[Interprofessional collaboration of general practitioners and nurses in primary care: A qualitative study]. / Interprofessionelle Zusammenarbeit von Hausärzt_innen und Pflegefachpersonen in der Primärversorgung.

Interprofessional collaboration of general practitioners and nurses in primary care: A qualitative study Abstract. Background: There is a need to strengthen interprofessional collaboration of general practitioners and home care nurses in the primary care of people with chronic diseases and long-term care needs. Aim: This study investigated a) how general practitioners and nurses in Germany perceive their collaboration in primary care and b) which development perspectives of collaboration exist from their point of view. Methods: Expert interviews were conducted with seven general practitioners and eight home care nurses. The data were analysed using thematic-structured qualitative content analysis. Results: The interviewees from both professional groups report that their collaboration is hindered by poor mutual accessibility. At the same time, they emphasise their appreciation of the professional exchange with the other professional group. Nevertheless, the perceptions of the professional competence of home care nurses differ. To improve their cooperation, the interviewees recommend the establishment of interprofessional meetings and cooperation in spatial proximity for regular professional exchange. They expect this to lead to a joint development of trust and competence and to an expansion of the area of responsibility of home care nurses in primary care. Conclusions: Binding communication structures, cooperation in spatial proximity and an expansion of the area of responsibility of home care nurses offer high potential for strengthening primary care in Germany.

[Role understanding of expert nurses in primary and acute care in Germany: A descriptive cross-sectional study]. / Rollenverständnis von Pflegeexpert_innen in der Primär- und Akutversorgung in Deutschland.

Role understanding of expert nurses in primary and acute care in Germany: A descriptive cross-sectional study Abstract. Background: Innovative care concepts are necessary to cope with the increase in complex care situations due to a rising number of older people with chronic diseases and a simultaneous shortage of nursing and medical staff. In the context of the implementation and development of new, innovative nursing roles, an unclear role understanding is considered a barrier. Aim: Description of expert nurses' (EN) role understanding in primary and acute care in Germany. Method: Using questionnaires, EN are asked cross-sectionally about role clarity, competencies and performance as well as perceived autonomy and interprofessional collaboration. Results are analysed descriptively. Results: A total of eight (primary care) and 14 (acute care) EN completed the questionnaires. The majority of EN often/very often perform both the clinical (77.5% and 85.7%, respectively) and the expert role (75% and 78.6%, respectively) and indicate that they can explain their role to patients (75% and 92.9%, respectively) and physicians (87.5% and 90.9%, respectively). Having a high degree of autonomy is more likely to be perceived by EN working in acute care. Conclusion: Although there are similarities in terms of role understanding, EN working in acute care can apparently benefit from already established structures, which is reflected, among other things, in their perceived autonomy.

[The contribution of advanced practice nurses in Swiss family practices: Multiple case study design]. / Der Beitrag von Advanced Practice Nurses in Schweizer Hausarztpraxen.

The contribution of advanced practice nurses in Swiss family practices: Multiple case study design Abstract. Background: The increase in chronic diseases, multimorbidity and shortage of health professionals make it essential to adapt primary health care. New models of care are needed which are oriented towards patient needs and thus ensure comprehensive care for chronically ill people. In this context, there is great potential for the use of advanced practice nurses in Swiss family practices. Aims: In this study we investigated the contribution of advanced practice nurses in the interprofessional context in two family practices. Methods: We conducted a multiple case study design. We investigated two advanced practice nurses, located in family practices in rural and in mountainous regions. We used qualitative and quantitative methods. As an intermediate step, within-case analyses were performed and we summarized data inductively to create case vignettes. Results: The cases showed that advanced practice nurses contribute to self-management, prevention and health promotion in complex, stable and unstable patients. These areas have not been covered adequately by other health professionals in family practices. They strengthened interface management through hybrid employment and flexible, addressee-appropriate communication. Conclusions: Similarities and differences between family practices with and without new professional roles should be elicited to specifically identify gaps in care for the chronically ill.

In-the-moment ratings on the Early Relational Health Screen: A pilot study of application in home visiting and primary care.

