Disaster Preparedness Evaluation Tool (DPET): Adaptation and psychometric evaluation for nurses in Germany.

Background: The Disaster Preparedness Evaluation Tool (DPET) with 47 items was developed to assess the disaster preparedness level among nurses in the USA. Aim: This study aimed (1) to adapt and validate the DPET for the nursing context in Germany and (2) to perform its psychometric evaluation. Methods: The DPET items were translated to German (DPET-GER). Adaptation was performed to identify irrelevant items and content validity was estimated using the scale-level content validity index (S-CVI) based on expert ratings. Psychometric evaluation was performed based on data from an online survey of 317 nurses. Internal consistency (Cronbach's alpha) and factor structure were assessed with an exploratory factor analysis. Results: Ten items were unanimously rated as irrelevant by four experts and removed. Based on ratings by further seven experts, the content validity of DPET-GER was low for all 37 items (S-CVI of 0.53) or moderate for 19 items rated as relevant (S-CVI of 0.74). The internal consistency of DPET-GER was high (Cronbach's alpha of 0.94) and 37 items were reduced to five factors that explain 55% of variance in all items. Conclusions: The DPET-GER has acceptable psychometric properties (internal consistency and factor structure). However, low content validity indicates that further adaptation of the DPET-GER is required before it could be used to assess disaster preparedness among nurses in Germany. More research is also needed to contextualize the construct of disaster preparedness.

[Suicides Among Adolescents in a Major German City]. / Suizide unter Adoleszenten in einer deutschen Großstadt.

Suicides Among Adolescents in a Major German City Abstract. Objective: Adolescent suicide is a major contributor to the overall mortality in this age group. This study examined sex and age differences in suicide methods. Method: The investigation is based on death certificates from the years 1996 to 2019 of the city of Leipzig and includes all suicides in the age group under 25 years. The impact of sex and age on the method and location of suicide was examined using chi square statistics. Moreover, we verified the association between suicides and death by drug overdose through statistical regression. Results: 140 suicides were included in the study. The suicide methods differed between the age groups (χ² = 17,878; p = .022). Individuals under 21 years of age committed suicide almost exclusively by strangulation, jumping from heights, railway suicide, or deliberate intoxication. With the onset of early adulthood, the spectrum of methods expanded. Suicide methods were also different between the sexes (χ² = 35,166; p < .001): Male adolescents preferred highly lethal methods such as strangulation, whereas in female adolescents intoxication was the leading method of suicide, with a predominance of antidepressants. The annual rates of suicide and death by drug overdose were found to correlate (Pearson correlation = 0,571, p = .004). Minors (χ² = 3.125, p = .077) tended to avoid their own residential environment as a place of suicides compared to adults. Conclusion: When assessing the individual suicide risk and weighing safeguarding measures in clinical practice, the differences shown in the choice of methods should be taken into account.

[Genetic counseling in Germany: development of demand]. / Humangenetische Beratung in Deutschland: Entwicklung der Inanspruchnahme.

BACKGROUND: With the Act on Genetic Testing (GenDG), the German legislator has issued far-reaching regulations for human genetic services, including genetic counseling. This paper presents data on the use of human genetic counseling in the years before and after the entry into force of GenDG in order to provide an informed assessment of the possible effects of the law. MATERIALS AND METHODS: Over a period of 13 years (2005 to 2017), the human genetic counseling services provided within the framework of the statutory health insurance and billable by EBM via the Kassenärztliche associations were recorded via a database query at the Central Institute of the National Association of Statutory Health Insurance Physicians (ZI-KBV) and via individual Kassenärztliche Vereinigungen Deutschlands. For the discussion of the observable development of using genetic counseling and possible future development, additional data on the referral behavior, the waiting times, processing time, and reasons for consultations were extracted from the GenBIn database. RESULTS AND DISCUSSION: Demand for genetic counseling has steadily increased at an average rate of approximately 6% per year since 2009. This increase started well before the enactment of the GenDG and may be attributed to a multiplicity of factors. Change in demand for genetic counseling is characterized by increasing self-referrals and by increasing referrals by specialists other than obstetricians/gynecologists. Waiting times between 2011 and 2016/2017 have increased. While demand has been growing, the number of key service providers, the contracted medical specialists in human genetics, has remained almost constant. It is foreseeable that capacity limits will be reached if both trends continue.

