Gesundheitswesen最新文献

Compared to the general population, individuals with Down syndrome carry a much higher genetic risk of developing early onset Alzheimer's dementia. This leads to unique challenges and the need for a targeted patient journey.In a qualitative interview study with medical professionals, patient organisations and formal and informal care persons, we assessed barriers within the medical care process of this patient group as well as current approaches to overcome these problems. The study is one module of a multi-method project founded by the Innovation Fund of the German Joint Commission. The results presented here focus on access to and transitions within the medical care process. 14 guided interviews were conducted by a team of moderators by video conference, recorded and transcribed. The analysis of the results was carried out as a qualitative content analysis based on the methods of Mayring.Given the varying degree of premorbid intellectual disability, difficulties recognizing dementia symptoms were reported leading to delays in initiating the diagnostic process. Limited knowledge of the special disease risk and symptom manifestation in routine medical care as well as the lack of specialized medical institutions were identified as additional hurdles. Insufficient dissemination of information about existing specialised institutions to regular physicians and caregivers was criticized. All stakeholder groups drew attention to limitations in access to occupational and speech therapy because of the inadequate number of specialized therapists. Improvements suggested by the interview partners focussed on topics such as the implementation of guidance of the patient journey to and within the medical care process by one institution, easily accessible information for patients and caregivers as well as optimised training for physicians in routine care.Barriers such as insufficient availability of specialised service providers and information deficits about the specific disease risks and symptoms of the population have also been identified in international literatur; in addition, management and coordination deficits in the fragmented German health care system represent well known additional barriers. Approaches to improve the situation can be seen, on the one hand, in improved information and training offers for caregivers and service providers, and, on the other hand, in the expansion of the range of specialized service providers, in particular the Medical Centres for Adults with Disabilities. Informed by these study results and the results of other project modules, health policy recommendations for the improvement of the patient journey of patients with Down syndrome and dementia will be developed in the last project module.

The number of dental care centers (ZMVZ) in Germany has been increasing rapidly since 2015. This new form of practice is being discussed critically, especially when run by investors. This study analyzes the opinions and attitudes towards ZMVZ of dentists practicing in Germany, focusing on age and gender differences in dentists' attitudes as well as different aspects of working for a ZMVZ.A total of 937 dentists throughout Germany (63% female, aged 23 to 77 years) were asked in an online survey via the LimeSurvey platform conducted in 2021/2022 about their attitudes towards ZMVZ, readiness to work in one of them and whether there was a basic willingness to change their workplace; 575 of these questionnaires were available for analysis.The critical view of ZMVZ, especially management by investors, was shared by most of the respondents. There were differences between the age groups. Younger respondents were more in favor of management by specialist colleagues, while older respondents had a more positive attitude towards investor-run ZMVZ. The oldest respondents also tended to agree with the statement that the ZMVZ would replace the traditional practice. In general, practitioners feared that they would not be able to practice freely. However, one-third of the surveyed dentists who were considering a job change could imagine working in a ZMVZ.This study provides an insight into the attitudes of practicing dentists towards ZMVZ as well as their willingness to work in one. Since the ZMVZ are becoming increasingly important, while at the same time are subject to debate, the present overview of the advantages and disadvantages from the perspective of those working in practice should help in clarifying the issues involved. They also demonstrate that, despite all the criticism, there are positive aspects, and a significant proportion of those surveyed could imagine working in a ZMVZ. Since the ZMVZ have become a relevant part of the dental care system, it is important to identify problems and potential areas for development in order to improve care of dental patients.

As digitization progresses, citizens, patients and providers increasingly encounter digital or hybrid prevention or care services and digitally supported health information. Under these circumstances, electronic health literacy (eHL) as an extension of health literacy (HL) is a crucial skill that entails searching, finding, understanding, evaluating and applying health information based on digital sources when encountering challenges to health. There are currently multiple definitions that do not take into account newer digital applications in particular. The aim of part I of this article by the members of the Digital Health working group of the German Network for Health Services Research (DNVF) is to derive a working definition of eHL which is founded on known definitions of (e-)health literacy and on dimensions of relevant framework models and theories. Particular attention is paid to the delimitation and similarities between HL and eHL. Also, this article looks at the operationalization of eHL in the context of internationally proven approaches. Here, eHL is viewed as a relational construct that can be approached via multidimensional operationalization at the individual, interaction-related and system levels.

