[What it means for patients to have their illness experiences published in the Internet]. / Wie erleben Patienten die Veröffentlichung ihrer Krankheitserfahrungen im Internet?

Aim of the study was to explore meaning and consequences for patients for having their illness experiences published in the internet. Patients who participated in the establishment of a research-based internet website on illness experiences were interviewed about their experiences of taking part in the project. 14 patients with diabetes and 29 patients with chronic pain participated in the follow-up. They were interviewed with an open narrative and semi-structured approach about their motives and experiences of taking part in the project and the impact of the publication on them. Interview transcripts were coded and aggregated in a computer-assisted thematic analysis. Patients unanimously evaluated their participation positively. Many of them reported that it had been an intense and relevant experience, which equalled an intervention. They conveyed that the special effort of the researchers to establish a trustful and caring relationship had proven of value and led to a high identification of the participants with the aims of the website.

Appropriateness of proton pump inhibitor recommendations at hospital discharge and continuation in primary care.

Background: Inappropriate prescriptions of proton pump inhibitors (PPI) in hospital and primary care have been widely reported. Recommendations from hospital have been implicated as one reason for inappropriate prescriptions of PPI in primary care. Objective: To quantify the amount of appropriate PPI recommendations in hospital discharge letters and the influence of these recommendations on general practitioners' (GPs') PPI-prescriptions. Materials and Methods: This is an observational study in 31 primary care practices. We identified patients discharged from hospital with PPI recommendation between 2006 and 2007 and assessed practice records and PPI prescription six months prior and after hospital admission. Hospital recommendation for continuous PPI-treatment and continuation by GPs was classified as appropriate, inappropriate or uncertain. Logistic regression analysis was used to calculate factors associated with indicated and non-indicated PPI continuation. Results: In 263 (58%) out of 506 patients discharged from 35 hospitals with a PPI recommendation no indication could be found. Non-indicated PPIs were continued by GPs in 58% for at least 1 month. Indicated PPIs were discontinued in 33%. Two thirds of non-indicated PPIs were initiated in hospital. The strongest factor associated with non-indicated continuation was a PPI-prescription prior to hospital admission [OR: 3.0; 95% confidence interval (CI): 1.7-5.4]. This was also the strongest factor for continuation of an indicated PPI medication (OR: 3.2; 95% CI: 1.4-7.5). Conclusions: We found a strong influence of hospital recommendations and previous prescriptions on PPI prescriptions after discharge. Hospitals should critically review their practice of recommending PPI and document indications. GPs should carefully assess hospital recommendations and their medication prior to admission to avoid over- and under-prescribing.

[Relation between defined daily doses (DDD) and prescribed daily doses: a 3-month analysis of outpatient data from a statutory health insurance company]. / Inwieweit bilden definierte Tagesdosen (DDD) die tatsächlich verordneten Tagesdosen ab? Eine Analyse ambulanter Verordnungsdaten.

AIM: Defined daily doses (DDD) are used to analyse drug utilisation. For frequently prescribed drug groups, we studied to what extent the DDD correspond to the average prescribed daily doses (PDD). METHODS: We analysed all drugs prescribed for more than three months to insured of a large health insurance fund in Mecklenburg-Vorpommern, one federal state in Germany. PDD for plain ACE inhibitors, selective beta-antagonists and some antidiabetics (sulfonylurea compounds) were calculated and compared with their DDD. RESULTS: During the study period, about 38 500 patients received continuous prescriptions of each ACE inhibitors or selective beta-antagonists, and about 9 000 of sulfonylurea compounds. PDD differed from DDD in varying degrees. For ACE inhibitors, PDD ranged between 1.5 DDD (for captopril) and 3.5 (for ramipril). The PDD for beta antagonists were on average 0.9 DDD, similar for bisoprolol (0.8 DDD) and metoprolol (0.9 DDD). As for oral antidiabetics, doctors prescribed 1.0 DDD glibenclamid per day and patient and 2.0 DDD glimepirid. Depending on differences between DDD and PDD, real daily costs for drug therapy differed from the theoretical costs per DDD, for example in the case of ramipril they were 0.24 euros compared to 0.07 euros. CONCLUSION: The PDD were much higher than the DDD for several frequently prescribed drugs. Consequently, the daily drug costs exceeded the drug costs based on DDD. Evaluations of drug costs on the basis for DDD require careful interpretation. Moreover, the number of DDD alone is not a valid measurement for the appropriateness of drug therapy and can only give a rough estimate of the number of patients treated, at least for the drug groups in this study.