[Geognosy versus Geology: National Modes of Thought and Cultural Practices Concerning Space and Time in Competition]. / Geognosie versus Geologie: Nationale Denkstile und kulturelle Praktiken bezüglich Raum und Zeit im Widerstreit.

Natural science investigators at the end of the eighteenth century made use of conflicting labels to position their respective preferred fields of activity in the Earth sciences. This mania for labelling marked their break with natural science and the umbrella term 'mineralogy'. In this conflict situation of specialist classifications and explanations, two terms in particular were established: geognosy and geology, which covered the very promising project of research in the areas of the 'origin of the Earth' and the 'formation of the Earth'. These and the associated research goals were subsequently accorded a dazzling career. Proceeding from the conceptual core-meaning in the formation of terms und its semantic spectrum and conceptual shifts in a time of change, my study will look at the identity and heterogeneity functions of geology and geognosy. For whereas in French and English speaking countries the term geology came to be used exclusively (geology, géologie), this was avoided in German, particularly because the term geognosy was preferred. These national differences may be explained with reference to the different cultural and national styles of science: for example the social embedding of geology in the culture of the English gentleman or the French museum culture, and the close connection of 'German' geognosy to mining. A further starting point in the analysis of the double use of both geology and geognosy in German speaking countries until 1840 is provided by the different references to temporalization and spatialization of the two terms. And we should also include the practical implications and the epistemic requirements that were bound up with the defence of geognosy in the German speaking world.

Development and validation of a short clinical risk management implementation (Short CRiMI) questionnaire.

Clinical Risk Management (CRM) is an important instrument to continuously improve safety of health care delivery. In Germany, hospitals are required by law to implement CRM and incidence reporting systems. Since 2010, nation-wide surveys have been conducted periodically to evaluate implementation of CRM in hospitals. The instrument used in these surveys is constantly being updated to reflect previous experiences, as well as to adapt to ongoing trends and developments in CRM practices. The survey instrument used in 2022 consisted of up to 200 items and took up to an hour to complete. In this study, we aimed to develop a short instrument to measure the level of CRM implementation in hospitals, evaluate its psychometric properties, and to offer benchmarking data for health care facilities of different sizes. We used data collected in 2022 as part of KHaSiMiR study, employing a cross-sectional self-reported online survey. The hospital administrations were invited to designate one CRM manager to participate in the study. Out of 1,411 general hospitals invited, 401 responses were collected (response rate of 28%). After removing the cases with excessive missings, we imputed remaining missing values using multiple imputation, and split the resulting sample (n=362) in two halves (i.e., exploratory and testing subsamples). A principal component analysis was applied on the first subsample. We validated the resulting model using confirmatory factor analysis in the testing subsample. We evaluated internal consistency, and tested external validity of the established instrument using correlation analysis with two single-item measures: subjective evaluation of CRM implementation compared to similar organizations and compared to own ideal level. The principal component analysis included 45 items from the full instrument. The analysis resulted in a three-factor model with 26 items. In the confirmatory factor analysis, the model demonstrated acceptable fit with the data according to the commonly used fit indices: Chi2/df=1.36, CFI=0.941, TLI=0.930, RMSEA=0.045 (90% CI=0.032-0.056), SRMR=0.049. Cronbach's alpha of all three factors was good (>0.70). All three factors had statistically significant positive correlations with each other (0.359-0.497) and with the two single items (0.282-0.532). None of the correlations were high enough (>0.7) to indicate multicollinearity. The proposed short clinical risk management implementation (Short CRiMI) questionnaire is psychometrically valid and can be used to rapidly evaluate CRM implementation in hospitals. Further research can provide evidence of its external validity and association with quality and safety outcomes. Benchmarking data can be used to compare the results with the data from the most recent Germany-wide survey.

[Experiences of people with Long COVID in their medical accompaniment and in the social environment]. / Erfahrungen von Menschen mit Long COVID bei ihrer ärztlichen Begleitung und im sozialen Umfeld.

