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This position paper is based on the authors' many years of clinical experience and basic science research on the diagnosis and treatment of children and adolescents with a presymptomatic early stage of type 1 diabetes. The benefits as well as potential disadvantages of early detection of type 1 diabetes by islet autoantibody screening are critically discussed. In addition, the perspectives of delaying the onset of the clinical metabolic disease through treatment with teplizumab are addressed. Today, we see the chance for a relevant improvement in therapeutic options and life perspectives of affected children and adolescents. Important next steps for the implementation of islet autoantibody screening in Germany are the training of pediatricians who should inform families about the screening, establishment of a few transregional laboratories that carry out the test, and expansion of regional capacities for the training and care of children with an early stage of type 1 diabetes., Competing Interests: A.G.Z. ist Mitglied im Data Monitoring Committee (DMC) der Protect-Studie und der Petite-Studie (Teplizumab). O.K. ist National-Principle Investigator für Deutschland in der PROTECT-Studie (Teplizumab). R.B. ist Principle Investigator in der Protect-Studie (Teplizumab). Die weiteren Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Based on the relevance of an established and broad foundation of physical activity in healthcare, this position paper of the DNVF working group Physical Activity-Related Health Services research presents current conceptual approaches to physical activity-related health services in Germany and highlights the need for interprofessional and interdisciplinary approaches. Three central positions are outlined and elaborated in order to integrate the evidence on health benefits of physical activity and exercise more strongly into healthcare and to show that, against the background of the challenges in the German healthcare system, physical activity-related health services can make a cost-effective and high-quality contribution to improve healthcare. These three positions include 1) the integration of all professional groups involved in healthcare into physical activity-related health services, 2) the greater integration of physical activity professions and physical activity interventions into all healthcare contexts and 3) the systematic consideration of physical activity- and exercise-related expertise in clinical guidelines., Competing Interests: JW ist Konsortialführer des genannten MOVE-ONKO Projektes und Koordinator der S3-Leitlinie Bewegungstherapie bei onkologischen Erkrankungen. JW und KE haben an der S2k-Leitlinie in der pädiatrischen Onkologie mitgearbeitet. GS ist Konsortialpartner des genannten ImPuls-Projekts. SP ist Mitarbeiter im DVGS e. V., der als Fachverband Bewegungsfachkräfte qualifiziert, für die qualitätsgesicherte Umsetzung von Bewegung in allen Versorgungskontexten eintritt und Mandatstragende für die Mitarbeit an Leitlinien entsendet. CT ist Professor für Physiotherapie an der Hochschule für Gesundheit Bochum, die einen primärqualifizierenden Bachelor-Studiengang „Physiotherapie“ anbietet und für die Vollakademisierung der Physiotherapie eintritt. BW ist im Präsidium der Deutschen Vereinigung für Sportwissenschaft (dvs) und vertritt im Ressort „Gesundheit und Bewegung“ die Interessen der Sportwissenschaft. Alle Autorinnen und Autoren haben Projekterfahrung mit der Entwicklung, Implementierung und/oder Evaluation von bewegungsbezogenen Interventionen in verschiedenen Versorgungskontexten. AS, CT, LG und SP sind im Sprecherrat der AG bewegungsbezogene Versorgungsforschung und verweisen auf die Darlegung ihrer entsprechenden Interessen (https://dnvf.de/gruppen/ag-bewegungsbezogene-versorgungsforschung.html). Alle anderen Autorinnen und Autoren sind Mitglied der AG Bewegungsbezogenen Versorgungsforschung und geben an, keine Interessenkonflikte zu haben., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: Recent analyses have shown that in health services research in Germany, healthcare organisations are often considered primarily as a study setting, without fully taking their complex organisational nature into account, neither theoretically nor methodologically. Therefore, an initiative was launched to analyse the state of Organisational Health Services Research (OHSR) in Germany and to develop a strategic framework and road map to guide future efforts in the field. This paper summarizes positions that have been jointly developed by consulting experts from the interdisciplinary and international scientific community., Methods: In July 2023, a scoping workshop over the course of three days was held with 32 (inter)national experts from different research fields centred around OHSR topics using interactive workshop methods. Participants discussed their perspectives on OHSR, analysed current challenges in OHSR in Germany and developed key positions for the field's development., Results: The seven agreed-upon key positions addressed conceptual and strategic aspects. There was consensus that the field required the development of a research agenda that can guide future efforts. On a conceptual level, the need to address challenges in terms of interdisciplinarity, terminology, organisation(s) as research subjects, international comparative research and utilisation of organisational theory was recognized. On a strategic level, requirements with regard to teaching, promotion of interdisciplinary and international collaboration, suitable funding opportunities and participatory research were identified., Conclusions: This position paper seeks to serve as a framework to support further development of OHSR in Germany and as a guide for researchers and funding organisations on how to move OHSR forward. Some of the challenges discussed for German OHSR are equally present in other countries. Thus, this position paper can be used to initiate fruitful discussions in other countries., Competing Interests: LA ist Vorstandsmitglied der DGMS und des DNVF. Sie ist Mitglied des Editorial Boards des Journal of Health Care Services and Implementation. JB erhält Fördermittel für mehrere OVF-Projekte in Australien und Europa. ME ist Vorsitzender der Society for Studies in Organizing Healthcare (SHOC). Die Arbeit des Instituts für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, wird durch einen zweckungebundenen Zuschuss des Arbeitgeberverbands der Metall- und Elektroindustrie Baden-Württemberg (Südwestmetall) unterstützt. Die übrigen Autor*innen erklären, dass keine Interessenkonflikte bestehen., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

With this discussion paper, the subgroup Mixed Methods of the working group Qualitative Research Methods in the non-profit organization German Network Health Services Research (DNVF) is taking up the topic of three previous discussion papers on the significance and potentials of qualitative research methods in health services research. Mixed methods are being increasingly used and demanded in health services research. However, there are also areas of conflict in the planning and implementation of mixed methods studies, and these are addressed in this paper from the perspective of qualitative research. Special attention is given to the aspect of integration as the fundamental signature of mixed methods research. With this discussion paper, our aim was to stimulate critical as well as constructive exchange of ideas on what constitutes high-quality health services research characterised by a diversity of methods and the framework conditions under which this can succeed., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