[What questions do headache patients pose in the internet? Content analysis of an internet expert forum]. / Mit welchen Fragen gehen Kopfschmerzpatienten ins Internet? Inhaltsanalyse eines Web-Expertenrates.

BACKGROUND: Most episodes of headache are not presented to doctors but are treated by self-management. Especially in these cases, the Internet has become an increasingly important source of health-care information. The aim of this study was to investigate the questions and needs of persons who sought help for their headache in an internet expert forum. METHODS: Using a content analysis approach, we analysed all questions sent to an internet expert forum for migraine and headache ( www.lifeline.de ). RESULTS: We analysed a total of 835 questions sent from April 2002 until April 2006. The majority of questions (85%) came from women. Most often the visitors asked questions about symptoms (32.2%, n=269), drugs or therapies (32.0%) and psychosocial problems (20%). Few visitors (45/835) complained about their doctors. Some of these were dissatisfied with their therapy and/or the effect and possible side effects of their prescribed drugs. In 19 questions we detected communication problems in former consultations with their doctors. CONCLUSION: Visitors of an expert forum for migraine and headache had questions about symptoms and their interpretation as well as drugs and therapies. Dissatisfaction with current treatment motivated only few patients to turn to the Internet. For most visitors the expert forum is obviously not an alternative but a supplement to professional care.

[Communication and exchange of clinical findings for low back pain between general practitioners and orthopaedic surgeons: a retrospective observational study]. / Kommunikation und Befundaustausch zwischen Hausärzten und Orthopäden bei Rückenschmerzen: Eine retrospektive Beobachtungsstudie.

INTRODUCTION: Low back pain is a frequent reason for consultation in general practice. Many patients are treated in cooperation with an orthopaedic surgeon which requires an effective exchange of information. The aim of this study was to investigate the level of communication between general practitioners (GPs) and orthopaedic surgeons. MATERIAL AND METHODS: In this retrospective observational study referrals from GPs and corresponding response letters from orthopaedic surgeons were analyzed. GPs were asked to provide reasons for referral and to rate the quality of the response letters. RESULTS: A total of 12 out of 82 GPs from the teaching network of the Medical School of Göttingen participated in the study. Of 911 referrals to ambulatory orthopaedic surgeons within 3 months, 34% (n=312) were referred for low back pain. GPs provided little information beyond a diagnosis on the referral contrary to their self-perception. Most referrals (61%) were initiated by patients and most of them were considered at risk for chronification (72%) by the referring GP. Despite a formal obligation to report back, GPs received a response letter for only one-third (114/312) of the patients. GPs rated most of them as satisfactory, however, 59% were unsatisfied with the treatment recommendations. Only 10% of the letters contained psychosocial details. The information provided in the orthopaedic response letters was heterogeneous and only partly fulfilled the criteria set by the Interdisciplinary Society for Orthopaedic Pain Management. CONCLUSION: Incomplete and scant information on referral forms from GPs and a high non-response rate from orthopaedic surgeons suggest that current health care system and referral forms do not promote effective communication about the patient. This might explain the satisfaction of GPs with the orthopaedic response letters despite the lack of information. The GPs dissatisfaction with the treatment recommendations reflects the limited treatment options for chronic low back pain in ambulatory care.

German primary care doctors' awareness of osteoporosis and knowledge of national guidelines.