BACKGROUND: Permanent health impairments after a COVID-19 infection can lead to a lack of social participation and pronounced emotional stress. The aim of this study was to find out how Long COVID affects the social activities of those affected and understand the role that medical support and the immediate social environment play in this. METHODS: Between January and May 2022, 25 participants with long COVID were interviewed about their health situation, their perception of health care in Germany, and their social and professional context. The interviews, which were mainly conducted online, were analyzed for content, and the results were assessed using lifeworld-theoretical approaches. RESULTS: The participants reported a variety of health symptoms such as fatigue, shortness of breath, and cognitive impairments. The majority of respondents had a pessimistic attitude toward a timely recovery. Most participants perceived the medical support for long COVID as inadequate. Long waiting times for specialist appointments and the lack of acceptance of the health impairment by some doctors lead to an increase in existing uncertainties. Long COVID also had a major impact on respondents' social life. Many participants referred to a burdensome decline in the number of meetings with family and friends. Many respondents avoided physical contact with friends and family members due to a high level of fear of infection. Some participants explained that they separated themselves from people in their environment because they did not take their precarious situation seriously. However, an important resource was the close circle of family and friends from whom the majority of the interviewees received support. DISCUSSION: While other research studies particularly emphasize the comprehensive psychological and emotional consequences of long COVID, such as identity conflicts, existential angst, or depression, the present study shows that a lack of understanding from medical professionals as well as heavily delayed treatment leave the interviewees in a state of emotional void. CONCLUSIONS: The findings show a considerable need for support among people with health impairments after a COVID-19 infection. Empathic and empirically based counseling and support by general practitioners as well as improvement of access to rehabilitative services can provide substantial support for people with long COVID.

[Closing care gaps after hospitalization: Study results [intersec-CM] on discharge and transfer management according to sect. 39 SGB V for people with cognitive impairments associated with dementia]. / Versorgungslücken nach dem Krankenhausaufenthalt schließen: Studienergebnisse [intersec-CM] zum Entlass- und Überleitungsmanagement nach § 39 SGB V für Menschen, die im Krankenhaus kognitive demenzielle Beeinträchtigungen zeigen.

In Germany, there are 1.8 million people currently living with dementia, and the trend is rising. In particular, the health system at the transition from hospital to outpatient care is facing major challenges given the high increase in a difficult patient clientele. Legal efforts have been undertaken (sect. 39a of the Fifth Social Code Book [SGB V]) to close the care gaps in the discharge and transfer process. This article aims to provide an overview of the documentation process of the discharge and transfer management for people with cognitive impairments in everyday clinical practice according to SGB V sect. 39 para. 1a after the Discharge Management Act came into force. Furthermore, the manuscript answers the research question "How is the statutory discharge management of people with cognitive impairments (MmkB) aged 65 and over documented" and highlights further characteristics of the discharge documentation for MmkB starting with the transition from the inpatient setting to other care settings. In order to answer the research question(s), a qualitative content analysis of all discharge documents available at the time of discharge was carried out as part of the intervention study on cross-sector care management to support cognitively impaired people during and after a hospital stay [intersec-CM], which was funded by the Federal Ministry of Education and Research. The results of the analysis show that, despite legal efforts, there are currently no standardized, unified processes of discharge management for people with cognitive impairments that can be traced in writing. However, departments with a large proportion of vulnerable patient groups were able to offer valuable insights: for example, their discharge documents included a short social history. Further evidence-based research and development in the domain of discharge management for people with cognitive impairments remains essential.

Epidemiology, comorbidity, and use of systemic therapies in patients with paediatric psoriasis in Germany.

