Organisational Health Services Research in Germany: A Scoping Review of Conference Abstracts. / Organisationsbezogene Versorgungsforschung in Deutschland: Ein Scoping Review von Konferenz-Abstracts.

BACKGROUND: Health Services Research (HSR) is a growing field in Germany, in which Organisational Health Services Research (OHSR) has emerged as a subfield. The aim of this scoping review was to provide an overview of the field of OHSR within HSR in Germany and to map systematically original contributions by describing the organisational setting, the research design, the research objectives and the theoretical underpinning. METHODS: A scoping review examined published abstracts from the 19th German Conference on Health Services Research 2020. Abstracts were included if (1) health care organisations, subunits or organisational processes were mentioned as research objects, and (2) if at least one out of five research perspectives from a recent German definition of OHSR was addressed. After intensive pilot screenings within a group of nine researchers, all abstracts were screened independently in three review teams with three researchers each, and data from included abstracts were extracted using content analysis based on a self-developed detailed coding scheme. RESULTS: Out of n=468 identified abstracts in German (84%) or English (16%) language, n=138 (29.5%) abstracts were included. The majority of included abstracts addressed acute care in hospitals (34.8%), reported results from observational studies (59.4%) and collected primary data (69.6%). There was a slightly higher use of quantitative (32.6%) than qualitative (24.6%) research methods with a considerable number of studies using more than one method (31.9%). An explicit reference to theory was made in 7.2% and 17.4% used the term 'organisation' or related terms explicitly in their abstract. CONCLUSION: This review provides a systematic but preliminary overview of the scope to which HSR in Germany addresses OHSR. The organisational perspective is considered extensively in HSR abstracts, but mostly implicitly. The research is reported largely free of theory which can reduce their explanatory power. Therefore, a research agenda, more awareness as well as education and better conceptualisation of OHSR topics within German HSR are needed.

Navigating the Future of Organisational Health Services Research in Germany and beyond: a Position Paper. / Die Zukunft der organisationsbezogenen Versorgungsforschung in Deutschland und darüber hinaus ­ ein Positionspapier.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Increasing social disparities in obesity among 15 000 pre-schoolers in a German district from 2009 to 2019.

BACKGROUND: Although childhood obesity prevalence has stagnated in many high-income regions after decades of increase, it continues to be a major public health problem with adverse effects. The objective was to examine obesity trends as a function of parental social status to identify obesity disparities among children. METHODS: Data from school entry examinations from 2009 to 2019 of 14 952 pre-schoolers in one German district were used. Logistic regression models (obesity/overweight as dependent variable) and a linear regression [BMI z-score (BMIz) as dependent variable] were performed adjusted for social status and sex to investigate time trends in overweight and obesity. RESULTS: Overall, we found an increase of obesity over time [odds ratio (ORs): 1.03 per year, 95% CI: 1.01-1.06]. Children with low social status had an OR of 1.08 per year (95% CI: 1.03-1.13), while the trend was less expressed in children with high social status (OR: 1.03 per year, 95% CI: 0.98-1.08). The mean BMIz decreased per year (regression coefficient -0.005 per year, 95% CI: -0.01 to 0.0) when considering all children. This decrease was more pronounced in children with high social status (regression coefficient: -0.011 per year, 95% CI: -0.019 to -0.004), compared with a slight increase of 0.014 (95% CI: -0.003 to 0.03) per year among children with low social status. Also, children with low parental social status were heavier and smaller than their peers with high social status. CONCLUSIONS: Although the mean BMIz decreased among pre-schoolers, obesity prevalence and status-related inequity in obesity prevalence increased from 2009 to 2019 in the region studied.

[A case management questionnaire for family caregivers of geriatric patients]. / Ein Case-Management-Fragebogen für Angehörige geriatrischer Patienten.