AIMS: With the aging of populations in industrialized countries, managing osteoporosis in the primary care setting becomes increasingly important. General practitioners (GPs) are in an ideal position to identify and manage patients who are at an increased risk of osteoporosis and fracture. In a cross-sectional survey we studied whether German GPs (1) are aware of osteoporosis as an urgent health problem, (2) felt competent to manage patients with osteoporosis, (3) knew and used the national guideline for osteoporosis treatment and if not, (4) which barriers prevented them from doing so. PARTICIPANTS AND METHODS: A representative random sample of German GPs were sent a 30-item standardized questionnaire by mail. Chi-square statistics and multiple logistic regression were used to detect associations between knowledge of guidelines and explanatory variables. RESULTS: Of 2,194 doctors addressed, 892 (41.1%) answered the questionnaire. The majority of doctors (82.7%) felt competent in osteoporosis management (95% confidence interval: 80.2 - 85.2) and only 11.2% (8.2 - 13.1) did not consider osteoporosis an important problem in their practice. About half (459/892) reported knowing the national osteoporosis guideline well (51.7%; 48.4 - 55.0), whereas 22.6% (19.9 - 25.4) admitted to not being familiar with it at all. Knowledge of the guideline was positively associated with being a female doctor (OR=1.36; 1.01-1.85), having Internet access (OR=1.40, 1.06 - 1.85), seeing institutionalized patients (OR=1.67; 1.03 -2.69), and caring for patients with osteoporosis at a higher frequency (OR=2.60; 1.93 - 3.50). Nearly 43% (39.7 - 46.2) used the guideline in their practice without problems. In free-text fields, GPs reported most frequently that budgetary restrictions preventing the prescription of appropriate medication represented a severe problem for osteoporosis management. CONCLUSION: Although most GPs are aware of osteoporosis as an important health problem and felt competent in the management of this disease, only half of the respondents knew and used the national guideline. This may explain deficits in diagnosis and therapy of osteoporosis in Germany. Since guideline knowledge and frequency of consultations for osteoporosis strongly correlate, proper dissemination of the guideline may further enhance awareness of, and evidence-based treatment for, osteoporosis.

[The use of benzodiazepines and Z-drugs for patients with sleeping problems - A survey among hospital doctors and nurses]. / Benzodiazepine und Z-Substanzen als Schlaf- und Beruhigungsmittel in einem Krankenhaus.

Aim | Benzodiazepines and Z-drugs are frequently prescribed sleep medications in spite of their poor risk-benefit ratio when used over a longer period of time. The aim of the study was to find out how the medical and nursing staff in a general hospital estimated the frequency of use for these drugs, and the risk-benefit ratio for elderly patients as well as the factors which positively influence the perceived use of these drugs. Methods | All members of the medical and nursing staff of a hospital received a questionnaire about their use of, and attitudes towards, benzodiazepines and Z-drugs. Absolute and relative frequencies were calculated to estimate the perceived frequency of use and the risk-benefit ratio. Multiple logistic regressions were used to analyze which factors are associated with a perceived high use of benzodiazepines or Z-drugs for insomnia. Results | More nurses than hospital doctors believed that they dispensed benzodiazepines often or always (57 % vs. 29 %) to patients with insomnia; this was also the case for Z-drugs (66 % vs. 29 %). Nearly half of the hospital doctors and 29 % of the nurses perceived more harms than benefits for benzodiazepines in the elderly. The following factors were associated with a high perceived usage of Z-drugs: working as a nurse (OR: 13,95; 95%-CI: 3,87-50,28), working in a non-surgical department (5,41; 2,00-14,61), having < 5 years of professional experience (4,90; 1,43-16,81) and feeling that the benefits of Z-drugs outweigh the risks for elderly patients (5,07; 1,48-17,35). For benzodiazepines, only the perceived positive risk-benefit ratio had an influence on the perceived use (3,35; 1,28-8.79). Conclusion | The medical and nursing staff perceived the frequency of prescription of benzodiazepines and Z-drugs and the risk-benefit ratio in different ways. Other aspects, such as working in a non-surgical department or having a smaller amount of working experience may also influence the decision to use Z-drugs.

What do primary care patients think about generic drugs?

OBJECTIVE: To examine the attitude of patients towards generic drugs and prescriptions containing generic drugs as an alternative to brand-name products, with a special focus on information on patients attitude to generic drugs provided by their general practitioners (GPs). METHODS: A total of 804 patients in 31 general practices were surveyed using a self-questionnaire. The influence of age, sex, education, disease, knowledge of generic drugs, experience with generic substitution and information provided by the GP on patient attitudes towards generic drugs and substitutions were examined. RESULTS: Nearly two thirds of the patients (509/804) stated that they knew of the difference between brand-name drugs and generics; of these, one third were not satisfied with the information given by their GPs and 37% of patients expressed general skepticism towards generic drugs because of their lower price. This attitude was more frequent among those who felt that generic prescribing was "invented" to solve the financial crisis in the German health insurance system at their expense (odds ratio (OR): 6.2; 95% confidence interval: 4.0 - 9.8) and those who had not been confronted personally with a generic substitution (OR: 1.8; 1.3 3.0). Patients who had been skeptical when first confronted with a generic substitution were more frequently among those who considered inexpensive drugs to be inferior (OR: 4.5; 2.0 10.4) and they were frequently not satisfied with the information on substitution provided by their GP (OR: 2.7; 1.2 - 5.9). CONCLUSION: GPs are in an ideal position to inform their patients adequately about the equivalence of brand-name and generic drugs. However, the patient view that inexpensive drugs must be inferior may be difficult to rectify in the short term.

