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Find video protocols related to scientific articles indexed in Pubmed.
Re-profiling today's health care curricula for tomorrow's workforce: establishing an interprofessional degree in Germany.
J Interprof Care
PUBLISHED: 11-13-2014
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Abstract Laws regulating education of most health professional groups in Germany today mean that curricula re-profiling in response to changing priorities in the practice environment is a significant challenge. Legally dictated theoretical and clinical requirements for the vocational training of health professionals leaves little room for re-profiling in response to movements such as interprofessional education. An educational innovation was needed that worked within existing structures in Germany. The result was a formal collaboration between the Academy for Health Professionals and the University of Heidelberg allowing students undertaking vocational training to also complete a university degree in parallel. The aim of this article is to describe the curriculum development for the Bachelor of Science - Interprofessional Health Care. This article outlines an evidence-based approach to the process to curriculum development that resulted in a competency-based degree offering comprehensive interprofessional education at undergraduate level for healthcare students based in Germany.
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[Developing a tailored intervention: implementing recommendations for polypharmacy in multimorbid patients (PomP)].
Z Evid Fortbild Qual Gesundhwes
PUBLISHED: 07-29-2014
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Implementation research deals with the question of how to ensure that evidence-based knowledge is put into practice. One approach is the development of "tailored interventions (TI)". These are designed to address previously identified barriers and enablers. A common definition or methodological concept for TI has not yet been established. In this paper, a concept for TI is introduced. We describe the stepwise development of an implementation intervention for GP settings where recommendations based on current evidence are provided for the treatment of multimorbid patients receiving polypharmacy. Each step will be explained and illustrated by original data.
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[Structured medication management in primary care - a tool to promote medication safety].
Z Evid Fortbild Qual Gesundhwes
PUBLISHED: 07-29-2014
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Patients with chronic disease usually need to take multiple medications. Drug-related interactions, adverse events, suboptimal adherence, and self-medication are components that can affect medication safety and lead to serious consequences for the patient. At present, regular medication reviews to check what medicines have been prescribed and what medicines are actually taken by the patient or the structured evaluation of drug-related problems rarely take place in Germany. The process of "medication reconciliation" or "medication review" as developed in the USA and the UK aim at increasing medication safety and therefore represent an instrument of quality assurance. Within the HeiCare(®) project a structured medication management was developed for general practice, with medical assistants playing a major role in the implementation of the process. Both the structured medication management and the tools developed for the medication check and medication counselling will be outlined in this article; also, findings on feasibility and acceptance in various projects and experiences from a total of 200 general practices (56 HeiCare(®), 29 HiCMan,115 PraCMan) will be described. The results were obtained from questionnaires and focus group discussions. The implementation of a structured medication management intervention into daily routine was seen as a challenge. Due to the high relevance of medication reconciliation for daily clinical practice, however, the checklists - once implemented successfully - have been applied even after the end of the project. They have led to the regular review and reconciliation of the physicians' documentation of the medicines prescribed (medication chart) with the medicines actually taken by the patient.
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Effectiveness of a quality management program in dental care practices.
BMC Oral Health
PUBLISHED: 04-23-2014
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Structured quality management is an important aspect for improving patient dental care outcomes, but reliable evidence to validate effects is lacking. We aimed to examine the effectiveness of a quality management program in primary dental care settings in Germany.
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Involving patients in detecting quality gaps in a fragmented healthcare system: development of a questionnaire for Patients' Experiences Across Health Care Sectors (PEACS).
Int J Qual Health Care
PUBLISHED: 04-23-2014
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The purpose of this study was to develop and validate a generic questionnaire to evaluate experiences and reported outcomes in patients who receive treatment across a range of healthcare sectors.
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Rural area in a European country from a health care point of view: an adoption of the Rural Ranking Scale.
BMC Health Serv Res
PUBLISHED: 03-26-2014
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In many countries, rural areas are facing a shortage of general practitioners (GPs). Appropriate strategies to address this challenge are needed. From a health care delivery point of view, the term rural area is often poorly defined. However rural areas have to be adequately defined to ensure specific strategies are tailored to these environments. The aims of this study were to translate the New Zealand 6-item Rural Ranking Scale (RRS), to culturally adapt it and to implement it to identify rural areas from a health care delivery perspective. Therefore we aimed to validate the RRS by defining cut-off scores for urban, semi-rural and rural areas in Germany.
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On a European collaboration to identify organizational models, potential shortcomings and improvement options in out-of-hours primary health care.
Eur J Gen Pract
PUBLISHED: 03-24-2014
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Abstract Background: Out-of-hours care (OOHC) provision is an increasingly challenging aspect in the delivery of primary health care services. Although many European countries have implemented organizational models for out-of-hours primary care, which has been traditionally delivered by general practitioners, health care providers throughout Europe are still looking to resolve current challenges in OOHC. It is within this context that the European Research Network for Out-of-Hours Primary Health Care (EurOOHnet) was established in 2010 to investigate the provision of out-of-hours care across European countries, which have diverse political and health care systems. In this paper, we report on the EurOOHnet work related to OOHC organizational models, potential shortcomings and improvement options in out-of-hours primary health care. Needs assessment: The EurOOHnet expert working party proposed that models for OOHC should be reviewed to evaluate the availability and accessibility of OOHC for patients while also seeking ways to make the delivery of care more satisfying for service providers.
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Tailored Implementation for Chronic Diseases (TICD): a protocol for process evaluation in cluster randomized controlled trials in five European countries.