INTRODUCTION: Psoriasis is a chronic, inflammatory disorder with a physical and psychosocial burden. Recent epidemiological data on paediatric psoriasis in Germany is lacking. The aim of this study was to examine the prevalence, the incidence and associated epidemiological features of paediatric psoriasis in Germany using health claims data from a national health claims database. METHODS: Continuously insured patients with paediatric psoriasis (2014-2017) from the Institute of Applied Health Research Berlin (InGef) database were included in this analysis. Between 2014 and 2017, we analysed the prevalence and incidence of paediatric psoriasis (aged ≤17 years), relevant comorbidities, the most frequently attended and diagnosing medical specialties, and the number of systemic treatment prescriptions. RESULTS: Overall, psoriasis prevalence (0.15-0.16%) and incidence (0.06-0.07%) remained stable between 2014 and 2017; both prevalence and incidence were higher in female patients. Psoriasis prevalence gradually increased with age between the age groups <6 years and 16-17 years. Obesity (11.5%) and somatoform disorders (7.0%) were the most common comorbidities identified. Overall, 90.4% of the psoriasis cases were diagnosed by either a dermatologist (50.9%), general practitioner (27.8%), or paediatrician (11.7%). Patients most frequently attended general practitioners (74.5%), dermatologists (57.9%) and paediatricians (56.5%). The use of systemic treatment(s) increased from 4.7% to 5.4% between 2014 and 2017. DISCUSSION: The prevalence and incidence of paediatric psoriasis in Germany remained stable between 2014 and 2017, with a higher prevalence and incidence observed in females and older adolescents. Obesity and somatoform disorders were the most common comorbidities. General practitioners, dermatologists, and paediatricians were most often involved in the treatment of patients, highlighting the need for interdisciplinary management of paediatric psoriasis.

[Medical care with or without cooperative agreements? A cross-sectional study in nursing homes in Bremen and Lower Saxony]. / Ärztliche Versorgung mit oder ohne Kooperationsvertrag? Eine Querschnittsuntersuchung in stationären Pflegeeinrichtungen in Bremen und Niedersachsen.

BACKGROUND: Empirical studies in nursing homes show that people in need of long-term care have less contact with medical specialists (except for neurologists) compared to those of the same age who are not in need of long-term care, which can be an indication of insufficient health care provision. Against this background, a cooperative agreement between medical specialists and nursing homes was first made legally possible, then requested and finally made mandatory (section 119b SGB V [Social Code Book V] in the currently valid version). OBJECTIVE: The aim of this study is to investigate to what extent contact density to physicians and the needs-based medical treatment of nursing home residents in nursing homes with and without a cooperative agreement differ from each other and, hence, how effective such cooperation agreements are in this context. METHODOLOGY: Using data from 396 people in need of care from 44 nursing homes in Lower Saxony and Bremen we compared facilities with and without cooperative agreements with respect to the number of home visits, practice visits and telephone contacts and the realization of adequate specialist medical treatment. At the time of the survey, 26 of the 44 nursing homes had cooperative agreements with dentists, 17 with general practitioners and 7 with neurologists. RESULTS: The number of personal contacts to general practitioners tends to be higher if cooperation agreements between general practitioners and nursing homes exist. In nursing homes having cooperation agreements with dentists the number of home visits is twice as high as in nursing homes without such an agreement, whereas cooperation agreements with neurologists have no effect on the number of contacts with these specialists. Furthermore, cooperation agreements with dentists promote appropriate dental care. CONCLUSIONS: The results show that cooperation agreements can be a useful instrument to ensure medical care in nursing homes. To guarantee the effectiveness of the cooperation agreements, however, the number of medical visits should be stipulated in the agreements.

Financing health promotion, prevention and innovation despite the rising healthcare costs: How can the new German government square the circle?

The German health system is under pressure due to increasing costs of healthcare provision and rising demand for health services. With the new coalition government, Germany has increased efforts to build a modern, innovative infrastructure for prevention and high-quality health services. The coalition agreement has a strong climate, innovation, and sustainability focus, reflecting at the same time the ambition of the new government to implement a preventive, inter-connected, and modern healthcare system in Germany. However, the agreement lacks detailed information on the achievement of the plans, especially concerning the question of how those measures should be funded in light of increasing expenditures for healthcare. Thus, the objectives of this study are to interpret the new government's plans and answer the question of how Germany in the new legislative period can ensure and fund population-based prevention programmes, health-promoting measures and innovative solutions despite the rising healthcare costs. By analysing the relevant content of the coalition agreement and drawing on an expert workshop, this paper suggests the establishment of a prevention fund and flexible remuneration model for digitalised and innovative forms of care in the new legislative period. Our findings may help identify feasible approaches to sustainable financing of health promotion, prevention and innovation in the German healthcare system.

[Social inequality in home care: A scoping review on the impact of socio-economic resources on home care arrangements]. / Soziale Ungleichheit in der häuslichen Pflege: ein Scoping-Review zum Einfluss sozioökonomischer Ressourcen auf die Gestaltung häuslicher Pflegearrangements.