From 2014 to 2022, the BMBF has funded five research networks in prevention research and health promotion that are also jointly coordinated (Research Network Primary Prevention and Health Promotion, www.fp2g.net). The researchers have produced a large number of relevant research outputs with insights gained into essential aspects of prevention research and health promotion. The networks research focused on basic principles, application-relevant findings, and implementation conditions of long-term prevention and health promotion for non-communicable diseases (NCDs). The constraints imposed by the pandemic from 2020 onwards were partly addressed by integrating Corona-related research and transfer activities. The importance of resilience for dealing with multiple health and social challenges got increased attention and was analyzed and discussed during the pandemic. For prevention research, research questions such as how to better implement prevention measures through digital tools are gaining additional importance. Together, the research networks have presented achievements and desiderata for future research. This perspective paper with its nine theses formulated in conclusion is intended as a stimulus for discussion among funders as well as the communty of researchers on the subject of successful prevention and health promotion. It is explicitly part of the continuity of the memoranda on prevention research developed in 2012., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

The methodological challenges of evaluating digital interventions (DI) for health services research are omnipresent. The Digital Health Working Group of the German Network for Health Services Research (DNVF) presented and discussed these challenges in a two-part discussion paper. The first part addressed challenges in definition, development and evaluation of DI. In this paper, which represents the second part, the definition of outcomes, reporting of results, synthesis of evidence, and implementation are addressed as methodological challenges of DI. Potential solutions are presented and the need to address these challenges in future research are discussed., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The development and application of digital interventions in health-related topics are gaining momentum in health service research. Digital interventions are often complex and need to be evaluated and implemented in complex settings. Due to their characteristics, this poses methodological challenges for health services research that have to be identified and addressed. Hence, the Working Group on Digital Health of the German Network for Health Services Research (DNVF) has prepared a discussion paper. This paper discusses methodological, practical and theoretical challenges associated with the development and evaluation of digital interventions from the perspective of health services research. Possible solutions are suggested and future research needs to address these methodological challenges are identified., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Goals for health and health care are an indispensable basic requirement for a functioning health care system. The dilemma of the German health care system is that it has not been designed in a planned way, but that it has grown historically. In recent years, it has developed through the free play of forces into what it is today. The OECD characterizes the current state as follows: The costs of the German health system do not correspond to the often only average health outcomes for the population. To meet the legal requirements (especially SGB V §§ 12, 27 and 70), health care/the health system in Germany needs concrete goals. An orientation towards health care goals entails measures on all levels of health care: on the macro level (overall system/total population), on the meso level (subdivided according to regions, specific population groups, etc.) as well as on the micro level (patients and health care providers). Based on national and international experiences, this position paper of the DNVF e.V. (German Network for health services research) shows the potential of how operationalised health care targets can ensure effective, affordable and high-quality health care. The coalition agreement of the current government propagates a reorientation with patient-related health care goals. Now it is important to derive concrete and realisable goals from this declaration of intent and to involve all important groups in the process. In addition, values and ethical standards for implementation shall be agreed upon in this process. The Health Ministry (BMG) should facilitate and promote the process of societal will-building for the definition of national health care goals. This requires a clear political will. As a result, the National Health Care Goals are available at the end of the process, which are published and maintained together with evidence-based facts as well as valid and resilient data in a Manual "National Health Care Goals". The operational responsibility for implementation could lie with the newly to be founded Federal Institute of Public Health, as already announced in the agreement of the governing coalition. The DNVF is willing to actively participate in the development of health care targets., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Goal of the Study: An intent of the Patient Protection and Affordable Care Acts (ACA), also know as Obama Care, was to slow the expenditure growth in the public Medicare-System by shifting the accountability for health care outcomes and costs to the provider. For this purpose, provider were allowed to form networks, which would then take accountability for a defined population - Accountable Care Organizations (ACOs). Ten years after the introduction of ACOs, this paper looks at the impact of ACOs both on quality of care and costs of care to assess if ACOs can be a model of care delivery for Germany., Methods: In a mixed-method approach, a rapid review was conducted in Health System Evidence and PubMed. This was supported with further papers identified using the snowballing-technique. After screening the abstracts, we included articles containing information on cost- and/or quality impact of US-Medicare-ACOs. The findings of the rapid review were challenged with 16 ACO-experts and stakeholder in the USA., Results: In total, we included 60 publications which incorporated 6 reports that were either conducted directly by governmental institutions or ordered by them, along with 3 previous reviews. Among these, 31 contained information on costs of care, 18 contained information on quality of care and 11 had information on both aspects. The publications show that ACOs reduced costs of of care. Cost reductions were achieved compared to historic costs, to populations not cared for in ACOs, and counterfactuals. Quality of care stayed the same or improved., Conclusion: ACOs contributed to slowing the cost growth in US Medicare without compromising quality of care. Thus, a transferal of this model of care to Germany should be considered. However, various policies have led to ACOs failing to unleash their full potential. Against this background, and against the background of stark