[Does the Prevention Act Improve Prevention in Pediatric Outpatient Settings!?] / Mehr Prävention durch das Präventionsgesetz in der kinder- und jugendärztlichen Praxis!?

Aim of the study: The Prevention Act was adopted by the German Federal Parliament on 18.06.2015. The paediatric practice is an important place from which to reach out to children and teenagers and to positively influence them through targeted prevention services in their health-related behaviour. It is therefore an important setting for the implementation of the Prevention Act. Could the delegation of prevention services to qualified medical assistants promote the successful implementation of the Prevention Act? Since 2003, medical assistants have qualified as "Prevention Assistants" after completing training courses and offered support in preventive services to children and teenagers in the paediatrician's office. The aim of this study was to improve the effectiveness of the training to increase the competence of the participants, expansion of preventive services for children and teenagers in the paediatrician's office and reduction of physician workload. Methodology: Training was accompanied by ongoing evaluation; there were two extensive studies in 2009 and 2011, respectively. Between 2003 and 2006 (n=126, after 75% response rate) and in 2011 (n=119 after 24% response rate), participants were assessed with standardized questionnaires, and in the survey of 2011, their employers also were interviewed, (n=76, after 22% response rate). Results: The prevention assistants assess their learning successes as good and are able to take over delegated tasks in the paediatrician's office. The involvement of a trained prevention assistant contributed to the transformation and re-establishment of prevention offers in paediatrician's offices and reduced physician workload. 44% of physicians felt that the time saved by prevention assistant was very good or good, 80% of physicians surveyed also indicated that prevention assistants carried out preventive consultations in the doctor's office. Conclusion: In light of the paediatricians' workload and their own wishes and demands, and for a targeted implementation of the Prevention Act, it is necessary to delegate preventive services to trained personnel. It is also possible to accomplish this task. It is necessary to introduce billing numbers in the fee schedule for doctors similar to the billing numbers for dental health prophylaxis.

[Promotion of breast feeding in paediatric outpatient settings]. / Stillförderung in der Kinderarztpraxis - Möglichkeiten und Grenzen.

With some data and examples it can be shown that the competence and the knowledge of paediatric doctor's assistants and paediatric nurses can and should be improved. The training courses to become a "prevention assistant" have been very positively accepted by doctor's assistants and paediatric nurses, and it seems an appropriate method to reach these aims. Prevention and especially promotion of breast feeding is possible in paediatric outpatient settings. The immediate contact between infants, parents, paediatric doctor's assistants, paediatric nurses, and doctors offers a unique opportunity to promote the health of children, mainly due to the high acceptance of regular check-ups. So why not introduce the promotion of breast feeding in paediatric outpatient settings with specially trained doctor's assistants and paediatric nurses?

[Cost-effectiveness studies of ambulatory educational programs for children with asthma and their families]. / Kosten-Nutzen-Untersuchungen bei ambulanten Schulungsmassnahmen für asthmakranke Kinder und ihre Familien.

Increasingly, economic aspects become important in public health which makes necessary the quantification to economical and operational efficiency. One of the instruments applied in this process is cost-benefit-analysis, comparing preventive, curative and rehabilitative services under the aspect of cost and benefit and effectiveness. In this context, we have evaluated a project of ambulant training of asthmatic children and of their parents. We included 142 affected children and their parents, who were trained in the offices of 24 physicians. Evaluation was done with a questionnaire in which data were collected on asthma-management, on quality of life, and on cost-effectiveness. We looked at the year before starting the training and on the year after completion of the training. Treatment costs were decreased by training, life quality improved. Thus, ambulant training of asthmatic children and of their family is a useful and efficient part of preventive rehabilitation.

[Analysis of the current status of asthma education for children and adolescents in German-speaking countries]. / Analyse zur gegenwärtigen Situation der Asthmaschulung für Kinder und Jugendliche im deutschsprachigen Raum.

Systematic training of children and adolescents to cope with asthma has been practised in Germany for long years parallel to the development of training for adult asthmatics. An analysis conducted in mid-1992 revealed a considerable gap between the actual need for such training and the available training facilities. The analysis covered asthma training both for outpatients and inpatients including those referred to rehabilitation hospitals. The analysis revealed that there have been some achievements in the topics that were analysed (general framework of conditions for training, target groups of patients, agreement on the direction in which to proceed with regard to scope and aims, follow-up and aftercare, interdisciplinary exchange of ideas and actions, financing and government-piloted sponsorship by the compulsory health insurance bodies, qualification of the asthma pupils and evaluation), whereas in many cases these achievements are in the nature of a pilot study or of a matured model without meeting as yet the essential conditions for a full-range and adequate asthma training offer that can be realised in a sufficiently large area. However, a general consensus has been reached recently on medical contents of the training, on problems of methods and didactic approach and also on standards of evaluation. The paper expressing this general consensus was passed on the occasion of the 3rd Annual General Meeting of the Work Team for Asthma Training in Childhood and Adolescence. This means that the essential prerequisites for expanding the training programme from a local to a large-area programme have now been created.