INTRODUCTION: Inequalities in long-term home care are still rarely considered in the discourse on health inequalities, although there is reason to assume that opportunities for a successful home care arrangement are not equally distributed among those in need of it. This paper pursues the question how socio-economic resources of people in need of care and their family caregivers are influencing the utilization of care services in Germany. METHODS: A scoping review has been conducted to analyse the current state of research. To identify relevant papers the online databases CINAHL including MEDLINE, PubMed, LIVIVO and Web of Science were searched and supplemented by internet research. According to Bourdieu, the research studies included were arranged in economic, educational and social resources. RESULTS: 29 qualitative and quantitative research papers were included in the analysis. 14 papers represent quantitative research results, nine papers are based on qualitative research. Six further papers are analyses based on an international data record. The utilization of care services increases with the level of income and wealth as well as education. On closer examination of individual care services, however, the evidence is inconsistent and only the so-called 24-hour care service is distinguishable as a care arrangement for high-status groups. A compensation of the lower utilization of professional care by informal support cannot be described in quantitative terms. Caregivers with low income and education levels seem to be more likely to not only provide care but also to provide higher-intensity care. DISCUSSION: Despite increasing research reflected in the literature, the evidence remains incomplete and shows inconsistencies so that a valid statement on the degree of inequalities in care provision is not possible. A conceptual basis for the definition of social inequality in the context of long-term home care is lacking as well as a common understanding of equity in care provision. The perspective of people in need of care and their caregivers has hardly been addressed. CONCLUSION: Home care is not only determined by individual need but seems to be decisively influenced by socio-economic restrictions. For a more targeted approach, further research on the use of care services depending on socio-economic resources is needed, explicitly taking into account the user perspective.

Advance Care Planning in Germany.

Advance Care Planning (ACP) defined as a comprehensive concept requiring a cultural change following implementation at the individual, institutional and regional level in order to achieve care consistency with care preferences when individuals are incapable of participating in critical decisions was first implemented in two regional projects (LIMITS and beizeiten begleiten, North Rhine Westphalia) in Germany in the 2000s. Based on the positive evaluation of beizeiten begleiten, legislation of 2015 (§ 132g, Social Code Book V) allows nursing homes and care homes for persons with disabilities to offer qualified ACP facilitation covered by the statutory health insurance. However, trainers for ACP facilitators need no specific qualification, and the training program for ACP facilitators is only broadly defined, which resulted in great heterogeneity of ACP facilitator qualifications. Furthermore, neither the institutional nor the regional implementation are sufficiently considered in this legislation, i.e. essential components of a successful implementation of ACP are missing. Nevertheless, a growing number of initiatives, research projects and a professional national society for ACP, engage in approaches to advance institutional and regional implementation, and to offer ACP to other target groups beyond the legal framework.

[Pilot survey on continuing education for pharmacists in Germany]. / Piloterhebung zur Fortbildungssituation der Apotheker*innen in Deutschland.

INTRODUCTION: Continuing education (CE) for pharmacists is mandatory in Germany. However, the findings on CE activities of pharmacists are limited. The aim of this study was to conduct a pilot survey on the CE situation of pharmacists in Germany, including licensed and future pharmacists, to determine the commitment to CE, the attitude towards CE and an obligation to provide evidence, the extent of CE considered necessary and the application of CE content in professional practice. METHODS: A cross-sectional study was conducted in the form of an online survey using SoSci survey, which was addressed to licensed pharmacists, pre-registration pharmacists, and pharmacy students. The online survey was promoted by pharmaceutical professional societies, trade media and interest groups. RESULTS: In total, 880 participants were included in the study: 695 pharmacists, 136 pharmacy students and 49 pre-registration pharmacists. Only 50.0% of the participants were aware of their CE obligations. Among the pharmacists, 44.9% reported that they held the voluntary advanced training certificate issued by the Chambers of Pharmacists. 551 participants reported the CE points of the past twelve month. On average, 56.2 ±â€¯50.2 CE points were collected (x̅ = 210.8 CE minutes per month). Pharmacists not holding the voluntary advanced training certificate of the Chamber of Pharmacists collected significantly fewer (p < 0.001) CE points (39.5 ±â€¯32.0 points; x̅ = 148.1 CE minutes per month). On average, the study population considered a minimum number of 33.9 ±â€¯20.9 CE points per year (x̅ = 127.1 CE minutes per month) to be adequate to meet the CE requirements. DISCUSSION: Although the majority participated in CE, the introduction of nationwide CE commitment monitoring was rejected. On the one hand, this may be linked to a lack of willingness to engage in lifelong learning. On the other hand, it should be borne in mind that, despite the same common nationwide legal basis, the different Chambers of Pharmacists districts have set up different rules concerning the minimum yearly CE commitment, the proof of compliance with CE requirements and fines for non-compliance. Therefore, the introduction of nationwide standard regulations may result in a greater acceptance of CE commitment checks. CONCLUSION: Pharmacists' willingness to CE participation has so far been dependent on intrinsic motivation. Although many licensed pharmacists were in possession of the advanced training certificate issued by the Chambers of Pharmacists, the majority of participants did not support the introduction of a nationwide CE commitment monitoring. 127.1 CE minutes per month were considered appropriate to fulfill the CE obligations, which is significantly less than the 187.5 CE minutes per month which are required to obtain the advanced training certificate of the Chambers of Pharmacists.