Early infant-parent interaction sets a critical foundation for young children's well-being, and evidence regarding the protective role of secure early relationships has led to increased interest in effective screening and promotion of early relational health in pediatric primary care and home visiting settings. We report findings from two pilot studies conducted in the United States that describe the reliability and validity of a relational health screening tool, the Early Relational Health Screen (ERHS), implemented in two different contexts: an innovative model of relational health promotion in pediatric primary care (Study 1) and an Infant Mental Health Home Visiting (IMH-HV) model (Study 2). Across both studies, a trained clinician rated the ERHS following real-time observation of interaction (i.e., "in-the-moment" ratings). Reliability was assessed by comparing "in-the-moment" ERHS ratings to subsequent coding of the same interaction from video by an independent evaluator. In addition, Study 2 data permitted evaluation of the validity of "in-the-moment" ERHS ratings. Results from both studies indicated reliability of "in-the-moment" ERHS ratings. In addition, Study 2 clinician "in-the-moment" ratings were associated with maternal depression and ratings of child-parent interaction derived from a separate observational task coded by independent evaluators using a different well-validated research-based measure. Discussion highlights the potential of the ERHS as a screening, promotion, and prevention tool that may be feasibly administered by providers across pediatric primary care and home visiting settings.

La temprana interacción infante-progenitor establece una fundación esencial para el bienestar de los niños pequeños, y la evidencia sobre el papel de protección de tempranas relaciones receptivas ha aumentado el interés en la efectiva detección y promoción de la salud de la relación en el cuidado pediátrico primario y los escenarios de visitas a casa. Reportamos los resultados de dos estudios experimentales que describen la confiabilidad y validez de la Temprana Detección de la Salud de la Relación (ERHS) implementada en dos contextos: un modelo innovador de promoción de la salud de la relación en el cuidado primario (Estudio 1) y un modelo de salud mental infantil de visitas a casa (Estudio 2). A lo largo de ambos, un profesional clínico entrenado evaluó ERHS siguiendo una observación de interacción en tiempo real (v.g. puntajes asignados "en el momento"). Se evaluó la confiabilidad por medio de una comparación entre los puntajes del profesional clínico y los subsecuentes puntajes de la misma interacción en video por un evaluador independiente. Adicionalmente, los datos del Estudio 2 permitieron la evaluación de la validez de los puntajes de ERHS. Los resultados de ambos estudios indicaron la confiabilidad de los puntajes ERHS "en el momento." Es más, los puntajes del profesional clínico del Estudio 2 se asociaron con la depresión materna y los puntajes de la interacción niño-progenitor derivados de una tarea separada usando una medida bien validada basada en la investigación. Las discusiones subrayan el potencial de ERHS como una herramienta de detección, promoción y prevención que puede ser administrada factiblemente por los proveedores tanto en el cuidado primario como en los casos de visitas a casa.

L'interaction précoce nourrisson-parent jette les bases essentielles du bien-être du jeune enfant et l'évidence concernant le rôle protecteur des relations précoces sécures a mené à un intérêt plus grand pour le dépistage efficace et la promotion de la santé relationnelle précoce dans les soins de santé primaire en pédiatrie ainsi que les contextes de visites à domicile. Nous rapportons ici les résultats de deux études pilotes faites aux Etats-Unis d'Amérique, qui décrivent la fiabilité et la validité d'un outil de dépistage de la santé relationnelle, le Dépistage Précoce de Santé Relationnelle (en anglais Early Relational Health Screen dont nous gardons l'abréviation ici, ERHS), mis en place dans deux contextes différents: un modèle innovateur de promotion de la santé relationnelle précoce en soin pédiatrique primaire (Etude 1) et un modèle de visite à domicile pour la santé mentale du nourrisson (Etude 2). Au travers de ces deux études un clinicien entraîné a évalué l'ERHS après une observation en temps réel de l'interaction (c'est-à-dire, des scores "sur le moment"). La fiabilité a été évaluée en comparant l'ERHS "sur le moment" au codage ultérieur de la même interaction à partir d'une vidéo, par un évaluateur indépendant. De plus les données de l'Etude 2 ont permis l'évaluation de la validité des scores ERHS "sur le moment." Les résultats des deux études ont indiqué la fiabilité des scores ERHS "sur le moment." De plus les scores "sur le moment" du clinicien de l'Etude 2 étaient liés à la dépression maternelle et aux scores d'interaction enfant-parent dérivés d'une tâche observationnelle séparée codée par des évaluateurs indépendants en utilisant une mesure basée sur les recherches différente et communément validée. La discussion met en lumière le potentiel de l'ERHS en tant qu'outil de dépistage, de promotion et de prévention qui peut être réalistement utilisé par les professionnels au sein des soins primaires pédiatriques et des contextes de visites à domicile.

