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Background: Family practice is an important setting for health promotion and prevention in Germany. However, there is a research gap regarding the involvement of nonmedical practice staff in health promotion. Therefore, our aim is to gain an indepth understanding of the role health care assistants (HCAs) can play regarding health promotion in family practice. Methods: We conducted 21 qualitative semi-structured interviews via telephone with 14 physicians and 7 HCAs, inquiring both professional groups about the role of HCAs concerning health promotion in their practice. The interviews were evaluated separately for both professions using thematic analysis. Results: In addition to organizational tasks such as making an appointment and communicating with physicians, HCAsmainly take on a key function as the first contact person in all practices: They recognize preventive needs, select eligible patients early at the reception and actively address them about preventive services. In some practices, HCAs carry out health-promoting measures such as training courses. However, with regard to further delegation of tasks, physicians in particular expressed concerns as they did not want to overburden HCAs. Conclusions: HCAs often take on organizational activities with regard to health promotion in family practice, but due to their function in the practice structure, they can also shape the practice as a health-promoting setting for patients. In addition, HCAs navigate patients with regard to preventive and health-promoting services. In accordance with their key role as initial contact, it should be worked out together with HCAs how health promotion can be addressed in a structured way at first contact. [ABSTRACT FROM AUTHOR]

Background: As the first point of contact for patients with health issues, general practitioners (GPs) are frequently confronted with patients presenting with non-specific symptoms of unclear origin. This can result in delayed, prolonged or false diagnoses. To accelerate and improve the diagnosis of diseases, clinical decision support systems would appear to be an appropriate tool. The objective of the project 'Smart physician portal for patients with unclear disease' (SATURN) is to employ a user-centered design process based on the requirements analysis presented in this paper to develop an artificial Intelligence (AI)-based diagnosis support system that specifically addresses the needs of German GPs. Methods: Requirements analysis for a GP-specific diagnosis support system was conducted in an iterative process with five GPs. First, interviews were conducted to analyze current workflows and the use of digital applications in cases of diagnostic uncertainty (as-is situation). Second, we focused on collecting and prioritizing tasks to be performed by an ideal smart physician portal (to-be situation) in a workshop. We then developed a task model with corresponding user requirements. Results: Numerous GP-specific user requirements were identified concerning the tasks and subtasks: performing data entry (open system, enter patient data), reviewing results (receiving and evaluating results), discussing results (with patients and colleagues), scheduling further diagnostic procedures, referring to specialists (select, contact, make appointments), and case closure. Suggested features particularly concerned the process of screening and assessing results: e.g., the system should focus more on atypical patterns of common diseases than on rare diseases only, display probabilities of differential diagnoses, ensure sources and results are transparent, and mark diagnoses that have already been ruled out. Moreover, establishing a means of using the platform to communicate with colleagues and transferring patient data directly from electronic patient records to the system was strongly recommended. Conclusions: Essential user requirements to be considered in the development and design of a diagnosis system for primary care could be derived from the analysis. They form the basis for mockup-development and system engineering. [ABSTRACT FROM AUTHOR]

General practices are rooted in the local community and considered to be particularly well‐positioned for engaging in preventive and health‐promoting activities. The overall aim of the scoping review is to identify priorities and gaps in research published in the past 20 years on preventive and health‐promoting activities provided by general practitioners or their teams in general practices in Germany. MEDLINE and Embase databases were systematically searched in November 2020. Papers were selected in dual‐review mode and extracted in single‐review mode. Data analysis was finished by May 2021. In total, 530 papers were included in the synthesis. Little research has been carried out into collaboration opportunities both within the general practice team and in communities as a whole, with specialists (18%), hospitals (9%), and health insurance companies (6%) being the most frequent cooperation partners of GPs. 15%–20% of papers each dealt with 'early detection', 'information provision' and 'cardiovascular prevention'. Secondary (53%) and tertiary prevention (43%) was more often the subject of research than primary (39%) and quaternary prevention (15%). Healthy subjects (26%) were less often studied than people with pre‐existing conditions (42%) and risk factors (48%). Little information was available on preventive activities in terms of gender, young people, migration background, housing conditions or educational background. Personal counselling (15%) was the most frequently described approach to health promotion in general practices, along with printed information materials (10%). This scoping review provides information on which to base targeted interventions and future research that can contribute towards transforming general practices into promoters of health within the community. [ABSTRACT FROM AUTHOR]

