Selbstmedikation und die Rolle des Hausarztes - eine Telefonbefragung

Self medication seems to support patient autonomy. This raises the question whether consumers would like their general practitioner (GP) to play a more active role in self medication management or whether they feel bothered and controlled. The aim of this study was to explore the consumers’ attiudes towards self medication and the perceived as well as expected role of their GP. A telephone survey was conducted with a representative sample of households in Germany, based on random digits provided by ZUMA, a scientific centre for survey research in Mannheim. Members of households were selected following the ‘birthday method’. The response rate was 59% (432/727). More than one-third had practised self medication within the last four weeks; 81 informants (19%) could not remember to have ever taken an over the counter (OTC) drug. Sixty percent of the respondents agreed that self medication supports autonomy but 50% felt, at least sometimes, disturbed by self medication and 81 (19%) had the feeling that serious diseases could be overlooked. Only 9% had talked with their GP about self medication within the last 12 months. About 40% of the informants had the feeling their GP would feel bothered by such a conversation; 71% would like their GP to give a recommendation for self medication. Respondents were more likely not to use self medication if their doctor had not recommended a drug (Odds Ratio [OR]: 4.0; 95% confidence interval: 1.1 – 11.5) and if they felt disturbed by self medication (OR: 3.9; 2.1 – 7.3). Fear of side effects by self medication were more frequently reported by respondents who were lower educated and who perceived their doctor as rejecting self medication. Most respondents had some experience in the use of self medication and many of them considered self medication a way of self-responsible health behaviour. At the same time, fear of side effects and worries about adequate use of self medication were reported. GPs could support these persons by properly informing them and expressing a positive attitude towards self medication. In this case, the majority of respondents would not feel bothered and controlled in their health behaviour.     

Healthcare utilisation and disclosure of injecting drug use among clients of Australia's needle and syringe programs

Background : People who inject drugs (PWID) report limited access to healthcare, and may avoid disclosing drug use. Health service utilisation was examined among participants in the Australian Needle and Syringe Program Survey (ANSPS), an annual cross‐sectional sero‐survey of needle syringe program (NSP) attendees. Methods : An anonymous questionnaire was self‐completed by 2,395 NSP clients throughout Australia. Multivariable logistic regressions identified variables independently associated with (i) disclosure of injecting to the most recent healthcare provider; and (ii) recent presentation to emergency departments. Results : Seventy‐eight percent of participants reported accessing healthcare in the preceding 12 months. Reasons for presentation included general health issues (46%); medication seeking (17%); and both (37%). Participants who recently accessed healthcare or had previously visited their most recent provider were more likely to disclose injecting drug use. Participants presenting to a GP or medical centre were less likely than others to disclose injecting. Those accessing emergency departments were more likely to report recent imprisonment. Conclusions : Despite Australia's universal healthcare system and harm reduction policies, NSP‐participants remain reluctant to disclose injecting, potentially hindering appropriate care and highlighting the need for multiple entry points to the healthcare system, including NSPs and opioid substitution therapy clinics.     

Unmet home healthcare needs and quality of life in cancer patients: a hospital‐based Turkish sample

Home healthcare services in Turkey are provided primarily to patients that are bedridden or seriously disabled. There are no such services integrated with hospital services that are specifically designed for cancer patients. The present study aimed to explore the home healthcare needs of cancer patients and their experiences related to unmet home healthcare needs. The study included 394 adult cancer patients who were followed up at the surgical oncology department of a university hospital. A 37‐item, study‐specific questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for cancer patients (EORTC‐QLQ‐C30) were administered, and patient clinical records were evaluated. Home healthcare was provided primarily by the patients' immediate family members; the professional home healthcare usage rate was only 2.8%. Patient quality of life (QoL) was negatively affected by cancer, especially those with stage three and four disease. The frequency of the need for home healthcare services due to disease‐related health problems during the 30 days prior to administration of the questionnaires was as follows: pain (62.9%), surgical wound care (44.9%), injection of therapeutics (52.3%), gastrointestinal complaints (51.8%), anxiety (87.1%), psychosocial assistance (77.2%) and information about cancer (94.4%). In the absence of home healthcare services, the patients primarily used institutional healthcare services to meet their needs; otherwise, their needs were not met. The physical and psychosocial problems that cancer patients experience could be solved in most cases by professional home healthcare services. Hospital‐integrated home healthcare services might not only improve cancer patient QoL but might also increase the effectiveness of hospital‐based healthcare services.     