Not all individuals or population groups can participate equally in digital transformation due to varying levels of (e)HL and their socioeconomic conditions. This disparity is known as the "digital divide." A lower socioeconomic status and older age appear to be associated with lower eHL. In the interest of reducing health inequalities, targeted efforts to promote dGK among disadvantaged groups should be pursued. This paper by the members of the working group Digital Health of the German Network for Health Services Research (Deutsches Netzwerk Versorgungsforschung e.V. (DNVF)) therefore addresses the importance of eHealth Literacy (eHL) for health services research and practice in Germany, with an emphasis on measures to enhance eHL. Building on a theory-based definition of eHL established in the first publication (Relevance of eHealth Literacy (eHL) for health services research and practice - Part I), the current state of eHL in Germany and the effects of low eHL are examined. Guided by the Delphi study conducted by the DNVF working group Digital Health and the guidelines of the German Advisory Council on Health and Care (Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen und in der Pflege (SVR)), the digital divide is addressed and analyzed. Specific proposals for enhancing eHL are presented, with a focus on theory-driven interventions co-developed with users. Evaluation and implementation aspects of such interventions are also considered.

Palliative care aims to improve the quality of life for patients with potentially life-threatening illnesses and their families by early identification and treatment of physical, psychosocial, and spiritual suffering and symptoms. The aim of this study was to examine the impact of the hospital structural reform in North Rhine-Westphalia (NRW, 01.04.2025) on the accessibility of facilities offering specialized inpatient palliative care.Hospitals providing specialized inpatient palliative care were identified through the Palliative Care Registry and the §136b data submitted to the Joint Federal Committee (G-BA). The average weighted travel times to these facilities were calculated and compared with the future locations proposed under the NRW hospital structural reform in service group 29, "Palliative Care." Accessibility was correlated with socio-economic deprivation (German Index of Socioeconomic Deprivation, GISD) at the municipal level.A total of 162 hospitals in NRW offering specialized palliative care were identified. In 2022, the average weighted travel time to these hospitals was 11.4 minutes, with 53% of the population able to reach a hospital within 10 minutes and 97% within 30 minutes. No significant correlation was found between the accessibility of specialized inpatient palliative care facilities and socio-economic deprivation. Under the planned hospital structural reform, the average travel time is expected to increase to 12.2 minutes; 48% of the population will be able to reach a palliative care facility within just under 10 minutes, and 96% within 30 minutes.The results suggest that the planned reform will have only a marginal impact on the accessibility of specialized palliative care in NRW. Although average travel times are expected to increase slightly, access will still remain feasible for the majority of the population within a short timeframe.

The corona pandemic has exposed numerous existing weaknesses in the Public Health Service (PHS). This clearly pointed out that the PHS requires modernization. In the future scientific methods will become even more crucial within the PHS. The aim of this article, among other things, is to formulate a clear definition, of a municipal teaching and research health department (TRHD). We also desire to precisely define the scope of the tasks and the necessary requirements for the establishment and further development of a TRHD.On December 11, 2024, the Hanover Region hosted an inter-municipal conference including participants who also attended the conference remotely. Within the focus groups questions regarding our goals were adressed. Based on these results, an article was formulated and circulated among the participants. The authors agreed upon and accepted the final version of this paper on February 20, 2025.A municipal TRHD is defined as a health department that represents an innovative interface between practical efforts on the one hand and university-level teaching and research on the other hand. That means, its task is to combine the two. For example, it offers internships and electives during the last year of medical school. The qualification and further development of employees is another central concern. TRHD municipalities work together to ensure and control their own quality. The ideal prerequisite for a TRHD is contractual cooperation with an university medical faculty and various other faculties. Valuable here would be the establishment of "bridging professorships" and connecting the TRHD with the university as an affiliated institute. Ultimately, a TRHD requires a solid structural foundation in order to establish itself in the scientific field. This also includes connecting with a regionally important health department or a network of health departments.The development of a TRHD strengthens every local health department by developing local solutions and addressing the diversity of regional challenges. This will also increase diversity in the applied scientific approach. With a regionaly-oriented implementation the future of a TRHD will gain innovative strength and significantly greater self-sufficiency in scientific research. This will also prove to be indispensable for the wellbeing of our population in the future.

