Gesundheitswesen最新文献

{"title":"Länder des Geldes.","authors":"Manfred Wildner","doi":"10.1055/a-2930-6397","DOIUrl":"https://doi.org/10.1055/a-2930-6397","url":null,"abstract":"","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":"88 10","pages":"569-572"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128934","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":"[Telemedicine consultations for post-COVID in a university-based specialist outpatient clinic: focus group results on factors influencing the participation of general practitioners].","authors":"Lia Heyl, Nils Schneider, Kristine Engeleit, Anja Hesse, Christoph Egen, Andrea Boekel, Christoph Korallus, Franziska A Herbst","doi":"10.1055/a-2661-8280","DOIUrl":"10.1055/a-2661-8280","url":null,"abstract":"<p><strong>Introduction: </strong>The care of patients suffering from post-COVID presents general practitioners with a number of challenges in terms of diagnosis and treatment, as well as in the coordination of further care options at various levels (primary care, specialist care and maximum care, e. g., at university hospitals). Cooperation between general practitioners and specialist providers is of particular importance for complex conditions such as post-COVID. In the ViCoReK project, general practitioners and their patients have the option of receiving telemedical advice from an interdisciplinary team comprising staff from a university hospital. The study's was to identify the factors that influence general practitioners' participation in the project.</p><p><strong>Method: </strong>The study, conducted in February and April 2024, utilized two focus groups, namely general practitioners who had and those who had not utilized consultation opportunities within the ViCoReK project. The focus groups were subjected to qualitative content analysis.</p><p><strong>Results: </strong>The results of the 93- and 102-minute focus groups with 13 general practitioners and one physician assistant showed that only a small number of severely affected patients with post-COVID were currently being treated in the respondents' practices. Caring for these patients was time-consuming and put pressure on general practitioners, as the currently available treatment options were experienced as only partially helpful. The personal dedication of general practitioners encouraged participation in the project: The general practitioners expressed a desire to exchange ideas with experts on the subject of post-COVID and were committed to incorporating digital technologies into their practices. The most significant barriers to their participation were challenges related to the digitalization of their practices, inadequate reimbursement options, and lack of time.</p><p><strong>Conclusion: </strong>Despite a willingness to utilise telemedical post-COVID services for networking with specialist outpatient clinics, general practitioners encounter significant barriers to their implementation at the structural level, including technical, financial and temporal constraints. To address these challenges, the development of digital services to support post-COVID care must be guided by principles of accessibility and pragmatism, ensuring their feasibility in general practices, even in the context of limited time.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"600-605"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859736","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":"[Medical Delegation to Physician Assistants (PAs): Organizational Liability as the Primary Risk in Borderline Cases].","authors":"Sebastian Johannes Springer, Patrick Bruns","doi":"10.1055/a-2763-5405","DOIUrl":"10.1055/a-2763-5405","url":null,"abstract":"<p><strong>Background: </strong>The delegation of medical tasks to Physician Assistants (PAs) is legally permissible in Germany but subject to clear limitations. Potential risks arise particularly from organizational deficiencies.</p><p><strong>Method: </strong>Two fictitious clinical case vignettes are used to analyze liability-relevant situations in which delegation decisions resulted in complications.</p><p><strong>Results: </strong>Case 1 illustrates the risks associated with delayed physician oversight following PA-conducted examinations. Case 2 highlights the legal consequences of inadequately regulated invasive procedures. Both examples demonstrate that primary risks arise mainly from missing standard operating procedures (SOPs), unclear supervision structures, and insufficient documentation.</p><p><strong>Conclusion: </strong>Tasks legally reserved to physicians cannot be delegated. For delegable activities, civil and criminal liability requirements apply to physicians, PAs, and, in particular, to healthcare organizations. Ensuring patient safety requires not only individual responsibility but also clearly defined organizational structures.