Depression als komorbide Störung in der primärärztlichen Versorgung

As part of the DETECT study, a nationwide representative clinical-epidemiological study, the frequency and associated problems of comorbid depression with a wide range of somatic illnesses were studied in N = 51,000 primary care patients. Further the association with health related quality of life and disability is examined. Depression was assessed with the Depression Screening Questionnaire (DSQ) with an ICD-10 algorithm. RESULTS: (1) 7.5 % of all primary care patients met criteria for ICD-10 depressive disorders. (2) Depression risk was increased whenever any somatic disorder was present and increased in a dose-response relationship by number of comorbid conditions. (3) Elevation of depression risk was fairly independent of type of diagnosis, although associations with coronary heart disease (OR: 1.7), diabetic complications (OR: 1.7- 2.0), stroke (OR: 2.5) and pain-related chronic disorders (OR: 1.5) were particularly pronounced. Moderate associations were found for hyperlipidaemia (OR: 1.1). (4) Associated with the increasing number of comorbid conditions, patients with comorbid depression had increasingly more disability days and lower health related quality of life. It is concluded that the degree to which the frequency and the deleterious effects of comorbid depression is underestimated and unrecognized is alarming. The use of comorbidity indices might improve recognition.     

Medizinische Versorgung in der hausärztlichen Praxis

Competence networks in medicine, involving departments of general practice (www.kompetenznetze-medizin.de), as well as a large research support program “General Practice” funded by the German Federal Ministry of Education and Research (www.gesundheitsforschung-bmbf.de/de/439.php) mirror the increasing importance of academic general practice for health services research. The use and benefit of computerized medical records is exemplified by the classification of therapeutic measures and prevalence estimates of diseases. Computerized medical records from 134 practices could be extracted via the BDT (BehandlungsDatenTräger) interface. Using SQL (structured query language) queries, we identified patients with urinary tract infection (UTI), airway obstruction and chronic heart failure and the therapeutic management for these illnesses. Age and sex of the patients were nearly completely documented in the BDT data. Patients with UTI (6,239 consultations) received most often cotrimoxazole (69%) and fluoroquinolone (15%), less often trimethoprim (9%) and herbal UTI drugs (4%). About half of the 2,714 patients with asthma received inhaled steroids, to a somewhat lesser degree than patients suffering from chronic obstructive pulmonary disease (50 vs 53%). In a subsample of practices (n=44), we identified 4,120 patients with a diagnosis of chronic heart failure. Using refined analysis tools, computerized medical records from general practices may be helpful to answer relevant questions of health services research and contribute to quality assurance in ambulatory patient care.     

Zurückgelegte Wegzeiten in der ambulanten ärztlichen Versorgung in Deutschland

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Die von Patienten zur Arztpraxis zurückgelegten Wegzeiten stellen einen wichtigen Indikator des realisierten Zugangs zu...     

Systemwechsel in der ambulanten ärztlichen Versorgung — Erklärungen aus der Perspektive der ostdeutschen ärzte

With the East German state’s accession to the FRG, the dynamic of the future development of the ambulatory medical sector was still unclear; a slow process of adaptation to the West German model was seen most likely. In fact, however, the transformation from the polyclinic system to the West German system of office based physicians took place very rapidly; although a majority of the East German doctors in the early phase after the political change in East Germany was sceptical on such a development. This article tries to offer an explanation for this rapid and ex ante unexpected dynamic of the process of transformation. The study is based on quantitative data as well as on expert interviews and a study of relevant documents. It is proposed that the dynamic is based partly on a change of preferences of doctors in comparison to the early phase after the political change in East Germany. More important, however, is the management of the legal and factual framework for the doctors decisions by governmental actors and semi-public interest groups. The most important reason for former polyclinic doctors to become office-based was their expectation, that in the long run it would not be possible to stay in the polyclinics. The activities of the local governments, who were running the polyclinics, were particularly decisive in this respect.     

Qualitätsentwicklung in der vertragsärztlichen Versorgung: ein Baukasten mit vielfältigen Ansätzen

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Welche Unterstützungsangebote und freiwilligen Initiativen gibt es im vertragsärztlichen Bereich in Bezug auf...     

