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Objectives: Patients in German ambulatory care frequently report patient safety problems (PSP). It is unclear whether patients report PSP back to their general practitioner (GP) or specialist in charge. This study reports on how patients respond to experienced PSP., Design: Retrospective cross-sectional study., Setting: Computer-assisted telephone interviews (CATI) with randomly recruited citizens aged ≥40 years in Germany., Participants: 10 037 citizens ≥40 years. About 52% of the interviewees were female, 38% were between 60 and 79 years old and about 47% reported that they were chronically ill. A total of 2589 PSPs was reported., Primary and Secondary Measures/results: According to the respondents (n=1422, 77%, 95% CI: 74.7 to 79.1), 72% (95% CI: 70.2 to 73.7) of PSP were reported back to the GP in charge or to another GP/specialist. Further reactions were taken by 65% (95% CI: 62.5 to 67.5) of the interviewees: around 63% (95% CI: 62.5 to 66.2) of the reported PSP led to a loss of faith in the physician or to complaints. χ 2 and binary logistic regression analyses show significant associations between the (a) reporting and (b) reaction behaviour and determinants like 'medical treatment area' ((a) χ 2 =17.13, p=0.009/(b) χ 2 =97.58, p=0.000), 'PSP with/without harm' ((a) χ 2 =111.84, p=0.000/(b) χ 2 =265.39, p=0.000) and sociodemographic characteristics when respondents are aged between 40 and 59 years ((a) OR 2.57/(b) OR 2.60) or have chronic illnesses ((a) OR 2.16/(b) OR 2.14)., Conclusion: The data suggest that PSPs are frequently reported back to the GP or specialist in charge and have a significant serious impact on the physician-patient relationship. Much could be learnt from the patient reporting and reacting behaviour to prevent PSPs in ambulatory care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The epidemiology of patient safety problems (PSPs) in the German ambulatory care sector is largely unknown. So far, there has been a lack of appropriate survey instruments., Objective: Development and application of a questionnaire (PSP-AMB), which records the epidemiology of PSP in the ambulatory care sector from the patient's perspective by using computer-assisted telephone interviews (CATI) on a population sample of ≥40-year-olds., Methods: The questionnaire items were developed by means of a literature search and guided interviews with ambulatory care physicians (N=10) and patients (N=20). The conversion to CATI and its application in the field was carried out by a survey institute. Qualitative (N=20) and quantitative (N=110) pretests were conducted before going into the field. The sample was generated via randomly generated fixed and mobile telephone numbers., Results: PSP-AMB collects 32 PSPs in seven areas of medical treatment, from medical history-taking to practice organisation, and surveys all PSPs from the last 12 months (PSP-one-year incidence), PSPs with harm since the age of 40 (PSP-40+-prevalence), as well as PSPs resulting in death or severe need for care via proxy survey of the participants' parents and children. Detailed questions record the consequences and handling of PSPs and participants' socio-demographic data. Between May and October 2018, a total of 10,037 citizens (participation rate: 12.4%) were interviewed. The drop-out rate was 8.3%. The sample represents the German population aged 40 years or older., Discussion: PSP-AMB is suitable for systematically recording PSPs in the ambulatory care sector from the patient's perspective. Thus, PSP-AMB meets the international demand to actively involve patients as a valuable source of information to improve patient safety., (Copyright © 2021. Published by Elsevier GmbH.)