Background: Error management plays a key role in patient safety. It is a systematic approach aimed at identifying and learning from critical incidents by reporting, documenting and analyzing them. Almost nothing is known about the incidents physicians in outpatient care consider to be critical and how they deal with them. We carried out an interview study to explore outpatient physicians' views on error management, discover what they regard as critical incidents, and find out how error management is put into practice in ambulatory care. Methods: We conducted 72 semi-structured interviews with physicians from ambulatory practices. We asked participants what they considered to be a critical incident, how they reacted following an incident, how they discussed incidents with their coworkers, and whether they used critical incident reporting systems. The interviews were transcribed verbatim and analyzed using qualitative content analysis. Results: Interviewed physicians defined the term "critical incident" differently. Most participants reported that they recorded information on incidents and discussed them in their teams. Several physicians reported taking a 'pay better attention next time-approach' to the analysis of incidents. Systematic error management involving incident documentation, analysis, preventive measure development, and follow-up, was the exception. Conclusions: To promote error management, medical training should include teaching on the topic, so that medical professionals can learn about critical incidents and how to deal with them in an open and structured manner. This would help establish the culture of safety that has long been called for internationally. [ABSTRACT FROM AUTHOR]

Objective: At the Medical Faculty of the Goethe University Frankfurt am Main, the elective course "climate change and health" was offered to students in the clinical phase of their medical studies for the first time in the winter semester 2021/22 (any unfilled places were made available to interested students studying other subjects). Despite attracting considerable attention, this topic has not yet been incorporated into the curriculum of medical studies. Our aim was therefore to teach students about climate change and discuss its effects on human health. The students evaluated the elective in terms of various factors relating to knowledge, attitudes and behavior. Project description: The elective focused on the concept of Planetary Health, with an emphasis on the health consequences of climate change, as well as possibilities for action and adaptation in clinical and practical settings. The course took place in three live, online sessions (with inputs, discussion, case studies and work in small groups), as well as online preparation and a final written assignment for which students were asked to reflect on the subject. The standardized teaching evaluation questionnaire (=didactic dimension) of Goethe University was used online to evaluate the elective, whereby the questionnaire was extended to include the measurement of changes in students' agreement with items (dimensions) relating to knowledge, attitudes and behavior (personal behavior and behavior as physicians) before and after the course (pre/post comparison). Results: Students expressed high levels of satisfaction with the course content, the presentation of the course, and the organization of the elective. This was reflected in very good to good overall ratings. The pre/post comparisons further showed a significant, positive shift in agreement ratings in almost all dimensions. The majority of respondents also wanted the topic to be firmly embedded in the medical curriculum. Conclusion: The evaluation shows that with respect to the impact of climate change on human health, the elective course had a clear influence on the knowledge, attitudes, and behaviors of the students. In view of the relevance of the topic, it is therefore important that this subject is included in medical curricula in the future. [ABSTRACT FROM AUTHOR]

Background: Such patient-reported outcome measures (PROMs) and patient-centered outcome measures as the Integrated Palliative Care Outcome Scale (IPOS), Phase of Illness, and IPOS Views on Care (IPOS VoC), facilitate patient-centered care and help improve quality. To ensure sustainability, implementation and usage should be adapted according to setting. When settings involve several distinct teams that differ in terms of views and working practices, it is more difficult to integrate outcome measures into daily care. The ELSAH study aimed to learn how health professionals working in specialized outpatient palliative care (SOPC) viewed the use of these outcome measures in daily care, and what they express is needed for successful sustainable, state-wide application. Methods: We used a parallel mixed-methods design involving three focus groups (n = 14) and an online-survey based on normalization process theory (n = 76). Most participants were nurses and physicians from 19 SOPC-teams in Hesse, Germany. We used a triangulation protocol including convergence coding matrices to triangulate findings. Results: The majority of health professionals were able to integrate the outcome measures into their working lives and said that it had become a normal part of their day-to-day work. To ensure their sustainable integration into daily care, the motivation and concerns of health professionals should be taken into consideration. Health professionals must clearly recognize how the measures help improve daily care and quality evaluation. Conclusions: To implement the outcome measures in a number of teams, it will be necessary to take individual team characteristics into account, because they influence motivation and concerncs. Further, it will be necessary to offer opportunities for them to engage in peer support and share information with other teams. The sustainable use of outcome measures in SOPC will require continuous support within each team as well as across teams. When several distinct teams are working in the same setting, a cross-team coordination unit can help to coordinate their work efficiently. Trial registration: German Clinical Trials Register DRKS-ID: DRKS00012421; [ABSTRACT FROM AUTHOR]

