Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen最新文献

{"title":"[Too thin on the ground? Regional disparities in hospice and palliative care in Germany].","authors":"Beate Apolinarski, Stephanie Stiel, Franziska A Herbst, Siegfried Geyer","doi":"10.1016/j.zefq.2024.07.007","DOIUrl":"https://doi.org/10.1016/j.zefq.2024.07.007","url":null,"abstract":"<p><strong>Introduction: </strong>Outpatient and inpatient hospice and palliative care services have been significantly expanded in Germany in recent decades and are increasingly being supplemented by day care services. However, the availability of these services varies greatly from region to region. The extent to which the availability of these care structures is matched by a regional need based on local population structures is as yet unknown.</p><p><strong>Methods: </strong>In four Poisson regression models, the relationship between population indicators from the areas of demographics, employment, income, education and health and the number of offers of outpatient and inpatient hospice work and palliative care is exploratively examined. The cumulated data at district level is drawn from the INKAR database of the Federal Institute for Research on Building, Urban Affairs and Spatial Development on living conditions in Germany and from the guide of the German Association for Palliative Medicine. By means of logistic regression, factors influencing the establishment of day care services will also be identified.</p><p><strong>Results: </strong>The analysis included 401 districts and cities in Germany. The number of inhabitants, settlement density, and the average age of inhabitants are the strongest predictors of the number of palliative care services. In metropolitan regions, both outpatient palliative care services and palliative care units tend to be more frequently available, while the number of outpatient hospice services and inpatient hospices increases in districts with a higher number of inhabitants regardless of settlement density. The regression model was unable to demonstrate a significant influence on the emergence of semi-inpatient care facilities, neither for the population indicators nor for the existing care structures.</p><p><strong>Discussion: </strong>Regional population structures can only partially explain the geographically uneven distribution of hospice and palliative care services in districts and cities in Germany. Despite an increase in hospice and palliative care services, fewer hospice and palliative care structures are available in low population density regions that tend to have a higher share of older inhabitants.</p><p><strong>Conclusion: </strong>Future health care planning should give more consideration to other population characteristics than to population size alone in order to improve care in regions with higher care needs that are, for example, due to a higher proportion of older residents. Subsequent studies should investigate which population characteristics can best describe the actual care needs.</p>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606835","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":"Health issues of young adults with hearing loss or deafness: A basis for the development of a chatbot.","authors":"Miriam Meng, Hannele Hediger, Alexandre de Spindler, Daniela Händler-Schuster","doi":"10.1016/j.zefq.2024.09.002","DOIUrl":"https://doi.org/10.1016/j.zefq.2024.09.002","url":null,"abstract":"<p><strong>Background: </strong>The loss of hearing and thus communication affects the well-being of millions of people worldwide. Digital tools for coping with everyday life are becoming increasingly important and can have a positive impact on health literacy, especially among young adults. This raises the question of which issues such apps should specifically address in order to meet the needs of young adults with hearing loss or deafness.</p><p><strong>Methods: </strong>The aim was to identify the health issues of young adults (aged 18-28 years) with hearing loss or deafness in order to derive specific recommendations for a conversational agent (chatbot). A multiple embedded case study design consisting of chat interviews (n = 8) and an online-based expert survey (n = 14) was used.</p><p><strong>Results: </strong>The central phenomenon focuses on \"The sense of belonging and feeling well in spite of hearing loss\", which is influenced by two main categories: a. the ability to be oneself despite one's vulnerability; b. the desire to be strong despite one's vulnerability. Important health issues include depression, drug use, diet, exercise, isolation due to COVID measures and HIV prophylaxis.</p><p><strong>Conclusion: </strong>Written information must be provided in simple and accessible language supported by images and symbols. Conversation agents developed to support people with hearing impairment should be easy to install and self-explanatory to use.