Clinical trial research agenda on COVID-19 - the first two years in Germany and beyond.

BACKGROUND: We have followed the COVID-19 clinical trial research agenda from the beginning using the COVID-evidence.org platform. Now, two years after the COVID-19 pandemic started, our aim was to re-examine this research agenda with the latest data to provide a global perspective on the research landscape with a focus on Germany. METHODS: We reviewed and updated previously published data on the COVID-19 clinical research agenda as of 28February 2022 focusing on randomized trials. We used the COVID-evidence.org platform including registry entries from ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform as well as publications from the Living OVerview of Evidence platform for COVID-19 (L·OVE). RESULTS: Two years on from the pandemic outbreak, there were 4,673 registered trials. The majority of these trials have remained small with a median of 120 planned participants (IQR 60-320). In the first hundred days of the pandemic most of them (50%) had been registered in China. More than two years later, the five countries with the most registered trials (alone or within a framework of international collaborations) were the USA (825 trials; 18%), Iran (619 trials; 13%), India (566 trials; 12%), China (353 trials; 8%), and Spain (309 trials; 7%). Only 119 trials were reported to have a study site in Germany (2.5% of the registered trials). Of the 4,673 trials registered, 15% (694 trials) had published their results by February 2022. The clinical research agenda has been marked by both successes, such as the large RECOVERY trial providing evidence on 10 treatments for COVID-19 including over 45,000 patients as of February 2022, and failures: worldwide only 57 randomized trials have been registered over two years that aimed to assess non-pharmaceutical interventions (e.g., face mask policies and lockdown measures) to prevent COVID-19, and only 11 of them had published results informing decisions that have an impact on the life of billions of people worldwide. CONCLUSIONS: The COVID-19 clinical research agenda has highlighted the substantial effort of the research community but also the challenges of the clinical research ecosystem. Most importantly, it has shed light on the ability to circumvent traditional barriers and to make trials more useful even under extraordinary conditions. The time to learn our lessons and apply them is now, and the time to demonstrate how we have improved the system is before the next pandemic.

[Approaches to increase HPV vaccination rate in Germany - challenges and opportunities. A qualitative study]. / Ansätze zur Steigerung der HPV-Impfquote in Deutschland ­ Hindernisse und Chancen: Eine qualitative Studie.

BACKGROUND: In Germany, the prevalence of infections with the human papilloma virus (HPV) among women and men is high. High-risk HPV types can lead to certain types of cancer (e. g., cervical cancer). Vaccination against HPV infections associated with cancer and genital warts was introduced in Germany in 2007. Currently, HPV vaccination is recommended for girls and boys by the German Standing Committee on Vaccination. The vaccination rate, however, remains rather low, with rates below 50% in 15-year-old girls and of about 5% in 15-year-old boys in 2019. This suggests that new approaches are urgently needed to increase HPV vaccination coverage in Germany in the coming years. OBJECTIVES: This qualitative study aimed at identifying opportunities and challenges related to the application and implementation of different approaches designed to increase HPV vaccination uptake among male and female adolescents in Germany according to expert views. MATERIALS AND METHODS: From April to July 2020, 43 experts from the field of HPV vaccination in Germany were interviewed using a semi-standardized interview guide. The audiotaped interviews were transcribed and analyzed using qualitative content analysis by Udo Kuckartz. RESULTS AND CONCLUSION: According to the experts interviewed the following would be the most promising approaches to increase HPV vaccination rates in Germany: educational measures, school vaccination programs, increasing participation in the adolescent health check-up "J1", reminder and recall systems. The most reasonable solution would be to pursue several approaches simultaneously. According to the experts, more political support with implementing strategies and reducing bureaucratic obstacles as well as an increase in cooperation between relevant stakeholders is required to achieve the effective implementation of these strategies.

