Gesundheitswesen最新文献

{"title":"Implementation of a telemedical urgency assessment procedure in the pediatric emergency room: evaluation results.","authors":"Angelika Beyer, Kilson Moon, Thomas Hirsch, Holger N Lode, Wolfgang Hoffmann, Neeltje van den Berg","doi":"10.1055/a-2325-0194","DOIUrl":"10.1055/a-2325-0194","url":null,"abstract":"<p><strong>Background: </strong>In rural areas in Germany, the number of emergency departments with pediatric expertise decreases. Telemedicine solutions are used sporadically, but they lack certain parameters for assessing a child's health status, such as touch and smell. We tested and evaluated the implementation of a telemedical, cross-hospital urgency assessment in pediatric emergency rooms. The telemedical urgency assessments were carried out via video conferences and were compared to the usual on-site procedure. Primary results of the concordance analysis have been published elsewhere. This work describes the results of the evaluation of the implementation.</p><p><strong>Methods: </strong>The telemedical urgency assessment was carried out in 5 pediatric emergency departments during the years 2015-2019. Various methods were used to evaluate the implementation. The following reports are based on (a) a parent questionnaire with two statements to be evaluated (entire project duration), (b) a survey of the physicians using telemedicine after each case (entire project duration) and (c) detailed process documentation (July 2017 until end of the project).</p><p><strong>Results: </strong>A total of 266 patients under 18 years old, recruited from four hospitals, were included in the study. (a) 210 parents completed the questionnaire. 78% of the parents felt adequately cared for and 70% could imagine telemedicine becoming established as a future supplementary care procedure. (b) The physicians' questionnaires for the telemedicine site were completed in 232 cases (87%). The average satisfaction rating was 1.8 on a 6-point-likert-scale (95% confidence interval: 1.64; 1.95). (c) The most frequent implementation problem concerned the technical implementation of the video conference. The evaluation of the accompanying documentation revealed in particular implementation barriers in the technical area (e. g. limited video and/or audio quality) and in the provision of human resources.</p><p><strong>Conclusion: </strong>Despite implementation barriers, the project showed that telemedical urgency assessment in acute pediatric care is a promising option for supporting care. Most of the participating clinicians needed a high level of support, which in some cases indicated a rather low level of digital competence. Increasing acceptance of telemedicine functionalities requires changes in society as a whole with improved framework conditions.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140917231","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 Care Research & Implementation.","authors":"Wolfgang Hoffmann, Martin Härter","doi":"10.1055/a-2356-2053","DOIUrl":"10.1055/a-2356-2053","url":null,"abstract":"","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989152","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":"Introduction of ICD-11 in Germany: Seizing opportunities together.","authors":"Karl Broich, Johanna Callhoff, Peter Kaskel, Christoph Kowalski, Jürgen Malzahn, Christine Mundlos, Christoph Schöbel","doi":"10.1055/a-2342-4453","DOIUrl":"10.1055/a-2342-4453","url":null,"abstract":"<p><p>With the new ICD-11 developed by the WHO and translated into German for use in Germany by the Federal Institute for Drugs and Medical Devices, the German healthcare system is facing a change that is more than a simple change of a medical coding system. The ICD-11 modernises the coding system, for example, by including new, separate health conditions such as sleep-wake disorders and conditions related to sexual health, thus making the corresponding diseases more visible. The ICD-11 is more precise than the ICD-10: it allows cross-referencing between diagnoses, symptoms, functionality and locations and partially abandons the strict hierarchy of the ICD-10. In addition, a greater number of rare diseases are represented with their own specific code than was previously possible with ICD-10. Finally, the ICD-11 is also significantly more \"modern\" than the ICD-10 (which dates back to pre-digital times) in that it enables new, digitally-supported processes, such as keywords flexibility and sustainability when updating the system as well as actual coding at the point of care. The switch to ICD-11 can be a great opportunity for the German healthcare system that should not be missed. It will benefit health service research, which at best will be able to work with much more detailed and correct data sets. But medical care will also benefit because the ICD-11 reflects current medical knowledge. In addition, certain illnesses will be removed from the psychiatric category, meaning that those affected will no longer be stigmatised by their classification in the ICD. The improved coding of diagnoses will ultimately also support guideline-based treatments. However, the changeover is only the first step. The challenges - also for health service research - include in particular the latency of introduction and uniform use as well as the necessary change in coding habits. For ICD-11 to be a success in Germany, authorities, the medical profession, payers and patients must work together on strategies to ensure not only a rapid but also a comprehensive implementation that maximises the potential of ICD-11.