</p>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548142","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":"[Information and support needs of women planning an abortion according to counselling regulations in Germany - A qualitative study].","authors":"Caroline Jeltsch, Birte Berger-Höger","doi":"10.1016/j.zefq.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.zefq.2024.09.001","url":null,"abstract":"<p><strong>Background: </strong>For women seeking legal abortion care, access to information and care options is not transparent in Germany. This can affect health and complicate the decision-making process. In its guideline, the WHO recommends the use of evidence-based information to enable women to make informed decisions. This qualitative study aims to assess preferences and decisional needs of women in Germany.</p><p><strong>Method: </strong>For the needs assessment, a qualitative study based on semi-structured guided interviews was conducted with pregnancy conflict counsellors and women who terminated a pregnancy in the past five years in Germany. These data were supplemented with social media group postings of women with pregnancy conflict experiences. All data were analysed using content-structuring analysis according to Kuckartz.</p><p><strong>Results: </strong>Three women who had undergone an abortion and two pregnancy conflict counsellors were interviewed. In addition, 89 posts from a closed social media group were analysed. Three main categories were identified: women's categorisation in value systems, factors influencing the experience of the care process and information needs of women facing conflict situations in connection with their pregnancy (\"pregnancy conflict\"). Abortion is considered to be stigmatised, so women rarely use existing counselling services. Overall, there is a high need for information and support among those seeking care. Concerns exist, especially with regard to the methods of abortion. The results of the study also indicate a burden caused by fragmented care, which requires a high degree of self-organisation of women.</p><p><strong>Discussion: </strong>The care situation in Germany does not meet the recommendations of the WHO guideline on safe abortion. The results indicate that care close to home and with an abortion procedure that meets women's individual preferences and thus complies with their self-determination has not yet been achieved in Germany.</p><p><strong>Conclusion: </strong>Neutral and evidence-based information could be helpful to enable women to make informed decisions and reduce anxiety. It would also be desirable to increase the opportunities for women to talk about their experiences in a protected environment.</p>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548141","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":"[Children and adolescents with post-COVID-19 condition: A qualitative study on the experiences and satisfaction with treatment in a model project in Bavaria (Post-COVID Kids Bavaria)].","authors":"Susanne Brandstetter, Maja Pawellek, Chiara Rathgeb, Martin Alberer, Cordula Warlitz, Uta Behrends, Michael Kabesch, Stephan Gerling, Christian Apfelbacher","doi":"10.1016/j.zefq.2024.08.008","DOIUrl":"https://doi.org/10.1016/j.zefq.2024.08.008","url":null,"abstract":"<p><strong>Background: </strong>Against the background of inadequate healthcare provision for children and adolescents with post-COVID-19 syndrome (PCS), a model project was initiated in Bavaria (PoCoKiBa: Post-COVID Kids Bavaria), offering specialized diagnostics and care. The aim of this study was to explore and describe the experiences and satisfaction of children and adolescents with PCS, as well as their parents, with the healthcare provided in the model project.</p><p><strong>Methods: </strong>From October to December 2022, seven focus group discussions were conducted via video conference or in person with a total of 32 participants (19 children/adolescents, twelve mothers, one father). These represented 28 children and adolescents affected by PCS (aged 7 to 17 years). The focus group discussions were recorded, transcribed and analysed using qualitative content analysis.</p><p><strong>Results: </strong>Study participants talked about their experiences with the care they received within and beyond the model project, continuity of care, communication between doctors and patients, patient information, and the accompanying study. At the sites of the model project, patients found physicians who spent more time with their patients and took them seriously. Following diagnosis, some patients have benefited from recommendations for therapeutic services or everyday behaviours, while others complained about a lack of treatment suggestions or support for dealing with PCS in their everyday life.