Gesundheitswesen最新文献

{"title":"[INVADE: a real-life primary care long-term intervention program for brain health - results from 2013 to 2020].","authors":"Horst Bickel, Bernhard Nimmrichter, Klaus Pürner, Dirk Sander, Hans Förstl","doi":"10.1055/a-2525-2794","DOIUrl":"https://doi.org/10.1055/a-2525-2794","url":null,"abstract":"<p><p>The primary care prevention program INVADE (INtervention project on VAscular brain diseases and Dementia in the district of Ebersberg) is intended to prevent stroke and dementia through systematic detection and evidence-based treatment of modifiable vascular risk factors. The study reports on the results of an eight-year evaluation phase.Longitudinal study with non-randomized control group. AOK-insured patients over the age of 50 from the Bavarian district of Ebersberg were invited to participate in the project. The control group consisted of AOK-insured individuals of the same age-group from the district of Dachau. Primary clinical endpoints (mortality and long-term care dependency) and secondary endpoints (inpatient treatment due to cerebrovascular diseases) were based on the administrative data from the AOK. Analyses were carried out according to the principle \"intention to treat\".The intervention group (n=10,663) included 39.7% of insured persons who had enrolled in the program. Significant advantages were observed in the intervention group compared to the control group (n=13,225). Mortality was reduced by 6%, the incidence of long-term care by 10% and the prevalence of long-term care by 18.6%. There were about 190 fewer deaths and 260 fewer new cases of long-term care dependency than expected over a period of eight years. The prevalence of care dependency decreased by 1,600 years. The frequency of hospital treatment for cerebrovascular diseases, however, did not differ between the groups.Our results suggest that a real-life practice-based prevention program aimed at better control of vascular risk factors can possibly contribute to a reduction of care dependency and an increase in life expectancy.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626466","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":"[Cross-sector Management of Medical Treatment and Integrated Forms of Therapy for Post-COVID-19 Patients with Fatigue and Sensorimotor Instability].","authors":"Thomas Urban, Fritjof Reinhardt, Peter Lohse, Stefan G Spitzer, Heinz Reichmann","doi":"10.1055/a-2520-4654","DOIUrl":"10.1055/a-2520-4654","url":null,"abstract":"<p><p>For the medical treatment of post-COVID-19 syndrome, only a few cross-sector medical treatment networks, such as the Post-COVIDLMU CONCEPT [1], are currently being implemented. However, no causal therapy can be reliably recommended based on evidence-based criteria. A cross-sector, doctor-led treatment management will be inaugurated for post-COVID-19, initially focusing on the syndrome of fatigue/immunometabolic depression (as a target for precision medicine) and sensorimotor instability as a cognitive parameter. The corresponding parameters will be recorded and analyzed in real time and at the same time become an important environmentally stable training object. The use of internet and mobile-based interventions represents an essential component here.Changes in the leading syndromes of fatigue and sensorimotor instability through stress-controlled standardized training therapy, intensified cognitive behavioral therapy and the process design of interdisciplinary therapy management in compliance with the guidelines of the Federal Joint Committee (G-BA) for cross-professional and cross-sector care for post-COVID-19 patients were the overarching goals of an intervention study at the post-COVID-19-Center Lausitz over a 3-year period (Q1-2021-Q2-2024). The results of a stress-controlled intervention study were integrated into the derivation, design and evaluation of a cross-sector management process. The outcome and management of the training therapy were assessed based on the post-COVID-19 key symptoms and motor fatigue parameters. A secondary psychosomatic syndrome that emerged during treatment was examined using cognitive fatigue parameters.With the stress-controlled sensorimotor intervention integrated into the designed management process as well as intensified cognitive behavioral therapy, improvements in post-COVID-19 key symptoms as well as in the parameters of motor and cognitive fatigability were achieved. The timing of the start of the process stages of the overall management had an influence on the outcome of the treatment path. Intensification of cognitive behavioral therapy also had positive effects, resulting in an increasing level of activity and self control in patients.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014073","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":"[Change in the dental profession and the attitude of dental professionals towards dental care centers (ZMVZ)].","authors":"Patricia Gaillard, Rainer Haak, Heide Glaesmer","doi":"10.1055/a-2525-2919","DOIUrl":"https://doi.org/10.1055/a-2525-2919","url":null,"abstract":"<p><p>The number of dental care centers (ZMVZ) in Germany has been increasing rapidly since 2015. This new form of practice is being discussed critically, especially when run by investors. This study analyzes the opinions and attitudes towards ZMVZ of dentists practicing in Germany, focusing on age and gender differences in dentists' attitudes as well as different aspects of working for a ZMVZ.A total of 937 dentists throughout Germany (63% female, aged 23 to 77 years) were asked in an online survey via the LimeSurvey platform conducted in 2021/2022 about their attitudes towards ZMVZ, readiness to work in one of them and whether there was a basic willingness to change their workplace; 575 of these questionnaires were available for analysis.The critical view of ZMVZ, especially management by investors, was shared by most of the respondents. There were differences between the age groups. Younger respondents were more in favor of management by specialist colleagues, while older respondents had a more positive attitude towards investor-run ZMVZ. The oldest respondents also tended to agree with the statement that the ZMVZ would replace the traditional practice. In general, practitioners feared that they would not be able to practice freely. However, one-third of the surveyed dentists who were considering a job change could imagine working in a ZMVZ.This study provides an insight into the attitudes of practicing dentists towards ZMVZ as well as their willingness to work in one. Since the ZMVZ are becoming increasingly important, while at the same time are subject to debate, the present overview of the advantages and disadvantages from the perspective of those working in practice should help in clarifying the issues involved. They also demonstrate that, despite all the criticism, there are positive aspects, and a significant proportion of those surveyed could imagine working in a ZMVZ. Since the ZMVZ have become a relevant part of the dental care system, it is important to identify problems and potential areas for development in order to improve care of dental patients.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626464","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":"[Unmet Needs in Stroke Aftercare - A Survey of Stroke Survivors in Germany].","authors":"Christina Franzisket, Christian Voigt, Michael Brinkmeier, Markus Wagner, Rebecca Pries","doi":"10.1055/a-2525-2857","DOIUrl":"https://doi.org/10.1055/a-2525-2857","url":null,"abstract":"<p><p>Surviving stroke has become more common since implementing stroke units in Germany. Little information is available regarding life after stroke and unmet stroke survivors' needs in Germany. This survey is an attempt to close some information gaps.The German Stroke Foundation developed an unmet needs questionnaire in German based on three validated stroke assessment tools covering different domains of life after stroke. The questionnaire was tested and finalized including stroke survivors' expertise. In May 2021, it was sent to more than 3,000 stroke survivors from the German Stroke Foundation database.A total of 979 completed responses could be included in the analysis (response rate 29%). The majority was male (56%) and the average age at the time of stroke was 56 years. Approximately 70% of the respondents reported at least one unmet need. Unmet needs were primary found in the following areas: further rehabilitation measures, remembering and concentrating, further therapeutic measures, and stiffness in arms, hands and/or legs (spasticity).This survey offers a better overview of stroke survivors' needs in Germany. Additional research is needed as unmet needs are not closely monitored in German stroke aftercare. Knowledge of these is important for individualized patient care and a good quality of life for those affected.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626468","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":"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}