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Aim: To date, there are only a few studies analyzing health professionals' health literacy (HL). Mostly, the focus has been on personal rather than professional HL. To bridge this gap, a new concept and an associated survey instrument have been developed in a three-country consortium. The aim of this article was to examine the professional HL of general practitioners (GPs) in Germany.

Method: The survey instrument used consists of 34 items and assesses subjective difficulties in four dimensions to be addressed in promoting patients' HL: "information and knowledge management", "conveying information and knowledge", "patient-centred communication", "professional digital HL". A total of 297 GPs and internists working in general practice were surveyed online over the summer of 2022. The professional HL (score from 0 to 100) was analyzed descriptively and examined in relation to gender, selected job-related, and organizational characteristics, using multiple linear regression.

Results: Depending on the four areas, GPs achieved approximately half to almost three-quarters of the highest possible score. The dimension "patient-centred communication" was perceived as the easiest, followed by "information and knowledge management", and "conveying information and knowledge". The most challenging dimension was "professional digital HL". According to the multivariate analysis, professional HL shows a relation to gender, organizational framework and training conditions, job duration, and coping with the diversity of digital information. The strength of correlation varies by area and is rather weak in some instances.

Conclusions: The results demonstrate the importance of promoting professional HL of GPs and provide numerous indications of where to start. They also indicate that the regression models should be extended by additional determinants, since the included variables can explain only a small amount of variance.

Background: Saxony-Anhalt has the highest old-age dependency ratio among the German federal states. The proportion of long-term care-dependent people can be expected to increase in the future, given the aging of the population. The SARS-CoV-2 pandemic has influenced nursing care, reduced the utilisation of services and led to changes in care arrangements. The aim of this study was to analyse the development of long-term care-dependency in Saxony-Anhalt, Germany, taking into account the legal changes, the pandemic and the development after the lifting of the contact ban.

Method: The analysis uses aggregated and anonymised health claims data from people insured with AOK Saxony-Anhalt from 2017 to 2022 in need of long-term care. Changes over time in the use of various care services were analysed.

Results: In 2017, 64,591 people insured in the statutory health insurance AOK Saxony-Anhalt (AOK ST) were in need of long-term care. The prevalence increased continuously throughout the observation years. For the lowest level of care (minor impairment of independence), the most significant and strongest increase was recorded in the first years after its introduction from 2017-2019. The majority of people in need of long-term care (41-44%) were in the category of care level 2 (considerable impairment of independence). Overall, the proportion of cash benefits has risen steadily since 2017, from 40.5% to 50.3% in 2022. At the same time, the proportion of long-term care in nursing homes decreased at all care levels. The trend toward less nursing home care has become stronger since 2017 and particularly since the onset of the SARS-CoV-2 pandemic in 2020.

Conclusion: Since the introduction of the new definition of the need for long-term care in Germany, the analysis shows an increase in the number of people in need of long-term care, with those with considerable impairment of independence making up the largest proportion. There has been a significant increase in the number of people receiving cash benefits and a decline in nursing home care. Compared to the nationwide data of health claims, data show a greater use of nursing services in home-based arrangements. The analysis during the COVID-19 pandemic shows a trend towards home care, but no fundamental change. Special situations such as contact restrictions may have influenced the use of care services. Future research should examine the design of home care arrangements and the needs of those affected in greater detail.

Background: The principle of "rehabilitation before care" is a principle of social law. The recommendation of the Medical Service (MD) as part of the assessment (§ 31 SGB XI) plays an important role in rehabilitation recommendations. In around 3% of its assessments, the MD recommends implementation of rehabilitation. Only every fourth to fifth recommendation is actually carried out. The aim of the study was to find out if rehabilitation recommendations are utilized and exploited.

Materials and methods: This study aimed to examine the perspective of insured persons whose recommended rehabilitation was actually carried out. After evaluating 586,228 routine data records with care assessments by the MD, 1,972 survey questionnaires were sent out in March 2023, and 1,116 analyzable questionnaires were included in the data analysis. In seven questions, the respondents were asked to retrospectively assess the overall success and satisfaction with rehabilitation procedures carried out.

