Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen最新文献

{"title":"[The potential of telemedicine applications to achieve universal health service coverage using the example of teledermatology].","authors":"Anne Kis, Christina Sorbe, Matthias Augustin, Marina Otten, Jobst Augustin","doi":"10.1016/j.zefq.2024.11.012","DOIUrl":"https://doi.org/10.1016/j.zefq.2024.11.012","url":null,"abstract":"<p><strong>Background: </strong>Telemedicine applications are perceived as having great potential to address regional health service deficits. However, it is unclear to what extent telemedicine can actually contribute to ensuring care in medically underserved regions. The aim of this study is to prospectively identify underserved regions and to investigate the potential of telemedicine applications using teledermatology as an example.</p><p><strong>Methods: </strong>Well-served regions were identified using selected indicators. Points were awarded for each indicator and added up to form two scores. The results were analyzed for spatial autocorrelation (Moran's I), and visualized as a bivariate choropleth map. Data on broadband availability (BMVI) and descriptive statistics (Spearman's Rho, Beeswarm plots) were used to analyze the potential for telemedicine applications. All analyses were carried out at county level.</p><p><strong>Results: </strong>Out of 401 counties, 159 can be classified as vulnerable because of their supply situation. They are mainly located in the north-west part of Germany. Locally, there are infrastructure deficits, i. e. insufficient bandwidth for telemedicine applications. Spearman's Rho shows negative correlations between broadband availability and the scores obtained (ρ: -0.654/-0.229, p < 0.001).</p><p><strong>Conclusions: </strong>The results indicate a consolidation of regional disparities. If the identified regions are inhabited by patients with limited mobility and by socially disadvantaged patients, there is a risk of \"double gaps in care\". In the context of an increasing demand and workload, barriers to telemedicine should be removed, especially in the identified areas, and alternative care models should be implemented.</p>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915883","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":"[Integration of physician assistants into primary care: Acceptance and concerns among general practitioners].","authors":"Alessia Dehnen, Benjamin Borchardt, Philip Schillen, Jürgen In der Schmitten, Christine Kersting, Angela Fuchs, Nino Chikhradze, Dorothea Dehnen","doi":"10.1016/j.zefq.2024.11.008","DOIUrl":"https://doi.org/10.1016/j.zefq.2024.11.008","url":null,"abstract":"<p><strong>Background: </strong>Strategies to counteract the impending and in some places already existing shortage of general practitioners (GPs) are being discussed in Germany. One approach could be to establish interprofessional teams in GP practices by integrating physician assistants (PAs).</p><p><strong>Question: </strong>Can GPs imagine employing a PA in their practice and if so, under what conditions?</p><p><strong>Methods: </strong>In March/April 2023, about 5,000 GPs in North Rhine-Westphalia (NRW), who work in a region with a care level of < 100 %, and about 1,000 GPs from Saxony-Anhalt were asked to take part in an online-based survey. Simultaneously, semi-structured preliminary interviews (one online focus group with four participants, seven individual interviews) were conducted with GPs from NRW.</p><p><strong>Results: </strong>290 GPs participated in the survey (response rate approx. 5 %). Of these, 46.3 % expressed interest in employing a PA in their practice. A majority of 60 % considered assignments such as conducting an open consultation for uncomplicated respiratory tract infections or vaccination consultations to be delegable. As many as 21.9 % would be willing to pay a PA more than 3,500 euro gross monthly salary (based on a full-time position) (8.7 % more than 4,000 euro), while 38.4 % stated that they could not currently afford the cost of employing a PA. The qualitative results underline these findings. One of the respondents' conditions for the employment of a PA was to abolish the quarterly budget limits for GPs.</p><p><strong>Discussion: </strong>Many GPs already express their interest and willingness to both employ PAs and to delegate medical tasks to them - in spite of unanswered questions and, possibly, by necessity. About a fifth of the participants can even imagine paying from their own budget the same gross salary that PAs employed by hospitals are paid. Reliable clarification of feasibility, safety and cost-effectiveness of the use of PAs as well as effects on the quality of treatment in primary care should be a priority for health policy actors.</p><p><strong>Take-home message: </strong>From the GP's point of view, the integration of PAs into GP-centred care in terms of an interprofessional team practice has got potential. At the same time, the question of financial feasibility is still unsettled.