Contextual factors and mechanisms in the implementation of Value Stream Mapping in breast cancer centres - A multiple case study.

INTRODUCTION: Lean, especially Value Stream Mapping is increasingly used in hospitals to optimize processes. This method, which originated in the automotive industry, enables all staff involved in the process to make it more customer-friendly. Despite the widely reported success of Lean projects, they have failed in some cases. This study investigated the contextual factors and mechanisms that contribute to a successful implementation of Value Stream Mapping. METHODS: Value Stream Mapping was applied to the discharge process in four breast cancer centers. A mixed-method approach was used in two steps. First, to verify the successful implementation, defined as time optimization, time measurement was conducted at three points in time and analyzed using an ANOVA. Second, an analysis of contextual factors was combined with a qualitative content analysis of mechanisms based on normalization process theory, using routine data, meeting protocols, field notes, and interview transcripts as data source. RESULTS: At one of the four breast cancer centers, lead- and waiting time were significantly reduced; at the others, these reductions did not occur. Failure/success cannot be explained by the size of the hospital, the number of cases or staffing levels. The variable project team composition is evident, especially leadership involvement. DISCUSSION: A comparative analysis was conducted to identify the factors that led to success. These factors were: participation of all leaders relevant to the process, in the case of the discharge process including medical and nursing leaders; dissemination of the changes from the project team to colleagues including its sense and possibility to discuss it; joint reflection of the implementation process in regular work team meetings. CONCLUSIONS: These results confirm the important role of leadership in implementation projects. Leadership support enabled the mechanisms found. The used combination of theoretical approaches from management research and implementation science determined the interpretation and should be applied more often in implementation science.

Coping with breast cancer during medical and occupational rehabilitation: a qualitative study of strategies and contextual factors.

PURPOSE: This study aimed to gain a deeper understanding of the coping processes of breast cancer survivors (BCSs) during medical and occupational rehabilitation after acute treatment. METHODS: This study is part of the mixed-methods Breast Cancer Patients' Return to Work study conducted in Germany. Data were collected through semistructured interviews with 26 female BCSs 5-6 years after their diagnosis. A qualitative content analysis was conducted to investigate the coping strategies and contextual factors of coping of BCSs. RESULTS: The participants used different strategies for coping with their breast cancer, namely, approach- versus avoidance-oriented coping and emotion- versus problem-focused coping. During the medical rehabilitation process, coping behavior was used mainly to address disease management and its consequences. During the occupational rehabilitation process, most coping strategies were used to overcome discrepancies between the patient's current work capacity and the job requirements. The contextual factors of coping were in the health, healthcare, work-related, and personal domains. CONCLUSION: The study findings provide in-depth insights into the coping processes for BCSs during the rehabilitation phase and highlight the importance of survivorship care after acute cancer treatment. IMPLICATIONS FOR CANCER SURVIVORS: The results indicate that BCSs employ approach- and avoidance-oriented strategies to cope with their cancer during rehabilitation. As both attempts are helpful in the short term to cope with physical and emotional consequences of the cancer, healthcare and psychosocial personnel should respect the coping strategies of BCSs while also being aware of the potential long-term negative impact of avoidance-oriented coping on the rehabilitation process.

The Implementation of an Electronic Medical Record in a German Hospital and the Change in Completeness of Documentation: Longitudinal Document Analysis.