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307132","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":"Dementia-Sensitive Environmental Design of Living Units in German Nursing Homes: First Results of the German Environmental Audit Tool (G-EAT).","authors":"Anne Fahsold, Kathrin Schmüdderich, Hilde Verbeek, Rebecca Palm, Bernhard Holle","doi":"10.1055/a-2326-6612","DOIUrl":"10.1055/a-2326-6612","url":null,"abstract":"<p><strong>Background: </strong>The built environment is a key component of dementia-specific care. Little is known about the characteristics of dementia-sensitive environmental elements in living units of nursing homes in Germany. The German Environmental Audit Tool (G-EAT) is a systematic assessment tool for describing these elements in detail.</p><p><strong>Aim of the study: </strong>To describe the extent of dementia-sensitive design principles and environmental elements in a regionally limited sample of living units in Germany.</p><p><strong>Methods: </strong>The built environment was assessed using G-EAT and analysed quantitatively and descriptively. Definitions of living units were developed based on site visits and analysed using qualitative content analysis.</p><p><strong>Results: </strong>The 42 participating living units were heterogeneous in terms of space and composition. Dementia-sensitive design principles varied greatly in their implementation in the built environment; on average, 87.7% of the environmental elements were oriented towards a familiar environment. In contrast, visual accessibility was much less frequently enabled by the built environment (mean 37.3%).</p><p><strong>Conclusions: </strong>The characteristics of various dementia-sensitive environmental elements need to be further investigated against the background of the nursing home care concept and the homogeneity of the resident group to enable the initiation of tailored environmental adaptation that can be implemented by interdisciplinary teams in nursing homes. This also requires a follow-up study with a larger sample of living units to identify the factors that promote and inhibit the development of a dementia-sensitive environment.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856795","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":"Spatial and Socioeconomic Patterns of Mental Health and Healthcare Utilization in Cologne, Germany.","authors":"Adriana Poppe, Lena Ansmann, Ingo Meyer, Timo-Kolja Pförtner","doi":"10.1055/a-2326-6768","DOIUrl":"10.1055/a-2326-6768","url":null,"abstract":"<p><strong>Background: </strong>Children and adolescents are significantly tied to their family's socioeconomic position and living environment. Neighbourhood and the living environment have been identified as potential risk factors for mental disorders in this age group.</p><p><strong>Aim of the study: </strong>The aim of the study was to investigate the distribution of mental and behavioural disorders (prevalence) and the provision of mental health services for children and adolescents aged 0-19 years in the city of Cologne. In particular, the study aimed to examine the association of these factors with area deprivation and the availability of mental health services covered by statutory health insurance. Finally, possible spatial variations in these aspects were analysed.</p><p><strong>Method: </strong>Claims data of children and adolescents aged 0 to 19 years included in four statutory health insurance of the year 2021 were analysed. A deprivation index using data on the level of the ZIP code area was calculated. Analyses were carried out descriptively, using ordinary least squares (OLS) and geographically weighted regression (GWR).</p><p><strong>Results: </strong>The prevalence of mental and behavioural disorders in children and adolescents varied across ZIP code areas, with higher rates in the northern, southern, and eastern parts of the city. The results indicated that the use of services by male children and adolescents with a prevalent diagnosis of mental and behavioural disorders was higher in areas with a higher density of healthcare providers. However, prevalence was on the whole lower in areas with a higher density of healthcare providers. In addition, the density of health care providers was higher in the city centre with comparatively lower deprivation.</p><p><strong>Conclusion: </strong>These results indicate inadequate access to care for children and young people outside the city centre. However, due to the heterogeneity of the population in these areas, this study provides only preliminary insights. Data with a finer geographic resolution are needed for further research in order to analyse the association further.