matched to the BeSD model suggests a lack of awareness of infection risk by both patients and physicians (Figure 1).Figure 1.Coverage of domains matched to the WHO BeSD ModelConclusionThe view of vaccination in CIRD patients diverges between patients and rheumatologists. Our results show that in-depth counseling on vaccines is important for patients, whereas physicians need support in implementing specific immunization recommendations. The themes identified provide a starting point for future interventions to improve vaccine rates in CIRD patients.Disclosure of InterestsNone declared
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