Gesundheitswesen最新文献

{"title":"Doppelte Facharztschiene: Die Versorgungsbeiträge des vertragsärztlichen und des krankenhausgebundenen Strangs zu ausgewählten Parametern der fachärztlichen Versorgung.","authors":"Ursula Hahn, Joerg Koch, Ulrich Kellner","doi":"10.1055/a-2557-5437","DOIUrl":"https://doi.org/10.1055/a-2557-5437","url":null,"abstract":"","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617298","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":"[Characteristics of the \"Behavioural and cultural insights (BCI)\" approach in Public Health - a consensus paper of the network \"Behavioural Science Connect\"].","authors":"Julika Loss, Cornelia Betsch, Christin Ellermann, Benjamin Ewert, Eva Grill, Mirjam Annina Jenny, Susanne Jordan, Thomas Kubiak, Jutta Mata, Felix G Rebitschek, Eva Annette Rehfuess, Falko Sniehotta","doi":"10.1055/a-2528-8276","DOIUrl":"10.1055/a-2528-8276","url":null,"abstract":"<p><p>Public health interventions are often intended to make it easier for people to adopt health-related behaviours, e. g., by changing the social environment and material living conditions. With the concept of \"Behavioral and Cultural Insights\" (BCI), the World Health Organization (WHO) has established an approach that aims at a better understanding of health-related behaviours, in order to be able to develop corresponding public health interventions in a more targeted manner. The focus is on the empirical identification of individuals as well as cultural, social and environmental barriers to and facilitators of health behaviour.The BCI approach can be used to plan preventive measures in a more evidence-based and needs-oriented manner. To this end, the current article outlines some basic features of BCI which should be taken into account for integrating the concept into a contemporary understanding of \"new public health\". This includes social and individual factors influencing health as well as social inequalities in health.First, the article distinguishes the BCI concept from the approach of behavioural economics (e. g., nudging). To illustrate its potential for population health and health equity, the article then explains that BCI-based measures that (a) focus on both behaviour and environment, (b) aim at health equity, (c) are developed and implemented in a participatory manner, and (d) follow the logic of the well-established Public Health Action Cycle. For BCI, it is crucial to systematically identify and analyse the factors influencing human behaviour in everyday life. BCI-based interventions must also consider the characteristics of complex interventions and be tailored to local conditions and the cultural diversity of specific population groups.The BCI approach has many similarities with other approaches of quality-assured and needs-oriented prevention measures. The focus on a systematic identification of barriers and facilitators offers an important added value in the planning of public health measures. Research into BCI and their use in prevention should be expanded in Germany.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068845","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":"[A qualitative interview study to streamline integration of patient participation in research].","authors":"Anna-Francesca Jessica Di Meo, Feyza Gökce, Lisa Pfeiffer, Clara Teusen, Jan Gehrmann, Caroline Jung-Sievers, Antonius Schneider, Jochen Gensichen, Karolina De Valerio, Gabriele Pitschel-Walz","doi":"10.1055/a-2445-5498","DOIUrl":"10.1055/a-2445-5498","url":null,"abstract":"<p><p>Integration of the patient perspective in research projects is essential to strengthen the relevance and quality of research results. In order to rectify the lack of structured procedures for patient integration in German research projects, this study summarises the currently available knowledge in a simplified practice-oriented checklist for researchers.Through 13 semi-structured qualitative interviews conducted with members of a research group in December 2022, this study explored patient participation possibilities and barriers. The inductive-deductive coding and analysis in the software MAXQDA led to a standardized checklist development for seamless patient integration across similar contexts and research fields.Of 13 experts, nine researchers (69%) incorporated patient insights into their work, covering topics, concepts, focus prioritization, and study materials. Four researchers (31%) faced barriers due to the absence of guidelines. More than 90% recognized potential for patient integration in topic prioritization, concept formation, evaluation, result review, and interpretation. Researchers highlighted barriers such as patient's limited scientific basis, restricted access, and knowledge gaps in patient interaction. Among the respondents, 56% pointed to training needs and 44% to structural barriers such as workload, unclear funding, guidelines and stakeholder involvement. The resulting checklist includes six sub-categories, each with an average of four sub-items, which operationalise the integration process.Current research lacks effective patient inclusion processes due to inadequate access, tools, and knowledge. While immediate training can address some challenges, longer-term changes in policy and funding are necessary. With the new checklist, researchers receive a support tool to integrate the patient perspective in their projects in a systematic manner.