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"615-618"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991319","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":"[Medical resource needs and telemedical potential in after-hours care: An exploratory survey among physicians].","authors":"Johannes Hagelskamp, Kalina Witt, Edgar Steiger, Sebastian Carnarius, Dominik Stillfried","doi":"10.1055/a-2745-8944","DOIUrl":"10.1055/a-2745-8944","url":null,"abstract":"<p><strong>Background: </strong>Our-of-hours care is part of the statutory mandate of the Associations of Statutory Health Insurance Physicians (KVs) and guarantees outpatient care outside of regular consultation hours. Despite coordinated availability via the 116117 telephone number, there are structural and qualitative differences in the implementation of the out-of-hour care, particularly with regard to equipment and human resources. Against the background of increasing expectations of cross-sectoral care and the existing shortage of specialists, the question arises as to which lack of resources in the out-of-hours care leads to avoidable emergency admissions and to what extent telemedical options can help to relieve the burden from a medical perspective.</p><p><strong>Methodology: </strong>A survey was conducted among physicians on out-of-hours care between June 1st, and August 31st 2023 using an anonymized online questionnaire. Participants were recruited by the Regional Statutory Health Insurance Physician Associations which organize out-of-hours care regionally. The questionnaire included demographic and professional items, questions about resource requirements and potential of telemedical services in the out-of-hours care. Data were subjected to descriptive analysis.</p><p><strong>Results: </strong>A total of 4,052 physicians participated in the survey. Resource limitations most frequently associated with potentially avoidable hospital admissions were laboratory diagnostics, sonography and specialist expertise. The greatest perceived potential for telemedicine services lay in specialist consultation for diagnostic and therapeutic, as well as for radiological assessment. Approximately 67% of respondents indicated that home visits by healthcare assistants could be supported with telemedical support.</p><p><strong>Conclusion: </strong>Targeted use of telemedicine and improved access to diagnostic resources can, in the view of the surveyed physicians, strengthen the out-of-hours care and help avoid unnecessary hospital admissions. There is particular potential in specialist consultations, diagnostics, and the support of non-physician home visits-also as a response to the growing shortage of healthcare professionals. However, this requires careful implementation that takes legal, technical, personnel, and financial factors into account.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"585-591"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960518","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":"[Work-organizational Strategies and Measures for Pandemic Management in Inpatient Care: Findings from Scenario Workshops].","authors":"Maria Zink, Niels Jansen, Florence Zurfluh, Dodo Vögler, Marlen Melzer","doi":"10.1055/a-2764-6645","DOIUrl":"10.1055/a-2764-6645","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to develop suitable measures and strategies through a trans- and interdisciplinary discourse to improve pandemic management in (acute) inpatient care facilities (clinics, nursing homes) and thereby reduce the burden on nursing staff.</p><p><strong>Methods: </strong>Two scenario-based workshops were conducted-one focused on acute care and the other on long-term care. Following a collaborative, transdisciplinary approach, the workshops integrated perspectives from nursing practice, research, and relevant institutions. Using foresight methods such as the Futures Wheel and Ideation Canvas, participants co-developed potential solutions for optimizing pandemic preparedness and response. A total of 38 participants took part in the two-day workshops (acute care: 18; long-term care: 20).</p><p><strong>Results: </strong>Participants developed outcomes at both structural and organizational levels, identifying short- and long-term effective strategies and interventions. Key findings addressed areas such as communication, internal organization, interface management, and the involvement of nursing practitioners. Examples include the (political) empowerment and increased participation of nurses, the development of digital and interdisciplinary structures, including skill-grade mix teams. Across both care settings, participants emphasized the need for formal nursing representation and clearly defined professional roles and responsibilities.</p><p><strong>Conclusion: </strong>Effective crisis management in inpatient care settings requires a systemic approach that integrates actions at the micro, meso, and macro levels. Coordinated collaboration between policy, science, and practice is essential to strengthen system resilience and sustainably improve working conditions in healthcare.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"592-599"},"PeriodicalIF":1.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345449","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":"[The impact of motivation on the digital transformation of the German healthcare system - an exploratory derivation].","authors":"Stephanie Krebs, Martina Hasseler","doi":"10.1055/a-2943-1025","DOIUrl":"https://doi.org/10.1055/a-2943-1025","url":null,"abstract":"<p><strong>Introduction: </strong>In international comparison, the German healthcare system lags in digital transformation behind. This has been attributed to insufficient involvement of professional groups, limited availability and use of specific digital tools, inadequate development of digital literacy, as well as various structural factors. The following focuses on the influence of motivation on digital transformation within the German healthcare system.