Zeitschrift fur Evidenz Fortbildung und Qualitaet im Gesundheitswesen最新文献

Introduction: Collaboration between general practitioners (GPs) and specialist providers is of particular importance in the care of patients with post-acute COVID-19 syndrome. In the ViCoReK project, GPs and their patients had the option of receiving telemedical advice on rehabilitative care, self-management, and psychosocial support from a medical team consisting of members of the departments of rehabilitation medicine and general medicine of a university hospital. In this study, the project was evaluated in terms of its utilization, participant characteristics, added value for GPs, and patient satisfaction.

Method: In the quantitative evaluation, the number of ViCoReK consultations was counted, and questionnaire data from GPs and patients on their health and experiences with the consultation were analyzed descriptively.

Results: Between 09/2023 and 10/2024, 218 ViCoReK consultations took place. Data from 118 patient and 104 GP questionnaires were analyzed. GPs registered patients with a high bio-psycho-social burden and previously unsuccessful treatments to the project, while also appreciating the opportunity to reduce their own workload. The project provided GPs with new insights into treatment options. However, at the time of data collection, 56 % of patients had not yet or only partially implemented the recommended measures, which was, e.g., due to difficulties in scheduling appointments for recommended follow-up treatments.

Discussion: The project's goal was achieved in that GPs managed to receive support with the care for patients suffering from complex cases of post-COVID. This suggests that projects promoting telemedicine collaboration between GPs and universities on the topic of post-COVID should be supported. These projects should also provide practical solutions for patients to bridge existing gaps in care.

Background: Thyroid nodules are commonly discovered incidentally during routine examinations in general practice, which often leads to extensive diagnostics and overtreatment. To provide general practitioners (GPs) with evidence-based guidance on the diagnosis and management of thyroid nodules, the S3 guideline "Thyroid Nodules in Adults" by the German Society for General and Family Medicine (DEGAM) was developed in three versions: a short, a long, and a patient leaflet format. An assessment of the effectiveness of the guideline in general practice was undertaken.

Methods: We ran a practice test in 17 general practices, yielding data from 17 GPs and 94 patients. Quantitative data were collected using documentation forms and questionnaires for GPs and patients. Two semi-structured online workshops provided qualitative data. Data were analyzed using descriptive statistics and qualitative content analysis.

Results: About 50 % of GPs reported modifying their diagnostic methods, while therapy adjustments were reported in 21 % of the consultations. The patient leaflet received positive feedback from patients and GPs, but both groups requested more detailed content. The workshops revealed challenges, including limited consultation time, difficulties in explaining extended follow-up intervals to patients, and differences in approaches between primary care and specialist services.

Discussion: The guideline proved applicable in practice. The feedback served ongoing improvements, including plans for supportive tools like conversation guides, case examples, and training materials.

Conclusion: The practice test showed the level of guideline comprehensibility and acceptance in general practice, highlighting areas of improvement. These include clearer communication with patients, interprofessional alignment and modification of materials according to patient requirements.

Background: With the increasing use of digital services in rehabilitation, there is a need to prepare therapists and patients for using them in the best possible way. Quality-assured training concepts can contribute to improving the quality of care of digital services. This study aimed to identify requirements for developing and implementing training courses in telerehabilitation aftercare.

Methods: In January 2024, two World Cafés regarding training for patients and therapists were held. They took place online with patients, therapists, physicians, and software manufacturers. Kuckartz's structuring content analysis was based on the dimensions of concept, structural, process, and outcome quality.

Results: Fourteen people participated in each of the two World Cafés. To ensure concept quality, the participants recommended not only imparting knowledge about the process, effectiveness, and relevance, but also practical testing of the digital tools - for example, through accompanied training for patients during their rehabilitation stay or work shadowing for therapists. Regarding structural quality, qualified training staff and suitable spatial, technical, and financial resources were considered necessary. To achieve high process quality, the interviewees stated that not only the persons involved in aftercare, but all clinic staff and all rehabilitation patients should be informed. Training processes should be standardized, for example, through checklists for therapist onboarding or through the mandatory inclusion of the aftercare decision in the rehabilitation discharge consultation with patients. Adequately designed training courses can help reduce prejudices against digital services, increase acceptance and thus promote a high outcome quality of training courses.

Discussion: The content analysis resulted in a catalog including 14 requirement areas along the four quality dimensions, which supports the needs-oriented, structured design and implementation of future training courses in telerehabilitation aftercare.