GMS German Medical Science最新文献

{"title":"Systematic identification of critically ill and dying patients in primary care using the German version of the Supportive and Palliative Care Indicators Tool (SPICT-DE).","authors":"Kambiz Afshar,&nbsp;Birgitt Wiese,&nbsp;Nils Schneider,&nbsp;Gabriele Müller-Mundt","doi":"10.3205/000278","DOIUrl":"https://doi.org/10.3205/000278","url":null,"abstract":"<p><p><b>Objective:</b> The systematic identification of patients who are at risk of deteriorating and dying is the prerequisite for the provision of palliative care (PC). This study aimed to investigate the feasibility and practicability of the German version of the Supportive and Palliative Care Indicators Tool (SPICT-DE) for the systematic identification of these patients in general practice. <b>Methods:</b> In the beginning of 2017, twelve general practitioners (GPs; female n=6) were invited to take part in the study. GPs were asked to apply the SPICT-DE in everyday practice over a period of two months in patients with chronic progressive diseases. Six months after initial assessment, a follow-up survey revealed how the clinical situation of the initially identified patients had changed and which PC actions had been initiated by GPs. In addition, GPs gave feedback on the practicability of SPICT-DE in daily routine. <b>Results:</b> 10 of the 12 GPs (female n=5, median age 46 years, range 38-68) participated in both the two-month assessment period and the follow-up survey. A total of 79 patients (female n=40, median age 79 years, range 44-94) was assessed with the SPICT-DE. Main diagnoses were predominately of cardio-vascular (n=28) or oncological (n=26) origin. Follow-up after six months showed that 38 patients (48%) went through at least one crisis during the course of disease and almost one third (n=26) had died. The majority of GPs (n=7) considered the SPICT-DE to be practical in daily routine and helpful in identifying patients who might benefit from PC. Seven GPs indicated that they would use the SPICT-DE as part of everyday practice. <b>Conclusions:</b> The SPICT-DE seems to be a practical tool supporting the systematic identification of critically ill and dying patients in general practice.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"18 ","pages":"Doc02"},"PeriodicalIF":0.0,"publicationDate":"2020-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6997946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37634730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The quality of acute intensive care and the incidence of critical events have an impact on health-related quality of life in survivors of the acute respiratory distress syndrome - a nationwide prospective multicenter observational study.","authors":"Thomas Bein,&nbsp;Steffen Weber-Carstens,&nbsp;Christian Apfelbacher,&nbsp;Susanne Brandstetter,&nbsp;Sebastian Blecha,&nbsp;Frank Dodoo-Schittko,&nbsp;Magdalena Brandl,&nbsp;Michael Quintel,&nbsp;Stefan Kluge,&nbsp;Christian Putensen,&nbsp;Sven Bercker,&nbsp;Björn Ellger,&nbsp;Thomas Kirschning,&nbsp;Christian Arndt,&nbsp;Patrick Meybohm,&nbsp;Florian Zeman,&nbsp;Christian Karagiannidis","doi":"10.3205/000277","DOIUrl":"https://doi.org/10.3205/000277","url":null,"abstract":"<p><p><b>Background:</b> Initial treatment (ventilator settings, rescue therapy, supportive measures), and prevention of critical events improve survival in ARDS patients, but little data exists on its effect on health-related quality of life (HRQOL) and return to work (RtW) in survivors. We analyzed the association of the intensity of treatment at ARDS onset and the incidence of critical events on HRQOL and RtW a year after ICU discharge. <b>Methods:</b> In a prospective multi-centre cohort study, the intensity of treatment and the incidence of critical events were determined at 61 ICUs in Germany. At 3, 6, and 12 months, 396 survivors reported their HRQOL (Short-Form 12) and RtW. The parameters of the intensity of acute management (lung protective ventilation, prone position, hemodynamic stabilization, neuromuscular blocking agents), and critical events (hypoxemia, hypoglycemia, hypotension) were associated with HRQOL and RtW. <b>Results:</b> Patients ventilated at ARDS onset with a low tidal volume (VT≤7 ml/kg) had higher arterial carbon dioxide levels (PaCO₂=57.5±17 mmHg) compared to patients ventilated with VT>7ml/kg (45.7±12, p=0.001). In a multivariate adjusted dichotomized analysis, a better mental 3-month SF-12 was observed in the higher VT-group (mean 43.1±12) compared to the lower VT-group (39.5±9, p=0.042), while a dichotomized analysis for driving pressures (≤14 mbar vs >14 mbar) did not show any difference neither in PaCO₂ levels nor in HRQOL parameters. A decrease in the mental (6-month: 40.0±11 vs 44.8±13, p=0.038) and physical SF-12 (12-month: 38.3±11 vs 43.0±13, p=0.015) was reported from patients with hypoglycemia (blood glucose <70 mg/dl) compared to those without hypoglycemic episodes. More frequent vasopressor use with mean arterial pressure ≥65 mmHg was associated with an impaired physical SF-12 (6-month: 38.8±10) compared to less vasopressor use (43.0±11, p=0.019). <b>Conclusions:</b> In acute management of ARDS, a lower VT strategy associated with hypercapnia, as well as the frequent usage of catecholamines and the management of blood glucose may influence short-term HRQOL of survivors. The awareness of these findings is of clinical importance for the acute and post-ICU care.