A Qualitative Analysis of Cancer Patients' Perceptions of an Interprofessional Counseling Service on Complementary and Integrative Healthcare.

Medical guidelines recommend actively addressing patients' information needs regarding complementary and integrative healthcare (CIH). Within the CCC-Integrativ study, an interprofessional counseling program on CIH was developed and implemented at four comprehensive cancer centers (CCCs) in Germany. As part of the process evaluation, this study examines cancer patients' experiences with interprofessional CIH counseling sessions conducted by a physician and a nurse. Forty problem-centered interviews were conducted using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim, and analyzed using deductive-inductive content analysis based on Kuckartz and Rädiker's approach. Findings revealed that most participants had prior experience with CIH approaches and were burdened by physiological and psychological symptoms. Counseling sessions focused on cancer- and treatment-related symptoms and appropriate CIH recommendations (e.g., herbal poultice against anxieties and acupressure against nausea). Participants appreciated the mutual exchange and integration of perspectives from different healthcare professions within the interprofessional approach. They noted that the counseling team comprehensively addressed their healthcare and CIH information needs. Suggestions for improvement included the specificity of the CIH recommendations. As the participants only received counseling and no CIH treatments, information about reputable CIH providers was particularly important to many seeking advice. Patients with cancer receiving tailored CIH counseling from two healthcare professionals experienced benefits in CIH counseling for symptom management. The interprofessional teams offered a comprehensive perspective on patients' needs, proposing personalized recommendations for symptom control. These insights may foster collaboration between healthcare professionals interested in CIH counseling, enabling them to expand and consolidate their counseling services.

[Integrated Care for Patients with Somatic Symptom Disorder in Primary Care - A Qualitative Participatory Evaluation of a Randomised Feasibility Trial]. / Integrierte Behandlung von Patient*innen mit somatischer Belastungsstörung in Hausarztpraxen ­ Eine qualitative, patient*innenbeteiligende Evaluation einer randomisierten Machbarkeitsstudie.

OBJECTIVE: The VISION intervention is a manualized short-term treatment for people with somatic symptom disorder, integrated into the primary care and delivered by psychotherapists via video consultations. As an innovative technology-based approach, the intervention was most recently piloted in a randomized feasibility trial. During the qualitative accompanying study presented here, the intervention was evaluated and optimised from the user perspective of patients who participated in the feasibility study. METHODS: We interviewed a total of N=10 patients included in the intervention group in three semi structured focus group discussions focusing on how they (1) assess the intervention in terms of acceptance and individual benefit and (2) which adjustments are necessary from the user perspective for further optimization of the intervention. We performed a qualitative content analysis using MAXQDA Plus 2022. RESULTS: Respondents reported initial reservations on their part regarding care via video consultation. After a brief period of habituation, the intervention was universally accepted. Main suggestions for improvement included a stronger focus on supporting patients find follow-up psychotherapy (if indicated) more flexible settings (e. g., location of video consultation), and a stronger integration of treatment into primary care. DISCUSSION AND CONCLUSION: The study provides systematically elaborated comprehensive findings on participants' practical experiences with the intervention. The model is appropriate for treating people with somatic symptom disorder. Before implementation, important suggestions for improvement should be thoroughly considered with continued patient and public involvement.

Protocol for the process evaluation of a counselling intervention designed to educate cancer patients on complementary and integrative health care and promote interprofessional collaboration in this area (the CCC-Integrativ study).