BACKGROUND: To ease the burden for family caregivers healthcare concepts are urgently needed. The healthcare concept continuous care in a regional network (RubiN) offers a care and case management in physician networks for geriatric patients and aims to relieve family caregivers. The aim of the study was to develop and to test the psychometric properties of a questionnaire that evaluates the satisfaction and acceptance of the healthcare provided by case management (CM) from the perspective of family caregivers. METHODS: A mixed methods design was used to develop the questionnaire based on qualitative interviews, a literature search and own project experiences. After a pilot run the subsequent data acquisition took place in the participating RubiN physician networks from May to August 2020. Each of the 5 participating networks received a set of 50 questionnaires for family caregivers. The psychometric properties of the questionnaire were evaluated. RESULTS: The questionnaire consisted of 11 items. A total of 137 family caregivers participated in the survey (response rate 55%). Overall, the family caregivers were very satisfied (78.1%) with the care offered. There were only a few missing values in the data. The 11 items in the questionnaire loaded on 2 factors. The first factor called effects from coordination showed an internal consistency of 0.843 and for the second factor called accessibility an internal consistency of 0.683 was observed. CONCLUSION: The questionnaire with 11 items is characterized by its brevity and includes the acceptance and satisfaction of the care elements offered for family caregivers in a geriatric CM.

[DNVF-Memorandum III - Methods For Health Services Research, Part 4 - Concept and Methods For Organizational Health Services Research. Chapter 1 - Definition and Concept of Organizational Health Services Research]. / DNVF-Memorandum III ­ Methoden für die Versorgungsforschung, Teil 4 ­ Konzept und Methoden der organisationsbezogenen Versorgungsforschung. Kapitel 1 ­ Definition und Konzept der organisationsbezogenen Versorgungsforschung.

Organizational health services research is still a relatively young field of research in Germany which is of increasing interest. The German Network Health Services Research e.V. (DNVF e.V.) published in 2009 - supported by expert associations and individual members of the DNVF - a guide on "Methods for organizational health services research" of the Memorandum III, part 1[1]. Originating from this publication and facilitated by the increasing relevance of the field, a necessity to refine the conceptual and methodological basis became evident. The update and extension of the publication from 2009 consists of three chapters: (1) Definition and concept of organizational health services research, (2) Methodological approaches in organizational health services research: indicators, data sources, data collection and data analysis, (3) Methodological approaches for the design, evaluation and implementation of complex interventions in health care organizations. The aim of the first chapter is to present the theoretical framing and the definition of terms and tasks within organizational health services research.

[DNVF-Memorandum III - Methods for Health Services Research, Part 4 - Concept and Methods for Organizational Health Services Research: Short Version]. / DNVF-Memorandum III ­ Methoden für die Versorgungsforschung, Teil 4 ­ Konzept und Methoden der organisationsbezogenen Versorgungsforschung: Kurzfassung.

Organizational health services research in Germany is of increasing relevance. Based on the guide on methods for organizational health services research of the Memorandum III, part 1 from the year 2009, the fundamentals and standards have now been refined. The memorandum captures the theoretical framework, basic methodological approaches and methods in health services research for the design, evaluation and implementation of complex interventions in healthcare organizations.

[Digital Information on Rehabilitation and Retirement for Physicians - A Practical Test]. / Digitale Bereitstellung von Informationen für Ärzte zum Thema Rehabilitation und Rente ­ ein Praxistest.

BACKGROUND: About 1.6 million rehabilitation applications are submitted to the German pension insurance annually. Physicians working in ambulatory care play an important role in the application process. Studies show that there is too little knowledge about medical rehabilitation in these groups of physicians, the detection of rehabilitation needs and the process of application for rehabilitation. Against this background, a website Information for Doctors on Rehabilitation & Retirement was developed which addresses especially these needs. The aim of the study was to evaluate the website within a practical test. METHODS: The practical test was performed with a mixed Methods Approach: 1) Quantitative survey with respect to increased knowledge after using the homepage, 2) assessment of cases with regard to rehabilitation indication and 3) evaluation of the user friendliness of the homepage by participating doctors by means of think-aloud technique. RESULTS: A total of 79 postgraduate General Practice trainees participated. They had high information needs regarding different aspects of rehabilitation, which were partly satisfied by the use of the homepage. The correct assessment of rehabilitation cases improved with the aid of the website for general practitioners with experience with application for rehabilitation only. The homepage was evaluated as clear and helpful, but the texts were judged as too extensive. CONCLUSION: The homepage can support physicians working in ambulatory care with respect to rehabilitation. Some impulses for optimization of the content have been identified and can help to further increase the usefulness of the website.