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"18 ","pages":"Doc01"},"PeriodicalIF":0.0,"publicationDate":"2020-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6997802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37634729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joint recommendations for a total services account as a factor in simplifying contracts","authors":"I. Bruns, C. Schade-Brittinger, Frank Wissing, T. Ruppert, Martin Trillsch","doi":"10.3205/000276","DOIUrl":"https://doi.org/10.3205/000276","url":null,"abstract":"The objective of clinical trials is to transfer findings gained from basic research to patients and to result in innovative treatment approaches. Along with basic research, results from clinical trials thus represent a core area of medical advances. As a location for clinical trials, Germany is currently well-positioned and internationally competitive. This is evident in its position as No. 2 in Europe and No. 3 worldwide – behind the US and UK – in clinical trials of pharmaceuticals [1]. Maintaining and further improving this favorable positioning as a location for clinical trials is in the mutual interest of all parties involved in the field of clinical research, patients, trial sites and sponsors of clinical trials. For patients, clinical trials offer opportunities to gain early access to innovative therapy options. In addition to the scientific interest from medical faculties, clinical research is thereby an important aspect for university clinics in Germany as they fulfill their medical care mandate. Their involvement in clinical trials gives physicians the ability to gather experience with new treatment approaches at an early stage and to pass this know-how on to their patients. A location’s clinical research is thus an important competitive factor in terms of international comparison as well. Industry likewise benefits from the favorable research infrastructure in Germany, which provides rapid patient recruitment and outstanding quality of results obtained and can thus contribute to the early approval of new drugs. From the perspective of the authors, it is therefore essential that Germany continues to remain competitive as a location for conducting clinical trials, precisely because the number of clinical trials is decreasing overall. Companies themselves are in international competition internally and externally, which often creates a certain pressure on trial preparation and thus on the start of a clinical trial. To ensure that a clinical trial can begin early, it is essential that contracts related to the trial are concluded quickly and simply, including remuneration for participants and full, transparent and comprehensible coverage of content for the business relationship. The swift agreement of key contractual and budgetary aspects is therefore in the interest of everyone involved. Against this backdrop, the German Association of Medical Faculties (MFT), the German Association of Academic Medical Centers (VUD), the Coordination Center for Clinical Studies (KKS-Netzwerk) and the German Association of Research-Based Pharmaceutical Companies (vfa) have held joint discussions regarding an important aspect of the contract negotiations – the cost consideration of clinical trials. As a result of these talks, these organizations have developed and published joint “Recommendations for the preparation of a total services calculation for remuneration related to the conduct of a clinical trial in a trial center” [2], [3]. The parties concerned s","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43922998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subgroups in chronic low back pain patients – a step toward cluster-based, tailored treatment in inpatient standard care: On the need for precise targeting of treatment for chronic low back pain","authors":"Anna-Maria Langenmaier, V. Amelung, M. Karst, C. Krauth, F. Püschner, D. Urbanski, C. Schiessl, R. Thoma, B. Klasen","doi":"10.3205/000275","DOIUrl":"https://doi.org/10.3205/000275","url":null,"abstract":"Objective: The purpose of this study was to find applicable clusters for the development of different treatment pathways in an inpatient multimodal pain-therapy setting based on the multifaceted nature of CLBP. Methods: Based on data of questionnaires (Hospital Anxiety and Depression Scale (HADS), Marburg Questionnaire on Habitual Health Findings (MFHW), quality of life assessment using the Short-Form 12 (SF 12)), a retrospective two-step cluster analysis involving a sample of chronic low back pain (CLBP) patients (N=320) was calculated. Subsequently, the clusters were precisely described and compared on the basis of further data collected during the patients’ standard care: pain characteristics, socio-demographic data and the general state of health, psychological variables, therapy intensity, and Diagnosis Related Groups (DRG) data. Results: We found a three-cluster solution: little psychological interference but marginal physical and mental quality of life (Cluster 1); poor well-being, low physical quality of life, and marginal mental