Originalarbeiten / Original Articles. Die Behandlung von Kindern und Jugendlichen mit substanzbezogenen Störungen im deutschen Gesundheitssystem ­ eine Quantitative Studie.

The Treatment of Children and Adolescents with Substance-Related Disorders in the German Health Care System - a Quantitative Study This study evaluates the minimum characteristics of OPS code 9-694 for specific treatment in special settings for substance-related disorders in children and adolescents. The research questions to be answered are the extent to which given minimum characteristics and potentials are assessed as practical, up-to-date, needs-oriented and necessary. The survey was conducted using a nationwide online survey in special wards of child and adolescent psychiatric clinics. Given minimum characteristics reflect everyday clinical practice and are assessed as practical, up-to-date and relevant. Nevertheless, setting- and method-specific potential for further development was identified, most of which has already been implemented in the clinics but has not yet been incorporated into the minimum characteristics. The topic has received little research attention to date. The findings of the original study can provide a basis for the optimization and adaptation of minimum characteristics and treatment offers for children and adolescents with substance-related disorders and lead to the further development of the OPS code. A theory-practice transfer tailored to the target group requires the networking of individual players in the help system as well as the health policy discussion and gradual adaptation of the content of given minimum characteristics and potential for change.

[Quality characteristics and relevance to care of psychodynamic training outpatient clinics:The QVA Project]. / Qualitätsmerkmale und Versorgungsrelevanz psychodynamischer Ausbildungsambulanzen: Das QVA-Projekt.

Introduction: Quality assurance (QA) in outpatient psychotherapy is currently undergoing a process of change. Hitherto, QA has been conducted by means of an expert review procedure (the so-called "Gutachterverfahren"), inter- and supervision as well as further mandatory training. Data-based QA systems have been increasingly discussed in recent years. On behalf of the G-BA, the IQTIG has recently published a draft of a legally binding QA procedure, which has, however, raised substantial concerns and resistance. Design: TheQVA project has two objectives. First, it provides participating training outpatient clinics with a data-driven QA system that enables an automated and risk-adjusted overall evaluation based on relevant patient and referral parameters. Second, the data is used to conduct research on important issues regarding the relevant psychotherapeutic care provided by outpatient clinics. Results: Since the start of data collection in 2022, n = 2058 patients have been recruited so far (March 2023), and a complete baseline diagnostic report has been generated for n = 1112 patients. The cross-sectional analyses of all patients assessed so far show a high burden of depression, interpersonal problems and impaired quality of life with severe impairment of personality functions, pronounced conflict diagnosis and high utilization of inpatient and day hospital treatments. Discussion: This paper describes an easy-to-implement data-based QA system for psychodynamic training outpatient clinics, while at the same time allowing for the examination of healthcare- relevant questions in a large sample. The first experiences show that the system works technically stable and was well-received by the participating outpatient clinics.

[Diagnostic of Parent-Child-Interaction andTheir Relationship: Results from a Multiprofessional and Task Specific Survey]. / Diagnostik der Eltern-Kind-Interaktion und -Beziehung: Ergebnisse einer multiprofessionellen und tätigkeitsspezifischen Umfrage und Vorschläge für eine standardisierte Dokumentation.

The assessment of parent-child interactions and relationships (PCIR) plays an important role for many diagnostic purposes in child and adolescent psychology and psychological health care. While child and adolescent psychology has been intensively researched, the field still faces a lack of knowledge about health care practice. To offer knowledge about practical routine needs and derived needs in these domains, we aimed to obtain information from professionals who routinely assess PCIR.We aimed to gain a basic description of task-specific diagnostic fields, professional staff and their education, their clients, key diagnostic questions, observational settings, guidelines used in assessing PCIR and professionals' personal understanding of PCIR. To gain information on how professionals assess PCIR, we used an online survey containing multiple choice questions and rating scales.We describe differences between task-specific diagnostic fields of inpatient and outpatient settings, consulting and officially appointed surveyors for court decision. Only responses from professionals performing PCIR are analyzed (N = 166). PCIR is regularly used for more than a half of children between 0-12 years of age and for more than a third of adolescents for answering a broad spectrum of diagnostical questions. We describe differences for nearly all facets of PCIR except for the content related domain. Based on these differences between task-specific fields, we give suggestions for standardized documentation of PCIR and how findings from this study can be used for scientific development.