Evaluation of the implementation and effect of the healthcare cloud information platform for diabetes self‐management: A case study in Shanghai

With the high prevalence of diabetes, its long‐term treatment, and many complications, there is a need for a new diabetes self‐management model in developing countries. Therefore, this study aimed to assess the implementation and effect of a new diabetes self‐management model, known as the healthcare cloud information platform, in Shanghai, China. The implementation of the new model was evaluated in terms of the equipment coverage in community health service centres and the services provided. The effect was assessed according to the treatment rate and control rate from 2012 to 2017. Their correlations with the self‐management rate were analysed using Spearman's test. It was found that the Shanghai healthcare cloud information platform had covered a total of 237 community health service centres in all of the 16 administrative districts, equipping them with 2489 health stations, by 2017. An average of 8966 people uploaded data to the healthcare cloud information platform every day, with the accumulated service up to 12 043 508 person‐times and an average daily increase of 13 227.9. The treatment rate of diabetes patients in Shanghai increased from 42.9% in 2012 to 78.0% in 2017, and the control rate increased to 72% in 2017, compared with 63% in 2012. Furthermore, there was a significant correlation between the treatment rate, control rate, and self‐management rate. The findings indicate that it is feasible to implement the new healthcare cloud information platform for diabetes self‐management and that it is effective.     

Health service utilization,unmet healthcare needs,and the potential of telemedicine services among Korean expatriates

Background

With the significant growth of migration and expatriation, facilitated by increased global mobility, the number of Koreans living abroad as of 2016 is approximately 7.4 million (15% of the Korean population). Healthcare utilization or health problems, especially among expatriates in developing countries, have not been well researched despite the various health risks these individuals are exposed to. Consequently, we identified the health utilization patterns and healthcare needs among Korean expatriates in Vietnam, Cambodia, and Uzbekistan.

Methods

This cross-sectional survey examined 429 Korean expatriates living in Vietnam (n?=?208), Cambodia (n?=?60), and Uzbekistan (n?=?161) who had access to the Internet and were living abroad for at least 6?months. A 67-item questionnaire was used, and feedback was received via an online survey program. Stepwise logistic regression analyses were performed to evaluate factors associated with unmet healthcare needs and preferences of certain type of telemedicine.

Results

We found that 45.5% (195/429) of respondents had used medical services in their country of stay. Among those who visited health institutions >?3 times, the most popular choice was general hospitals (39.4%, 15/38); however, they initially visited Korean doctors’ or local doctors’ offices. The most essential criteria for healthcare service facilities was a “skilled professional” (39.3%, 169/429), 42% wanted a health program for chronic disease management, and 30% wanted specialized internal medicine. A substantial number wanted to access telemedicine services and were willing to pay for this service. They were particularly interested in experts’ second opinion (61.5%, 264/429) and quick, 24-h medical consultations (60.8%, 261/429). Having unmet healthcare needs and being younger was strongly associated with all types of telemedicine networks.

Conclusions

Nearly half of the expatriates in developing countries had unmet healthcare needs. Telemedicine is one potential solution to meet these needs, especially in developing countries.

     

How rates of perinatal mental health screening in Australia have changed over time and which women are missing out

Objectives : To report rates of perinatal mental health screening from 2000 to 2017 and investigate factors associated with not being screened both antenatally and postnatally more recently (2013–2017). Methods : A longitudinal community‐based study of self‐reported perinatal mental health screening with a national sample of 7,566 mothers from the Australian Longitudinal Study on Women's Health reporting on 9,384 children. The main outcome measure was whether mothers were asked about their emotional wellbeing by a health professional, including completing a questionnaire. Results : From 2000 to 2017, the percentage of women not screened decreased from 40.6% to 1.7%. The percentage of women screened both antenatally and postnatally increased from 21.3% to 79.3%. From 2013 to 2017, women who were older (aOR, 0.65; 95%CI, 0.52–0.81) or had reported emotional distress (aOR, 0.77; 95%CI, 0.60–0.99) were less likely to have been screened both antenatally and postnatally. Conclusions : Despite improvements, perinatal mental health screening is not yet universal. One‐in‐five women are not screened both antenatally and postnatally, including women in high‐risk populations such as those who have reported emotional distress. Implications for public health : Women are in regular contact with health professionals in the perinatal period. This opportunity to detect women at risk of perinatal mental health issues is too important to be missed.     

