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Hintergrund und Stand nationaler Forschung: Die ambulante spezialfachärztliche Versorgung (ASV) wurde mit dem Ziel eingeführt, eine hochqualifizierte, interdisziplinäre und sektorenübergreifende Behandlung für Patientinnen und Patienten mit seltenen oder komplexen Krankheiten [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Additional file 1. Codes MCA staff.

Additional file 2. Interview guide.

Additional file 1.

In the summer semester 2020, the module "People in different stages of life" in the Bachelor program "Interprofessional Health Care, B.Sc." had to be adapted to online teaching. The module exam, originally planned as an oral presentation, was presented by the students in interprofessional tandems as a video presentation using case studies. Based on cognitive and social constructivism, all students reflected on these video presentations using the "Think-Pair-Share” method. Similar to regular inverted classroom methods, knowledge transfer through the video presentations was asynchronous and cognitively constructive; accompanying discussion questions of the respective speakers were answered in writing by the fellow students (Think). The students met independently online in small groups on a regular basis to discuss the respective presentations and questions based on personal and professional experiences (Pair; socially constructed). In open online debriefings with the lecturers, the speakers and all interested students, relevant aspects were taken up and discussed again (Share). First experiences showed that the students enjoyed the production of the video presentations and that many of them voluntarily participated in the discussion rounds, in which aspects of health care beyond the presentations were discussed. Considering the experiences made, continuing online teaching in this format may be worthwhile for both lecturers and students., Im Rahmen der Umstellung auf Online-Lehre im Sommersemester 2020 wurde im Studiengang „Interprofessionelle Gesundheitsversorgung, B.Sc.“ das Modul „Menschen in verschiedenen Lebensphasen“ entsprechend angepasst. Die ursprünglich als Präsenzreferat geplante Prüfungsleistung wurde von den Student_innen in interprofessionellen Tandems als Videoreferat zu eigenen Fallbeispielen erbracht. Basierend auf kognitivem und sozialem Konstruktivismus wurden diese Videoreferate von allen Student_innen anhand der „Think-Pair-Share-Methode“ reflektiert. Die Wissensvermittlung anhand der Videoreferate fand, ähnlich wie in regulären inverted classroom Methoden, asynchron und kognitiv konstruierend statt; begleitende Diskussionsfragen der jeweiligen Referent_innen wurden von den Kommiliton_innen schriftlich beantwortet (Think). Die Student_innen trafen sich selbstständig online regelmäßig in Kleingruppen, um die jeweiligen Referate und Fragen basierend auf persönlichen und professionellen Erfahrungen zu diskutieren (Pair; sozial konstruiert). In einer offenen Online-Nachbesprechung mit den Dozentinnen, den Referent_innen und allen interessierten Student_innen wurden relevante Aspekte nochmals aufgegriffen und diskutiert (Share). Erste Erfahrungen zeigen, dass die Student_innen Freude an der Produktion der Videoreferate hatten und viele freiwillig an den Diskussionsrunden teilnahmen, in denen über die Referate hinausgehende Aspekte der Gesundheitsversorgung diskutiert wurden. Unter Berücksichtigung der gemachten Erfahrungen kann die Verstetigung dieses Formats gewinnbringend für Dozent_innen und Student_innen sein., GMS Journal for Medical Education; 37(7):Doc71

Background General Practitioners (GPs) are increasingly affected by stress-related complaints and burnout. Although many studies have addressed this issue, little is known about the stress burden and burnout rates of postgraduate trainees specialising in General Practice (GP). This cross-sectional study was performed to explore the prevalence and risk of depression, stress and burnout in a large cohort of GP trainees. Methods All GP trainees enrolled in the postgraduate training programme KWBW Verbundweiterbildung plus © in southwest Germany were invited to participate. A paper-based survey for the purpose of psychosocial screening was used: Prevalence of depression, perceived stress and burnout were measured with the depression module of the Patient Health Questionnaire (PHQ-9), Perceived Stress Questionnaire (PSQ-20) and Maslach Burnout Inventory (MBI). Additionally, linear regression models were used to analyse the association between sociodemographic characteristics and mental health scales. Results N = 211 GP trainees participated in this study (response rate 95%). 75.3% (n = 159) of the participants were female and median age was 34 (IQR 32; 39). GP trainees had a mean PHQ-9 sum score of 5.4 (SD 3.4). Almost 11% (n = 23) reported symptoms of a moderate or moderately severe depression. PSQ-20 revealed moderate level of distress, whereas 20.8% (n = 42) showed a high level of perceived stress with a sum-score higher than .59. GP trainees showed moderate rates of burnout and only 2.5% (n = 5) scored high in all three dimensions of the MBI score. GP trainees showed increased levels of depression, perceived stress and burnout when compared with age-matched general population. Being a woman led to a higher PHQ-9 sum score (p

Additional file 1. Checklist milestone conversations: quantitative developed checklist for the analysis of the MCs.

