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  • 1
    In: Das Gesundheitswesen, Georg Thieme Verlag KG
    Abstract: Hintergrund Die Gutachterkommissionen der Ärztekammern ermöglichen eine kostenfreie und außergerichtliche Bewertung von putativen ärztlichen Behandlungsfehlern. Sie erstellen Gutachten, die wertvolle Angaben zu Prozessschritten beinhalten, die dem eigentlichen Behandlungsfehler vorangehen. Ziel der vorliegenden Studie ist es, Prozessschritte in den Gutachtentexten zu identifizieren und systematisch zu kategorisieren, um damit die Voraussetzung für eine Auseinandersetzung mit Fehlern zu ermöglichen. Methodik In dieser Studie werden zehn zufällig ausgewählte und anonymisierte Gutachten der Gutachterkommission für Fragen ärztlicher Haftpflicht der Bezirksärztekammer Südwürttemberg mit festgestellten hausärztlichen Behandlungsfehlern nach der Methode der qualitativen Inhaltsanalyse ausgewertet. In einem iterativen Prozess wurden zentrale Elemente von Gutachten in ein deduktiv-induktiv erstelltes Kategoriensystem eingeordnet. Ergebnisse Es wurden sechs Hauptkategorien mit zugehörigen Unterkategorien identifiziert: 1) Strukturmerkmale des Gutachtens, 2) Arzt-Patienten-Kommunikation, 3) medizinischer Verlauf, 4) Patientenerleben, 5) Handlung Praxisteam, 6) Koordinierende Funktion im Gesundheitssystem. Das Kategoriensystem zeigte bei wiederholter Anwendung eine ausreichende Reliabilität. Schlussfolgerungen Fehler bieten die Chance, aus ihnen zu lernen. Die vorgeschlagene Systematik kann die Komplexität von Gutachten strukturieren und dadurch in verschiedenen Kontexten als Hilfsmittel dienen. Insbesondere ermöglicht sie eine differenzierte Betrachtung bei der Erstellung und vergleichenden Analyse von Gutachten und könnte in der Versorgungsforschung sowie in der Aus- und Weiterbildung genutzt werden.
    Type of Medium: Online Resource
    ISSN: 0941-3790 , 1439-4421
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    Language: German
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
    detail.hit.zdb_id: 1101426-X
    SSG: 20,1
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  • 2
    In: Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, Elsevier BV, Vol. 165 ( 2021-10), p. 77-82
    Type of Medium: Online Resource
    ISSN: 1865-9217
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    Language: German
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2413601-3
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  • 3
    In: Trials, Springer Science and Business Media LLC, Vol. 19, No. 1 ( 2018-12)
    Type of Medium: Online Resource
    ISSN: 1745-6215
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2018
    detail.hit.zdb_id: 2040523-6
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  • 4
    In: BMC Primary Care, Springer Science and Business Media LLC, Vol. 24, No. 1 ( 2023-05-06)
    Abstract: The results of critical illness and life-saving invasive measures during intensive care unit treatment can sometimes lead to lasting physical and psychological impairments. A multicentre randomized controlled trial from Germany (PICTURE) aims to test a brief psychological intervention, based on narrative exposure therapy, for post-traumatic stress disorder symptoms following intensive care unit treatment in the primary care setting. A qualitative analysis was conducted to understand feasibility and acceptance of the intervention beyond quantitative analysis of the main outcomes in the primary study. Methods Qualitative explorative sub-study of the main PICTURE trial, with eight patients from the intervention group recruited for semi-structured telephone interviews. Transcriptions were analysed according to Mayring's qualitative content analysis. Contents were coded and classified into emerging categories. Results The study population was 50% female and male, with a mean age of 60.9 years and transplantation surgery being the most frequent admission diagnosis. Four main factors were identified as conducive towards implementation of a short psychological intervention in a primary care setting: 1) long-term trustful relationship between patient and GP team; 2) intervention applied by a medical doctor; 3) professional emotional distance of the GP team; 4) brevity of the intervention. Conclusion The primary setting has certain qualities such as a long-term doctor-patient relationship and low-threshold consultations that offer good opportunities for implementation of a brief psychological intervention for post-intensive care unit impairments. Structured follow-up guidelines for primary care following intensive care unit treatment are needed. Brief general practice-based interventions could be part of a stepped-care approach. Trial registration The main trial was registered at the DRKS (German Register of Clinical Trials: DRKS00012589) on 17/10/2017.