[Potential improvements of psychosocial working conditions in general practices: Development of a discussion guide for medical assistants for staff appraisals]. / Mögliche Verbesserungen der psychosozialen Arbeitsbedingungen in Hausarztpraxen: Entwicklung eines Gesprächsleitfadens für Medizinische Fachangestellte zur Nutzung für Mitarbeitergespräche.

BACKGROUND: Staff appraisals can provide employees and their supervisors with the opportunity to improve their communication and collaboration. However, one can assume that staff appraisals are not yet common instruments for human resources management in physician practices. The aim of this study was to develop a discussion guide for medical assistants (MAs) in general practices to support MAs in preparing, carrying out and documenting staff appraisals. METHODS: MAs were recruited through their professional organization [Verband medizinischer Fachberufe e. V.] and social media (06/2020-10/2020). An early draft of the discussion guide was devised comprising an introduction, a checklist for logistic preparation, a documentation sheet and a section to prepare the content of the meeting. The discussion guide was revised based on interviews with MAs who also rated the instrument. Data collection, analyses and the revision of the guide were carried out in an iterative process to the point where no further significant suggestions for improvement were made. RESULTS: In total, 20 interviews were conducted. Revisions were based on recommendations pertaining to a) how to interact with the supervisor (e. g., raising awareness of and responding to changes of the topic; anticipating counterarguments, scheduling of follow-up meetings), b) the choice of topics, c) additional measures to respond to MAs' needs (e. g., rotation to distribute tasks), and d) the preparation of the staff appraisal (e. g., rehearsals with an experienced colleague). Both the likelihood to use the guide in the future and its usefulness for staff appraisals were considered to be high. DISCUSSION AND CONCLUSION: We developed a discussion guide for and with MAs in general practices which can be helpful in preparing, conducting and documenting staff appraisals. This serves the purpose of bringing one's psychosocial working conditions to the supervisor's attention and to possibly improve them. To further improve the tool, future research should explore the experiences of MAs and physicians who actually use the discussion guide.

Research on point-of-care tests in outpatient care in Germany: A scoping review and definition of relevant endpoints in evaluation studies.

BACKGROUND: The fast turnaround time and user-friendliness of point-of-care tests (POCTs) offer a great potential to improve outpatient health care where clinical decisions have to be made during the physician-patient encounter and time resources are limited. The aim of this scoping review is to describe the extent and nature as well as gaps in German research activities on POCT in outpatient care. In addition, we define research endpoints that should be addressed in the comprehensive evaluation of POCTs targeted for outpatient care. METHODS: We performed a scoping review with a systematic literature search in Medline (via PubMed), Scopus, Web of Science, Cochrane library and Google Scholar for German publications on POCT with relevance to German outpatient care published from January 2005 to November 2020. RESULTS: Our literature search identified 2,200 unique records. After literature selection 117 articles were included in this scoping review. Just over half of the articles (67/117, 57.3%) were primary research studies with original data, while one third of all the studies (33.3%) were secondary research articles (e.g., review articles). The remaining articles were clinical recommendations / position papers (7/117, 6.0%) and other types of articles (3.4%). The majority of articles focused on POCT use in infectious diseases (44/117, 37.6%), diabetic syndromes (15.4%), cardiac disease (12.0%) or coagulopathies and thrombosis (10.3%), while the remaining articles did not specify the disease (13.7%) or investigated other diseases (11.1%). Similar to international studies, most primary research studies investigated the diagnostic performance of POCT (e.g., sensitivity, specificity). Evidence beyond diagnostic accuracy remains scarce, such as the impact on therapeutic decisions and practice routines, clinical effectiveness, and user perspectives. In line with this, interventional studies (such as RCTs) on the effectiveness of POCT use in German outpatient care are limited. We define six endpoint domains that should be addressed in the evaluation of POCTs targeted for outpatient care: (i) diagnostic performance, (ii) clinical performance, (iii) time and costs, (iv) impact on clinical routines / processes, (v) perspectives of medical professionals and patients, and (vi) broader aspects. CONCLUSION: There is considerable research activity on POCTs targeted for use in outpatient care in Germany. Data on their potential benefits beyond diagnostic accuracy is often lacking and should be addressed in future POCT research studies.