BACKGROUND: Electronic medical records (EMR) are considered a key component of the health care system's digital transformation. The implementation of an EMR promises various improvements, for example, in the availability of information, coordination of care, or patient safety, and is required for big data analytics. To ensure those possibilities, the included documentation must be of high quality. In this matter, the most frequently described dimension of data quality is the completeness of documentation. In this regard, little is known about how and why the completeness of documentation might change after the implementation of an EMR. OBJECTIVE: This study aims to compare the completeness of documentation in paper-based medical records and EMRs and to discuss the possible impact of an EMR on the completeness of documentation. METHODS: A retrospective document analysis was conducted, comparing the completeness of paper-based medical records and EMRs. Data were collected before and after the implementation of an EMR on an orthopaedical ward in a German academic teaching hospital. The anonymized records represent all treated patients for a 3-week period each. Unpaired, 2-tailed t tests, chi-square tests, and relative risks were calculated to analyze and compare the mean completeness of the 2 record types in general and of 10 specific items in detail (blood pressure, body temperature, diagnosis, diet, excretions, height, pain, pulse, reanimation status, and weight). For this purpose, each of the 10 items received a dichotomous score of 1 if it was documented on the first day of patient care on the ward; otherwise, it was scored as 0. RESULTS: The analysis consisted of 180 medical records. The average completeness was 6.25 (SD 2.15) out of 10 in the paper-based medical record, significantly rising to an average of 7.13 (SD 2.01) in the EMR (t178=-2.469; P=.01; d=-0.428). When looking at the significant changes of the 10 items in detail, the documentation of diet (P<.001), height (P<.001), and weight (P<.001) was more complete in the EMR, while the documentation of diagnosis (P<.001), excretions (P=.02), and pain (P=.008) was less complete in the EMR. The completeness remained unchanged for the documentation of pulse (P=.28), blood pressure (P=.47), body temperature (P=.497), and reanimation status (P=.73). CONCLUSIONS: Implementing EMRs can influence the completeness of documentation, with a possible change in both increased and decreased completeness. However, the mechanisms that determine those changes are often neglected. There are mechanisms that might facilitate an improved completeness of documentation and could decrease or increase the staff's burden caused by documentation tasks. Research is needed to take advantage of these mechanisms and use them for mutual profit in the interests of all stakeholders. TRIAL REGISTRATION: German Clinical Trials Register DRKS00023343; https://drks.de/search/de/trial/DRKS00023343.

Irritation, General and Pandemic-Related Demands, and the Importance of Workplace Health Promotion in Long-Term Care-Results From a Survey of Managers in Outpatient and Inpatient Long-Term Care Facilities in Germany.

OBJECTIVE: This study examines the association between irritation and demands of long-term care managers during the COVID-19 pandemic, as well as the role of workplace health promotion (WHP). METHODS: Findings were derived from an online survey investigating long-term care managers as part of the employees in the COVID-19 pandemic (N = 207). Data analyses were performed with linear regression and interaction analyses. RESULTS: For managers in long-term care, there was found a significant positive association between pandemic-related and general demands and irritation. The irritation level was significantly lower among managers in facilities where WHP was offered whereas the association between irritation and demands did not significantly vary by WHP. CONCLUSIONS: The presence of WHP was associated with lower average irritation levels among managers during the COVID-19 pandemic. Thus, the implementation of WHP can contribute to maintain the well-being of long-term care managers.

Do I want to work from home today? Specific job crafting strategies of public service employees working from home during the COVID-19 pandemic in Germany: a qualitative study.

Background: After the outbreak of the COVID-19 pandemic, employees in Europe increasingly worked from home. In the German public sector, many employees experienced working from home for the first time. Concurrently, employees could use job crafting activities to alter job demands and resources while working from home. This exploratory case study aims to shed light on how public service employees craft their job demands and job resources, and how they perceive job satisfaction and productivity while working from home during the COVID-19 pandemic. A novel theoretical approach is applied to explore crafting activities that target specific job demands and resources when working from home, using a combined framework of resource-based job crafting based on the Job Demands-Resources model and time-spatial job crafting. Methods: Qualitative telephone interviews were conducted with employees from different public sectors in Germany between December 2021 and February 2022. According to the COREQ guidelines, the 12 semi-structured interviews were audio-recorded, transcribed verbatim, and content-analyzed using MAXQDA. Results: The results suggest that employees, who were new to working from home, developed personal crafting strategies for their flexible work environment. These strategies supported them in coping with hindering job demands (e.g., measures regarding work-related availability or interruptions) by optimizing their working conditions. Additionally, employees used strategies to increase their social resources (e.g., initiating meetings with colleagues) and structural resources (e.g., installing additional work equipment, planning of office days and working-from-home days). The use of given job resources and optimization of job demands are closely linked to the time-spatial demands fit. Thereby, the time-spatial demands fit is used to combine workplaces, work hours, or work tasks with the provided resources and demands to achieve an optimal work environment, which also facilitates employees' productivity and satisfaction. Conclusion: The results enrich the resource-based and time-spatial demand job crafting research by adding specific job crafting strategies utilized by public service employees. Furthermore, the results highlight job crafting strategies for enhancing job satisfaction and productivity when working from home in the post-pandemic world, thus offering valuable insights for researchers and practitioners.

