Hausarztzentrierte Versorgung in Baden-Württemberg – Konzept und Ergebnisse der kontrollierten Begleitevaluation

Gerlach, Ferdinand M.; Szécsényi, Joachim

doi:10.1016/j.zefq.2013.07.002

Cited by 18 publications

(9 citation statements)

References 3 publications

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“…Over recent years, innovative ways of introducing elements of the CCM into German primary care practices have been investigated. One promising method is the involvement of specially trained healthcare assistants in the care of patients with chronic conditions [3,50,51]. Healthcare assistants are employed in the majority of German primary care practices and are less qualified than nurses.…”

Section: Discussionmentioning

confidence: 99%

Implementation of chronic illness care in German primary care practices – how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling

Petersen

Paulitsch

Mergenthal

et al. 2014

BMC Health Serv Res

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BackgroundIn primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views.MethodsThis cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice).ResultsThe overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice.ConclusionsThis study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the implementation of structured care and counseling could be improved, particularly by helping patients set specific goals, coordinating care, and arranging follow-up contacts. Studies evaluating chronic care should take into consideration that a patient’s assessment is associated not only with practice-level factors, but also with individual, patient-level factors.Trial registrationCurrent Controlled Trials ISRCTN89818205.

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Section: Discussionmentioning

confidence: 99%

Implementation of chronic illness care in German primary care practices – how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling

Petersen

Paulitsch

Mergenthal

et al. 2014

BMC Health Serv Res

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“…At the beginning of telemedical networks, the concern among physicians was great that substituting processes might lead to the situation that other medical staff could assume ENT specific activities. VERAH [65][66][67][68][69][70] or AGNES [65,[71][72][73] as well as other similar concepts were considered as possible models that might restrict the medical spectrum by connecting them with a telemedical network and shift them to the sector of general medicine. Due to the clear statement of the German Medical Association against substituting processes [18] on one hand, but also an increasing number or reports about the scope of duties of VERAH and AGNES, obstacles could be removed.…”

Section: Acceptance Of Telemedical Methods Among Physiciansmentioning

confidence: 99%

Telemedizinische Methoden in der Hals-Nasen-Ohrenheilkunde

Beule

2019

Laryngo-Rhino-Otol

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ZusAmmenfAssunG Telemedizin ist ein Oberbegriff, der alle kommunikationstechnologisch unterstützte Verfahren zusammenfasst, die medizinische Leistungen über räumliche Entfernungen erbringen. Dieser rasch sich entwickelnde Bereich der Medizin besitzt gerade für das stark endoskopisch/mikroskopisch ausgerich-tete Fach der Hals-Nasen-Ohrenheilkunde interessante Optionen. Für die klinische Untersuchung von Ohr, Nase, Rachen und Larynx, aber auch für die postoperative Nachsorge und die Betreuung nach Kopf-Hals-Tumor-Erkrankungen liegen Daten zum telemedizinischen Vorgehen vor, ebenso für die audiologischen Messungen nach Cochlea-Implantation. Diese Daten bieten z. T. ein interessantes Potential, z. T. weisen sie aber gerade auch auf Probleme bei unkritischer Anwendung der Telemedizin hin, deren Erfolg entscheidend von der Ausbildung des Untersuchers vor Ort abhängt. Der vorgestellte Artikel fasst die wesentlichen Erkenntnisse dieses sich sehr rasch entwickelnden Forschungsgebietes überblickartig zusammen. ABsTR AC TTelemedicine is a generic term summarizing all communication techniques assisting to provide medical services over distance. This rapidly developing medical area provides especially for the field of otorhinolaryngology with its high dependency on endoscopy and microcopy vaulable options. For clinical examination of ear, nose, throat and larynx, but also for postoperative care and surveillance of head and neck tumor patients data exist using the telemedical approach. Furthermore, audiological telemedical measurements even after Cochlear implantation are deemed feasible. While first data indicate interesting approaches, they also demonstrate problems, if a telemedical approach is used without proper preparation. Especially the observers at the remote location of the patients and their training are highly important in this regard. This review summarizes the current state of science of this rapidly changing are of research and clinical care. Inhaltsverzeichnis Redaktionelle Anmerkung 130Einleitung und Hinweise zur Methodik 130

