INTRODUCTION: Abstinence rates after inpatient treatment for alcohol use disorder (AUD) are modest (1-year rate around 50%). One promising approach is to re-train the automatically activated action tendency to approach alcohol-related stimuli (alcohol-approach bias) in AUD patients, as add-on to regular treatment. As efficacy has been demonstrated in well-controlled randomized controlled trials, the important next step is to add alcohol-approach-bias modification (alcohol-ApBM) to varieties of existing treatments for AUD. Therefore, this prospective, multicenter implementation-RCT examined whether adding alcohol-ApBM to regular treatments (various abstinence-oriented treatments including both individual and group-based interventions) would significantly increase abstinence rates compared to receiving regular treatment only, in a variety of naturalistic settings with different therapeutic approaches. METHODS: A total of 1,586 AUD inpatients from 9 German rehabilitation clinics were randomly assigned to receive either ApBM in addition to regular treatment or not. Training satisfaction of patients and therapists was measured after training. Success rates were determined at 3, 6, and 12 months post-treatment. RESULTS: Return rates of the post-treatment assessments varied greatly between clinics, often being low (18-76%). Nevertheless, ApBM significantly increased success rates after 3 months. After 6 and 12 months, the differences were not significant. ApBM was evaluated mostly positively by patients and therapists. DISCUSSION/CONCLUSION: ApBM was an effective add-on to regular treatment of AUD at 3 months follow-up, across a variety of AUD treatment settings. However, low return rates for the clinical outcomes reduced the effect size of ApBM considerably. The application of ApBM proved feasible in varying clinical settings, offering the opportunity to modify automatic processes and to promote abstinence.
Alcoholism , Cognitive Behavioral Therapy , Humans , Alcoholism/therapy , Cognitive Behavioral Therapy/methods , Prospective Studies , Alcohol Drinking , Randomized Controlled Trials as Topic
Tobacco dependence is a common comorbidity in patients with COPD (Chronic Obstructive Pulmonary Disease) that negatively affects the course of the disease. However, clinically relevant improvement in COPD can only be achieved by complete and permanent abstinence. Therefore, abstinence from tobacco use is a central therapeutic concept in smoking patients with COPD and requires specific and targeted treatment.After detailed documentation of smoking behaviour and motivational counseling outlining the risks of smoking, all such patients shall be offered a structured therapy for tobacco cessation. There is high-quality evidence for the effectiveness of a combination therapy of behavioral therapy and medication (to treat the withdrawal syndrome). Due to insufficient data, there is currently no recommendation for the use of e-cigarettes as a primary option for a cessation attempt.Smoking is the most important cause of COPD. Smoking cessation is the most effective and cost-efficient single intervention to reduce the risk of developing and progressing COPD.
Electronic Nicotine Delivery Systems , Pulmonary Disease, Chronic Obstructive , Smoking Cessation , Tobacco Use Disorder , Humans , Smoking/adverse effects , Smoking/psychology , Tobacco Use Disorder/therapy
Non-smoker protection and tobacco cessation Abstract. Objective: Whereas, on the one hand, employees in child and adolescent psychiatric institutions (CAP) have to enforce smoking bans among patients, on the other hand, they have a high likelihood of being smokers themselves. Little data are available on the enforcement of smoking regulations and what cessation support is offered by CAP institutions. Method: In an online survey, n = 78 senior staff members or directors of German CAP institutions (41.9 % of all addressed CAP institutions) responded to questions on smoking regulations, exceptions, and cessation support for employees. Results: The enforcement of comprehensive smoking bans is rarely reported (<20 % of CAP institutions). Employees are exempted or allowed to smoke mostly outside of the building (e. g., in designated smoking areas: 69-78 % depending on ward type). Cessation support was offered by less than half of the CAP institutions (47%). Conclusions: The data presented point toward future areas for tobacco control in CAP care, including transparent regulations, staff training, and dissemination of support for occupational smoking cessation.