What organisational and regional factors influence the outpatient provision of curettages in Germany? A longitudinal secondary data analysis using hospital quality reports data from 2013 to 2019.

OBJECTIVES: The rate of outpatient therapeutic curettage is lower in Germany than in other countries, although there are no differences in patient safety between outpatient and inpatient management. In this context, outpatient surgery is economically advantageous and efficient. This study aims to identify organisational and regional factors that determine the rate of outpatient curettage in German hospitals. METHODS: We analysed the hospital quality reports for 2013-2019, which include data from all German hospitals with gynaecology departments (n=709). These organisational data (teaching status, size, ownership, department type and hospital group) are enhanced by contextual data (degree of urbanisation, market concentration and population income). We calculated a zero-one inflated beta regression model to identify factors that influence the rate of outpatient curettages in 2019. RESULTS: Increasing numbers of curettages are provided on an outpatient basis; accordingly, the number of inpatient curettages declined during the analysis period. In 2019, 69.6% of in-hospital curettages were performed as outpatient surgery. Hospital size is significantly negative and outpatient physician department type is significantly positively associated with outpatient curettage rates. We found no effects of hospital ownership type, degree of urbanisation or market concentration. A high income in the surgical district's population is also associated with a higher rate of outpatient curettages. CONCLUSIONS: The analyses demonstrate that organisational factors are associated with the outpatient curettage rate. This indicates that external elements, such as reimbursements and regulations, influence outpatient surgical events in Germany, and current regulations do not incentivise hospitals to significantly increase their rate of outpatient curettages.

Patients' perspectives on the quality of care of a new complex psycho-oncological care programme in Germany - external mixed methods evaluation results.

BACKGROUND: Guideline-compliant provision of psycho-oncological (PO) care is still challenging in Germany. Hence, a new care programme, called integrated cross-sectoral psycho-oncology (isPO), was implemented to improve the integration of needs-oriented PO care. Quality of care (QoC) was externally evaluated from the patient's perspective. We aim to gain insight into patients' experiences with isPO and how their assessment affects relevant patient-reported outcomes (anxiety and depression, health status, and work ability). METHODS: An explanatory, sequential mixed-methods design was applied. Patients were surveyed twice during their 1-year care trajectory: after 3 (T1) and 12 (T2) months. Data sets were matched using pseudonyms. Care documentation data, including sociodemographic characteristics and the primary outcome variable (anxiety and depression), were matched. In the survey, patients rated their satisfaction with respective isPO service providers and the programme in general (QoC). Health status (EORTC-QLQ-C30) and work ability (WAS) were measured. Descriptive analyses and t-tests for dependent samples were conducted to assess changes in outcome variables over time. Linear regression analyses were conducted to assess whether care satisfaction predicted outcome variables. Patients who completed their isPO care trajectory were asked to participate in semi-structured telephone interviews to share their experiences. Purposeful sampling was applied. All 23 interviews were audiotaped, transcribed, and analysed via content-structuring method. RESULTS: Patients reported medium-to-high satisfaction with their isPO care. All patient-related outcomes significantly improved over time and QoC measures predicted those outcomes. Needs orientation (e.g., care intensity or mode of delivery) was perceived as essential for high QoC, and outpatient care with fixed contact persons as highly important for care continuity. Furthermore, patients identified programme optimisation needs, such as period of care or extension of care to relatives. CONCLUSIONS: Patients assessed the isPO programme's QoC positively. They identified facilitators for QoC and optimisation needs. Therefore, data on QoC can function as an indicator for a programme's feasibility and maturity within care reality. As patients' care satisfaction positively influences important patient-related outcomes, it may be routinely considered for quality management. Based on patients' perspectives, isPO seems to be recommendable for routine psycho-oncological care in Germany, if ongoing programme optimisation within structured quality management is guaranteed. TRIAL REGISTRATION: The study was registered in the German Clinical Trials Register (No. DRKS00015326) on 30.10.2018.