How do academic heads of departments of general practice organize patient care? A European survey.

BACKGROUND: Compared with other clinical disciplines, academic general practice is in a difficult situation with respect to patient care. There are at least three different possible models of working arrangements for heads of departments of general practice: to work in a surgery in a medical school; to work in a surgery in the community, separate from a part-time university post; or to work part-time in a surgery in the community, separate from a university post. AIM: A study was undertaken to explore these models and to gain an understanding of academic teachers' organization of patient care in Europe. METHOD: A total of 77 heads of departments in universities in 12 European countries were sent a questionnaire enquiring about important characteristics of their department, the number of patients they treated per week and how they allocated their time. RESULTS: Sixty nine heads of department (90%) responded. Of respondents, 55% worked part-time in a surgery, separate from a university post, nearly one third worked mainly in a surgery, separate from a part-time university post, and 16% worked in a surgery in a medical school. Those working in a surgery with only a part-time university post spent most time in patient care compared with those working in other models (mean of 57%). Respondents working in a surgery in a medical school spent most time on administration (34%); they spent 22% of their time on patient care and 20% on education. Respondents working in a surgery in a medical school spent 25% of their time on research, those working in a surgery separate from a part-time university post spent 12% of their time on research, and those working mainly in a university with a part-time practice post spent 24% of their time on research. Those working mainly in a university post spent only 17% of their time in patient care. CONCLUSION: Working in a surgery in a medical school represented a well-balanced model of time allocation between patient care, research and education and seemed to be a good approach for the integration of general practice into medical schools. Working part-time in a surgery with a university post is an appropriate model for academic integration, but patient care seemed to be neglected. Those doctors working mainly in the community with a part-time university post were able to provide continuity of care and to come into close contact with the everyday problems of general practitioners. However, they might have to struggle for academic recognition.

Complementary medicine: are patients' expectations being met by their general practitioners?

Complementary, or alternative, medicine has increased in popularity among patients during the past 20 years. The purpose of this study was to determine whether general practitioners met their patients' expectations with regard to complementary medicine. In a postal survey all 71 accredited general practitioners in the district of Kassel, Germany, received a structured questionnaire about their experience with complementary medicine. Forty (56%) replied. In 10 of these practices 310 patients were interviewed about their attitudes towards and expectations of such treatment. Of the responding doctors 95% used, at least occasionally, some form of complementary medicine (most commonly herbal medicine, neural therapy or homeopathy). All but three patients accepted the value of complementary medicine, 58% of them (especially younger, more highly educated patients and those from rural practices) preferred it to orthodox medicine and 40% of the patients had received some form of complementary therapy. Nearly 70% of the patients requested that complementary medicine be practised by their general practitioner more frequently than at present. There was no significant link between patient satisfaction with the doctor and patients' view of, or demand for, complementary medicine. Although both patients and practitioners were interested in complementary therapy, there was a gap between the willingness, or the ability, of general practitioners to use complementary medicine and the patients' demand for these alternative forms of treatment.

Management of involuntary childlessness in general practice--patients' and doctors' views.

In order to determine whether general practitioners (GPs) are interested in infertility counselling and whether infertile patients seek help from their family doctor, we personally interviewed doctors and infertile patients. Almost all of the board-certified GPs in Göttingen, Germany, and two independent samples of infertile women and men attending the Göttingen University Hospital participated. The majority of the GPs did not routinely ask childless patients about their desire to have children, although half of the infertile men and one-quarter of the infertile women would prefer it if their doctor were to raise the subject. About half of these doctors emphasized their role as an important source of information and advice during assisted conception and almost half of the patients expected emotional support from their GP.