Smoke-Free Policy , Smoking Cessation , Tobacco Use Cessation , Child , Humans , Adolescent , Non-Smokers , Smoking Cessation/psychology , Surveys and Questionnaires
OBJECTIVE: Tobacco control measures are relevant also in child and adolescent psychiatric institutions and their implementation in Germany will be assessed in this study. METHODS: In an online survey, n=78 leading staff members responded to standardized questions assessing how smoking in patients was dealt in such institutions. RESULTS: The majority of institutions (70-87%) had smoking bans in the psychiatric clinic buildings and premises. Depending on the type of psychiatric ward, exceptions were in place in the form of a designated smoking area (38%), smoking pavilion (19%), or when patients suffered from certain mental disorders (28%). Documentation of violations of the ban varied with the type of ward (30-79%), while in most cases violations led to consequences (84-93%) including confiscation of smoking utilities (42-63%) or a curfew (25-38%). Smoking cessation aids were reported by 78% of the institutions, most often as consultations (64%). Pharmacological treatments for smoking were provided in inpatient wards (71-83%). One in two institutions documented the result of cessation attempts (54%). Smoking-related working groups (14%) or the use of standardized diagnostic instruments (0-4%) were much less frequently reported. DISCUSSION: We provide a first look at tobacco control policy measures in child and adolescent psychiatric institutions on a national scale. This allows us to derive future areas for tobacco control.
INTRODUCTION: In addition to the prevention of tobacco consumption, the establishment and assurance of high-quality treatment for harmful use and dependence on tobacco products remains an important health-related task in Germany. Regular updating of the Association of the Scientific Medical Societies (AWMF) S3 guideline "Smoking and Tobacco Dependence: Screening, Diagnosis, and Treatment" (Tobacco Guideline) offers a sustainable and reputable source of knowledge on smoking cessation. METHODS: Under the auspices of the German Society for Psychiatry, Psychotherapy, Psychosomatics, and Neurology (DGPPN) and the German Society for Addiction Research and Addiction Therapy (DG-Sucht), the Tobacco Guideline was revised in 2019-2020 by 63 experts, who were involved in the development process of the text, in 11 working groups. Undue influence of conflicts of interest on the guideline could be minimized through careful conflict of interest management. Delegates from 50 professional societies discussed the 80 guideline recommendations and voted online. RESULTS: In addition to recommendations for screening and diagnostics, the Tobacco Guideline takes a positive stance towards the use of low-threshold counseling and support services. If, due to the severity of the tobacco-related disorder, brief counseling, telephone counseling, or internet- or smartphone-based methods are not sufficiently effective, individual or group behavioral therapy, possibly in combination with medication, is indicated. If nicotine replacement therapy is not effective, varenicline or bupropion should be offered. Alternative strategies with a lower level of recommendation are hypnotherapy, mindfulness-based treatments, or medication with cytisine. In adolescents and pregnant women, the use of medication should be limited to well-specified exceptions and nicotine replacement. The mean agreement with the recommendations reached a value of 98%. A general overview of the treatment recommendations of the Tobacco Guideline is provided by three clinical algorithms.
Alcoholism , Smoking Cessation , Tobacco Use Disorder , Adolescent , Alcoholism/drug therapy , Female , Humans , Pregnancy , Smoking , Tobacco Use Cessation Devices , Tobacco Use Disorder/diagnosis , Tobacco Use Disorder/therapy , Varenicline
OBJECTIVE: Patients seeking treatment for their asthma are most likely motivated by a change in their experience of symptoms, but primary complaints are not always related to the pulmonary system. This study aimed to determine the frequency of such extrapulmonary symptoms in asthma outpatients and their association with psychopathology and asthma outcomes. METHODS: This cross-sectional study utilized data collected as part of a nationwide, clinical-epidemiological study. The final sample of 572 asthma patients represented all levels of asthma control and severity. Information on demographics and respiratory function was obtained from physicians' documentation. Symptoms were explored using a standardized checklist. RESULTS: Primary symptoms reported by asthma patients were not necessarily airway-related. Patients reported feeling at least occasionally "tired" (72.1%) and "exhausted" (66.8%) more than any other asthma symptom. Hyperventilation and mood symptoms were experienced by 34.4-42.6% of patients. Anxiety or depression diagnoses indicated higher scores in all symptom domains. Controlling for asthma-related factors and psychopathology, fatigue had a small but significant effect on both asthma-related quality of life (AQLQ) (rsp2 = 0.02, P < .001) and asthma control (rsp2 = 0.01, P = .003). Mood symptoms also showed a small but significant effect on AQLQ (rsp2 = 0.02, P < .001). CONCLUSION: Findings suggest that extrapulmonary symptoms are endorsed more frequently than previously reported. Symptoms nonspecific to asthma can play a substantial role in clinical presentation and exclusive focus on airway symptoms may miss important information related to patients' well-being. Surveillance of extrapulmonary symptoms alongside pulmonary function is warranted for an integrated medicine approach to asthma management.
