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Colorectal cancer (CRC) screening tests differ in benefits, harms, and processes, making individual informed decisions preference based. The objective was to analyze the preferences of insurees in Germany for characteristics of CRC screening modalities.A generic discrete choice experiment with 2-alternative choice sets and 6 attributes (CRC mortality, CRC incidence, complications, preparation, need for transportation, and follow-up; 3 levels each) depicting characteristics of fecal testing, sigmoidoscopy, and colonoscopy was generated. Participants completed 8 choice tasks. Internal validity was tested using a within-set dominated pair. Between June and October 2020, written questionnaires were sent to a stratified random sample (n = 5000) of 50-, 55-, and 60-year-old insurees of the AOK (Allgemeine Ortskrankenkasse) Lower Saxony, who had previously received an invitation to participate in the organized screening program including evidence-based information. Preferences were analyzed using conditional logit, mixed logit, and latent-class model.From 1282 questionnaires received (26% [1282 of 4945]), 1142 were included in the analysis. Approximately 42% of the respondents chose the dominated alternative in the internal validity test. Three heterogeneous preference classes were identified. Most important attributes were preparation (class 1; n = 505, 44%), CRC mortality (class 2; n = 347, 30%), and CRC incidence (class 3; n = 290, 25%). Contrary to a priori expectations, a higher effort was preferred for bowel cleansing (class 1) and accompaniment home (classes 1 and 2).Internal validity issues of choice data need further research and warrant attention in future discrete choice experiment surveys. The observed preference heterogeneity suggests different informational needs, although the underlying reasons remained unclear.

Melanie Brinkmann, Isabell von Holt, Leonie Diedrich, Christian Krauth, Gabriele Seidel, Maren Dreier Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, GermanyCorrespondence: Melanie Brinkmann, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany, Email Brinkmann.Melanie2@mh-hannover.dePurpose: This qualitative study is part of the SIGMO study, which evaluates general populations’ preferences for colorectal cancer (CRC) screening in Germany using a discrete choice experiment. Attribute identification and selection are essential in the construction of choice tasks and should be evidence-based ensuring that attributes are relevant to potential beneficiaries and contribute to overall utility. Therefore, this qualitative study aims to identify relevant attributes characterizing CRC screening tests from the perspective of those eligible for screening in Germany.Patients and Methods: Individuals aged 50 to 60 were purposively selected. A questioning route was developed and piloted. Four focus groups (FG) (n=20) were conducted (November 2019) with two moderators and one observer each. FGs were audio recorded, transcribed, and analyzed using qualitative content analysis. Attributes were deductively assigned based on a priori identified attribute categories, and inductively derived.Results: Across FGs, 24 attributes (n=293 codes) were discussed, five of which (sedation, inability to work, transportation home, predictive values, waiting time for screening colonoscopy) were inductively derived (n=76 codes). Four attributes identified a priori were not addressed in any FG. The most frequently discussed attribute category was procedural characteristics, followed by measures of screening test validity, benefits, harms, and structural characteristics of health care. The most commonly addressed attributes were preprocedural bowel cleansing, kind of procedure, and predictive values.Conclusion: Newly identified attributes characterizing CRC screening tests from an individual’s perspective, and a priori identified attributes not addressed by any FG stress the added value of qualitative research and thereby the importance of applying a mix of methods in identifying and selecting attributes for the construction of choice tasks. This study meets the requirements for a transparent and detailed presentation of the qualitative methods used in this process, which has rarely been the case before.Keywords: focus groups, qualitative study, colorectal cancer screening, attribute identification, discrete choice experiment

BACKGROUND: In recent years, telemedicine has gained increasing importance in the delivery of pharmaceutical care. The use of video technologies for remote communication between different parties offers the potential to meet the future challenges which arise from the increase in elderly and chronically ill patients. However, the influence of these technologies on patient-related outcomes in pharmaceutical care is not yet sufficiently known.; METHOD: In December 2018 a systematic literature search was conducted in the databases Medline, Cochrane Library and PubPharm. Randomized controlled trials were considered, which investigate real-time video conferencing between pharmacists on the one hand and patients or other healthcare providers on the other hand. The influence on patient related outcomes compared to standard care was assessed. The bias potential was evaluated using the Cochrane Risk-of-Bias instrument. A total of 4 randomized controlled trials could be included.; RESULTS: The studies describe partly complex intervention settings with adults and adolescents suffering from asthma, chronic renal failure, HIV infection, hyperlipidemia, hypertension and/or diabetes. None of the studies considers the interprofessional communication of pharmacists with other service providers. No influence on clinical or psychological endpoints was found. In some cases, an increase in adherence and correct medication use is evident. Healthcare utilization is not influenced. In all studies there is an increased risk of systematic bias.; DISCUSSION: Teleconsultations with pharmacists can rather be used to ensure the general provision of pharmaceutical care than to improve patient-related outcomes. Further studies are necessary to fully depict the influence of telemedical interventions in pharmaceutical care. Copyright © 2020 Elsevier Inc. All rights reserved.

