Gesundheitswesen最新文献

{"title":"Methods for health economic evaluation of complex interventions in healthcare: current practice, challenges and guidance for future research.","authors":"Nadja Chernyak, Damon Mohebbi, Adrienne Alayli, Johann Behrens, Helene Eckhardt, Cornelia Henschke, Rolf Holle, Nadja Kairies-Schwarz, Sebastian Liersch, Ralph Möhler, Dirk Müller, Anja Neumann, Markus Vomhof, Ingrid Zechmeister-Koss, Juliane Köberlein-Neu, Andrea Icks","doi":"10.1055/a-2569-9765","DOIUrl":"10.1055/a-2569-9765","url":null,"abstract":"<p><p>Health economic methods can support the development and evaluation of new healthcare interventions by generating data on the resources used and relating these to a defined benefit. However, the standard methodology of health economic evaluation that is usually used does not do justice to the high degree of complexity of interventions in healthcare. As a result, there is a lack of decision-relevant information, for example, on the preferences of the target group, on spillover effects on the part of carers, or on implementation costs and the role of different contexts in the implementation of interventions into routine care. The UK Medical Research Council's (MRC) standard-setting framework for complex interventions therefore emphasises the need to incorporate health economic aspects more strongly into all phases of the development and evaluation of complex interventions. To make this possible, the MRC's recommendations for expanding and adapting the standard methodology of health economic evaluation must be concretised and supplemented. Building on already established methodological procedures, recommendations should be developed and proposals for necessary further research formulated.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transferring Knowledge on Patient-Centered Care through the Establishment of an International Network.","authors":"Nadine Lages, Isabelle Scholl, Constanza Quezada, Pola Hahlweg, Stefan Zeh, Angelina Dois, Paulina Bravo, Martin Härter","doi":"10.1055/a-2673-6046","DOIUrl":"10.1055/a-2673-6046","url":null,"abstract":"<p><p>Patient-centered care (PCC) is a key principle of high-quality health care and is becoming increasingly relevant in many countries. In 2006, Chile declared PCC as a fundamental pillar of its health care system. However, PCC implementation in the Chilean healthcare system is still lagging. Some factors contributing to this are 1) the complexity of the concept, 2) the interdependence between healthcare activities and policy regulations, and 3) the need for a cultural change in health politics and care. This paper shares experiences of how we have tried to address some of these challenges by establishing an international network for PCC.As part of a collaborative project between researchers and clinicians based in Chile and Germany, have established the International Network for Patient-Centered Care (PCC NET) that enables knowledge exchange and trainings through different means.A website was developed and launchedas a platform to share knowledge. Furthermore, a series of online seminars on PCC was organized, each conducted by an international expert in the field. In January 2023, several face-to-face were held in Chile attended by 51 participants, comprising health care professionals responsible for implementing PCC in the country, those working for the Ministry of Health or those in primary care in Chile. Workshops were evaluated by assessing the participants&apos; reactions via surveys, and the participants rated the workshops positively. In January 2024, the first Latin American Conference on Patient-Centered Care was implemented in Santiago de Chile. There were four keynotes, two roundtables, five workshops, 31 oral and 19 poster presentations from both research and clinical practice during the two conference days with 196 participants on location.Establishing the PCC NET has facilitated international collaboration, knowledge exchange, and capacity-building for PCC implementation in Chile. Through different communication strategies, such as workshops, seminars and a conference, it was possible to enhance awareness and practical knowledge among healthcare professionals and policymakers. These initiatives represent significant steps toward advancing PCC in Chile, although continued efforts are needed to address remaining challenges and sustain momentum in policy and practice.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Piloting of a surveillance system for acute respiratory diseases: COVID-19 monitoring using Sick Leave Certificates.","authors":"Inga Overesch, Ulrike Junius-Walker, Johanna Schneider, Mareike Wollenweber, Karina Usipbekova, Wiebke Böhne, Ina Holle, Johannes Dreesman, Elke Mertens, Sveja Eberhard","doi":"10.1055/a-2497-6449","DOIUrl":"10.1055/a-2497-6449","url":null,"abstract":"<p><p>With the end of the COVID-19 pandemic and the decreasing significance of official reporting figures, the Lower Saxony State Health Office developed and tested a new indicator: the \"7-day sick leave incidence\". Unlike previous surveillance indicators, it is intended for syndromic surveillance of COVID-19. This article explains the methodological development as well as its benefits, possible applications, and limitations.The indicator is based on the weekly number of sick leaves due to COVID-19 per 100,000 health insurance members entitled to sickness benefits (KGbM) of the AOK Lower Saxony (AOKN). The development of the indicator involved differentiating between initial and follow-up sick leaves, investigating fluctuations in the number of KGbM, analysing the doctors' assignments