[General Self-Efficacy Scale (GSE) in Simple Language: Internal Consistency, Standard Values and Correlations with Demographic Variables in a Representative German Sample]. / Skala Selbstwirksamkeitserwartung in Leichter Sprache (SWE-LS): interne Konsistenz, Normwerte und Zusammenhänge mit demografischen Variablen in einer repräsentativen Stichprobe.

BACKGROUND: Approximately 6,2 million people with limited literacy live in Germany. They are unable to communicate in written language beyond single sentences and thus experience limited social participation in many everyday areas. In addition, they are also excluded from participation in survey-based social science research. METHOD: In order to enable persons with limited literacy to participate in written surveys, existing questionnaires need to be converted to easy language and their psychometric quality needs to be reexamined. We went through this process for the Self-Efficacy Expectancy (SWE) questionnaire and tested the new scale in easy language (SWE-LS) on a representative sample of the German population aged 14 years and older (N=2,531). RESULTS: The SWE-LS scale showed good internal consistency (Cronbach's-Alpha=0,84) and adequate item difficulty and discriminatory power. We found correlations consistent with expectations for the demographic variables surveyed. Thus, men and persons with higher education and higher income showed significantly higher self-efficacy expectations. The effect was also evident for East Germans versus West Germans, married persons living together versus separated, unmarried, or persons living as singles. DISCUSSION: Compared to the original SWE scale, the SWE-LS scale in easy language has no methodological disadvantages. The additional effort of linguistic adaptation and renewed psychometric testing is thus directly offset by enabling participation in survey-based research by over 12% of the adult population. A systematic translation of particularly frequently used questionnaires or those that do not concern fundamental research but research areas in which demographic variables themselves are part of the research object would be desirable.

Point-of-care laboratory testing in primary care: utilization, limitations and perspectives of general practitioners in Germany.

BACKGROUND: Due to their fast turnaround time and user-friendliness, point-of-care tests (POCTs) possess a great potential in primary care. The purpose of the study was to assess general practitioners' (GPs) perspectives on POCT use in German primary care, including utilization, limitations and requirements. METHODS: We conducted a cross-sectional survey study among GPs in Germany (federal states of Thuringia, Bremen and Bavaria (Lower Franconia), study period: 04/22-06/2022). RESULTS: From 2,014 GPs reached, 292 participated in our study (response rate: 14.5%). The median number of POCTs used per GP was 7.0 (IQR: 5.0-8.0). Six POCTs are used by the majority of surveyed GPs (> 50%): urine dipstick tests (99%), glucose (urine [91%] and plasma [69%]), SARS-CoV-2 (80%), urine microalbumin (77%), troponin I/T (74%) and prothrombin time / international normalized ratio (65%). The number of utilized POCTs did not differ between GP practice type (p = 0.307) and population size of GP practice location (p = 0.099). The great majority of participating German GPs (93%) rated POCTs as useful diagnostic tools in the GP practice. GPs ranked immediate decisions on patient management and the increase in diagnostic certainty as the most important reasons for performing POCTs. The most frequently reported limitations of POCT use in the GP practice were economic aspects (high costs and inadequate reimbursement), concerns regarding diagnostic accuracy, and difficulties to integrate POCT-testing into practice routines (e.g. time and personnel expenses). CONCLUSION: Although participating German GPs generally perceive POCTs as useful diagnostic tools and numerous POCTs are available, several test-related and contextual factors contribute to the relatively low utilization of POCTs in primary care.

Point-of-care measurement of C-reactive protein promotes de-escalation of treatment decisions and strengthens the perceived clinical confidence of physicians in out-of-hours outpatient emergency medical services.

OBJECTIVES: Out-of-hours outpatient emergency medical services (OEMS) provide healthcare for patients with non-life-threatening conditions in need for urgent care when outpatient practices are closed. We studied the use of point-of-care-testing of C-reactive protein (CRP-POCT) at OEMS. DESIGN: Cross-sectional questionnaire-based survey. SETTING: Single centre OEMS practice in Hildesheim, Germany (October 2021 to March 2022). PARTICIPANTS: OEMS physicians answering a questionnaire immediately after performing CRP-POCTs (CUBE-S Analyzer, Hitado) on any patients. PRIMARY AND SECONDARY OUTCOMES: Impact of CRP-POCTs on clinical decision-making and perceived usefulness. RESULTS: In the 6-month study period, 114 valid CRP-POCTs were performed in the OEMS practice by 18 physicians and the questionnaire was answered in 112 cases (response rate: 98.2%). CRP-POCTs were used in the diagnosis of inflammatory diseases of the gastrointestinal tract (60.0%), respiratory tract infections (17.0%), urinary tract infections (9.0%) and other non-gastrointestinal/non-specified infections (11.0%). The use of a CRP-POCT resulted in a change of the physicians' clinical decision in 83.3% of the cases. Specifically, in 13.6% and 35.1% of the cases, rapid CRP measurements led to decision changes in the (1) initiation of antimicrobial therapy and (2) other drug treatment, respectively. Notably, in 60% of all cases, the use of a CRP-POCT reportedly changed the decision on hospitalisation/non-hospitalisation of OEMS patients. In respect of antimicrobial therapy and hospitalisation, these decision changes primarily (≥73%) promoted 'step-down' decisions, that is, no antibiotic therapy and no hospital admission. In the great majority of CRP-POCT applications (≥95%), OEMS physicians reported that rapid CRP measurements increased the confidence in their diagnostic and therapeutic decision. In almost all cases (97%), physicians rated the CRP-POCT use as useful in the treatment situation. CONCLUSION: Quantitative CRP-POCT promotes step-down clinical decisions and strengthens the clinical confidence of physicians in out-of-hours OEMS.