Results: The evaluation of the results showed that 87% of the study participants would be ready to undergo repeat rehabilitation. The assessment of the success of rehabilitation in terms of remaining at home for a longer period of time also carried weight. On the other hand, only around 10% of rehabilitation was carried out on an outpatient basis.

Conclusions: One previously assumed reason for the low rate of patients taking advantage of recommended rehabilitation was that those in need of care had already received rehabilitation in the previous year. In this study focussing on whether recommended rehabilitation is taken advantage of, this assumption was found not to be correct. The question needs to be raised whether the strong focus in Germany on inpatient rehabilitation is up-to-date, both medically and with regard to the preferences of those entitled to rehabilitation. In contrast to inpatient rehabilitation, individual, outpatient and, if necessary, mobile rehabilitation offers might be more suitable, and these would also take into consideration issues of individual mobility and patient autonomy. The offer of different modes of rehabilitation also enables meeting the wish of those patients who prefer to have rehabilitation carried out in a home environment.

Background: Heatwaves might diminish the sense of well-being and are associated with increased mortality. Individual measures to protect against heat are often insufficient, with the perception of one's own risk playing a crucial role. Due to varying levels of vulnerability, it is expected that the perception differs among populations. Presumably, symptom awareness is higher when people are concerned with and inform themselves about the topic of heat. Our study examined subjective health impairment during the heatwave in 2022, its association with socio-demographic and economic factors, as well as perceived heat stress and individual engagement with the issue.

Method: An online survey of a population-based sample from five federal states of Germany was carried out. Multivariable regression analyses were conducted to explore the relationship between subjective health impairment due to heat and potential risk indicators.

Results: Out of 3,111 people contacted, 1,522 responded, with 649 (20.9%) included in the analysis as they were affected by heat in their region of residence during the summer of 2022. The average subjective health impairment was 9.29 (SD: 5.25) out of 29 possible points. Higher age was associated with lower impairment; -1.36 points (95%-CI: -4.10; 1.38) in the group of those aged 80 and compared with the reference group of 60 to 69-year-old people. Furthermore, higher impairment was reported more by women and individuals with lower educational levels. Low impairment was associated with a high perceived level of information.

Conclusion: Interventions aimed at reducing heat-related health problems should target a broader audience, particularly young people, women, individuals with lower education, and working people.

The effect of service concentration on outcome quality of inpatient services in the hospital sector is debated, and is particularly important in the field of obstetrics. The aim of this article was to investigate the influence of volume-outcome factors and competitive economic parameters on the quality of outcomes in obstetric departments of German hospitals. In this study, structural and performance data on 412 German hospitals in 2021 were analyzed with a quantitative research approach. To test the hypotheses, a polynomial multiple regression model with a total of eleven independent variables was estimated. Newborn mortality was used as an indicator of outcome quality in obstetrics departments. Contrary to expectations, the competitive economic parameters that are important for births play a rather subordinate role, while strong empirical evidence was found for volume-outcome relationships. The results of this study suggest that positive quality effects of service concentrations also predominate in the field of obstetrics and thus provide evidence in support of the forthcoming hospital reform in Germany.