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477669","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":"Travel costs and ecologic imprint associated with different fractionation schedules in prostate cancer radiotherapy.","authors":"Georg W Wurschi, Maximilian Graf, Steffen Weimann, Matthias Mäurer, Christoph Straube, Daniel Medenwald, Justus Domschikowski, Marc Münter, Klaus Pietschmann","doi":"10.1055/a-2512-9269","DOIUrl":"https://doi.org/10.1055/a-2512-9269","url":null,"abstract":"<p><p>Improving the sustainability and cost-effectiveness of healthcare systems has become increasingly relevant in times of climate change, energy transition, an aging population and skyrocketing social costs. The selection of an adequate fractionation schedule is of fundamental importance in the field of Radiation Oncology. We evaluated three internationally established fractionation schedules for definitive prostate cancer radiation therapy (RT) with respect to their ecological and health-economic impacts.We analyzed the data of 109 patients with prostate cancer, who underwent outpatient radiation therapy at Jena University Hospital in 2022. After determination of travel distances between their homes and the treatment facility, carbon dioxide (CO₂)-emissions and taxi costs were calculated for normofractionated RT (39 fractions, A), moderately hypofractionated RT (20 fractions, B) and ultrahypofractionated RT (5 fractions, C).Travel distances of 1616 km (A), 848 km (B) and 242 km (C) were calculated with corresponding costs ranging from 638 € (C) to 4255 € (A). According to the 2024 German physician's fee schedule, 9,604 € would be invoiced for medical treatment and transportation in (A), with transportation costs accounting for 44% of total treatment costs in normofractionated RT. The travel distance, CO₂-emissions and transportation costs could be reduced by up to 85% by hypofractionation.(Ultra-)hypofractionated radiation therapy for prostate cancer has great potential to lower healthcare costs and reduce environmental pollution. Given that and the non-inferiority of oncological outcome and toxicity, hypofractionation should appear beneficial from patient's and healthcare provider's point of view. Current reimbursement structures seem to be inappropriate regarding increased personnel and technical efforts required for highly precise dose application and might hinder comprehensive establishment of ultrahypofraktionated RT in Germany.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568198","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":"[Primary care physicians' perspectives on the referral of patients with social problems to non-medical services - a cross-sectional survey].","authors":"Sinah Evers, Thomas Kloppe, Ansgar Gerhardus","doi":"10.1055/a-2518-8609","DOIUrl":"10.1055/a-2518-8609","url":null,"abstract":"<p><p>Physicians in primary care practices encounter social problems among their patients on a daily basis. Physicians can refer these patients to social services to improve their health and reduce pressure on the health care system. Open questions remain about how these referral practices are carried out and what areas have potential for improvement.An online survey with 21 closed or open-ended questions was conducted among primary care physicians (general practitioners and paediatricians) in Bremen, Germany. Data from closed questions were analysed for frequency distributions, while responses to open-ended questions were coded and interpreted using qualitative content analysis.Out of 580 primary care physicians in Bremen, 45 (8%) participated in the survey. Most of the respondents considered it important to be able to refer patients to support services outside the medical care system. Physicians referred a median of 10% of patients for whom they identified a need for social support. The most common reasons for not referring patients included a lack of knowledge about available services or the absence of such services, as well as time constraints. A total of 33 physicians (73%) reported feeling highly burdened when unable to refer patients. Furthermore, 34 respondents (76%) anticipated that a central contact point for social issues would greatly improve their job satisfaction. More general practitioners than paediatricians considered support services related to finances, unemployment, and housing to be important, while paediatricians were more open to providing external social support services in their own practices or using a \"Gesundheitskiosk\" (health kiosk).This is the first study to compare general practitioners and paediatricians regarding social issues in patient care. Given the low response rate, the results should be interpreted with caution. Notably, physicians reported that they did not refer most patients with identified social needs and experienced this as a burden. The majority indicated that, if available, they would use various forms of collaboration with social services.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014070","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":"[Challenges and good practices of regional hospice and palliative care networks in Germany: Results of an online survey].","authors":"Sven Schwabe, Hanna A A Röwer, Franziska A Herbst","doi":"10.1055/a-2452-9723","DOIUrl":"10.1055/a-2452-9723","url":null,"abstract":"<p><p>Regional hospice and palliative care networks (RHPCN) can help improve collaboration between health care providers in order to provide comprehensive care for seriously ill patients and their families in the last stages of life. In Germany, RHPCNs are eligible for funding by statutory health insurers from 2022 under Section 39 d SGB V. What are the challenges RHCPNs face and what good practices have emerged in their work?As part of the project HOPAN (German Innovation Fund of the Federal Joint Committee [G-BA], grant N° 01VSF22042), an online survey was conducted among RHPCNs in Germany between December 2023 and February 2024. The survey explored challenges and good practices in six areas of network work. Quantitative data was analysed using a frequency analysis with the statistical software SPSS (closed questions). Free text answers were openly coded using MAXQDA 