[General practices and community care points work hand in hand in the care of multimorbid patients: What are the advantages? - A qualitative study with general practitioners and medical practice assistants]. / Hausarztpraxen und Pflegestützpunkte Hand in Hand in der Versorgung multimorbider Patient*innen: Welche Vorteile kann das bringen? ­ Eine qualitative Studie mit Hausärzt*innen und Medizinischen Fachangestellten.

BACKGROUND: Caring for an increasing number of multimorbid people is a challenge for general practices in Germany. A possible approach to ensure future care could be the cooperation between general practices and community care points, which have so far been a little-known option among general practitioners. The aim of this study was to investigate the benefits or additional burdens that, from the perspective of general practices, a cooperation between general practices and community care points would bring for both the general practitioners themselves and their patients. METHODS: In the mixed-methods study COMPASS II, general practices were able to refer multimorbid patients with social counselling needs to a community care point. Semi-structured guideline-based telephone interviews were conducted with nine general practitioners and nine medical practice assistants regarding the feasibility of cooperation with the community care points. The interviews were analysed using framework analysis. RESULTS: In the qualitative interviews, the general practitioners and medical practice assistants reported that the community care points helped them save time by relieving them of social counselling tasks. The interviewees felt relieved by knowing that the community care points expertly take care of their patients' social concerns. From the perspective of the interviewees, multimorbid patients experienced changes in their care through the counselling in community care points, such as adjusting the level of care they require. Social counsellors provided patients and their relatives with an overview of the support options available. The majority of the interviewees did not feel that cooperating with the community care point put an additional burden on their patients or on themselves. DISCUSSION AND CONCLUSION: Cooperation between general practices and community care points has the potential to improve care for multimorbid patients and reduce the workload burden on general practices. Community care points are legally anchored counselling services which general practitioners could increasingly involve in the care of patients with multimorbidity.

[Referrals from general practice to community care points. What are the patients' experiences? An interview study]. / Von der Hausarztpraxis zum Pflegestützpunkt überwiesen. Welche Erfahrungen haben die Patient*innen gemacht? Eine Interview-Studie.

INTRODUCTION: Primary care for multimorbid patients does not only include medical but also social counseling. In Germany, community care points represent an institutionalised support offer for counseling for social and care-related issues at district level. METHODS: Within the framework of an intervention study on the cooperation between general practices and community care points in Berlin, 14 telephone interviews were conducted with multimorbid patients with social counseling needs who received advice by a community care point. The aim was to investigate satisfaction with the cooperation process as a whole and with the counseling provided by the community care points. The transcribed interviews were analysed using the framework analysis. RESULTS: Overall, the patients were satisfied with the counseling they received from the community care points. In many cases, even after counseling, patients were not aware of the range of services offered by the community care points, and there was confusion about community care points and locally known mobile care services. Patients felt that it was particularly important to have a friendly, reliable contact person, to be close to their own place of residence and to have a long-term connection to the service. From the point of view of those affected, the general practitioner remains an important contact person who initiates the counseling, if necessary, and coordinates the interventions to be derived from the counseling result. DISCUSSION: The confusion about community care points and mobile care services due to a lack of knowledge about the range of services offered by community care points are central topics in the interviews. This could be due to the heterogeneous supply of the community care points as well as the lack of networking with GP practices. A standardisation of the offer and increased information and networking activities of the community care points at district level could contribute to an increased level of awareness and improve transparency of their services. CONCLUSION: In the long term, cooperation between community care points and general practitioners could help relieve the burden on general practitioners and improve social care for multimorbid patients at district level.

[Do General Practitioners have Experience with Social Care Points? A Berlin-Wide Survey]. / Haben Hausärzt*innen Erfahrungen mit Pflegestützpunkten? Eine berlinweite Fragebogenerhebung.

Primary care for multimorbid patients involves social counseling in addition to medical care. Community care points are established institutions for social counseling at district level in Berlin. A Berlin-wide questionnaire survey examined primary care physicians' knowledge of and experience with community care points. 700 questionnaires were analysed exploratively and descriptively. General practitioners were only partially familiar with the services of community care points (60% barely or not at all). 57% of the general practitioners stated that they already had contact with community care points. General practitioners who had not yet had contact with a community care point recommended other advice centers for social (76%) and care-related advice (79%) to their patients. A majority of general practitioners expressed a wish to get more information about community care points.

COMPASS II-Coordination of Medical Professions Aiming at Sustainable Support Protocol for a feasibility study of cooperation between general practitioner practices and community care points.