[Adherence to guidelines in the diagnosis and treatment of ADHD in children and adolescents in routine care: A representative survey]. / Leitlinienadhärenz in der Diagnostik und Therapie von ADHS bei Kindern und Jugendlichen in der Routineversorgung ­ eine repräsentative Befragung.

Adherence to guidelines in the diagnosis and treatment of ADHD in children and adolescents in routine care: A representative survey Abstract. Objective: The study evaluated guideline adherence in the current routine care of children and adolescents with Attention Deficit-/Hyperactivity Disorder (ADHD) in various groups of healthcare providers nationwide. Method: N = 275 providers from all relevant groups of a Germany-wide random sample (specialists in pediatric and adolescent medicine, child and adolescent psychiatry and psychotherapy, child and adolescent psychotherapists and all Social Pediatric Centers, outpatient departments of child and adolescent psychiatric clinics and behavioral therapy training institutes) participated in an online interview. Results: The recommendations in the guidelines were implemented on average in 75-100 % of the patients. Exceptions were those of teacher/educator exploration and school interventions. Questionnaires on diagnostics and follow-up or psychotherapeutic interventions were applied comparatively rarely, in about 50 % of the patients. Differences between provider groups and correlations with sociodemographic variables were analyzed at the level of the adherence indices. Conclusions: Overall, the participants reported high guideline adherence. We found a high similarity of the data in different care segments within the care providers. Differences in self-reports of the various care groups stimulate considerations of the roles in the care process with ADHD patients.

[Stakeholders' experiences with flexible and integrative treatment models in German child and adolescent psychiatry according to § 64b SGB V - A qualitative study]. / Erfahrungen der Stakeholder mit den Modellvorhaben nach § 64b SGB V in der Kinder- und Jugendpsychiatrie und -psychotherapie ­ eine qualitative Studie.

Stakeholders' experiences with flexible and integrative treatment models in German child and adolescent psychiatry according to § 64b SGB V - A qualitative study Abstract. Background and Aims: Since 2013, new possibilities for flexible and integrative forms of treatment (FIT) exist within the German mental healthcare system. These FIT models, created according to § 64b of the Social Security Code V, have been implemented in adult as well as child and adolescent psychiatry over the past years. This paper investigates stakeholders' experiences with these innovative FIT models. Methods: Focus groups were conducted in two hospital departments that had implemented a FIT model according to § 64b. In total, 36 participants were included, comprising employees, patients, and their caretakers. We also conducted a thematic analysis. Results: According to all stakeholders, these forms of acute outpatient treatment form a core component of FIT models that may serve to prepare, replace, or follow-up on inpatient treatment. In addition, the flexibility of treatment and increased continuity of care were mentioned as benefits of FIT models according to § 64b. Third, these FIT models allow for a better integration of caretakers in the treatment of their kin, which also produces various challenges for this stakeholder group. Conclusions: The introduction of FIT models in German child and adolescent psychiatry has complex implications for the treatment process and the experiences of all stakeholders. They perceive it as a needs-adapted extension of current forms of psychiatric support.

[Outpatient care for mentally traumatized children and adolescents in Germany]. / Ambulante psychotherapeutische Versorgungssituation von traumatisierten Kindern und Jugendlichen in Deutschland.

Outpatient care for mentally traumatized children and adolescents in Germany Abstract. Objective: In Germany, information on outpatient care for mentally traumatized children and adolescents are not available. Therefore, the study tried to investigate outpatient care in this patient-group by licensed medical and psychological psychotherapists. Method: Altogether, 206 outpatient psychotherapists with qualification for trauma therapy and license to treat children and adolescents were asked to participate by completing an anonymous standardized questionnaire. Results: The response rate was 44 %. Only 20 out of 92 participants stated that they gained sufficient knowledge regarding mental trauma treatment during their training. Besides, the study revealed that not all traumatized children and adolescents have prompt access to treatment, due to the lack of therapeutic capacities by the psychotherapists. Conclusion: The results point to the problem of not sufficient education on mental trauma in children and adolescents during the training of psychotherapists. Moreover, an increase of the capacities for treatment became obvious. Psychotherapeutic care of traumatized children and adolescents can be difficult in some regions in Germany. Consequently, training and post-graduate education of psychotherapists as well as the planning of outpatient infrastructure should be changed.