</p>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915913","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":"[Delphi-Study: Evaluation of the new job profile \"Chief Digital Officer\" in German hospitals].","authors":"Katrin Spohn, Daniela Aufermann, Philipp Gregor Albert, Narmin Dzhabbarova, Christin Frühling, Antonina Jakob, Timo Neunaber, Felix Hoffmann","doi":"10.1016/j.zefq.2024.10.008","DOIUrl":"https://doi.org/10.1016/j.zefq.2024.10.008","url":null,"abstract":"<p><strong>Introduction: </strong>The main objective of the present study was to analyze the new job profile \"Chief Digital Officer (CDO) in German hospitals\". Here, best practices for the introduction of the job profile should be determined and the need for a CDO position to execute the digital transformation should be evaluated.</p><p><strong>Methods: </strong>A standardized three-stage online Delphi process (expert consensus finding) followed by a roundtable discussion was performed, including 16 experts.</p><p><strong>Results: </strong>The survey showed that most CDOs have been employed as CDOs in a hospital for a maximum of two years. Just over half of these hospitals already have a digitization strategy. Lack of human resources, underfunding of projects, lack of willingness to change among operational staff and management as well as legal hurdles have been reported as the primary problems in digital transformation. In addition to project management skills, CDOs should also have change management expertise and the ability to abstract and simplify complex processes. They should have a high level of knowledge about everyday work and technical content of interdisciplinary health professions. A CDO can be considered as the fourth pillar of responsibility, in addition to the business, medical and nursing director at the management level, and should be responsible in this role for the implementation of digital transformation.</p><p><strong>Discussion: </strong>This study was able to show which activities CDOs are involved in and which coping strategies they use to handle the hurdles.</p>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910987","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":"[Structural benefits on prescription? Exploring potentials and challenges of the pSVV concept in the approval process of digital health applications in Germany].","authors":"Sara Gehder, Moritz Goeldner","doi":"10.1016/j.zefq.2024.11.003","DOIUrl":"https://doi.org/10.1016/j.zefq.2024.11.003","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;With the introduction of the Digital Healthcare Act (DVG) at the end of 2019, digital health applications (DiGA) were included in the statutory health insurance in Germany. DiGA are digital medical products whose primary function is based on digital technologies. In the definition of the approval process, the term \"therapeutic benefit\", which is crucial to the evaluation of pharmaceuticals, was expanded to include the broader concept of \"positive healthcare effect\" (\"pVE\"). In particular, the concept of \"patient-relevant structural and procedural improvements\" (pSVV) has been introduced alongside the well-known \"medical benefit\" to facilitate market access for applications that specifically aim to strengthen the role of the patient in healthcare. Three and a half years after the implementation of DiGA, it has become evident that the concept of pSVV has not yet been adopted in the healthcare system to the extent intended by the legislation. As of July 1&lt;sup&gt;st&lt;/sup&gt; 2024, only one of the 56 listed DiGA uses pSVV as a primary endpoint, with ten others using pSVV as a secondary endpoint.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;A qualitative approach was chosen to explore the new and under-researched topic of DiGA and, in particular, pSVV. The Grounded Theory method was applied in combination with the Gioia method, which is particularly suitable for analyzing innovative subject areas. The inductive approach allows for new concepts to be developed from the data of the study participants, thus supporting flexible and dynamic theory building. Decision-makers from groups including DiGA manufacturers with and without pSVV, manufacturers of digital medical products without DiGA approval, consultancies, and institutions involved in the DiGA approval process were included in the study by conducting semi-structured interviews. The evaluation was conducted through a multi-step analysis leading to the identification of first-order concepts, second-order themes, and aggregated dimensions. The developed data structure was supported by the presentation of relevant quotes as part of the Anhang A.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analysis indicates that refining the benefit definition for the pSVV categories defined in the DiGA guidelines is critical to the successful establishment of the pSVV concept. Additionally, further analysis of potential methods for demonstrating pSVV, suitable measurement tools, and the general inclusion of economic considerations in the benefit analysis appear sensible.