Patient–professional partnerships and chronic back pain self‐management: a qualitative systematic review and synthesis

Chronic back pain is common, and its self‐management may be a lifelong task for many patients. While health professionals can provide a service or support for pain, only patients can actually experience it. It is likely that optimum self‐management of chronic back pain may only be achieved when patients and professionals develop effective partnerships which integrate their complementary knowledge and skills. However, at present, there is no evidence to explain how such partnerships can influence patients' self‐management ability. This review aimed to explore the influence of patient–professional partnerships on patients' ability to self‐manage chronic back pain, and to identify key factors within these partnerships that may influence self‐management. A systematic review was undertaken, aiming to retrieve relevant studies using any research method. Five databases were searched for papers published between 1980 and 2014, including Cochrane Library, CINAHL, Medline, EMBASE and PsycINFO. Eligible studies were those reporting on patients being supported by professionals to self‐manage chronic back pain; patients being actively involved for self‐managing chronic back pain; and the influence of patient–professional partnerships on self‐management of chronic back pain. Included studies were critically appraised for quality, and findings were extracted and analysed thematically. A total of 738 studies were screened, producing 10 studies for inclusion, all of which happened to use qualitative methods. Seven themes were identified: communication, mutual understanding, roles of health professionals, information delivery, patients' involvement, individualised care and healthcare service. These themes were developed into a model suggesting how factors within patient–professional partnerships influence self‐management. Review findings suggest that a partnership between patients and professionals supports patients' self‐management ability, and effective communication is a fundamental factor underpinning their partnerships in care. It also calls for the development of individualised healthcare services offering self‐referral or telephone consultation to patients with chronic conditions.     

Self‐reported health,healthcare service use and health‐related needs: A comparison of older and younger homeless people

The number of older homeless people with a limited life expectancy is increasing. European studies on their health‐related characteristics are lacking. This study compared self‐reported health, healthcare service use and health‐related needs of older and younger homeless people in the Netherlands. It is part of a cohort study that followed 513 homeless people in the four major Dutch cities for a period of 2.5 years, starting from the moment they registered at the social relief system in 2011. Using cross‐sectional data from 378 participants who completed 2.5‐year follow‐up, we analysed differences in self‐reported health, healthcare service use, and health‐related needs between homeless adults aged ≥50 years (N = 97) and <50 years (N = 281) by means of logistic regression. Results show that statistically significantly more older than younger homeless people reported cardiovascular diseases (23.7% versus 10.3%), visual problems (26.8% versus 14.6%), limited social support from family (33.0% versus 19.6%) and friends or acquaintances (27.8% versus 14.6%), and medical hospital care use in the past year (50.5% versus 34.5%). Older homeless people statistically significantly less often reported cannabis (12.4% versus 45.2%) and excessive alcohol (16.5% versus 27.0%) use in the past month and dental (20.6% versus 46.6%) and mental (16.5% versus 25.6%) healthcare use in the past year. In both age groups, few people reported unmet health‐related needs. In conclusion, compared to younger homeless adults, older homeless adults report fewer substance use problems, but a similar number of dental and mental problems, and more physical and social problems. The multiple health problems experienced by both age groups are not always expressed as needs or addressed by healthcare services. Older homeless people seem to use more medical hospital care and less non‐acute, preventive healthcare than younger homeless people. This vulnerable group might benefit from shelter‐based or community outreach programmes that proactively provide multidisciplinary healthcare services.     

Can social firms contribute to alleviating the economic burden of psychiatric disabilities for the public healthcare system?