quality of life (Cluster 2); and heavy mental strain and marginal physical quality of life (Cluster 3). Conclusions: Similar to previous studies, our results suggest that patients suffering from CLBP differ with regard to the magnitude of mental burden and the presence of physical impairment. These differences ascertain the need for precise targeting of treatment for CLBP. Inpatient pain centers therefore should offer different multimodal therapy pathways and integrate a meaningful triage, taking into account the multifaceted nature of CLBP based on sophisticated knowledge about forms, differences, and relationships among the biopsychosocial components of CLBP.","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49177161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Poor, old and in need of care: A qualitative study about the consequences for home care and participation","authors":"M. Messer","doi":"10.3205/000274","DOIUrl":"https://doi.org/10.3205/000274","url":null,"abstract":"Background: For people in old age and in need of care, there is an increased risk of being affected by poverty. The aim of the study was to explore the forms of poverty that nurses in Germany perceive in older people in need of care who are living at home, as well as the perceived strategies to deal with this situation regarding health and nursing care and the consequences for the possibilities of participation. Methods: A qualitative study was performed as a secondary data analysis of 39 transcribed problem-oriented expert interviews. The data analysis was conducted through content and thematic analysis. Results: Two forms of poverty among people in need of care were described by the nurses interviewed: 1) a self-imposed austerity, and 2) a material and financial poverty. The possible consequences of poverty reported in those in need of care are harmful self-restrictions and limited opportunities for participation, e.g. through the multiple use of medical aids and reduced intake of medications, but also restricted food intake. This situation is often accepted without complaint by people in need of care. However, restrictions in social activities can be a considerable burden on the quality of life of patients. The interviewees described that offering professional help can be challenging, because people in need of care and affected by poverty often show a degree of high shame in accepting financial support or negate their own precarious life situation, but also because support structures in the social and health system are limited. Conclusion: The results indicate how older people in need of care impose self-restrictions due to their poverty, which are harmful to health and limit the quality of life. Furthermore, the described strategies can pose a significant risk to the medical safety of patients. This has implications for the nursing and social care, but also for the medical treatment of the affected patients. The existing support systems seem to be only partially prepared for dealing with such situations. In view of a trend towards an older population structure, future research should put more emphasis on the user-friendly adaptation of the social and health systems. Strategies to prevent and deal with poverty in older people in need of care, easy access to social support systems, as well as the preparation of the health professions for the associated tasks seem to be particularly indicated.","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44731977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of inadvertent perioperative hypothermia – Guideline compliance in German hospitals","authors":"P. Gabriel, J. Höcker, M. Steinfath, Kevin R. Kutschick, Jana Lubinska, E. Horn","doi":"10.3205/000273","DOIUrl":"https://doi.org/10.3205/000273","url":null,"abstract":"Patients undergoing elective surgery are at risk for inadvertent postoperative hypothermia, defined as a core body temperature below 36°C. This study was conducted to investigate the acceptance of the recommendations of the German S3 Guideline, in particular with respect to the concept of pre-warming and sublingual temperature measurement. The main focus was to gather data concerning the postoperative core temperature and the frequency of perioperative hypothermia in patients receiving a pre-warming regime and those without. The study team investigated the local concept and measures employed to avoid inadvertent perioperative hypothermia with respect to defined outcome parameters following a specific protocol. In summary, the study hospitals vary greatly in their perioperative processes to prevent postoperative hypothermia. However, each hospital has a strategy to prevent hypothermia and was more or less successful in keeping its patients normothermic during the perioperative process. Our data could not demonstrate major differences between hospitals in the implementation strategy to prevent perioperative hypothermia in regard to the hospital size. The results of our study suggest a wide-spread acceptance, as no postoperative hypothermia was detected in a cohort of 431 patients.","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45145943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous chest compressions with a simultaneous triggered ventilator in the