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Background High continuity of care has a positive impact on health outcomes, but insight into the mechanisms underlying this impact is limited. Information continuity, on which our study focuses, is especially important when relational continuity is not given, which is often the case at hospital admission or hospital discharge. The aim of this study is to provide insight into the information flows between general practices and hospitals in Germany, and to identify factors associated with these flows of information. Methods This is a qualitative interview study in a purposeful sample of staff from hospitals and general practices (general practitioners, care assistants in general practice, hospital management, hospital physicians, and nursing staff). Interviews were conducted via telephone or face-to-face using a self-developed semi-structured interview guide. Stepwise systematic content analysis was used to structure collected material into themes and sub-themes that related to the study aim. Data was analysed by two researchers in several cycles, alternating between inductive and deductive approaches. Results A total of 49 interviews were conducted. Duration of the interviews varies between 21 and 78 min (mean duration 43 min). Across all groups, more than two thirds of participants were female (n = 34, 69%). The analysis highlighted six interdependent main themes regarding factors that affect information flows between hospitals and general practices: organisational, legal, financial, patient factors, individual characteristics, and emotional & social factors. The latter theme emerged as particularly rich and was therefore divided into four subthemes: appreciation and understanding of the respective other, (intrinsic) motivation, socialisation, and relationships. Organised meetings and events were mentioned as strategies to address emotional and social factors. Conclusions Digitalisation can facilitate information flows between care providers. However, knowing each other and good personal relations remain important for effective collaboration. Cooperation between all stakeholders is needed to aim to achieve continuity of care. Trial registration: DRKS00015183 on DRKS/ Universal Trial Number (UTN): U1111-1218–0992. Date of registration 23/08/2018.

Item does not contain fulltext Background: Key recommendations for the management of patients with polypharmacy are structured medication counselling (SMC), medication lists and systematic medication reviews. Objective: The aim of this study was to identify determinants (hindering and facilitating factors) for the implementation of the recommendations in general practice. Methods: This study was linked to a tailored intervention aimed at improving the implementation of the recommendations in German general practice. Interviews and focus groups with different healthcare professionals were carried out in the design phase and after delivery of the intervention. The material from both data collections was analysed separately in a content analytical approach resulting in two sets of categories. For this study, the subcategories of both sets were assigned to the Tailoring Interventions for Chronic Diseases (TICD) checklist, a comprehensive framework of determinants of practice. Results: Interviews with 24 general practitioners (GPs), 4 other medical specialists, 1 pharmacist, 3 nurses and 6 medical assistants as well as 2 mixed focus groups with 17 professionals were conducted. We identified 93 determinants: 29 referred to medication counselling, 21 to the use of medication lists, 20 to medications reviews and 23 to all recommendations. The determinants were related to all 7 main domains and to 25 of the 57 subdomains on the TICD checklist including guideline factors, patient factors, individual healthcare professional factors, social, political and legal factors, incentives and resources, and capacity for organizational change. Conclusion: While many interventions to improve polypharmacy focus on the provision of pharmacological knowledge, a much wider range of domains need to be addressed, such as communication skills, patient involvement and practice organization.

In 2015, more than 890,000 asylum seekers were registered in Germany. The provision of medical and psychosocial care for asylum seekers is facing numerous obstacles. Access to health care is mostly insufficient, particularly in initial reception centres. The present article describes the development and implementation of an interdisciplinary outpatient clinic for asylum seekers at the main registration authority in the state of Baden-Wuerttemberg operated by physicians of the University Hospital of Heidelberg and the local Medical Association in Heidelberg. A steering committee was appointed to plan and implement the interdisciplinary outpatient clinic. Semi-structured interviews with nine steering committee members were conducted to elucidate perceived barriers during the planning and implementation phase. The steering committee's strong personal commitment and the health authorities' impartial management were cited as the main contributing factors to the success of the implementation process. Significant barriers were seen in the funding of personnel, equipment, and language mediation as well as in legal liability and billing-related aspects. Results are discussed with a focus on financing, administrative and legal framework as well as language mediation, documentation and further matters that are essential to ensure high-quality care.

Zusammenfassung Hintergrund Hausarzte zahlen zu den Facharztgruppen mit den haufigsten Medikamenten-verordnungen. Die Vertiefung pharmakologischer Kenntnisse ist deshalb ein wichtiger Bestandteil der hausarztlichen Fort- und Weiterbildung. Das hausarztliche Selbstverstandnis, als erster Ansprechpartner bei allen Gesundheitsproblemen zu helfen, macht es zu einer Herausforderung, Weiterbildungsinhalte zu definieren und zu erwerben. Wahrend das von der Deutschen Gesellschaft fur Allgemeinmedizin entwickelte „Kompetenzbasierte Curriculum Allgemeinmedizin" essentielle Diagnosen, Beratungsanlasse und Kompetenzen fur die hausarztliche Tatigkeit definiert, fehlt eine solche Orientierung fur den pharmakologischen Bereich. Ziel dieser Arbeit ist, Wirkstoffe zu identifizieren und zu charakterisieren, die jeder Hausarzt so gut beherrschen sollte, dass er dazu beraten und Monitoringmasnahmen einleiten und durchfuhren kann. Methodik Es wurden die Verordnungen von Privat- und Kassenrezepten aller am CONTENT-Projekt teilnehmenden Praxen des Zeitraums 2009 bis 2014 analysiert. Die Analyse wurde auf oral applizierbare Wirkstoffe beschrankt, die von mindestens 25% (n=11) der Hausarztpraxen mindestens einmal verordnet wurden. Wahrend die hundert am haufigsten verordneten Wirkstoffe, die bereits uber 80% der Gesamtverordnungen ausmachten, aufgrund ihrer Verordnungshaufigkeit eingeschlossen wurden, wurden die weniger haufig verordneten Wirkstoffe in einem Rating-Verfahren zusatzlich nach ihrem Risikopotential und der hausarztlichen Relevanz beurteilt. Die auf dieser Basis eingeschlossenen Wirkstoffe wurden nach Beratungsanlassen/Diagnosen klassifiziert dargestellt. Ergebnisse Es wurden 1.912.896 Einzelverordnungen auf Basis der anatomisch-therapeutisch-chemischen Klassifikation (ATC) aus 44 Hausarztpraxen von 112.535 Patienten analysiert. Nach Anwendung der Einschlusskriterien verblieben 453 Wirkstoffe, von denen 302 Wirkstoffe als hausarztlich-relevant eingeschatzt wurden. Diese konnten 45 Beratungsanlassen/Diagnosen zugeordnet werden. Schlussfolgerung Das Ergebnis dieser Arbeit kann als Entwicklungsversion eines hausarztlich-pharmakologischen Curriculums gesehen werden und perspektivisch das kompetenzbasierte Curriculum Allgemeinmedizin sinnvoll erganzen.