differences between US Medicare and the German health care system, a critical reflection of the necessary policies underlying ACOs-like structures in Germany, needs to be undertaken., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: The SARS-Cov-2 outbreak in the spring of 2020 challenged the health care system, and thus primary care, on an unprecedented scale. Knowledge about the new disease was low, whereas the dynamics of knowledge generation were high and inhomogeneous. A number of new primary care tasks related to the pandemic situation emerged. Guidance in the management of COVID-19 was therefore needed, although robust evidence was not yet available. The information required concerned not only the virus and the new disease COVID-19, but also regulatory requirements and organizational issues. In this situation, a flexible, web-based information tool, easy to update and usable at the point of care, was developed at Karl Landsteiner Private University Krems and put online under the name of "COVID-19: prevention and management in primary care practices" on March 25, 2020. In a retrospective process description, we describe the needs-triggered process of developing and disseminating a practice-based tool to support practicing primary care physicians in a period of high uncertainty with an urgent need for information. Afterwards, we reflect on the learning process from a purely pragmatic to an increasingly structured approach and try to draw conclusions regarding optimization possibilities in terms of creation and dissemination., Conclusion and Outlook: In situations of high uncertainty combined with an acute need for action and decision-making, there is a significant need for information that is as reliable as possible. Science transfer must be done in such a way that information can be implemented quickly. Dissemination, as always, plays an essential role. Gaps must be accepted. A structured process of quality assurance must be established in parallel. Funds and resources for knowledge transfer should be included in future pandemic plans., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: The project "Health for Everyone in the District" was implemented in Nuremberg from May 2017 to October 2022 as part of the law passed to strengthen health promotion and disease prevention with funding from Public Health Insurance, Bavaria. The aim was to implement health promotion measures through a decentralized system in four deprived parts of the city and thus promote health equity on site. Among other aspects, program loyalty, project scope, and acceptance, as well as continuity and establishment of permanent structures underwent external assessment., Method: As part of the evaluation, quantitative data from the paper-and-pencil feedback forms of the measures (n=580), four qualitative focus group interviews with participants of the project (n=20), and an in-depth partially standardized predominantly quantitative online survey of participants and course instructors from the districts (n=67) were conducted., Results: The programs were accepted by those most in need, namely women, elderly people and those with a migration background. Women, senior citizens and people with a migration background were well reached by the measures. The very high level of satisfaction with the measures showed that there were opportunities for implementation of health promotion measures into daily life taking into consideration the local environment and deprived target groups. The specifications of the guidelines for prevention, however, represented a hurdle for the long-term establishment of the measures in these districts., Conclusion: The project "Health for Everyone in the District " represents a local low-threshold approach to social situation-related health promotion in the municipal setting and is suitable for reaching deprived target groups with health-promoting measures. Adjustments to the guidelines for prevention could help create permanent structures on a broader scale., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Objective: The aim of this study was to measure the acceptance of a telemedical, inpatient-outpatient care concept by physicians, patients and the relatives of patients. Based on a quantitative survey of acceptance, both the potential and success factors influencing the use of telemedicine were to be highlighted., Methods: The TELnet@NRW study is a national, multicenter, cluster-randomized study in stepped-wedge design conducted from February 2017 to January 2020 for the purpose of documenting changes in the quality of care through telemedicine in an inpatient-outpatient network. Consultations were focused on intensive care medicine and infectious diseases. This current study used questionnaires for specific groups of patients to determine acceptance of the telemedical care concept practiced in the main study. The survey was anonymously conducted once in either digital or paper-based form during the reporting period., Results: The answers of 126 questionnaires from physicians and 1686 questionnaires from patients and their relatives were evaluated. The physicians of both sectors attributed high potential (up to 88.4%) for telemedicine to improve guideline-adherent treatment. A trustworthy and appreciative communication during the telemedical consultation represented a positively reinforcing success factor. The additional workload generated by telemedicine inhibited acceptance, especially in the inpatient sector. A continuation of telemedicine beyond the end of the project was supported by the majority of surveyed physicians (inpatient 60.6%, outpatient 82.1%) as well as in patients and their relatives (inpatient 79.7%, outpatient 57.4%) in both sectors., Conclusion: There is widespread acceptance of telemedical, inpatient-outpatient care concepts among physicians, patients and their relatives. Low-effort processes and user-centered technology are crucial to increase the rate of use. Telemedicine has the potential to improve the quality of care and can serve as a robust component of sustainable healthcare in Germany., Competing Interests: Sandra Dohmen: Vorstandsmitglied der Deutschen Gesellschaft für Telemedizin; Gernot Marx: Koordinator der S1-Leitlinie Telemedizin in der Intensivmedizin, Vorsitzender der Deutschen Gesellschaft für Telemedizin (DGTelemed) und Vizepräsident der Deutschen Interdisziplinären Vereinigung für Intensivmedizin (DIVI e.V.), in der Vergangenheit Vortragstätigkeiten für Philips, Mitbegründer der Clinomic GmbH für Co-Autor Rainer Beckers:Die ZTG GmbH wurde von der RWTH Aachen für Beratungsleistungen beauftragt. Geschäftsführer der ZTG GmbH und Vorstandsmitglied der DGTelemed., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