Trials
PUBLISHED: 03-21-2014
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In the 'Tailored Implementation for Chronic Diseases (TICD)' project, five tailored implementation programs to improve healthcare delivery in different chronic conditions have been developed. These programs will be evaluated in distinct cluster-randomized controlled trials. This protocol describes the process evaluation across these trials, which aims to identify determinants of change in chronic illness care, to examine the validity of the tailoring methods that were applied, and to analyze the association of implementation activities and the effectiveness of the program.
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Practice network-based care management for patients with type 2 diabetes and multiple comorbidities (GEDIMAplus): study protocol for a randomized controlled trial.
Trials
PUBLISHED: 03-07-2014
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Care management interventions in the German health-care system have been evaluated with promising results, but further research is necessary to explore their full potential in the context of multi-morbidity. Our aim in this trial is to assess the efficacy of a primary care practice network-based care management intervention in improving self-care behaviour among patients with type 2 diabetes mellitus and multiple co-occurring chronic conditions.
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[Hospitalisations for ambulatory care sensitive conditions in Germany].
Z Evid Fortbild Qual Gesundhwes
PUBLISHED: 03-01-2014
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On the basis of the assumption that a significant proportion of hospitalisations for so-called ambulatory care sensitive conditions (ACSCs) are potentially avoidable by ambulatory care measures, hospitalisation rates for ACSCs are used internationally as population based indicators for access to and quality of ambulatory care. The German Council of Health Experts proposes hospitalisation rates for diabetes, asthma, hypertension and chronic heart failure as ACSC measures in Germany.
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Internal consistency of the readiness for interprofessional learning scale in German health care students and professionals.
BMC Med Educ
PUBLISHED: 01-09-2014
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The implementation of a bachelor degree in "Interprofessional Health Care" at the University of Heidelberg, Germany has fostered the need to evaluate the impact of this innovative programme. The Readiness for Interprofessional Learning Scale (RIPLS) was developed by Parsell and Bligh (1999) to assess student's attitudes towards interprofessional education. The RIPLS consists of 19 items and four subscales were identified by McFadyen (J Interprof Care19:595-603, 2005): "teamwork and collaboration", "negative professional identity", "positive professional identity" and "roles and responsibilities". The RIPLS has been translated into a number of languages and used in a variety of different educational settings. A German version of the RIPLS was not available. Aim of the study was the translation of the RIPLS into German and testing of internal consistency.
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[Transfer-Time and -Rates from Inpatient to Outpatient Care of Mental Ill Persons in Baden Wurttemberg.]
Psychiatr Prax
PUBLISHED: 10-02-2013
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Objective: The time of transfer between discharge from inpatient mental health care and first contact to the outpatient sector is considered to be an indicator for continuity of care.Methods: This indicator is assessed using health care claims data of one of the mayor health insurances in Baden-Wurttemberg, Germany.Results: About 80 % of cases with the diagnosis of a defined mental disorder sought outpatient care at general or mental health practitioners within six months from discharge. 50 % of them did so within six days, 75 % within three weeks. The majority sought outpatient care at general practitioners. Cases that sought care in outpatient clinics specialized for severe mental illness (SMI) could not be considered in the data. However, considering them by estimation, the rate of cases with SMI seeking outpatient care at mental health practitioners within six months from discharge estimated to be at least 70 %.Conclusions: General practitioners are an important source for aftercare of mentally ill people discharged from inpatient care. Time of transfer as an indicator can be predominantly assessed by using health claims data in Germany.
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Health-related quality of life and risk factor control: the importance of educational level in prevention of cardiovascular diseases.
Eur J Public Health
PUBLISHED: 09-24-2013
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This study aimed to describe and to analyse the importance of educational level for controlled risk factors and health-related quality of life (HRQoL).
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What contributes to good patient outcomes in the home treatment of the severely mentally ill: study protocol of a multi-centre analysis.
BMC Psychiatry
PUBLISHED: 09-03-2013
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While evidence is available that home treatment could be effective for treating severe mental illness, there is a lack of evidence on what exactly makes home treatment effective. The study presented here aims to develop recommendations for structures and processes in home treatment that are necessary for its effectiveness.
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A tailored implementation intervention to implement recommendations addressing polypharmacy in multimorbid patients: study protocol of a cluster randomized controlled trial.
Trials
PUBLISHED: 08-19-2013
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Multimorbid patients frequently receive complex medication regimens and are at higher risk for adverse drug reactions and hospitalisations. Managing patients with polypharmacy is demanding, because it requires coordination of multiple prescribers and intensive monitoring. Three evidence-based recommendations addressing polypharmacy in primary care are structured medication counselling, use of medication lists and medication reviews to avoid potentially inappropriate medication (PIM). Although promising to improve patient outcomes, these recommendations are not well implemented in German routine care. Implementation of guidelines is often hindered by specific "determinants of change". "Tailored" interventions are designed to specifically address previously identified determinants. This study examines a tailored intervention tto implement the aforementioned recommendations into German primary care practices. This study is part of the European Tailored Interventions for Chronic Diseases project, which aims at contributing knowledge about the methods used for tailoring.
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Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions.
Ann Fam Med
PUBLISHED: 07-10-2013
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Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are seen as potentially avoidable with optimal primary care. Little is known, however, about how primary care physicians rate these hospitalizations and whether and how they could be avoided. This study explores the complex causality of such hospitalizations from the perspective of primary care physicians.
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[Current challenges of external quality assurance in the German healthcare system].
Z Evid Fortbild Qual Gesundhwes
PUBLISHED: 06-17-2013
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External quality assurance has three main aims: to make service provision in medicine and nursing comparable, to systematically identify deficits in service quality and to support the introduction of measures for quality improvement. This article reflects on three major developments in mandatory external quality assurance in the German healthcare system that took place during the last five years. These developments include the implementation of cross-sectoral quality assurance, the utilisation of new data sources and a new focus on quality deficits and practicability. The article highlights the challenges that come along with these developments.