In a number of countries, unemployment rates for people with psychiatric disabilities are much higher than in the general population. On the one hand, the expenses for mental health reach 3.5% of the total public health and social services budget in Québec. On the other hand, social firms (SFs) receive government subsidies. The objective was to compare public healthcare expenses for people with psychiatric disabilities who work in SFs with those associated with people with a similar condition who are looking for a job in the competitive labour market. This study followed a retrospective comparative design and considered two groups, namely: 122 employees working in SFs and 64 individuals participating in a supported employment program as job‐seekers. Two complementary datasets were used: a self‐report questionnaire and public healthcare databases. The cost analysis was performed from the perspective of the public healthcare system and included outpatient visit fees to physicians, outpatient visits to health professionals other than physicians in public healthcare centres, inpatient expenses due to hospitalisations, emergency room visits and amounts reimbursed to patients for medication. Regression analyses using generalised linear models with a gamma distribution and log link were used. Our results revealed that when controlling for sociodemographic variables (gender, age, marital status, education, physical disability), global health (EuroQol EQ‐5D‐5L), the severity of psychiatric symptoms (18‐item Brief Symptom Inventory) and self‐declared primary mental health diagnosis, annual healthcare costs paid by the public insurance system were between $1,924 and $3,912 lower for people working in SFs than for the comparison group. An explanatory hypothesis is that working in SFs could act as a substitute for medical treatments such as outpatient visits and medication use. There might be a form of compensation between supporting SFs and financing the public healthcare system, which provides valuable insights for public decision‐making.     

Health‐related quality of life and activities of daily living in 85‐year‐olds in Sweden

Few studies have examined health‐related quality of life (HRQoL) with respect to daily living and health factors for relatively healthy elderly individuals. To this end, this study examines 85‐year‐olds' reported HRQoL in relation to social support, perceived health, chronic diseases, healthcare use and instrumental activities of daily living (IADL). Data were collected from 360 participants (55% response rate) between March 2007 and March 2008 using a postal questionnaire and a home visit interview. HRQoL was assessed using the EQ‐5D‐3L. For the items in the EQ‐5D‐3L, more problems were related to lower HRQoL. Restricted mobility and occurrence of pain/discomfort was common. Lower HRQoL was associated with increased risk for depression, increased use of medication, increased number of chronic diseases and more problems with IADL. Healthcare use and healthcare costs were correlated with lower HRQoL. HRQoL is of importance to healthcare providers and must be considered together with IADL in the elderly population when planning interventions. These should take into account the specific needs and resources of the older individuals.     

青岛市社区卫生服务人力资源现况调查

目的了解青岛市社区卫生人力资源现况，为合理配置社区卫生服务人力资源提供依据。方法采取随机抽样方法，对161名社区卫生服务从业人员进行问卷调查。结果社区卫生服务从业人员的平均年龄为43．57岁；11．2％的从业人员学历为本科，40．4％的为专科，中专的占28．6％；具有高级职称的从业人员占13．2％，中级职称的占43．4％，初级职称的占33．3％；原从事医疗卫生工作的占97．5％；57．1％的社区卫生服务人员参加过全科医学培训，平均培训时间为22．74周。结论社区卫生服务人员缺乏全科医学培训、存在学历层次低、缺乏高水平带头人等问题．应加以解决。     

To what degree are health insurance enrollees in the Netherlands aware of the restrictive conditions attached to their policies?

BackgroundWithin the Dutch healthcare system of managed competition, health insurers can contract healthcare providers selectively. Enrollees who choose a health insurance policy with restrictive conditions will have to make a co-payment if they consult a non-contracted provider. This study aims to gain insight into enrollees' awareness of the conditions of such health insurance policies.MethodsIn August 2020, an online questionnaire was sent out via health insurers to their enrollees with restrictive health plans. In total 13,588 enrollees responded.ResultsOne fifth of the respondents appeared to be totally unfamiliar with the policy conditions. Men, younger people, people with a low level of education, a lower income, a poorer health status and non-care users were found to be less familiar with the conditions. Of those who have been in the situation that they wanted to visit a healthcare provider whose care was not fully reimbursed, 62% went to that provider. Of those who had to pay extra because hospital care was not fully reimbursed, 62% did not know this in advance and 30% indicated that paying extra was a serious problem.ConclusionsNot all enrollees who choose a policy with restrictive conditions are aware of the consequences of receiving care from non-contracted providers. Increased awareness among enrollees will benefit the functioning of the healthcare system based on managed competition.     

