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Sarah AK Uthoff,1 Anna Zinkevich,1 Jens Boenisch,2 Stefanie K Sachse,2 Tobias Bernasconi,2 Anna L Brütt,1 Lena Ansmann1 1Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany; 2Department of Special Education and Rehabilitation, University of Cologne, Cologne, GermanyCorrespondence: Sarah AK Uthoff, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 140, Oldenburg, 26129, Germany, Tel\Fax +494417984167, Email sarah.uthoff@uni-oldenburg.dePurpose: Many care settings are characterized by collaboration between a variety of stakeholders. People without natural speech who rely on augmentative and alternative communication (AAC) are often strongly dependent on the involved stakeholders and collaboration among them. Since collaboration can be challenged by many barriers, this study examines the impact of a complex intervention on collaboration in AAC care.Methods: In a quasi-experimental mixed methods intervention study which include AAC training, AAC therapy and case management, caregivers of AAC users were surveyed at 3 time points to assess collaboration and case management in the intervention versus comparison group. In addition, semi-structured focus group interviews were conducted with caregivers in the intervention group. Quantitative data were analyzed descriptively and by comparison of means. Qualitative data were analyzed using qualitative content analysis.Results: The Mann–Whitney U-test showed significantly better collaboration in the intervention group with stakeholders that are more actively involved in AAC care, such as schools (p=0.026) and residential or social facilities (p=0.010), but not with passive stakeholders such as health insurance companies. Most aspects of case management were rated significantly better in the intervention group (p< 0.001). The focus group results show mainly positive changes in collaboration with the active stakeholders, such as more commitment and openness toward AAC.Conclusion: The results show a positive impact of the intervention on the collaboration between stakeholders involved in AAC care – especially with active stakeholders. In particular, the organization of care and the accompanying case management by the AAC consultation centers seem to positively affect collaboration.Keywords: stakeholders, teamwork, mixed methods, focus groups, complex care

Anna Levke Brütt,1 Julia Luise Magaard,1 Sylke Andreas,1,2 Holger Schulz1 1Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 2Psychology Institute, Alps-Adria-University Klagenfurt, Klagenfurt, Austria Objective: Psychosomatic inpatient rehabilitation aims at promoting functioning in patients with mental disorders. Although generally effective, some patients do not benefit from this rehabilitation and suffer from symptoms as well as functional impairment. This study aimed to identify patient-reported factors influencing activity and participation outcomes.Subject and methods: Five focus groups with N=23 former psychosomatic rehabilitation inpatients were conducted. The discussions focused on facilitators and barriers of treatment outcome. The material was analyzed inductively according to qualitative content analysis. Categories were derived from the material.Results: Patients reported sociodemographic and clinical characteristics as well as personal factors, preparation before psychotherapy, and aspects of employment and health care as predictors of treatment success.Conclusion: A wide range of possible factors that influence the course of functioning from the patients’ perspective were determined. These factors can be assigned to the ICF conceptual model. Clinician and researcher perspectives may complement these factors. Keywords: activities of daily living, qualitative study, psychiatric rehabilitation, patient-centered care

Background: Demographic changes are leading to a rise in the demand for care services, with nursing homes (NHs) playing an increasingly important role in end-of-life care. Evidence suggests that NH residents at the end of life significantly benefit from hospice and palliative care and the implementation of advance care planning (ACP). In 2018, Germany passed a law to promote the implementation of ACP in NHs and to enable the refinancing of ACP services by the statutory health insurance funds. The present study aimed at assessing current hospice and palliative care structures, examining the implementation of ACP and identifying barriers to obtain approval for billing for ACP services under this specific legislative (§ 132 g SGB V)., Methods: As a part of the "Gut-Leben" project, the present study administered a cross-sectional quantitative survey in 2023 to evaluate hospice and palliative care structures, the implementation of ACP, and barriers to ACP approval in German NHs. A questionnaire was distributed to a random sample of N = 1,369 NH managers. Responses were analyzed using descriptive statistical methods., Results: N = 330 NH managers responded to the questionnaire (24.1% response). The majority described the end-of-life care structures in their region as rather good (77.7; n = 256), and very strong collaboration was reported with general practitioners (54.7%), physiotherapists (42.9%), and palliative care physicians (38.6%). Awareness of the legislative for ACP was reported by n = 201 NHs (64.4%), and 100 (50.3%) of these NHs had already obtained approval. The primary barriers to approval identified by 68 NHs included a lack of available staff (48.5%; n = 33) and a small facility size (27.9%; n = 19)., Conclusions: Although half of the NHs have implemented ACP, there is still a need to enhance awareness of the ACP legislative. These efforts should aim to reduce the existing barriers to approval, which could be achieved, for instance, by fostering collaboration between NHs or by cooperating with external ACP service providers., Competing Interests: Declarations. Ethics approval and consent to participate: The present study received a waiver from the local medical ethics committee of the Carl von Ossietzky Universität of Oldenburg (no. 2022–154). Since data was collected anonymously, consent to participate was not required. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: With the entry into force of sect. 132g of the Social Code Book [SGB] V in 2018, nursing homes and homes for persons with disabilities providing integration support in Germany can get reimbursed by the statutory health insurance funds for advance care planning (ACP) services. The aim of this feasibility study was to evaluate the number of service records to be submitted, examine the containing information about the consultation process, and assess their potential for research., Methods: We analyzed aggregated data from a large German statutory health insurance fund (AOK Lower Saxony) for 2018-2022 on the contracts concluded for ACP. In addition, anonymized service records from nursing homes and homes for persons with disabilities providing integration support from 2020 to 2022 (no records available for 2018 and 2019) were evaluated descriptively. These records contained information on the type and duration of the consultation process, as well as the number of consultations conducted. Furthermore, facility-specific information was available for facilities with at least one service record, including the number of care places and the number of consultants meeting the qualification requirements of sect. 132g SGB V., Results: In 2018-2022, n = 101 ACP contracts were concluded between the n = 1,415 nursing homes located in Lower Saxony and the state associations representing the interests of the health insurance providers (homes for integration support: n = 104). For the years with service records available (2020-2022), n = 134 contracts were signed. Of these facilities, n = 50 (37 %) had at least one service record, and only one facility (2 %) had more than one facilitator. Of the total n = 230 service records, 97 % documented a first-time consultant process. The process had a mean duration of 33 days and included an average of 2.9 consultant sessions. 13 % of the processes were completed in one day and almost 90 % after three months., Discussion/conclusion: We found a low number of (1) signed ACP contracts, (2) facilitators in the facilities, and (3) service records available at the health insurance company. However, service records are only one part of ACP. This is why, overall, service records in their current form appear to be of poor usability in the context of both scientific research and the further development of ACP., (Copyright © 2024. Published by Elsevier GmbH.)