[Community health nursing in urban setting (CoSta): Development of a care concept for people with chronic conditions in primary care]. / Community Health Nursing in der Stadt (CoSta).

Community health nursing in urban setting (CoSta): Development of a care concept for people with chronic conditions in primary care Abstract. Background: Community Health Nursing (CHN) is currently being discussed in German-speaking countries to implement nursing professionals in primary care. It comprises patient-oriented-, evidence-based and community care. Academic nurses provide care autonomously. In other countries, CHN has been established for many years. In Germany, there is a lack of model tests and evidence to evaluate the specific mode of action in application and to map reimbursement options of potential healthcare payers. Aim: The CoSta project is developing a professional CHN model concept for people with chronic conditions in a marginalized urban neighborhood. Methods: The practice development of the CHN care concept is based on a theoretical frame, a literature review and needs assessment in the neighborhood involving the multiprofessional team in a health center. Results: Concept modelling is completed. The model is based on the components public health, nursing theory, mission statement, legal framework, and evidence base. Interventions include nurse-led home visits, consultations, and trainings. Their effectiveness is currently being tested in an ongoing intervention study, and feasibility results are expected soon. Conclusions: The model-concept is assessed as a needs-based offer. For the intervention, cultural and peer sensitive aspects seem to be even more significant than expected.

Application of Motivational Interviewing in climate-sensitive health counselling - A workshop report.

INTRODUCTION: This workshop report explores the application of Motivational Interviewing (MI) in Climate-sensitive Health Counselling (CSHC) within the context of primary health care. As there is a growing interest in the connection of individual health and climate change mitigation, we provide practical guidance on integrating MI techniques in CSHC. METHODS: In June 2023, a 2-day workshop on MI was conducted at the Institute of General Medicine, University of Cologne. The workshop, facilitated by a certified MI trainer, combined theoretical content with practical group exercises. In a second workshop the staff of the Institute of General Medicine discussed the application of MI in CSHC. RESULTS: We identified and specified five tools to apply MI in CSHC: A) risk assessment scores, B) relevance assessment scales, C) decision matrices, D) confidence assessment scales, and E) SMART goals. These tools provide practical insights for integrating MI into primary care consultations, offering a time-efficient approach to CSHC. DISCUSSION: Our results present a promising approach for healthcare professionals to incorporate climate-related aspects into health counselling of patients. Feasibility and effects of MI in CSHC are still unclear and require further research. CONCLUSION: The tools identified provide practical guidance for the application of MI in climate-sensitive health counselling (CSHC) as well as guidance on conducting appropriate studies.

[Factors influencing patient competency and health care of service members of the German armed forces with deployment-related mental illness: A patient interview study]. / Einflussfaktoren auf die Patientenkompetenz und die Versorgung einsatzgeschädigter, psychisch erkrankter Soldat*innen der Bundeswehr: eine Interviewstudie mit Betroffenen.