Knowledge of medication abortion among adolescent medicine providers

PurposeAdolescents are at high risk for unintended pregnancy and abortion. The purpose of this study was to understand whether providers caring for adolescents have the knowledge to counsel accurately on medication abortion, a suitable option for many teenagers seeking to terminate a pregnancy.MethodsUsing an online questionnaire, a survey related to medication abortion was administered to U.S. providers in the Society for Adolescent Health and Medicine. We conducted χ² analyses to evaluate the knowledge of medication abortion by reported adolescent medicine fellowship training, and to compare responses to specific knowledge questions by medication abortion counseling. Furthermore, we examined the relationship between providers' self-assessed and actual knowledge using ANOVA.ResultsWe surveyed 797 providers, with a 54% response rate. Almost 25% of respondents incorrectly believed that medication abortion was not very safe, 40% misidentified that it was < 95% effective, and 32% did not select the correct maximum recommended gestational age (7–9 weeks). Providers had difficulty identifying that serious complications of medication abortion are rare. Those who counseled on medication abortion had more accurate information in all knowledge categories, except for expected outcomes. Medication abortion knowledge did not differ by adolescent medicine fellowship completion. Only 32% of respondents had very good knowledge, and self-assessed knowledge minimally predicted actual knowledge (r² = .08).ConclusionsKnowledge regarding medication abortion safety, effectiveness, expected outcomes, and complications is suboptimal even among adolescent medicine fellowship trained physicians, and self-assessment poorly predicts actual knowledge. To ensure pregnant teenagers receive accurate counseling on all options, adolescent medicine providers need better education on medication abortion.     

Adherence to recommended health checks by women in mid‐life: data from a prospective study of women across Australia

Objective: To examine the factors related to Papanicolaou (Pap) tests, mammography and cholesterol testing in mid‐aged Australian women as they age. Methods: Data were obtained from the 1946–51 cohort of the Australian Longitudinal Study on Women's Health, a prospective study of the health and lifestyle of Australian women. Data were collected via self‐report mailed surveys on a three‐yearly basis since 1996, when participants were aged 45–50. Demographic factors, health service use and health‐related factors were examined in relation to screening practices in a lagged analysis. Results: As women aged, they were less likely to have a Pap test and more likely to report having a mammogram and a cholesterol test. Smokers were less likely to have all screening tests, and HRT use and more general practitioner (GP) visits were associated with increased odds of having health checks. Compared to healthy weight, higher BMI was associated with increased odds of cholesterol testing but decreased odds for Pap testing; obese women had lower odds for mammography. Underweight women had lower odds for mammography and Pap testing. Worse self‐rated health and self‐report of a chronic condition were significantly related to increased likelihood of cholesterol testing. While some demographic and area of residence factors were also significantly associated with screening, large inequities based on socioeconomic status were not evident. Conclusions: Health and healthcare use are important determinants of screening. Implications: Greater advantage needs to be taken of opportunities to encourage women with more health risk behaviours and health problems to engage in screening.     

Rural adolescents' help-seeking intentions for emotional problems: the influence of perceived benefits and stoicism