[The treatment needs of migrant children according to child and adolescent psychiatrists from medical clinics and in private practice]. / Anforderungen an die Behandlung von Migrantenkindern aus Sicht niedergelassener und leitender Ärzte für Kinder- und Jugendpsychiatrie.

OBJECTIVE: How does the German child and adolescent psychiatry system respond to the increasing number of migrant children and adolescents? METHOD: Senior doctors from German child and adolescent psychiatric hospitals (Association of Medical Hospital Directors in Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Germany, BAG) completed a specially constructed questionnaire about the treatment needs of migrant children, while a «random, representative¼ sample of child and adolescent psychiatrists in private practice (German Professional Association for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, BKJPP) was administered a slightly modified version. RESULTS: The 100 psychiatrists in private practice represented only about one-eighth of their group, whereas the 55 medical directors comprised a representative sample. One-third of the hospitals has treatments tailored to the specific needs of migrants. In both settings, however, competent interpreters were rarely found, despite the treatment problems arising from the understanding the illness by the parents, language problems, and the clinical knowledge of the patient. Cultural diversity is perceived as enriching. The migration background and the sex of child and adolescent psychiatrists influence the treatment of migrants. CONCLUSION: Facilitating the process of «cultural opening¼ in child and adolescent psychiatry involves enacting concrete steps, such as the funding of interpreter costs.

[Effectiveness of hometreatment in light of clinical elements, chances, and limitations]. / Behandelt zu Hause Gesund werden. Hometreatment in Verzahnung mit Klinikelementen, Chancen und Herausforderungen.

OBJECTIVE: The main objective was to evaluate two models of care for children and adolescents requiring hospitalization due to severe mental illness. Model 1: early discharge followed by a newly established home treatment service enhanced by clinical elements according to need (BeZuHG); Model 2: admission to an inpatient unit (TAU). METHODS: 100 children and adolescents admitted to inpatient care were randomized to either a control group (regular inpatient stay) or an intervention group (BeZuHG group). Sociodemographic data, ICD-10 and DSM-IV diagnoses, health and social functioning, psychopathology, clinical impairment, and service use were assessed pre- and posttreatment regarding effectiveness, outcome, contact time, and acceptance within the families. RESULTS: Clinical outcome in BeZuHG treatment was as effective as inpatient care. There was a good acceptance within the families, family resources enhanced treatment outcome, and a significant reduction in length of inpatient stay could be shown. CONCLUSIONS: The BeZuHG model should be a regular option in child and adolescent psychiatric care. Further rigorous evaluation of the model is required: A 1-year follow-up investigating the stability of the shown effects is planned.

Interethnische Analysen der Verteilungen psychischer Störungen bei Kindern und Jugendlichen in einer Inanspruchnahmepopulation.

Interethnic Analyses of Distributions in Children and Adolescents Mental Disorders in a Health Care Utilization The study examines ethnic differences in mental disorders in a child and adolescent psychiatry population in a major German city from 2007 to 2011 (N = 5,680). Risks of developing specific mental disorders were calculated. African migrant children and adolescents showed higher risk in traumatic stress and adjustment disorders (F 43 in ICD-10), the Asiatic group in dissociative disorders (F 44-45). Compared to other European migrants the German children and adolescents without migration background had a higher risk of affective disorders (F 3). Adolescents (N = 3,556) with Russian and Polish background had a higher risk of disorders induced by psychotropic substances (F 1). Turkish and Arabic adolescents had a 4- to 5-times increasing risk in schizophrenia as well as schizotypal or delusional disorders (F 2). In addition, mental disorders were influenced by gender and nationality. These study results suggest that a different vulnerability to specific mental disorders is associated to ethnicity.

[The situation of early career researchers in health services research: A survey study]. / Situation des wissenschaftlichen Nachwuchses in der Versorgungsforschung ­ eine Survey-Studie.