Perspectives of physicians and medical assistants on the implementation of NAAT-based point-of-care testing for SARS-CoV-2 in primary care in Germany.

INTRODUCTION: Given their high diagnostic accuracy and fast turnaround time, rapid SARS-CoV-2 tests based on nucleic acid amplification technologies (NAAT) have great potential to expand access to testing and decrease delays in diagnosis of COVID-19. OBJECTIVES: The aim of this study was to investigate feasibility, acceptance, organizational consequences and other implementation aspects of the use of a NAAT-based SARS-CoV-2 rapid test (ID NOW™ COVID-19, Abbott Diagnostics) for symptomatic primary care patients with a suspected SARS-CoV-2 infection. METHODS: Cross-sectional survey among primary care physicians and medical assistants from Thuringia (Germany) during the third wave of the COVID-19 pandemic in March and April 2021. The health care providers surveyed had previously used the NAAT-based SARS-CoV-2 rapid test as part of a pilot study. RESULTS: Eleven physicians (ten general practitioners and one paediatrician) and 22 medical assistants from Thuringia (Germany) participated in the written survey. Four physicians were additionally interviewed. The majority of the surveyed health care providers rated user-friendliness, integration into practice routine, impact on communication with patients and technical reliability of the NAAT-based SARS-CoV-2 rapid test as (very) positive. Greater workload and the costs for measuring devices were identified as disadvantages compared to PCR laboratory tests. Four out of ten physicians rated the lower sample turnover as unfavourable. CONCLUSION: Our survey shows that NAAT-based point-of-care SARS-CoV-2 testing gained widespread acceptance among physicians and medical assistants, positively influences workflows, can improve patient communication and could therefore be successfully implemented into routine primary care.

"It Was Very Comforting to Find Out Right Away." - Patient Perspectives on Point-of-Care Molecular SARS-CoV-2 Testing in Primary Care.

Background: The use of point-of-care tests (POCTs) has been a central strategy to cope with the COVID-19 pandemic. Yet, evidence on the application and consequences of POCTs within medical settings is rare. Purpose: To assess and understand patient perspectives on molecular point-of-care SARS-CoV-2 testing conducted in primary care. Methods: We conducted a cross-sectional survey study among patients who were tested with a molecular SARS-CoV-2 rapid test (ID NOWTM COVID-19 rapid test, Abbott) in 13 primary care practices in the state of Thuringia (Germany) from February to April 2021. The following aspects were covered in the questionnaire through rating scales and open text formats: test characteristics, trust in test result, consequences of immediate result, cost amount willing to pay and expectations in the future. Open text answers were categorized; quantitative data were analyzed using descriptive statistics and a Mann-Whitney U-test to reveal differences in cost contribution depending on the test result. Results: A total of 215 patients from nine family practices and one pediatric practice participated. The immediate availability of the test result was important to the majority of patients (94.3%). 95.7% of patients trusted in their test result. Personal consequences of the immediate test result referred to pandemic measures, certainty of action and reassurance. For further tests, patients were willing to pay between 0€ and 100€ (interquartile range = 10-25€) for the molecular SARS-CoV-2 POCT, regardless of the test result. Expectations of being offered the test again in case of renewed cold symptoms were reported by 96.2%. Conclusion: Patients highly appreciated molecular SARS-CoV-2 rapid testing conducted in primary care practices. The immediate availability of the test result led to adjustments in patients' behavior and emotional wellbeing. However, potentially challenging for the implementation of POCTs in primary care practices may be the reimbursement of test costs and patients' expectations in future situation.

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.

Outpatient teaching in specialist practices - a qualitative study with doctors about attitudes, influencing factors and specialist features.

Aim: The aim is to record existing attitudes, influencing factors and specialised requirements with regard to the training of medical students in specialist outpatient care with doctors working in outpatient care. Method: Between September 2020 and May 2021, individual interviews with 15 specialists employed in outpatient care were held as part of this qualitative study. The recorded interviews were evaluated structurally in accordance with the Kuchartz method. Results: Enhanced outpatient training for medical students in specialist teaching practices was considered as important by all participants. Among other things, motivational factors were pleasure in teaching, a feeling of duty, the desire to pass something on, the need to convey one's own ideas and to generate future talent for the field. A lack of time, greater organisational effort and legal concerns were stated as hurdles. Reducing organisational effort for teaching practices, appreciation of their teaching activity and financial considerations were in particular given as significant incentives for participating. The attitude of participants towards financial remuneration was heterogeneous. Different specialist features and requirements for student training were mapped out. Conclusion: This study provides, for the first time, findings about teaching in specialist outpatient establishments. They point to a great degree of willingness of specialist doctors to undertake teaching and provide starting points for creating concepts about producing teaching practices in specialist fields. Further quantitative investigation is required to substantiate the findings before us.