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Association of costs with somatic symptom severity in patients with medically unexplained symptoms.
J Psychosom Res
PUBLISHED: 04-24-2013
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To analyse the association of direct and indirect costs in patients with medically unexplained symptoms (MUS) with somatic symptom severity (SSS).
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Practice assistants in primary care in Germany - associations with organizational attributes on job satisfaction.
BMC Fam Pract
PUBLISHED: 04-19-2013
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Job satisfaction and organizational attributes in primary care teams are important issues as they affect clinical outcomes and the quality of health care provided. As practice assistants are an integral part of these teams it is important to gain insight into their views on job satisfaction and organizational attributes. The aim of this study was to evaluate the job satisfaction of practice assistants and the organizational attributes within their general practices in Germany and to explore the existence of possible associations.
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Job satisfaction of practice assistants in general practice in Germany: an observational study.
Fam Pract
PUBLISHED: 04-19-2013
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Job satisfaction of practice staff is important for optimal health care delivery and for minimizing the turnover of non-medical professions.
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Comparison of physician referral and insurance claims data-based risk prediction as approaches to identify patients for care management in primary care: an observational study.
BMC Fam Pract
PUBLISHED: 04-11-2013
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Primary care-based care management (CM) could reduce hospital admissions in high-risk patients. Identification of patients most likely to benefit is needed as resources for CM are limited. This study aimed to compare hospitalization and mortality rates of patients identified for CM either by treating primary care physicians (PCPs) or predictive modelling software for hospitalization risk (PM).
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[How chronically ill patients evaluate their care: results of an evaluation study of the family doctor-centred health care model].
Z Evid Fortbild Qual Gesundhwes
PUBLISHED: 04-11-2013
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Considering the demographic development models for primary care have to be focused on chronic illness care especially. The so called "Hausarztzentrierte Versorgung" (HzV) in Baden-Wuerttemberg constitutes such a model of an implementation of family doctor-centred health care. For evaluation purposes the perspective of patients is of particular interest. Therefore the aim of this study was to analyse how chronically ill patients assess their medical care. Altogether 53 primary care practices in Baden-Wuerttemberg took part in a patient survey. The quality of chronic illness care from the patients perspective was assessed by means of the PACIC short form. Furthermore the general satisfaction with care as well as sociodemographic characteristics were determined. For analysis two different groups were regarded: HzV-doctor and HzV-patient with a chronic condition (group 1) and non-HzV-doctor and non-HzV-patient with a chronic condition (group 2). Altogether 2,535 patients were recruited for the survey (response rate 47.8%). Out of these, 836 patients could be assigned to group 1 and 319 patients could be assigned to group 2. Patients in both groups were very satisfied with their care. The patients in group 1 stated more frequently that they received a written treatment plan from their general practitioner and that they were asked about their state of health when leaving the practice. Overall satisfaction was positively associated with organisation of care (?= 0.484), support in difficult situations (?= 0.171) and information on the usefulness of consulting other doctors (?= 0.163) with an explained variation of R(2)=0.459. Irrespective of their group affiliation patients rate the medical care of their chronic condition very positively. Especially the assessment of the quality of care from the perspective of different patient groups (HzV participants and non-HzV participants) could contribute essentially as a feedback for physicians concerning the implementation of the main contents of the HzV for participating physicians.
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[Evaluation of family doctor centred medical care based on AOK routine data in Baden-Württemberg].
Z Evid Fortbild Qual Gesundhwes
PUBLISHED: 04-11-2013
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The agreement on family-doctor centred care (Hausarztzentrierte Versorgung, "HzV") pursuant to Sect. 73b, Volume V of the German Social Security Code became effective in Baden-Wuerttemberg, Germany, on July 1(st), 2008. This complex intervention, which is voluntary for both family doctors and patients, aims to strengthen the coordinative function of family practices. As a result, this intervention is believed to increase the quality of medical health care for persons insured - in the medium to long-term - and thereby, ideally, to additionally save expenses. Working package 1 was one out of a total of four working packages and focused on the evaluation of potential intervention effects of the HzV intervention based on the analyses of AOK routine data in Baden-Wuerttemberg. A total of 1.44 million insured persons were eligible for the present analyses. Insured adults voluntarily participating in the family doctor-centred health care intervention (HzV insured persons: n=580,924 in the intervention group) of the AOK were compared to those not participating in this intervention (non-HzV insured persons: n=862,237 in the control group). For both HzV and non-HzV insured persons, a comparison of each outcome of interest (encounters with family doctors, encounters with specialists, rate of hospitalisations, duration of hospitalisations, rate of re-hospitalisations, costs of pharmacotherapy, rate of polypharmacy, rate of Me-Too pharmaceuticals) was conducted for quarters 3 and 4 of 2008 as well as for quarters 3 and 4 in 2010. Both groups of insured persons differed in that they either participated in the HzV intervention between January 1, 2009 and June 30, 2011 or not. Before January 1, 2009 individuals in both groups did not participate in the HzV intervention. This design allowed for both longitudinal and cross-sectional comparisons. Moreover, the design implicitly controlled for potential seasonal bias. In order to adjust for relevant covariates (insured persons age, gender, nationality, insurance state, morbidity), multivariate multilevel regression models were developed and applied. On average, HzV insured persons were about 3 years older (56.2 ± 27.3 vs. 53.1 ± 18.4 years) and had higher levels of comorbidity (Charlson Comorbidity Index: 1.45 ± 1.86 vs. 1.19 ± 1.71). No significant differences in terms of rate and duration of hospitalisations were observed. The same applied to the number of rehospitalisations within 30 days. After adjustment for covariates, however, an increase in visits to the respective family doctor of 38% was found in the intervention group. Moreover, a decrease of encounters to specialists with and without referrals from family doctors could be observed (-29.8 % and -12.5%, respectively). Interestingly, even costs of pharmacotherapy, polypharmacy and prescriptions of Me-Too drugs were statistically significantly lower or less frequent, respectively, in the group of HzV insured persons. In conclusion, besides the observed associations in terms of pharmacotherapy, the HzV intervention appears to have advantageous effects in terms of family doctor centred health care.