BACKGROUND: The number of service members of the German armed forces suffering from deployment-related mental health problems is steadily rising. Preliminary studies have shown that less than 50 % seek professional help. There is little knowledge about the factors influencing the development of an adequate level of patient competence to cope with the complexity of the clinical picture and the care of people with operational disabilities in the interprofessional network. METHODS: The article presents data gathered by semi-structured, guided interviews from 14 affected individuals analyzing salient beliefs about the perceived factors influencing their patient competence and care through the interprofessional network of supporters inside and outside the German armed forces. Data evaluation was carried out by means of content-structuring, qualitative content analysis using the method of deductive-inductive category formation. FINDINGS: Based on the interviews conducted, we identified four groups of salient beliefs having an influence on patient competence: identify changes and limitations, recognize illness, redirect one's life, help shape one's life again, and four groups of salient beliefs having an influence on care: intangible / material support, medical supplies, psychosocial support, third-party support. All main topics could be assigned to three levels of influence (individual, individual-contextual, contextual) and stored with a total of 70 topics (codes). INTERPRETATION: The development of an effective "social structure" was named by those affected as an important influencing factor. Family members, comrades, superiors, and military GPs appear to have a significant impact on patient competence and care. The respondents' opinions about the importance of internal factors such as the soldier's self-image and fear of stigmatization are consistent with previous findings. Structural factors like supply procedures were mentioned as specific German armed forces phenomena.

[Coordinated primary care of older patients with complex needs. The perspective of family doctors in the light of a case management project within practice networks of independent physicians in Germany]. / Koordinierte Versorgung geriatrischer Patientinnen und Patienten aus ärztlicher Sicht: Erfahrungen aus einem kontrollierten Modellversuch in zertifizierten Praxisnetzen.

BACKGROUND: Cross-sectoral and interdisciplinary care and case management can contribute to an improved integration of the primary care for patients with geriatric characteristics. Following this approach, the pilot study RubiN (Regional ununterbrochen betreut im Netz / Continuous Care in Regional Networks) implemented a specific geriatric Care and Case Management (CCM) in five certified practice networks of independent physicians in different regions in Germany. As part of the accompanying process-based evaluation of the project, a survey was conducted among general practitioners and other specialists from these networks in order to find out how, in their view, collaboration with case managers can improve medical care of geriatric patients and contribute to closing possible gaps in primary care structures. METHODS: The overall project RubiN, which was designed as a pragmatic controlled trial, compared patients from five practice networks where CCM has been implemented (intervention networks), with patients from three networks where the intervention was not taking place (control networks). Physicians of all eight participating practice networks were included in the present survey. The survey was conducted via a self-developed questionnaire. RESULTS: A total of 111 physicians participated in the survey, 76 of whom were part of an intervention network and 35 part of a control network. The calculated response rate was 15.4% (networks reported a total of approx. 720 members). 91,1% of the participants from intervention networks, who had joined RubiN with their patients, reported satisfaction with their collaboration with case managers (n=41 of 45). 87.0% of the physicians from intervention networks stated that care for geriatric patients had improved as a result of their participation in the pilot study (n=40 of 46). When asked about the overall quality of care provided for their geriatric patients, the assessments of participants from intervention networks were more positive than those of the participants from control networks (MV 3.48 vs. 3.27 on a scale of 1=poor to 5=very good). Agreement with whether external case managers could provide certain services was higher among participants from intervention networks compared to participants from control networks. This was the case, in particular, of services related to medical data collection and test procedures. Overall, both comparison groups showed a high level of willingness to delegate tasks to a CCM. DISCUSSION: Delegation of tasks to geriatric case managers seems to be more readily accepted by physicians in intervention networks than by their colleagues from the control networks, especially as regards medical assessment methods and advanced advisory tasks. The results suggest that interventions in this domain were able to convince physicians of the value that case managers can bring to medical practice and help resolve reservations and skepticism. Especially, the implemented CCM seemed to be an effective way of generating geriatric anamnestic data and fostering the flow of general patient-centered information. CONCLUSION: From the point of view of general practitioners and other specialists participating in the intervention, CCM has been successfully implemented in their practice networks and seems to be a worthwhile approach that will help provide better coordinated and more team-oriented care to their geriatric patients.

[Long COVID: Care and support needs from the perspective of "long-haul" patients and primary care practitioners - a mixed-methods study from Baden-Wuerttemberg]. / Versorgungsbedarfe zu Long-COVID aus Sicht von Betroffenen und Hausärzt*innen ­ eine Mixed-Methods-Studie aus Baden-Württemberg.

