Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen最新文献

Introduction: The increasing digitalization of the healthcare system makes it possible to provide medical services using digital technologies without direct patient-provider contact. This study aimed to investigate 1) the use and acceptance of video consultation and 2) factors associated with the use of video consultation.

Methods: A cross-sectional online survey was conducted in February 2023. Overall, 20,000 adults insured at a statutory health insurance company in Germany (10,000 users and 10,000 non-users of video consultation) were invited by email to an online survey with 31 items. The items addressed use and acceptance of digital health services with a focus on video consultation, digital health literacy and sociodemographic characteristics. Data were analyzed using descriptive statistics and factors associated with video consultation use were assessed using binary logistic regression.

Results: Among the 1657 participants, 686 were users and 971 were non-users of video consultation. The participants were aged between 18 and 80 years (M ± SD: 44 ± 13 years), 55% were female, 59% reported a medium subjective socioeconomic status, and 69% a good to very good health status. Video consultation were predominantly used following physician recommendations (71%) as part of general medical care (50%). The main reasons for using video consultation were time saving (93%) and flexibility in terms of location (87%). Most video consultation users felt well cared-for during video consulting (93%), would use it again (95%), and would recommend it to others (93%). Factors associated with video consultation use were age from 30 to 49 years, high subjective socioeconomic status, high digital health litercay, and very poor to moderate health status.

Conclusion: The acceptance of video consultations in this study was high. Advantages and barriers to offering video consultations from a physician perspective should be investigated to incorporate video consultations in everyday medical practice.

Introduction: Social reporting in Hamburg identifies existing inequalities at the urban area level. These social-contextual variations may potentially influence preventive health behaviors. The aim of this article is to examine correlations between the degree of social regional disadvantage of Hamburg's population and the utilization of regular screening examinations for children, adolescents, and adults through small-area analysis.

Methods: The analyses are based on claims data from 2017 of insured individuals living in Hamburg from three cooperating statutory health insurance funds. A socially contextual indicator (1 = "very low" to 7 = "high") was assigned to the data at urban area level. Based on this, binary correlations between the social indicator and calculated utilization rates (stratified by gender and age) of early detection examinations were examined using Kendall's tau correlation analysis.

Results: The study population included N = 433,053 individuals (53.7 % female) from the city of Hamburg. Strong positive associations were found between utilization rates and social contextual index classes for U7 to U9 examinations (r > 0.7; p-values < 0.05) as well as cervical cancer screening (r > 0.9; p-values = 0.002), indicating that utilization increases with the rising social status of the urban area level. Additionally, strong positive correlations can be observed in some subgroups for prostate cancer screening (> 59 years: r = 0.905, p-value = 0.004) and colorectal cancer screening (women aged 50-60 years: r = 0.905, p-value = 0.004). No significant correlations were found for other subgroups, as well as for skin cancer screening, breast cancer screening and the J1 examination (p-value > 0.05). Strong negative associations have only been detected for the general health check-up for individuals aged 35 to 59 (women: r = -0.810, p-value = 0.011; men: r = -0.714, p-value = 0.024).

Discussion and conclusion: The results indicate inequalities in the use of early detection examinations provided by statutory health insurers for children and adults to the disadvantage of urban areas ranking lower in social status. This socially selective utilization may lead to an accumulation of health problems in urban areas that are already disadvantaged socially, which would result in an exacerbation of existing social and health inequalities. Small-scale and socially differentiated analyses of healthcare provision should be seen as a regular component of regional healthcare provision. They provide starting points for a more needs-oriented further development of the healthcare system and secondary prevention services.

Introduction: Web-based health information can support health-related decisions if it is of high quality, i. e. accurate, understandable and barrier-free. Our study systematically searched for German-language, web-based health information on the prevention and prediction of food allergies in children and assessed their content and quality.

Methods: In July 2022, four researchers conducted a systematic Google search for German-language web-based health information (HI) on the prediction and prevention of food allergies in children. They searched independently of each other with a predefined search algorithm. Two independent reviewers analyzed the data using qualitative and quantitative content analysis (step/analysis 1) and assessed the quality of HI (step/analysis 2) using a comprehensive criteria catalog (transparency, text design, content, language, presentation of frequencies and statistical information, visualization, and accessibility).