    Type of Medium: Online Resource
    ISSN: 2731-4553
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 3107315-3
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  • 5
    Online Resource
    Online Resource
    MDPI AG ; 2019
    In:  International Journal of Environmental Research and Public Health Vol. 16, No. 19 ( 2019-10-05), p. 3754-
    In: International Journal of Environmental Research and Public Health, MDPI AG, Vol. 16, No. 19 ( 2019-10-05), p. 3754-
    Abstract: Background: There are well-known methodological and analytical challenges in planning regional healthcare services (HCS). Increasingly, the need for data-derived planning, including user-perspectives, is discussed. This study aims to better understand the possible contribution of citizen experience in the assessment of regional HCS needs in two regions of Germany. Methods: We conducted a written survey in two regions of differing size—a community (3653 inhabitants) and a county (165,211 inhabitants). Multinomial logistic regression was used to assess the impact of sociodemographic and regional factors on the assessment of HCS provided by general practitioners (GPs) and specialists. Results: Except for age and financial resources available for one’s own health, populations did not differ significantly between the regions. However, citizens’ perception of HCS (measured by satisfaction with 1 = very good to 5 = very poor) differed clearly between different services (e.g., specialists: 3.8–4.3 and pharmacies: 1.7–2.5) as well as between regions (GPs: 1.7–3.1; therapists: 2.9–4). In the multivariate model, region (next to income and age) was a consistent predictor of the perception of GP- and specialist-provided care. Discussion: Citizens’ perceptions of HCS correspond to regional provider density (the greater the density, the better the perception) and add insights into citizens’ needs. Therefore, they can provide valuable information on regional HCS strengths and weaknesses and are a valid resource to support decision makers in shaping regional care structures.
    Type of Medium: Online Resource
    ISSN: 1660-4601
    Language: English
    Publisher: MDPI AG
    Publication Date: 2019
    detail.hit.zdb_id: 2175195-X
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  • 6
    In: Journal of Telemedicine and Telecare, SAGE Publications
    Abstract: Although teledermatology has been proven internationally to be an effective and safe addition to the care of patients in primary care, there are few pilot projects implementing teledermatology in routine outpatient care in Germany. The aim of this cluster randomized controlled trial was to evaluate whether referrals to dermatologists are reduced by implementing a store-and-forward teleconsultation system in general practitioner practices. Methods Eight counties were cluster randomized to the intervention and control conditions. During the 1-year intervention period between July 2018 and June 2019, 46 general practitioner practices in the 4 intervention counties implemented a store-and-forward teledermatology system with Patient Data Management System interoperability. It allowed practice teams to initiate teleconsultations for patients with dermatologic complaints. In the four control counties, treatment as usual was performed. As primary outcome, number of referrals was calculated from routine health care data. Poisson regression was used to compare referral rates between the intervention practices and 342 control practices. Results The primary analysis revealed no significant difference in referral rates (relative risk  = 1.02; 95% confidence interval = 0.911–1.141; p = .74). Secondary analyses accounting for sociodemographic and practice characteristics but omitting county pairing resulted in significant differences of referral rates between intervention practices and control practices. Matched county pair, general practitioner age, patient age, and patient sex distribution in the practices were significantly related to referral rates. Conclusions While a store-and-forward teleconsultation system was successfully implemented in the German primary health care setting, the intervention's effect was superimposed by regional factors. Such regional factors should be considered in future teledermatology research.