Munich Emergency Medical Services: a case series.","authors":"Stefan J Schaller,&nbsp;Sonja Altmann,&nbsp;Annalise Unsworth,&nbsp;Gerhard Schneider,&nbsp;Viktoria Bogner-Flatz,&nbsp;Thomas Paul,&nbsp;Petra Hoppmann,&nbsp;Karl-Georg Kanz","doi":"10.3205/000272","DOIUrl":"https://doi.org/10.3205/000272","url":null,"abstract":"<p><p><b>Background:</b> Mechanical chest compression devices are commonly used providing a constant force and frequency of chest compression during cardiopulmonary resuscitation. However, there are currently no recommendations on ventilation during cardiopulmonary resuscitation with a mechanical chest compression device using continuous mode. An effective method for ventilation in such scenarios might be a triggered oxygen-powered resuscitator. <b>Methods:</b> We report seven cardiopulmonary resuscitation cases from the Munich Emergency Medical Service where mechanical chest compression devices in continuous mode were used with an oxygen-powered resuscitator. In each case, the resuscitator (Oxylator^®) was running in automatic mode delivering a breath during the decompression phase of the chest compressions at a frequency of 100 per minute. End-tidal carbon dioxide and pulse oximetry were measured. Additional data was collected from the resuscitation protocol of each patient. <b>Results:</b> End-tidal carbon dioxide was available in all cases while oxygen saturation only in four. Five patients had a return of spontaneous circulation. Based on the end-tidal carbon dioxide values of each of the cases, the resuscitator did not seem to cause hyperventilation and suggests that good-quality cardiopulmonary resuscitation was delivered. <b>Conclusions:</b> Continuous chest compressions using a mechanical chest compression device and simultaneous synchronized ventilation using an oxygen-powered resuscitator in an automatic triggering mode might be feasible during cardiopulmonary resuscitation.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"17 ","pages":"Doc06"},"PeriodicalIF":0.0,"publicationDate":"2019-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41215374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of pain in individuals with spinal cord injury: Guideline of the German-Speaking Medical Society for Spinal Cord Injury.","authors":"Steffen Franz, Barbara Schulz, Haili Wang, Sabine Gottschalk, Florian Grüter, Jochen Friedrich, Jean-Jacques Glaesener, Fritjof Bock, Cordelia Schott, Rachel Müller, Kevin Schultes, Gunther Landmann, Hans Jürgen Gerner, Volker Dietz, Rolf-Detlef Treede, Norbert Weidner","doi":"10.3205/000271","DOIUrl":"10.3205/000271","url":null,"abstract":"<p><p><b>Introduction:</b> Pain is a prominent complication in spinal cord injury (SCI). It can either occur as a direct or as an indirect consequence of SCI and it often heavily influences the quality of life of affected individuals. In SCI, nociceptive and neuropathic pain can equally emerge at the same time above or below the level of injury. Thus, classification and grading of pain is frequently difficult. Effective treatment of SCI-related pain in general and of neuropathic pain in particular is challenging. Current treatment options are sparse and their evidence is considered to be limited. Considering these aspects, a clinical practice guideline was developed as basis for an optimized, comprehensive and standardized pain management in SCI-related pain. <b>Methods:</b> The German-Speaking Medical Society for Spinal Cord Injury (Deutschsprachige Medizinische Gesellschaft für Paraplegiologie - DMGP) developed a clinical practice guideline that received consensus from seven further German-speaking medical societies and one patient organization. The evidence base from clinical trials and meta-analyses was summarized and subjected to a structured consensus-process in accordance with the regulations of the Association of Scientific Medical Societies in Germany (AWMF) and the methodological requirements of the \"German instrument for methodological guideline appraisal\". <b>Results:</b> This consensus-based guideline (S2k classification according to the AWMF guidance manual and rules) resulted in seven on-topic statements and 17 specific recommendations relevant to the classification, assessment and therapy of pain directly or indirectly caused by SCI. Recommended therapeutic approaches comprise pharmacological (e.g. nonsteroidal anti-inflammatory drugs or anticonvulsants) and non-pharmacological (e.g. physical activity or psychotherapeutic techniques) strategies for both nociceptive and neuropathic pain. <b>Discussion:</b> Assessment of SCI-related pain is standardized and respective methods in terms of examination, classification and grading of pain are already in use and validated in German language. In contrast, valid, evidence-based and efficient therapeutic options are limited and ask for further clinical studies, ideally randomized controlled trials and meta-analyses.