Objectives: Data on patient safety problems (PSPs) in ambulatory care are scarce. The aim of the study was to record the frequency, type, severity and point of origin of PSPs in ambulatory care in Germany., Design: Retrospective cross-sectional study., Setting: Computer-assisted telephone interviews with randomly recruited citizens aged ≥40 years in Germany who were asked about their experiences with PSPs in ambulatory care., Participants: 10 037 citizens ≥40 years., Measures: A new questionnaire was developed to record patient experiences with PSPs in ambulatory care. The study reported here targets patient experiences in the last 12 months. The questionnaire focuses on PSPs in seven areas of medical treatment: anamnesis/diagnostic procedures; medication; vaccination, injection, infusion; aftercare; outpatient surgery; office administration; other areas. For each PSP reported, detailed questions were asked about the specialist group concerned, and, on the most serious harm, the severity of the harm and its consequences. The target parameters are presented as proportions with 95% CIs., Results: 1422 of the respondents (14%) reported 2589 PSPs. The areas most frequently affected by PSPs were anamnesis/diagnostic procedures (61%) and medication (15%). General practitioners accounted for 44% of PSPs, orthopaedists for 15% and internists for 10%. 75% of PSPs were associated with harm, especially unnecessarily prolonged pain or deterioration of health; 35% of PSPs led to permanent harm. 804 PSPs (32%) prompted patients to see another doctor for additional treatment; 255 PSPs (10%) required inpatient treatment., Conclusion: PSPs experienced by patients are widespread in ambulatory care in Germany. The study reveals in which areas of medical treatment efforts to prevent PSPs could make the greatest contribution to improving patient safety. It also demonstrates the valuable contribution of patient reports to the analysis of PSPs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The study aimed to illustrate the effect of the patients' sex, age, self-rated health and medical practice specialization on patient satisfaction., Design: Secondary analysis of patient survey data using multilevel analysis (generalized linear mixed model, medical practice as random effect) using a sequential modelling strategy. We examined the effects of the patients' sex, age, self-rated health and medical practice specialization on four patient satisfaction dimensions: medical practice organization, information, interaction, professional competence., Setting: The study was performed in 92 German medical practices providing ambulatory care in general medicine, internal medicine or gynaecology., Participants: In total, 9888 adult patients participated in a patient survey using the validated 'questionnaire on satisfaction with ambulatory care-quality from the patient perspective [ZAP]'., Main Outcome Measure(s): We calculated four models for each satisfaction dimension, revealing regression coefficients with 95% confidence intervals (CIs) for all independent variables, and using Wald Chi-Square statistic for each modelling step (model validity) and LR-Tests to compare the models of each step with the previous model., Results: The patients' sex and age had a weak effect (maximum regression coefficient 1.09, CI 0.39; 1.80), and the patients' self-rated health had the strongest positive effect (maximum regression coefficient 7.66, CI 6.69; 8.63) on satisfaction ratings. The effect of medical practice specialization was heterogeneous., Conclusions: All factors studied, specifically the patients' self-rated health, affected patient satisfaction. Adjustment should always be considered because it improves the comparability of patient satisfaction in medical practices with atypically varying patient populations and increases the acceptance of comparisons., (© The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com)

Background: The National Association of Statutory Health Insurance Physicians develops quality indicators (QIs) for ambulatory care in Germany. This study explores the feasibility of a total of 48 QIs., Methods: Cross-sectional observational study with primary data collection in writing from medical practices in 10 specialist fields of outpatient care. "Feasibility" covers 7 criteria for indicator assessment and data collection: applicability, availability, retrievability, complexity, relevance, reliability, and acceptance. A questionnaire consisting of 10 questions was used to evaluate these feasibility criteria for each indicator. Survey results were subjected to descriptive analysis., Results: The analyzed sample comprises 103 participants who have been working as practice-based physicians for an average of 13 years. 40% only keep electronic medical records and 2% only paper records, and the rest uses both. The rating of QIs in the field-specific QI sets shows the following mean values: 67% of the participants consider the QIs assigned to them as corresponding to their practice care mandate. Data on these QIs deemed to be applicable are collected by 94% of respondents, documented by 91%, and by 51% electronically. 58% of the data required for the denominator, and 38% for the numerator are retrievable from the practice management system. The time required to access data on a QI is more than 30minutes for 84% of respondents, and 67% consider the effort involved as unacceptable. The rating received was 61% for the relevance of QIs to the assessment of a practitioner's own quality of health care, 69% for the estimated reliability of data collection, and 58% for the acceptance of being evaluated via QIs., Conclusions: In order to improve the feasibility of QI-based practice assessments it will be necessary to a) fine-tune the selection of QIs for the respective groups of specialist, b) to promote the use of computerized practice management systems, and c) integrate effective and user-friendly retrieval functions in the software. Another aspect to be explored is how the acceptance of QI-based practice evaluations can be improved in individual specialist fields., (Copyright © 2015. Published by Elsevier GmbH.)

