Search

Objectives: The aim of the study was to explore the subjective views of general practitioners on the applicability of the Adult ADHD Self-Report Screening Scale for DSM-5 (ASRS-5) as a screening tool for attention-deficit/hyperactivity disorder (ADHD) in adults in general practice., Method: Eleven general practitioners, who had participated in the validation study of the German version of the ASRS-5, were interviewed. For this purpose, a semi-structured interview guide was designed using the Consolidated Framework for Implementation Research (CFIR). The interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis according to Kuckartz., Results: The ASRS-5 seems to work well in general medical practice. But there is evidence for a lack of knowledge about ADHD in adults among general practitioners and a demand for further training in this area. Moreover, insufficient possibilities for subsequent treatment after a positive ADHD screening were claimed., Discussion: In general medicine, the introduction of a screening using ASRS-5 in cases of clinical suspicion could be the first step towards improving the management of adult patients with ADHD., Conclusion: Optimizing the management of adults with ADHD requires additional information and training initiatives to support early diagnosis especially in the primary care setting, and to reveal treatment options and care concepts for adults with ADHD., (Copyright © 2024. Published by Elsevier GmbH.)

Background: There is a discussion among general practitioners and psychiatrists regarding over-diagnosing versus under-reporting of psychiatric diagnoses. A deeper understanding of this topic is relevant for providing reasonable health care and for planning future studies. A crucial factor to understanding this discussion is the difference in the prevalence of a disease in each sector. One way to attain knowledge about such prevalences is the analysis of routine care data of the sector in question. However, diagnosis-related data might be modified by several additional influencing factors., Aims: This study aims to explore what kind of motives and modifying factors play a role for or against giving psychiatric diagnoses in psychiatric and general medical settings., Methods: Twenty-six semi-structured interviews were conducted with German physicians in the fields of general medicine and psychiatry. Interviews were analysed using content analysis., Results: The analysis revealed three major motivational categories for finding a diagnosis: (1) "objective matters" such as "categorisation for research"; (2) "functional and performance-related factors" such as "requirement for medication", "billing aspects" that go with certain diagnoses or "access to adequate care" and (3) "Individual factors" such as the "personality of a physician". Similarly, factors emerged that lead to not making psychiatric diagnoses like "fear of stigmatization among patients" or "detrimental insurance status with psychiatric diagnosis". Additionally participants mentioned other reasons for "not diagnosing a psychiatric diagnosis", such as "coding of other clinical pictures"., Conclusion: The diagnostic process is a complex phenomenon that goes far beyond the identification of medical findings. This insight should be considered when processing and interpreting secondary data for designing health care systems or designing a study., (© 2024. The Author(s).)

Background: Postgraduate training in general medicine should be oriented on competencies and profession-forming, as is suggested by the German Regulations on Specialist Training of federal and state governments and the Competence-based Curriculum General Medicine. The learnability of general practitioner (GP) roles and the profession-forming orientation of the postgraduate training conditions during the outpatient postgraduate training period were investigated., Methods: A cross-sectional study in questionnaire design was conducted from October until December 2019 among 220 physicians in postgraduate training who were registered at the Association of Statutory Health Insurance-Accredited Physicians in Rhineland-Palatinate for the specialty of general medicine. The GP roles surveyed were based on the "CanMEDS General Medicine" roles. Using indicators created from the didactic model "Cognitive Apprenticeship", profession-forming alignment of postgraduate training conditions in the GP practices were studied. The data obtained were analysed descriptively., Results: The response of 70 evaluable questionnaires included a gender distribution of 51 female and 18 male family medicine residents. The family medicine residents were almost equally divided between single-handed practices, cooperating practice associations and group practices. Slightly more than half of the female physicians worked part-time, whereas the male physicians were all full-time employees. The roles of "member of an interprofessional team", "health advocate" and "medical expert" were perceived as learnable by 70 to 90% of the family medicine residents. In addition to approval, varying degrees of indecision and rejection were expressed regarding the learnability of the roles of "teacher/scholar", "member of a network" and "employer". A slight majority considered the appropriation of the role of "practice manager" to be critical. Within the survey of profession-forming postgraduate training conditions, the indicators "accessible contact person", "collegial appreciation" and "assumption of responsibility" were approved by more than 90% in some cases. The indicators "access to GP acting" (approx. 86%) and "resilience" (approx. 71%) also received high approval ratings. However, the indicator "continuous feedback" only received a slight majority of approval., Discussion: GP postgraduate training practices in Rhineland-Palatinate apparently offer suitable educational locations to family medicine residents to acquire a solid basis for professional practising and the skills for patient-oriented communicating of preventive health-promoting contents. Male physicians seem to follow more traditional professional hierarchies. In contrast, female physicians are more receptive to teamwork but tend to be sceptical about adopting a leadership position. The learnability of particular GP roles may benefit from close collaboration with the practice owner, especially in single-handed practices. In addition, the working time model chosen seems to have an effect., Conclusions: It can be assumed that profession-forming postgraduate training conditions predominate in Rhineland-Palatinate GP postgraduate training practices, where the role of "medical expert" also appeared to be learnable in most cases. In some cases the learnability of GP roles was significantly influenced by the factors "gender", "working time model" and "form of practice". Consequently, it could have a quality-enhancing impact if these factors were taken into account in the development of measures to realize competence orientation in GP postgraduate training., (Copyright © 2023. Published by Elsevier GmbH.)

The hospital benchmarking system in Germany was originally introduced to detect unintended consequences of reimbursement based on diagnosis-related groups. The new nationwide SQG programme aims to provide information on quality and outcomes of health care provided in hospital, ambulatory specialist and primary care settings, including the healthcare delivery across different sectors. In 2010 the topics for indicator development were cataract surgery, cervical conization, colectoral cancer and percutaneous coronary interventions or coronary angiography. A systematic stepwise modified RAND/UCLA procedure is applied to develop quality indicators in each of these domains. A general framework for data collection is implemented. Benchmarking results are fed back to providers on a regular basis. [ABSTRACT FROM PUBLISHER]

Graded exams are prerequisites for the admission to the medical state examination. Accordingly the exams must be of good quality in order to allow benchmarking with the faculty and between different universities. Criteria for good quality need to be considered - namely objectivity, validity and reliability. The guidelines for the processing of exams published by the GMA are supposed to help maintaining those criteria. In 2008 the Department of General Medicine at the University of Munich fulfils only 14 of 18 items. A review process, appropriate training of the staff and the introduction of the IMSm software were the main changes that helped to improve the 'GMA-score' to 30 fulfilled items. We see the introduction of the IMSm system as our biggest challenge ahead. IMSm helps to streamline the necessary workflow and improves their quality (e.g. by the detection of cueing, item analysis). Overall, we evaluate the steps to improve the exam process as very positive. We plan to engage co-workers outside the department to assist in the various review processes in the future. Furthermore we think it might be of value to get into contact with other departments and faculties to benefit from each other's question pools.