The predictive value of asthma medications to identify individuals with asthma--a study in German general practices.

BACKGROUND: The assessment of prescribing performance by aggregated measures mainly developed from automated databases is often helpful for general practitioners. For asthma treatment, the frequently applied ratio of anti-inflammatory to bronchodilator drugs may, however, be misleading if the specificity of a drug for the treatment of asthma, compared with other diseases, is unknown. AIM: To test the association of specific drugs with the diagnosis of asthma compared with other diagnoses. DESIGN OF STUDY: Cross-sectional study analysing prescription data from a retrospective chart review. SETTING: Eight general practices and one community respiratory practice in a town in Northern Germany. METHOD: All patients in the participating practices who received at least one of the 50 asthma drugs most frequently prescribed in Germany within the past 12 weeks were identified. Odds ratios (ORs) with 95% confidence intervals (ClI) were calculated to reveal any association between a specific drug and the diagnosis of asthma. The unit of analysis was the item prescribed. RESULTS: Topical betamimetics (e.g salbutamol, fenoterol) were the most often prescribed asthma drugs in the general practices (52.1 ) and in the respiratory practice (57.6%). Inhaled steroids accounted for 15% and 13%; systemic steroids accounted for 10% and 13%, respectively. In the general practices, inhaled betamimetics had a moderate marker function for asthma (OR = 2.0; 95% CI = 1.14-3.58). A fixed oral combination drug of clenbuterol plus ambroxol was a marker drug against asthma (OR = 0.35; 95% CI = 0.20-0.61). In the respiratory practice, the diagnosis of asthma was strongly marked by fixed combinations of cromoglycate plus betamimetics (OR = 29.0; 95% CI = 6.86-122.24) and moderately by inhaled betamimetics (OR = 2.6; 95% CI = 1.28-5.14). In contrast, systemic steroids (OR = 0.24; 95% CI 0.10-0.57) and even inhaled steroids (OR = 0.46; 95% ClI= 0.22-0.96) proved to contradict the diagnosis of asthma. CONCLUSION: Only betamimetics were markers for asthma patients in both types of practices; inhaled steroids, however, were not. Combinations of cromoglycate were markers in the respiratory practice only. Limited specificity of drugs for a disease (e.g asthma) should be taken into account when analysing prescribing data that are not diagnosis linked.

Management of involuntary childlessness.

Any definition of involuntary childlessness has to consider the difference between sterility and subfertility. As the latter affects about 20-30% of all couples at least once in their lives, general practitioners (GPs) may be the first to be confronted with this problem. This review presents the most relevant diagnostic and therapeutic options in cases of female or male infertility, and discusses the new assisted reproductive technologies (such as insemination, in vitro fertilization, gamete transfer and intracytoplasmatic sperm injection) so that GPs may adequately inform their patients about these procedures and their risks and outcomes. Although controversial, involuntary childlessness and its clinical treatment seem to have a strong psychological impact on a couple's social, emotional and sexual life. Being available for discussion with childless couples and offering ongoing support may be the most important role for the GP in this context.

Attitudes of primary care physicians towards the use of a drug formulary--preliminary results of a study in Germany.

Although the concept of a drug formulary in primary health care is known for more than 10 years it was only recently that the drug budget of the new German Health Legislation has drawn doctors' attention to the use of such formularies. The loose-leaf form "Göttingen formulary" has been specifically compiled for the need of primary care doctors. It contains less than 300 drugs and drug combinations (including pseudo-placebos). This formulary was ordered by 830 colleagues from November 1992 until the end of May. In June 1993 we sent a semi-structured questionnaire to the users to learn about their experience with and attitude towards the formulary and about changes in their prescribing habits. Until the end of August 223 questionnaires have been returned. Seventy-four % of the respondents were general practitioners with considerable experience (more than 10 years in practice: 77%). The majority were satisfied or very satisfied with the drugs selected for the formulary and found the list helpful or very helpful (68%). Sixty-seven % indicated that the use of the formulary changed their prescribing habits; 70% appreciated an official (governmental) positive list. Although this study did not use a representative sample and the response rate was rather low until the cut-off point, it is noteworthy that the overall appreciation of a drug formulary for primary health care was very positive. The great majority of the respondents were convinced that an individual drug formulary does not render an official positive list superfluous.

Drug changes at the interface between primary and secondary care.