The study addresses the gap in rehabilitation care of people with cognitive and/or multiple Impairments. Conventional medical care structures are often insufficiently adapted to the needs of this patient group. In this project, the rehabilitative care gap is practically closed with a social space-oriented rehabilitation concept for people with cognitive and/or multiple Impairments and to create sustainable solutions. The challenges of needs-oriented rehabilitative care for IdmD and the solutions from the experimental pilot project are presented and discussed.This study was designed as a prospective, monocentric pilot study with an exploratory character. An interprofessional team systematically documented the challenges and inhibiting factors during the implementation and intervention phase in a laboratory book.A total of 15 people with different cognitive and/or multiple Impairments and contextual factors participated in the pilot study. Even during the preparation for the intervention phase, challenging structural aspects arose, particularly in resource and process planning. During the intervention phase, organizational challenges came to the fore, such as scheduling appointments with caregivers, coordinating transport services and managing room availability. Direct interactions with patients required spontaneity and improvisation to address individual behaviors and challenging situations effectively.The social environment-oriented rehabilitation concept shows that the heterogeneous needs of people with cognitive and/or multiple Impairments can be addressed individually and that participants can be successfully supported in achieving their participation goals. The social environment-oriented rehabilitation concept is practical to implement. It appears to be a promising development in the health care system in the context of demographic changes, increase in chronic illnesses, and increased use of outpatient medical treatment.

In 2019, the Digital Care Act introduced digital health applications as "apps on prescription" in the statutory health insurance. However, little is known about the knowledge and acceptance of digital care services for the treatment of depression among the affected patients. The aim of the present study was to gather information about knowledge, attitudes and intention to use of such services. An anonymous survey of people diagnosed with depression aged 18-70 was conducted. Patients were invited by their health insurer to participate in the study via mail. Data from 624 people were analysed. About half of the participants had acute depression according to PHQ-9 at the time of the survey. Only 28% of the respondents were already aware of digital possibilities for depression treatment. The picture regarding possible future use was heterogeneous. A third of participants could consider using digital services, around a quarter ruled this out. Possible fields of application were seen as an aftercare model, a digital technology to bridge waiting times or to supplement specialists-guided therapy. Digital offers as a replacement for personal therapies were rejected by the majority of the participants. Quality control and a prescription by the practitioner appear to be particularly important. The study provides relevant findings regarding the premises and the context in which digital care services have the potential to be successfully established in routine care.

The scope and definition of health care research is a matter of discussion in our scientific community. The Board of the German Network for Health Care Research has drafted a position paper that was extensively reviewed and commented upon by all working groups and specialist groups of the network. The present version represents consented common grounds to a large degree but is neither complete nor final. We consider this position paper a living document that will evolve and further converge in an ongoing discussion in the network.

The care of patients suffering from post-COVID presents general practitioners with a number of challenges in terms of diagnosis and treatment, as well as in the coordination of further care options at various levels (primary care, specialist care and maximum care, e. g., at university hospitals). Cooperation between general practitioners and specialist providers is of particular importance for complex conditions such as post-COVID. In the ViCoReK project, general practitioners and their patients have the option of receiving telemedical advice from an interdisciplinary team comprising staff from a university hospital. The study's was to identify the factors that influence general practitioners' participation in the project.The study, conducted in February and April 2024, utilized two focus groups, namely general practitioners who had and those who had not utilized consultation opportunities within the ViCoReK project. The focus groups were subjected to qualitative content analysis.The results of the 93- and 102-minute focus groups with 13 general practitioners and one physician assistant showed that only a small number of severely affected patients with post-COVID were currently being treated in the respondents' practices. Caring for these patients was time-consuming and put pressure on general practitioners, as the currently available treatment options were experienced as only partially helpful. The personal dedication of general practitioners encouraged participation in the project: The general practitioners expressed a desire to exchange ideas with experts on the subject of post-COVID and were committed to incorporating digital technologies into their practices. The most significant barriers to their participation were challenges related to the digitalization of their practices, inadequate reimbursement options, and lack of time.Despite a willingness to utilise telemedical post-COVID services for networking with specialist outpatient clinics, general practitioners encounter significant barriers to their implementation at the structural level, including technical, financial and temporal constraints. To address these challenges, the development of digital services to support post-COVID care must be guided by principles of accessibility and pragmatism, ensuring their feasibility in general practices, even in the context of limited time.