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":" ","pages":"Doc05"},"PeriodicalIF":0.0,"publicationDate":"2019-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47803839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National survey of evaluation practices and performance-guided resource allocation at German medical schools.","authors":"Sarah Schiekirka-Schwake,&nbsp;Janina Barth,&nbsp;Josef Pfeilschifter,&nbsp;Reinhard Hickel,&nbsp;Tobias Raupach,&nbsp;Christoph Herrmann-Lingen","doi":"10.3205/000270","DOIUrl":"https://doi.org/10.3205/000270","url":null,"abstract":"<p><p><b>Background:</b> Little is known about evaluation practices as well as performance-oriented allocation of resources according to teaching quality at German medical schools. For this reason, the Association of the Scientific Medical Societies in Germany and the German Association of Medical Faculties aimed to analyse current practices at German medical schools. <b>Methods:</b> Data were collected by a questionnaire which was sent to all medical schools in Germany. <b>Results:</b> 30 medical schools with 33 undergraduate medical programs participated in the survey (response rate: 83%). The evaluation tools used at these schools mainly assessed structural and procedural aspects of teaching and were designed to obtain overall student ratings of teaching quality. Evaluation tools were quite heterogeneous across the sample, and some uncertainty remained with regard to the psychometric properties of these tools and whether they meet international quality standards. Various algorithms underlying resource allocation for teaching are being used, but most focus on quantity rather than quality of teaching. <b>Conclusion:</b> A nationwide agreement on a generalizable definition of high-quality teaching is desirable. At the same time, reliable and valid tools measuring teaching quality need to be identified and/or created. This could be accomplished through a wider collaboration of medical schools and could represent an advancement for the allocation of resources for high-quality teaching.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"17 ","pages":"Doc04"},"PeriodicalIF":0.0,"publicationDate":"2019-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6533543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37288975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A close look at lay-led self-management programs for chronic diseases and health care utilisation: A systematic review and meta-analysis.","authors":"Mareike Lederle,&nbsp;Eva-Maria Bitzer","doi":"10.3205/000269","DOIUrl":"https://doi.org/10.3205/000269","url":null,"abstract":"<p><p><b>Introduction:</b> Chronically ill people are confronted with significant challenges when dealing with health care services. Lay-led self-management programs aim to improve self-management skills and might enable patients to make appropriate decisions as to when to use health care services. Contrary to the general attitude that self-management programs reduce health care utilisation, we suspect that better self-management skills lead to increased or possibly more appropriate health care utilisation. Our review and meta-analysis sheds light on the relationship between lay-led self-management programs and health care utilisation. <b>Methods:</b> In March 2017, we searched 7 databases (CDSR, DARE, HTA, Medline, CINAHL, PsycInfo, and SSCI) to perform a systematic review and meta-analysis to identify studies that reported empirical data on lay-led self-management programs and health care utilisation. We extracted the characteristics of all primary studies and the data of four indicators of utilisation (physician visits, emergency department visits, hospital admissions, and length of stay in hospital), and analysed the role of health care utilisation in these studies. We present the results in frequency tables and as a conventional meta-analysis with the standardized mean difference (SMD), 95% confidence intervals (CI), and pooled overall effect sizes using RevMan 5.3.5. The manuscript follows the PRISMA checklist. <b>Results:</b> Overall, we include 49 primary studies; 10 studies provided sufficient data for the meta-analysis. Health care utilisation played a different role in the studies; 15 studies reported a clear explicit hypothesis on the influence of a lay-led self-management program on health care utilisation, and 17 studies assumed an implicit assumption. 8 studies discussed the possibility that a lay-led self-management program could lead to more appropriate health care utilisation. The meta-analysis showed mixed results, and many effect sizes were not statistically significant. The participants of a lay-led self-management program had fewer emergency department visits (SMD: -0.08; 95% CI: -0.15 to -0.01; p=0.02) than the control group. <b>Conclusion:</b> Although the statistically significant effects of the meta-analysis are low, our overall findings show that only a small number of the included studies tackled the task of comprehensively investigating self-management skills in the context of health care utilisation. This fails to do justice to the potential of self-management programs. It is essential to consider the appropriateness of health care utilisation. We propose the term <i>self-management-sensitive utilisation</i> for this purpose.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"17 ","pages":"Doc03"},"PeriodicalIF":0.0,"publicationDate":"2019-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6533545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37288974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}