[Experience with orthopaedic insoles-a cross-sectional study]. / Erfahrungen mit der orthopädischen Einlagenversorgung ­ Eine Querschnittsstudie.

BACKGROUND: Orthopaedic insoles (OI) are used to treat a variety of foot problems. OBJECTIVES: The aim of this cross-sectional study was to investigate the perceptions of the treatment with OI among the manufacturers of the OIs, the orthopaedic technicians (OT). METHODS: OT from the federal states of Schleswig-Holstein and Lower Saxony in Germany were invited to take part in a survey. The questions included, among others, the number of prescriptions for the production of an OI per month and the materials used. Descriptive statistics, subgroup analyses and a linear regression analysis were performed. RESULTS: Of the 312 questionnaires distributed, 159 were completed (response rate 51%). Most of the respondents were male (80%). The average age of the participants was 50. On average, OT produced 290 OI per month, with plastic being the most commonly used material (73%). OT with less than 20 years of professional experience are more likely to follow the doctor's instructions when producing OI than OT with more than 20 years of professional experience. The latter are more likely to base their decisions regarding the manufacture and issuing of OI on their own experience. CONCLUSIONS: The production and issuing process of OI differs among OT. The different professional perspectives of the OT could play a role here, as does the lack of a standardized procedure. The factors listed in this study represent potential starting points for future research projects that could contribute to the development of evidence-based standards.

Explaining the health system in a practical way - the use of a simulation game in medical sociology teaching.

Objective: A simulation game is a valuable method for conveying teaching content in a practical way. The aim was to design a teaching module for medical sociology on the subject of "The German health care system" which would convey the contents and connections to the students in a practical way using a simulation game. Project description: In addition to the development of scenarios for the simulation game, role cards for various institutions of the health care system were also produced as a result. The students were given the opportunity beforehand to work on theoretical content regarding the German health care system online (the "flipped classroom method"). In the 90-minute face-to-face event the simulation game was played, followed by a feedback session. The initial impressions of the students were collected. Results: In the 2022 summer semester, a total of 185 students from the 4th pre-clinical semester took part in the seminar. The students were divided into twelve seminars. One scenario was worked on per seminar. The simulation game contributed to a better understanding of the health care system. The students were generally very satisfied with this type of knowledge transfer and thought that this method might well be integrated into teaching in the future. Conclusion: Communicating the health care system through a simulation game is evidently suitable for explaining clearly complex issues and presenting the various interests of the individual institutions. In addition, a simulation game stimulates critical debate and can contribute to imparting theoretical content in teaching medical sociology in a practical way.

[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.

[Fit for the Future: Development of a seminar on aspects of digitization of healthcare as a contribution of Medical Sociology]. / Fit for the Future - Entwicklung eines Seminars zu Aspekten der Digitalisierung im Gesundheitswesen als Beitrag der Lehre im Fach Medizinische Soziologie.

INTRODUCTION: Topics regarding the digitization of the healthcare system are hardly being addressed during the undergraduate training of medical students, even though the promotion of skills in this area has been defined as a learning goal in the German National Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM) since 2015. At the same time, telemedicine as one part of digitization is becoming increasingly important in the public perception as a tool supplementing access to care. Therefore, the aim was to give medical students in the fourth pre-clinical semester a first insight into topics of telemedicine and other aspects of digitization in the healthcare sector as part of a seminar. METHODS: On the basis of the existing literature, we developed the content and a didactic concept for the seminar "The doctor-patient relationship in the field of technological developments" in the Medical Sociology course for undergraduate medical students in their second year at the University of Lübeck. Inspired by Kirkpatrick's four-level model, the students were asked for topics they wished to cover regarding the digitization of healthcare and telemedicine at the start and their attitudes towards and experiences with telemedicine at the end of the seminar. RESULTS: A total of 184 students from the fourth pre-clinical semester attended the seminar. The survey response rate was 32%. The topics most frequently requested by students were "Legal Framework", "Electronic Patient Record" and "Tele-consultation". 85% of the students rated the topic "digitization of healthcare" as highly relevant for their future profession. Also 85% of the students wished for easy-to-use telemedicine equipment. A third or more of the students reported considerable uncertainty about their ability to evaluate the benefits of health apps. CONCLUSIONS: The contents of the seminar met the students' demands. In the future, topics relating to the digitization of the health system should be increasingly integrated into undergraduate training; also, the students' feeling uncertain about their ability to assess various telemedical applications should be addressed.