Aim: Development of a starter set of quality indicators for application by general practitioners and specialists in the outpatient care sector., Methodology: The results of a systematic search for national and international quality indicators relevant to the outpatient care sector in Germany provided the basis for the indicator selection process. Outpatient care doctors rated the relevance and feasibility of the indicators according to the RAND/UCLA method. In a further step the indicators were tested in medical practices, focussing on data availability and accessibility., Results: As a result, we established a set of 48 reliable, structurally developed and patient-oriented quality indicators which can be used for quality improvement in the outpatient care setting, both by specialists and general practitioners., Discussion: The project provides important information with regard to the future development and use of quality indicators. Depending on the potential fields of application, the development of new indicators as well as a corresponding IT infrastructure is of high priority. Possible unintended effects of indicators will have to be considered.

Cooperation in psychosocial care is gaining increasing importance due to newly established psychosomatic departments in the acute care setting and to structural changes following the Health Care Modernization Act. The presented study aims at describing the psychosomatic treatment and cooperation practice in the ambulatory sector and the cooperation possibilities with the inpatient psychosomatic care sector. Registered doctors in all specialties along with psychotherapists working in private practice in the southwestern region of the Association of Panel Doctors (Nordbaden) were surveyed about this in a written questionnaire in 2003. Respondents totaled 497 (33 %). General practitioners (GPs) and somatic specialists first estimated the psychosocial treatment necessities based on patients in their own practice. Half reported cooperation with a psychosomatic colleague, 10 % took part in a Balint-style group. GPs and somatic specialists unlicensed in psychosomatic basic care reported significantly lower numbers on the existing psychosocial care practice compared to those with the respective license. GPs and somatic specialists regard diagnostic procedures as central for improving their daily psychosomatic/psychosocial care. More than 50 % would request a brief diagnostic screening instrument. Psychiatrists and psychotherapists prefer the option of case conferences. The reported cooperation preferences of a psychosomatic department follow established setting structures with little mention of cooperation options falling outside established sectors. GPs and psychiatrists/psychotherapists share the same priority in designating a contact person in the department for crisis intervention. This expresses their feelings for greater need in direct and acute cooperation features. Somatic specialists prefer to request a second opinion from the department. The predominant diagnoses to admit patients for both psychiatrists and psychotherapists are eating disorders, pain syndromes, and personality disorders.

Background: In settings like the ambulatory care sector in Germany, where data on the outcomes of interdisciplinary health services provided by multiple office-based physicians are not always readily available, our study aims to develop a set of indicators of health care quality and utilization for 14 groups of ambulatory-care-sensitive conditions based on routine data. These may improve the provision of health care by informing discussions in quality circles and other meetings of networks of physicians who share the same patients.Methods: Our set of indicators was developed as part of the larger Accountable Care in Deutschland (ACD) project using a pragmatic consensus approach. The six stages of the approach drew upon a review of the literature; the expertise of physicians, health services researchers, and representatives of physician associations and statutory health insurers; and the results of a pilot study with six informal network meetings of office-based physicians who share the same patients.Results: The process resulted in a set of 248 general and disease specific indicators for 14 disease groups. The set provides information on the quality of care provided and on patient pathways, covering patient characteristics, physician visits, ambulatory care processes, pharmaceutical prescriptions and outcome indicators. The disease groups with the most indicators were ischemic heart diseases, diabetes and heart failure.Conclusion: Our set of indicators provides useful information on patients' health care use, health care processes and health outcomes for 14 commonly treated groups of ambulatory-care-sensitive conditions. This information can inform discussions in interdisciplinary quality circles in the ambulatory sector and foster patient-centered care. [ABSTRACT FROM AUTHOR]