Asthma , Quality of Life , Anxiety , Asthma/epidemiology , Cross-Sectional Studies , Fatigue , Humans , Surveys and Questionnaires
Based on real-life data for the stage distribution of COPD patients (GOLD) and the actual stage-related treatment costs in a large nationwide cohort study (COSYCONET) 1, the influence of the reduced smoking rate on treatment costs was determined for the scenario of a reduction in the smoking rate of 26â% in this patient group by 10 percentage points to 16â%. The assumption was made that with a reduced smoking rate, lower stages (I/II) will be more strongly represented, while higher and more cost-intensive stages (III/IV) will be proportionally reduced. The intervention to achieve tobacco abstinence was calculated for the rough model calculations with the typical costs of a guideline-compliant treatment by a behavioral therapy group cessation program and the parallel use of medication support 2 3. The result showed a potential reduction of case costs by 10.5â%, not including reduction in costs associated with treatment of comorbidities.
Pulmonary Disease, Chronic Obstructive , Smoking Cessation , Tobacco Use Cessation , Cohort Studies , Cost-Benefit Analysis , Germany , Health Care Costs , Humans , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/therapy
A constitutional expert opinion, which reviews the social and constitutional foundations of tobacco cessation within the framework of statutory health insurance in Germany, comes to the conclusion that the legislator must release the reimbursement of professional tobacco cessation as a curative service by the statutory health insurance - and not only as a subsidy for a psychotherapeutically oriented measure within the framework of prevention.
National Health Programs , Tobacco Use Cessation/economics , Expert Testimony , Germany , Humans , Insurance, Health, Reimbursement , National Health Programs/economics , National Health Programs/legislation & jurisprudence
Smoking is the biggest cause of premature mortality. Almost half of smokers meet the criteria for addiction. Treatment fails primarily because of the lack of reimbursement. Doctors could treat tobacco addiction and with it the secondary diseases with high efficacy if the conditions with behavioral therapy and medication were made available to them.
Smoking Cessation , Smoking/therapy , Tobacco Use Disorder/therapy , Cognitive Behavioral Therapy , Cross-Sectional Studies , Germany/epidemiology , Health Knowledge, Attitudes, Practice , Humans , Internet , Smoking Cessation/economics , Smoking Cessation/psychology , Smoking Cessation/statistics & numerical data , Smoking Cessation Agents , Surveys and Questionnaires
BACKGROUND: Depression is a frequent comorbidity of COPD and leads to worse clinical COPD-outcomes. PHQ-9 and PHQ-2 are two widely used brief instruments to assess depression. However, psychometric properties in COPD patients are unknown. This study examines factorial validity, measurement invariance and composite reliability (CR) of PHQ-9/PHQ-2, respectively, and concordance between both tools. METHODS: This is a secondary analysis of N = 561 COPD patients who filled out the PHQ-9 at the begin (T0), the end (T1) and 3/6/9/12 (T2/T3/T4/T5) months after pulmonary inpatient rehabilitation. Structural equation modeling was used to examine factorial validity and measurement invariance between gender, GOLD disease severity groups and over time. Concordance was assessed using Cohen's Kappa, Yules Y, positive and negative agreement. RESULTS: A one-factor model (with one freed residual covariance) showed best model fit. At least partial scalar invariance could be established. Concordance between both instruments was substantial. 31.7% (26.2%) COPD patients showed clinically relevant depression according to PHQ-9 (PHQ-2) at T0. At T0-T2, PHQ-9 classified more patients as depressed than did PHQ-2. According to both measures, depression rates declined after rehabilitation. Reliability was high for both PHQ-9 (CR = 0.94) and PHQ-2 (CR = 0.89). LIMITATIONS: No gold-standard (clinical interview) to assess depression was used. Therefore, diagnostic accuracy for PHQ-9/PHQ-2 remains unclear. CONCLUSIONS: PHQ-9 and PHQ-2 fulfill important psychometric criteria (factorial validity, invariance, reliability) for measuring depression in COPD. The results support their use in clinical practice to assess severity of depression. Diagnostic accuracy to identify major/minor depression of both instruments should be examined in future studies.