2022.A total response rate of n=408 data sets was achieved, of which n=64 data sets were included in the analysis after plausibility checks and data cleaning. The most significant challenges facing RHPCNs were the lack of awareness of the network among the general public (n=39; 60.9%) and care providers (n=27; 42.2%), varying qualifications and quality standards of network partners (n=31; 48.2%), and acquisition of new network partners (n=27; 42.2%). The most frequently mentioned good practices were appreciative, transparent, and regular communication (n=41; 50.6%), a personal approach to new network partners (n=38; 28.3%), and attractive network activities (n=33; 25.2%).Many RHPCNs are currently encountering challenges in establishing and expanding their network infrastructure. The implementation of effective network moderation and delivery of high-quality network activities can enhance the reach of RHPCNs. Joint training and further education, in addition to the development of regional care practices and standards, require a high level of commitment from the network partners, which is not yet the case in many instances.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523333","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":"(Digital) Mind-Body Intervention to Promote Health and Subjective Well-Being of Residents in Nursing Homes: A Cluster-Randomized Controlled Pilot Study.","authors":"Jule Uhl, Simone Schönfeld, Laura Meyer, Annika Reus, Claudia Neumann, Lena Langer, Maren M Michaelsen, Tobias Esch","doi":"10.1055/a-2517-8263","DOIUrl":"10.1055/a-2517-8263","url":null,"abstract":"<p><p>Nursing care insurance companies in Germany have the legal mandate to develop measures to strengthen the health resources of residents of nursing homes. The present study aimed to examine a mindfulness-informed mind-body intervention (on-site and app) adapted for residents in nursing homes regarding their effect on health-related parameters.A pilot study (DRKS00030409) was carried out with three groups in twelve nursing homes (RCT). There was an on-site intervention in a group (O), an individual app application with technical support (A) and a passive control group (C). The participating residents (n_O=28; n_A=29; n_C=19) were cluster-randomized. Before, after, and three months after the intervention period (December 2022 - January 2023), among other things, subjective well-being (WHO-5, primary outcome) and mindfulness (KIMS-D, including four subscales) were assessed. Differences within and between study groups and participants with different participation intensity were tested. In addition, a sensitivity analysis was carried out with people who did not have severe cognitive impairments at all three survey times.Indications of differences were found in subjective well-being during the intervention period between the study groups of medium size. While a decrease was observed in the control group, there was no change in the intervention groups. When the intensity of participation was taken into account, the difference between the groups became clearer. In addition, the app group showed an increase in mindfulness (subscale <i>Observing</i>) immediately after the intervention compared to the control group.Although further studies with larger samples are needed, the results already indicate that the intervention improves the well-being and mindfulness of the target group. Individual support could explain the higher effectiveness in the app group. The influence of the Covid-19 pandemic and the season (winter) on effectiveness must also be examined.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014075","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":"[Weaning in the out-of-hospital setting: a Scoping Review].","authors":"Corina Schiegl, Irmgard Schroll-Decker","doi":"10.1055/a-2504-0195","DOIUrl":"10.1055/a-2504-0195","url":null,"abstract":"<p><p>In 2021, a transitional form of housing for outpatient weaning was certified based on paragraph 17 of the Bavarian Law on Quality Assurance of Care and Housing. In order to get an overview over the research field, we carried out a scoping review. In particular, we focussed on two research questions: 1. What are the factors that contribute to the quality of life of people receiving artificial respiration in an outpatient setting? 2. Which factors necessitate weaning in an outpatient setting and what are the conditions that facilitate weaning?Seven data bases were searched with defined search terms. After two extractions, 401 matches were found. On the basis of an analysis of these abstracts, the results were systematically categorized. In order to answer the research questions, the topic \"intensive and respiration care\" was chosen for closer analysis; 120 texts were analysed more thoroughly.Results showed that we do not have sufficient data to answer the research questions in a satisfactory manner. The quality of life of ventilated people was found to be heterogenous, but self-determination and empathetic communication between the relevant institutions, on the one hand, and patients, on the other, clearly enhanced it. What was also beneficial was the inclusion of patients in social networks. What was obviously negative was the lack of competent personnel. It was also observed that the weaning potentials in outpatient care were not sufficiently made use of. Intersectoral care concepts are being discussed.The issues of intensive outpatient care as well as weaning and the question of how a self-determined and satisfactory life can be achieved have hardly been evaluated. Moreover, the terms quality of life and self-determination in this setting have hardly been operationalized. Further research is necessary. Nonetheless, self-determination appears to contribute to the life quality of seriously ill patients.