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The qualitative analysis demonstrates that refining the pSVV concept and defining appropriate measurement methods are essential for a successful implementation in the German healthcare system. An economic evaluation could bring objectivity to the debate on DiGA costs and contribute to transparency in the approval process. Further research and the involvement of key stakeholders are necessary to clarify the intende","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848014","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":"Measurement of non-invasive rectal and ear temperature in inpatients ≥ 18 years old: A cross-sectional comparative study.","authors":"Lone Jørgensen, Birgitte Boll, Kristina Fischer Rosenkilde, Niels Henrik Bruun, Preben Ulrich Pedersen, Marianne Wetendorff Nørgaard","doi":"10.1016/j.zefq.2024.11.005","DOIUrl":"https://doi.org/10.1016/j.zefq.2024.11.005","url":null,"abstract":"<p><strong>Introduction: </strong>Body temperature measurement is a fundamental requirement for clinical decisions in nursing care, medical diagnosis, and treatment. Therefore, it is pivotal that body temperature measurements are accurate and precise.</p><p><strong>Aims: </strong>To test the diagnostic accuracy of an ear temperature screening procedure among adult hospitalized patients. Further aims were to test the precision of the measurements being carried out by trained registered nurses compared with daily routine practice and to investigate patients' preferences for different measurement methods.</p><p><strong>Methods: </strong>In Aalborg University Hospital, 274 patients were included in a cross-sectional comparative study. Each patient had four temperature measurements and responded to a survey regarding their preference for measurement. Bland-Altman analysis was used to evaluate the difference between ear- and rectal measurements. Sensitivity and specificity were evaluated at different cut-off points.</p><p><strong>Results: </strong>The ear temperature was 0.1 to 0.2 °C lower than rectal temperature. At a cut-off point at 37.5 °C an ear thermometer is accurate and can be used for screening, while higher cut-off points risk missing patients with fever. There was no significant difference in the mean temperature measured by a trained registered nurse or other staff members and patients. Patients preferred ear measurements to rectal measurements.</p><p><strong>Conclusion: </strong>The tested ear thermometer is accurate for screening fever in an adult population during hospital admission. Using ear measurement as a screening tool can contribute to a less resource-demanding care activity and a more convenient alternative to rectal measurements in hospitalised patients.</p>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824691","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":"[Work experience and work environment of midwives in German maternity theatres: Implications for the quality and safety of care].","authors":"Katja Stahl","doi":"10.1016/j.zefq.2024.11.007","DOIUrl":"https://doi.org/10.1016/j.zefq.2024.11.007","url":null,"abstract":"<p><strong>Background: </strong>Nursing research indicates a correlation between work environment and the quality and safety of nursing care. For intrapartum care there is evidence that continuous one-to-one support is associated with better perinatal outcomes and fewer interventions. Little is known about the work environment of midwives working in German maternity theatres.</p><p><strong>Aim: </strong>To analyse the work environment in German maternity theatres from the midwife's perspective.</p><p><strong>Methods: </strong>Online survey among 1,599 midwives using a validated instrument adapted to the specific characteristics of midwifery care.</p><p><strong>Results: </strong>The response rate for the survey was 44%. The number of patients has risen substantially over the last three years without an equivalent increase in staff numbers. Nearly two thirds of the midwives (65%) are responsible for three or more women simultaneously, most of the time; 35% are normally providing care for two women at the same time. There are significant differences between these two groups with regard to nearly all the work environment aspects analysed. The most pronounced differences were found with regard to not being able to accomplish tasks during regular working hours (64% vs. 33%; OR 3.7, 95% CI 3.0 to 4.6; p<0.001), taking legally required breaks (5% vs. 19%; OR 4.2, 95% CI 2.9 to 5.9; p<0.001), frequency of interruptions (96% vs. 88%; OR 3.5, 95% CI 2.3 to 5.4; p<0.001), lack of time for individual care (90% vs. 63%; OR 5.6, 95% CI 4.2 to 7.4; p<0.001), need for improving the personal interaction between midwives and obstetricians (28% vs. 20%; OR 1.6, 95% CI 1.2 to 2.0; p=0.001), lack of support from hospital management (92% vs. 83%; OR 2.2, 95% CI 1.6 to 3.1; p<0.001) and the intention to leave the employer (60% vs. 40%; OR 2.2, 95% CI 1.8 to 2.7; p<0.001).</p><p><strong>Conclusion: </strong>The current work environment of midwives in German maternity theatres does not allow for one-to-one-care during labour. If the necessary increase in midwifery staff is to be effective, it needs to be accompanied by an improved work environment. Further research into the work environment of midwives, likely predictors and associations with perinatal outcomes is urgently needed.