Results: The systematic search yielded 59 websites, which were provided by nine sectors. The most frequent sectors were "Health portals and expert opinions" and "Guidelines/scientific and medical specialized information" (22 % each). The content analysis (step 1) showed, among other things, that the topic of prediction was only implicitly addressed. 49 materials (83 %) contained guideline-compliant information. However, there were also 26 materials (44 %) whose content was not in line with the current S3 guideline on allergy prevention. Quality assessment (step 2) revealed that only a small number of the 43 HI received good or very good ratings regarding the transparency (n = 3, 7 %) and content (n = 9, 21 %) criteria. The criterion concerning frequencies and statistical information was rated good or very good quality in only 11 HI (26 %). Almost all HI met the quality criteria for language (n = 38, 88 %), text design (n = 43, 100 %), and visualization (n = 43, 100 %). None of the evaluated HI was given a good or very good rating in terms of accessibility criteria. The analysis by sector revealed only minor differences (Mean of the seven criteria: 56-69 %).

Conclusion: The quality of the available web-based health information on the prevention and prediction of food allergies in children is highly heterogeneous. There is need for improvement in terms of accessibility, content (e. g., selective presentation of prevention measures), and transparency (e. g., missing details of contacts). Further research is needed for expanding the user perspective and analyzing social media in the context of prediction and prevention of food allergies in children.

Background: Pregnant women and their families, especially those navigating chronic illness or challenging life situations, often seek information and counseling. The pregnancy period and the transition to parenthood can exacerbate these circumstances, leaving families particularly vulnerable. Addressing stressful situations becomes a hurdle in this context. Digital health technologies (DHTs), encompassing mobile apps, wearable devices and online platforms, present a valuable avenue for pregnant women and their families to access health information, educational parenting resources and personalized recommendations. The aim is to analyze the current research of digital health interventions designed to support parents throughout the transition from pregnancy to parenthood.

Methods: We conducted a scoping review and analyzed MEDLINE via PubMed, CINAHL, Cochrane Library, IEEE Xplore Digital Library, ScienceDirect and PsycINFO. Relevant German and English articles from 2004 to 2023 referring to DHTs to improve the time before and after birth were included.

Results: In 78 articles, pregnant women and parents utilized various DHTs such as mobile applications, multi-functional digital platforms, social media, videos and health websites during the transition from pregnancy to parenthood. Mobile apps and multi-component digital interventions were most frequently used in these studies. A large proportion of the studies employed experimental designs such as randomized controlled trials (RCTs) and quasi-experimental methods. DHTs empower healthcare professionals to enhance parental health education for expecting and new parents in areas such as breastfeeding, preterm birth risks and mental health. DHTs provide accessible support, instruction, counseling and health services, including care for premature infants and guidance on baby-care practices. These DHTs also enable innovative monitoring of pregnancy progress, women's health, breastfeeding and mental wellbeing, thereby revolutionizing healthcare support for pregnant individuals and young families.

Conclusion: DHTs allow pregnant women and their families to access health information, participate in parenting training, and receive personalized recommendations. This can contribute to increased self-care and a sense of control over the pregnancy journey. There is also a need for research to understand the effectiveness and feasibility of implementing and evaluation existing digital health interventions.

Background: The ongoing implementation of electronic medical records (EMRs) in German hospitals is currently slow. Implementation science widely acknowledges the barriers and facilitators to implementation. Thus, specific preconditions are necessary to address the former and to support an effective EMR implementation. However, a lack of knowledge exists about these necessary preconditions in Germany. This study aims to gain insight into key stakeholders' experiences with implementing EMR systems in German hospitals to identify preconditions for embedding EMRs in this social context.

Methods: Expert interviews were conducted with members of hospital-wide implementation teams concerning EMR implementation. The interviewees belonged to the nursing, IT, medical, and pharmaceutical professions and worked in hospitals with different contextual characteristics. The interview guideline was based on the practical Consolidated Framework for Implementation, which supports the systematic assessment of potential barriers and facilitators to identify implementation strategies and necessary adaptations. Data was collected between May 2021 and September 2022, and the interviews were analyzed using qualitative content analysis.

Results: Thirteen interviews were conducted with employees from eleven hospitals. Five critical preconditions emerged for EMR implementation based on our analysis: 1) adaptation, where the clinical context and EMRs are aligned; 2) stakeholder co-production, where all relevant stakeholders (e. g., professional groups, departments, and hierarchical levels) are involved in planning, implementing, and evaluating; 3) end-user participation, where end-users are involved in the implementation through close support and training; 4) integration into daily routines, where EMRs are integrated into daily work, including work processes that initially require additional effort but are necessary to experience the relative advantages; and 5) the continuous Plan-Do-Check-Act cycle, where the EMR implementation process is continuously reviewed and adjusted. In addition, activities to enact these preconditions were derived based on the interview data.