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[Family doctor-centred care in Baden-Wuerttemberg: concept and results of a controlled evaluation study].
Z Evid Fortbild Qual Gesundhwes
PUBLISHED: 04-10-2013
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Pursuant to Section 73b, volume V of the German Social Security Code (SGB V), the agreement on family doctor-centred care (HzV), which went into effect in Baden-Wuerttemberg on July 1, 2008, provides for spatially inclusive and comprehensive medical coverage. The most important elements of the agreement are: the voluntary registration of family practices and patients, the strengthening of the coordinative function of family practices, the fulfilment of certain training, quality and qualification requirements, the standardised remuneration system and the use of specified practice software for billing and the prescription of drugs. The aim of this complex intervention is to strengthen family medicine, improve health care, in particular for patients with chronic disease, and to limit primary health care costs while improving its quality wherever possible. This first controlled nationwide evaluation examines the question whether these objectives were met in the early phase (2008 to 2011) and, if so, to what extent.
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[New ways in caring for patients with functional syndromes - interdisciplinary group intervention in the primary care setting: a qualitative study].
Psychother Psychosom Med Psychol
PUBLISHED: 03-08-2013
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Interface problems between health care sectors hinder collaborative care in functional syndromes. The speciAL trial investigated a disorder-oriented group intervention conducted by the general practitioner (GP) and a psychosomatic specialist (PS) in the GPs office. To evaluate the GP-PS cooperation, our qualitative study analysed free text statements about collaborative group leading of all 18 intervention GPs. In the GPs view, all sessions should structuredly be prepared and reviewed together for 20 min. Functions of the preparatory communication were gaining distance from daily business, attunement to the group and to each other, and preparing for the session topics. Functions of the communication after the sessions were professional exchange, reflection of the session and further treatment planning. The GPs saw the PSs role as a group leader and expert, their own role as a reference person for the patient, a link between all dimensions and a cotherapist. Crucial seemed a succeeding role splitting.
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Which practice characteristics are associated with the quality of cardiovascular disease prevention in European primary care?
Implement Sci
PUBLISHED: 03-06-2013
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Prevention of cardiovascular diseases (CVD) is a major health issue worldwide. Primary care plays an important role in cardiovascular risk management (CVRM). Guidelines and quality of care measures to assess CVRM in primary care practices are available. In this study, we assessed the relationship between structural and organisational practice characteristics and the quality of care provided in individuals at high risk for developing CVD in European primary care.
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The influence of workload and health behavior on job satisfaction of general practitioners.
Fam Med
PUBLISHED: 02-05-2013
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Workload, personal health behavior, and job satisfaction of the physicians are crucial aspects for the quality of care they provide. The aim of our study was to identify influencing factors on job satisfaction with regard to general practitioners (GPs) characteristics such as age, gender, health behavior, body mass index (BMI), and workload.
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Family Doctors Seen through the Eyes of Specialists: A Qualitative Study.
Int J Family Med
PUBLISHED: 01-28-2013
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Germany is facing a shortage of young family doctors. In search of possible reasons the aim of this study was to explore the perception of specialists on family doctors. Within a qualitative study 16 medical specialists from different fields in hospital and outpatient care setting were interviewed. Interviews were analysed using qualitative content analysis according to Mayring. Most of the interviewed specialists have a positive view on family doctors although a certain depreciative assumption is resonated in a number of statements. According to the specialists, family doctors enjoy a high status in public, even if social processes of change may have a negative influence on their rather old-fashioned image. Specialists find that family medicine is underrepresented in university education suffering from an upgrading of specialized disciplines. Altogether the majority of the interviewed specialists certify family doctors in Germany a positive image. Lecturer in medical education and training should be aware of their key role in the career choices of young trainees and avoid degradation or upgrading of certain medical disciplines. Interlinked measures on different levels focusing on the improvement of working conditions and representation at the universities would be needed to regain attractiveness for the family doctors profession as a career choice for young doctors.
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Effectiveness of a supportive telephone counseling intervention in type 2 diabetes patients: randomized controlled study.
PLoS ONE
PUBLISHED: 01-01-2013
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This randomized controlled trial investigated whether a patient-centered supportive counseling intervention comprising monthly telephone-based counseling sessions by practice nurses over 12 months improved diabetes-related medical and psycho-social outcomes above usual care in type 2 diabetes patients with poor glycemic control at baseline (HbA1c >7.5%) in a primary care setting.
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Validation of the German version of the patient activation measure 13 (PAM13-D) in an international multicentre study of primary care patients.