Depressive Disorder/complications , Depressive Disorder/diagnosis , Inpatients/psychology , Patient Health Questionnaire/standards , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/rehabilitation , Depressive Disorder/psychology , Female , Germany , Humans , Inpatients/statistics & numerical data , Male , Middle Aged , Psychometrics , Pulmonary Disease, Chronic Obstructive/psychology , Reproducibility of Results , Translations
BACKGROUND: Methamphetamine is considered more dangerous than other stimulants because of its acute complications, long-term neurotoxicity, and potential for drug dependence. Until now, there have been no evidence-based guidelines for the treatment of methamphetamine-related disorders, either in Germany or abroad. METHODS: A systematic literature search was performed on the treatment of methamphetamine-related disorders. Based on this literature review, a multidisciplinary expert panel developed recommendations using the nominal group technique. RESULTS: The evidence base for the treatment of methamphetamine-related disorders is sparse. The efficacy of psychotherapeutic techniques such as cognitive behavioral therapy and contingency management and the efficacy of complex, disorder-specific treatment programs have been proven in ran - domized controlled trials, but it remains unclear which method is best. Persons carrying a diagnosis of substance abuse should be offered psychotherapy. Structured exercise programs, whether self-directed or professionally led, can improve addiction-specific endpoints as well as comorbid disorders and should, therefore, be offered as well. Pharmacotherapy has shown little to no effect in relatively low-quality clinical trials with low case numbers and high dropout rates, and therefore only a few weak recommendations were made. These include tranquilizers for the short-term treatment of agitation and atypical antipsychotics if necessary. Attempts to substitute other substances, such as methylphenidate or dexamphetamine, for methamphetamine have not yielded any robust evidence to date. Sertraline should not be administered due to serious adverse events. CONCLUSION: Many of the recommendations in the guideline are made with a weak grade of recommendation because of the poor evidence base and the modest size of the reported therapeutic effects. In acute situations, symptomoriented treatment is recommended. Psychotherapy and exercise should be offered as well.
Amphetamine-Related Disorders/therapy , Methamphetamine , Antipsychotic Agents/therapeutic use , Anxiety , Germany , Humans , Randomized Controlled Trials as Topic
The increasing abuse of the street drug crystal meth (methamphetamine) in many countries worldwide has resulted in a growing demand to treat patients who have acquired a methamphetamine-related disorder. The results of a systematic literature search which led to the consensus-based recommendations by the Working Group of the German Agency for Quality in Medicine (Ärztliches Zentrum für Qualität in der Medizin - ÄZQ) are presented. Pharmacological treatments were reviewed in 58 out of the 103 publications included. They were mainly randomized controlled trials (RCT). Despite increased research activities, none of the medications studied demonstrated a convincing and consistent effect on abstinence rates, despite some having an impact on craving and retention rates or symptom control. In addition, as yet there is no sufficient evidence available for dopamine analogue treatment ("substitution") after the initial withdrawal-period. Methamphetamine-related, post-acute persistent or comorbid syndromes such as methamphetamine-associated psychosis (MAP), depressive syndromes, anxiety, and sleep disorders are usually treated in a symptom-oriented manner. Risks of interactions with methamphetamine have to be taken in account when prescribing medications with doubtful efficacy. Further research is warranted.
Amphetamine-Related Disorders/drug therapy , Evidence-Based Medicine , Mental Disorders/drug therapy , Methamphetamine/adverse effects , Practice Guidelines as Topic , Psychoses, Substance-Induced/drug therapy , Secondary Prevention/methods , Amphetamine-Related Disorders/epidemiology , Antipsychotic Agents/therapeutic use , Benzodiazepines/therapeutic use , Comorbidity , Humans , Mental Disorders/epidemiology , Recurrence
RATIONALE: Despite the importance of trigger perceptions for asthma diagnosis and management, associations among asthma triggers, affective disorders, and asthma outcome have received little attention. OBJECTIVES: Because anxiety and depression are known to influence patients' health reports, we measured and controlled for these affective disorders in analyzing associations among patient perceptions of asthma triggers and asthma treatment outcomes. METHODS: Patients from a nationally representative sample of respiratory specialist practices (N = 459) were assessed for clinically significant anxiety and depression and completed questionnaires on asthma triggers, quality of life, and asthma control. Physicians recorded exacerbation and emergency treatment frequencies in the prior year, spirometric lung function, and allergy test results. Hierarchical multiple regressions examined associations among reported trigger factors, anxiety, depression, and asthma outcomes, including quality of life, asthma control, exacerbations, emergencies, and spirometry. MEASUREMENTS AND MAIN RESULTS: Patients across asthma severity levels were well represented. Anxiety and depression were associated with more frequent nonallergic, in particular psychological, triggers. Controlling for demographics, asthma severity, anxiety, and depression, nonallergic asthma triggers (including psychological triggers) explained substantial portions of variance in asthma control (total of 19.5%, odds ratios [ORs] = 2.07-1.37 for individual triggers), asthma-related quality of life (total of 27.5%, ORs = 3.21-1.49), and general quality of life (total of 11.3%, ORs = 1.93-1.55). Psychological triggers were consistently associated with exacerbations and emergency treatments (ORs = 1.96-2.04) over and above other triggers and affective disorders. Spirometric lung function was largely unrelated to perceived asthma triggers. CONCLUSIONS: Patients' perceptions of asthma triggers are important determinants of asthma outcomes, which can help identify individuals at risk for suboptimal asthma management.