Health literacy at work - individual and organizational health literacy, health supporting leadership and employee wellbeing.

BACKGROUND: Against the backdrop of demographic change and the shortage of skilled workers, employees' psychological wellbeing is of special interest for employers. In previous studies, individual health literacy has already been positively associated with psychological wellbeing. However, in order to improve health literacy, it is essential to take into account both the individual prerequisites and the demands and complexity of the system in which individuals operate. As current studies primarily focus on employees' individual health literacy and as the concept of organizational health literacy, so far, is mainly used in the context of health care institutions, this study investigates on the impact of organizational health literacy and health supporting leadership on the relationship between individual health literacy and employees' psychological wellbeing in a big German company based in the financial sector. METHODS: Data of an employee survey that was conducted in a big German company of the financial sector in October 2021 were analyzed by two mediation analyses using the PROCESS macro by Hayes for SPSS. A total of 2555 employees was included in analyses (51.4% male and 48.6% female). RESULTS: The relationship between individual health literacy and employees' psychological wellbeing is partially mediated by organizational health literacy, indirect effect ab 0.268 - CI [0.170, 0.378] and by health supporting leadership, indirect effect ab 0.228 - CI [0.137, 0.329]. CONCLUSION: Study results provide new indications for planning and evaluating the health strategy of companies. Regarding the psychological wellbeing of employees, practitioners and researchers should focus not only on individual health literacy but also on organizational health literacy and health supporting leadership.

Reducing uncertainty in evidence-based health policy by integrating empirical and theoretical evidence: An EbM+theory approach.

BACKGROUND: To reduce their decisional uncertainty, health policy decision-makers rely more often on experts or their intuition than on evidence-based knowledge, especially in times of urgency. However, this practice is unacceptable from an evidence-based medicine (EbM) perspective. Therefore, in fast-changing and complex situations, we need an approach that delivers recommendations that serve decision-makers' needs for urgent, sound and uncertainty-reducing decisions based on the principles of EbM. AIMS: The aim of this paper is to propose an approach that serves this need by enriching EbM with theory. MATERIALS AND METHODS: We call this the EbM+theory approach, which integrates empirical and theoretical evidence in a context-sensitive way to reduce intervention and implementation uncertainty. RESULTS: Within this framework, we propose two distinct roadmaps to decrease intervention and implementation uncertainty: one for simple and the other for complex interventions. As part of the roadmap, we present a three-step approach: applying theory (step 1), conducting mechanistic studies (EbM+; step 2) and conducting experiments (EbM; step 3). DISCUSSION: This paper is a plea for integrating empirical and theoretical knowledge by combining EbM, EbM+ and theoretical knowledge in a common procedural framework that allows flexibility even in dynamic times. A further aim is to stimulate a discussion on using theories in health sciences, health policy, and implementation. CONCLUSION: The main implications are that scientists and health politicians - the two main target groups of this paper-should receive more training in theoretical thinking; moreover, regulatory agencies like NICE may think about the usefulness of integrating elements of the EbM+theory approach into their considerations.

Integrating one-to-one peer support into psycho-oncological care in Germany: multi-perspective, mixed-methods evaluation of the isPO onco-guide service.