of ICD Codes U07.1! and U07.2!, and ensuring the timely availability of sick leave data.Initial and follow-up sick leaves were distinguished using a temporal algorithm. In 2022 and 2023, on average, 83.0% (s=5.4%) and 88.9% (s=2.3%) of all initial COVID-19-related sick notes were submitted on time by the end of the respective calendar week. Four out of 5 initial sick notes contained the doctors' ICD code U07.1! (lab-confirmed COVID-19). The number of KGbM proved to be stable (M=1.218.202, s=11.003). When comparing the new \"7-day sick leave incidence\" with the officially used \"7-day incidence rates\" during pandemic, trends were highly similar in 2022 (r=0.89), but diverged significantly in 2023 (r=0.26) due to declining diagnostic activities for the \"7-day incidence rates\".The new 7-day-sick-leave incidence is a good representation of the post-pandemic COVID-19 infection dynamics. The indicator uses routine data and is easy to establish. Limitations relate to possible changes in diagnostic procedures, doctors' coding behaviors and changing demands for sick leave.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Health security, politics and responsibility. Laudatory speech at the award of the Johann Peter Frank Medal 2025 and acceptance speech by the award winner].","authors":"Johannes Donhauser, Sabine Schleiermacher","doi":"10.1055/a-2652-1101","DOIUrl":"10.1055/a-2652-1101","url":null,"abstract":"<p><p>Publication of the laudation and acceptance speeches on the occasion of the award of the Johann Peter Frank Medal by the Federal Association of Physicians in the Public Health Service (BVÖGD) 2025 at its National Congress in Erlangen. This highest award of the BVÖGD is presented annually in memory of Johann Peter Frank, who is considered the founder of the German Public Health Service.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"585-588"},"PeriodicalIF":0.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Between Tuition Fees and Trainee Allowances: Financing of Schools in the German Health Care System].","authors":"Florian Sandeck, Alina Hanke-Szymczak, Janna Ziegler","doi":"10.1055/a-2416-0948","DOIUrl":"10.1055/a-2416-0948","url":null,"abstract":"<p><p>Schools in the health sector play a significant role in the structure of the German education system. In addition to public schools, there are numerous schools, either substitute or supplementary, in the private sector. Many schools are directly attached to a hospital, in contrast to others operating financially independently having cooperation agreements with corresponding facilities for practical training. This article explains the differences between public, substitute and supplementary schools in the health care sector, with particular emphasis on their financing. It also shows the impact of the integration of a school at a hospital.The information regarding the types of schools was generated through expert interviews and by reviewing current laws. A schematic illustration is intended to promote further understanding of school financing in the health care sector, thus contributing to more transparency.The legal framework conditions for the professions of physiotherapy, occupational therapy and speech therapy are elaborated, as well as basic German Law forming the legal basis for the Hospital Financing Act (KHG). The financing of public schools is regulated by law and is carried by the respective state or municipality. This also applies to public schools in the health care sector. Uniform regulations are also applicable to replacement and supplementary schools falling under the KHG. Trainees receive a salary if their schools cooperate with hospitals with which corresponding funding agreements are in place. However, private schools not affiliated with the KHG training fund must rely on alternative sources of funding, ultimately leading to the necessity to charge tuition fees.Different federal/state-specific regulations contributing to the financing of health care education is often unclear and incomprehensible. Due to current laws, tuition-free education cannot be guaranteed in every federal state or at every school. It remains to be seen if or to what extent changes will take place leading to uniform, transparent and comprehensible financing of the training landscape in the health professions in the German education system.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"635-639"},"PeriodicalIF":0.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Gender-Specific and Cross-Gender Reasons for Choosing 'Surgeon' as a Career - A Scoping Review].","authors":"Johanna Hirsch, Vanessa Bäcker, Katrin Schüttpelz-Brauns","doi":"10.1055/a-2390-2343","DOIUrl":"10.1055/a-2390-2343","url":null,"abstract":"<p><p>The availability of highly qualified surgical staff in Germany has been a challenge for years. Despite various initiatives to increase the attractiveness of surgical training programs, there are still problems in attracting motivated and qualified doctors to surgery. In order to develop customized offers for recruiting junior staff, the decision-making factors must be known.To present the gender-specific and cross-gender reasons for choosing a surgical specialist training program.As part of a scoping review, studies were identified using PubMed and a subsequent reverse search to answer the research question. Data extracted from the studies were summarized narratively and categories were defined.The analysis of 12 studies revealed that men and women wanted to become a surgeon based on the characteristics of the surgical specialty, personal factors and factors related to the training position. Gender-specific differences were also identified.Specific measures are proposed to promote the next generation of surgeons.