OBJECTIVE: To analyze the frequency and factors associated with drug change in a sample of patients referred to hospital by their general practitioner. METHODS: This observational study is based on a chart review of 100 consecutively recruited patients with a chronic disease who were referred to the general internal medicine wards in each of 3 district general hospitals in Germany (total 300 patients). The frequency of drug cancellation, replacement, dosage alteration, change in manufacturer and of commencing treatment with a new drug were recorded. RESULTS: Half of the drugs used in chronic treatment (644/1,330) and prescribed by general practitioners were continued during hospitalization. The fraction canceled was 36%. In the rest of the drugs in this group, there were some minor changes carried out by the hospital. On the day of the drug survey, a total of 1,572 drugs were being taken by the patients and 724 of these drugs were newly prescribed by hospital. Only 13 patients experienced no change to their drug regimen during their stay in hospital. In more than 60% of patients (184/300), there were 3 or more changes made in their drug regimen. The rate of drug cancellation for antihypertensive and cardiac drugs in patients referred to hospital for cardiovascular and non-cardiovascular problems did not differ. CONCLUSION: During hospitalization, nearly every patient is confronted with some form of drug change. Of major concern is the high rate of drug change affecting drugs being taken for diseases other than that associated with the hospitalization. Hospital drug policy should encourage clinicians to continue drug regimens in newly admitted patients whenever medically appropriate and caution clinicians against making unnecessary changes to drug regimens prescribed by general practitioners.

Changes in drug prescribing under the Public Health Reform Law--a survey of general practitioners' attitudes in East and West Germany.

The aim of the study was to examine general practitioners' attitudes towards drug prescribing in times of economic pressure, and to determine the relevance of different factors for changed prescribing behavior. A random sample of general practitioners in Eastern Germany and in Western Germany was surveyed, after the Public Health Reform Law, a budgetary initiative to reduce prescribing costs in Germany, had come into effect. Multiple logistic regression was performed to analyze the association between self-reported prescribing behavior and covariates (such as sex and age, level of certification, doctors' prescribing costs, criteria of prescribing, sources of drug information). Response rates had been 53.4% (n = 550) in Eastern Germany and 56.8% (n = 579) in Western Germany respectively. About two thirds of the doctors (East: 60.4%, West: 73%) believed that they had changed their prescribing behavior under the new law. They used generic drugs more often (East: 29.5%, West: 52.3%) and often used more generic drugs (East: 29.5%, West: 52.3%) and were less liberal in meeting patients' wishes (61.0% and 72.8%, respectively). Doctors whose total prescribing costs were above the average of their colleagues, more frequently reported change in prescribing behavior in response to the new law (OR: 3.11, 95% CI: 1.63, 5.91 for Eastern doctors and OR: 5.90, 95% CI: 2.49, 13.98 for Western doctors). This was also true for doctors who considered the price of a drug to be a very important criterion for drug selection (OR: 4.34, 95% CI: 2.69, 7.01 and OR: 3.23, 95% CI: 1.9, 5.49, respectively). "Price-oriented" and "cost-concerned" doctors were also more likely to handle patient prescription wishes less liberal and to prescribe generic rather than original brand name drugs more often. We conclude that budgetary initiatives, such as the German Public Health Reform Law, seem to influence general practitioners towards a more economic prescribing behavior. Doctors concerned about their prescribing costs or about drug costs may be more responsive to such administrative regulations.

Comparing women's views on family and sexual problems in family and gynecological practices.

This study compares the role of community gynecologists and family physicians, seen from the patients' perspective. A sample of 126 female patients in family practices and 212 patients in gynecological practices were surveyed about their preferences and expectations of whether their doctor should address personal, family and sexual problems. The effects of covariates (such as the type of doctor, patient age, family status, child desire) on patient expectations were simultaneously assessed by multiple logistic regression. Between 40% and 70% of the patients contacted confirmed the family-oriented approach, both in family practices and gynecological practices. Family practice patients more frequently stressed their doctor's knowledge of personal and family aspects (odds ratio [OR] = 1.7, 95% confidence interval [95% CI] = 1.1-2.7); whereas communication about sexual problems and a possible desire to have a child was more often considered as the gynecologist's domain (OR = 2.8 [95% CI = 1.8-4.4] and OR = 1.8 [95% CI = 1.1-2.8], respectively). Female patients older than 30 years were more often interested in communication on family related affairs (OR = 2.2, 95% CI = 1.4-3.4). These data illustrate that many patients would like both their community gynecologist and their family physician to take notice of their personal and family life conditions, including sexual problems and to initiate communication about these subjects.