</p><p><strong>Method: </strong>Based on a secondary data analysis of 249 datasets derived from a questionnaire survey assessing the subjective perception of digital competencies among professional groups in the healthcare sector, indicators and determinants of motivation will be identified. As motivation related to the digital transformation of the healthcare system was not explicitly assessed, (partial) assumptions regarding interactions between psychological well-being using the validated WHO-5 Well-Being Index, frequency of use of specific digital tools along a five-point Likert scale, and organizational readiness for change following the Organizational Readiness for Implementing Change (ORIC) scale are employed as proxies for motivation.</p><p><strong>Results: </strong>The frequency of use varies depending on the digital tool. Furthermore, an average psychological well-being was determined. There is a discernible trend that higher organizational readiness for change is associated with higher commitment (mean=3.0, SD=0.9) and higher capacity for change (mean=3.9, SD=1.1). Capacity for change is being rated higher overall than commitment to change. The high standard deviations indicate very heterogeneous assessments, especially in the occupational groups of medical professionals and nursing staff.</p><p><strong>Discussion: </strong>Based on the assumed interactions, it can be inferred that motivation of professional groups regarding digital transformation in the German healthcare system ranges from low to moderate. Hierarchical structures within the healthcare system, legally mandated access and usage regulations, as well as the availability of digital tools and risk assessments associated with their use - particularly in light of age-related, contextual, and socialization-based differences between societal generations - may significantly influence motivation.</p><p><strong>Conclusion: </strong>The identified indicators and determinants of motivation for developing digital competence among healthcare professionals in the German healthcare system need to be deepened and verified.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116667","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":"[Schaffung einer Plattform für eine bundesweite anlassbezogene Datenzusammenführung und ‑analyse in der Onkologie - PLATO 2 - Kurzkonzept].","authors":"Sylke Ruth Zeißig, Stefan Benz, Anne Hennings, Bianca Franke, Johannes Bruns, Wolfgang Hoffmann, Hedy Kerek-Bodden, Franz Kohlhuber, Christoph Kowalski, Gerd Nettekoven, Olaf Ortmann, Steffen Ortmann, Jochen Schmitt, Olaf Schoffer, Thomas Seufferlein, Kerstin Weitmann, Monika Klinkhammer-Schalke","doi":"10.1055/a-2961-5956","DOIUrl":"https://doi.org/10.1055/a-2961-5956","url":null,"abstract":"","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082455","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":"[Regional distribution of depressive disorders among adults in Bavaria: A multivariable analysis of socioeconomic, settlement-structural and environmental factors].","authors":"Laura Anderle, Johannes Brettner, Martin Tauscher, Christoph Geigl, Daniela Blank-Matthes","doi":"10.1055/a-2940-0095","DOIUrl":"https://doi.org/10.1055/a-2940-0095","url":null,"abstract":"<p><strong>Background: </strong>Depressive disorders contribute substantially to the burden of disease in Germany and may be associated with serious health consequences. Regionally, the prevalence of depressive disorders varies across Bavaria. Therefore, this analysis aimed to examine associations between socioeconomic, settlement-structural, and environmental factors and the rate of depressive disorders among adults at the regional level in Bavaria.</p><p><strong>Methods: </strong>This cross-sectional study was based on outpatient billing data on depressive disorders (F32, F33) from the Association of Statutory Health Insurance Physicians of Bavaria (KVB) for statutorily insured patients at the level of all 96 Bavarian districts and independent cities from 2018 to 2023. Predictors included the German Index of Socioeconomic Deprivation (socioeconomic factor), settlement-structural type of district (settlement-structural factor), and the proportion of areas designated for sports, leisure, and recreation area, and green spaces (environmental factor) at the district level. Demographic characteristics were included to control for potential confounders. Associations between these factors and the rate of depressive disorders in 2023 were analyzed using multivariable negative binomial regression in both an overall model and models stratified by sex.</p><p><strong>Results: </strong>In the multivariable analysis, increasing socioeconomic deprivation was associated with higher rates of depressive disorders. The strongest effect was found in quintile 5 (RR=1.17; 95% CI=1.08-1.28) compared to quintile with the lowest deprivation (Q1). Quintiles 1-4 of the environmental area showed lower Rate Ratios for depressive disorders compared to Q5 (highest proportion of area). No significant effects were observed for settlement-structural type of district.