Anxiety Disorders/psychology , Asthma/physiopathology , Depressive Disorder/psychology , Emergency Treatment/statistics & numerical data , Quality of Life/psychology , Stress, Psychological/psychology , Adult , Air Pollution/adverse effects , Asthma/etiology , Asthma/psychology , Attitude to Health , Cross-Sectional Studies , Disease Progression , Female , Humans , Hypersensitivity/complications , Logistic Models , Male , Middle Aged , Mood Disorders/psychology , Odds Ratio , Perception , Pollen/adverse effects , Severity of Illness Index , Spirometry , Stress, Psychological/complications , Surveys and Questionnaires
RESEARCH QUESTION: According to the German Guidelines for Psychotherapy, psychotherapists need the consent of the respective insurance company to commence outpatient therapy. They have two options: (1) To begin a so-called short-term therapy (KZT) for up to 25 sessions--a quick and easy procedure requiring few formal expenses. Afterwards the therapist must provide the reasons for extending the therapy in a formal expert assessment request (extension request). (2) It is also possible to obtain the consent of the insurance company at the beginning of therapy (initial request) for up to 50 sessions (psychodynamic long-term therapy) or even for up to 160 sessions (analytical psychotherapy), both of which require the same expert assessment to be filled out beforehand (LZT). This study examines the initial and extension requests submitted for evaluation for psychodynamic therapies according to the German Guidelines for Psychotherapy. The question is posed as to what influences are important in the selection of therapists for these two types of request. METHODOLOGY: In the context of the MARS study, we evaluated a total of 362 randomly chosen requests submitted between May 2007 and June 2008, 128 of which were initial requests and 234 of which were requests for an extension. The evaluation of the reports proceeded on the basis of a previously developed documentation system with various modules comprising information on the sociodemographics and morbidity of the patients as well as information on the therapists themselves. Further modules are assessed in this review. RESULTS: There were many more requests for an extension submitted than initial requests. Initial requests were preferably made when planning analytical psychotherapy. Patients for whom initial requests were submitted were also distinctly younger. The morbidity of the patients had no noticeable influence on the choice of procedure. In particular, diagnoses that could require crisis intervention were not more common in the requests for an extension than in the initial requests. Variables among the therapists had no influence on the form of procedure. These results were confirmed by a multivariate statistical analysis. DISCUSSION: The inconsistencies found in the reported and encoded morbidity of the patients confirm earlier results. Basic conditions, like the guidelines themselves or the payment of trial treatment, seem to determine therapists' behaviour. We also discuss whether or not the advantages of the current procedures to both the patient and the therapist outweigh the possible disadvantages..