Additional file 1.

Additional file 1.

Additional file 2. Checklist for follow-up calls: quantitative developed checklist for the analysis of follow-up calls.

Additional file 3. Relevant term definitions MCs: Contains the definition of relevant terms from the checklist of MCs and explains them using a suitable example.

Additional file 4. Relevant term definitions Follow-up calls: Contains the definition of relevant terms from the checklist of Follow-up calls and explains them using a suitable example.

Background The number of patients with chronic illness is increasing worldwide. These patients usually receive care from a primary care facility. The Patient Assessment of Chronic Illness Care (PACIC) is a tool that is increasingly used in several countries to measure how the patients perceive the care they receive. The goal of this validation study is to provide and validate an extended version of the tool, the PACIC+ questionnaire, in Thailand. Methods In this observational validation study, patients with type 2 diabetes from the outpatient clinic at a university hospital in Thailand completed the PACIC+ at the clinic. For follow-up, they received the questionnaire per mail after four weeks. The Thai PACIC+ comprises 26 items, which map onto 5 subscales and a summary score related to the Chronic Care Model (CCM) and 5 subscales and a summary score related to the 5A model, a counseling model for behavioral changes. Data-analysis focused on the use of most extreme answering categories (> 15%), internal consistency (Cronbach’s alpha), and test-retest reliability. An exploratory factor analysis (EFA) was performed for the CCM and the 5A model separately to examine the factor structure. Results A total of 151 patients participated. The average age of the sample was 63 ± 9 years (range 29–86 years). Fifty-three percent of the respondents were female. In the Delivery System subscale, 20% of patients reported the highest possible value; in all other subscales, relative frequencies of the most extreme categories did not exceed 15%. Cronbach’s alpha per subscale varied from 0.58 to 0.81, while that of the summary scores were 0.89 and 0.91. The mean difference from the test-retest varied from − 0.06 to 0.17 across subscales. The Kaiser-Meyer-Olkin criterion for sampling adequacy (KMO) was good for both models as well as the Bartlett’s test for sphericity p. While the factor loadings in rotated factor solution showed good concordance with the CCM, concordance was not as good for the 5A model, especially for the subscales “Assess” and “Advice”. Conclusion A validated Thai version of the PACIC+ is now available to measure how the patients perceive the care they receive. Electronic supplementary material The online version of this article (10.1186/s12875-018-0801-y) contains supplementary material, which is available to authorized users.

Background and Purpose: As the average length of stay of nursing home residents is decreasing, more elderly people are experiencing the transition to a nursing home. This is a critical life event for those affected. The purpose of this study was to examine how elderly people in need of care experience[for full text, please go to the a.m. URL], 1st International Conference of the German Society of Nursing Science

SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents*. (PDF 144 kb)

Description of the intervention. (PDF 293 kb)

Interview Guideline. (PDF 75 kb)

Pacicplus. The original PACIC+ questionnaire. (PDF 110 kb)

Subthemes. (PDF 190 kb)

Confirmation Approval. (PDF 717 kb)

Thai pacicplus. The Thai version of the PACIC+ questionnaire. (PDF 71 kb)

Guideline for interviews with patients and relatives. (DOC 63Â kb)

Background: The 2014 recommendations from the German Council of Science and Humanities (Wissenschaftsrat) [ref:1] called for medical programme reforms to enhance the academic preparation of physicians for complex future health care environments. New curricula developments related to doctors’[for full text, please go to the a.m. URL], Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

