Optimizing home-based long-term intensive care for neurological patients with neurorehabilitation outreach teams - protocol of a multicenter, parallel-group randomized controlled trial (OptiNIV-Study).

BACKGROUND: Even with high standards of acute care and neurological early rehabilitation (NER) a substantial number of patients with neurological conditions still need mechanical ventilation and/or airway protection by tracheal cannulas when discharged and hence home-based specialised intensive care nursing (HSICN). It may be possible to improve the home care situation with structured specialized long-term neurorehabilitation support and following up patients with neurorehabilitation teams. Consequently, more people might recover over an extended period to a degree that they were no longer dependent on HSICN. METHODS: This healthcare project and clinical trial implements a new specialised neurorehabilitation outreach service for people being discharged from NER with the need for HSICN. The multicentre, open, parallel-group RCT compares the effects of one year post-discharge specialized outpatient follow-up to usual care in people receiving HSICN. Participants will randomly be assigned to receive the new form of healthcare (intervention) or the standard healthcare (control) on a 2:1 basis. Primary outcome is the rate of weaning from mechanical ventilation and/or decannulation (primary outcome) after one year, secondary outcomes include both clinical and economic measures. 173 participants are required to corroborate a difference of 30 vs. 10% weaning success rate statistically with 80% power at a 5% significance level allowing for 15% attrition. DISCUSSION: The OptiNIV-Study will implement a new specialised neurorehabilitation outreach service and will determine its weaning success rates, other clinical outcomes, and cost-effectiveness compared to usual care for people in need for mechanical ventilation and/or tracheal cannula and hence HSICN after discharge from NER. TRIAL REGISTRATION: The trial OptiNIV has been registered in the German Clinical Trials Register (DRKS) since 18.01.2022 with the ID DRKS00027326 .

[The Delegation Agreement and its Implementation Inside and Outside the GP Office from the Perspective of Practice Owners]. / Die Delegations-Vereinbarung und ihre Umsetzung innerhalb und außerhalb der hausärztlichen Praxis aus Sicht der Niedergelassenen.

BACKGROUND: In many regions in Germany, demographic changes are affecting general practitioners (GPs). The 2017 "Delegation Agreement" (D-A) rolled out the 2015 reform and was introduced initially only for regions with GP shortages, allowing delegation to non-medical practice personnel for all regions in Germany. OBJECTIVES: This article explores GPs' knowledge regarding current regulations and the task-based delegation inside and outside their office. MATERIALS AND METHODS: We conducted a quantitative anonymous postal questionnaire survey of a randomized sample of 30% of GPs working in Nord Rhine-Westphalia. The response rate was 32%. Outcomes included attitude towards delegation, self-perceived level of information about the D-A and task-based attitude towards delegation (is being delegated/is not delegable) for 34 medical tasks. RESULTS: Over two-thirds of GPs had a positive attitude towards delegation, but only 24% reported having a good/very good level of Information regarding the D-A. "Diagnostic tasks" were most frequently delegated. Agreement on what can be delegated in the areas of "general tasks" and "counselling/education" showed significant differences based on level of information. Both well-informed and poorly informed GPs delegated in equal measure "therapeutic tasks". Two distinct groups of "diagnostic tasks" were distinguished based on GPs' information level. CONCLUSIONS: The list of tasks being currently delegated to PAs in the fields of "diagnostics", "organization/administration" and "general tasks" shows further potential for expansion. This could be supported by improved information communicated to GPs about the health policy reform introduced by the D-A.

Health and Healthcare Utilization among Asylum-Seekers from Berlin's LGBTIQ Shelter: Preliminary Results of a Survey.

BACKGROUND: LGBTIQ asylum-seekers face multiple health risks. Yet, little is known about their healthcare needs. In 2016, Berlin opened the only major shelter for LGBTIQ asylum-seekers in Germany. This preliminary study describes health and healthcare utilization by asylum-seekers living in Berlin's LGBTIQ shelter. To identify particular healthcare needs, we compared our results to asylum-seekers from other shelters. METHODS: We surveyed residents of the LGBTIQ shelter and 21 randomly selected shelters in Berlin, using a validated questionnaire in nine languages (n = 309 respondents, including 32 respondents from the LGBTIQ shelter). Bivariate tests and generalized linear mixed models were applied to examine differences in health and healthcare utilization between the two groups. RESULTS: Residents of the LGBTIQ shelter show high rates of chronic and mental illness. They use ambulatory and mental health services more frequently than asylum-seekers from other shelters, including a significantly higher chance of obtaining psychotherapy/psychiatric care in case of need. Emergency room utilization is also higher in the LGBTIQ group. CONCLUSIONS: Asylum-seekers from the LGBTIQ shelter face high chronic and mental health burdens. Tailored services in the LGBTIQ shelter help obtain adequate healthcare; they should be scaled up to maximize their potential. Yet, unmet needs remain and warrant further research.