BACKGROUND: Conducting a process evaluation is essential to understand how health interventions work in different healthcare settings. Particularly in the case of complex interventions, it is important to find out whether the intervention could be carried out as planned and which factors had a beneficial or hindering effect on its implementation. The aim of this study is to present the detailed protocol of the process evaluation embedded in the controlled implementation study CCC-Integrativ aiming to implement an interprofessional counselling program for cancer patients on complementary and integrative health care (CIH). METHODS: This mixed methods study will draw upon the "Consolidated Framework for Implementation Research" (CFIR) combined with the concept of "intervention fidelity" to evaluate the quality of the interprofessional counselling sessions, to explore the perspective of the directly and indirectly involved healthcare staff, as well as to analyze the perceptions and experiences of the patients. The qualitative evaluation phase consists of analyzing audio-recorded counselling sessions, as well as individual and group interviews with the involved persons. The quantitative evaluation phase applies questionnaires which are distributed before (T0), at the beginning (T1), in the middle (T2) and at the end (T3) of the intervention delivery. DISCUSSION: This protocol provides an example of how a process evaluation can be conducted parallel to a main study investigating and implementing a complex intervention. The results of this mixed methods research will make it possible to identify strengths and weaknesses of the team-based intervention, and to target more specifically the key factors and structures required to implement healthcare structures to meet patients' unmet needs in the context of CIH. To our knowledge, this study is the first applying the CFIR framework in the context of interprofessional CIH counselling, and its results are expected to provide comprehensive and multidisciplinary management of cancer patients with complex supportive healthcare needs.

Spirituality, Self-Care, and Social Activity in the Primary Medical Care of Elderly Patients.

BACKGROUND: Self-efficacy is decisive for the quality of life of elderly, multimorbid persons. It may be possible to strengthenpatients' self-efficacy can be strengthened by the targeted reinforcement of individual spirituality, social activity, and self-care.This hypothesis was tested with the aid of a complex intervention. METHODS: A non-blinded, exploratory, cluster-randomized, controlled trial was carried out, with primary care practices as therandomization unit (registration number DRKS00015696). The patients included were at least 70 years of age, had at least threechronic diseases, were taking at least three medications, and were participating in a disease management program. In theintervention group, primary care physicians took a spiritual history, and medical assistants advised the patients on the use ofhome remedies (e.g., tea, application of heat/cold) and on regionally available programs for the elderly. The primary endpoint-health-related self-efficacy, measured using the SES6G scale-and further, secondary endpoints were evaluated withmultistep regression analyses. RESULTS: Data from 297 patients treated in 24 primary care practices were evaluated. The analysis of the primary endpointindicated no effect (mean difference between study arms 0.30 points, 95% confidence interval [-0.21; 0.81], d = 0.14, p = 0.25).Subgroup analysis revealed the following situation for the secondary endpoint "mental well-being" (SF-12 subscale): patientswho had already been using home remedies before the trial began experienced a marked improvement (a difference of 7.3points on a scale from 0 to 100; d = 0.77, p < 0.001). This was also the case for patients who stated that spirituality played amajor role in their lives (a difference of 6.2 points on a scale from 0 to 100; d = 0.65; p = 0.002). CONCLUSION: The main hypothesis concerning health-related self-efficacy was not confirmed. The results of the analysis ofsecondary parameters indicate that some subgroups of patients can benefit from the interventional approach.

Self-Efficacy, Social Activity, and Spirituality in the Care of Elderly Patients with Polypharmacy in Germany-A Multicentric Cross-Sectional Study within the HoPES3 Trial.

About one third of Europe's elderly population takes ≥5 drugs. Polypharmacy increases their risk of adverse drug reactions. To ensure drug safety, innovative approaches are needed. The aim of this cross-sectional study was to explore the relationship between psychosocial factors and medication-related beliefs and behaviors. Medication lists of 297 patients were recorded according to the ATC classification. Correlations between the dependent variables, Medication Adherence (MARS) and Beliefs about Medicines (BMQ), and independent variables, General Self-Efficacy (GSE), self-efficacy for managing chronic diseases (SES6G), spiritual needs (SpNQ), patient activity (PAM), loneliness (DJG), and social networks (LSNS), were measured. Patients with higher self-efficacy (OR: 1.113; 95% CI [1.056-1.174]; p < 0.001) or self-confidence in managing their chronic condition (OR: 1.188; 95% CI [1.048-1.346]; p < 0.007) also showed higher adherence. Lonely patients (OR: 0.420; 95% CI [0.267-0.660]; p < 0.001) and those with a need for inner peace (OR: 0.613; 95% CI [0.444-0.846], p = 0.003) were more likely nonadherent. Stronger positive beliefs about medications' usefulness weakly correlated with higher scores on the SES6G (ρ = 0.178, p = 0.003) and GSES scale (ρ = 0.121, p = 0.042), patient activity (ρ = 0.155, p = 0.010) and functioning social networks scale (ρ = 0.159, p = 0.008). A weak positive correlation was found between loneliness and the belief that drugs were harmful (ρ = 0.194, p = 0.001). Furthermore, interesting correlations were detected regarding the number of medications and overuse beliefs. Psychosocial factors, such as self-efficacy, loneliness, and spiritual needs and medication-related beliefs and behaviors seem to interrelate. Addressing these factors may improve medication management and drug safety.