[The "Allgemeinarztbarometer A" - an instrument to assess primary care competencies during medical education and training]. / Das Allgemeinarztbarometer A ­ ein Instrument zur Erhebung von primärärztlichen Kompetenzen in der medizinischen Ausbildung.

INTRODUCTION: The primary goal of medical education and training is to develop clinical competencies. Competency-based curricula exist for both medical education which - once the current reform is implemented - will be geared more towards primary care, and specialty training for General Practice. The "Allgemeinarztbarometer" is a German-language instrument to assess primary care competencies during specialty training and has so far been mainly used as a self-assessment tool. The aim of this study was (i) to test the application of the "Allgemeinarztbarometer" in the context of medical education as an external assessment tool (in its "Allgemeinarztbarometer A [ABA]" version) and (ii) to evaluate its basic psychometric properties. METHODS: Physicians involved in teaching were asked to assess medical students after a two-week internship in General Practice during their fifth year of study using the ABA (9-item external assessment version). After data processing and displaying basic distributions, we conducted exploratory factor analysis, followed by confirmatory factor analysis. The detected factor structure was then tested for internal consistency. RESULTS: A total of 150 completed questionnaires were included in the analysis. One item showed a high number of missing values (response option "Not assessable"). Exploratory factor analysis indicated a two-factor structure ("Patient-oriented skills" and "General Practice decision-making"). Three items were not unambiguously assignable and hence erased. Confirmatory factor analysis validated the identified factor structure. The two factors showed a Cronbach's α of 0.73 and 0.84 (moderate to very good internal consistency). DISCUSSION: Our study provides a first analysis of the ABA in the context of medical education. The detected two-dimensional structure shows a high goodness-of-fit when giving up three items still used in this survey. The analysis of missing data showed a high number of "I can't say" answers when assessing the development of strategies against burnout. CONCLUSIONS: The ABA (6-item version) seems to be a suitable tool for the external assessment of General Practice competencies in the context of medical education. Further studies are needed to evaluate both the completeness of the assessment and the external assessability of certain items in the context of medical education.

[The "National Aeronautics and Space Administration-Task Load Index" (NASA-TLX) - an instrument for measuring consultation workload within general practice: evaluation of psychometric properties]. / Der "National Aeronautics and Space Administration-Task Load Index" (NASA-TLX) ­ ein Instrument zur Erfassung der Arbeitsbelastung in der hausärztlichen Sprechstunde: Bestimmung der psychometrischen Eigenschaften.

OBJECTIVE: The aims of the study were the translation and a first reflection of the psychometric properties of the Aeronautics and Space Administration-Task Load Index (NASA-TLX), a multidimensional instrument to measure workload in general practice. METHODS: During April and September 2015, the NASA-TLX was translated and evaluated. For this purpose, a questionnaire composed of the NASA-TLX items and others items related to demographic data, was developed. Postgraduate family medicine trainees and family physicians were then asked to assess patient consultations by applying the questionnaire. The psychometric properties of the NASA-TLX were identified using explorative and confirmatory factor analysis. Reliability was assessed using Cronbach's α. RESULTS: Overall, 16 participants completed 769 surveys after a single patient consultation. The highest average was observed for the item 'mental demand' (mean 6.9 ± 5.4), followed by the item 'effort' (mean 6.6 ± 5.5). Factor analysis revealed a one-factor solution with an explained variance of 56.9 %. The German version of NASA-TLX demonstrated a high internal consistency (Cronbach's α = 0.84). Confirmatory factor analysis showed that there was an acceptable consistency between the expected unidimensional structure and the data. CONCLUSIONS: The German version of NASA-TLX provides preliminary indications of psychometric properties and presents an important tool to evaluate family physicians' workload in direct patient contact.

["The Crutch is in the corner  " - Experience of Mental Ill People with Cross-Sectoral Care in Integrated Care - A Qualitative Study]. / "Die Krücke steht in der Ecke  " ­ Erfahrungen psychisch kranker Menschen in einem Versorgungsmodell der ambulanten sektorenübergreifenden vernetzten Versorgung.