PLoS ONE
PUBLISHED: 01-01-2013
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The patients active participation in their medical care is important for patients with chronic diseases. Measurements of patient activation are needed for studies and in clinical practice. This study aims to validate the Patient Activation Measure 13 (PAM13-D) in German-speaking primary care patients. This international cross-sectional multicentre study enrolled consecutively patients from primary care practices in three German-speaking countries: Germany, Austria, and Switzerland. Patients completed the PAM13-D questionnaire. General Self-Efficacy scale (GSE) was used to assess convergent validity. Furthermore Cronbachs alpha was performed to assess internal consistency. Exploratory factor analysis was used to evaluate the underlying factor structure of the items. We included 508 patients from 16 primary care practices in the final analysis. Results were internally consistent, with a Cronbachs alpha of 0.84. Factor analysis revealed one major underlying factor. The mean values of the PAM13-D correlated significantly (r?=?0.43) with those of the GSE. The German PAM13 is a reliable and valid measure of patient activation. Thus, it may be useful in primary care clinical practice and research.
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Evaluating the quality of colorectal cancer care across the interface of healthcare sectors.
PLoS ONE
PUBLISHED: 01-01-2013
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Colorectal cancer (CRC) has a high prevalence in western countries. Diagnosis and treatment of CRC is complex and requires multidisciplinary collaboration across the interface of health care sectors. In Germany, a new nationwide established program aims to provide quality information of healthcare delivery across different sectors. Within this context, this study describes the development of a set of quality indicators charting the whole pathway of CRC-care including data specifications that are necessary to operationalize these indicators before practice testing.
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Questionnaire of chronic illness care in primary care-psychometric properties and test-retest reliability.
BMC Health Serv Res
PUBLISHED: 11-02-2011
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The Chronic Care Model (CCM) is an evidence-based approach to improving the structure of care for chronically ill patients with multimorbidity. The Assessment of Chronic Illness Care (ACIC), an instrument commonly used in international research, includes all aspects of the CCM, but cannot be easily extended to the German context. A new instrument called the "Questionnaire of Chronic Illness Care in Primary Care" (QCPC) was developed for use in Germany for this reason. Here, we present the results of the psychometric properties and test-retest reliability of QCPC.
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Evaluating self-efficacy for managing chronic disease: psychometric properties of the six-item Self-Efficacy Scale in Germany.
J Eval Clin Pract
PUBLISHED: 08-23-2011
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Self-efficacy - the confidence to carry out certain behaviour in order to achieve a specific goal - has increasingly been recognized as an essential prerequisite of effective self-management of chronic diseases. Therefore, valid and reliable measures are needed to evaluate self-efficacy in both research and clinical practice. This study explored the psychometric properties of the German version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6G).
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Patients evaluations of European general practice--revisited after 11 years.
Int J Qual Health Care
PUBLISHED: 08-10-2011
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In the last decade many things have changed in healthcare systems, primary care practices and populations.
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Differences in local and systemic inflammatory markers in patients with obstructive airways disease.
Prim Care Respir J
PUBLISHED: 08-03-2011
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Asthma and chronic obstructive pulmonary disease (COPD) are characterised by airway and systemic inflammation, but little is known about differences and similarities in inflammatory markers in patients with obstructive airways disease.
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Evaluation of job satisfaction of practice staff and general practitioners: an exploratory study.
BMC Fam Pract
PUBLISHED: 08-02-2011
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Primary care teams job satisfaction is an important issue in quality of care. The purpose of our study was to evaluate the job satisfaction of general practitioners (GPs) and non-physician staff and to explore the elements that may impact on overall job satisfaction for GPs and non-physician staff separately.
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[He that knows nothing doubts nothing: availability of foreign language patient education material for immigrant patients in Germany - a survey].
Z Evid Fortbild Qual Gesundhwes
PUBLISHED: 07-21-2011
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Patients with little knowledge of the German language have a special need for information. Due to language barriers they behave more passively in medical encounter, have a poorer knowledge about their disease and are generally less satisfied with their medical care. Foreign language patient information material could bridge the gap between medical consultation and the patients self-responsibility and involve patients more actively in the treatment process. Based on extensive research in several areas (internet, clinic and practice leaflets, drug patient information leaflets) the present article illustrates that in all these areas foreign language patient information is very poorly available compared to German material. The reinforcement of the development of such material could lead to a higher involvement of immigrant patients in the decision-making process, higher rates of patient safety and satisfaction and, overall, to a better quality of care for all patient groups in Germany.
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Tailored Implementation For Chronic Diseases (TICD): a project protocol.
Implement Sci
PUBLISHED: 07-19-2011
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The assumption underlying tailoring is that implementation interventions are most helpful if these effectively address the most important determinants of practice for improvement in the targeted setting. The aim of the Tailored Implementation For Chronic Diseases (TICD) project is to develop valid and efficient methods of tailoring implementation interventions to determinants of practice for knowledge implementation in chronic illness care.
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Applicability of the Assessment of Chronic Illness Care (ACIC) instrument in Germany resulting in a new questionnaire: questionnaire of chronic illness care in primary care.
BMC Health Serv Res
PUBLISHED: 07-07-2011
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The Chronic Care Model (CCM) is an evidence based, population based approach to improve care for people with chronic conditions. The Assessment of Chronic Illness Care (ACIC) instrument is widely used to measure to what extent within a healthcare system the CCM is implemented. The aim of this study was to translate and culturally adapt the ACIC Instrument for the German healthcare system.
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Identification of patients likely to benefit from care management programs.
Am J Manag Care
PUBLISHED: 07-02-2011
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To compare predictive modeling (PM), selection by primary care physician (PCP), and a combination of both as approaches to prospective patient identification for care management programs.
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Predictors of health-related quality of life in patients at risk for cardiovascular disease in European primary care.