Potenziell vermeidbare Risikofaktoren für primäre Kopfschmerzen

Background

Strategies to prevent primary headaches could be very beneficial, especially given that primary headaches can lead to the development of chronic headache. In order to establish headache prevention strategies, the modifiable risk factors for primary headaches need to be identified.

Material and methods

A systematic literature search on the risk factors for primary headaches was conducted independently by two persons using the databases MEDLINE and Embase. Further inclusion criteria were observational studies in adult general populations or case-control studies, where the effect sizes were reported as odds ratios or where the odds ratios could be calculated from the given data.

Results

In all, 24 studies were included in the analysis. There was a large amount of heterogeneity among the studies concerning headache acquisition, headache classification, and risk factors for headache development. Independent of headache trigger and definition of headache, the association between headache and the risk factor “stress” was very high: The meta-analysis shows an overall effect of 2.26 (odds ratio; 95?%-CI =?[1.79; 2.85]). Studies evaluating neck and shoulder pain also report a strong association with headache; however, these results could not be summarized in a meta-analysis. Equally, the overall effects of smoking and coffee consumption on headaches could not be verified because the effect sizes were rather small and predominantly noticeable only at higher doses.

Conclusion

A strong association between headache and the risk factors stress and neck and shoulder pain was confirmed. The effect sizes of smoking and coffee consumption on headaches were rather small.     

Ärztemangel in der hausärztlichen Versorgung auf dem Lande und im Öffentlichen Gesundheitsdienst

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Der Mangel an Ärztinnen und Ärzten in der hausärztlichen Versorgung (speziell in ländlichen Regionen) und im...     

E-Learning in der ärztlichen Aus- und Weiterbildung

E-learning has been established in the education and training of physicians in various types: linear sequential and hyper-textual forms of multimedia presentations and texts, tutorial systems and simulations. Case-based e-learning systems are of special importance in medicine because they allow for mediation of process and practical knowledge by presentation of authentic medical cases in a simulated environment. The integration into the medical education and advanced professional training is crucial for the long-term success of e-learning; in case-based systems this can be accomplished by blended learning approaches which combine elements of traditional teaching with e-learning. Learning management systems (LMS) support integration of traditional teaching and e-learning by serving as an organizational platform for content of teaching. Further, they provide means of communication for trainers and trainees, authoring tools, interactive components, course management and role-based sharing concept. The dissemination of e-learning can be fostered by attention to requirements and user analysis, early adoption to organizational structures, curricular integration and continuous cooperation with students. Summarized, didactic and organizational aspects determine the success of our own e-learning offers as well as they influence the general further development of e-learning more than technical features.     

Effekte der gesetzlichen Qualitätssicherung in der akutstationären Versorgung

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Die gesetzliche Qualitätssicherung (QS) dient der Sicherung und Weiterentwicklung der Qualität der Leistungserbringung....     

Präventive Aspekte in der palliativen Versorgung

Background

Palliative care focuses not only on the support and assistance of incurably ill patients in the terminal and final phases, but also on the pertinent early integration of the palliative care approach into existing care areas. The goal of this work is to develop interfaces for prevention.

Methods

The systematic literature search on prevention and palliative care was based on PubMed (last 5 years) along with free research in selected trade literature. Theme categories were generated aligned to the article contents. The identified publications were assigned to the categories and analysed in terms of form and content.

Results

The journal search resulted in 223 hits. The predominant focal point of content revolves around pain therapy and symptom control in bone metastases. In none of the trade books were prevention and palliative care explicitly linked with each other. However, further interfaces were displayed, above all in the field of rehabilitation.

Conclusions

Prevention and palliative care have clinically relevant interfaces and are classic cross-functional areas in heath care which have been underdeveloped to date.     