[Utilization and reporting of qualitative research methods in health services research in Germany: A scoping review on original research publications (2010-2019)]. / Anwendung und Darstellung qualitativer Methoden in der Versorgungsforschung in Deutschland: ein Scoping Review zu Primärstudien (2010­2019).

BACKGROUND: Qualitative research methods offer a unique perspective on health care services. However, little is known about the actual application of qualitative methods in health services research. Therefore, the aim of this study was to gain an overview of volume and variety of the use of qualitative research methods in health services research in Germany. METHODS: By means of a scoping review, a systematic literature search of the database PubMed was conducted in September 2020. We included (1) qualitative studies in (2) a health services setting (3) in Germany, (4) published in either German or English as (5) original research in a journal (6) between 2010 and 2019. After removing duplicates, tandem teams of researchers first performed a title and abstract screening, followed by a full text screening. Data was extracted by using a category grid considering research focus, study design and reporting. RESULTS: In total, 759 articles were included in the title and abstract screening. After applying the exclusion criteria, 97 articles were included in the data extraction. The studies investigating mainly subjective perspectives of different stakeholders, especially physicians and patients, covered 13 areas of health care. Interviews were the dominant form of data collection (n=64). Data analysis was mainly conducted using content analysis (n=65). CONCLUSION: A clear absolute increase in publications since the mid-2010s can be observed. At the same time, there has been a strong tendency towards certain methods being used for data collection and analysis. Compared to reporting standards and guidelines (e.g., COREQ), incomplete reporting of research methods has been noted. The results show that both an extension of the range of methods and the quality of reporting need to be discussed.

[Long COVID: Care and support needs from the perspective of "long-haul" patients and primary care practitioners - a mixed-methods study from Baden-Wuerttemberg]. / Versorgungsbedarfe zu Long-COVID aus Sicht von Betroffenen und Hausärzt*innen ­ eine Mixed-Methods-Studie aus Baden-Württemberg.

INTRODUCTION: The approaches to cope with the challenges of providing medical care to patients with symptoms of long COVID are multidisciplinary and involve primary care worldwide. The aim of this study was to explore the experiences and ideas for continued development of medical care of long COVID from the patients' (PAT) and primary care practitioners' (PCP) perspective. METHODS: Between the third and fourth COVID-19 wave in Germany (July to September 2021), a mixed methods study was conducted by inviting patients and PCPs in two neighboring districts (urban and rural) in Baden-Wuerttemberg to a paper-based questionnaire with both closed and open questions. On the part of the PCPs a written, anonymized, complete survey was conducted, on the part of symptomatic COVID long-haulers an anonymized online survey with announcement of the study by multiple recruiting processes. Qualitative content analysis was applied to free text entries. The quantitative results were analyzed mainly descriptively. RESULTS: The responses of n = 72 PCPs (response rate 12%) and n = 126 PAT showed a heterogeneous assessment regarding the satisfaction with medical care for long COVID as well as the perception of the attitude towards patients and their disease in both groups. Uncertainty and dealing with it played a relevant role in both groups as well. The professional medical knowledge was assessed by 3,1 (self-assessment PCPs) and 3,2 (PAT) on average using a five-point Likert scale (1 = not applicable; 5 = applicable). The request for a structured overall concept with competent contact points and coordination of medical care for long COVID patients emerged out of the statements of both groups. CONCLUSION: The results support an interdisciplinary, intersectoral and interprofessional stepped-care concept for long COVID in Germany with PCPs as the first contact persons, integration of specialized contact points and knowledge transfer. Therefore, it appears to be both reasonable and appropriate to establish regional networks with links between regional outpatient medical care structures and the university medical sector.