INTRODUCTION: The approaches to cope with the challenges of providing medical care to patients with symptoms of long COVID are multidisciplinary and involve primary care worldwide. The aim of this study was to explore the experiences and ideas for continued development of medical care of long COVID from the patients' (PAT) and primary care practitioners' (PCP) perspective. METHODS: Between the third and fourth COVID-19 wave in Germany (July to September 2021), a mixed methods study was conducted by inviting patients and PCPs in two neighboring districts (urban and rural) in Baden-Wuerttemberg to a paper-based questionnaire with both closed and open questions. On the part of the PCPs a written, anonymized, complete survey was conducted, on the part of symptomatic COVID long-haulers an anonymized online survey with announcement of the study by multiple recruiting processes. Qualitative content analysis was applied to free text entries. The quantitative results were analyzed mainly descriptively. RESULTS: The responses of n = 72 PCPs (response rate 12%) and n = 126 PAT showed a heterogeneous assessment regarding the satisfaction with medical care for long COVID as well as the perception of the attitude towards patients and their disease in both groups. Uncertainty and dealing with it played a relevant role in both groups as well. The professional medical knowledge was assessed by 3,1 (self-assessment PCPs) and 3,2 (PAT) on average using a five-point Likert scale (1 = not applicable; 5 = applicable). The request for a structured overall concept with competent contact points and coordination of medical care for long COVID patients emerged out of the statements of both groups. CONCLUSION: The results support an interdisciplinary, intersectoral and interprofessional stepped-care concept for long COVID in Germany with PCPs as the first contact persons, integration of specialized contact points and knowledge transfer. Therefore, it appears to be both reasonable and appropriate to establish regional networks with links between regional outpatient medical care structures and the university medical sector.

Perspectives of physicians and medical assistants on the implementation of NAAT-based point-of-care testing for SARS-CoV-2 in primary care in Germany.

INTRODUCTION: Given their high diagnostic accuracy and fast turnaround time, rapid SARS-CoV-2 tests based on nucleic acid amplification technologies (NAAT) have great potential to expand access to testing and decrease delays in diagnosis of COVID-19. OBJECTIVES: The aim of this study was to investigate feasibility, acceptance, organizational consequences and other implementation aspects of the use of a NAAT-based SARS-CoV-2 rapid test (ID NOW™ COVID-19, Abbott Diagnostics) for symptomatic primary care patients with a suspected SARS-CoV-2 infection. METHODS: Cross-sectional survey among primary care physicians and medical assistants from Thuringia (Germany) during the third wave of the COVID-19 pandemic in March and April 2021. The health care providers surveyed had previously used the NAAT-based SARS-CoV-2 rapid test as part of a pilot study. RESULTS: Eleven physicians (ten general practitioners and one paediatrician) and 22 medical assistants from Thuringia (Germany) participated in the written survey. Four physicians were additionally interviewed. The majority of the surveyed health care providers rated user-friendliness, integration into practice routine, impact on communication with patients and technical reliability of the NAAT-based SARS-CoV-2 rapid test as (very) positive. Greater workload and the costs for measuring devices were identified as disadvantages compared to PCR laboratory tests. Four out of ten physicians rated the lower sample turnover as unfavourable. CONCLUSION: Our survey shows that NAAT-based point-of-care SARS-CoV-2 testing gained widespread acceptance among physicians and medical assistants, positively influences workflows, can improve patient communication and could therefore be successfully implemented into routine primary care.

[Factors promoting and hindering the use of an evidence-based clinical pathway for the management of overweight or obese children and adolescents]. / Förderliche und hinderliche Faktoren für den Einsatz eines evidenzbasierten Behandlungspfades zur Versorgung von übergewichtigen oder adipösen Kindern und Jugendlichen.