The use of participatory design (PD) provides a framework for involving users in the process of developing healthcare technologies. Within PD, theoretical and methodological decisions need to be made. However, these decisions are often not adequately described or justified. This can lead to limited interpretability of the results. This paper has three objectives: First, to provide an overview of the key theoretical and methodological decisions that must be made in PD from the perspective of health services research; second, to describe the associated challenges and third, to describe action requirements for the future development of PD in health services research., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Health services research examines the structures and processes of health care under everyday conditions. Routine data of the statutory health insurance (SHI) - the so-called routine practice data - represent real health care and are therefore an important data source for health services research. This paper presents 5 key questions that researchers and data-holding institutions can use to assess the suitability of this data source for answering their health services research question. The aim of these guiding questions is to generate a common understanding between researchers and data-holding institutions of the research project, the research objective, and the feasibility of implementation in health services research. The five guiding questions cover the formulation of the research question, the planned method, the target population, the relevant study periods, and the required information from SHI data. These methodologically oriented guiding questions are supplemented by the question of how the results of the research project could improve care. Thus, for researchers, the five guiding questions provide an initial structuring for data requests; for data-holding institutions, they provide a framework for considering possible involvement in or support of a research idea in health services research., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: The aim of this study was to investigate the experiences, barriers, and solutions in communication during the provision of care for people with intellectual developmental disabilities in Germany. As there are approximately 350,000 people living with intellectual or developmental disabilities in Germany, who rely on assistance when communicating with healthcare providers, this study was conducted to examine the communication challenges and potential solutions in this population. The analysis especially focused on the potentials of digital applications facilitating information transfer., Methods: Thirteen expert interviews were conducted using a structured interview guide with caregivers and medical providers to people with intellectual developmental disabilities. The interviews were analyzed using an inductive and deductive content analysis approach, according to Meuser and Nagel., Results: The results revealed that the provision of care for people with intellectual developmental disabilities was characterized by time constraints and uncertainty when caregivers lack experience in caring for this population. Additionally, information transfer increased in complexity due to an overload of individual information provided by caregivers verbally or paper-based as well due to the passive role of patients who were usually not actively involved in the communication process. With regard to the potential for integrating digital applications for information transfer, a controversy between opportunity and risk emerged., Conclusion: The findings demonstrate that there is a need to implement training programs for professionals to enable them to offer improved health care for people with intellectual developmental disabilities. It is essential that caregivers are given sufficient time to communicate with patients, and that digital applications are utilized to support information transfer. Moreover, other research shows that digital applications offer new possibilities to communicate with people with intellectual developmental disabilities, such as the use of simplified or pictorial language. By addressing these communication challenges, healthcare professionals may be able to provide more effective and efficient care to this population. However, this requires further research, which addresses the controversial results regarding digital applications outlined in this paper., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: Employed informal caregivers often experience role conflicts between caring for an elderly person in need of care at home and their employment. The goal of this paper was to identify a risk profile of care-related termination of employment., Methods: Analyses are based on the cross-sectional Benefits of Being a Caregiver Study (October 2019 - March 2020) with data from 481 informal caregivers of elderly persons in need of care. The data collected relate to characteristics of the care recipient, the informal caregiver, and the caregiving situation, as well as aspects of the employment situation. The risk profile of care-related cessation of employment is based on a binary logistic regression., Results: Approximately one in nine in the present sample (n=55) terminated employment because of having to offer informal care to an elderly person at home. Factors characterizing the risk profile of a care-related termination of employment were female gender of the caregivers, younger age of the care receiver, co-residence with the care receiver, and a higher care level of the care receiver., Conclusions: In order to reduce care-related cessation of employment, support and relief services need to be adapted to the factors of the identified risk profile. In particular, the form and content of informal caregiver counselling should be modified in order to reach informal caregivers at an early stage. Adapted support programs should focus on and reach in particular female employed caregivers., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Objective: Reconciling informal caregiving and gainful employment is a challenge for many informal caregivers. The goals of this paper are to identify factors influencing care-related employment reduction, and to record work-related wishes for improving the compatibility of informal caregiving and being employed., Methods: Analyses were based on the cross-sectional Benefits of Being a Caregiver Study of 426 employed caregivers of an older person in need of care. Data were collected on characteristics of the care receivers and caregivers, and aspects of the caregiving and employment situation. Potential influencing factors of care-related employment reduction (n=426) were analyzed using binary logistic regression. The wishes regarding the compatibility of informal care at home and employment were examined descriptively using structured content analysis according to Mayring., Results: One quarter of the employed informal caregivers (n=108) reduced their hours of employment due to the demands of caregiving. The profile of influencing factors of a care-related employment reduction was composed of a higher number of working hours, higher effort for activities of daily living, and co-residence with the care receiver. Employed caregivers primarily expressed a desire for flexibility in working hours, a reduction in working hours, and some concessions with regard to absenteeism., Conclusions: Relieving the burden on caregivers in the activities of daily living in form of formal and informal support services can probably reduce the likelihood of a care-related reduction in gainful employment., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Introduction: Despite the growing numbers of physicians in outpatient care, continuing discussion about the planning of physician requirements suggests remaining problems in this field, which could be due to focussing on the ratio of physician to population rather than on morbidity-based evaluations. Against this background, this paper tries to depict the latent need in outpatient care, illustrates supply and demand and further tests the hypothesis that there is a relative inequality in distribution due