Background: Guidelines serve as practice-based decision support and recommend the use of standardized instruments to measure functional capacity in individuals with multiple sclerosis (MS). However, the extent to which a person's functioning is captured by these instruments is unclear., Objectives: The aim of this study is to link the content of the MS disease guideline with the International Classification of Functioning, Disability and Health (ICF) in order to capture the distribution of the content on the functional domains and contextual factors and to uncover existing gaps., Materials and Methods: Instruments of the S2k guideline "Diagnosis and therapy of multiple sclerosis, neuromyelitis optica spectrum diseases and MOG-IgG-associated diseases", which were available free of charge in German or English and designed for adult people, were included. The instruments were classified into their meaningful concepts (meaningful concepts = MCs) and subsequently coded using standardized ICF rules by two raters., Results: The 23 included instruments contained 351 items and 718 MCs. Of these, 663 MCs could be linked to the ICF according to the coding rules. Of these, 51% (340 MCs) related to body functions, 44% (291 MCs) to the activity and participation component, and 5% (32 MCs) to environmental factors. The most frequently coded chapter was mobility (d4) with 201 MCs. Interrater agreement was k = 0.79., Discussion: The linking of the guideline-recommended instruments to the ICF shows that the instruments cover different themes. The area of environmental factors is underrepresented. The ICF linkage reveals a broad spectrum of functioning covered by the guideline-recommended instruments and facilitates the selection of appropriate instruments for the affected persons., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: J. Bolte, E.-M. Dilger und A.L. Brütt geben an, dass kein Interessenkonflikt besteht. Im Rahmen der vorliegenden Arbeit wurden keine Daten von Menschen erhoben, sondern verschriftlichte Instrumente der MS-Leitlinie qualitativ untersucht. Das Einholen eines Ethikvotums war dementsprechend nicht erforderlich., (© 2024. The Author(s).)

Introduction: People with multiple sclerosis and gait impairment are particularly susceptible to facing restrictions in their participation. This study aims to investigate (a) which contextual factors within the framework of the International Classification of Functioning, Disability and Health (ICF) are relevant for participation from the perspective of people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices, and (b) how these contextual factors shape the subjective facets of participation, including a sense of connection, efficacy and meaning, based on the social identity approach to health and well-being., Methods: We conducted a qualitative analysis on data gathered from four online focus group interviews, each involving four to six people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices (totalling N = 19), and 12 individual online interviews conducted with participants from the focus group interviews. The analysis followed the qualitative content analysis according to Kuckartz., Results: Mobility assistive devices such as walkers, manual wheelchairs and electric wheelchairs/scooters were seen as facilitators that enabled participation in various life situations and enhanced a sense of efficacy by promoting independence. Challenges were encountered in relation to architectural barriers, pathways, weather conditions, public transportation and the lack of integral accessibility to services and systems. Although instrumental support could ease participation, it was also associated with an impaired sense of efficacy. Attitudes, particularly developing an understanding of the experiences of people with multiple sclerosis and gait impairment from others' perspectives, were considered important but often lacking, and discriminatory attitudes were experienced. On the level of personal factors, acceptance of both the mobility assistive devices and the disease itself were seen as facilitators for maintaining involvement in life situations., Conclusions: This study extends the existing literature by shedding light on the interconnectedness of contextual factors within the ICF and various facets of perceived participation, including a sense of connection, efficacy and meaning. These findings provide valuable insights for stakeholders such as urban planners and policymakers in developing inclusive environments that enhance the overall quality of participation for people with multiple sclerosis and gait impairment., Patient or Public Contribution: This study reports on the lived experiences of people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices. The research team stood in close exchange with project members of the German Multiple Sclerosis Society Lower Saxony, a group representing the interests of people with multiple sclerosis, to design and conduct the focus group interviews. The results from the focus group interviews were the basis for the design of a participatory future workshop in which people with multiple sclerosis and stakeholders involved in the healthcare process collaboratively developed recommendations for improving the provision of mobility assistive devices., Trial Registration: German Clinical Trials Register number: DRKS00025532., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)