Incorporating psychosocial care into routine oncological care: Insights into challenges and strategies from certified cancer centers' audit data.

PURPOSE: Provision of psychosocial care is obligatory in cancer centers certified in accordance with the criteria of the German Cancer Society, but the extent to which it is utilized differs greatly between centers. Anomalous utilization percentages are discussed during certification audits. This analysis aims to describe (1) how certified centers explain psychosocial care utilization percentages during audits and (2) the measures they then plan for improving psychosocial care utilization. The aim of the analysis is to help understand patterns of psychosocial care utilization in oncology and reduce potential disparities by describing the challenges that cancer centers face and their strategies for integrating psychosocial care into routine oncological care. METHODS: The content of free-text comments regarding psychosocial utilization percentages by certified centers during certification audits in 2019 was analyzed. In total, 178 comments were analyzed from 116 prostate, colorectal, and breast cancer centers in Germany, Switzerland, Austria, Italy, and Luxembourg. RESULTS: The explanations for utilization percentages most often mentioned involved patients' levels of interest and need, outpatient care, staff shortages, inclusion of psychosocial care in other processes in the center, documentation issues, and factors regarding different legal regulations in countries outside Germany. The measures most often planned for improving psychosocial care utilization involved adjusting work processes, increasing staff resources, optimizing documentation, and establishing quality-assurance groups/task forces. CONCLUSION: This exploratory analysis shows that the challenges and strategies involved in incorporating psychosocial care into routine oncological care are diverse. Further research should identify process-level strategies that can promote the integration of psychosocial care.

[Prevalence of People without Health Insurance and Interventions of Hospital Social Work at the University Hospital of Essen]. / Menschen ohne Krankenversicherung ­ Prävalenz und Rückführung in die sozialen Sicherungssysteme durch den Sozialdienst am Beispiel des Universitätsklinikums Essen.

OBJECTIVE: In Germany, a number of people remain without health insurance, thus unable to access the formal health care sector. Reliable statistics covering the prevalence and description of uninsured patients, especially in the inpatient health care sector, are still lacking. Our study therefore aimed to assess the prevalence of uninsured patients at University Hospital of Essen over a period of five years. Furthermore, we report rates of identification of cost providers and refunded disbursement. METHODS: Uninsured patients from 2014-2018 were included. We defined the following subgroups for stratification according to the right of access to health insurance: patients with right of access to health insurance in Germany, EU citizens, patients from third countries, patients without residence permit status. RESULTS: Data of 918 uninsured patients (mean age 31.3±20.6 years, 52,1% men) from 2014 to 2018 were evaluated. Over five years, identification of cost provider was successful in 74% and yielded in a total refund of 7.5 million Euros. In most instances, patients were treated in the gynaecological and maternity clinic (20%), paediatric clinic (17%), orthopaedic clinic and trauma surgery (14%) and the clinic for internal medicine (13%). CONCLUSION: Our study shows that there are still people in Germany who do not have health insurance. Referring to the inpatient health care sector, results show that it is possible to calculate treatment costs, to identify cost providers and to refund medical costs. To apply target group-specific approaches in practice, more research is needed addressing both causes and risk factors. The availability of comprehensive data could improve discussions at a political level on medical compensation not available to patients.