to physicians preferring to locate in socially privileged areas in the German state of Brandenburg., Methods: We aggregated all data available on a small scale with potential impact on demand and examined it via principal component analysis. The generated factor was mapped together with the locations of general practitioners and specialists in general care. Using linear regressions, the number of practitioners was compared to the local index value to determine regional inequalities., Results: The PCA suggested a one factor solution; that factor was designated Social Structure Index due to its values. The mapping showed a tendency of higher index values towards the central areas of Brandenburg surrounding Berlin. Regressions of the number of practitioners against the index values revealed no significant differences between communities with high and low index values., Conclusion: The extension of factors concluding the evaluation of physician demand in outpatient care confirms the problems of physician supply in rural areas, where sparse populations meet social disadvantages and poor accessibility. An underlying inequality in distribution in terms of physicians preferring socially privileged areas could not be detected., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Having to face the challenges posed by a shortage of skilled care workers and an increasing number of older people in need of care, policy makers and economic enterprises perceive care robotics as a promising solution. However, studies have shown that potential users have little interest in technology and that technology developers have little knowledge about the needs and wishes of potential users. Against this background, this paper explores, based on 16 qualitative interviews with stakeholders from the area of technology development, marketing, and nursing care (science), which assumptions and expectations regarding age and gender of users are relevant in this field. The results revealed three perspectives of the stakeholders regarding the users of care robotics: 1) the need to take age and gender in development and implementation of care robotics was acknowledged, 2) the relevance of other social categories, such as education, culture and illness, was mentioned, and 3) the relevance of social categories was rejected altogether. These results are discussed in the context of discourses about diversity in care-robotics and conclusions are drawn for user-centred and diversity-sensitive technology development and implementation., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Urbanization is advancing worldwide and thus, cities are increasingly living spaces for people. Therefore, it is essential to place the health and well-being of city dwellers at the center of urban planning. The research funding program "City of the Future - Healthy and Sustainable Metropolises" from the Fritz and Hildegard Berg Foundation at the German Stiftungszentrum has been providing important inter- and transdisciplinary research impulses on this topic since 2010. Junior research groups at the interfaces of health sciences and other disciplines in the natural and social sciences were funded. One focus of the research program is to enable intensive cooperation with practitioners, in order to reflect upon and work on problems and issues from practice using the best possible scientific methods and to catalyze the transfer of knowledge. The research consortia are accompanied by annual conferences on a wide variety of urban health topics at various venues in Germany. In addition, transdisciplinary networks have been established and further initiatives (e. g., founding of an institute) have been launched. In this paper, the development of the multifaceted research funding program "City of the Future - Healthy and Sustainable Metropolises" is presented, including an outlook into its future development., Competing Interests: Mitglieder (Fehr, Hornberg, Zerbe) im Programmbeirat des Programms "Stadt der Zukunft" der Berg-Stiftung (Koordination Frau Macher, Deutsches Stiftungszentrum)., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

The field of urban health, i.e., the application of public health for people in the city, is oriented towards both scientific knowledge and practical action. In the international arena, a scientific infrastructure exists for this purpose. Despite the common roots of public health and urban planning in Germany, the connection between these fields of work was not very apparent for a long time. Legal requirements for the participation of public health service in (urban) planning processes have had little impact so far. The aim of this study was to connect to international urban health developments in order to make the topic more visible, to support professional exchange and to give impulses for research and practice. To express the close links between human health, ecological stability and social justice, the approach was conceived as sustainable urban health. With this in mind, the program "City of the Future - Healthy, Sustainable Metropolises" was initiated in 2011.This article characterizes the basic approach as integrating and describes the underlying guiding principles, i.e., "View field expansion" as an epistemological principle and "Bridge building" as an action-guiding principle, and outlines the details. The spectrum of topics ranges from medical and nursing care over "classical" prevention and health promotion to health in all policies. Within this approach, "smaller" tasks can be pursued, e.g., an overview of local health actions and actors, networking promotion, or preserving significant developments in collective memory. At the same time, it is about contributions to the solution of "big" tasks, e.g., the derivation of conclusions from the Corona learning experience, a more consistent implementation of health in all policies, or transformation steps towards an ecologically sustainable development of society. Legal norms, public health services, health reporting, and urban planning come up as leitmotifs. The article also outlines the genesis of the position papers in this supplementary volume and concludes with an outlook., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Schizophrenia psychoses can be treated much better today due to the introduction of antipsychotics about 70 years ago in conjunction with the implementation of specific psychotherapies. However, current treatment options are still limited in the area of negative symptoms and disease-associated cognitive deficits. In the last 15 years, randomised controlled trials (RCTs) have been able to show that physical training and especially endurance training could represent a comprehensive complementary treatment approach and could lead to a significant improvement in positive, but especially also in negative symptoms and cognitive deficits. As a result, sports therapy for schizophrenia psychoses has found its way not only into the national treatment guidelines of the German Society for Psychiatry, Psychotherapy, Psychosomatics and Neurology (DGPPN), but also into European recommendations such as those of the European Psychiatric Association (EPA). With the introduction of the "Living guideline" format (here an update takes place at least once a year), a broader implementation in health care will be easier in the future. Based on a narrative review, this paper describes the process of implementing sports therapy for schizophrenia psychoses from its