[Reasons for non-participation in a patient survey in the context of prehospital emergency medical care by community emergency paramedics - A retrospective observational study]. / Gründe für die Nichtteilnahme an einer Patientenbefragung im Kontext der prähospitalen Notfallversorgung durch Gemeindenotfallsanitäter - eine retrospektive Beobachtungsstudie.

BACKGROUND: In order to evaluate whether the new rescue means "community emergency paramedics" (Gemeindenotfallsanitäter [G-NFS]) relieves the emergency medical service (EMS) in the care of low-priority emergencies, the perspective of general practitioners and patients was also surveyed in a written questionnaire as part of an innovation fund project. Recruitment for participation in the study proved to be difficult. The aim of this study is to evaluate why the G-NFS decided against providing information on study participation and what measures would be necessary to include more emergency patients in surveys in the future. METHODS: Retrospective analysis of the assignment protocols from April 1, 2021 to June 30, 2022. In addition to patient characteristics, data on treatments, interventions and recommendations to patients as well as reasons for non-participation in the patient survey were collected. RESULTS: 5,395 G-NFS protocols that contained information on non-participation were included in the analysis. The average age of the patients was 62.4 years (SD 22.7), and 50.2% were female. 57.4% of the cases were categorised as non-urgent, and 35.2% of the cases required an additional ambulance to be alerted. 404 (7.5%) patients used the EMS more than once, 1,120 (20.8%) did not have sufficient language skills, 1,012 (18.8%) patients declined study participation, and 2,975 (55.1%) patients were not able to participate according to the G-NFS assessment. Dementia/neurocognitive impairment (35%), acute/emergency situation (26.5%), mental health impairment (10.3%), and substance abuse (6.5%) were given as reasons for non-participation from the G-NFS perspective. DISCUSSION: The results show that more than half of the patients were unable to take part in a written survey for various reasons, even though there was no need for urgent care. This could be due to a high demand for care and the complex consent procedure. In addition, further resources are required to provide needs-based care for these patients in order to relieve the burden on emergency medical care. Over half of the patients were unable to take part in a written survey for various reasons. Further research is needed to determine what consent procedures are appropriate to facilitate patients' study participation.

[Frequency and characteristics of interventions by community paramedics on people in need of care : Analysis of 2,410 deployment protocols for people aged 65+ years]. / Häufigkeit und Charakteristika von Einsätzen der Gemeindenotfallsanitäter bei Pflegebedürftigen : Analyse von 2410 Einsatzprotokollen bei Personen im Alter von 65+ Jahren.

BACKGROUND: The aim of this study was to obtain a differentiated view of interventions delivered by community paramedics (Gemeindenotfallsanitäter, G­NFS) in older people in need of care living in nursing homes and at home. MATERIALS AND METHODS: A retrospective analysis of G­NFS documentation from 2021 with a focus on patients aged ≥65 years was performed. Data were grouped into callouts to nursing homes or private homes. Interventions, urgency, transport, and further recommendations were analyzed descriptively. RESULTS: Of 5,900 G-NFS protocols, 43.0% (n = 2,410) were related to elderly people (mean age 80.8 years, 49.7% female). A total of 20.6% of these callouts involved nursing home residents, 38.4% (n = 926) were homecare patients, and 41% (n = 988) of callouts were to persons who did not rely on care. No specific interventions except advice were given to 48.4% of nursing home residents, and to even 82.1% of those in homecare and 83.7% of those without care needs. About 60% of the G­NFS interventions were classified as non-urgent. Transport was waived for 63.1% of nursing home residents, for 58.1% in homecare, and for 60.6% of persons without care needs. A visit to the emergency department was recommended to 29.4% of nursing home residents, 37.6% of homecare patients, and 33.6% of persons without need of care. Measures related to urine catheters were documented much more often in nursing homes (38.5%) than in patients in homecare (15.1%) or without need of care (9.3%). CONCLUSION: Community paramedics perform primary care tasks and can contribute to a reduction in unnecessary transport. It should be discussed whether the emergency medical service is responsible for such interventions and how older people in need of care can be cared for according to their needs in the future.

[Use of emergency services for suicide attempts during the SARS-CoV-2 pandemic-a prevalence study]. / Inanspruchnahme des Rettungsdiensts bei Suizidversuchen im Verlauf der SARS-CoV-2-Pandemie.

Background: The pandemic has caused several changes in the emergency care system. The deployment figures in emergency medical services have shown atypical fluctuations. This has also been explained by changes in behavior and an increased sense of stress among the population. Existing research provides hints for the increased incidence of mental health symptoms in emergency care during ongoing pandemics. Objective: In this context, this paper examines the occurrence of emergency medical services calls related to the keyword suicide in relation to total calls. Methods: This is a retrospective cross-sectional study based on routine documentation from a fire and rescue dispatch center with descriptive and exploratory data analyses. The data are divided by settlement-structural county types and compared with incidences and pandemic phases. Results: Phase 1 and 2a show a decrease in the number of dispatches during the pandemic. In addition, there is a shift in the number of dispatch cases with a context of suicide by structure types in phase 3. A decreased dispatch rate in the sparsely populated rural county is offset by an increase in the metropolitan area. Changes made to the control center system resulted in an increase in the number of dispatch cases in the context of suicide. Conclusion: Continuous mental health surveillance, including data collected by emergency medical services, can provide valuable insight. The study also highlights the need for standardization of emergency dispatch center data.

ILEG - A Case of Recording Patient Journeys.

In 2019 the Gemeindenotfallsanitäter was introduced in the area of Oldenburg, and scientific monitoring starting 2021 with Inanspruchnahme, Leistungen und Effekte des Gemeindenotfallsanitäters. Since then, it is possible to track patient journeys, starting from the emergency call to the subsequent treatment. This short communication provides an overview of the necessary data-acquisition and dataflow from all participating institutions and its possibilities.