BACKGROUND/OBJECTIVE: Evidence-based clinical pathways can be a useful tool for guideline implementation. However, there seem to be barriers to the use of clinical pathways. The aim of the present questionnaire survey was to assess the perceived usability of the clinical pathway "Overweight/obesity in children and adolescents at primary care level" and to identify factors promoting and hindering the use of the clinical pathway. METHODS: In January 2020, an online questionnaire survey was sent out to 3,916 general practitioners and 470 pediatricians in Austria. The data collected were analysed descriptively. RESULTS: A total of 148 people took part in the questionnaire survey (response rate 3.7 %). The majority of respondents indicated that they, in general, perceive evidence-based clinical pathways as helpful (90 %) and also make use of them (57 %). Few respondents (9 %) felt well-informed about new clinical pathways developed in Austria. Most of the respondents considered the clinical pathway "Overweight/obesity in children and adolescents at primary care level" as a useful support (60 %), as a reference work (72 %) or as a facilitator for justifying their approach to their patients (68 %). However, a large proportion of the respondents stated that the clinical pathway is not easily applicable in everyday practice. The three most frequently cited barriers to using the clinical pathway were lack of time resources, lack of structures and lack of financial incentives. Other display and access options (e. g., individualisation, integration into practice software) were most frequently cited as factors that might promote the use of the pathway. CONCLUSION: Although the majority of the respondents had positive expectations regarding the use of the clinical pathway "Overweight/obesity in children and adolescents at primary care level", many of them still perceived its usability in everyday clinical practice as difficult. The necessary next steps to improve the use of evidence-based clinical pathways seem to be: an economic and practicable design, easy accessibility of clinical pathways and the creation of framework conditions that facilitate their use in everyday practice.

Experiences made by family physicians managing patients with SARS-CoV-2 infection during spring 2020 - a cross-sectional analysis.

BACKGROUND: In Germany, family physicians care for about 85% of the patients infected with SARS-CoV-2. The geographic distribution of the first wave in 2020 was heterogeneous, and each federal state experienced different percentages of patients that died from COVID-19. Each of the 16 federal states implemented its own regulation about medical care for SARS-CoV-2 infected patients. Against this background, the objective of this analysis was to gather experiences made by primary care physicians managing SARS-CoV-2 infected patients during the first wave in March 2020 and to clinically characterize these patients. METHODS: In total, 5,632 physicians were invited to participate in an online questionnaire surveying routine data regarding the general care situation at the physician practice level and the care for patients infected with SARS-CoV-2. Bivariate and multivariate analyses were applied to characterize treatment experiences and to identify patient characteristics predicting the course of disease. RESULTS: 132 family physicians from all German federal states (except from Berlin) participated in this analysis (response rate 2.3%) and provided routine care data for 1,085 patients. Information from 373 of these patients were provided in greater detail. On average, each physician treated 8.5 patients infected with SARS-CoV-2. About 15% of the physicians used video consultations to communicate with their infected patients. More than 82% made positive experiences with the exceptional regulation to provide a certificate of incapacity to work by telephone. Half of the physicians faced equipment insufficiencies due to a lack of protective gear, and in 10% of the practices, the staff themselves acquired SARS-CoV-2 infection. Greater numbers of SARS-CoV-2 cases treated in a practice translated into higher odds for members of the practice to get infected (odds ratio (OR) 1.03, 95% CI [1.01;1.06]). Older persons, males and patients in rural areas had higher odds of a severe course of disease. CONCLUSIONS: Our results show that a large percentage of primary care physicians additionally managed their COVID-19 patients remotely by telephone or video during the outbreak, while also being at a higher risk for SARS-CoV-2 infection. Further, the increased severity in rural areas underlines the importance of strong primary health care in order to enable hospitals to concentrate on critically ill patients.

[How do young general practitioners experience the transition to general practice? A qualitative study]. / Wie erleben junge Allgemeinärzt*innen den Übergang in die hausärztliche Praxis? Eine qualitative Studie.