Introduction: This project report describes the development, “piloting” and evaluation of an interprofessional seminar on team communication bringing together medical students and Interprofessional Health Care B.Sc. students at the Medical Faculty of Heidelberg University, Germany. Project Description: A five-member interprofessional team collaborated together on this project. Kolb’s experiential learning concept formed the theoretical foundation for the seminar, which explored three interprofessional competency areas: team work, communication and values/ethics. Evaluation for the purposes of quality assurance and future curricula development was conducted using two quantitative measures: descriptive analysis of a standardized course evaluation tool ( EvaSys ) ANOVA analysis of the German translation of the University of the West of England Interprofessional Questionnaire (UWE-IP-D). Results: The key finding from the standardized course evaluation was that the interprofessional seminars were rated more positively [M=2.11 (1 most positive and 5 most negative), SD=1, n=27] than the monoprofessional seminars [M=2.55, SD=0.98, n=90]. The key finding from the UWE-IP-D survey, comparing pre and post scores of the interprofessional (IP) (n=40) and monoprofessional (MP) groups (n=34), was that significant positive changes in mean scores for both groups towards communication, teamwork and interprofessional learning occurred. Conclusions: Lessons learnt included: a) recognising the benefit of being pragmatic when introducing interprofessional education initiatives, which enabled various logistical and attitudinal barriers to be overcome; b) quantitative evaluation of learning outcomes alone could not explain positive responses or potential influences of interprofessional aspects, which highlighted the need for a mixed methods approach, including qualitative methods, to enrich judgment formation on interprofessional educational outcomes., Einleitung: Dieser Projektbericht beschreibt die Entwicklung, Pilotierung und Evaluation eines interprofessionellen Seminars zur Team-Kommunikation, das Studierende der Humanmedizin und Studierende des Studiengangs Interprofessionelle Gesundheitsversorgung B.Sc. an der Medizinische Fakultät der Universität Heidelberg zusammengebracht hat. Projektbeschreibung: Ein fünfköpfiges interprofessionelles Team arbeitete zusammen an diesem Projekt. Kolbs Theorie des erfahrungsorientierten Lernens bildete die theoretische Grundlage für das Seminar, in dem drei interprofessionelle Kompetenzdomänen vermittelt wurden: Teamarbeit, Kommunikation und Werte/Ethik. Die Evaluation zum Zwecke der Qualitätssicherung und der zukünftigen curricularen Entwicklung wurde mit zwei quantitativen Instrumenten durchgeführt: deskriptive Analyse eines standardisierten Kurs-Bewertungsinstruments (EvaSys) Varianzanalyse (ANOVA) der deutschen Version des Fragebogens „University of the West of England Interprofessional Questionnaire“ (UWE-IP-D). Ergebnisse: Das Hauptergebnis der standardisierten Kursevaluation war, dass die interprofessionellen Seminare positiver bewertet wurden [MW=2,11 (Bereich: 1 sehr positiv bis 5 sehr negativ), SD=1, n=27] als die monoprofessionellen Seminare [MW=2,55, SD=0,98, n=90]. Der Vergleich der Vorher-/Nachher-Ergebnisse in der UWE-IP-D Befragung der interprofessionellen (IP) (n=40) und monoprofessionellen (MP) Gruppen (n=34) zeigte signifikante positive Veränderungen der Mittelwerte für beide Gruppen hinsichtlich Kommunikation, Teamarbeit und interprofessionellem Lernen. Schlussfolgerungen: Erkenntnisgewinne aus dem Projekt: a) Nutzen einer pragmatischen Vorgehensweise bei der Einführung interprofessioneller Ausbildungssequenzen, die es ermöglichte, dass verschiedene Barrieren bzgl. Logistik sowie Einstellung/Haltung überwunden werden konnten; b) eine quantitative Evaluation allein konnte die positiven Rückmeldungen des interprofessionellen Settings nicht erfassen. Dies erfordert einen Mixed-Methods-Ansatz inklusive qualitativer Methoden, um die Effekte interprofessioneller Ausbildung besser zu verstehen., GMS Journal for Medical Education; 33(2):Doc22

Hintergrund/ Fragestellung: Inwieweit die zunehmenden Forderungen nach evidenzbasierter Praxis (EBP) in der Versorgung von Patienten mit Kreuzschmerzen durch Physiotherapeuten (PT) in Deutschland umgesetzt werden, ist derzeit unklar. Der in Großbritannien entwickelte STarT-Back-Therapieansatz[zum vollständigen Text gelangen Sie über die oben angegebene URL], Gemeinsam informiert entscheiden; 17. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin

Background: Family caregivers play a key role in palliative care at home, and understanding the interdependencies in the constellation of patient, family caregivers and service providers is important. As few longitudinal studies have examined the influence of patient quality of life (QoL) in palliative care on burden of family caregivers, the aim of this study was to identify correlations between changing patient QoL and changing burden of family caregivers that need consideration in patient management. Methods: Palliative patients with cancer in primary care evaluated their QoL (Quality of Life Questionnaire Core 15 Palliative Care, QLQ-C15-PAL). They were assessed monthly for an interval of 6 months or until death of the patient. Family caregivers reported the burden they perceived while supporting the patient (Short form of the Burden Scale for Family Caregivers, BSFC). Longitudinal data were analysed for all patients with at least 3 available assessments, considering the most recent data for participants with more than 3 assessments. Changes in patient QoL were analysed using the Friedman test. In a stepwise regression analysis, influences of change in patient QoL on changing caregiver burden were investigated. Results: One hundred patients (63 men, 37 women; average age: 68 years) were enrolled in the study. The most common primary diagnoses were colon, lung or breast cancer. In 58 cases, assessments were available from both patients and caregivers. Patients reported overall quality of life increasing towards end of life, although reporting that physical functioning deteriorated. Symptoms of pain and fatigue bothered patients most. Caregiver burden was moderate and on average did not change over time. In a stepwise regression model, the difference in emotional functioning and the difference in dyspnoea showed an influence on the development of caregiver burden (explained variance of 19.3 %). Conclusions: Patients’ dyspnoea, feelings of depression and anxiety impacted on the perceived burden of family caregivers, but are manageable symptoms. Our results corroborate the need of regular assessment of patients’ needs taking into account caregiver burden. In this way, general practice teams can intervene early and may more likely meet patients’ needs in the end of life care process. Trial registration: Current Controlled Trials ISRCTN78021852, assigned on 04/04/2007