[Care of older patients by community emergency paramedics : Comparison of community-dwellers and nursing home residents]. / Versorgung älterer Patienten durch Gemeindenotfallsanitäter : Vergleich der Einsätze im Pflegeheim und in der Häuslichkeit.

BACKGROUND: Emergency departments and emergency services are increasingly burdened by non-emergency patients. A substantial proportion of these is represented by older people. The project "community emergency paramedic" ("Gemeindenotfallsanitäter" [G-NFS]) was initiated to prevent unnecessary use of emergency services. OBJECTIVE: To identify specific utilizations of the G­NFS services by older people at home and in nursing homes. MATERIAL AND METHODS: Retrospective analysis of the assignment protocols from July 2019 through June 2020. Only data from patients aged ≥ 65 years were included. Data were grouped into whether patients lived on their own or in nursing homes. RESULTS: A total of 2358 protocols of older patients (mean age 80.8 years; 52.9% female) were evaluated and 55% of patients were treated on-site. The most frequently used measures by G­NFS were counselling (79.4%), aid in self-medication (16.7%) and administration of medication (23.2%). Of the G­NFS assignments 329 (14.0%) were carried out for nursing home residents. Measures related to urine catheter complications were more frequently performed in nursing home residents than in patients who lived at home (32.2% vs. 5.7%). Compared to other emergency cases, patients with catheter-related complications were most often treated at the scene (84.3% vs. 52.2%). CONCLUSION: The G­NFS enabled the majority of patients to be treated on-site, thus saving resources of emergency services and hospitals; however, the G­NFS also performed measures that were normally the responsibility of general practitioners. This possibly highlights structural deficits in the medical and nursing care of older people.

Cross-sectional study in an out-of-hours primary care centre in northwestern Germany - patient characteristics and the urgency of their treatment.

BACKGROUND: Due to the increasing number of non-urgent visits to emergency departments, it is becoming increasingly important to also investigate emergency care in out-of-hours (OOH) primary care. The aim of this study was to provide an insight into the care structures of an OOH primary care centre, to evaluate the reasons for encounter (RFE) and to assess the urgency of the treatment from the physicians´ point of view. METHODS: In the summer of 2017, we conducted a cross-sectional study over four weeks in the OOH primary care centre of Oldenburg, a city in Lower Saxony with about 160,000 inhabitants. We collected socio-demographic data, RFE and the duration of the complaints. The International Classification for Primary Care 2nd Edition (ICPC-2) was used to categorize symptoms. The attending physicians supplemented information on further treatment (including hospitalization) and the urgency of consultation in the OOH primary care centre. RESULTS: A total of 892 of the 1098 OOH patients which were visiting the OOH primary care centre took part in the study (participation: 81.2%). More than half of the patients were between 18 and 39 years old. A quarter of all RFE named by study participants were in the ICPC-2 category "skin". More than 60% of patients had the symptoms for more than two days before visiting the OOH primary care centre. In 34.5% of all cases no medication was prescribed and one in six patients received further diagnostic tests such as urinalysis and blood tests (15.8%). From the physicians' point of view, 26.3% of all study participants could have been treated by the family doctor during the regular consultation hours. CONCLUSION: The study shows that in the OOH primary care centre about a quarter of all patients could have waited until regular consultation hours. Mostly young patients used the easily accessible and free care in the OOH primary care centre. Further studies are necessary to better understand the individual reasons of patients to use the OOH primary care centre.

[Outpatient emergency treatment of nursing home residents : Analysis of insurance claims data]. / Ambulante Notfallversorgung von Pflegeheimbewohnern : Auswertung von GKV-Routinedaten.

BACKGROUND: Utilization of outpatient emergency services by nursing home residents is increasing; however, out of hours medical care (OOHC) in Germany has not yet been studied. OBJECTIVE: In Bremen the used billing codes enabled a comparison between the use of outpatient emergency care in the year before and the year after admission to a nursing home stratified by emergency departments and OOHC. MATERIAL AND METHODS: In this retrospective cohort study we used insurance claims data of residents in Bremen, who were insured in a large German statutory health insurance (DAK-Gesundheit). We compared the use of emergency care in hospitals or OOHC practices in the year before and the year after admission to a nursing home. The incidence rates of visits, distribution on weekdays and coded diagnoses were investigated. RESULTS: We included 1175 nursing home residents (77% female) with a mean age of 85 years. After admission to a nursing home the incidence rate of visits in the OOHC practices increased from 30.4 up to 63.7 and in emergency departments (ED) from 27.4 up to 50.7 per 100 person years. A total of 59% of all visits in OOHC practices were on weekends. The most common diagnoses in ED were injuries and poisoning (75%) while a wide range of diagnoses were coded in the OOHC practices. CONCLUSION: There is a significant difference between diagnoses in the ED and OOHC practices. More research is needed to assess the appropriateness of care.

IT Infrastructure for Biomedical Research in North-West Germany.

The efficient use of routine data for biomedical research presupposes an IT infrastructure designed for health care facilities. The objective of this study was to analyse which IT infrastructure is used in hospitals and by general practitioners' (GP) practices in the region Oldenburg-Bremen and to examine how well this supports research projects. To this end, IT managers and GPs were interviewed. The usage of hospital information systems (HIS) and data warehouse systems (DWS) in hospitals is of major importance for the study. Over 90 % use DWS for administration, 42 % for clinical research. None of the hospitals implemented consent for the use of routine data for research. Only a third of the GPs have participated in studies. The GPs' offices based EHR systems in use offer virtually no support for research projects. The study results demonstrate that technical and organisational measures are required for the further usage of routine data in the region.