The aim of the qualitative study was the evaluation of experiences with integrated care especially with the care in network "NetzWerk psychische Gesundheit" (NWpG) from the perspective of mental ill patients. The patients were recruited from the NWpG. Focus groups were conducted in five of these networks and analyzed with qualitative content analysis. 40 mental ill patients participated on the focus groups. Overall, they were very positive about their care in such a network. Especially, aspects like need orientation, 24/7 telephone hotline, involvements of relatives as well as outreach care has been experienced as a support for their own care. The health care in NWpG seems to be important for an independent existence and presents relevant components for an autonomous life.

Neuregulin-1 mutant mice indicate motor and sensory deficits, indeed few references for schizophrenia endophenotype model.

Neuregulins (Nrg) are a gene family that binds to tyrosine kinase receptors of the ErbB family. The protein of Nrg1 is to be involved in heart formation, migration of neurons, axonal pathfinding and synaptic function. A relation between Nrg1 and schizophrenia is assumed. Chronic impairment in schizophrenia is characterized by different positive and negative symptoms. Detectable markers of this disease in human and in animal models are activity, social behavior and sensory processing. In this study we compared heterozygous Nrg1 mutant mice in behavior and quantification of dopaminergic and serotoninergic neurons with wild type-like littermates. In the Nrg1 mutant mice the epidermal growth factor-like domain is replaced by the neomycin resistance gene. We found significant differences in locomotor and pain perception behavior. No differences were found in specific schizophrenia social interaction and prepulse inhibition behavior. The number of dopaminergic and serotoninergic neurons did not differ in the investigated regions ventral tegmental area, substantia nigra, periaqueductal grey and raphe nuclei. In conclusion, this analyzed Nrg1 mutant mice model did not serve as a complete schizophrenia model. Particular aspects of schizophrenia disease in locomotor and sensory behavior deficits could represent in this Nrg1 mutant mice. Beside several different models could Nrg1 deficiency represent an endophenotype of schizophrenia disease.

["Hope Dies Last  " - Cross-Sectoral Cooperation in Integrated Care]. / "Die Hoffnung stirbt zuletzt  " ­ sektorenübergreifende Kooperation in der Integrierten Versorgung.

Objective Multiple models of Integrated Care (IC) have been implemented in German mental health services in the last decade in order to improve cross-sectoral, interdisciplinary cooperation. This study investigates an IC network model providing home treatment, case management and a 24/7 hotline. The aim of the study was to explore how health professionals working in this service model perceive both cooperation within their facilities and with external stakeholders. Methods 5 focus groups with 39 health professionals working in an IC mental health network were conducted and analyzed with qualitative content analysis. Results Focus groups participants reported on excellent cooperation within their facilities. The cooperation with external stakeholders, i. e. physicians, psychotherapists and psychiatric clinics, leaves room for improvement. Conclusions Until now little consideration has been given to the perspectives of health professionals. Cooperation within IC mental health networks seems to be effective. Cooperation with stakeholders outside the networks needs to be enhanced.

[Structured Outpatient Care in a New Orthopaedic Healthcare Program: Patients' Experiences as Criterion for Quality]. / Strukturierte ambulante Patientenversorgung im Facharztvertrag Orthopädie: die Erfahrungen der Patienten als Qualitätskriterium.