Acupuncture as Complementary Treatment for Acute Tinnitus: A Randomized Controlled Pilot Study.

BACKGROUND: Up to now, tinnitus has been an almost non-treatable symptom affecting more than 18% of the population in industrialized countries. So far, there are only a few studies evaluating the effectiveness of acupuncture in tinnitus treatment, none of which include acute tinnitus (<3 months). The aim of this pilot study was to explore the feasibility of recruitment and adherence to acupuncture conducted according to the principles of traditional Chinese medicine in patients with acute idiopathic tinnitus and to assess effect sizes on subjective and objective outcomes within a randomized controlled design. PATIENTS AND METHODS: After randomization patients of the control group received usual care (n = 23), and patients of the intervention group (n = 25) received 4 additional acupuncture treatments in a 4- to 6-week period. Tinnitus severity was assessed by means of a visual analogue scale as well as standardized and validated tinnitus questionnaires (Tinnitus Functional Index and 12-item Mini Tinnitus Questionnaire) at baseline and 6 weeks after. These subjective parameters were completed by tone audiometry. Comparisons of the groups were carried out using the Wilcoxon-Mann-Whitney test. RESULTS: Both groups were comparable without significant differences in baseline values. All outcomes, except for the overall well-being, showed better improvements in the intervention group with clinically significant differences from baseline to end point. However, among the outcomes only the subjective change in tinnitus severity showed a significant group difference. No serious side effects were observed. CONCLUSION: The design of our pilot study was feasible in terms of recruitment, although patient adherence to treatment remained challenging. However, considering the small intergroup differences, procedures regarding the numbers of acupuncture sessions and the total period of the acupuncture treatment should be reconsidered. The results of this pilot study provide a good basis for future confirmatory trials.

[Psychotherapeutic Video Consultations in Primary Care - Concept of the PROVIDE Intervention and Results on the Intent to Adopt in Psychotherapists]. / Videokonsultationen durch Psychotherapeuten in der Hausarztpraxis.

Mental health conditions represent a significant burden to the individual as well as the society. Within the health care system, the general practitioner is the first and, in most cases, the only provider. Timely referral of patients to specialized care is often difficult due to several barriers, particularly in rural areas. These barriers comprise long waiting times, the rising prevalence of psychosomatic and somatopsychic comorbidity, immobility in the elderly and stigmatisation related to mental health conditions. Following the Integrated Health Care approach, diagnosis and therapy of mental health conditions by psychotherapists directly within the general practice constitute an effective care model. We present a care model that is based on a telemental treatment approach for depression and anxiety disorders. Central is the piloting of psychotherapeutic video consultations in the general practice. The following article provides an overview of the care model and provides results concerning the intent to adopt the model in office-based psychotherapists.

Holistic care program for elderly patients to integrate spiritual needs, social activity, and self-care into disease management in primary care (HoPES3): study protocol for a cluster-randomized trial.