Insurance Coverage/legislation & jurisprudence , Long-Term Care/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Psychoanalytic Therapy/legislation & jurisprudence , Psychotherapy, Brief/legislation & jurisprudence , Adult , Aged , Aged, 80 and over , Expert Testimony/legislation & jurisprudence , Female , Germany , Guidelines as Topic , Humans , Male , Middle Aged , Young Adult
BACKGROUND: As many as 50% of older smokers develop chronic obstructive pulmonary disease (COPD), and more than 80% of COPD-associated morbidity is caused by tobacco smoking. Despite the severe symptoms from which COPD patients suffer, they are often unable to quit smoking on their own. METHODS: Experts from 9 medical societies, under the aegis of the German Society of Pulmonology and Respiratory Medicine (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin), have developed an S3 guideline on smoking cessation in COPD. They took previously published guidelines into account, as well as more than 2000 initially surveyed publications, and created the new guideline in two consensus conferences followed by a Delphi process. RESULTS: The following strongly evidence-based statements can be made: A smoking cessation strategy based on a combination of medication and psychosocial support has been found to be effective in COPD patients. Smoking cessation improves pulmonary function, alleviates dyspnea and cough, reduces the frequency of COPD exacerbations, and lowers mortality. Mere smoking reduction does not improve pulmonary function or alleviate symptoms. Smoking cessation is the most effective and least expensive single means of lowering the risk of developing COPD and of arresting its progression. Smoking cessation should therefore be strongly promoted at all levels of health care delivery. CONCLUSIONS: There is no question that smoking cessation ranks among the most effective medical interventions, yet the German health care system still does not assign it an adequate priority.
Counseling/methods , Counseling/statistics & numerical data , Nicotine/therapeutic use , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/prevention & control , Smoking Cessation/methods , Smoking Cessation/statistics & numerical data , Germany/epidemiology , Health Promotion/methods , Health Promotion/statistics & numerical data , Humans , Psychology , Risk Assessment , Risk Factors , Smoking , Treatment Outcome
BACKGROUND: Despite the high prevalence of headache and migraine in the general population, many people do not receive adequate medical attention and treatment. OBJECTIVE: To evaluate the effects of pharmaceutical care (defined as intensified structured counseling between patient and pharmacist, including the use of drug databases), for patients with headache or migraine, on both clinical and psychological endpoints. METHODS: A prospective, randomized, controlled intervention study was conducted using pharmacies in Northern Germany. A total of 112 pharmacies (26% of all pharmacies in the study region) recruited 410 patients with headaches. Pharmacies were randomly assigned to an intervention or control group. Patients were interviewed by telephone prior to the intervention and again after 4 months. Primary endpoints were number of days with headache, number and severity of headaches, self-efficacy, and the patients' perceptions of their health-related quality of life. RESULTS: Each pharmacy treated an average of 4.6 patients (total time effort 9 h). The intervention group consisted of 201 patients who received pharmaceutical care, whereas the control group comprised 209 patients who received standard counseling. In both groups, the number of headache attacks and intensity of pain in treated headache attacks did not change significantly between the first and second interviews. However, a statistically significant improvement in mental health and self-efficacy was shown in the intervention group. Intensity of pain in untreated headache attacks and the number of days with headache decreased in both groups. Most participants described this intervention as helpful and effective and 90% reported that they would recommend pharmaceutical care to other patients with headache. CONCLUSIONS: A short-term pharmaceutical care intervention improved patients' mental health and self-efficacy, although it did not significantly change the number and severity of headaches. The increase in self-efficacy and mental health associated with pharmaceutical care may be instrumental in improving long-term pharmacotherapy of patients with migraine and headache. To fully assess the effects of pharmaceutical care, a longer study may be required.
Community Pharmacy Services/standards , Directive Counseling/methods , Headache Disorders/drug therapy , Migraine Disorders/drug therapy , Adult , Data Collection , Databases, Factual , Directive Counseling/standards , Female , Follow-Up Studies , Germany/epidemiology , Headache Disorders/psychology , Humans , Male , Middle Aged , Migraine Disorders/psychology , Patient Education as Topic/methods , Patient Education as Topic/standards , Patient Satisfaction/statistics & numerical data , Pharmacists/organization & administration , Pharmacists/standards , Professional Role , Quality of Life , Self Efficacy , Severity of Illness Index
OBJECTIVE: Information on patient satisfaction with professional health care delivery in asthmatics is rare, and the question as to how asthma education programmes affect such satisfaction has not yet been addressed. METHODS: This multi-centre study investigated three different variants of an asthma education programme for adults. Patients participated either in variant B (basic training with teacher-directed presentation, two 90 min sessions), variant C (comprehensive training, four sessions), variant D (including additional psychological components, minimum five sessions), or variant E (equivalent to B in outpatient context). At the end of the training the perceived satisfaction with the programme and reported personal benefit were assessed by means of a new inventory that was developed. RESULTS: The sample comprised N = 320 patients (n = 244 inpatients and n = 76 outpatients) ranging in age from 18 to 80 years (M = 46.3 years). The average total score for educational satisfaction of all participants was 8.0 (maximum score = 10). Choice of topics was judged particularly positive (M = 8.58), followed by the structure of training/setting-conditions (M = 8.0). The perceived personal benefit from the training was evaluated less positively (M = 7.32). When comparing the programme variants, patients' average satisfaction tends to increase with the extent and intensity of the training offered. Outpatients showed significantly less satisfaction in contrast to inpatients. Inpatients' satisfaction with the three variants increased with extensiveness and intensity of the training, while the contrast of between-group comparisons (B-C, B-D and C-D) was significant. CONCLUSION: Assessment of the patient's view of health care services should complement standardised evaluation methods, especially in multi-intervention rehabilitation programmes. PRACTICE IMPLICATIONS: Rehabilitation-specific diagnostic measures should be developed and validated in order to better assess patients' satisfaction and training efficacy from the patient's perspective. Further study is recommended on how far individualised training measures might increase subjective benefit.