Background In 2015 a survey was conducted in Baden-Württemberg (Germany) among patients treated by orthopaedic specialists participating in a medical specialists' contract between doctors and statutory health insurance funds, in accordance with § 73c of the German Social Code, Book V (SGB V). This contract aims to improve orthopaedic care by structured cooperation between orthopaedic specialists and general practitioners, who are the central coordinators of care, and refer patients to a specialist if necessary. The program is intended to achieve patient-centred care by taking into account the physical, psychological and social aspects of the patients' orthopaedic complaints, as well as informing and motivating patients for self-management and health promoting activities. The survey was intended to receive feedback on the quality of care from the patients enrolled in this medical specialists' program, particularly concerning the specific aims of the program. A feedback report with individual results and a comparison with the overall results of all participating medical practices was sent out to those practices that provided at least 20 analysable questionnaires. Material and Methods The anonymous survey was conducted using a questionnaire specifically developed for the project. Participating practices handed out questionnaires to up to 100 patients who were enrolled in the program and consulted their orthopaedic or surgical specialist within 3 months of the start of the survey. Completed questionnaires were collected and sent to the research institute for data analysis in a sealed box. Results A total of 10,010 patients from 267 practices took part in the survey. Data analysis (including an anonymous comparison of the results of participating practices) was conducted on the basis of patients' responses from 183 practices that had obtained at least 20 completed questionnaires (8,988 patients, response rate 49.1%). Survey results are presented on doctor-patient communication, scheduling appointments, waiting times, cooperation with general practitioner, referral and treatment. On the whole, patients were satisfied with the care provided by their orthopaedic or surgical specialist. The comparison between the practices revealed significant differences in the patients' sociodemographic features and their feedback on the medical care received. Patients' evaluation of information and the counselling received from their orthopaedic/surgical specialist showed the strongest correlation with overall satisfaction. Referral by their general practitioner had a positive influence on patients' intentions to consult their orthopaedic/surgical specialist again. From the patients' point of view, doctors' information and counselling on self-help activities (e.g. eating habits, physical activity) had the largest potential for improvement. Conclusions The survey's results confirm the objectives of this new orthopaedic health care program, especially motivational counselling on adequate physical activity and self-management. They provide a basis for the further development of the quality of care, in accordance with both the contractual aims and the patients' needs.

[Manual medicine from the user's perspective: a qualitative study with physicians]. / Manuelle Medizin aus Sicht der Anwender: Eine qualitative Studie mit Ärzten.

BACKGROUND: Manual medicine (MM) has high importance in the ambulant treatment of complaints of the musculoskeletal system. Although there are several randomized controlled trials and meta-analyses, evidence about its efficacy is limited due to different organizations offering MM courses teaching different techniques. The aim of this study was to gain an understanding of the motivation and experiences of physicians using MM in daily practice. METHODS: In a qualitative study, 21 semi-structured phone call interviews were performed with physicians who have an additional qualification in MM. Recruitment was done by sending an e-mail to every physician listed on the homepage of the German Society for Manual Medicine or known to be interested in MM research from a previous study. Interviews were performed, recorded, transcribed and evaluated content-analytically using the software program Atlas.ti. RESULTS: One of the main motivations for using MM therapy was a better doctor-patient relationship because of improved patient access, with often rapid treatment success. Further advantages were the relative simplicity of the method, the independence from spatial or apparatus conditions and the associated low costs. Positive factors discussed as directly influencing the satisfaction with MM are the possibility to use own skills, the gratitude of the patient, and the possibility to influence the patient towards a healthy lifestyle. Factors negatively influencing the satisfaction were named as follows: the low gratification for the therapy, heterogeneous evidence, the indication in often self-limiting diseases, the risk of serious adverse effects and the risk of iatrogenic fixation. CONCLUSIONS: The results of this study show a wide range of mostly positive views and experiences of physicians when applying MM. The immediate curative action seems to be a welcome change for physicians who perceive the practice of their profession seen as distant from the patient.

[Benchmarking in ambulatory care practices--The European Practice Assessment (EPA)]. / Benchmarking in der ambulanten Versorgung am Beispiel des Europäischen Praxisassessments (EPA).

The European Practice Assessment (EPA) is a comprehensive quality management which consists of 220 indicators covering 5 domains (infrastructure, people, information, finance, and quality and safety). The aim of the project presented was to evaluate EPA as an instrument for benchmarking in ambulatory care practices. A before-and-after design with a comparison group was chosen. One hundred and two practices conducted EPA at baseline (t1) and at the 3-year follow-up (t2). A further 209 practices began EPA at t2 (comparison group). Since both practice groups differed in several variables (age of GP, location and size of practice), a matched-pair design based on propensity scores was applied leading to a subgroup of 102 comparable practices (out of the 209 practices). Data analysis was carried out using Z scores of the EPA domains. The results showed significant improvements in all domains between t1 and t2 as well as between the comparison group and t2. Furthermore, the results demonstrate that the implementation of total quality management and the re-assessment of the EPA procedure can lead to significant improvements in almost all domains.