BACKGROUND: Strategies to improve the care of elderly, multimorbid patients frequently focus on implementing evidence-based knowledge by structured assessments and standardization of care. In Germany, disease management programs (DMPs), for example, are run by general practitioners (GPs) for this purpose. While the importance of such measures is undeniable, there is a risk of ignoring other dimensions of care which are essential, especially for elderly patients: their spiritual needs and personal resources, loneliness and social integration, and self-care (i.e., the ability of patients to do something on their own except taking medications to increase their well-being). The aim of this study is to explore whether combining DMPs with interventions to address these dimensions is feasible and has any impact on relevant outcomes in elderly patients with polypharmacy. METHODS: An explorative, cluster-randomized controlled trial with general practices as the unit of randomization will be conducted and accompanied by a process evaluation. Patients aged 70 years or older with at least three chronic conditions receiving at least three medications participating in at least one DMP will be included. The control group will receive DMP as usual. In the intervention group, GPs will conduct a spiritual needs assessment during the routinely planned DMP appointments and explore whether the patient has a need for more social contact or self-care. To enable GPs to react to such needs, several aids will be provided by the study: a) training of GPs in spiritual needs assessment and training of medical assistants in patient counseling regarding self-care and social activity; b) access to a summary of regional social offers for seniors; and c) information leaflets on nonpharmacological interventions (e.g., home remedies) to be applied by patients themselves to reduce frequent symptoms in old age. The primary outcome is health-related self-efficacy (using the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES-6G)). Secondary outcomes are general self-efficacy (using the General Self-Efficacy Scale (GSES)), physical and mental health (using the Short-Form Health Survey (SF-12)), patient activation (using the Patient Activation Measure (PAM)), medication adherence (using the Medication Adherence Report Scale (MARS)), beliefs in medicine (using the Beliefs About Medicines Questionnaire (BMQ)), satisfaction with GP care (using selected items of the European Project on Patient Evaluation of General Practice (EUROPEP)), social contacts (using the 6-item Lubben Social Network Scale (LSNS-6)), and loneliness (using the 11-item De-Jong-Gierveld Loneliness Scale (DJGS-11)). Interviews will be conducted to assess the mechanisms, feasibility, and acceptability of the interventions. DISCUSSION: If the interventions prove to be effective and feasible, large-scale implementation should be sought and evaluated by a confirmatory design. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00015696 . Registered on 22 January 2019.

The effects of an integrated supportive care intervention on quality of life outcomes in outpatients with breast and gynecologic cancer undergoing chemotherapy: Results from a randomized controlled trial.

The aim of the Complementary Nursing in Gynecologic Oncology study was to investigate the effects of a complex, nurse-led, supportive care intervention using Complementary and Integrative Medicine (CIM) on patients' quality of life (QoL) and associated patient-reported outcomes. In this prospective, pragmatic, bicentric, randomized controlled trial, women with breast or gynecologic cancer undergoing a new regimen of chemotherapy (CHT) were randomly assigned to routine supportive care plus intervention (intervention group, IG) or routine care alone (control group, CG). The intervention consisted of CIM applications and counseling for symptom management, as well as CIM information material. The primary endpoint was global QoL measured with the EORTC-QLQ-C30 before and after CHT. Mixed linear models considering fixed and random factors were used to analyze the data. In total, 126 patients were randomly assigned into the IG and 125 patients into the CG (median age 51 years). The patients' medical and socio-demographic characteristics were homogenous at baseline and at follow-up. No group effects on QoL were found upon completion of CHT (estimate -1.04 [-4.89; 2.81]; P = 0.596), but there was a significant group difference in favor of the IG 6 months later (estimate 6.643 [1.65; 11.64]; P = 0.010). IG patients did also experience significant better emotional functioning (P = 0.007) and less fatigue (P = 0.027). The tested supportive intervention did not improve patients' QoL outcomes directly after CHT (T3), but was associated with significant QoL improvements when considering the change from baseline to the time point T4, which could be assessed 6 months after patients' completion of CHT. This delayed effect may have resulted due to a strengthening of patients' self-management competencies.

Novel oral anticoagulants in primary care in patients with atrial fibrillation: a cross-sectional comparison before and after their introduction.