PURPOSE: One-to-one peer supporters called isPO onco-guides (isPO OGs) are an integral part of the new German psycho-oncological form of care 'integrated, cross-sectoral Psycho-Oncology' (isPO), additionally to professional care. The isPO OGs are cancer survivors with experiential knowledge, offering information on local support services and answering questions 'all around cancer' to newly diagnosed cancer patients. We aimed to evaluate the isPO OG service from three perspectives: patients, isPO OGs, and professional service providers. METHODS: A mixed-methods approach was pursued. We conducted interviews and focus groups with the three person groups, and applied qualitative content analysis on the reported resources, processes and outcomes regarding the isPO OG service. Relations with patients' utilisation and isPO OGs' work satisfaction were identified with regression and correlation analyses of questionnaire and isPO care data. We compared isPO care networks (CN) with X2-tests or ANOVA. Qualitative and quantitative results were integrated during interpretation phase. RESULTS: Qualitatively, the three person groups agreed on the benefits of the isPO OG service. The implementation's maturity differed between the CN concerning established processes and resource availability. Attitudes of professional service providers appeared to be crucial for patients' utilisation of the isPO OG service. Quantitative results emphasised the differences between the CN. CONCLUSION: Beyond differences in the CN, the isPO OG service has two psychosocial benefits: providing relevant, reliable, and understandable information; and offering the encouraging example that surviving and living with cancer is possible. TRIAL REGISTRATION: The study was registered in the German Clinical Trials Register (No. DRKS00015326) on 30.10.2018.

Complex implementation mechanisms in primary care: do physicians' beliefs about the effectiveness of innovation play a mediating role? Applying a realist inquiry and structural equation modeling approach in a formative evaluation study.

BACKGROUND: The adoption of digital health technologies can improve the quality of care for polypharmacy patients, if the underlying complex implementation mechanisms are better understood. Context effects play a critical role in relation to implementation mechanisms. In primary care research, evidence on the effects of context in the adoption of digital innovation for polypharmacy management is lacking. STUDY AIM: This study aims to identify contextual factors relevant to physician behavior and how they might mediate the adoption process. METHODS: The physicians who participated in this formative evaluation study (n = 218) were part of the intervention group in a cluster-randomized controlled trial (AdAM). The intervention group implemented a digital innovation for clinical decision making in polypharmacy. A three-step methodological approach was used: (1) a realist inquiry approach, which involves the description of a context-mechanism-outcome configuration for the primary care setting; (2) a belief elicitation approach, which involves qualitative content analysis and the development of a quantitative latent contextualized scale; and (3) a mediation analysis using structural equation modeling (SEM) based on quantitative survey data from physicians to assess the mediating role of the contextualized scale (n = 179). RESULTS: The key dimensions of a (1) context-mechanism-outcome model were mapped and refined. A (2) latent construct of the physicians' innovation beliefs related to the effectiveness of polypharmacy management practices was identified. Innovation beliefs play a (3) mediating role between the organizational readiness to implement change (p < 0.01) and the desired behavioral intent of physicians to adopt digital innovation (p < 0.01; R2 = 0.645). Our contextualized model estimated significant mediation, with a relative size of 38% for the mediation effect. Overall, the model demonstrated good fit indices (CFI = 0.985, RMSEA = 0.034). CONCLUSION: Physician adoption is directly affected by the readiness of primary care organizations for the implementation of change. In addition, the mediation analysis revealed that this relationship is indirectly influenced by primary care physicians' beliefs regarding the effectiveness of digital innovation. Both individual physician beliefs and practice organizational capacity could be equally prioritized in developing implementation strategies. The methodological approach used is suitable for the evaluation of complex implementation mechanisms. It has been proven to be an advantageous approach for formative evaluation. TRIAL REGISTRATION: NCT03430336 . First registration: 12/02/2018. CLINICALTRIALS: gov.

