Refine
Year of publication
Document Type
- Article (28)
- Conference Proceeding (1)
Has Fulltext
- yes (29)
Is part of the Bibliography
- no (29)
Keywords
- Multimorbidity (4)
- Primary care (4)
- Depression (3)
- Allgemeinmedizin (2)
- Chronic disease (2)
- E-Learning (2)
- General practice (2)
- Quality of life (2)
- Agreement (1)
- Assessment of care (1)
Institute
- Medizin (29)
- Psychologie (1)
E-Learning soll im Rahmen der allgemeinmedizinischen Ausbildung von Medizinstudierenden erprobt werden. Ein zielgruppenspezifisches, multimodulares Online-Angebot begleitet Medizinstudenten des 10. Semesters während ihres dezentralen Praktikums in hausärztlichen Praxen. Folgende Lehrziele werden angestrebt: (1) Einführung in das E-Learning, (2) Klinische Allgemeinmedizin - Online-Modul, (3) Chronic Care Online-Modul, (4) Online-Bewerbung. Die systematische Evaluation zeigt, dass E-Learning die Kommunikation der Studierenden untereinander und mit der universitären Lehreinheit während des Praktikum fördert. Auf der Grundlage der in diesem Pilotversuch gewonnenen Erfahrungen erscheint die Kombination mit Präsenzunterricht (Blended Learning) eine vielversprechende Option für die allgemeinmedizinische Ausbildung zu sein.
Background: Osteoarthritis (OA) has a high prevalence in primary care. Conservative, guideline orientated approaches aiming at improving pain treatment and increasing physical activity, have been proven to be effective in several contexts outside the primary care setting, as for instance the Arthritis Self management Programs (ASMPs). But it remains unclear if these comprehensive evidence based approaches can improve patients' quality of life if they are provided in a primary care setting. Methods/Design: PraxArt is a cluster randomised controlled trial with GPs as the unit of randomisation. The aim of the study is to evaluate the impact of a comprehensive evidence based medical education of GPs on individual care and patients' quality of life. 75 GPs were randomised either to intervention group I or II or to a control group. Each GP will include 15 patients suffering from osteoarthritis according to the criteria of ACR. In intervention group I GPs will receive medical education and patient education leaflets including a physical exercise program. In intervention group II the same is provided, but in addition a practice nurse will be trained to monitor via monthly telephone calls adherence to GPs prescriptions and advices and ask about increasing pain and possible side effects of medication. In the control group no intervention will be applied at all. Main outcome measurement for patients' QoL is the GERMAN-AIMS2-SF questionnaire. In addition data about patients' satisfaction (using a modified EUROPEP-tool), medication, health care utilization, comorbidity, physical activity and depression (using PHQ-9) will be retrieved. Measurements (pre data collection) will take place in months I-III, starting in June 2005. Post data collection will be performed after 6 months. Discussion: Despite the high prevalence and increasing incidence, comprehensive and evidence based treatment approaches for OA in a primary care setting are neither established nor evaluated in Germany. If the evaluation of the presented approach reveals a clear benefit it is planned to provide this GP-centred interventions on a much larger scale.
Kurzfassung Vortrag: Fächerübergreifende Lehre und verpflichtende Fortbildung (CME) für Ärzte erfordern innovative Lernmethoden. Eine Lösung wird teilweise in der Nutzung elektronischer Medien gesehen. Unklar ist jedoch, wie konkret eine Umsetzung in der Aus-, Fort- und Weiterbildung im Fach Allgemeinmedizin bisher erfolgte, welche Chancen und Möglichkeiten es gibt und wie die weitere Entwicklung aussehen kann. Um einen Überblick über die aktuellen E-Learning-Aktivitäten zu erhalten, formierte sich eine universitäts- und bundesländerübergreifende Initiative. In drei Phasen soll die Grundlage für die Entwicklung einer Strategie für die effektive Nutzung elektronischer Lehr- und Lernmedien für das Fach Allgemeinmedizin geschaffen werden: Phase 1 - Nationales Expertentreffen (Juli 2005 in Frankfurt): Diskussion von Erfahrungen, Problemen und Möglichkeiten des Einsatzes elektronischer Medien in der Allgemeinmedizin. Phase 2 - Gründung eines Netzwerks: Zusammenarbeit, Koordination und gegenseitige Unterstützung bei der Entwicklung von E-Learning-Modulen. Phase 3 - Evaluation von E-Learning in der Allgemeinmedizin: systematische qualitative und quantitative Untersuchungen. Im Rahmen eines Workshops sollen die Erfahrungen aus dem Expertentreffen mit Lehrenden und Fortbildenden aus anderen Fachbereichen diskutiert werden. Kooperationen über die Allgemeinmedizin hinaus können weitere Synergien schaffen. Der Workshop dient dem Austausch über Chancen und Limitationen entsprechender Angebote.