Objective: This study explores the factors that influence adolescents' help‐seeking intentions. Specifically, the study investigates the extent to which perceived benefits of help seeking, stoicism, gender and symptoms of psychological distress are associated with intentions to seek professional help for emotional problems. Design and setting: A cross sectional self‐report questionnaire was administered to adolescents recruited from seven high schools in rural towns in the Riverina region of New South Wales. Participants: A total of 778 adolescents were recruited. The sample included 373 male and 404 female participants between 13 and 18 years of age. Main outcome measure(s): Participants completed an anonymous self‐report questionnaire designed to measure help‐seeking intentions in the advent that they were to experience emotional problems, psychological distress symptoms, perceived benefits of help seeking and stoicism. Results: In all, 17% of male participants and 29% of female participants reported they would be likely to seek help from doctors if they were to experience emotional problems. In total, 15% of male participants and 23% of female participants reported they would be likely to seek help from other health care professionals. Multiple regression analysis suggested that adolescents are more likely to seek help from professionals if they perceive help seeking as beneficial (t = 12.91; P < 0.001). Female particpants reported that they were more likely to seek help than male participants (t = 2.69; P = 0.01). Conclusions: Findings suggest that adolescents are reluctant to seek professional help if experiencing emotional problems, because they do not believe professional help seeking is beneficial. Improving adolescents' beliefs about the benefits of professional help seeking might be a key strategy for increasing their use of professional health services to address mental health problems.     

The influence of communication and information sources upon decision‐making around complementary and alternative medicine use for back pain among Australian women aged 60–65 years

This study examined factors influencing decision‐making on complementary and alternative medicine (CAM) use for back pain and back pain sufferers' communication about CAM use. A cross‐sectional postal survey was conducted in 2011/2012 as a sub‐study of the Australian Longitudinal Study on Women's Health (ALSWH). The sample contained 1620 women from the 1945–1951 cohort of the ALSWH, aged 60–65 years who were eligible for the sub‐study, as they had experienced back pain during 12 months prior to the survey. Of these, 1310 (80.9%) returned completed questionnaires. A significant proportion of women consulted a CAM practitioner (76%, n = 1001) and/or had self‐prescribed CAM treatment (75%, n = 985). Of the women who used CAM for their back pain, 20% consulted their general practitioner (GP) prior to using CAM and 34% always informed their GP following CAM use. Forty‐three per cent of the women were influenced by their doctors, 39% by friends/colleagues, 36% by family/relatives, 33% by their partner, 30% by a CAM practitioner, 20% by a pharmacist, 16% by a book/magazine, 11% by mass media, 10% by an allied health worker and 6% by the Internet. Our results show that information sources used by women for their decision‐making on CAM use differed according to the symptoms. While non‐professional information sources (e.g. family/relatives) positively influenced women in their decision to use CAM for a range of back pain‐related symptoms (e.g. headaches/migraines), doctors and allied health workers (e.g. nurses) negatively influenced women in their decision to consult a CAM practitioner for a range of back pain‐related symptoms (e.g. headaches/migraines, neck pain). Women seek information from a wide range of professional and non‐professional sources with regard to their decision‐making around CAM use for back pain. Back pain care providers need to ensure effective communication with their back pain patients regarding safe, effective and co‐ordinated back pain care options.     

Help-seeking in the Norwegian Police Service

A traditional view is that police officers possess negative attitudes toward seeking professional help. However, few empirical studies have investigated help-seeking behaviour in police services. This study aimed to investigate help-seeking behaviour, gender differences, and the relationship to self-reported physical and mental health problems in the Norwegian police service. Comparisons were made with a sample of the general Norwegian population. A comprehensive nationwide questionnaire survey of 3,272 Norwegian police officers at all hierarchical levels was conducted; measurements included help-seeking, Subjective Health Complaint questionnaire (SHC), the Hospital Anxiety and Depression Scale (HADS), Paykel's Suicidal Feelings in the General Population, alcohol and medication to cope, self reported health, and sick leave. Female police officers contacted nearly all health professionals more than their male counterparts. Help-seeking was largely unaffected by age. Less than 10% of those reporting anxiety or depressive symptoms or serious suicidal ideation had contacted a psychologist or psychiatrist. A chiropractor had been contacted by 14.5% of the sample during the past year, compared with 7% in the general Norwegian population. Anxiety symptoms were associated with seeking a chiropractor (OR 1.9, 95% CI 1.3-2.7). The strongest association with contacting a psychologist or psychiatrist was medication used to cope (OR 5.8, 95% CI 3.0-11.1). The first nationwide study on help-seeking behaviour showed that police officers sought help among specialists in private practice, physiotherapists and chiropractors relatively often. However, they contacted a psychologist or psychiatrist rarely, even when reporting serious suicidal ideation.