Discussion: Our findings indicate that overall contextual adaptation is required. The five preconditions include essential activities to facilitate the integration of the EMR into daily routines. Participation, communication, and support are fundamental, as described in the international literature. Failure to comply with these preconditions can lead to challenges during implementation, such as end-user resistance.

Conclusion: Considering social and technical aspects is paramount in implementing EMRs, which may also apply to future digital innovations' change management processes.

Background: In Germany, Eastern European live-in carers are filling a gap in home-based long-term care for older persons. As a care reality fraught with diverse problems, live-in care is an unregulated care format bordering between formal and informal structures and has so far received little attention from health services research. The aim of the qualitative study described here was to analyze the current discourses among stakeholders from care practice, politics, and associations, as well as the arguments contained therein regarding the status quo and future of live-in care.

Methods: We analyzed 22 online available documents from stakeholders, such as statements and contributions to the discussion, as well as ten expert interviews. Within the scope of a qualitative content analysis, triangulation of the two data corpora was conducted. Using a deductive-inductively developed system of categories, viewpoints and arguments were analyzed on this basis.

Results: Three arguments regarding the future regulation of live-in care were identified in current socio-political discourses: 1) Maintain: professionalization of live-in care, 2) Supplement: integrating live-in care into the care mix, 3) Abolish: alternatives to the live-in care model. Despite different perspectives regarding the implementation of live-in care in the long-term care system, there is consensus that political measures must move beyond purely legal solutions. Regulation of framework conditions, mediation, and care practices is necessary.

Discussion and conclusion: Regarding the future design of live-in care, particular emphasis is placed on adjusted financial incentives, professionalized live-in and live-out services, as well as the organization and promotion of informal care networks and collaborations with formal providers like outpatient services as key levers. In a broader discourse on the regulation of live-in care, it should be clarified how requirements for quality-assured long-term care can be applied, taking into account the needs of care arrangements.

Introduction: Diagnosis in dermatology is primarily based on the assessment and description of the clinical appearance of the skin. The German medical literature focuses almost exclusively on white skin, so it is questionable whether this one-sided training is sufficient to do justice to all patients since the diversity of skin types increases.

Methods: Online survey among German dermatologists regarding training and experience in the diagnosis of dark skin, difficulties in recognizing dermatoses and the desire for training and further education in skin diseases of "skin of color".

Results: A total of 236 responses were received. 65 % of participants felt unsure to very unsure about recognizing skin conditions in people with dark skin. Training in the recognition of skin types IV-VI was rated as poor to very poor by 76 %, and 73 % rated the current literature on the diagnosis of dark skin as poor to very poor. 89 % reported that they have difficulties in diagnosing skin diseases in dark skin in their daily practice.

Conclusion: There is uncertainty among German dermatologists in the diagnosis of skin diseases in people with dark skin. This diagnostic uncertainty may lead to poorer treatment outcomes. More training opportunities should be offered to improve skills in the diagnosis and treatment of skin diseases in skin of color and the associated care.

Background: Telemedicine applications are perceived as having great potential to address regional health service deficits. However, it is unclear to what extent telemedicine can actually contribute to ensuring care in medically underserved regions. The aim of this study is to prospectively identify underserved regions and to investigate the potential of telemedicine applications using teledermatology as an example.

Methods: Well-served regions were identified using selected indicators. Points were awarded for each indicator and added up to form two scores. The results were analyzed for spatial autocorrelation (Moran's I), and visualized as a bivariate choropleth map. Data on broadband availability (BMVI) and descriptive statistics (Spearman's Rho, Beeswarm plots) were used to analyze the potential for telemedicine applications. All analyses were carried out at county level.

Results: Out of 401 counties, 159 can be classified as vulnerable because of their supply situation. They are mainly located in the north-west part of Germany. Locally, there are infrastructure deficits, i. e. insufficient bandwidth for telemedicine applications. Spearman's Rho shows negative correlations between broadband availability and the scores obtained (ρ: -0.654/-0.229, p < 0.001).

Conclusions: The results indicate a consolidation of regional disparities. If the identified regions are inhabited by patients with limited mobility and by socially disadvantaged patients, there is a risk of "double gaps in care". In the context of an increasing demand and workload, barriers to telemedicine should be removed, especially in the identified areas, and alternative care models should be implemented.