Background: Depression is a disorder with high prevalence in primary health care and a significant burden of illness. The delivery of health care for depression, as well as other chronic illnesses, has been criticized for several reasons and new strategies to address the needs of these illnesses have been advocated. Case management is a patient-centered approach which has shown efficacy in the treatment of depression in highly organized Health Maintenance Organization (HMO) settings and which might also be effective in other, less structured settings. Methods/Design: PRoMPT (PRimary care Monitoring for depressive Patients Trial) is a cluster randomised controlled trial with General Practice (GP) as the unit of randomisation. The aim of the study is to evaluate a GP applied case-management for patients with major depressive disorder. 70 GPs were randomised either to intervention group or to control group with the control group delivering usual care. Each GP will include 10 patients suffering from major depressive disorder according to the DSM-IV criteria. The intervention group will receive treatment based on standardized guidelines and monthly telephone monitoring from a trained practice nurse. The nurse investigates the patient's status concerning the MDD criteria, his adherence to GPs prescriptions, possible side effects of medication, and treatment goal attainment. The control group receives usual care – including recommended guidelines. Main outcome measure is the cumulative score of the section depressive disorders (PHQ-9) from the German version of the Prime MD Patient Health Questionnaire (PHQ-D). Secondary outcome measures are the Beck-Depression-Inventory, self-reported adherence (adapted from Moriskey) and the SF-36. In addition, data are collected about patients' satisfaction (EUROPEP-tool), medication, health care utilization, comorbidity, suicide attempts and days out of work. The study comprises three assessment times: baseline (T0) , follow-up after 6 months (T1) and follow-up after 12 months (T2). Discussion: Depression is now recognized as a disorder with a high prevalence in primary care but with insufficient treatment response. Case management seems to be a promising intervention which has the potential to bridge the gap of the usually time-limited and fragmented provision of care. Case management has been proven to be effective in several studies but its application in the private general medical practice setting remains unclear.
Background: Diabetes model projects in different regions of Germany including interventions such as quality circles, patient education and documentation of medical findings have shown improvements of HbA1c levels, blood pressure and occurrence of hypoglycaemia in before-after studies (without control group). In 2002 the German Ministry of Health defined legal regulations for the introduction of nationwide disease management programs (DMP) to improve the quality of care in chronically ill patients. In April 2003 the first DMP for patients with type 2 diabetes was accredited. The evaluation of the DMP is essential and has been made obligatory in Germany by the Fifth Book of Social Code. The aim of the study is to assess the effectiveness of DMP by example of type 2 diabetes in the primary care setting of two German federal states (Rheinland-Pfalz and Sachsen-Anhalt). Methods/Design: The study is three-armed: a prospective cluster-randomized comparison of two interventions (DMP 1 and DMP 2) against routine care without DMP as control group. In the DMP group 1 the patients are treated according to the current situation within the German-Diabetes-DMP. The DMP group 2 represents diabetic care within ideally implemented DMP providing additional interventions (e.g. quality circles, outreach visits). According to a sample size calculation a sample size of 200 GPs (each GP including 20 patients) will be required for the comparison of DMP 1 and DMP 2 considering possible drop-outs. For the comparison with routine care 4000 patients identified by diabetic tracer medication and age (> 50 years) will be analyzed. Discussion: This study will evaluate the effectiveness of the German Diabetes-DMP compared to a Diabetes-DMP providing additional interventions and routine care in the primary care setting of two different German federal states.
Kongressbericht: Auf der Tagung der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM) 2004 entstand die Idee, E-Learning-Aktivitäten in der Allgemeinmedizin sichtbar zu machen und zu bündeln. Ein Kongress sollte die allgemeinmedizinischen Vertreter aus Lehre und Forschung sowie Industrievertreter zusammenbringen, um das Spektrum der Möglichkeiten und laufende Projekte kennen zu lernen. Mit motivierten Referenten, über 60 aktiven Teilnehmern und einem positiven Feedback, kann der Kongress in Frankfurt am 8. und 9. Juli 2005 als erster dieser Art in Deutschland als erfolgreich bezeichnet werden.
Background: Chronic congestive heart failure (CHF) is a complex disease with rising prevalence, compromised quality of life (QoL), unplanned hospital admissions, high mortality and therefore high burden of illness. The delivery of care for these patients has been criticized and new strategies addressing crucial domains of care have been shown to be effective on patients' health outcomes, although these trials were conducted in secondary care or in highly organised Health Maintenance Organisations. It remains unclear whether a comprehensive primary care-based case management for the treating general practitioner (GP) can improve patients' QoL. Methods/Design: HICMan is a randomised controlled trial with patients as the unit of randomisation. Aim is to evaluate a structured, standardized and comprehensive complex intervention for patients with CHF in a 12-months follow-up trial. Patients from intervention group receive specific patient leaflets and documentation booklets as well as regular monitoring and screening by a prior trained practice nurse, who gives feedback to the GP upon urgency. Monitoring and screening address aspects of disease-specific selfmanagement, (non)pharmacological adherence and psychosomatic and geriatric comorbidity. GPs are invited to provide a tailored structured counselling 4 times during the trial and receive an additional feedback on pharmacotherapy relevant to prognosis (data of baseline documentation). Patients from control group receive usual care by their GPs, who were introduced to guidelineoriented management and a tailored health counselling concept. Main outcome measurement for patients' QoL is the scale physical functioning of the SF-36 health questionnaire in a 12-month follow-up. Secondary outcomes are the disease specific QoL measured by the Kansas City Cardiomyopathy questionnaire (KCCQ), depression and anxiety disorders (PHQ-9, GAD-7), adherence (EHFScBS and SANA), quality of care measured by an adapted version of the Patient Chronic Illness Assessment of Care questionnaire (PACIC) and NTproBNP. In addition, comprehensive clinical data are collected about health status, comorbidity, medication and health care utilisation. Discussion: As the targeted patient group is mostly cared for and treated by GPs, a comprehensive primary care-based guideline implementation including somatic, psychosomatic and organisational aspects of the delivery of care (HICMAn) is a promising intervention applying proven strategies for optimal care. Trial registration: Current Controlled Trials ISRCTN30822978.