BACKGROUND: Novel oral anticoagulation (NOAC) has been introduced in recent years, but data on use in atrial fibrillation (AF) in primary care setting is scarce. In Germany, General Practitioners are free to choose type of oral anticoagulation (OAC) in AF. Our aim was to explore changes in prescription-rates of OAC in German primary care before and after introduction of NOAC on the market. METHODS: Data of a representative morbidity registration project in primary care in Germany (CONTENT) were analysed. Patients with AF in 2011 or 2014 were included (before and after broad market authorization of NOAC, respectively). We defined three independent groups: patients from 2011 without follow-up (group A), patients from 2014 but without previous record in 2011 (group B) and patients with AF and records in 2011 and 2014 (group C). RESULTS: 2642 patients were included. Group A (n = 804) and B (n = 755) were comparable regarding patient characteristics. 87.3% of group A and 84.8% of group B had CHA2DS2-VASc-Score ≥ 2, indicating a need for oral anticoagulation (OAC). Prescription of OAC increased from 23.1% (n = 186) to 42.8% (n = 323, p < .01) with stable use of vitamin-k-antagonist (22.6-24.9%). NOAC increased from 0.6 to 19.2% (p < .01). Monotherapy with Acetylsalicylic acid (ASA) decreased from 15.3% (n = 123) to 8.2% (n = 62, p < .01). In group C (n = 1083), OAC increased from 35.3 to 55.4% (p < .01), with stable prescription rate of vitamin-k-antagonist (34.4-35.7%). NOAC increased from 0.9 to 21.5% (p < .01). CONCLUSIONS: In summary, our study showed a significant increase of OAC over time, which is fostered by the use of NOAC but with a stable rate of VKA and a sharp decrease of ASA. Patients on VKA are rarely switched to NOAC, but new patients with AF are more likely to receive NOAC.

Komplementäre und Integrative Medizin in der Facharztweiterbildung Allgemeinmedizin: Ergebnisse einer Bedarfserhebung bei Ärzten in Weiterbildung.

Hintergrund: Inhalte aus den Bereichen der klassischen Naturheilverfahren und Komplementärmedizin sind im Rahmen der ärztlichen Approbationsordnung curricular verankert. Im Gegensatz dazu werden in den Weiterbildungsordnungen zum Facharzt für Allgemeinmedizin keine komplementärmedizinischen Inhalte abgebildet. Bisher ist nicht bekannt, ob Ärzte in Weiterbildung (ÄiW) zum Facharzt für Allgemeinmedizin innerhalb ihrer Weiterbildung mit komplementärmedizinischen Verfahren in Kontakt kommen und ob sie solche erlernen bzw. erlernen möchten. Das Ziel der vorliegenden Studie war die Erhebung der Einstellung zum und des Weiterbildungsbedarfs im Bereich Komplementärmedizin bei ÄiW zum Facharzt für Allgemeinmedizin. Methoden: In Rahmen einer Querschnittsstudie erfolgte eine Fragebogen-gestützte Umfrage unter ÄiW zum Facharzt für Allgemeinmedizin innerhalb des Weiterbildungsprogramms «Verbundweiterbildungplus Baden-Württemberg¼. Diese wurde onlinebasiert initiiert und durch eine papierbasierte Umfrage komplettiert. Ergebnisse: Insgesamt nahmen 138 Teilnehmer der Verbundweiterbildungplus Baden-Württemberg an der Umfrage teil. Der Gesamtrücklauf betrug damit 28%. Dabei zeigte sich, dass die Teilnehmenden ein hohes Interesse an Komplementärmedizin hatten. Gleichzeitig gaben sie an, Unsicherheiten sowohl inhaltlicher als auch formaler Art wahrzunehmen (z.B. Evidenz der einzelnen Methoden und Kostenübernahme durch gesetzliche Krankenkassen). Die große Mehrheit der befragten Ärzte befürwortete, dass in der Weiterbildung zum Facharzt Allgemeinmedizin Kompetenzen aus dem Bereich Komplementärmedizin vermittelt werden. Schlussfolgerungen: Vor dem Hintergrund der weiten Verbreitung komplementärmedizinischer Methoden im hausärztlichen Alltag muss diskutiert werden, ob im Rahmen der Weiterbildung zum Facharzt für Allgemeinmedizin Basiskompetenzen für diesen Bereich definiert werden sollten. Diese könnten beispielsweise in das «Kompetenzbasierte Curriculum Allgemeinmedizin¼ der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM) einfließen.

How the Consolidated Framework for Implementation Research Can Strengthen Findings and Improve Translation of Research Into Practice: A Case Study.