BACKGROUND: Early career researchers in health services research work in an interdisciplinary field of research. So far, information on early career researchers in health services research has only been available from surveys of individual disciplines, which do not adequately reflect the concerns in the field of health services research. Therefore, a working group of the German Network for Health Services Research (DNVF) conducted a first survey. The following research questions can be answered on the basis of the data obtained: (1) Which socio-demographic aspects characterize early career researchers in health services research? (2) What is the professional biographical background of early career researchers in health services research? (3) What are the research fields of early career researchers? (4) What are the career perspectives of early career researchers? METHOD: The survey among early career researchers was conducted as an online survey in January/February 2019. The study was addressed to individuals currently working as early career researchers in health services research in Germany. The online survey was conducted using a standardized questionnaire. Participants were recruited through the DNVF access points and by snowball sampling. RESULTS: 336 early career researcher aged between 23 and 57 participated in the online survey study, 102 of whom held a doctorate. The majority were employed as scientific staff (58%) and were in temporary employment (75%); 69% of them were emplyed at a university, followed by health care institutions (17%) and non-university research institutions (16%). About one-third of the respondents (36%) completed a vocational training prior to their studies. Of the participants, 50% said they were strongly or very strongly aspiring to a professional career in academia, 43% at a non-university research institution, and 30% at a university of applied sciences. DISCUSSION: The results of the online survey show the heterogeneity in terms of age and professional biography of early career researchers in health services research. Few researchers have permanent positions. However, the majority of respondents would like to have a professional future at a university, a research institute or a university of applied sciences. Further studies should be conducted to determine (possible) career paths taken by young scientists in health services research. CONCLUSION: There is still scope for improvement in the promotion of early career researchers.

[Evaluation of electronic medical records from general practices using the example of the diagnosis of community-acquired pneumonia: A qualitative feasibility study]. / Nutzung von Daten aus dem Praxisverwaltungssystem eines großen hausärztlichen Verbundes medizinischer Versorgungszentren am Beispiel der Diagnosestellung einer ambulant erworbenen Pneumonie ­ eine qualitative Machbarkeitsstudie.

BACKGROUND: Data collected by general practitioners (GPs) may provide potential for health services research. In this study, we investigated if clinical questions can be answered with GPs' electronic medical records (EMRs) by means of diagnosing community-acquired pneumonia (CAP). METHOD: Patients diagnosed with CAP, defined as ICD code J18.9, were identified in the fourth quarter of 2021. The data were derived from the EMR system (Medical Office®) of a central German association of 30 general practices, using three different approaches: 1. The integrated statistic tool was used to record whether patients were referred for radiological diagnostic confirmation. 2. Retrospectively, EMRs were evaluated manually by a doctor familiar with the EMR. 3. The raw data of the EMR system were extracted by automated export. The information obtained through the three types of access was compared. For each patient case, detailed comments on problems and specifics were documented and evaluated by qualitative content analysis (QCA) according to Mayring. RESULTS: In total, 164 patients diagnosed with CAP were identified. The numbers of documented radiological diagnostic confirmations varied between data approaches: While the manual evaluation of the EMRs revealed 60 referred patients, the statistics tool identified 38 of these cases. The export of the raw data identified 58 referrals to radiography after adjustment. According to QCA, there was a high variation in applied diagnostics and time of diagnosis. Referrals for radiography were made both before and after coding of the diagnosis. In case of hospitalization, X-rays were usually performed during the inpatient stay. Laboratory tests were performed as an alternative to radiography. There was also a high variation in the documentation of risk factors and diagnostic certainty. DISCUSSION: The statistics tool integrated into the EMR system is a quick way to perform simple queries but proved to be impracticable for complex questions. The EMRs provide detailed information but need to be evaluated manually. An automated data export from the raw data offers both detailed information and access to large volumes of data but requires complex preparation and appropriate IT expertise. CONCLUSION: Based on the example of diagnosed CAP in a GP setting, the use of data extracted from an EMR system seems to be feasible to answer simple clinical questions. However, it is necessary to adapt the data export, and a comparison with a small number of manually evaluated cases is useful to achieve valid results.

[Empirically derived recommendations for the development and expansion of day hospices in Germany - Results of a Delphi expert panel]. / Empirisch abgeleitete Empfehlungen für den Auf- und Ausbau von Tageshospizen in Deutschland ­ Ergebnisse einer Delphi-Befragung mit Expert:innen.