</p><p><strong>Conclusion: </strong>Socioeconomic and environmental factors were associated with the rate of depressive disorders documented in outpatient care at the regional level in Bavaria. To reduce regional inequalities, particular attention should be given to socioeconomically deprived districts. Further small-area analyses of other environmental areas as well as their characteristics are necessary for targeted structural preventive measures.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076279","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":"[Analysis of claims data on regional aspects of HIV pre-exposure prophylaxis and specialized treatment in selected regions of the Association of Statutory Health Insurance Physicians from 2019 to 2022].","authors":"Frederik Valbert, Daniel Schmidt, Christian Kollan, Martin Friebe, Konstantinos Voulgaris, Barbara Gunsenheimer-Bartmeyer, Jürgen Wasem, Anja Neumann","doi":"10.1055/a-2949-5865","DOIUrl":"https://doi.org/10.1055/a-2949-5865","url":null,"abstract":"<p><strong>Introduction: </strong>Since September 2019, HIV pre-exposure prophylaxis (PrEP) has been covered by German statutory health insurance for individuals at substantial risk of HIV infection. PrEP is considered as an effective way to prevent new HIV infections. To maximize the success of prevention, it is important that care structures reach and continuously involve as many people at increased risk of HIV infection as possible. The analyses reported here aim to describe PrEP and HIV care for people living in regions of the Brandenburg, Lower Saxony, Mecklenburg-Western Pomerania, and Schleswig-Holstein associations of statutory health insurance physicians (KV) (regions with a less developed HIV specialized care).</p><p><strong>Methods: </strong>In anonymous routine data from a statutory health insurance (BARMER) from 2019 to 2022, individuals using PrEP and individuals living with HIV and receiving specialized HIV care were selected. The KV region of the physicians who prescribed PrEP or provided HIV care was determined for these individuals. A descriptive comparison was carried out between the KV regions of the insured persons and the treating physicians.</p><p><strong>Results: </strong>Significant differences exist among the regions considered in terms of the proportion of people receiving PrEP in their KV region. While PrEP for users in Brandenburg is prescribed exclusively outside Brandenburg, 775 of the prescriptions for PrEP users in Lower Saxony are provided in their own region and only 164 prescriptions are provided in other KV regions. Mecklenburg-Western Pomerania and Schleswig-Holstein are situated between these two regions. A similar pattern emerges in HIV care. In Brandenburg, however, individuals are also provided HIV care in their own KV region. Both analyses demonstrate the importance of care structures, particularly in Berlin and Hamburg, for individuals from neighboring KV regions.</p><p><strong>Conclusion: </strong>It can be observed that healthcare structures in Berlin and Hamburg provide a high proportion of care to PrEP users and people living with HIV from other KV regions. Additionally, the results may suggest that people who are unable to meet the associated mobility requirements may be underserved in regions where a large proportion of the selected persons receives services in other KV regions.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065116","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":"[Ludwig Teleky and Social Medicine during the Interwar Period: A Qualitative Content Analysis of His Innovative Public Health Concepts].","authors":"Angelika Poppele, Fabian Standl, Heribert Stich","doi":"10.1055/a-2951-3603","DOIUrl":"10.1055/a-2951-3603","url":null,"abstract":"<p><strong>Background: </strong>The social hygiene thinking of physician and social medicine specialist Ludwig Teleky (1872-1957) in the context of social medicine in interwar Germany was characterized by a pioneering health science concept. The aim of this literature study was to explore his work systematically and to classify it in terms of medical history.</p><p><strong>Methods: </strong>Based on a systematic literature screening, nine substantial primary texts by Teleky were identified and evaluated using qualitative content analysis. The category system was developed deductively and supplemented with inductive subcategories during the course of analysis. This analysis was carried out by using MAXQDA and by tabular coding.</p><p><strong>Results: </strong>Teleky's writings reveal a multidimensional understanding of health that integrates social, occupational and individual factors. His writings address key elements of social hygiene healthcare: the state's responsibility for welfare, preventive education, occupation-specific health risks, statistical and epidemiological methodology, and normative guiding principles such as solidarity and social justice.</p><p><strong>Conclusions: </strong>As a pioneer of resource-oriented social medicine, Teleky understood health as a collective good and a social responsibility. His groundbreaking concepts can be interpreted as a link between traditional social medicine and modern public health approaches. This concept was far ahead of its time.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881993","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}