PURPOSE/OBJECTIVES: To answer how the planned intervention was performed in routine care, which factors supported or distracted from its implementation, and how key organizational structures have been built and sustained.
. RESEARCH APPROACH: Mixed-methods process evaluation.
. SETTING: Two German outpatient cancer clinics.
. PARTICIPANTS: Purposive sampling of 297 recruited patients with gynecologic cancer, their treating oncology nurses, and their interprofessional healthcare team, and the clinical stakeholders of two different outpatient cancer clinics.
. METHODOLOGIC APPROACH: Guided by the Consolidated Framework for Implementation Research (CFIR), five distinct interrelated substudies were designed to evaluate intervention characteristics, inner and outer settings, characteristics of the individuals involved, and the process of implementation. Quantitative and qualitative data will be analyzed separately and then integrated into a framework analysis.
. FINDINGS: Oncology nurses found the regular process analytic sessions to be beneficial, not only for sharing their experience, but also for experiencing social support and social connectedness.
. INTERPRETATION: Key implementation facets of the nurse-led intervention will be examined systematically. The results can guide future implementation processes, which need to be tailored to interested facilities.
. IMPLICATIONS FOR NURSING: The CFIR framework is well established but not yet widely applied in supportive treatment research. The current study aims to apply and combine this framework with the concept of intervention fidelity.

["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.

[Changing to a career in general practice - a qualitative study reveals motives of specialists]. / Liebe auf den zweiten Blick - qualitative Erhebung von Motiven für den Quereinstieg in die Allgemeinmedizin.

BACKGROUND: In 2011, the national German Medical Association (Bundesärztekammer) published guidelines for a slim-lined training program in general practice (Quereinstieg) for qualified medical specialists in other fields (e. g., surgeons, internists or anesthesiologists). This step is part of a strategy to prevent further shortages of general practitioners in Germany. In the state of Baden-Wuerttemberg, qualified medical specialists are allowed to complete their general practice training in approximately two years instead of five. The aim of this study was to understand the reasons of specialists for changing to a career in general practice. METHODS: The postgraduate training program VerbundweiterbildungplusBaden-Württemberg had 597 trainees at the time of the study in December 2015. Previously qualified specialists in another medical discipline were identified and invited to participate in this study. Qualitative data was gathered using semi-structured interviews with content analysis of the interviews performed by three independent members of the research team. RESULTS: In total, 36 out of 597 trainees were identified as previously qualified specialists in another medical discipline. All 36 were invited to take part and 15 agreed to participate in this study. Overall, 15 interviews were performed, with a mean time of 24.19minutes. Participants with a median age of 40 years (33-59 years) - mainly anesthesiologists (n=7), surgeons (n=3) and internists (n=3) - presented with an average of 6.5 years of professional experience in their specialty. First, the participants' motivation to switch career arose from the wish to intensify the quality of patient contacts with a holistic approach including family and social background and from the infinite variety of general practice. Another reason given for a career change was self-employment opportunities. Finally, feelings of frustration over poor working conditions in hospitals resulted in a job search elsewhere in medicine, taking account of the challenges of ageing and family life. A major finding was that without the slim-lined program, the majority of participants would not have changed their career. DISCUSSION: The slim-lined training program in general practice attracts experienced medical doctors. Specialists decide to change career because of the particular ways of working in general practice and with the intention to improve their daily work as a physician, either to improve individual working conditions and/or to improve their individual curative work profile. In addition, specialists are attracted by the concept of self-employment in general practice. Therefore, appreciation of the specific ways of working in general practice as well as management skills are most important during the reduced 2-year training. Further studies should investigate if facilitating a career switch to general practice is a good way to improve the shortage of general practitioners.

Differences between Practice Patterns of Conventional and Naturopathic GPs in Germany.