PLoS ONE
PUBLISHED: 06-29-2011
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Cardiovascular risk management plays an important role in primary care. In patients at high risk for cardiovascular diseases (CVD) lifestyle and, where appropriate, medical interventions are recommended in guidelines. Health-related quality of life (HRQoL) is an important outcome in clinical practice. This study aimed to assess the HRQoL of this patient group and to investigate the impact of both patients characteristics and practice quality scores on their assessments of HRQoL.
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[Benchmarking in ambulatory care practices--The European Practice Assessment (EPA)].
Z Evid Fortbild Qual Gesundhwes
PUBLISHED: 06-16-2011
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The European Practice Assessment (EPA) is a comprehensive quality management which consists of 220 indicators covering 5 domains (infrastructure, people, information, finance, and quality and safety). The aim of the project presented was to evaluate EPA as an instrument for benchmarking in ambulatory care practices. A before-and-after design with a comparison group was chosen. One hundred and two practices conducted EPA at baseline (t1) and at the 3-year follow-up (t2). A further 209 practices began EPA at t2 (comparison group). Since both practice groups differed in several variables (age of GP, location and size of practice), a matched-pair design based on propensity scores was applied leading to a subgroup of 102 comparable practices (out of the 209 practices). Data analysis was carried out using Z scores of the EPA domains. The results showed significant improvements in all domains between t1 and t2 as well as between the comparison group and t2. Furthermore, the results demonstrate that the implementation of total quality management and the re-assessment of the EPA procedure can lead to significant improvements in almost all domains.
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[Does implementation of benchmarking in quality circles improve the quality of care of patients with asthma and reduce drug interaction?].
Z Evid Fortbild Qual Gesundhwes
PUBLISHED: 06-16-2011
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The purpose of this cluster-randomised controlled trial was to evaluate the efficacy of quality circles (QCs) working either with general data-based feedback or with an open benchmark within the field of asthma care and drug-drug interactions.
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Autonomy support in primary care--validation of the German version of the Health Care Climate Questionnaire.
J Clin Epidemiol
PUBLISHED: 05-31-2011
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There is a growing need for studies to measure how patients feel supported in their autonomy. The Health Care Climate Questionnaire (HCCQ) is an instrument to assess the physicians support to motivate the patient to take personal responsibility for his/her health. The aim of this study was to translate the HCCQ into German and validate the translated version, called the HCCQ-Deutschland (HCCQ-D).
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Becoming a general practitioner--which factors have most impact on career choice of medical students?
BMC Fam Pract
PUBLISHED: 05-09-2011
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In Germany, there is a shortage of young physicians in several specialties, the situation of general practitioners (GP) being especially precarious. The factors influencing the career choice of German medical students are poorly understood. This study aims to identify factors influencing medical students specialty choice laying a special focus on general practice.
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Characteristics and job satisfaction of general practitioners using complementary and alternative medicine in Germany--is there a pattern?
BMC Complement Altern Med
PUBLISHED: 04-19-2011
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The use of Complementary and Alternative medicine (CAM) has increased over the past years. In Germany, many general practitioners (GPs) use CAM in their daily practice. However, little is known about possible differences of GPs using CAM compared to GPs not using CAM. The aim of the study was to explore differences in personal and practice characteristics, work load and job satisfaction of GPs depending on their use of and attitude towards CAM. Furthermore, predictors for CAM use should be explored.
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["General Practice is a great job anyway" - a qualitative study with vocational trainees].
Z Evid Fortbild Qual Gesundhwes
PUBLISHED: 04-19-2011
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Due to the increasing lack of physicians, an ageing and thus multi-morbid society and a misdistribution of physicians in Germany primary care provided by general practitioners is at risk. Therefore, approaches to recruit more physicians for general practice are being sought. The aim of the present study was to explore individual motivations for choosing a career in general practice, vocational trainees perspectives on the current situation of vocational training and to identify possible approaches to improve the situation with suggestions from vocational trainees in Germany.
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A comparison of the workload of rural and urban primary care physicians in Germany: analysis of a questionnaire survey.
BMC Fam Pract
PUBLISHED: 04-13-2011
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Many western countries are facing an existing or imminent shortage of primary care physicians especially in rural areas. In Germany, working in rural areas is often thought to be associated with more working hours, a higher number of patients and a lower income than working in urban areas. These perceptions might be key reasons for the shortage. The aim of this analysis was to explore if working time, number of treated patients per week or proportion of privately insured patients vary between rural and urban areas in Germany using two different definitions of rurality within a sample of primary care physicians including general practitioners, general internists and paediatricians.
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Development and pilot of an internationally standardized measure of cardiovascular risk management in European primary care.
BMC Health Serv Res
PUBLISHED: 04-07-2011
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Primary care can play an important role in providing cardiovascular risk management in patients with established Cardiovascular Diseases (CVD), patients with a known high risk of developing CVD, and potentially for individuals with a low risk of developing CVD, but who have unhealthy lifestyles. To describe and compare cardiovascular risk management, internationally valid quality indicators and standardized measures are needed. As part of a large project in 9 European countries (EPA-Cardio), we have developed and tested a set of standardized measures, linked to previously developed quality indicators.
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Primary care practice-based care management for chronically ill patients (PraCMan): study protocol for a cluster randomized controlled trial [ISRCTN56104508].
Trials
PUBLISHED: 03-28-2011
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Care management programmes are an effective approach to care for high risk patients with complex care needs resulting from multiple co-occurring medical and non-medical conditions. These patients are likely to be hospitalized for a potentially "avoidable" cause. Nurse-led care management programmes for high risk elderly patients showed promising results. Care management programmes based on health care assistants (HCAs) targeting adult patients with a high risk of hospitalisation may be an innovative approach to deliver cost-efficient intensified care to patients most in need.