Item does not contain fulltext BACKGROUND: The aim of this umbrella review was to summarize the research evidence on programs to improve the transition between ambulatory and hospital care. METHODS: The MEDLINE database and the Cochrane library were searched. Systematic reviews of randomized controlled trials published between January 2000 and September 2018 in English or German were included. Studies were eligible if an assessment or coordination intervention had been evaluated and if patients had been transferred between hospital (defined as internal medicine, surgery, or unspecified hospital setting) and home (defined as any permanent residence). Risk of bias was assessed using the AMSTAR criteria. Results are presented descriptively and in table format. RESULTS: Thirty-nine systematic reviews comprising 492 different studies were included. More than half of these studies were conducted in the United States, the United Kingdom, Canada, and Australia. All studies evaluated strategies to improve discharge management (introduced after patients' arrival at the hospital); no study assessed strategies to improve admission management (initiated in primary care before patients' transition to hospital). The reviews included focused on a specific patient group, a specific intervention type, or a specific outcome. Overall, interventions focusing on elderly patients and high-intensity interventions seemed to be most effective. An overview of classifications of care transition strategies is provided. CONCLUSIONS: Future research should focus on hospital admission management programs.

IntroductionThe aim of this study was to assess the effectiveness of a patient-held health record (PHR) for asylum seekers on the availability of health-related information.MethodsAn explorative, cluster-randomised stepped-wedge trial with reception centres as unit of randomisation was conducted. All reception centres (n=6) in two large administrative areas in South Germany with on-site health services were included. All physicians working at these centres were invited to participate in the study. The intervention was the implementation of a PHR. The primary outcome was the prevalence of written health-related information. Secondary outcomes were the physicians’ dissatisfaction with the available written information and the prevalence of missing health-related information. All outcomes were measured at the level of patient–physician contacts by means of a standardised questionnaire, and analysed in logistic multi-level regression models.ResultsWe obtained data on 2308 patient–physician contacts. The presence of the PHR increased the availability of health-related information (adjusted OR (aOR), 20.3, 95% CI: 12.74 to 32.33), and tended to reduce missing essential information (aOR 0.71, 95% CI: 0.39 to 1.26) and physicians’ dissatisfaction with available information (aOR 0.5, 95% CI: 0.24 to 1.04). The availability of health-related information in the post-intervention period was higher (aOR 4.22, 95% CI: 2.64 to 6.73), missing information (aOR 0.89, 95% CI: 0.42 to 1.88) and dissatisfaction (aOR 0.43, 95% CI: 0.16 to 1.14) tended to be lower compared with the pre-intervention period.ConclusionsHealthcare planners should consider introducing PHRs in reception centres or comparable facilities. Future research should focus on the impact of PHRs on clinical outcomes and on intersectoral care.Trial registrationISRCTN13212716. Registered 24 November 2016. Retrospectively registered. http://www.isrctn.com/ISRCTN13212716

In 2015 Germany received more than 476 600 asylum applications.1 Incoming asylum seekers are accommodated in reception centres (RCs) for up to 6 months before they are dispersed to other federal states or districts. Due to the high immigration since the end of 2014, many federal states established new RCs to expand their capacities in hosting asylum seekers. Baden Wurttemberg, for example, one of the largest federal states receiving about 13% of incoming asylum seekers, expanded its capacity from one RC up until 2014 to five RCs thereafter. Since there are no nationwide standards in place, healthcare provision in RCs is highly heterogeneously organised and fragmented.2 In Heidelberg, former barracks of the US army were reorganised as an RC in August 2015 and hosted about 6500 asylum seekers. The concentration of asylum seekers in the RC, linked with insufficient provision of primary health care, led to an unmanageable number of consultations in emergency departments of nearby hospitals. Asylum seekers have specific healthcare needs due to exposure to pre-, peri-, and postmigration health risks. These include traumatic events,3 endemic infectious diseases in the countries of origin or transit,4 and chronic conditions which may have been exacerbated during the migration process. They are also at higher risk of developing psychological distress5 and acquiring infectious diseases in the host country due to mass accommodation.6 To address both the shortcomings in primary care provision and the special needs, a walk-in clinic jointly led by the university hospital, the public health services, and the local physicians’ association was established in the RC with funds from the state government and the university hospital. The clinic provides general medicine as well as gynecological, paediatric, and psychiatric and psychosomatic health care. The aim of this article is to report challenges and solutions of …