Hintergrund Die chronische Herzinsuffizienz erfordert als Systemerkrankung hausärztliche sowie spezialärztliche Versorgung. Die evidenzbasierte DEGAM-Leitlinie (LL) zur hausärztlichen Versorgung der Herzinsuffizienz wurde formal interdisziplinär konsentiert, nachdem der Entwurf ein mehrstufiges internes und externes Reviewverfahren durchlaufen hatte. Methode Wissenschaftliche Fachgesellschaften und Organisationen (FG/O) wurden zu einem Nominalen Gruppenprozeß (NGP) eingeladen und entsandten autorisierte Teilnehmer. Diese erhielten den LL-Entwurf inkl. Methodenreport sowie eine Liste zentraler LL-Empfehlungen für ein persönliches Ranking (44-Items; 6-stufige Likert-Skala). Beim Konsentierungstreffen wurden aus dem 1. Ranking Themen ohne deutliche Übereinstimmung (Likert =4) identifiziert, unter Hinzunahme weiterer Themenvorschläge in priorisierter Reihenfolge diskutiert und erneut abgestimmt. Der überarbeitete LL-Entwurf wurde in einem zweiten Ranking im Delphi-Verfahren konsentiert. Ergebnisse Im Abstimmungsprozess mit 10 Vertretern aus 11 FG/O wurden ~35 Themen diskutiert. Bei zwei Empfehlungen mit fehlender Evidenz wurde ein von internationalen LL abweichender Konsens getroffen (z.B. ß-Blocker bei asymptomatischen Patienten nur nach durchgemachtem Herzinfarkt). Vier Formulierungen bewertenden Charakters zur BNP-Bestimmung wurden zugunsten einer Negativempfehlung gestrichen, eine Empfehlung mit der STIKO harmonisiert (Pneumokokkenimpfung), bei weiteren wurden ergänzende Konditionen im Wortlaut eingefügt oder sprachliche Änderungen vorgenommen. Fünf Themen wurden neu erstellt (z.B. kontraindizierte Pharmaka). Bis auf drei (z.B. Flussdiagramme nicht vollständig konsensfähig: unangemessene Vereinfachung vs. fehlende Praktikabilität) wurden alle Empfehlungen der LL konsentiert. Schlussfolgerungen Der NGP ist für evidenzbasierte LL eine geeignete Vorgehensweise. Interdisziplinarität ist insbesondere bei Entscheidungsunsicherheit (fehlende oder inkonsistente Evidenz) und zur Schnittstellendefinition wertvoll.
Background This study was carried out to compare the HRQoL of patients in general practice with differing chronic diseases with the HRQoL of patients without chronic conditions, to evaluate the HRQoL of general practice patients in Germany compared with the HRQoL of the general population, and to explore the influence of different chronic diseases on patients HRQoL, independently of the effects of multiple confounding variables. Methods A cross-sectional questionnaire survey including the SF-36, the EQ-5D and demographic questions was conducted in 20 general practices in Germany. 1009 consecutive patients aged 15–89 participated. The SF-36 scale scores of general practice patients with differing chronic diseases were compared with those of patients without chronic conditions. Differences in the SF-36 scale/summary scores and proportions in the EQ-5D dimensions between patients and the general population were analyzed. Independent effects of chronic conditions and demographic variables on the HRQoL were analyzed using multivariable linear regression and polynomial regression models. Results The HRQoL for general practice patients with differing chronic diseases tended to show more physical than mental health impairments compared with the reference group of patients without. Patients in general practice in Germany had considerably lower SF-36 scores than the general population (P < 0.001 for all) and showed significantly higher proportions of problems in all EQ-5D dimensions except for the self-care dimension (P < 0.001 for all). The mean EQ VAS for general practice patients was lower than that for the general population (69.2 versus 77.4, P < 0.001). The HRQoL for general practice patients in Germany seemed to be more strongly affected by diseases like depression, back pain, OA of the knee, and cancer than by hypertension and diabetes. Conclusion General practice patients with differing chronic diseases in Germany had impaired quality of life, especially in terms of physical health. The independent impacts on the HRQoL were different depending on the type of chronic disease. Findings from this study might help health professionals to concern more influential diseases in primary care from the patient´s perspective.