A workplace mindfulness training program may affect mindfulness, well-being, health literacy and work performance of upper-level ICT-managers: An exploratory study in times of the COVID-19 pandemic.

Introduction: Mindfulness-based interventions have gained more importance in workplace health promotion due to increased psychological distress in the digital era. Although managers in the information communication technology sector (ICT)-sector are at risk for lower mental health, few studies have evaluated the effects of workplace mindfulness trainings (WMT) on upper-level ICT-managers. Methods: By applying a mixed methods approach, the study aimed at exploring differences in upper-level ICT-managers' mindfulness, well-being, health literacy and work performance at the beginning of a WMT (t0), immediately after (t1) and 3 months after (t2) a WMT. Thirteen groups of managers (n = 56) completed the training and three corresponding surveys consecutively from October 2019 to April 2021. Managers rated their mindfulness (MAAS), well-being (WHO-5), health literacy, and work performance (HPQ). During the COVID-19-pandemic the training switched from a live on-site mode to a hybrid mode and finally to a digital mode. Repeated measures ANOVAs and Bonferroni-adjusted post hoc analyses were used for data analysis. Open-ended responses were content analyzed. Results: We found significant differences in managers' mindfulness [F(2.106) = 3.376, p = 0.038, ηp 2 = 0.06, n = 54], well-being [F(2.106) = 73.019, p < 0.001, ηp 2 = 0.17, n = 54], health literacy [F(2.108) = 9.067, p < 0.001, ηp 2 = 0.15, n = 55], and work performance [F(2.80) = 7.008, p = 0.002, ηp 2 = 0.15, n = 41] between t0 and t2. Significant differences between t0 and t1 were also found for well-being, health literacy and work performance, but not for mindfulness. Qualitative findings demonstrated positive training effects, barriers and facilitators to daily application of mindfulness practice. Discussion: The results suggest that compared to the beginning of the WMT, the post and follow-up measurements showed outcome improvements. The workplace mindfulness training may thus be a promising program to facilitate mental health and working capabilities among upper-level ICT-managers. Contextual workplace factors need to be considered to sustain long-term mindfulness practice of managers.

Effects of a Primary Care-Based Intervention on the Identification and Management of Patients with Coronary Heart Disease and Mental or Cognitive Comorbidity-A Study Protocol.

Mental and cognitive disorders (MCD) negatively affect the incidence and prognosis of coronary heart disease (CHD). Medical guidelines recommend the appropriate management of comorbid MCD in patients with CHD, yet there is evidence that the implementation in primary care is not always adequate. We present the protocol for a pilot study that aims to develop a minimally invasive intervention and evaluate its feasibility in the primary care setting to improve the identification and management of comorbid MCD in patients with CHD. The study consists of two consecutive parts and will be carried out in Cologne, Germany. Part 1 comprises the development and tailoring of the intervention, which is guided by qualitative interviews with primary care physicians (PCPs, n = 10), patients with CHD and MCD and patient representatives (n = 10). Part II focuses on the implementation and evaluation of the intervention in n = 10 PCP offices. Changes in PCP behaviour will be analysed by comparing routine data in the practice management system six months before and six months after study participation. In addition, we will explore the influence of organisational characteristics and perform a socio-economic impact assessment. The outcomes of this mixed-method study will inform the feasibility of a PCP-based intervention to improve quality of care in patients with CHD and comorbid MCD.

Transforming Health Care Delivery towards Value-Based Health Care in Germany: A Delphi Survey among Stakeholders.

