Understanding health care pathways of patients with sepsis: protocol of a mixed-methods analysis of health care utilization, experiences, and needs of patients with and after sepsis.

BACKGROUND: Sepsis is associated with about 20% of deaths worldwide. It often presents with non-specific initial symptoms, making its emergency treatment an interdisciplinary and cross-sectoral challenge. Three in four sepsis survivors suffers from new cognitive, psychological, or physical sequelae for which specific treatment concepts are scarce. The AVENIR project aims to improve the understanding of patient pathways, and subjective care experiences and needs along the entire healthcare pathway before, with and after sepsis. Based on this, concrete recommendations for the organization of care and patient information materials will be developed with close patient participation. METHODS: Mixed-methods study including (1) analysis of anonymized nationwide health claims data from Germany, (2) linkage of health claims data with patient care reports (PCR) of emergency medical services from study regions in two federal states within Germany, and (3) qualitative exploration of the patient, relative, and care provider perspective on sepsis care. In (1), we analyze inpatient and outpatient health care utilization until 30 days pre-sepsis; clinical sepsis care including intra- and inter-hospital transfers; and rehabilitation, inpatient and outpatient aftercare of sepsis survivors as well as costs for health care utilization until 24 months post-sepsis. We attempt to identify survivor classes with similar health care utilization by Latent Class Analyses. In (2), PCR are linked with health claims data to establish a comprehensive database outlining care pathways for sepsis patients from pre-hospital to follow-up. We investigate e.g., whether correct initial assessment is associated with acute (e.g., same-day lethality) and long-term (e.g., new need for care, long-term mortality) outcomes of patients. We compare the performance of sepsis-specific screening tools such as qSOFA, NEWS-2 or PRESEP in the pre-clinical setting. In (3), semi-structured interviews as well as synchronous and asynchronous online focus groups are conducted and analyzed using qualitative content analyses techniques. DISCUSSION: The results of the AVENIR study will contribute to a deeper understanding of sepsis care pathways in Germany. They may serve as a base for improvements and innovations in sepsis care, that in the long-term can contribute to reduce the personal, medical, and societal burden of sepsis and its sepsis sequelae. TRIAL REGISTRATION: Registered at German Clinical Trial Register (ID: DRKS00031302, date of registration: 5th May 2023).

[Determinants of the utilization of cancer screening among older adults in Saxony-Anhalt-What is the influence of health literacy?] / Determinanten der Inanspruchnahme der Krebsfrüherkennung von älteren Erwachsenen in Sachsen-Anhalt ­ Welchen Einfluss hat die Gesundheitskompetenz auf die Inanspruchnahme?

BACKGROUND: In order to preserve health and thus social participation, it is important for older people to make health-related decisions, such as those regarding the use of a secondary prevention service like cancer screening. National and international studies show that various predictors determine cancer screening participation. The aim of this study is to determine the cancer screening utilization of older people in a structurally weak region. METHODS: In 2021, a cross-sectional study in each of two urban and rural communities in Saxony-Anhalt surveyed individuals aged 55 years and older about determinants, reasons, and barriers to preventive service use (n = 954). Binary logistic regression analysis is used to analyze determinants of cancer screening use. RESULTS: Three quarters of the study population (76.6%) self-reported participating in a cancer screening service at least once. The multivariable analyses demonstrate factors that influence the utilization of cancer screening. Age, partial knowledge on cancer screening, cancer screening as a benefit offered by a statutory health insurances' bonus program, experience with cancer in the immediate environment, thoughts about one's own health, and the feeling of security that participation gives are factors that significantly influence the use of cancer screening. Descriptively, the physician's recommendation is the strongest factor for participation. CONCLUSION: The analyses show that cancer screenings are generally well received by older people in Saxony-Anhalt, but participation in them is not related to health literacy. In keeping with the National Cancer Plan, older people should generally be supported in making an informed decision, for example, through target-group-specific physician education.

Digital Health Information Provided by Public Health Stakeholders on Colorectal Cancer Screening: A Systematic Evaluation.

In the federal state of Germany, Saxony-Anhalt, colorectal cancer is the second most frequent cause of death among cancer patients. In order to identify cancer precursors early, colorectal cancer screenings are essential. In this context, health information contributes to informing individuals and imparting them with necessary knowledge to make a decision about (non-)utilization of preventive services. Numerous public health stakeholders (e.g., statutory health insurances) provide health information. This study aimed to evaluate the quality of web-based health information offered by public health stakeholders in Saxony-Anhalt, Germany. A systematic evaluation was used. A search was performed using pre-defined eligibility criteria and search terms. Two independent reviewers assessed the search results based on seven main categories (60 items) developed by the study team in line with the "Guideline Evidence-based Health Information". In total, 37 materials from 16 different stakeholders were included and yielded a "mediocre quality" (median = 69%). The materials had only partially fulfilled the requirements of national recommendations for evidence-based health information. Access to digital health information regarding colon cancer screening was unsatisfactory, especially for individuals with auditory or visual impairments, due to use of inappropriate communication technologies. Further efforts are required to improve digital health information about colorectal cancer screening.