beginnings to its incorporation into guidelines and can be applied analogously to other forms of therapy., Competing Interests: RS, AS, LR und IM haben keinen Interessenkonflikt. PF ist Mitherausgeber der deutschen (DGPPN) Schizophrenie-Behandlungsleitlinien und Mitverfasser der Schizophrenie-Behandlungsleitlinien der WFSBP; er ist in Beiräten tätig und erhält Vortragshonorare von Janssen, Lundbeck, Otsuka, Servier und Richter., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Objective: Families with one parent suffering from cancer are exposed to extraordinary emotional and organizational burdens, affecting underaged children. To help coordinated access to social and logistic support options and thus reduce the stress on family members, the project Brückenschlag was founded. The aim of this paper was to evaluate the implementation of this pilot project following the healthcare utilization model by Andersen., Methods: A cross-sectional observational study was conducted using a mixed-method approach. Semi-structured written expert surveys (n=10) and secondary analysis of routine data of the care model (n=171 families) were combined., Results: Quantitative secondary analysis: The participating families had 1-7 children (median (m) 2, range (s) 6). In 66% of the cases, the mother was affected by cancer, in 20% the diseased parent was in a single parent household. The communication structure in these families was rated "limited" to "rather open". Of the total of 171 contacts (study period 9/14 to 11/17), 133 families made use of Brückenschlag; 59.2% of the contacts were made by psycho-oncologists and the social services department of the hospital. If the contact was initiated by the patients themselves or by psycho-oncologists, a guidance was established significantly more frequently (significance of chi-squared test 0.047). Qualitative analysis: There was a lack of awareness and coordination of existing support services and a lack of family resources to use existing support offers. Both the desired and the established support fell primarily in the area of organizational support. Brückenschlag improved networking and took on a navigating function for the families., Conclusion: The data collected indicate that in families, matching the German average in their socio-demographic characteristics, a great need for organizational support develops as soon as one parent becomes sick with cancer. The model project Brückenschlag creates an access to support services for families with one parent suffering from cancer., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Study Aim: Psychosocial stress can complicate the first phase of life for young families. One group that has received little attention so far are families with increased parental stress and conflict potential. This paper aims to 1) classify knowledge and use of support services for families with increased parental stress and conflict potential and 2) describe the psychosocial characteristics and parenting behaviours of these families., Methods: For this purpose, data from a representative cross-sectional study in 2015 with n=7 549 families as well as the follow-up study with n=905 families were analyzed. Parents who took their child to a pediatrician's office for a screening examination (U3-U7a) completed a written questionnaire. Knowledge and use of services were assessed using four pre-defined stress groups (unstressed, socioeconomically stressed, with parental stress and conflict potential, and highly burdened)., Results: Families with increased parental stress and conflict potential are less likely to receive support offers. Despite high knowledge of selective prevention services, they use these offers less frequently than socioeconomically or highly stressed families. They are more likely to report dysfunctional parenting behaviors., Conclusion: This raises the question of whether families with increased parental stress and conflict potential receive too little support because they have no clearly visible need for help or whether they are adequately provided for due to the high socioeconomic resources, service knowledge, and use of universal medical and family education services. The results provide important information for the care of families in various stressful situations and contribute to the assessment of the need for support., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The German research data center for health will provide claims data of statutory health insurances. The data center was set up at the medical regulatory body BfArM pursuant to the German data transparency regulation (DaTraV). The data provided by the center will cover about 90% of the German population, supporting research on healthcare issues, including questions of care supply, demand and the (mis-)match of both. These data support the development of recommendations for evidence-based healthcare. The legal framework for the center (including §§ 303a-f of Book V of the Social Security Code and two subsequent ordinances) leaves a considerable degree of freedom when it comes to organisational and procedural aspects of the center's operation. The present paper addresses these degrees of freedom. From the point of view of researchers, ten statements show the potential of the data center and provide ideas for its further and sustainable development., Competing Interests: Stefanie March, Falk Hoffmann, Holger Gothe, Ingo Meier, Sebastian Claudius Semler, Christoph Stallmann, Enno Swart und Peter Ihle erklären, dass Sie innerhalb der vergangenen 3 Jahre Gutachtertätigkeit für das Bundesministerium für Gesundheit ausgeübt haben, und einzelne Autor*innen am begleitenden Arbeitskreis zum Forschungsdatenzentrum Gesundheit beim BfArM beteiligt sind., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: In order to manage the Covid-19 pandemic in Germany in March 2020, the government implemented non-pharmaceutical interventions including school closures, case-based measures, social distancing, and a ban of all public events. Under these circumstances, professional societies and associations in the healthcare sector recommended the use of video consultations. The objective of this analysis was to generate statistically relevant insights into the use of video consultations before and during the Covid-19 pandemic METHODS: This study is based on the analysis of a comprehensive claims data set comprising anonymized data of 5.6 million beneficiaries of a large German health insurance fund. The dataset encompassed healthcare claims from 1 January 2019 to 30 June 2020 covering 29,464,913 patient contacts. The claims were divided into video consultations and face-to-face consultations. This paper presents descriptive statistics and analyses associations between variables., Results: In 8,077 out of all contacts, a video consultation had taken place. This translates into 3.12 of 10,000 contacts. There was no significant difference in the utilization of video consultations by gender. However, the age differed significantly (Chi-square:2280.01, Sig: 0.000) between the contacts with or without use of video consultation. There is a significant increase of up to 27 times the use of video consultation in the first lockdown compared to the same month in 2019., Conclusions: Apparent higher usage of telemedicine by patients in the age group 50 to 64 years and the very low usage in the group of 65 to 74 years shows that the use of video consultation is age sensitive and should be subject