INTRODUCTION: General practitioners (GP) increasingly face the challenge of meeting the complex care needs of multi-morbid patients. Previous studies show that GP practices would like support from other institutions in advising on social aspects of care for multi-morbid patients. Already existing counselling services, like community care points, are not sufficiently known by both GPs and patients. The aim of COMPASS II is to investigate the feasibility of cooperation between GP practices and community care points. METHODS AND ANALYSIS: During the intervention, GPs send eligible multi-morbid patients with social care needs to a community care point. The community care points report the consultation results back to the GPs. In preparation for the intervention, in a moderated process, GP practices meet with the community care points to agree on information exchange. The primary outcome is the feasibility of the cooperation: Questionnaires will be sent to GPs, medical practice assistances and community care point personnel (focus: practicality, acceptability). Data will be collected on frequency and reasons for GP-initiated consultations at community care points (focus: demand). Qualitative interviews will be conducted with all participating groups (focus: acceptability, satisfaction). The secondary outcome is the assessment of changes in health-related quality of life, social support and satisfaction with care: participating patients complete a questionnaire before and three to six months after their counselling. The results of the study will be incorporated into a manual in which the experiences of the cooperation will be made available to other GP practices and community care points. DISCUSSION: In COMPASS II, GP practices establish cooperation with community care points. The latter are already existing institutions that provide independent and free advice on social matters. By using an existing institution, the established cooperation and experiences from the study can be used beyond the end of the study. TRIAL REGISTRATION: The trial is registered with DRKS-ID: DRKS00023798, Coordination of Medical Professions Aiming at Sustainable Support II.

Development of a patient-oriented navigation model for patients with lung cancer and stroke in Germany.

BACKGROUND: The concept of patient navigation was first established in the USA to support vulnerable patient groups in receiving timely and comprehensive access to cancer care. It has recently gained increasing interest in Germany to support patients with chronic diseases in a fragmented healthcare system. The aim of this paper is to present the development of such a model adapted to the German context based on the results of mixed-methods studies investigating the need for and barriers to patient-oriented care. METHODS: In a process adapted from Delphi rounds, we conducted regular structured workshops with investigators of the project to discuss results of their studies and identify content and structure of the model based on the data. Workshop discussions were structured along seven core components of a navigation model including target patient groups, navigator tasks, occupational background and education of navigators, and patient-navigator interaction mode. RESULTS: Using an approach based on empirical data of current care practices with special focus on patients' perspectives, we developed a patient-oriented navigation model for patients who have experienced stroke and lung cancer in the German healthcare context. Patients without personal social support were viewed as struggling most with the healthcare system, as well as multimorbid and elderly patients. Navigators should serve as a longer-term contact person with a flexible contact mode and timing based on the individual situation and preferences of patients. Navigator tasks include the provision of administrative and organizational support as well as referral and guidance to available resources and beneficial health programs with special forms of knowledge. Implementation of the navigator should be flexibly located to ensure a reliable outreach to vulnerable patients for first contact in settings like specialized in-patient and out-patient settings, while navigation itself focuses on care coordination in the out-patient setting. CONCLUSION: Flexibility of navigator tasks needed to be a core characteristic of a navigation model to be perceived as supportive from patients' perspectives. In a subsequent feasibility study, an intervention based on the model will be evaluated according to its acceptance, demand, and practicality.

Patient Navigation-Who Needs What? Awareness of Patient Navigators and Ranking of Their Tasks in the General Population in Germany.

The aim of the present study was to investigate the awareness of patient navigation (PN) in the general population in Germany and to assess which navigator tasks are considered most important. The analysis drew on a 2019 nationwide telephone survey of 6110 adults. We compared rankings of emotional support, administrative support and information among respondents with and without experience of patient navigation. One-fifth of the sample reported having heard of PNs; 13% of this group already had experience with PN. In both groups, the majority (>47%) considered assistance with applications to be most important. This was particularly the case among younger adults and those with a chronic disease. Within the inexperienced group, higher educated people had higher odds of ranking provision of information as most important for them, whereas women and those without a partner had higher odds of ranking emotional support as the most important task. This study shows that the majority of people predominantly expect PN services to offer administrative support, irrespective of their socioeconomic and health status. Whether these expectations are met by the diverse existing PN programs, which often have a strong focus on other tasks (e.g., increasing health literacy), has yet to be evaluated.

[Support for General Practitioners in the Care of Patients with Complex Needs: A Questionnaire Survey of General Practitioners in Berlin]. / Unterstützungsbedarf und -möglichkeiten für Hausärzte in der Versorgung von Patienten mit komplexem Bedarf: Eine Fragebogenerhebung Berliner Hausärzte.

OBJECTIVES: Because of demographic changes, new models of care are important for supporting general practitioners in the care of patients with complex needs. This study addresses the question of the type of support that is requested by general practitioners working in Berlin. METHODS: All general practitioners working in Berlin (n=2354) were asked between August and September 2018 to return a questionnaire by post which has been developed for this study. Questions addressed support needs as well as support models within the practice (delegation, substitution) and outside the practice (social worker, navigator, community care points). Data were analysed descriptively and by exploratory multivariate analysis to show the influence of practice and doctor characteristics on the preference of support models (age, gender, location of the practice, type of practice, working hours). RESULTS: A total of 557 questionnaires (response rate 23.7%) were included in the analysis. Need for support was seen particularly for administrative, coordinative and organisational tasks and for advice on social issues. The majority of the study participants approved delegation and substitution. In their view, it was conceivable to get support from professionals or institutions outside their practice, such as mobile care services, community care points, social workers or navigators. Particularly younger and female doctors working in group practices were open for cooperative care models integrating other health professions. CONCLUSIONS: There is unused potential for delegation and cooperation within existing structures. Further research should investigate the acceptance and feasibility of different support models.