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840005","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":"[Medication safety in German hospitals: An analysis of structured quality reports].","authors":"Nadin Kastirke, Beatrice Groß","doi":"10.1055/a-2501-0241","DOIUrl":"10.1055/a-2501-0241","url":null,"abstract":"<p><p>Medication safety represents an increasingly pertinent aspect of quality and risk management in hospitals. However, little is known about the relevance of specific methods in controlling medication safety with respect to medical care processes. The aim of this study, therefore, is to assess the implementation of medication safety measures and the significance of specific hospital characteristics.We analyzed data from 2018, comprising structured quality reports of 1987 sites that were the first to contain information on 13 medication safety tools and measures. Relative implementation rates were assessed both in general and for subgroups. The latter were formed based on site size, presence of specialized departments as well as university hospital affiliation. The relevance of corresponding differences between subgroups was examined using threshold analysis.Across all 13 medication safety measures, implementation rates varied highly (gapless medication safety after hospital release: 71.4%; SOP for good prescription practice: 23.5%). Rates also increased in relation to site size from 31.5% (<50 hospital beds) to 61.5% (>500 hospital beds). This pattern was especially prevalent for medication safety measures pertaining to electronics and IT. There were significant differences between eight measures based on the presence of specialized departments as well as university hospital affiliation. Two measures (medication safety training, description of optimal medication processes) did not vary with the hospital characteristics.Our results highlight the importance of standardized assessments of quality assurance data in hospital settings. The present data analysis enables the identification of those measures that have already been implemented. Implementation seems to be associated with hospital characteristics as well as regulatory guidelines. However, it is noteworthy that medication safety measures are not being implemented across the board. This might be explained by economic, social and technological barriers. These hurdles should be dealt with on a long-term basis and via adequate incentives.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"193-201"},"PeriodicalIF":0.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411259","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":"[Can SARS-CoV-2 Infection Status in Preschool Children be Predicted by Pandemic-related Attitudes and Concerns of their Parents? Data from the Würzburg Daycare Centre Studies (Wü-KiTa-CoV, 2020-2022)].","authors":"Thomas Jans, Maike Krauthausen, Carsten Bauer, Johannes Forster, Geraldine Engels, Franziska Pietsch, Julia Wallstabe, Victoria Rücker, Julia Wendel, Benedikt Weissbrich, Peter Heuschmann, Christoph Härtel, Lars Dölken, Oliver Kurzai, Ildikó Gágyor, Johannes G Liese, Marcel Romanos, Andrea Streng","doi":"10.1055/a-2386-4490","DOIUrl":"10.1055/a-2386-4490","url":null,"abstract":"<p><p>As part of the Würzburg KiTa-CoV study series, SARS-CoV-2 pandemic-related attitudes/concerns of parents of preschool children attending day care centres were surveyed over a 21-month period. We expected associations between these parental attitudes/concerns and their change over the course of the pandemic, on the one hand, and the SARS-CoV-2 infection status of the children, on the other. Parents of children from nine day-care centres who completed a survey on pandemic-related attitudes/concerns in October 2020, July 2021 and July 2022, were included in the analysis. In July 2022, the children's infection status was determined by measuring nucleocapsid protein antibodies (N-AK) and, in the case of N-AK negative, unvaccinated children, the measurement results of spike protein antibodies (S-AK) against SARS-CoV-2 as indicators of previous infection were also taken into account. Changes in parental attitudes/concerns were analysed using trend tests, and their significance in predicting the child's infection status was analysed using multiple binomial regression analyses. Data were available from parents of 159 children (mean age 3.2 years). The overall group of parents showed an increasingly relaxed attitude towards the pandemic over the study period, although the parents' concerns towards a possible infection of their own increased. The infection status of the children could not be predicted from the initial attitudes and concerns of the parents. However, the subgroup of parents with an uninfected child tended to have a higher level of concerns over the course of the pandemic than the parents with an infected child and did not show the same increasing composure towards the pandemic event. The parents' increasing composure is understandable in the context of the reduced virulence of the virus variants prevailing over time, the increasing availability of testing strategies and vaccinations, and the withdrawal of pandemic-related restrictions. In addition, the mildness of most children's infections may have contributed to their parents' sense of security. The seemingly contradictory increase in parental concerns about infection may be related to the strong increase in the incidence due to omicron variant infections in the population since January 2022. It is possible that the higher level of concerns among parents of uninfected children had a protective effect behaviourally.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":"216-226"},"PeriodicalIF":0.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976928","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}