to goal-oriented implementation of telemedical offers. The observed increase, however, is small relative to the total number of patient contacts and is not significant. Thus, there is no evidence in this large dataset to support the claim that video consultation had risen dramatically through the Covid-19 pandemic. Qualitative research to determine the factors for patients and general practitioners that lead to or hinder the use of video consultation should help in addressing the slow digitalization in the outpatient sector in Germany., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: (Excess) mortality and years of life lost are important measures of health risks from the Corona pandemic. The aim of this paper was to identify methodological factors that affect the calculation of mortality and further to point out possible misinterpretations of years of life lost., Methodology: Standardized mortality ratios (SMRs) can be used to compare mortalities (e. g., an SMR of 1.015 means excess mortality of 1.5%, an SMR of 0.990 means that mortality is reduced by 1.0%). In this study, SMRs as a measure of association for mortality in Germany were calculated for 2020 using different methods. In particular, the influence of different data sources and reference periods was examined. Furthermore, its influence on the calculated mortality was also examined to take into account increasing life expectancy. In addition, published results on years of life lost were critically analyzed., Results: Using January 2022 data from the Federal Statistical Office on mortality for 5-year age groups resulted in higher SMR values than using preliminary data from February 2021 with 20-year age groups (SMR=0.997, 95% confidence interval (CI): 0.995-0.999 versus SMR=0.976 (95% CI: 0.974-0.978)). The choice of the reference period had a large impact on calculated mortality (for men, SMR=1.024 (95% CI: 1.022-1.027) with 2019 as the reference year versus SMR=0.998 (95% CI: 0.996-1.001) with 2016 to 2019 as the reference period). Analyses in which declining mortality in 2016 to 2019 was carried forward into 2020 when calculating expected deaths resulted in significantly higher SMR values (for men SMR=1.024 (95% CI: 1.021-1.026) with, and SMR=0.998 (95% CI: 0.996-1.001) without carrying forward declining mortality). Figures for pandemic-related years of life lost per person who died from COVID-19 should be interpreted with caution: Calculation from remaining life reported in mortality tables can lead to misleading results., Conclusion: When calculating mortality and years of life lost during the pandemic, a number of methodological assumptions must be made that have a significant impact on the results and must be considered when interpreting the results., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim of the Study: To outline basic information on communication structures and obstacles between GPs and nursing homes as well as GPs' perspectives on usage of E-health technology., Methods: A questionnaire-based cross-sectional study carried out among n=600 randomly selected GPs in Germany sent by mail., Results: The response rate was 20% (n=114). The respondent's mean age was 53 years (min=35; max=77), two-thirds were women (65%). GPs mainly used fax (92%) and telephone (87%) to communicate with nursing homes. Less than 10% routinely used digital technologies like E-mail (7%), E-health software (6%) or chat-services (1%). About half of GPs reported unnecessary (52%) or unspecific (51%) nursing home visit requests as well as unreported medication plan changes by other physicians (51%) as a common but avoidable problem. Many GPs wanted to use E-medication plans (85%), E-follow-up prescriptions (79%) and E-letters of referral (69%) in the future. 33% of GPs were already using fully digitalized patient files. Only 9% worked exclusively paper-based., Conclusion: Though GPs are open to digitalized communication with nursing homes, fax and telephone are still mostly used. GPs prefer to execute less complex tasks digitally, such as change of medication plans and letters of referral. Fewer can imagine digital solutions for complex procedures such as acute health problems and ward rounds. Only 8% do not want to work digitally at all., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim of the Study: The digital transformation in healthcare is also of fundamental importance for healthcare research. For this reason, experts should agree on, prioritize and identify key topics for a medium-term strategy of the German Network for Health Services Research and classify the general development of digital health in the context of health services research., Methods: Between April and September 2018, the working groups "Digital Health" and "Validation and Linkage of Secondary Data" of the German Network for Health Services Research were asked to submit their expertise online using the methodological approach of a Delphi study. For this purpose, a multi-stage modified Delphi method with quantitative and qualitative approaches was chosen. Initially, a list of theses was drawn from the network's published position papers on digital health applications and medical apps. A total of 131 statements were formulated. The final survey instrument included questions on the biographical background of the participants, 42 developed items (33 statements and 8 open-ended questions), and one free-text field to add further aspects. Items were evaluated with a five-point Likert scale. A statement was accepted if the agreement rate was 75% or higher., Results: Of the 110 potential participants, 50 (46%) took part in the first round and 39 (36%) in the second round of the Delphi survey. In the first round, there was a clear result for 24 of 33 statements. There were 20 statements "agreed with" and four "disagreed with." Nine statements were between 60 and 75% and were presented to the participants again for evaluation in the second round. In round two, of these nine statements, four statements were "agreed with" and five statements were "disagreed with." Digital Health Literacy" emerged as a particular focus in this Delphi study., Conclusion: In this Delphi study, experts were involved in selecting and prioritizing possible topics for the Digital Health working group and assessing future developments in digital health in the context of health services research. The results reflect both the expectations and interests of the members and are largely consistent with the recommendations of the report "Digitalization for Health" made by the expert council for assessing developments in the health sector., Competing Interests: Horst Christian Vollmar und Ursula Kramer sind Sprecher der „AG Digital Health“ des Deutschen Netzerk für Versorgungsforschung (DNVF e. V.). Ursula Kramer ist Inhaberin einer Agentur für Gesundheitskommunikation, zudem ist sie Gründerin der Plattform HealthOn, die Gesundheits-Apps analysiert und bewertet. Jutta G. Richter ist Sprecherin der Kommission Digitale Rheumatologie der Deutschen Gesellschaft für Rheumatologie und Mitglied in der Kommission Digitale Transformation in der Inneren Medizin der Deutschen Gesellschaft für Innere Medizin. Madlen Fiebig ist Mitglied der AG „Digitalisierung in der Pflege“ beim Bundesverband Gesundheits-IT-bvitg e. V. Alle anderen Autoren sind Mitglieden der AG Digital Health oder der AG Validierung und Linkage von Sekundärdaten. Sie geben an, keine Interessenskonflikte zu haben., (Thieme. All rights reserved.)