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005545","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":"Navigating the Future of Organisational Health Services Research in Germany and beyond: a Position Paper.","authors":"Lena Ansmann, Stefan Nöst, Mirjam Körner, Carolin Auschra, Roland Bal, Marina Böddeker, Ingo Bode, Jeffrey Braithwaite, Clara Breidenbach, Marie Coors, Ibrahim Demirer, Mark Exworthy, Lorenz Harst, Christian Heuser, Julia Hoffmann, Juliane Köberlein-Neu, Karl Krajic, Gregory Maniatopoulos, Russell Mannion, Ralph Möhler, Holger Pfaff, Monika A Rieger, Esther Rind, M A Helge Schnack, M A Anke Wagner, Matthias Weigl, Michel Wensing, Siri Wiig, Eva Wild, Hendrik Wilhelm, Markus Wirtz, Katja Götz","doi":"10.1055/a-2308-7384","DOIUrl":"10.1055/a-2308-7384","url":null,"abstract":"<p><strong>Background: </strong>Recent analyses have shown that in health services research in Germany, healthcare organisations are often considered primarily as a study setting, without fully taking their complex organisational nature into account, neither theoretically nor methodologically. Therefore, an initiative was launched to analyse the state of Organisational Health Services Research (OHSR) in Germany and to develop a strategic framework and road map to guide future efforts in the field. This paper summarizes positions that have been jointly developed by consulting experts from the interdisciplinary and international scientific community.</p><p><strong>Methods: </strong>In July 2023, a scoping workshop over the course of three days was held with 32 (inter)national experts from different research fields centred around OHSR topics using interactive workshop methods. Participants discussed their perspectives on OHSR, analysed current challenges in OHSR in Germany and developed key positions for the field's development.</p><p><strong>Results: </strong>The seven agreed-upon key positions addressed conceptual and strategic aspects. There was consensus that the field required the development of a research agenda that can guide future efforts. On a conceptual level, the need to address challenges in terms of interdisciplinarity, terminology, organisation(s) as research subjects, international comparative research and utilisation of organisational theory was recognized. On a strategic level, requirements with regard to teaching, promotion of interdisciplinary and international collaboration, suitable funding opportunities and participatory research were identified.</p><p><strong>Conclusions: </strong>This position paper seeks to serve as a framework to support further development of OHSR in Germany and as a guide for researchers and funding organisations on how to move OHSR forward. Some of the challenges discussed for German OHSR are equally present in other countries. Thus, this position paper can be used to initiate fruitful discussions in other countries.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749272","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":"Correction: Navigating the Future of Organisational Health Services Research in Germany and beyond: a Position Paper.","authors":"Lena Ansmann, Stefan Nöst, Mirjam Körner, Carolin Auschra, Roland Bal, Marina Böddeker, Ingo Bode, Jeffrey Braithwaite, Clara Breidenbach, Marie Coors, Ibrahim Demirer, Mark Exworthy, Lorenz Harst, Christian Heuser, Julia Hoffmann, Juliane Köberlein-Neu, Karl Krajic, Gregory Maniatopoulos, Russell Mannion, Ralph Möhler, Holger Pfaff, Monika A Rieger, Esther Rind, M A Helge Schnack, M A Anke Wagner, Matthias Weigl, Michel Wensing, Siri Wiig, Eva Wild, Hendrik Wilhelm, Markus Wirtz, Katja Götz","doi":"10.1055/a-2379-0611","DOIUrl":"10.1055/a-2379-0611","url":null,"abstract":"","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009701","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":"Shifting from Theoretical Best Evidence to Practical Best Evidence: an Approach to Overcome Structural Conservatism of Evidence-Based Medicine and Health Policy.","authors":"Holger Pfaff, Jochen Schmitt","doi":"10.1055/a-2350-6435","DOIUrl":"10.1055/a-2350-6435","url":null,"abstract":"<p><p>There is disparity in the healthcare sector between the extent of innovation in medical products (e. g., drugs) and healthcare structures. The reason is not a lack of ideas, concepts, or (quasi-) experimental studies on structural innovations. Instead, we argue that the slow implementation of structural innovations has created this disparity partly because evidence-based medicine (EBM) instruments are well suited to evaluate product innovations but less suited to evaluate structural innovations. This article argues that the unintentional interplay between EBM, which has changed significantly over time to become primarily theoretical, on the one hand, and caution and inertia in health policy, on the other, has resulted in structural conservatism. Structural conservatism is present when healthcare structures persistently and essentially resist innovation. We interpret this phenomenon as an unintended consequence of deliberate EBM action. Therefore, we propose a new assessment framework to respond to structural innovations in healthcare, centered on the differentiation between the theoretical best (possible) evidence, the practical best (possible) evidence, and the best available evidence.