In the early phase of the COVID-19 pandemic, many local collections of clinical data on patients infected with SARS-CoV-2 were initiated in Germany. As part of the National Pandemic Cohort Network (NAPKON) of the University Medicine Network, the "Integration Core" was established to design the legal, technical and organisational requirements for the integration of inventory data into ongoing prospective data collections and to test the feasibility of the newly developed solutions using use cases (UCs). Detailed study documents of the data collections were obtained. After structured document analysis, a review board evaluated the integrability of the data in NAPKON according to defined criteria. Of 30 university hospitals contacted, 20 responded to the request. Patient information and consent showed a heterogeneous picture with regard to the pseudonymised transfer of data to third parties and re-contact. The majority of the data collections (n=13) met the criteria for integration into NAPKON; four studies would require adjustments to the regulatory documents. Three cohorts were not suitable for inclusion in NAPKON. The legal framework for retrospective data integration and consent-free data use via research clauses (§27 BDSG) was elaborated by a legal opinion by TMF - Technology, Methods and Infrastructure for Networked Medical Research, Berlin. Two UCs selected by the NAPKON steering committee (CORKUM, LMU Munich; Pa-COVID-19, Charité- Universitätsmedizin Berlin) were used to demonstrate the feasibility of data integration in NAPKON by the end of 2021. Quality assurance and performance-based reimbursement of the cases were carried out according to the specifications. Based on the results, recommendations can be formulated for various contexts in order to create technical-operational prerequisites such as interoperability, interfaces and data models for data integration and to fulfil regulatory requirements on ethics, data protection, medical confidentiality and data access when integrating existing cohort data. The possible integration of data into research networks and their secondary use should be taken into account as early as the planning phase of a study - particularly with regard to informed consent - in order to maximise the benefits of the data collected.

Background: Health Services Research (HSR) is a growing field in Germany, in which Organisational Health Services Research (OHSR) has emerged as a subfield. The aim of this scoping review was to provide an overview of the field of OHSR within HSR in Germany and to map systematically original contributions by describing the organisational setting, the research design, the research objectives and the theoretical underpinning.

Methods: A scoping review examined published abstracts from the 19th German Conference on Health Services Research 2020. Abstracts were included if (1) health care organisations, subunits or organisational processes were mentioned as research objects, and (2) if at least one out of five research perspectives from a recent German definition of OHSR was addressed. After intensive pilot screenings within a group of nine researchers, all abstracts were screened independently in three review teams with three researchers each, and data from included abstracts were extracted using content analysis based on a self-developed detailed coding scheme.

Results: Out of n=468 identified abstracts in German (84%) or English (16%) language, n=138 (29.5%) abstracts were included. The majority of included abstracts addressed acute care in hospitals (34.8%), reported results from observational studies (59.4%) and collected primary data (69.6%). There was a slightly higher use of quantitative (32.6%) than qualitative (24.6%) research methods with a considerable number of studies using more than one method (31.9%). An explicit reference to theory was made in 7.2% and 17.4% used the term 'organisation' or related terms explicitly in their abstract.

Discussion: This review provides a systematic but preliminary overview of the scope to which HSR in Germany addresses OHSR. The organisational perspective is considered extensively in HSR abstracts, but mostly implicitly. The research is reported largely free of theory which can reduce their explanatory power. Therefore, a research agenda, more awareness as well as education and better conceptualisation of OHSR topics within German HSR are needed.

Background: Children and adolescents are significantly tied to their family's socioeconomic position and living environment. Neighbourhood and the living environment have been identified as potential risk factors for mental disorders in this age group.

Aim of the study: The aim of the study was to investigate the distribution of mental and behavioural disorders (prevalence) and the provision of mental health services for children and adolescents aged 0-19 years in the city of Cologne. In particular, the study aimed to examine the association of these factors with area deprivation and the availability of mental health services covered by statutory health insurance. Finally, possible spatial variations in these aspects were analysed.

Method: Claims data of children and adolescents aged 0 to 19 years included in four statutory health insurance of the year 2021 were analysed. A deprivation index using data on the level of the ZIP code area was calculated. Analyses were carried out descriptively, using ordinary least squares (OLS) and geographically weighted regression (GWR).

Results: The prevalence of mental and behavioural disorders in children and adolescents varied across ZIP code areas, with higher rates in the northern, southern, and eastern parts of the city. The results indicated that the use of services by male children and adolescents with a prevalent diagnosis of mental and behavioural disorders was higher in areas with a higher density of healthcare providers. However, prevalence was on the whole lower in areas with a higher density of healthcare providers. In addition, the density of health care providers was higher in the city centre with comparatively lower deprivation.

Conclusion: These results indicate inadequate access to care for children and young people outside the city centre. However, due to the heterogeneity of the population in these areas, this study provides only preliminary insights. Data with a finer geographic resolution are needed for further research in order to analyse the association further.