Patient questionnaire used in the study. (PDF 146 kb)

Background: Current research emphasizes the high prevalence and costs of low back pain (LBP). The STarT Back Tool was designed to support primary care decision making for treatment by helping to determine the treatment prognosis of patients with non-specific low back pain. The German version is the STarT-G. The cross-cultural translation of the tool followed a structured and widely accepted process but to date it was only partially validated with a small sample. The aim of the study was to test the psychometric properties construct validity, discriminative ability, internal consistency and test-retest-reliability of the STarT-G and to compare them with values given for the original English version. Methods: A consecutive cohort study with a two-week retest was conducted among patients with non-specific LBP, aged 18 to 60 years, from primary care practices. Questionnaires were collected before the first consultation, and two weeks later by post, using the following reference standards: the Roland and Morris disability questionnaire, the Tampa Scale of Kinesiophobia, the Pain Catastrophizing Scale and the Hospital Anxiety and Depression Scale. Psychometric properties examined included the tool’s discriminative abilities, whether the psychosocial subscale was one factor, internal consistency, item redundancy, test-retest reliability and floor and ceiling effects. Results: There were 228 patients recruited with a mean age of 42.2 (SD 11.0) years, and 53 % were female. The areas under the curve (AUC) for discriminative ability ranged from 0.70 (STarT-G Subscale - Pain Catastrophizing Scale; CI95 0.63, 0.78) to 0.77 (STarT-G Total - Composite reference standard, CI95 0.60, 0.94). Factor loadings ranged from 0.49 to 0.74. Cronbach’s alpha testing the internal consistency and redundancy for the total/subscale scores were α = 0.52/0.55 respectively. The STarT-G test-retest reliability Kappa values for the total/subscale scores were 0.67/0.68 respectively. No floor or ceiling effects were present. Conclusions: The STarT-G shows acceptable psychometric properties although not in exact agreement with the original English version. The items previously regarded as a psychosocial subscale may be better seen as an index of different individual psychosocial constructs. The relevance of using the tool at the point of consultation should be further examined.

Background In Germany, complementary and alternative medicine (CAM) in primary health care is offered by general practitioners (GPs) and by natural health practitioners, so called ‘Heilpraktiker’ (HPs). Considering the steadily growing number of unregulated HPs, the aim of the study was to assess characteristics of patients consulting HPs in comparison to patients consulting GPs. Methods In a cross-sectional study, patients of randomly selected GPs and HPs were asked to complete a questionnaire about their health care status, health care behavior, and symptoms rated on the Measure Yourself Medical Outcome Profile (MYMOP-D). Patient groups were compared based on health care provider (HP, GP with high use of CAM (CAM-GP), and GP with no/little use of CAM (nCAM-GP)) using Kruskal-Wallis tests and analyses of variance (ANOVA). Results Altogether, 567 patients (91 of 11 HPs, 223 of 15 CAM-GPs, 253 of 19 nCAM-GPs) filled in the questionnaire. Patients of HPs had a higher education level and were more often female. The most common reason for encounter among all three groups were musculoskeletal problems (30.2–31.1 %). Patients seeing HPs reported more psychological (4.4 % vs. 17.8 %), but less respiratory problems (19.9 % vs. 7.8 %), and longer symptom duration (>5 years: 21.1 % vs. 40.7 %), than patients of nCAM-GPs. Conclusions The high percentage of patients with psychological illness and chronic health problems consulting HPs demonstrates the urgent need for action with regard to CAM therapy in primary care and regulation of natural health practitioners. Appropriate measures with regard to quality and patient safety should be taken given the growing numbers of HPs and the absence of a regulatory body. Electronic supplementary material The online version of this article (doi:10.1186/s12906-016-1402-8) contains supplementary material, which is available to authorized users.