[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.

[Spatial accessibility to animal health care - a GIS based analysis]. / Räumliche Zugänglichkeit zu tiermedizinischer Versorgung ­ eine GIS-basierte Analyse.

INTRODUCTION: Various studies from the past years examine the changing conditions and challenges in the veterinary sector. Secured access to public and private care services is a prerequisite for a holistically oriented health care system ("One Health"). In the present study, a multidimensional concept of accessibility to care services was used for the first time to determine and visualize the density of the animal health care system in Switzerland. Traditional indicators used to describe care structures focus either on availability or accessibility. In order to overcome the limitations of traditional indicators, the family of methods known as Floating-Catchment-Area-Methods (FCA) has been developed in care geographical research. The strength of FCA methods lies in the fact that they output accessibility independent of administrative boundaries and at the same time consider the spatial distance and available capacities. The study provides insight into the density of animal health care services using FCA methods and geographical information systems (GIS). Data on providers of veterinary services in the companion animal sector and, on the demand side, data on dogs and cats kept in Switzerland served as illustrative example. The result was interactive maps of the density of health care and the structure of spatial accessibility to veterinary providers and consumers. As expected, high spatial accessibility is found in the urban centers and the agglomerations of the Central Plateau. In contrast, spatial accessibility to medical services for dogs and cats is often lower in peripheral areas. Due to hitherto unavailable data, various analyses had to be postponed for the time being. For example, the model could of course be extended to all animal species and all types of medical services. In addition, it would also be possible to forecast the future density of health care, or to optimize the care system. Together with the relevant industry stakeholders, these gaps could be closed, and the model and the resulting findings could be further differentiated. The results should serve private actors in the concerned value chains, but also decision-makers in the public veterinary service, governmental authorities, agricultural bodies, universities, etc. as a basis for strategic decisions regarding the issue of medical supply density and care services in the animal sector.

INTRODUCTION: Ces dernières années, divers travaux ont examiné l'évolution des conditions cadres et des défis dans le secteur vétérinaire. L'assurance d'un accès aux soins publics et privés est une condition préalable à un système de santé holistique (« One Health ¼). Dans le travail présent, on a tenté pour la première fois d'enregistrer et de visualiser la densité d'approvisionnement du système de soins vétérinaires en Suisse en utilisant un concept multidimensionnel d'accessibilité aux offres de soins. Les indicateurs traditionnels pour décrire les structures de soins se concentrent soit sur la disponibilité soit sur l'accessibilité. Afin de contrer les limites des indicateurs traditionnels, la famille de méthodes du Floating-Catchment-Area (FCA) s'est développée dans la recherche en géographie sanitaire. La force des méthodes FCA est qu'elles fournissent un accès indépendamment des limites administratives, tout en tenant compte de la distance spatiale et de la capacité disponible. Ce travail permet d'avoir un aperçu de la densité de l'offre vétérinaire en utilisant la méthodologie FCA en tenant compte de systèmes d'information géographique (SIG). Les données sur les prestataires de services vétérinaires dans le secteur des animaux de compagnie et sur la demande concernant les chiens et les chats vivant en Suisse ont servi d'exemple. Le résultat a été des cartes interactives de la densité de l'offre et de la structure de l'accessibilité spatiale aux prestataires vétérinaires et de celle des consommateurs. Comme prévu, il existe un degré élevé d'accessibilité spatiale dans les centres urbains et les agglomérations du plateau suisse. En revanche, l'accessibilité spatiale aux services vétérinaires pour chiens et chats est souvent plus basse dans les zones périphériques. En raison de données indisponibles précédemment, diverses analyses ont dû être abandonnées dans un premier temps. Ce modèle pourrait être étendu à toutes les espèces animales et aux diverses offres vétérinaires. En outre, il serait également possible de faire des prévisions sur la future densité de l'offre ou sur son optimisation. Conjointement avec les acteurs de la branche concernés, ces lacunes pourraient être comblées avec certitude et le modèle et les résultats qui en résulteraient seraient encore plus différenciés. Les résultats sont destinés à aider les acteurs privés dans les chaînes de valeur ajoutée, mais ils pourraient aussi servir de base aux décideurs des services vétérinaires publics, aux autorités d'exécution, aux organes de l'agriculture, aux universités, etc., pour prendre des décisions stratégiques autour du thème de la densité de l'offre médicale dans le secteur animal.

[Health status of asylum seekers and their access to medical care: Design and pilot testing of a questionnaire]. / Gesundheitszustand und medizinische Versorgung von Asylsuchenden ­ Konzeption und Pilotierung eines Fragebogens.

BACKGROUND: Scientific evidence on the health status of asylum seekers in Germany and their access to health care is fragmentary. There is a lack of appropriate questionnaires collecting indicators of health status and health care, which enable a meaningful comparison with a reference population. This article presents experiences in designing a questionnaire and findings available from a pilot testing to pave the way to improve design and methods in future studies. MATERIALS AND METHODS: The questionnaire comprises 28 mainly closed questions on self-reported health status, access to medical care and sociodemographic indicators. In order to guarantee comparability with the general population in Germany, most questions are derived from national health surveys. The questionnaire was translated into seven languages. Pilot testing was conducted between October 2014 and February 2015 in the course of the monthly welfare payments to asylum seekers in three districts of the German federal state of Baden-Wuerttemberg. RESULTS: A total of 156 out of 614 contacted asylum seekers participated in the pilot study (response rate: 25.4 %). The completion rate for items concerning health status and health care was satisfactory (> 75 %). Several items regarding sociodemographic data and linguistically complex questions showed the lowest item response rates (< 50 %). We recommend streamlining the questionnaire and using precise, closed and culturally adapted items. CONCLUSIONS: The questionnaire proved to be expedient and practicable to assess relevant indicators of health status and health care provision. It appears that there is scope for improvement regarding the shortening and cultural adaptation of the questionnaire and the range of available translations. After addressing the mentioned limitations and further development, our approach could contribute to measuring regional disparities, differences between asylum seekers and the general population and temporal changes. In order to obtain representative data, the sampling strategy should be optimised.