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“…der Inanspruchnahme fachärztlicher Versorgung gerade auch von chronisch erkrankten Patienten geschätzt wird. In einer Befragung von 2535 Patienten bewerteten HZV-Teilnehmer insbesondere Angebote zur Krankheitsvorbeugung und die Durchführung körperlicher Untersuchungen deutlich besser als Nichtteilnehmer [16]. In qualitativen Interviews berichteten Patienten von einer Verringerung der Wartezeiten auf einen Termin bei Fachärzten, die sich im Rahmen von §-73c-Verträgen beteiligten [17].…”

Section: Studienergebnisse Im Vergleichunclassified

Strukturierte ambulante Patientenversorgung im Facharztvertrag Orthopädie: die Erfahrungen der Patienten als Qualitätskriterium

Klingenberg¹,

Kaufmann‐Kolle²,

Wensing

et al. 2017

Z Orthop Unfall

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In 2015 a survey was conducted in Baden-Württemberg (Germany) among patients treated by orthopaedic specialists participating in a medical specialists' contract between doctors and statutory health insurance funds, in accordance with § 73c of the German Social Code, Book V (SGB V). This contract aims to improve orthopaedic care by structured cooperation between orthopaedic specialists and general practitioners, who are the central coordinators of care, and refer patients to a specialist if necessary. The program is intended to achieve patient-centred care by taking into account the physical, psychological and social aspects of the patients' orthopaedic complaints, as well as informing and motivating patients for self-management and health promoting activities. The survey was intended to receive feedback on the quality of care from the patients enrolled in this medical specialists' program, particularly concerning the specific aims of the program. A feedback report with individual results and a comparison with the overall results of all participating medical practices was sent out to those practices that provided at least 20 analysable questionnaires. The anonymous survey was conducted using a questionnaire specifically developed for the project. Participating practices handed out questionnaires to up to 100 patients who were enrolled in the program and consulted their orthopaedic or surgical specialist within 3 months of the start of the survey. Completed questionnaires were collected and sent to the research institute for data analysis in a sealed box. A total of 10,010 patients from 267 practices took part in the survey. Data analysis (including an anonymous comparison of the results of participating practices) was conducted on the basis of patients' responses from 183 practices that had obtained at least 20 completed questionnaires (8,988 patients, response rate 49.1%). Survey results are presented on doctor-patient communication, scheduling appointments, waiting times, cooperation with general practitioner, referral and treatment. On the whole, patients were satisfied with the care provided by their orthopaedic or surgical specialist. The comparison between the practices revealed significant differences in the patients' sociodemographic features and their feedback on the medical care received. Patients' evaluation of information and the counselling received from their orthopaedic/surgical specialist showed the strongest correlation with overall satisfaction. Referral by their general practitioner had a positive influence on patients' intentions to consult their orthopaedic/surgical specialist again. From the patients' point of view, doctors' information and counselling on self-help activities (e.g. eating habits, physical activity) had the largest potential for improvement. The survey's results confirm the objectives of this new orthopaedic health care program, especially motivational counselling on adequate physical activity and self-management. They provide a basis for the further development of the quality...

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Hausarztzentrierte Versorgung in Baden-Württemberg – Konzept und Ergebnisse der kontrollierten Begleitevaluation

Cited by 18 publications

References 3 publications

Implementation of chronic illness care in German primary care practices – how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling

Implementation of chronic illness care in German primary care practices – how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling

Telemedizinische Methoden in der Hals-Nasen-Ohrenheilkunde

Strukturierte ambulante Patientenversorgung im Facharztvertrag Orthopädie: die Erfahrungen der Patienten als Qualitätskriterium

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