Value-based healthcare (VBC) represents one strategy to meet growing challenges in healthcare systems. To date, VBC is not implemented broadly in the German healthcare system. A Delphi survey was conducted to explore stakeholders' perspectives on the relevance and feasibility of actions and practices related to the implementation of VBC in the German healthcare system. Panellists were selected using purposive sampling. Two iterative online survey rounds were conducted which were preceded by a literature search and semi-structured interviews. After two survey rounds, a consensus was reached on 95% of the items in terms of relevance and on 89% of the items regarding feasibility. The expert panels' responses were in favor of the presented actions and practices of VBC in 98% of items for which consensus was found (n = 101). Opposition was present regarding the relevance of health care being provided preferably in one location for each indication. Additionally, the panel considered inter-sectoral joint budgets contingent on treatment outcomes achieved as not feasible. When planning the next steps in moving towards a value-based healthcare system, policymakers should take into account this study's results on stakeholders' perceptions of the relative importance and feasibility of VBC components. This ensures that regulatory changes are aligned with stakeholder values, facilitating greater acceptance and more successful implementation.

["Crazy bitch!"-Experienced aggression and violence in the daily clinical routine of pediatricians]. / "Crazy bitch!" ­ Erlebte Aggression und Gewalt im Klinikalltag von Kinderärzten.

Background: The indications for experienced aggression and violence towards doctors in children's hospitals are increasing and are the focus of this study. They are reported in contact with parents or relatives in emotionally highly charged situations caused by their child's illness. This empirical study investigated the extent to which experienced aggressive and violent behavior has been received by pediatricians in their everyday work in hospitals. Methods: Data from two previously unpublished nationwide surveys in 2009 (n = 160) and 2017 (n = 190) were analyzed. Using the same questionnaire, the forms of aggressive action, such as exerting pressure, insulting, threatening physical violence, attempting to use violence and actually using violence as well as the descriptions of the associated situations were questioned. The wording of the insults and the type of threat could be specified via open questions. Results: Approximately four out of five respondents said they have been the target of an aggressive action by parents or relatives. In 2017 approximately 3 out of 4 respondents (71.0%) considered the problem of aggressive behavior to be relevant to their everyday work compared to only every second respondent (51.9%) in 2009. Individual respondents reported up to 60 situations, in both survey waves at a median of 4.0 times per year. Conclusion: Experienced aggression and violence are often and increasingly part of everyday clinical life in the pediatric wards, ranging from insults to physical violence. Prevention strategies, such as preventive training for communication and de-escalation are explicitly desired.

[Oncologic Care of Breast Cancer Patients with Preexisting Disabilities: Results of a Qualitative Study on Perceived Barriers, Communication Difficulties, and Needs]. / Die onkologische Versorgung von Brustkrebspatientinnen mit vorbestehender Behinderung ­ Ergebnisse einer qualitativen Studie über wahrgenommene Barrieren, kommunikative Schwierigkeiten und Bedarfe.

Up to now, people with disabilities have received little consideration in health care with regard to their individual needs. This study gathers information on the internal perspective of breast cancer patients with a pre-existing disability with regard to needs and barriers in oncological care. For this purpose, qualitative, guideline-based interviews were conducted and analysed using qualitative content analysis. Twenty-three patients with physical disabilities, chronic physical illnesses, sensory disabilities, mental illnesses and/or intellectual disabilities were included. Depending on the type of disability, patients faced different barriers. In order to reduce the barriers experienced by people with disabilities in care, it is necessary to promote cooperation between care providers from different care sectors and to train care providers in dealing with people with disabilities.

[Recommendations for a Core Curriculum for Master's Degree Programs in Health Services Research]. / Empfehlungen für ein Kerncurriculum für Masterstudiengänge der Versorgungsforschung.

The aim of the present study was to develop recommendations for a core curriculum for master's degree programs in health services research. For this purpose, a standardized online survey of university lecturers was conducted in the first step. In the second step, the curricula of the existing study programs were analyzed. In the third step, a literature search was conducted. In the last step, the resulting recommendations were discussed in a panel of experts. The final recommendations comprise 13 topics on five guiding questions with 26 subtopics. The main topics come from the areas of basic sciences in the context of health services research, the health care system and health policy, the (empirical) health services research process, and knowledge transfer. The present recommendations will serve as a basis for discussion and as a starting point. The development of recommendations should be seen as an ongoing process, as the core competencies of health services researchers will have to be continuously adapted to new research topics, new research methods and regulations.