Asthma/psychology , Inpatients , Outpatients , Patient Education as Topic/organization & administration , Patient Satisfaction , Teaching/organization & administration , Adolescent , Adult , Aged , Aged, 80 and over , Analysis of Variance , Asthma/prevention & control , Asthma/rehabilitation , Curriculum , Female , Germany , Humans , Inpatients/education , Inpatients/psychology , Male , Middle Aged , Models, Educational , Outpatients/education , Outpatients/psychology , Patient-Centered Care/organization & administration , Program Evaluation , Quality of Life/psychology , Self Care , Surveys and Questionnaires
BACKGROUND: Despite significant progress in asthma drug therapy in recent years, there has been no major change in asthma morbidity and mortality. It is still important to determine whether pharmaceutical care (PC) influences health outcomes. OBJECTIVE: To evaluate the effectiveness of PC with regard to clinical, humanistic, and economic outcomes in adults with asthma. METHODS: An intervention study was conducted over 12 months. At baseline, 39 community/retail pharmacies, 84 primary care physicians (general practitioners, internal specialists, chest physicians), and 183 patients (aged 18-65 y) diagnosed with asthma were included. To evaluate economic outcomes, 2 German statutory health insurance funds provided 2 years of claims data for their insured patients (n = 55). A 1:10 matching was carried out to compare the data of this intervention subgroup with those of a control group (n = 550). RESULTS: Significant improvements were found for all humanistic outcomes (eg, asthma-specific quality of life, self-efficacy, knowledge, medication adherence). In addition, asthma severity, self-reported symptoms, peak expiratory flow, and patients' inhalation technique improved. Increases in forced expiratory volume in 1 second and vital capacity were not significant over time. Evaluation of the insurance claims data revealed a shift toward better adherence to evidence-based therapy. CONCLUSIONS: The study shows that PC for people with asthma has a positive impact on humanistic and, to some extent, on clinical outcomes. To determine potential economic benefits, future research should focus on patients with more severe asthma.
Asthma/drug therapy , Community Pharmacy Services/standards , Pharmaceutical Services/standards , Adrenergic beta-2 Receptor Antagonists , Adrenergic beta-Agonists/therapeutic use , Adult , Anti-Asthmatic Agents/classification , Anti-Asthmatic Agents/therapeutic use , Community Pharmacy Services/statistics & numerical data , Community Pharmacy Services/trends , Female , Hospitalization/statistics & numerical data , Humans , Insurance Claim Review/economics , Insurance Claim Review/statistics & numerical data , Male , Peak Expiratory Flow Rate/drug effects , Pharmaceutical Services/trends , Surveys and Questionnaires , Theophylline/therapeutic use , Time Factors , Treatment Outcome
Current estimates indicate that 50% of the population experience at least one mental disorder in their lifetime and that at least 25% have suffered a mental disorder in the past year. recognition, diagnosis, treatment, and referral depend overwhelmingly on general practitioners, at least one third of whose consultations have a direct and explicit psychological component. Yet despite this intensive familiarization with the presentation of mental pathology, and the appropriateness of the primary care setting to its management, even the most recent surveys indicate that performance is best described by the rule of diminishing halves: only half the patients with a thresh-old disorder are recognized; only half of those recognized are treated; and only half of those treated are effectively treated. There is no single solution to this problem, only multiple solutions, which must be aimed, consistently and simultaneously, at the patient, practitioner, practice, and research levels.