Kardiovaskuläre Risikofaktoren im Kindes- und Jugendalter

Being overweight in childhood causes several cardiovascular risk factors which in turn contribute to accelerated atherosclerosis. Being overweight itself represents a risk factor, but also contributes to an increased prevalence of arterial hypertension, dyslipidemia and impaired glucose tolerance. Thus, cardiovascular prevention should be included in the management of obese children. Most of all, therapy of adiposity should be performed, as weight reduction and increased fitness represent protective factors. Moreover, a detailed cardiovascular workup and therapy of secondary vascular disease must also be performed. Subclinical changes at the level of the endothelium may be diagnosed using modern imaging techniques such as the measurement of the intima–media thickness of the carotid artery. In general, the overweight child should be considered as a future patient with vascular disease! The following article focuses on the prevalence, diagnostics and therapeutic options in the cardiovascular management of overweight children.     

Digitale Gesundheitsanwendungen (DiGA) in der ärztlichen und psychotherapeutischen Versorgung. Chancen und Herausforderungen aus Sicht der Leistungserbringer

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Versicherte haben seit 2019 einen gesetzlichen Anspruch auf Verordnung von digitalen Gesundheitsanwendungen (DiGA). Die...     

Epidemien und Pandemien in der hausärztlichen Praxis

Background

As primary care givers with a coordinating function, general practitioners (GP) play a key role in dealing with epidemics and pandemics. As of yet, there are no studies in Germany describing the difficulties experienced by GPs in patient care during epidemics/pandemics.

Objectives

This study aimed at identifying the problem areas in GPs’ patient care during the H1N1 and EHEC (enterohemorrhagic strain of Escherichia coli) outbreaks. With this information, recommendations for guaranteeing proper patient care during future epidemics/pandemics can be derived.

Materials and methods

In all, 12 qualitative, semi-structured, open guideline interviews with GPs in Hamburg and Lübeck were conducted, transcribed, and evaluated with qualitative content analysis.

Results

Five areas in ambulatory patient care were identified in which changes are needed from the primary care perspective: provision of information for GPs, workload, financing of epidemic-related measures, organization of the practices, care of those taken ill.

Conclusions

The workload of GPs in particular can and should be reduced through successful, centralized information distribution during epidemics/pandemics. The GP’s function as a coordinator should be supported and consolidated, in order to relieve the in-patient sector in cases of an epidemic/pandemic. Secured financing of epidemic-associated measures can help ensure patient care.     

Die Potenziale von Patientenbefragungen für die Qualitätssicherung in der medizinischen Versorgung

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Was „Qualität“ in der medizinischen Versorgung ausmacht und mit welchen Mitteln sie kontrolliert, gesichert oder...     

Medizintechnik in der ärztlichen Aus-, Weiter- und Fortbildung

The education of medical professionals is divided into medical studies, postgraduate training leading to the qualification as a specialist, and continuing professional development. During education, all scientific knowledge and practical skills are to be acquired, which enable the physician to practice responsibly in a specialized medical area. In the present article, relevant curricula are analyzed regarding the consideration of medical device-related topics, as the clinical application of medical technology has reached a central position in modern patient care. Due to the enormous scientific and technical progress, this area has become as important as pharmacotherapy. Our evaluation shows that medical device-related topics are currently underrepresented in the course of medical education and training and should be given greater consideration in all areas of medical education. Possible solutions are presented.     

Soziale Unterschiede in der ambulanten und stationären Versorgung

There is controversy about social disparities in healthcare services in Germany, but a differentiated analysis regarding various dimensions of healthcare is lacking. This narrative review intends to summarize conceptually the current state of research and draw subsequent conclusions. Separated into access, utilization and quality, the findings of social inequality in outpatient and inpatient care in Germany are summarized. Besides the common individual indicators of socioeconomic status (SES), regional deprivation and health insurance status are also included. Despite methodical diversity, the results show that healthcare inequalities due to SES exist, but not universally. Furthermore, there is a differentiated pattern respecting separate dimensions of healthcare. Concerning access (e.g. waiting times, co-payments) lower status groups and patients covered by statutory health insurance are deprived. Higher utilization becomes apparent among higher status groups and privately insured patients in terms of specialist consultations and prevention services. The findings regarding quality of process and outcome differ depending on quality indicator and disease. In different dimensions of medical healthcare, social disparities still exist, though the impact on health remains unclear for some types of healthcare inequalities. Moreover, it is often difficult to conclude from unequal outcome quality the inequalities of healthcare. Depending on access, utilization and quality, separate interventions for reducing these disparities are to be introduced.