BACKGROUND: Limited evidence exists whether practice patterns of general practitioners (GPs) who have additionally completed training in naturopathy are different from those of conventional GPs. We aimed to assess and compare practice patterns of GPs in conventional and naturopathic GPs. METHODS: Routine data from 41 GPs (31 with and 11 without additional qualification in NP, respectively) and 180,789 patients, drawn from the CONTinuous morbidity registration Epidemiologic NeTwork (CONTENT)-registry and collected between 2009 and 2014, were used. To assess practice patterns determinants of (non-)phytopharmaceutical prescriptions, referrals and hospitalizations were analyzed using mixed-effects Poisson regression models. As explanatory variables, the qualification of the GP in NM, the age group and sex of the patient, as well as bivariate interactions between these variables were considered. RESULTS: GPs additionally qualified in naturopathy exhibited higher rates of phytopharmaceutical prescriptions (p<0.034; independent effect) compared to conventional GPs. This association was not observed with respect to non-phytopharmaceutical prescriptions. However, interaction effects between qualification and age group as well as sex were present with respect to both phytopharmaceutical and non-phytopharmaceutical prescriptions (all p<0.001). No further independent association existed between qualification and either referral rates or hospitalization rates, but again interactions between qualification and age group and sex (only referrals) were statistically significant (all p<0.0001). CONCLUSION: The results show that the rate of phyto-pharmaceutical prescriptions are generally higher when the GP has an additional qualification in naturopathy. Further differences in practice patterns between conventional and naturopathy GPs could be subject to certain age groups and sex. However, the magnitude of these differences seem to be rather small.

[Integrated Quality Management System (IQMS): a model for improving the quality of reproductive health care in rural Kenya]. / Integrated Quality Management System (IQMS): ein Modell zur Förderung der Qualität der reproduktiven Gesundheitsversorgung im ländlichen Kenia.

OBJECTIVES: To develop a model aiming to improve the quality of services for reproductive health care in rural Kenya and designed to measure the quality of reproductive health services in such a way that allows these services to identify measures for improving their performance. METHODS: The Integrated Quality Management System (IQMS) was developed on the basis of a pre-existing and validated model for quality promotion, namely the European Practice Assessment (EPA). The methodology for quality assessment and feedback of assessment results to the service teams was adopted from the EPA model. Quality assessment methodology included data assessment through staff, patient surveys and service visitation. Quality is assessed by indicators, and so indicators had to be developed that were appropriate for assessing reproductive health care in rural Kenya. A search of the Kenyan and international literature was conducted to identify potential indicators. These were then rated for their relevance and clarity by a panel of Kenyan experts. RESULTS: 260 indicators were rated as relevant and assigned to 29 quality dimensions and 5 domains. The implementation of IQMS in ten facilities showed that IQMS is a feasible model for assessing the quality of reproductive health services in rural Kenya. IQMS enables these services to identify quality improvement targets and necessary improvement measures. Both strengths and limitations of IQMS will be discussed.

[Developing a tailored intervention: implementing recommendations for polypharmacy in multimorbid patients (PomP)]. / Entwicklung einer maßgeschneiderten Intervention (Tailoring) am Beispiel der Implementierung von Empfehlungen zur Polypharmakotherapie bei multimorbiden Patienten (PomP).

INTRODUCTION: Implementation research deals with the question of how to ensure that evidence-based knowledge is put into practice. One approach is the development of "tailored interventions (TI)". These are designed to address previously identified barriers and enablers. A common definition or methodological concept for TI has not yet been established. In this paper, a concept for TI is introduced. We describe the stepwise development of an implementation intervention for GP settings where recommendations based on current evidence are provided for the treatment of multimorbid patients receiving polypharmacy. Each step will be explained and illustrated by original data. METHODS/RESULTS: A stepwise approach was used to develop a TI: problem analysis, identification and prioritisation of determinants, identification and prioritisation of strategies and the design of a complex intervention and its underlying logic model. DISCUSSION: The stepwise exemplary description of this tailoring strategy may support other researchers in this field when designing a TI.

[Transfer-time and -rates from inpatient to outpatient care of mental ill persons in Baden Wurttemberg]. / Übergangszeiten und -raten von stationär nach ambulant in der Versorgung psychisch kranker Menschen in Baden-Württemberg.