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Secondary Pharmacotherapeutic Prevention among German Primary Care Patients with Peripheral Arterial Disease.
Int J Vasc Med
PUBLISHED: 03-27-2011
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Background. The aim of the study was to determine the secondary preventive medical supply of patients with peripheral arterial disease (PAD) in German primary care. Methods and Results. A population-based case control study was conducted using electronic medical records of patients extracted from the CONTENT primary care database of Heidelberg, Germany, between April 2007 and March 2010. The prescription rates of cardiovascular medication among symptomatic PAD patients were analysed by means of the ATC classification and compared with those of patients with cardiovascular disease (CVD). 479 cases with PAD and 958 sex- and age-matched control CVD patients were identified. PAD patients showed significantly lower prescription rates for cardiac agents (21.7% versus 37%), ?-blockers (50.1% versus. 66.2%), and lipid-lowering agents (50.3% versus 55.9%) compared to CVD patients. In contrast, significantly more prescriptions of antidiabetic agents (28.2% versus 20.3%), particularly insulin and analogues (12.5% versus 8%), and calcium channel blockers (29.2% versus 24.3%) were found in PAD patients. Low-dose aspirin use among both PAD and CVD patients was underestimated, as it is available without a prescription. Conclusions. Optimal pharmacotherapeutical care of patients with PAD requires more intensive cardioprotective medication in primary care settings.
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Health related quality of life and comorbidity. A descriptive analysis comparing EQ-5D dimensions of patients in the German disease management program for type 2 diabetes and patients in routine care.
BMC Health Serv Res
PUBLISHED: 02-01-2011
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The co-occurance of multiple medical conditions has a negative impact on health related quality of life (HRQoL) for patients with type 2 diabetes. These patients demand for intensified care programs. Participation in a disease management program (DMP) for type 2 diabetes has shown to counterbalance this effect. However, it remains unclear which dimensions of HRQoL are influenced by the DMP. The aim of this study was to explore the HRQoL dimensions of patients with type 2 diabetes in the German DMP and patients in routine care (RC).
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Is the job satisfaction of primary care team members associated with patient satisfaction?
BMJ Qual Saf
PUBLISHED: 01-24-2011
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BACKGROUND Previous research has shown a correlation between physician job satisfaction and patient satisfaction with quality of care, but the connection between job satisfaction of other primary care team members and patient satisfaction is yet unclear. OBJECTIVE To evaluate whether there is an association between patient satisfaction and job satisfaction of the members of patient care teams. DESIGN The study was based on data from the European Practice Assessment and used an observational design. SETTING 676 primary care practices in Germany. PARTICIPANTS 47?168 patients, 676 general practitioners (practice principals), 305 physician colleagues (trainees and permanently employed physicians) and 3011 non-physician practice members (nurses, secretaries). MAIN OUTCOME MEASURES Patient evaluation was measured using the 23-item EUROPEP questionnaire. Job satisfaction was measured using the 10-item Warr-Cook-Wall job satisfaction scale and further items relating to practice structure. Bivariate correlations were applied in which factors of patient satisfaction and practice structure were compared with physicians and non-physicians satisfaction. RESULTS Patient satisfaction correlates positively with the general job satisfaction of the non-physician (r=0.25, p<0.01) and no significant correlation was found for the general job satisfaction of practice principals and physician colleagues. Patients satisfaction with the practice organisation correlates positively with the general job satisfaction of the non-physicians (r=0.30, p<0.01) and their view of practice structure (r=0.29, p<0.01). CONCLUSIONS The correlation between non-physician team member satisfaction and patient satisfaction was higher than the correlation between satisfaction of physicians and patients. Patients seem to be sensitive to aspects of practice structure.
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Diuretics for hypertension--an inconsistency in primary care prescribing behaviour.
Curr Med Res Opin
PUBLISHED: 01-06-2011
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Internationally there is an ongoing debate on diuretics as first-line therapy for most patients with hypertension. In spite of many arguments against them in antihypertensive monotherapy, the authors of the present study perceived them to be regularly prescribed in combination therapy in Germany. The study objective was to look for this discrepancy in prescribing reality as a contribution from clinical practice to an academic debate.
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Patients beliefs about medicines in a primary care setting in Germany.
J Eval Clin Pract
PUBLISHED: 11-18-2010
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The aim of this study was to explore patients beliefs about medicines by administering the German version of the Beliefs about Medicines Questionnaire (BMQ) in a primary care setting among chronically ill patients and to examine its psychometric properties. The BMQ assesses patients beliefs about their individual prescribed medication as well as their beliefs about medicines in general.
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Antibiotic prescribing in general practice--the rhythm of the week: a cross-sectional study.
J. Antimicrob. Chemother.
PUBLISHED: 09-23-2010
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Overprescribing of antibiotics in primary care is a worldwide phenomenon. Prescriptions can be used to reduce the uncertainty inherent in general practice. We assumed a heightened prescribing rate on Fridays because of more uncertainty before the pending weekend.
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[Needs assessment of a longitudinal training course in vocational training within the Verbundweiterbildung(plus)].
Z Evid Fortbild Qual Gesundhwes
PUBLISHED: 08-25-2010
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In Germany content-related vocational training mostly is the responsibility of the trainees themselves. The aim of this needs assessment is to explore the requirements of a longitudinal training course in vocational training.
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[Perspectives and experiences of vocational trainers in General Practice: a survey in Baden-Wuerttemberg].