</p><p><strong>Discussion: </strong>The experiences of study participants with the medical care of their PCS symptoms within or beyond the model project mirror the well-known challenges of healthcare provision. There is considerable room for improvement in the care of children and adolescents with PCS, particularly in the organization of the complex diagnostic process, which involves several organ systems, and in the provision of targeted information to patients and families affected.</p><p><strong>Conclusion: </strong>The supply of healthcare services, as established and offered in the PoCoKiBa model project, is crucial for families with a child affected by PCS, since it can offer expertise in diagnosis and treatment that is currently not available in routine health care.</p>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548140","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":"Editorial: Practicing what we Teach, Researching what we Practice, Teaching what we Research: The natural triad of an applied science.","authors":"Filipa Ventura, Dora Neves, Rosa Silva","doi":"10.1016/j.zefq.2024.08.004","DOIUrl":"https://doi.org/10.1016/j.zefq.2024.08.004","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146578","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":"Surgical patients’ assessment of healthcare encounters after elective surgery: A descriptive study","authors":"Lisbeth Uhrenfeldt ,&nbsp;Preben Ulrich Pedersen ,&nbsp;Mona Kyndi Pedersen ,&nbsp;Kari Ingstad","doi":"10.1016/j.zefq.2024.08.001","DOIUrl":"10.1016/j.zefq.2024.08.001","url":null,"abstract":"<div><h3>Introduction</h3><div>A Norwegian-Danish research team identified a gap in research regarding how surgical patients felt about their post-operative care needs being met in hospitals. A study was subsequently developed to understand their subjective assessments of how they value the perceived fulfilment of their actual care needs. The study was further informed by international calls to focus on the fundamentals of care practice. Our aim was to determine the extent to which surgical patients receiving elective treatment experience the physical environment, atmosphere and collaboration with staff as supportive of their care and treatment, and what this means for them after treatment. In addition, we aimed to document the extent to which patients experienced being understood and having influence in their care.</div></div><div><h3>Methods</h3><div>A descriptive observation study using a cross-sectional design. The validated <em>Perioperative User Participation Perspectives</em> (POUP) questionnaire was completed on the day of discharge by 194 adult (male and female) patients (mean age: 56 years) who had undergone elective surgery on gynaecological, internal medicine or orthopaedic wards. Agreement between the subjective importance of nursing care for patients and the perceived reality was determined.</div></div><div><h3>Results</h3><div>Agreement regarding the physical environment, a clean bed and clean surroundings was between 91.7 and 96.2%, and agreement with regard to a good relational atmosphere with staff it was 94.2 to 96.7%. In terms of the relational aspects of care, being understood and having influence the agreement was calculated to be 89.4 to 94.4%. However, 42.6% of the patients reported they were involved in drawing up a care plan. For those patients who valued collaborating in their care planning the congruency was 80%.</div></div><div><h3>Conclusion</h3><div>A conducive atmosphere and a keen eye for the patients’ wishes and needs is of particular importance at the time of discharge after elective surgery.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113313","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":"Editorial: Herausforderung Seltene Erkrankungen","authors":"Thomas Kaiser","doi":"10.1016/j.zefq.2024.07.004","DOIUrl":"10.1016/j.zefq.2024.07.004","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358647","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":"EbM und Gesundheitspolitik heute – und morgen?","authors":"Jürgen Windeler","doi":"10.1016/j.zefq.2024.08.003","DOIUrl":"10.1016/j.zefq.2024.08.003","url":null,"abstract":"","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113312","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":"Application of Motivational Interviewing in climate-sensitive health counselling – A workshop report","authors":"Johanna Römer ,&nbsp;Alina Herrmann ,&nbsp;Kira Molkentin ,&nbsp;Beate S. Müller","doi":"10.1016/j.zefq.2024.07.003","DOIUrl":"10.1016/j.zefq.2024.07.003","url":null,"abstract":"<div><h3>Introduction</h3><div>This workshop report explores the application of Motivational Interviewing (MI) in Climate-sensitive Health Counselling (CSHC) within the context of primary health care. As there is a growing interest in the connection of individual health and climate change mitigation, we provide practical guidance on integrating MI techniques in CSHC.