</p>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822738","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":"[Patient involvement using the example of the Innovation Fund project \"Integrated, cross-sectoral Psychooncology\" (isPO)].","authors":"Vera Schiewer, Anne Klein, Thilo Dietz, Hildegard Labouvie, Michael Kusch, Hedy Kerek-Bodden, Michael Hallek","doi":"10.1016/j.zefq.2024.11.004","DOIUrl":"https://doi.org/10.1016/j.zefq.2024.11.004","url":null,"abstract":"<p><strong>Background: </strong>In the German health care system, the participation of patients (patient representatives) and the consideration of their perspectives in all phases of research and care are being increasingly demanded. How appropriate patient participation (participation of patient representatives) can be designed is illustrated by the example of the project on the new form of care titled \"Integrated, cross-sectoral psychooncology nVF-isPOI\" and funded by the Innovation Fund at the Federal Joint Committee.</p><p><strong>Method: </strong>The realization of patient (representative) participation is presented by the example of the isPO project, taking into account the short form of the Guidance for Reporting Involvement of Patients and the Public (GRIPP2). This is done on the basis of the involvement and participation of patients (patient representatives) in research, care and care evaluation, as well as quality development (1) through the Haus der Krebs-Selbsthilfe - Bundesverband e. V. (HKSH-BV), as the consortium and contract partner in conceptual project work, (2) through the participation of cancer survivors in the role of isPO oncoguides, and (3) through the involvement of cancer patients in the evaluation of the nVF-isPO.</p><p><strong>Results: </strong>Through the constant involvement of the HKSH-BV as a consortium partner, the patients' perspective informed the development and implementation of the nVF-isPO at an early stage. The nVF-isPO's isPO-Oncoguide concept, developed in collaboration with the HKSH-BV, made it possible to involve cancer survivors as isPO-Oncoguides in health care. In addition, oncological patients, who are regarded as health benefit recipients in the health care evaluation, were involved in the further development of the quality of care of the nVF-isPO.</p><p><strong>Conclusion: </strong>The involvement and consideration of the expertise of patients (patient representatives) in all phases of development, implementation and evaluation have been realized in the isPO project. The isPO project has been recognized by the HKSH-BV as having a high degree of patient participation; and the nVF-isPO and the concept of the isPO-oncoguide are recognized as relevant, acceptable and of high quality from the perspective of both cancer survivors and cancer patients.</p>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822684","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":"[Barriers and facilitators to the use of mental health prevention programs among preschool- and elementary school-aged children].","authors":"Max Weniger, Josephine Kümpfel, Katja Beesdo-Baum, Julia Zink, Cornelia Beate Siegmund, Patricia Theresa Porst, Maria McDonald, Veit Roessner, Susanne Knappe","doi":"10.1016/j.zefq.2024.11.002","DOIUrl":"https://doi.org/10.1016/j.zefq.2024.11.002","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and aims: &lt;/strong&gt;Emotional and behavioural problems occur frequently in childhood and are usually associated with burdens on children, families, and society. Preventive interventions could reduce these burdens, but are rarely used despite their availability and effectiveness. The aim was to identify general, individual, structural, and family-related barriers/facilitators to potential and actual participation in prevention programs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;As part of a prospective implementation study, n = 3,231 project folders were handed out to parents in 28 paediatric practices in Dresden and surrounding area during routine health check-ups (U9-U11) for children aged 5 to 10 years. In addition to screening for mental health problems, a questionnaire was used to identify potential barriers/facilitators to participation in prevention programs. Of n = 2,844 families agreeing to participate in the study n = 2,122 (74.6 %) completed the questionnaire at least partially. Regression analyses were used to test associations between potential barriers/facilitators and actual participation in (a) a pre-intervention interview (PII; in order to check indications with the program provider) or (b) the prevention program among children with a prevention recommendation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the participating families, 1.8 % reported that they had already participated in a prevention program to improve mental health or had received a recommendation for it before. 59.5 % of the families expressed their general interest in such programs, and 95.7 % would participate if their paediatrician recommended it. At the structural level, a lack of knowledge about mental health prevention programs was identified as a barrier to potential participation; as only 9.2 % of the families were aware of such programs before participating in the study. 