OBJECTIVE: The time of transfer between discharge from inpatient mental health care and first contact to the outpatient sector is considered to be an indicator for continuity of care. METHODS: This indicator is assessed using health care claims data of one of the mayor health insurances in Baden-Wurttemberg, Germany. RESULTS: About 80 % of cases with the diagnosis of a defined mental disorder sought outpatient care at general or mental health practitioners within six months from discharge. 50 % of them did so within six days, 75 % within three weeks. The majority sought outpatient care at general practitioners. Cases that sought care in outpatient clinics specialized for severe mental illness (SMI) could not be considered in the data. However, considering them by estimation, the rate of cases with SMI seeking outpatient care at mental health practitioners within six months from discharge estimated to be at least 70 %. CONCLUSIONS: General practitioners are an important source for aftercare of mentally ill people discharged from inpatient care. Time of transfer as an indicator can be predominantly assessed by using health claims data in Germany.

Characteristics and job satisfaction of general practitioners using complementary and alternative medicine in Germany--is there a pattern?

BACKGROUND: The use of Complementary and Alternative medicine (CAM) has increased over the past years. In Germany, many general practitioners (GPs) use CAM in their daily practice. However, little is known about possible differences of GPs using CAM compared to GPs not using CAM. The aim of the study was to explore differences in personal and practice characteristics, work load and job satisfaction of GPs depending on their use of and attitude towards CAM. Furthermore, predictors for CAM use should be explored. METHODS: A questionnaire was developed based on qualitatively derived data. In addition, a validated instrument assessing job satisfaction was included in the questionnaire, which was sent to 3000 randomly selected GPs in Germany. RESULTS: 1027 returned the questionnaire of which 737 indicated to use CAM in daily practice. We found that GPs using CAM are more female, younger and have a trend towards a healthier life style. Their practices have higher proportions of privately insured patients and are slightly better technically equipped with ultrasound. GPs with a positive attitude had significant better values within the job satisfaction scale and lower working hours per week compared to GPs with neutral/negative attitude. Significant predictors for CAM use were a positive attitude towards CAM, holding a special qualification in CAM, own CAM use and the availability of an ultrasound in practice. CONCLUSIONS: The identified differences suggest that those GPs using and believing in CAM have a different medical orientation and approach which in turn may influence their job satisfaction. With this finding CAM use turns out to be a relevant factor regarding job satisfaction and, with this, may be a possible lever to counteract the growing dissatisfaction of GPs in Germany. This finding could also be important for designing strategies to promote the recruitment of young doctors to general practice.

["General Practice is a great job anyway" - a qualitative study with vocational trainees]. / "Allgemeinmedizin ist trotzdem ein schönes Fach" - eine qualitative Studie mit Ärzten in Weiterbildung.

BACKGROUND AND PURPOSE: Due to the increasing lack of physicians, an ageing and thus multi-morbid society and a misdistribution of physicians in Germany primary care provided by general practitioners is at risk. Therefore, approaches to recruit more physicians for general practice are being sought. The aim of the present study was to explore individual motivations for choosing a career in general practice, vocational trainees' perspectives on the current situation of vocational training and to identify possible approaches to improve the situation with suggestions from vocational trainees in Germany. METHODS: A qualitative study was conducted by interviewing 13 trainees. The interviews that were based on a predefined interview guideline were recorded and transcribed. The analysis was performed according to Mayring supported by the software Atlas.ti. RESULTS: In general, the reasons given for choosing general practice include the holistic view towards patients, the opportunity to see the direct impact of therapies and self-employment. Furthermore, general practice was perceived as a job with a positive work-life balance. Barriers to vocational training are the lack of structure of individual rotations and the low salaries during the rotation in practice. Furthermore, the basic conditions for working as a self-employed general practitioner in Germany were described as being a disincentive. A general suggestion for improvement was to promote professional recognition of general practice at universities. A qualification of vocational trainers was requested. Specific suggestions were: better payment, better-structured rotations and a specific preparation for the self-employed general practitioner. CONCLUSION: The results of this study reveal that a single measure is insufficient for recruiting more young doctors for general practice. In fact, a package of measures is necessary to improve aspects of the vocational training but also general conditions for the profession.