INTRODUCTION: A needs-based and patient-oriented hospice and palliative care also includes day hospices as a specialised semi-inpatient care offer. The establishment and development of these facilities in Germany has been rather unsystematic. In order to ensure quality and adequacy of these structures, research is needed. METHODS: A Delphi consensus study was conducted online from November 2022 to February 2023 aiming at generating recommendations for the development and expansion of day hospices in Germany. For each recommendation, the participants indicated on a four-point verbal rating scale how much they agreed upon a) the relevance and b) the feasibility of the recommendation. Items were considered consented when 80% of the participants (strongly) agreed with the recommendation regarding both criteria. If no consensus was reached, the recommendations were revised according to the participants' free text comments and presented in the next Delphi round. Descriptive analyses were applied. RESULTS: A total of 64 experts participated in the first Delphi round and 44 in the second. In round 1, 34 recommendations and in round 2 six recommendations were consented. The final set contains a total of 40 recommendations: 18 on the tasks of day hospices, 13 on cooperation, 7 on funding, and 2 on public relations. DISCUSSION: Recommendations for the development and expansion of day hospices in Germany were developed. Due to their highly rated feasibility, the recommendations should be directly transferable into care practice. It remains to be seen to what extent they will be taken into account in the renegotiation of the framework agreement for day hospices. CONCLUSION: The Delphi-consented recommendations provide a basis to guide action in the currently very dynamic development of hospice work and palliative care in Germany.

[Participation in primary care research - From the idea to the constitution of a citizens advisory board]. / Partizipation in der allgemeinmedizinischen Forschung ­ Von der Idee bis zur Gründung eines Bürger*innenbeirats.

INTRODUCTION: Public participation in research processes is becoming increasingly important and is justified with positive effects for research. The first successful initiatives can also be found in general practice and health services research. The transparent presentation of these projects is essential to the discussion about participation. The aim of this article is to present and discuss the conception and implementation of the initiative at the Institute of General Practice and Health Services Research at the Technical University of Munich and the kick-off event for the participation of patients, citizens and patient representatives. METHODS: This article reports the planning, recruitment, implementation, and evaluation of the kick-off event. Frameworks for future events are described. RESULTS: In total, twelve persons were recruited through various recruitment channels to participate in the kick-off event. The participants showed a diverse structure of motives with regard to participation in research. All participants shared the essential goal of improving research and care by adding their perspectives to research processes. However, the specific opportunities for participation and the role of patients and citizens in research processes were unclear. During the event, future workshops were planned to address these challenges. The focus was on strengthening relationships and communicating the basics of primary care research in order to enable sustainable participation. DISCUSSION: The participants' different motivations resulted in the need to explore the concrete possibilities of participation. One of the specific requirements was to focus on role identification and the structure of the initiative. The question of self-description and -identification as a patient and/or citizen seemed crucial. Furthermore, a concise introduction to the topic of participation in research processes, as well as patient and citizen qualifications, is considered necessary. CONCLUSION: Establishing an advisory board for patients and citizens in primary care research is associated with specific requirements. In addition to fundamental necessities such as the joint clarification of the possibilities of participation, defining the role and establishing the identity of the initiative should be promoted.

[Identification of regional hospice and palliative care networks in Germany - Results of a multi-method survey]. / Identifikation regionaler Hospiz- und Palliativnetzwerke in Deutschland ­ Ergebnisse einer multimethodischen Bestandserhebung.

INTRODUCTION: In the course of the implementation of the German Healthcare Development Act [Gesundheitsversorgungsweiterentwicklungsgesetz] of 2021, a funding structure according to sect. 39d of the Social Code Book V [SGB V] was established to promote regional hospice and palliative care networks (RHPN). The funded networks are expected to support the multiprofessional cooperation of hospice and palliative care providers at the structural level. It is still unclear how many existing and newly established network structures are eligible for funding according to sect. 39d SGB V and where these network structures are located regionally. The proportion of actually funded networks is also unknown. METHODS: Between January and March 2023, network structures of hospice and palliative care were identified in a tripartite, multi-method survey procedure, consisting of a) research of databases, literature, and internet; b) open quantitative online-survey via SoSciSurvey software, and c) telephone survey of federal offices of health insurers. The data were first documented separately. Then, the research and survey data were combined and analysed via descriptive statistics using SPSS. RESULTS: Based on the aggregated data from the literature-, database- and internet research and the online survey, n=308 network structures of hospice and palliative care could be identified, of which n=37 have applied for network funding according to sect. 39d SGB V. In the survey period, n=47 applications for network funding according to sect. 39d SGB V were submitted to the health insurance funds. There is a high density of network structures in the northern, southern and western federal states, while there are only a few networks in the eastern states. According to the online-survey, 56% (n=136) of all the identified network structures with known sponsorship are organised by providers of specialised outpatient palliative care. 47% (n=29) of the networks with funding interest are organised as independent structures. Of the network structures with known funding status, 18% (n=26) plan to apply for funding according to sect. 39d SGB V in 2024 for the first time. DISCUSSION: There are numerous network structures in hospice and palliative care, but they are differently distributed among the German federal states. The multi-method survey was able to provide a first nation-wide inventory of network structures as well as an assessment of networks with funding interest according to sect. 39 SGB V. A clear distinction between general network structures and structural networks according to sect. 39d SGB V is a challenge. In the next years the number of funding applications is expected to rise. CONCLUSION: The identification of existing and funded network structures of hospice and palliative care in Germany can be a starting point for a deeper analysis of the structure and the activities of the networks. A quality assessment tool that takes into account both the heterogeneity of the networks and the different dimensions of networking would be helpful.