German family physicians' attitudes toward care of involuntarily childless patients.

BACKGROUND AND OBJECTIVES: Many family physicians regard fertility counseling out of their scope of practice, although key elements in the care of involuntarily childless couples fall within the theoretical framework of family practice. This study analyzed the doctors' value system concerning the care of infertile patients and whether a personal interview leads to a greater sensitivity toward fertility issues. METHODS: We conducted 57 baseline and 51 follow-up interviews with family physicians in the area of Göttingen, Germany. We performed quantitative and qualitative analyses. RESULTS: During the baseline interview, all family physicians placed involuntary childlessness within the domain of fertility specialists or regarded it as patients' private matter. Fourteen family physicians (27%) considered fertility counseling more important at the follow-up interview than at the time of the baseline interview. Judgmental views of infertile couples could be detected in both interviews. More than one third of the family physicians assumed a connection between the patients' childlessness and their personal behavior or way of living. Although the majority (73%) of the family physicians regarded involuntary childlessness as a disease and considered assisted conception techniques as legitimate, a recommendation for fee reimbursement for fertility services was rejected by more than half of the physicians. CONCLUSIONS: Most German family physicians do not consider that care of involuntarily childless couples is within or appropriate to their scope of practice.

[Subject health concepts and health-related quality of life--is there a correlation?]. / Subjektive Gesundheitskonzepte und gesundheitsbezogene Lebensqualität--Gibt es einen Zusammenhang?

OBJECTIVES: The aim of this study was to explore associations between lay concepts of health, quality of life and the health-related evaluation of daily activities. METHODS: A total of 221 persons (patients from general practice and adult as well as young members of sporting clubs) participated in the study (response rate: 84%). RESULTS: Health was often defined as "highest value of life"; "normal functioning of body and soul" and "complete well-being". Many persons considered sports, sleeping and leisure time being highly important for their health. The single dimensions of quality of life were associated with some health-related evaluations of daily activities, e.g., bodily functioning and health-related evaluation of television. Dividing the sample into persons who did or did not consider a certain concept of health (e.g., well-being) to be highly important had the following consequences: The quality of life was associated with different evaluations of daily activities in different strata; this association was sometimes negative, sometimes positive in different strata; more variance was explained by dividing the sample into different strata. CONCLUSIONS: The often contradictory associations between evaluation of everyday activities, lay concepts of health and quality of life should warn us not to think of health concepts and health actions in form of linear relations. Rather, health promotion should be more stronger oriented towards the individual's life conditions and his or her attitude to health.

Sexual problems of male patients in family practice.

OBJECTIVES: Little is known about men's expectations of their family physicians regarding sexual disorders. Our goal was to evaluate the frequency of sexual problems among male patients in family practice and to assess their need for help. STUDY DESIGN: We performed a cross-sectional survey based on structured questionnaires answered by patients and physicians in German family practices. POPULATION: We approached 43 family physicians; 20 (43%) participated. On a single day all men 18 years and older visiting the participating practices were approached, and 307 (84%) took part in the survey. OUTCOMES MEASURED: Patients were asked about their frequency and type of sexual problems, their need for help, and their expectations of their physicians. The physicians described their perceptions and management of sexual problems in family practice. RESULTS: Nearly all patients (93%) reported at least 1 sexual problem from which they suffered seldom or more often. The most common problems were low sexual desire (73%) and premature ejaculation (66%). Occupational stress was considered causative by more than half of the men (107/201). Forty-eight percent considered it important to talk with their physicians about sexual concerns. However, most physicians initiated a discussion about sexual concerns only seldom or occasionally. There was a nonsignificant correlation between the physicians' assumed knowledge and the patients' wish to contact them in case of sexual problems (rho=0.26). CONCLUSIONS: The high frequency of self-reported sexual disorders and the hesitancy of family physicians to deal with this topic signals a neglected area in primary health care. Certain conditions, such as occupational stress, which may be associated with sexual concerns, should encourage the physician to initiate discussions about sexuality.