[Non-medical aspects in the care for multimorbid patients in general practice. What kind of support and cooperation is desired? Focus groups with general practitioners in Berlin]. / Nichtmedizinische Aspekte der Versorgung multimorbider Patient*innen in der Hausarztpraxis. Welche Unterstützung und Kooperationen werden gewünscht? Fokusgruppen mit Berliner Hausärzt*innen.

BACKGROUND: General practitioners (GPs) are the first point of contact and they coordinate the care for multimorbid patients. This article discusses possible solutions for GPs' needs and wishes regarding the support for non-medical issues, in particular social and legal tasks as well as the cooperation with already existing institutions. METHODS: In the third study phase of a mixed-methods approach, two focus groups with eleven GPs from Berlin were carried out. The project is part of the NAVICARE project, funded by the federal Ministry of Education and Research. The focus groups were analyzed using the framework analysis. RESULTS: GPs caring for multimorbid patients are often faced with non-medical patient needs and social consultation issues. They would like to receive support in these areas and want more cooperative care structures. They are largely unaware of existing offers by social institutions in their city districts. The designation of a fixed contact person in social institutions could improve communication and thus enable low-threshold access. DISCUSSION AND CONCLUSION: The GPs agree that there is a need for support with social and legal matters in general practice. The focus groups discussed already existing offers that GPs could use more frequently and how a cooperation with providers of social care could succeed. GPs in Berlin think that support and relief measures, in particular in the form of cooperation with institutions in the district that provide social and legal support, are both desirable and conceivable.

The Acceptability of Task-Shifting from Doctors to Allied Health Professionals.

BACKGROUND: The shifting of medical tasks (MT) to Qualified Medical Practice Assistants (MPA) is an option that can be pursued to ensure adequate health care in Germany despite the increasing scarcity of physicians. The goal of this study was to determine the acceptability of medical task-shifting to MPA among the general population. METHODS: In a nationwide, representative telephone survey, 6105 persons aged 18 or older were asked whether they would be willing to receive care from a specially trained MPA at a physician's office. Their responses were tested for correlations with sociodemographic characteristics by means of bivariate (chi-squared test, Mann-Whitney U test) and multivariable statistics (logistic regression). RESULTS: Of the respondents, 67.2% expressed willingness to accept the shifting of MT to an MPA for the treatment of a minor illness, and 51.8% for a chronic illness. Rejection of task-shifting was associated with old age, residence in western Germany, and citizenship of a country other than Germany. For example, non-Germans rejected task-shifting more commonly than Germans, for both minor illnesses (odds ratio [OR] 2.96; 95% confidence interval [2.28; 3.85]) and chronic illnesses (OR 1.61; [1.24; 2.10]). CONCLUSION: Further studies are needed to investigate the motives for rejection of medical task-shifting to MPA in order to assess the likelihood of successful nationwide introduction of a uniform delegation model.

Coordination of care for multimorbid patients from the perspective of general practitioners - a qualitative study.

BACKGROUND: In Germany, a decreasing number of general practitioners (GPs) face a growing number of patients with multimorbidity. Whilst care for patients with multimorbidity involves various healthcare providers, the coordination of this care is one of the many responsibilities of GPs. The aims of this study are to identify the barriers to the successful coordination of multimorbid patient care and these patients' complex needs, and to explore the support needed by GPs in the care of multimorbid patients. Interviewees were asked for their opinion on concepts which involve the support by additional employees within the practice or, alternatively, external health care professionals, providing patient navigation. METHODS: Thirty-two semi-structured, qualitative interviews were conducted with 16 GPs and 16 medical practice assistants (MPAs) from 16 different practices in Berlin. A MPA is a qualified non-physician practice employee. He or she undergoes a three years vocational training which qualifies him or her to provide administrative and clinical support. The interviews were digitally recorded, transcribed and analysed using the framework analysis methodology. RESULTS: The results of this paper predominantly focus on GPs' perspectives of coordination within and external to general practice. Coordination in the context of care for multimorbid patients consists of a wide range of different tasks. Organisational and administrative obstacles under the regulatory framework of the German healthcare system, and insufficient communication with other healthcare providers constitute barriers described by the interviewed GPs and MPAs. In order to ensure optimal care for patients with multimorbidity, GPs may have to delegate responsibilities associated with coordinating tasks. GPs consider the deployment of an additional specifically qualified employee inside the general practice to take on coordinative and social and legal duties to be a viable option. CONCLUSIONS: The cross-sectoral cooperation between all involved key players working within the healthcare system, as well as the coordination of the whole care process, is seemingly challenging for GPs within the complex care system of multimorbid patients. GPs are generally open to the assignment of a person to support them in coordination tasks, preferably situated within the practice team.