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"619-627"},"PeriodicalIF":0.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The burnout dimension emotional exhaustion and impairment of work participation: A prospective study of 2308 employees subject to social security contributions in Germany].","authors":"Uwe Rose, Friederike Buchallik, Hermann Burr, Norbert Kersten","doi":"10.1055/a-2505-9011","DOIUrl":"10.1055/a-2505-9011","url":null,"abstract":"<p><p>The present study examines the relationship between the burnout dimension emotional exhaustion and subsequent events of work nonparticipation (long-term sickness absence, unemployment, early retirement) and their duration.The data basis was the Study on Mental Health at Work (S-MGA); a follow-up study based on a random sample of n=4511 employees subject to social security contributions aged 31-60 years at baseline and their follow-up after 5 years (n=2460). Burnout symptoms were measured at the time of the baseline survey by means of a questionnaire, while the employment and sickness absence history was recorded at follow-up by means of an interview. Associations between the burnout scale at T1 and subsequent events of inactivity were analysed using a two-part model: i. e., events were predicted using logistic regression, and their duration was predicted using generalised linear regression models (GLM).The burnout scale was associated with the events and duration of long-term sickness absence; among men with an odds ratio [OR]=1.72 (95% CI=1.31; 2.27) and among women with an OR=2.23 (95% CI=1.73; 2.88) per scale point for the occurrence of an event. Among those who experienced long-term sickness absence, the duration (in months) increased by a factor of Exp(β)=1.44 (95% CI=1.23; 1.69) for men and Exp(β)=1.29 (95% CI=1.09; 1.52) for women for each scale point on the burnout scale.From a clinical and health economic point of view, it is a relevant finding that the burnout dimension of emotional exhaustion is associated with events and duration of work nonparticipation.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"628-634"},"PeriodicalIF":0.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12483600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Promoting cooperation between public health services and academic institutions in research: Experiences from the BMG-funded collaborative research project Infektionsschutz.Neu.Gestalten (I.N.Ge)].","authors":"Anja Herrmann, Emily Piontkowski, Gottfried Roller, Stefan Brockmann, Fabian Nill, Kersten Wolfers, Susanne Minkwitz, Jana Hailer, Uwe Stengele, Peter Schäfer, Pierre Braun, Nadja Oster, Stefanie Joos, David Häske, Brigitte Joggerst, Monika A Rieger","doi":"10.1055/a-2637-3372","DOIUrl":"10.1055/a-2637-3372","url":null,"abstract":"<p><p>The 2018 mission statement of the ÖGD emphasises the importance of scientific research and cooperation with scientific institutions. In 2020, the Federal Ministry of Health (BMG) took up this aspect in a call for proposals to strengthen cooperation between the ÖGD and public health research. In the context of this call, the research network 'Infektionsschutz.Neu.Gestalten (I.N.Ge)' was established with four health authorities and one university (funding period: 09/2021-08/2024). The aim was to improve the evidence-based work of the ÖGD in the field of health and infection protection. Digitalisation, quality assurance, risk communication and special groups were examined using the example of infection control in the COVID-19 pandemic. A participatory, transformative approach with real-world laboratories and experiments was used. Lessons for successful cooperation between public health and university institutions were drawn from the intensive collaboration. Important were appropriate frameworks, targeted resource planning and clear role definitions. Issues were identified that could make future collaboration more effective and sustainable. The resulting recommendations for action are intended, among other things, to support the conception of joint research projects. I.N.Ge showed that improved framework conditions were necessary for increased cooperation. Funding projects should allow for flexible cooperation models that adapt to the specific resources and competencies of the partners. Forward-looking resource planning was determined to be essential - including job calculations, substitution arrangements and additional capacity for induction or methodological adaptation. Clear roles and responsibilities should be defined at the tendering stage to create transparency and optimise implementation. I.N.Ge emphasized the need to promote cooperation between the ÖGD and academic institutions in order to further develop and strengthen the public health service. I.N.Ge emphasises that cooperation between the ÖGD and academic institutions must be encouraged in order to further develop and strengthen the ÖGD.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"589-594"},"PeriodicalIF":0.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12483603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Waiting times for a second opinion appointment for tonsillectomy/tonsillotomy - a study of simulated patients].","authors":"Barbara Prediger, Louis Traxel, Nadja Könsgen, Niklas Schäfer, Dawid Pieper","doi":"10.1055/a-2495-8494","DOIUrl":"10.1055/a-2495-8494","url":null,"abstract":"<p><p>  Since December 2018, statutory health insured people with indication for tonsillectomy/tonsillotomy have the right to obtain a second opinion (SO) according to the SO directive. It is a legal requirement that the physician providing the indication has to inform the patient about his/her right to obtain an SO. This has to be done usually at least 10 days before the procedure, but in any case in time for the patient to make a well-considered decision about seeking an SO. The aim was to assess waiting times for appointments with physicians to obtain an SO.  