[Web scraping applications in health services research: For web experts only, or a tool for every health services researcher?!] / Anwendungskontexte von Web Scraping in der Versorgungsforschung - Nur für Web-Expert:innen? Oder eine Methode für alle Versorgungsforscher:innen!?

Reviewing various care-related data, such as patient satisfaction, can provide valuable information for a health care organization to improve its services. Regular and automatic data collection of internet data can save time and money. This data collection can be performed using web scraping. Web scraping is well-suited for collecting and linking (secondary) data from the internet. In this paper, a low-threshold option for web scraping is illustrated: Web scraping using the commercial software OutWit. This method is also suitable for researchers with no experience in web scraping. Following web scraping, classical statistical methods can be used for quantitative data or qualitative content analysis for qualitative data. Before collecting data using web scraping methods, the legal framework for the individual research project should be clarified. Additionally, ethical considerations should be addressed because the automated extraction of data is not always compatible with the respective data holder's applicable terms of use.

[Advancement of an intermediate level of outpatient palliative care - A Delphi study]. / Weiterentwicklung der "Besonders qualifizierten und koordinierten palliativmedizinischen Versorgung" (BQKPMV) ­ Ergebnisse einer Delphi-Befragung.

INTRODUCTION: In the course of the further development of palliative care in Germany, an agreement on an intermediate level of outpatient palliative care, the so-called BQKPMV (specially qualified and coordinated palliative homecare) was realised in 2017. Family physicians play a central role in the BQKPMV; among other things, they are responsible for the coordination of care. There are indications that barriers exist in the practical implementation of the BQKPMV and that an adjustment may be necessary. This work is part of the Polite project (analysis of the implementation of an intermediate level of outpatient palliative care in the reality of care and recommendations for further development) and aims at building consensus on recommendations for the further development of the BQKPMV. METHODS: Between June and October 2022, an online Delphi survey was conducted among experts for outpatient palliative care from all over Germany (providers, professional associations, funders, science, self-government). The content of the recommendations, which were voted on as part of the Delphi survey, was based on the results of both the first project phase and an expert workshop. Participants rated the extent to which they agree with a) the clarity of the wording, and b) the relevance for the further development of the BQKPMV on a four-point Likert scale. Consensus was assumed when 75% of the participants (rather) agreed to a recommendation with regard to both criteria. If no consensus was reached, the recommendations were adjusted using the free text comments and presented again in the next round. Descriptive analyses were applied. RESULTS: Forty-five experts participated in the first Delphi round, 31 in the second, and 30 in the third round (43% female, average age 55). Consensus was obtained for seven recommendations in round 1, for six in round 2 and for three in round 3. These final 16 recommendations relate to four topics: awareness and implementation of the BQKPMV (6 recommendations), framework conditions of the BQKPMV (3), discrimination of forms of care (5), and cooperation at the interfaces of care (2). DISCUSSION: The Delphi method was used to identify concrete recommendations for the further development of the BQKPMV that are relevant to health care practice. In the final set of recommendations, a particular focus lies on increasing awareness and communicating information about the scope of the health care service, added value and framework conditions of the BQKPMV. CONCLUSION: The results provide an empirically sound basis for the further development of the BQKPMV. They show a concrete need for change and highlight that an optimisation of the BQKPMV is necessary.