Introduction: To reduce outpatient specialist waiting times and to help patients with statutory health insurance to get appointments and urgent referrals within four weeks, phone appointment service centres (ASC) were introduced in Germany in January 2016. The aim of this study was to analyse these booking patterns in the Westphalia-Lippe (WL) region, and to compare the types of regular specialist referrals with those made by the centers. Furthermore, neurology services to patients with ASC referrals were compared to those without., Methods: Appointment data from the second quarter of 2016 to the third quarter of 2019 were used, and an algorithm was developed to determine the range of services provided in appointments made by the ASCs. A total of 24,286,157 accounting slips were compared with 12,648 specialist service records from the Association of Statutory Health Insurance Physicians in the WL region., Results: The average waiting time for an appointment with a specialist was 21 days for 84% of the callers with a referral (aged mostly 35-59 years). Requests for appointments with neurologists, internists, and radiologists were the most frequent ones; 45% of service centre specialist appointments were made with neurologists, despite these comprising only 4% of total referrals in WL. There were only a few differences in the use of services in neurologist appointments with and without the mediation of the ASC. The higher level of ASC used for making neurologist appointments for initial psychotherapeutic assessment was statistically significant. However, the effect was small., Conclusions: Despite its relatively low use (0.19% of specialist referrals in general), ASCs in the WL region are able to make urgent specialist appointments for patients with statutory insurance, with average waiting times significantly lower than the legally set maximum waiting period. However, patients also take other factors into account when making appointments. While the benefits of these centres, especially for three types of specialists, was demonstrated, further discussion on the form of the ASCs in their current form is warranted. This paper provides a basis for evaluation of methodology and content for further decision-making., Competing Interests: Frau Sobiech-Eruhimovic ist Angestellte bei der KVWL. Sie wurde für die wissenschaftlichen Arbeiten im Rahmen ihrer Promotion zeitweise (20%) freigestellt. Es besteht kein Interessenkonflikt, da die KVWL keinen Einfluss auf die die Themenauswahl und die Bearbeitung der Ergebnisse hatte., (Thieme. All rights reserved.)

Background: Many people in German-speaking countries have a limited proficiency in the German language. In the health care system, this may result in barriers to accessing and utilization of health services. The aim of this review was to present the current state of research on the relevance of language barriers in medical care and to explain strategies used to address language-related communication problems., Methods: The review is based on a synthesis of German- and English-language systematic reviews on the topic of 'language interpretation in the health care sector', including also all original papers from Germany published since 2015., Results: The most common method used in hospitals for language problems was interpretation by relatives of patients or by bilingual staff of the hospital. The quality of this language mediation by untrained laypersons was often limited, which can affect health care outcomes. Using professional interpreters was associated with significantly better health care outcomes and, particularly in the form of interpretation via telephone, was a flexible and cost-effective approach., Conclusion: Language-based communication is an important prerequisite for patient-centered care and must be ensured by the health care system for ethical, social and legal reasons. In this context, professional interpretation solutions should be used, for which the required financial resources and infrastructure must also be made available., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: During the state of emergency in Bavaria in the early Corona phase 2020, some physicians in ambulatory care were appointed as regional medical coordinators (RMCs). The aim of the present study was to evaluate this newly introduced but temporary position., Methods: In November 2020, a paper-based questionnaire was sent out to all 85 RMCs who could be identified through an internet research and to all 197 teaching practices of the Institute of General Practice and Health Services Research at the Technical University of Munich. The data analysis was descriptive and anonymised., Results: Overall, 75 (88%) RMCs and 156 (79%) general practitioners (GPs) were included. 97% of the RMCs and 67% of the GPs assessed the introduction of RMCs in ambulatory care as reasonable, but also as an intervention concerning the self-administration of physicians (RMCs: 59% and GPs: 42%). 37% of the GPs stated that RMCs should be avoided as far as possible in future pandemic situations. Overall, GPs with more intensive contact to an RMC showed higher levels of agreement. Both groups rated the collaboration and communication strategies of politics, authorities and the Bavarian Association of Statutory Health Insurance Physicians as difficult and often contradictory. However, most of the RMCs assessed the cooperation with politics and authorities at the local level as positive. The lack of medical protective equipment at the beginning of the pandemic was judged critically by both groups of the respondents., Conclusions: The establishment of RMCs in the early Corona phase 2020 in Bavaria was considered sensible by almost all RMCs and the majority of the surveyed GPs. For the future, it seems necessary to involve primary care physicians more intensively and permanently in decision-making processes and to strengthen existing structures., Competing Interests: Die Autoren PW und FV waren selbst als Versorgungsärzte tätig. Alle weiteren Autor*innen erklären, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Employees in a low socio-economic position (SEP) are more likely to leave the labour market after medical rehabilitation for health reasons than those in a better social position. So far, almost nothing is known about whether certain types of rehabilitative care can reduce this inequality in rehabilitation success. This paper examines whether certain types of care modify the SEP's influence on return-to-work (RTW)., Method: The study is based on administrative data from the German statutory pension insurance on 266,413 medical rehabilitations of 253,311 persons fully integrated into working life. Poisson regression analyses were used to check whether there was a correlation between SEP (income, education, occupational position) and the probability of RTW in the year following the measure, and whether this correlation was lower in follow-up treatment (AHB), inpatient treatment or treatment with subsequent graded RTW compared to rehabilitation that did not meet these characteristics., Results: People with a low income, education or occupational position were at increased risk of incomplete return to work after medical rehabilitation. This correlation was comparatively lower for all 3 SEP indicators when the return to work was gradual. In the case of AHB and inpatient rehabilitation, this only applied to income., Conclusion: Socio-economically disadvantaged population groups are comparatively more likely not to return fully to work after medical rehabilitation. These inequalities are less pronounced for certain types of rehabilitative care. This tends to be the case with an active structuring role of the care system. However, there is a need for further research on the modification of effects by the type of treatment. This should be further investigated using data collected for this purpose to exclude selection effects., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)