BACKGROUND: Although the role of general practice has been strengthened in recent years, undergraduate teaching at medical schools and the clinical phase of specialist training remain dominated by specialized care of seriously ill people in hospitals. It is to be assumed that young doctors' views on medical care are strongly shaped by this clinical focus. OBJECTIVE: To investigate how young general practitioners (GPs) perceive transition from medical school and hospital work to general practice. METHODS: In a qualitative study, a total of 13 physicians in specialist training for general practice as well as general practitioners who had completed their specialist examination up to two years ago participated in problem-oriented interviews. The interviews were analyzed using content analysis. RESULTS: The significant differences between hospital-based and primary care practice initially came as quite a shock to the study participants. Key differences and challenges compared to working in a hospital included: 1) the totally different type of patients or complaints they faced; 2) learning that in many situations one can and should bide one's time ("wait-and-see" approach); 3) ruling out avoidable dangerous developments in patients reliably and coping with the corresponding residual risk; 4) the discovery that sometimes it makes sense not to make a diagnosis; 5) that the doctor-patient relationship should be more cooperative in general practice; and 6) that GPs are often under pressure to act although there is no clear need for taking action or no clear treatment option from a medical and scientific point of view. CONCLUSIONS: Our findings confirm that young doctors' initial views on medical care are strongly shaped by the clinical focus of medical schools and hospital work. Working in general practice is perceived as being very different from working in a hospital.

[The risk of re-identification when analyzing electronic health records: a critical appraisal and possible solutions]. / Das Risiko von Re-Identifizierung bei der Auswertung medizinischer Routinedaten ­ Kritische Bewertung und Lösungsansätze.

BACKGROUND AND OBJECTIVES: The use of primary care data gathered from electronic health records in local practices could be an important building block for the future of health services research. However, the risks and reservations associated with using this data for research purposes should not be underestimated. We show the data protection and privacy problems that may arise through secondary analysis of routine primary care data and describe the technical solutions that are available to address these concerns - as a trust-building measure. METHODS: We screened 40 variables that are deemed important for documentation in the electronic health records of primary care physicians and rated the risk of patient re-identification when using these records from routine medical data for research purposes. The criteria used to rate the risk of re-identification were "expert perception" (inferences of a professional observer of phenotypical characteristics which are documented in the 40 variables), "researchable additional knowledge" (knowledge of characteristics of a person through publicly available information and social media networks), and "statistic frequency" according to diagnosis and medication statistics. RESULTS: Diagnoses and reasons for contacting a general practitioner can contain particularly identifiable characteristics such as "obesity" (ICD-10 E66) and "nicotine dependence" (F17). About half of all ICD codes documented in primary care fall below a critical threshold value in their absolute frequency; this is all the more problematic if diagnoses allow for re-identification due to phenotypical characteristics. Medication information holds little potential risk of re-identification of a person. However, the application of medications could be a source of re-identification, e. g., self-injections of insulin or use of inhalators. Information about times and dates are especially sensitive for the re-identification of a person. Sex and age of a patient generally pose no problems, except in the case of very young or very old individuals when these age groups are seldom represented in the practice. DISCUSSION: Routine health data are, in principle, sensitive data. Knowledge about the variables in primary care data gathered from electronic health records in local practices and the evaluation of this data allow us to more accurately estimate the risk of re-identification for the persons concerned. In particular, chronic diagnoses and/or diagnoses in long text, calendar dates for patient contacts and therapies bear a high risk of re-identification. Technical measures such as removing data, masking values and coding should make re-identification considerably more difficult. There will always be a remaining risk of re-identification which should be openly discussed to counteract concerns about a lack of data protection or a sweeping critique of digitization in healthcare.

The Choosing Wisely Initiative: A critical analysis with a special focus on primary care.

The Choosing Wisely initiative (CWI), a campaign led by the American Board of Internal Medicine (ABIM) Foundation, promotes doctor-patient communication and reducing waste in healthcare. At present, many of the top 5 lists from the Choosing Wisely Initiative appear to be primarily eminence-based and influenced by self-interest. The implementation of recommendations from these lists may mean taking a step backwards to the time before evidence-based medicine. On the other hand, despite all the challenges that the Choosing Wisely initiatives are currently facing, it is difficult to deny that they also hold great potential in terms of making healthcare systems more efficient and beneficial to patients. The aim of the ongoing work in Germany and Austria is to create conditions that are necessary if CW initiatives are to evolve into a model tool that will help introduce the principles of evidence-based medicine into daily practice.

