The nephrology eHealth-system of the metropolitan region of Hannover for digitalization of care, establishment of decision support systems and analysis of health care quality.

BACKGROUND: Even though a high demand for sector spanning communication exists, so far no eHealth platform for nephrology is established within Germany. This leads to insufficient communication between medical providers and therefore suboptimal nephrologic care. In addition, Clinical Decision Support Systems have not been used in Nephrology until now. METHODS: The aim of NEPHRO-DIGITAL is to create a eHealth platform in the Hannover region that facilitates integrated, cross-sectoral data exchange and includes teleconsultation between outpatient nephrology, primary care, pediatricians and nephrology clinics to reduce communication deficits and prevent data loss, and to enable the creation and implementation of an interoperable clinical decision support system. This system will be based on input data from multiple sources for early identification of patients with cardiovascular comorbidity and progression of renal insufficiency. Especially patients will be able to enter and access their own data. A transfer to a second nephrology center (metropolitan region of Erlangen-Nuremburg) is included in the study to prove feasibility and scalability of the approach. DISCUSSION: A decision support system should lead to earlier therapeutic interventions and thereby improve the prognosis of patients as well as their treatment satisfaction and quality of life. The system will be integrated in the data integration centres of two large German university medicine consortia (HiGHmed ( highmed.org ) and MIRACUM ( miracum.org )). TRIAL REGISTRATION: ISRCTN16755335 (09.07.2019).

[General Practice in a University Emergency Department - Concept, Implementation and Evaluation]. / Allgemeinmedizin in einer universitären Notaufnahme ­ Konzept, Umsetzung und Evaluation.

Background: Accident and emergency departments (A&E) are facing increasing numbers of patients. While hospitalization rates have remained nearly constant, there has been an increase in outpatient cases. Therefore, at Hannover Medical School (MHH), general practitioners (GPs) have been integrated in A&E. Methods: In 2014, all GP contacts within the A&E were evaluated on the basis of hospital routine data and by an additional questionnaire. It contained questions about who initiated the admission, about medical examinations and tests and the patient-related admission decisions. Results: In 2014, GPs in A&E treated 1 646 patients. 76% of the patients were self-referrals and 23% referrals from primary care physicians. The most prevalent diagnoses were back pain, gastroenteritis and hypertension. GPs in A&E did not need any additional specialist involvement in most cases. 81% of the patients were sent home, most of them with the advice to consult their GPs (59%), and 22% to consult a specialist. Repeated visits were scarce. Conclusion: Deploying GPs in A&E represents a promising concept to cope with the rising number of patients in A&E. However, further studies are needed to examine the accuracy of the GPs' diagnosis-related decisions and patient satisfaction.

[Asthma guidelines: knowledge of family doctors and trainees in Germany]. / Wissen von Hausärzten und Ärzten in Weiterbildung über nationale Asthmaleitlinien.

In Germany as well as internationally, evidence-based asthma guidelines were developed as a decision aid for diagnosis and therapy. However, adherence to recommendations is usually less than optimal. The authors explore potential implementation barriers: knowledge gaps, practical presentation of guidelines, and attitudes of doctors and patients. In this paper, we compare results of our knowledge survey of family doctors and trainees with results of similar national and international studies. In all studies, all surveyed groups of physicians revealed considerable knowledge gaps. Many physicians in our own study erroneously preferred mucolytics and antibiotics to treat acute or subacute asthma symptoms though these drugs are not or only exceptionally indicated. The inflammatory character of asthma often goes unrecognized, as well as the importance of inhaled (and systemic) corticosteroids in long term treatment (or treatment of exacerbations).