Background: The use of patient-reported outcome measures (PROM) and caregiver-reported outcome measures can raise the patient centeredness of treatment and improve the quality of palliative care. Nevertheless, the everyday implementation of self-report in patients and caregivers is complex, and should be adapted for use in specific settings. We aimed to implement a set of outcome measures that included patient and caregiver self- and proxy-reported outcome measures in specialised outpatient palliative care (SOPC). In this study, we explore how the Integrated Palliative Outcome Scale (IPOS), IPOS Views on Care (IPOS VoC) and the Short-form Zarit Caregiver Burden Interview (ZBI-7) can be feasibly, acceptably and appropriately implemented in the daily care routines of SOPC. Methods: Five SOPC teams were trained, and used the outcome measures in daily practice. Team members were mainly nurses and physicians. To investigate their feedback, we used a multi-method qualitative design consisting of focus groups with SOPC-team members (n = 14), field notes of meetings and conversations with the SOPC teams. In an iterative process, we analysed the findings using qualitative content analysis and refined use of the outcome measures. Results: We found that integrating patient and caregiver outcome measures into daily care routines in SOPC is feasible. To improve feasibility, acceptability and appropriateness, the resulting burden on patients and relatives should be kept to a minimum, the usefulness of the measures must be understood, they should be used considerately, and administration must be manageable. We removed ZBI-7 from the set of measures as a result of feedback on its content and wording. Conclusions: SOPC-team members have reservations about the implementation of PROM in SOPC, but with appropriate adjustments, its application in daily care is feasible, accepted and perceived as appropriate. Previous to use, SOPC-team members should be trained in how to apply the measures, in the design of manageable processes that include integration into electronic documentation systems, and in ongoing evaluation and support. They should also be taught how useful the measures can be. Trial registration: May 19th, 2017, German Clinical Trials Register DRKS-ID: DRKS00012421. [ABSTRACT FROM AUTHOR]

Background: Specialised palliative home-care supports patients with life-limiting diseases in their familiar surroundings. The number of palliative care teams and patients being cared for is increasing worldwide. To assess and improve quality, it is needed to understand, how specialised palliative home-care can be provided successfully. For this purpose we examined the views of all involved stakeholders. Aim: To identify the issues that patients, their relatives and involved health professionals view as important in ensuring the success of specialised palliative home-care. Design: We used a qualitative design based on participant observations, interviews and focus groups following the principles of a Grounded Theory approach. Setting/participants: All specialised palliative home-care teams (n = 22) caring for adults in Hesse, Germany, participated. We conducted participant observations (n = 5), and interviewed patients (n = 14), relatives (n = 14) and health professionals working in or collaborating with specialised palliative home-care (n = 30). We also conducted focus groups (n = 4) with health professionals including a member check. Results: Successful specialised palliative home-care needs to treat complex symptoms, and provide comprehensive care including organisation of care, involving relatives and addressing issues of death and dying. Sense of security for patients and relatives is key to enable care at home. Care delivery preferences include a focus on the quality of relationships, respect for individuality and the facilitation of self-determination. Conclusions: Consideration of the identified key issues can help to ensure successful specialised palliative home-care. Knowledge of these should also be considered when researching and assessing quality of care. Trial registration: German Clinical Trials Register DRKS-ID: DRKS00012421; http://www.germanctr.de. [ABSTRACT FROM AUTHOR]