[Levers in Primary Health Care - Identifying Strategic Success Factors for Improved Primary Care in Upper Austria]. / Stellschrauben in der Hausarztversorgung ­ Identifizierung strategischer Erfolgsfaktoren für eine verbesserte hausärztliche Versorgung in Oberösterreich.

Current and projected general practitioner (GP) and primary care in Austria shows structural and process inadequacies in the quality as well as assurance of healthcare supply. The aim is therefore to develop solution- and patient-oriented measures that take patient-related requirements and medical perspectives into account. Using an effect matrix, subjective expert and user priorities were ascertained, cause and effect relationships were examined, and an expanded circle of success for the optimization of GP and primary care in Upper Austria was developed. Through this, the relevant levers for target-oriented development and optimization of the complex system of GP and primary care in Upper Austria were identified; these are training to become general practitioners, entrepreneurs as well as management and coordination. It is necessary to further adapt the identified levers conceptually and operationally in a targeted approach. This is to be achieved by means of the primary health care (PHC) concept as well as management tools and information and communication technologies (ICT) associated with it.

[The tele-visit as a telemedical technique in daily clinical practice. First results for elbow joint arthrolysis]. / Die Televisite als Anwendungsform der Telemedizin im klinischen Alltag. Erste Ergebnisse bei der Ellbogengelenkarthrolyse.

Technologies in telecommunication and information are being increasingly applied in the public health system of the western world. Also responsible for this development is the cost factor in the field of financing and maintenance of such a system of superior medical supply, as well as the concurrent patient' demand for optimized medical "24 h care and treatment". Pioneers in the use of telematic projects have, up until now, been large states such as the USA, Canada, Norway or Australia. Such projects have been used to provide, guarantee and maintain medical care in geographically remote regions with few medical facilities. After breaking the obstacle of geographic distance, telemedical solutions in general, and especially the tele-visit, represent a new form of treatment for patient care after discharge from hospital. In the year 2002, a prospective randomized two-armed study was initiated including patients after surgical intervention by arthroplasty in posttraumatic contracture of the elbow. The system of the tele-visit was used for 6 weeks after discharge and the patients were controlled as outpatients after 6 months, including a physical examination. The functional outcome, duration of stay in hospital and the costs for treatment arising were determined. A standardized questionnaire was developed and the degree of satisfaction of the patients surveyed. A shorter stay in hospital was found together with lowered costs in medical treatment, while no differences in functional outcome could be found in comparison to the control group, although there was an additionally high grade of satisfaction with the new system.

[The televisit system in patients care after discharge in clinical use--first experiences]. / Das System der Televisite zur poststationären Patientenbetreuung im klinischen Einsatz-erste Erfahrungen.

The televisite is a form of application of telemedicine, that allows a communication between the patient and the family doctor or specialist in the clinic after discharging of hospital. Pioneers for the use of telematic projects have been up to now wide states like the USA, Canada, Norway or Australia to provide, guarantee and maintain by the means of telemedical solutions medical care in geographic regions hardly reachable and of little medical attention. In central Europe and Germany telemedicine is gaining in significance on the one hand because of increasing importance of the cost factor and resulting pressure on the public health system and on the other hand because of the rising demand of the patients for optimised medical care. It specially represents a new form of treatment in patients care after dischargement of hospital. In the year of 2002 a prospective randomised two-armed study was initiated including patients after operative intervention by arthroplasty in posttraumatic contracture of the elbow. The system of the Televisite is used for 6 weeks after dischargement and patients had been controlled ambulant after 6 months including a physical examination. The functional outcome will be scored, the duration of stay in hospital measured, the arising costs for treatment calculated and the satisfaction of the patients in handling the Televisite surveyed. Over this first results showed a shortened stay in hospital together with lowered costs in medical treatment on the one hand and on the other no difference in functional outcome could be found in comparison to the control group by additionally high grade of satisfaction with the new system.

["State of the art" in epidemiology of arthroses. An overview of important studies of etiology and sequelae]. / "State of the Art" in der Arthrosenepidemiologie. Ein Uberblick über wichtige Studien zur Atiologie und zu den Krankheitsfolgen.

The term "Osteoarthrosis" encompasses a group of joint disorders characterized by pain and restriction of mobility. Currently, considerable confusion prevails with respect to the definition of the disease entity and the classification criteria to be utilized in epidemiologic research. Despite these methodological difficulties, it is discernible from the international rheumatology journals that during the past decade this emerging field of research has become firmly established in several European countries and in North America. Researchers have focused their attention on four major facets of the disease: 1. etiological or risk factors with respect to the initiation and clinical course of disease, 2. the impact of illness on the individual and his family, 3. the statistical estimation of incidence and prevalence rates in the total population or in selected at-risk groups of individuals, 4. health care utilization patterns and their costs and benefits. This survey article aims at providing a critical overview of this emerging field of research, as well as at suggesting to the reader future lines of development useful for public health and health promotion researchers in Germany.