Z Evid Fortbild Qual Gesundhwes
PUBLISHED: 08-23-2010
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In order to ensure the delivery of primary care part of the vocational medical training must take place in the general practice setting. In Germany, this requires the authorization to provide general practitioner (GP) training. While in many countries specific qualification programmes for GP trainers are obligatory, this does not yet apply in Germany. The aim of this survey was to explore perspectives and experiences of GP trainers focusing on their needs in view of a possible qualification course.
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Measuring organizational attributes in primary care: a validation study in Germany.
J Eval Clin Pract
PUBLISHED: 08-19-2010
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Models for the structured delivery of care rely on organizational attributes of practice teams. The Survey of Organizational Attributes for Primary Care (SOAPC) is known to be a valid instrument to measure this aspect in the primary care setting. The aim of this study was to determine the validity of a translated and culturally adapted German version of the SOAPC.
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Development of a primary care-based complex care management intervention for chronically ill patients at high risk for hospitalization: a study protocol.
Implement Sci
PUBLISHED: 07-18-2010
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Complex care management is seen as an approach to face the challenges of an ageing society with increasing numbers of patients with complex care needs. The Medical Research Council in the United Kingdom has proposed a framework for the development and evaluation of complex interventions that will be used to develop and evaluate a primary care-based complex care management program for chronically ill patients at high risk for future hospitalization in Germany.
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Family practice web sites: new perspectives for patient care and health information?
Fam Med
PUBLISHED: 07-15-2010
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To cater to the needs of informed and proactive patients in family medicine, health care providers could offer access to care and health information via practice Web sites. To determine the content and quality of family medicine Web sites, we performed a cross-sectional study on a large sample of family practices Web sites in Berlin, Germany.
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[Characteristics of beneficiaries of a GP-centred health care contract in Germany].
Med. Klin. (Munich)
PUBLISHED: 07-14-2010
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Since 2004, primary care in Germany has increasingly been provided in special general practitioner (GP)-centred health care contracts (HZV). To date there is limited evidence about the characteristics of their beneficiaries regarding morbidity burden and health care utilization.
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How do primary care doctors deal with uncertainty in making diagnostic decisions? The development of the Dealing with Uncertainty Questionnaire (DUQ).
J Eval Clin Pract
PUBLISHED: 07-08-2010
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Diagnostic uncertainty plays an important role in primary care. Nevertheless, the practical way how general practitioners (GPs) deal with uncertainty remains unclear. The purpose was to develop a questionnaire which describes and measures the level of action and active reasoning in dealing with uncertainty.
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Effectiveness and efficiency of primary care based case management for chronic diseases: rationale and design of a systematic review and meta-analysis of randomized and non-randomized trials [CRD32009100316].
BMC Health Serv Res
PUBLISHED: 05-07-2010
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Case management is an important component of structured and evidence-based primary care for chronically ill patients. Its effectiveness and efficiency has been evaluated in numerous clinical trials. This protocol describes aims and methods of a systematic review of research on the effectiveness and efficiency of case management in primary care.
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Future potential country doctor: the perspectives of German GPs.
Rural Remote Health
PUBLISHED: 05-07-2010
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There is a shortage of general practitioners (GPs) in many countries, especially in rural areas. There are several reasons for this shortage. Over the last decade, fewer medical students in Germany have decided to work in patient care, even fewer in general practice and fewer still in general practice in rural areas. The aim of this study was to explore the pros and cons of GPs work in rural areas and to identify from GPs perspective possible measures for counteracting future GP shortages.
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Diagnosing somatisation disorder (P75) in routine general practice using the International Classification of Primary Care.
J Psychosom Res
PUBLISHED: 05-04-2010
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(i) To analyze general practitioners diagnosis of somatisation disorder (P75) using the International Classification of Primary Care (ICPC)-2-E in routine general practice. (ii) To validate the distinctiveness of the ICD-10 to ICPC-2 conversion rule which maps ICD-10 dissociative/conversion disorder (F44) as well as half of the somatoform categories (F45.0-2) to P75 and codes the other half of these disorders (F45.3-9), including autonomic organ dysfunctions and pain syndromes, as symptom diagnoses plus a psychosocial code in a multiaxial manner.
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Patient- and provider-related determinants of generic and specific health-related quality of life of patients with chronic systolic heart failure in primary care: a cross-sectional study.
Health Qual Life Outcomes
PUBLISHED: 04-21-2010
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Identifying the determinants of health-related quality of life (HRQOL) in patients with systolic heart failure (CHF) is rare in primary care; studies often lack a defined sample, a comprehensive set of variables and clear HRQOL outcomes. Our aim was to explore the impactof such a set of variables on generic and disease-specific HRQOL.
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[Quality circles in German ambulatory care: results of a continuous documentation in the regions of Bremen, Saxony-Anhalt, Schleswig-Holstein and Westphalia-Lippe 1995-2007].
Z Evid Fortbild Qual Gesundhwes
PUBLISHED: 04-08-2010
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Quality circles (QC) are viewed as one of the most important tools of quality improvement and continuing education in ambulatory care. Yet, little is known about the quality of QC work.
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[General practitioners opinion and attitude towards DMPs and the change in practice routines to implement the DMP "diabetes mellitus type 2"].
Z Evid Fortbild Qual Gesundhwes
PUBLISHED: 04-01-2010
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Effective implementation of disease management programmes (DMPs) in primary care practices often requires changes in practice workflows and responsibilities and acceptance by the parties involved. Within the ELSID study (evaluation study of the DMP diabetes mellitus type 2) the physicians attitudes toward DMPs were obtained and an optimised implementation of DMPs was developed by conducting a quality management cycle with primary care practice teams. The aim was to investigate which practice workflows will have to be changed and what kind of barriers to implement these changes are perceived.
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JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.