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989153","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":"[Professional Health Literacy of General Practitioners - Results of the HLS-PROF].","authors":"Doris Schaeffer, Lennert Griese, Alexander Haarmann","doi":"10.1055/a-2350-6377","DOIUrl":"https://doi.org/10.1055/a-2350-6377","url":null,"abstract":"<p><strong>Aim: </strong>To date, there are only a few studies analyzing health professionals' health literacy (HL). Mostly, the focus has been on personal rather than professional HL. To bridge this gap, a new concept and an associated survey instrument have been developed in a three-country consortium. The aim of this article was to examine the professional HL of general practitioners (GPs) in Germany.</p><p><strong>Method: </strong>The survey instrument used consists of 34 items and assesses subjective difficulties in four dimensions to be addressed in promoting patients' HL: \"information and knowledge management\", \"conveying information and knowledge\", \"patient-centred communication\", \"professional digital HL\". A total of 297 GPs and internists working in general practice were surveyed online over the summer of 2022. The professional HL (score from 0 to 100) was analyzed descriptively and examined in relation to gender, selected job-related, and organizational characteristics, using multiple linear regression.</p><p><strong>Results: </strong>Depending on the four areas, GPs achieved approximately half to almost three-quarters of the highest possible score. The dimension \"patient-centred communication\" was perceived as the easiest, followed by \"information and knowledge management\", and \"conveying information and knowledge\". The most challenging dimension was \"professional digital HL\". According to the multivariate analysis, professional HL shows a relation to gender, organizational framework and training conditions, job duration, and coping with the diversity of digital information. The strength of correlation varies by area and is rather weak in some instances.</p><p><strong>Conclusions: </strong>The results demonstrate the importance of promoting professional HL of GPs and provide numerous indications of where to start. They also indicate that the regression models should be extended by additional determinants, since the included variables can explain only a small amount of variance.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082142","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":"[Development Of Long-Term Care Dependency And Utilisation Of Long-Term Care Services From 2017 To 2022 In Germany, Saxony-Anhalt: Analysis Of Health Insurance Data].","authors":"Stephanie Heinrich, Steffen Fleischer, Gabriele Meyer","doi":"10.1055/a-2366-9419","DOIUrl":"https://doi.org/10.1055/a-2366-9419","url":null,"abstract":"<p><strong>Background: </strong>Saxony-Anhalt has the highest old-age dependency ratio among the German federal states. The proportion of long-term care-dependent people can be expected to increase in the future, given the aging of the population. The SARS-CoV-2 pandemic has influenced nursing care, reduced the utilisation of services and led to changes in care arrangements. The aim of this study was to analyse the development of long-term care-dependency in Saxony-Anhalt, Germany, taking into account the legal changes, the pandemic and the development after the lifting of the contact ban.</p><p><strong>Method: </strong>The analysis uses aggregated and anonymised health claims data from people insured with AOK Saxony-Anhalt from 2017 to 2022 in need of long-term care. Changes over time in the use of various care services were analysed.</p><p><strong>Results: </strong>In 2017, 64,591 people insured in the statutory health insurance AOK Saxony-Anhalt (AOK ST) were in need of long-term care. The prevalence increased continuously throughout the observation years. For the lowest level of care (minor impairment of independence), the most significant and strongest increase was recorded in the first years after its introduction from 2017-2019. The majority of people in need of long-term care (41-44%) were in the category of care level 2 (considerable impairment of independence). Overall, the proportion of cash benefits has risen steadily since 2017, from 40.5% to 50.3% in 2022. At the same time, the proportion of long-term care in nursing homes decreased at all care levels. The trend toward less nursing home care has become stronger since 2017 and particularly since the onset of the SARS-CoV-2 pandemic in 2020.</p><p><strong>Conclusion: </strong>Since the introduction of the new definition of the need for long-term care in Germany, the analysis shows an increase in the number of people in need of long-term care, with those with considerable impairment of independence making up the largest proportion. There has been a significant increase in the number of people receiving cash benefits and a decline in nursing home care. Compared to the nationwide data of health claims, data show a greater use of nursing services in home-based arrangements. The analysis during the COVID-19 pandemic shows a trend towards home care, but no fundamental change. Special situations such as contact restrictions may have influenced the use of care services. Future research should examine the design of home care arrangements and the needs of those affected in greater detail.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074170","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}