Influence of Palliative Care Qualifications on the Job Stress Factors of General Practitioners in Palliative Care: A Survey Study.

Due to demographic change, the number of patients in palliative care (PC) is increasing. General Practitioners (GPs) are important PC providers who often have known their patients for a long time. PC can be demanding for GPs. However, there are few studies on the job stress factors of GPs performing PC and the potential influence of their PC training. To get more insights, a postal survey was performed with GPs in North Rhine, Germany. The questionnaire was based on a literature search, qualitative pre-studies, and the Hospital Consultants' Job Stress & Satisfaction Questionnaire (HCJSSQ). Participants state that a high level of responsibility, conflicting demands, and bureaucracy are the most important stressors they experienced in PC. The influence of PC qualification level on their perceived job stress factors is low. Only advanced but not specialist qualification shows a correlation with renumeration-related stress. Gender and work experience are more dominant influences. In our study, female GPs and physicians with more work experience tend to be more stressed. In conclusion, organisational barriers, such as administration, should be reduced and renumeration should be increased to facilitate the daily work of GPs.

GPs' involvement in specialised palliative home care: A mixed methods study in Germany.

BACKGROUND: General practitioners (GPs) are important providers of palliative home care (PHC). To deliver adequate palliative care, cooperation with specialised PHC teams is necessary. Specialised PHC is a type of care for severely ill patients by specialised providers. Little is known about the involvement of German GPs in specialised PHC. OBJECTIVES: To analyse GPs' experience with realised and desired involvement in specialised PHC. Realised involvement means GPs took part in specialised PHC patients' care. Desired involvement is GPs' hoped-for cooperation with specialised PHC teams: GPs could state whether they want to stay involved, be informed, or provide medical services themselves after referral to specialised PHC. METHODS: Mixed methods design (focus group with 6 GPs; survey of 445 GPs in North Rhine, Germany, about their experiences in PHC/specialised PHC): Qualitative data was interpreted using content analysis. The authors developed a questionnaire and performed descriptive analysis based on qualitative results. RESULTS: GPs are mostly satisfied with specialised PHC teams' care, although they report cooperation is not always optimal. GPs describe a high satisfaction with quality of care by specialised PHC teams. However, physicians with higher PC knowledge are less satisfied with specialised PHC. Also, GPs are often less involved in specialised PHC than they wish, especially when they have a higher PC qualification. CONCLUSION: In general, GPs are satisfied with the quality of care provided by specialised PHC teams but GPs do not always perceive cooperation as optimal. Involvement of GPs in specialised PHC needs to be improved.

Outpatient parenteral antimicrobial therapy in Germany: a prospective cohort study protocol.

INTRODUCTION: Outpatient parenteral antimicrobial therapy (OPAT) means intravenous administration of antibiotics outside the hospital. The antibiotics are administered at the patient's home. The advantages are the shortening of the inpatient stay, which means that patients can remain in their familiar environment, the reduction of nosocomial infections as well as the reduction of hospital and therapy costs. Nevertheless, OPAT is rarely performed in Germany, despite its international application. Therefore, systematic data on OPAT are not available in Germany. The project objective is to investigate the medical care using OPAT under medical, epidemiological and economic aspects within the framework of the Cologne Network of Infectious Diseases. METHODS AND ANALYSIS: Observational study with mixed-methods approach, qualitative analysis to identify physician-side factors to assess the attitude of general practitioners in Cologne with regard to possible implementation barriers of an OPAT. Longitudinal analysis of an OPAT patient cohort with respect to clinical and patient-relevant outcomes using descriptive and conclusive statistics. ETHICS AND DISSEMINATION: The study has been approved by the Institutional Review Board of the University of Cologne, Germany (19-1284-1). Written informed consent was obtained from all participants. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. TRIAL REGISTRATION NUMBER: NCT04002453.