    Type of Medium: Online Resource
    ISSN: 1357-633X , 1758-1109
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2007700-2
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  • 7
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2023
    In:  BMC Health Services Research Vol. 23, No. 1 ( 2023-06-05)
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2023-06-05)
    Abstract: Adequate health care in correctional facilities is often limited by staff shortage, which entails time-consuming consultations with physicians outside of these facilities. Video consultations (VC) have been implemented in many different health care settings and may also be useful in correctional facilities. As part of a pilot project, synchronous VC were implemented in five correctional facilities in Germany in June 2018. The aim of this study was to describe the implementation process from the providers’ perspective and to identify factors promoting or inhibiting the implementation process of VC with a focus on interprofessional collaboration between nursing staff and telemedicine physicians. Methods As part of the mixed-methods evaluation of the pilot project, site visits to the five correctional facilities were carried out. Nursing staff from the five correctional facilities ( n= 49) and telemedicine physicians ( n= 10) were asked to participate in interviews and a questionnaire survey. Interviews were analyzed using qualitative content analysis and questionnaires were evaluated using descriptive statistical methods. The results from both data sources were integrated and discussed in the framework of Normalization Process Theory. Results Interviews were conducted with 24.5% ( n= 12) of nursing staff and 20.0% ( n= 2) of telemedicine physicians, while questionnaires were returned by 22.5% ( n= 11) of nursing staff and 33.3% ( n= 3) of telemedicine physicians. VC with general practitioners and psychiatrists were perceived as an additional support during times when physicians were absent from the correctional facilities. Allocating telemedicine physicians to specific correctional facilities might further improve interprofessional collaboration with nursing staff during VC. Inhibiting factors comprised the lack of integrating nursing staff into the implementation process, increased workload, insufficient training and the implementation of VC at an inconvenient time. Conclusions To summarize, VC are a promising supplement to face-to-face health care in correctional facilities despite several limitations. These might be compensated by improving interprofessional cooperation and by integrating telemedicine physicians into local health care teams.
    Type of Medium: Online Resource
    ISSN: 1472-6963
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2050434-2
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  • 8
    In: JMIR Research Protocols, JMIR Publications Inc., Vol. 11, No. 5 ( 2022-5-16), p. e34026-
    Abstract: Symptom checker apps (SCAs) are accessible tools that provide early symptom assessment for users. The ethical, legal, and social implications of SCAs and their impact on the patient-physician relationship, the health care providers, and the health care system have sparsely been examined. This study protocol describes an approach to investigate the possible impacts and implications of SCAs on different levels of health care provision. It considers the perspectives of the users, nonusers, general practitioners (GPs), and health care experts. Objective We aim to assess a comprehensive overview of the use of SCAs and address problematic issues, if any. The primary outcomes of this study are empirically informed multi-perspective recommendations for different stakeholders on the ethical, legal, and social implications of SCAs. Methods Quantitative and qualitative methods will be used in several overlapping and interconnected study phases. In study phase 1, a comprehensive literature review will be conducted to assess the ethical, legal, social, and systemic impacts of SCAs. Study phase 2 comprises a survey that will be analyzed with a logistic regression. It aims to assess the user degree of SCAs in Germany as well as the predictors for SCA usage. Study phase 3 will investigate self-observational diaries and user interviews, which will be analyzed as integrated cases to assess user perspectives, usage pattern, and arising problems. Study phase 4 will comprise GP interviews to assess their experiences, perspectives, self-image, and concepts and will be analyzed with the basic procedure by Kruse. Moreover, interviews with health care experts will be conducted in study phase 3 and will be analyzed by using the reflexive thematical analysis approach of Braun and Clark. Results Study phase 1 will be completed in November 2021. We expect the results of study phase 2 in December 2021 and February 2022. In study phase 3, interviews are currently being conducted. The final study endpoint will be in February 2023. Conclusions The possible ethical, legal, social, and systemic impacts of a widespread use of SCAs that affect stakeholders and stakeholder groups on different levels of health care will be identified. The proposed methodological approach provides a multifaceted and diverse empirical basis for a broad discussion on these implications. Trial Registration German Clinical Trials Register (DRKS) DRKS00022465; https://tinyurl.com/yx53er67 International Registered Report Identifier (IRRID) DERR1-10.2196/34026
    Type of Medium: Online Resource
    ISSN: 1929-0748
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2022
    detail.hit.zdb_id: 2719222-2
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  • 9
    Online Resource
    Online Resource
    Informa UK Limited ; 2022
    In:  Medical Education Online Vol. 27, No. 1 ( 2022-12-31)
    In: Medical Education Online, Informa UK Limited, Vol. 27, No. 1 ( 2022-12-31)
    Type of Medium: Online Resource
    ISSN: 1087-2981
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2022
    detail.hit.zdb_id: 2052877-2
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  • 10
    Online Resource
    Online Resource
    Informa UK Limited ; 2021
    In:  Medical Education Online Vol. 26, No. 1 ( 2021-01-01)
    In: Medical Education Online, Informa UK Limited, Vol. 26, No. 1 ( 2021-01-01)
    Type of Medium: Online Resource
    ISSN: 1087-2981
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2021
    detail.hit.zdb_id: 2052877-2
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