IntroductionIn Germany, statutory insured persons are entitled to a stool test (faecal immunochemical test (FIT)) or colonoscopy for colorectal cancer (CRC) screening, depending on age and sex, yet participation rates are rather low. Sigmoidoscopy is a currently not available screening measure that has a strong evidence base for incidence and mortality reduction. Due to its distinct characteristics, it might be preferred by some, who now reject colonoscopy. The objective of this study is to estimate the economic consequences of the additional offer of sigmoidoscopy for CRC screening in Germany compared with the present screening practice while considering the preferences of the general population.Methods and analysisA decision-analytic modelling approach will be developed that compares the present CRC screening programme in Germany (FIT, colonoscopy) with a programme extended by sigmoidoscopy from a societal perspective. A decision tree and Markov model will be combined to assess both short-term and long-term effects, such as CRC and adenoma detection rates, the number of CRC cases, CRC mortality as well as complications. The incremental cost per quality-adjusted life year gained for each alternative will be calculated. The model will incorporate the general population’s preferences based on a discrete choice experiment. Further, input parameters will be taken from the literature, the German cancer registry and health insurance claims data.Ethics and disseminationEthical approval for the study was obtained from the Ethics Committee of Hannover Medical School (ID: 8671_BO_K_2019). The findings of the study will be published in peer-reviewed journals and presented at national and/or international conferences.Trial registration numberDRKS00019010.

Media reporting can influence the perception and development of attitudes through the frequency and the way certain topics are presented. The German Medical Journal “Deutsches Arzteblatt” is one of the most important media for agenda-setting in Germany. It thus has an influence on opinion-forming and acceptance within the medical profession in regard to innovative healthcare technologies. The aim of this work is to quantify the media representation of telemedicine and deduce the qualitatively depicted acceptance factors. All articles on telemedicine published in “Deutsches Arzteblatt” between 01/01/2008 and 01/01/2018 were reviewed. The type of article, the focus, the connotation, and the degree of explanation were recorded quantitatively as well as the discussed topics and content aspects. In a structured content analysis, acceptance factors were derived based on the unified theory of acceptance and use of technology (UTAUT). The representation of telemedicine in the German Medical Journal has increased significantly in the last 10 years, and shows a tendency towards neutral and balanced reporting. A change in content can be seen. While the focus was still on technical aspects until 2012, it is currently increasing in the scientific–medical field. Emphasis is put on the presentation of expectations of performance and effort as well as the description and modification of framework conditions. Further research is needed, focusing on the relevance of media representation of new forms of care such as telemedicine in order to increase acceptance and to develop attitudes on an individual, organizational, and systemic level.

Zusammenfassung. Hintergrund: Der Einsatz von Informations- und Kommunikationstechnologien in der ambulanten Pflege erfolgt vor dem Hintergrund des demografischen Wandels mit dem Ziel, auch in Zukunft die Qualität der pflegerischen Versorgung sicherzustellen. Die Akzeptanz der telematischen Anwendungen ist dabei entscheidend für die erfolgreiche Implementation. Ziel: Das Ziel der Untersuchung war eine Erfassung der subjektiven Haltungen und Einstellungen sowie der Nutzungsintention der Pflegekräfte hinsichtlich telematischer Anwendungen in der ambulanten Pflege. Methoden: Auf der theoretischen Grundlage der „Unified Theory of Acceptance and Use of Technology“ (UTAUT) wurde eine Onlineumfrage erstellt, anhand derer deutschlandweit ambulante Alten- und Krankenpflegekräfte sowie Auszubildende in Pflegeschulen befragt wurden. Insgesamt konnten 371 Befragte in die Analyse eingeschlossen werden. Ergebnisse: Der Informationsstand zur Telematik und die eigenen technischen Kompetenzen werden als gering eingeschätzt. Es wird eine verbesserte Transparenz des Pflegeprozesses erhofft; genauso wie eine Erleichterung des Austausches sektorintern und -übergreifend. Dagegen wird befürchtet, dass die telematischen Anwendungen mit erhöhten Kosten, Schulungsaufwand und Technikabhängigkeit einhergehen. Schlussfolgerungen: Die Ergebnisse zeigen die Relevanz der Einstellungen und Bedürfnisse von Nutzerinnen und Nutzern für eine erfolgreiche Implementierung. Aus-, Fort- und Weiterbildungen sollten in Zukunft verstärkt die technologische Kompetenz der Pflegekräfte fördern.