[General practitioners' commitment to treating excessive alcohol consumption: A question of role security in treating affected patients?]. / Hausärztliche Bereitschaft zur Intervention bei zu hohem Alkoholkonsum: Eine Frage der Sicherheit im Umgang mit betroffenen Patienten?

Only a few general practitioners (GPs) are committed to screen their patients for alcohol consumption and, in case of excessive alcohol consumption conduct by a brief intervention according to WHO recommendations. Apart from inadequate compensation and work load, another barrier identified by the GPs was their uncertainty about how to deal with affected patients. Most German universities presently spend no more than 90minutes lecture time on addiction medicine teaching. Our research aims to investigate the question whether medical studies and advanced medical education increases the role security of medical students and physicians and their commitment to implementing alcohol screening and brief intervention. Moreover, we will explore whether lack of therapeutic commitment can be related to lack of role security. Questionnaires were administered to pre-clinical and clinical medical students as well as senior house officers. Role security and therapeutic commitment of students and senior house officers were assessed using the Alcohol and Alcohol Problems Questionnaire (SAAPPQ) subscales "Role Security" and "Therapeutic Commitment". Analysis was based on 367 questionnaires. As expected, senior house officers reported more Role Security than clinical medical students who showed a higher level of Role Security than pre-clinical medical students. No differences could be found for Therapeutic Commitment. An association between Role Security and Therapeutic Commitment was only revealed for clinical medical students. Medical studies and advanced medical education can increase students' and senior house officers' Role Security to treat patients with excessive alcohol consumption, but not Therapeutic Commitment. Moreover, no association between Role Security and Therapeutic Commitment could be found for senior house officers. Hence, it may be assumed that educational activities aiming to increase Role Security do not promote the development of motivational aspects such as Therapeutic Commitment to the management of patients with excessive alcohol intake.

[(Expected) Consultation length, mental (co-)morbidity and patient satisfaction in the family practice encounter]. / (Erwartete) Konsultationsdauer, psychische (Ko-)Morbidität und Zufriedenheit mit dem ärztlichen Gespräch in der Hausarztpraxis.

INTRODUCTION: Mental disorders are common in family practice, but their meaning for variables of consultation is rarely considered. Thus, we examined the influence of mental disorders on patients' expectations regarding time, openness and seriousness as well as ratings of satisfaction with the consultation. METHODS: Prior to consultation for 219 patients a screening for anxiety (GAD-7), depression (PHQ-9) and hypochondriasis (WI-7) was performed. Before and after the consultation patient expectations and ratings were recorded. Subgroup analysis was based on Mann-Whitney U tests. RESULTS: Almost half of the sample were screen-positive. Prior the consultation, screen positive patients had higher ratings for expectations compared with screen negative patients, but did not differ in their experiences after the consultation. There was no association between consultation length and ratings for satisfaction. DISCUSSION: Patients screened positive for mental disorders do not necessarily require longer consultation length, if their expectations regarding openness and seriousness are met. This is underlines the importance of communication skills in undergraduate medical education and specialist training for future GPs.

[Diagnosis in context - broadening the perspective]. / Diagnose im Kontext - eine erweiterte Perspektive.

In a primary care setting the diagnostic process typically starts with a symptom or sign reported by the patient. Primary care physicians face the challenge to consider a broad spectrum of possible aetiologies or differential diagnoses when choosing appropriate diagnostic tests. The classical diagnostic cross-sectional study investigates the accuracy of a diagnostic test or a combination of several tests in regard to just one target disease. The complexity facing the clinician remains unconsidered or is being split and presented in several parts which the clinician has to combine. In this paper we suggest a design for diagnostic studies that considers the requirements of diagnosis in primary care more comprehensively: the comprehensive diagnostic study. The essential characteristic of the design is the simultaneous consideration of the whole spectrum of relevant aetiologies when evaluating several diagnostic tests. We present single characteristics and specific features of this design in regard to research question, study sampling, index test, reference standard and analysis, and illustrate them using the example of a study investigating chest pain in primary care.