</div></div><div><h3>Methods</h3><div>In June 2023, a 2-day workshop on MI was conducted at the Institute of General Medicine, University of Cologne. The workshop, facilitated by a certified MI trainer, combined theoretical content with practical group exercises. In a second workshop the staff of the Institute of General Medicine discussed the application of MI in CSHC.</div></div><div><h3>Results</h3><div>We identified and specified five tools to apply MI in CSHC: A) risk assessment scores, B) relevance assessment scales, C) decision matrices, D) confidence assessment scales, and E) SMART goals. These tools provide practical insights for integrating MI into primary care consultations, offering a time-efficient approach to CSHC.</div></div><div><h3>Discussion</h3><div>Our results present a promising approach for healthcare professionals to incorporate climate-related aspects into health counselling of patients. Feasibility and effects of MI in CSHC are still unclear and require further research.</div></div><div><h3>Conclusion</h3><div>The tools identified provide practical guidance for the application of MI in climate-sensitive health counselling (CSHC) as well as guidance on conducting appropriate studies.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019137","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":"Versorgungsqualität und -sicherheit nach Implantation eines Linksherzunterstützungssystems: eine qualitative Studie zur Patient*innenperspektive auf relevante Versorgungsaspekte","authors":"Michael Levelink ,&nbsp;Anna Levke Brütt","doi":"10.1016/j.zefq.2024.07.001","DOIUrl":"10.1016/j.zefq.2024.07.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Implantation of a left ventricular assist device (LVAD) requires extensive aftercare. It is largely unclear how aftercare should be designed from the patients’ perspective. Implications can be developed based on an examination of the healthcare context. Its main components are mapped on five tiers in the <em>Human Factors of Home Health Care Model</em> by Henriksen, Joseph, and Zayas-Caban (2009). Using this model, the present study explores the patient perspective on the context of healthcare after an LVAD implantation.</div></div><div><h3>Methods</h3><div>We employed a qualitative cross-sectional study, in which LVAD patients participated in semi-structured interviews. The transcribed interviews were analyzed using content analysis. First, relevant meaning units were identified and deductively categorized into the model. Then, categories of care-related aspects were developed inductively within each of the model tiers.</div></div><div><h3>Results</h3><div>We interviewed 18 patients aged 33 to 78 years who had been living with the LVAD between a few weeks and more than 10 years. Twenty-eight categories related to care aspects were developed within the model tiers: 3 categories on patient characteristics (e.<!--> <!-->g., self-management skills), 3 on caregiver characteristics (e.<!--> <!-->g., professionalism), 11 healthcare-related tasks and requirements (e.<!--> <!-->g., wound management), 8 on factors of the physical environment (e.<!--> <!-->g., controllability), medical devices and technologies (e.<!--> <!-->g., carrying systems for external components), and cultural, social and community environment (e.<!--> <!-->g., interaction with peers), as well as 3 on external environmental factors (e.<!--> <!-->g., healthcare infrastructure).</div></div><div><h3>Discussion</h3><div>The present study represents the first investigation focusing on aspects of the healthcare context influencing healthcare quality and safety from the perspective of LVAD patients in Germany. LVAD aftercare covers a broad and complex range of tasks. For this, patients, caregivers and healthcare professionals need specific knowledge, which is lacking in various respects. In the first place, this is compensated by the patients’ own initiative and the personal care provided by the VAD outpatient clinics.</div></div><div><h3>Conclusion</h3><div>Three key recommendations to optimize aftercare from the patient perspective are derived: Patients would benefit from a more flexible and decentralized aftercare concept, to which telemedicine could contribute. LVAD-specific expertise among general healthcare providers is perceived as insufficient by patients and could be strengthened through training and counseling services. The broad scope of tasks and the high level of responsibilities in LVAD aftercare pose challenges for patients and their families, which could be addressed through continuous information and training programs.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976852","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}