In our study of simulated patients, all practices with physicians of the Associations of Statutory Health Insurance Physicians of North Rhine and Westphalia-Lippe providing SO (n=53 medical practices) were contacted via phone up to three times between January and February 2022. Using a standardized and piloted protocol, it was stated that there was an indication for a tonsillectomy/tonsillotomy and that the patient wanted to make an appointment for an SO. It was assessed how long the waiting time for an appointment would be, as well as whether it would be possible to obtain the appointment via video consultation and whether any further questions or details were provided during this telephone call (e. g. reference to documents to be brought along).  Overall, 94.4% (50/53) of the medical practices could be reached. A great majority of them (92% (46/50)) offered an appointment in contrast to three medical practices that offered open consultation hours. The remaining practice offered both ways to obtain an SO. On average, a waiting time of 8.1 (Standard deviation 5.4) working days was needed for an appointment in the morning and 10.1 (standard deviation 5.9) for an appointment in the afternoon. The availability of the medical practices was high. In 31% of cases, it took longer than 10 days to obtain the SO. Nevertheless, the overall waiting times were short.  In principle, patients should be provided with a timely appointment for an SO, which is possible within the Associations of Statutory Health Insurance Physicians of North Rhine and Westphalia-Lippe. The SO is very rarely offered via video consultation. However, this could possibly increase rural care.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"613-618"},"PeriodicalIF":0.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Access to and Transitions within the Medical Care Process of Persons with Down Syndrome and Dementia: A Qualitative Analysis].","authors":"Anke Walendzik, Milena Weitzel, Godwin D Giebel, Pascal Raszke, Jürgen Wasem, Johannes Levin, Olivia Wagemann, Elisabeth Wlasich, Georg Nübling, Johannes Pantel, Valentina A Tesky, Arthur Schall, Theresa Hüer","doi":"10.1055/a-2486-6360","DOIUrl":"10.1055/a-2486-6360","url":null,"abstract":"<p><p>Compared to the general population, individuals with Down syndrome carry a much higher genetic risk of developing early onset Alzheimer's dementia. This leads to unique challenges and the need for a targeted patient journey.In a qualitative interview study with medical professionals, patient organisations and formal and informal care persons, we assessed barriers within the medical care process of this patient group as well as current approaches to overcome these problems. The study is one module of a multi-method project founded by the Innovation Fund of the German Joint Commission. The results presented here focus on access to and transitions within the medical care process. 14 guided interviews were conducted by a team of moderators by video conference, recorded and transcribed. The analysis of the results was carried out as a qualitative content analysis based on the methods of Mayring.Given the varying degree of premorbid intellectual disability, difficulties recognizing dementia symptoms were reported leading to delays in initiating the diagnostic process. Limited knowledge of the special disease risk and symptom manifestation in routine medical care as well as the lack of specialized medical institutions were identified as additional hurdles. Insufficient dissemination of information about existing specialised institutions to regular physicians and caregivers was criticized. All stakeholder groups drew attention to limitations in access to occupational and speech therapy because of the inadequate number of specialized therapists. Improvements suggested by the interview partners focussed on topics such as the implementation of guidance of the patient journey to and within the medical care process by one institution, easily accessible information for patients and caregivers as well as optimised training for physicians in routine care.Barriers such as insufficient availability of specialised service providers and information deficits about the specific disease risks and symptoms of the population have also been identified in international literatur; in addition, management and coordination deficits in the fragmented German health care system represent well known additional barriers. Approaches to improve the situation can be seen, on the one hand, in improved information and training offers for caregivers and service providers, and, on the other hand, in the expansion of the range of specialized service providers, in particular the Medical Centres for Adults with Disabilities. Informed by these study results and the results of other project modules, health policy recommendations for the improvement of the patient journey of patients with Down syndrome and dementia will be developed in the last project module.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"604-612"},"PeriodicalIF":0.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12483601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}