ZFA. Zeitschrift fur Allgemeinmedizin最新文献

Background: Regional Associations of Statutory Health Insurance Physicians in Germany are obliged to provide around-the-clock non-emergency care. This includes out-of-hours care, weekends, and public holidays. Due to a growing shortage of specialised doctors in private practice - especially in more rural area - this well-established system might be about to collapse. A possible solution could lie in training medical personnel to work under telemedical supervision.

Methods: The Association of Statutory Health Insurance Physicians of Lower Saxony, Klinikum Oldenburg AöR, and Johanniter-Unfall-Hilfe (JUH) Germany developed a pilot scheme in which specially-trained paramedics provided out-of-hours non-emergency medical services. Supervision was ensured by telemedical backup. Descriptive statistics were used to analyse the data.

Results: The majority of cases occurred in urban areas in the afternoon or at night. Most problems could be resolved by providing patient counselling. The majority of patients presented with unspecific symptoms. Telemedical support by a medical doctor was only required in 2.1 % of cases. In Germany, treatment by paramedics is widely accepted. In 63.5 % of cases patients could remain in an ambulatory setting.

Conclusions: Our study showed that non-emergency out-of-hours service can be competently delivered by paramedics under telemedical supervision. However, the expansion of high-speed wireless internet access is crucial for ensuring nationwide telemedical support. More research is needed to find out whether the described pilot scheme can be rolled out or even expanded in more rural areas of Germany.

Background: Sore throat is a common reason for consultation of family physicians. Acute sore throat (< 14 days) is usually triggered by infections of the pharynx. Less than 35 % of cases are caused by bacterial infections; nevertheless, antibiotics are prescribed far more often. Evidence-based guideline recommendations are available to reduce non-indicated administration of antibiotics in the treatment of sore throat.

Search methods: Update of the clinical guideline "sore throat" of the German College of General Practitioners and Family Physicians (DEGAM) by means of a systematic search of the literature for international guidelines and systematic reviews.

Main messages: After excluding red flags such as immunosuppression and severe systemic infections, acute sore throat is usually self-limiting with a mean duration of 7 days. Patients should be encouraged in self-management; ibuprofen and naproxen are recommended for symptomatic treatment. If antibiotics are considered, clinical scores (Centor, McIsaac, FeverPAIN) should be used to assess the risk of bacterial pharyngitis. At low risk (< 3 points), antibiotics are not indicated; if at least moderate (3 points), delayed prescription is an option; if high (> 3 points), antibiotics can be taken immediately. Even if scores suggestive a bacterial cause, the evidence suggests that antibiotic treatment only shortens the duration of symptoms modestly. Penicillin is the first choice (clarithromycin as an alternative). The antibiotic should be taken for 5-7 days.

Conclusions: In the absence of red flags, a regular use of symptomatic treatment will help to control discomfort. If administration of antibiotics is still considered a risk-adapted approach, using clinical scores is recommended.

Background: Due to the COVID-19 pandemic, the Objective Structured Clinical Examination (OSCE) examinations were cancelled in the short term. This project described how to offer medical students an alternative assessment at Miller's competence level of "shows how".

Methods: Students produced videos in which they can be seen performing various physical examinations related to family medicine consultations. Trained assessors rated the videos uploaded to the learning platform and gave verbal feedback if requested.

Results: The grading (65 "very good" and 38 "good") was very mild. Twelve per cent of the students requested verbal feedback. Their evaluation of the procedure was mixed. The evaluators consistently assessed their task and the process as positive. Technically, the video-based assessment could be implemented without any problems.

Conclusions: The short-term implementation of a video-based assessment in the context of medical education proved to be feasible. It could serve not only as an emergency solution under a pandemic, but also as an additional opportunity for formative feedback in the future.