65.8 % of all the families considered full reimbursement of the participation fees after paying in advance a prerequisite for their potential program participation, and 56.7 % wanted to receive a voucher from their health insurance fund entitling them to participate without prepayment. At the individual level, the parents' attitude towards the usefulness of prevention programs predicted the actual utilisation of the PII after the paediatrician's recommendation. At the structural level, the acceptance of longer travel times (up to 60 minutes) as well as the assumption/reimbursement of the entire course fees were relevant predictors. Furthermore, male sex (of the children) and higher screening scores were also important predictors at the family-related level. After the PII, the only factor associated with actual participation in prevention programs was efficient public transport accessibility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;In order to increase participation in prevention programs, funding to cover participation fees should be secured through health insurance funds. In addition, adverti","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819485","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":"Advances in Shared Decision Making in Brazil: The role of patient autonomy in curriculum reform, health system and clinical care.","authors":"Mirhelen Mendes de Abreu, Melanie Noël Maia, Alexandre Oliveira Telles, Renata Oliveira Maciel Dos Santos, Maria Katia Gomes, Ana Luisa Rocha Mallet, Lúcia Maria Soares de Azevedo","doi":"10.1016/j.zefq.2024.11.006","DOIUrl":"https://doi.org/10.1016/j.zefq.2024.11.006","url":null,"abstract":"<p><p>Clinical practice in Brazil has rapidly transformed. Doctor-patient relationships are the focus of these transformations, either within health policies or in the context of medical training. The Brazilian Curriculum Guidelines have emphasized the doctor-patient relationship as part of medical skills and competences, based on patient-centered care. In this article, we present the political advances in patient-centered care. In addition, we address an overview of the Brazilian status quo of decision support tools. Finally, we share experiences in curriculum reform for the advances of communication skills and the interfaces with narrative medicine and the arts in curricular medical training as a means to advance towards the practice of shared decision making.</p>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819420","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":"Implications of living evidence formats for coverage decisions in the German health care system","authors":"Susann Conrad,&nbsp;Jelka Hartwig,&nbsp;Lydia Jones,&nbsp;Robert C. Lorenz,&nbsp;Matthias Perleth","doi":"10.1016/j.zefq.2024.10.001","DOIUrl":"10.1016/j.zefq.2024.10.001","url":null,"abstract":"<div><div>Decision-makers consult systematic reviews and clinical guidelines to make informed coverage decisions based on the current state of evidence. Outdated recommendations in rapidly evolving areas such as lung cancer treatment, are challenging. The COVID-19 pandemic highlighted the need for good decision-making under uncertainty.</div><div>The descriptive analysis of two samples of evidence bases for evidence synopses to prepare the decision on appropriate comparators shows that living systematic reviews and living clinical guidelines are rare (41/5,463; 0.75<!--> <!-->%) but present, with COVID-19 being the most common indication. We also describe some characteristics and quality issues of these living formats in the German context.</div><div>We note an overlap between living and rapid formats, where updates may not adhere to methodological standards in evidence selection, appraisal and formulation of recommendations, or may lack transparency in their methodological processes. The need for critical appraisal of living formats is highlighted as crucial aspect.</div><div>The production of living systematic reviews and clinical guidelines requires considerable resources and expertise. While there is a need for timeliness in decision making, especially in situations of high uncertainty such as the COVID-19 pandemic, the trade-off between time and quality needs to be balanced. The focus should therefore be on how best to select and process recommendations that are relevant for updating and those that are not.</div><div>Regularly updated systematic reviews and clinical guidelines that adhere to recommended standards are important for decision-making bodies such as the Federal Joint Committee (G-BA). Transparent documentation of the process and methods used increases confidence in decision-making, even when the evidence base is not perfect.</div></div>","PeriodicalId":46628,"journal":{"name":"Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen","volume":"190 ","pages":"Pages 119-124"},"PeriodicalIF":1.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629992","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}