Telematics in ambulatory care: Exploring the nurses' perspective Abstract.In the context of demographic change, the use of information and communications technology in home care has the aim of ensuring the quality of nursing care in the future. The acceptance of telematic applications by all users is crucial in this regard.The aim of this study was to assess the subjective attitudes and intentions of nursing staff on telematic applications in home care.Based on the "Unified Theory of Acceptance and Use of Technology" (UTAUT), an online survey was conducted in which nursing staff as well as nursing students throughout Germany were surveyed. 371 questionnaires have been included in the analysis.Nursing students as well as nurses stated inadequate information and insufficient technical competence. Referring to performance expectations, both groups hope for improving care process transparency and communication inside and outside sectors. For effort expectancy, higher costs, training efforts and technology dependency were named.The results show the relevance of the attitudes and demands of users for a successful implementation. In the future, training and further education should increasingly promote the technological competence of nursing staff.Zusammenfassung. Hintergrund: Der Einsatz von Informations- und Kommunikationstechnologien in der ambulanten Pflege erfolgt vor dem Hintergrund des demografischen Wandels mit dem Ziel, auch in Zukunft die Qualität der pflegerischen Versorgung sicherzustellen. Die Akzeptanz der telematischen Anwendungen ist dabei entscheidend für die erfolgreiche Implementation. Ziel: Das Ziel der Untersuchung war eine Erfassung der subjektiven Haltungen und Einstellungen sowie der Nutzungsintention der Pflegekräfte hinsichtlich telematischer Anwendungen in der ambulanten Pflege. Methoden: Auf der theoretischen Grundlage der „Unified Theory of Acceptance and Use of Technology“ (UTAUT) wurde eine Onlineumfrage erstellt, anhand derer deutschlandweit ambulante Alten- und Krankenpflegekräfte sowie Auszubildende in Pflegeschulen befragt wurden. Insgesamt konnten 371 Befragte in die Analyse eingeschlossen werden. Ergebnisse: Der Informationsstand zur Telematik und die eigenen technischen Kompetenzen werden als gering eingeschätzt. Es wird eine verbesserte Transparenz des Pflegeprozesses erhofft; genauso wie eine Erleichterung des Austausches sektorintern und -übergreifend. Dagegen wird befürchtet, dass die telematischen Anwendungen mit erhöhten Kosten, Schulungsaufwand und Technikabhängigkeit einhergehen. Schlussfolgerungen: Die Ergebnisse zeigen die Relevanz der Einstellungen und Bedürfnisse von Nutzerinnen und Nutzern für eine erfolgreiche Implementierung. Aus-, Fort- und Weiterbildungen sollten in Zukunft verstärkt die technologische Kompetenz der Pflegekräfte fördern.

Background Heart failure is one of the most common and cost-intensive chronic diseases worldwide. Telemonitoring offers the potential to improve care of heart failure treatment and reduce cost. Empirical findings of its efficacy are inconsistent up to now. This systematic review examines the current state of research regarding health-related and economic endpoints. Methods A systematic review was conducted in July 2016 using the PubMed database and randomised controlled trials for the years 2011-2016. Only clinical research trials with heart failure patients were considered where the intervention was performed using external monitoring devices which transmitted data via information and communication technology. In all, 10 clinical trials were included. Results There is no definite evidence regarding improvement in care based solely on the most recent literature. Hospitalisation for heart failure and health-related quality of life were most positively influenced. There was no correlation between mortality and hospitalisations for all causes regarding telemonitoring. The overall costs tended to be higher for telemonitoring. Conclusion Further research is needed to examine the health-related and economic benefits of telemonitoring for heart failure. A particular challenge is the evidence of cause-effect relationships within complex technology-supported health-care settings. The latest studies support the previous state of research.