Search

Background A SARS-CoV-2 infection can lead from asymptomatic through to critical disease in a dynamic and unpredictable course within a few days. The challenge in outpatient monitoring the highly contagious COVID-19 disease during the ongoing pandemic is to filter severe courses followed by admission to hospital with the aim of preventing an overburdening of clinics. However, little is known of the effect of risk factors on the course of the infection of outpatient patients. To support general practices in managing high risk patients, we designed a COVID-19 surveillance and care tool (CovidCare). It includes an initial assessment of yet known risk factors and symptoms and a continuous telephone monitoring of signs and symptoms. This study aims to investigate the effects of different risk factors on the course of the COVID-19 disease, utilisation of different health care services and to gain insights into the utilisation of CovidCare in general practices. Methods We will conduct a multi-centered prospective, longitudinal non-controlled observational trial of COVID-19 patients in general practices. Overall, 700 GPs who participate in general-practice centered care by the AOK Baden-Württemberg (large German sickness fund) are eligible and will be invited for study participation, including adult, outpatient COVID-19 patients (or urgent suspicion and ≥ 50 years) with at least one additional known risk factor, who participate in general-practice centered care. The primary outcome is hospitalisation due to COVID-19. Secondary outcomes are diagnosis of pneumonia, utilisation of palliative care, mortality rate, anxiety and identification of predictive risk factors. Quantitative data analysis will focus on valid descriptive figures and mixed regression models. The accompanying process evaluation is based on interviews and questionnaires from general practice staff and patients. The analysis of the process evaluation is descriptive and explorative. Discussion The use of the COVID-19 surveillance and care tool is expected to encourage the provision of structured quality of care during the ongoing pandemic. This trial will provide an understanding of the COVID-19-disease and the effect of several risk factors on the course of the disease and health care utilisation. The results can be used for a better management of the COVID-19 pandemic and its consequences. Trial registration German Clinical Trials Register DRKS00022054.

ZusammenfassungWegen der durch die „corona virus disease 2019“ (COVID-19) ausgelösten Pandemie und den resultierenden Beeinträchtigungen persönlicher (d. h. von Angesicht zu Angesicht stattfindender) Behandlung haben Videokonsultationen in der Erbringung von Gesundheitsleistungen massiv an Bedeutung zugenommen. Die meisten Psychotherapeuten haben allerdings bis dato wenig praktische Erfahrung in der Durchführung von Videokonsultationen, nicht zuletzt auch aufgrund bisher eingeschränkter Möglichkeiten zur Abrechnung mit den Kostenträgern. Der vorliegende Beitrag stellt (1) eine Übersicht über die Wirksamkeit per Videokonsultation durchgeführter psychotherapeutischer Interventionen bei depressiven und Angststörungen, (2) Empfehlungen zur spezifischen Gestaltung des Behandlungsrahmens sowie (3) erste Erfahrungen von Patienten und Psychotherapeuten aus einer deutschen Machbarkeitsstudie sowie mit dem Routineangebot im Krankenhaus während der COVID-19-Pandemie vor.

The approaches to cope with the challenges of providing medical care to patients with symptoms of long COVID are multidisciplinary and involve primary care worldwide. The aim of this study was to explore the experiences and ideas for continued development of medical care of long COVID from the patients' (PAT) and primary care practitioners' (PCP) perspective.Between the third and fourth COVID-19 wave in Germany (July to September 2021), a mixed methods study was conducted by inviting patients and PCPs in two neighboring districts (urban and rural) in Baden-Wuerttemberg to a paper-based questionnaire with both closed and open questions. On the part of the PCPs a written, anonymized, complete survey was conducted, on the part of symptomatic COVID long-haulers an anonymized online survey with announcement of the study by multiple recruiting processes. Qualitative content analysis was applied to free text entries. The quantitative results were analyzed mainly descriptively.The responses of n = 72 PCPs (response rate 12%) and n = 126 PAT showed a heterogeneous assessment regarding the satisfaction with medical care for long COVID as well as the perception of the attitude towards patients and their disease in both groups. Uncertainty and dealing with it played a relevant role in both groups as well. The professional medical knowledge was assessed by 3,1 (self-assessment PCPs) and 3,2 (PAT) on average using a five-point Likert scale (1 = not applicable; 5 = applicable). The request for a structured overall concept with competent contact points and coordination of medical care for long COVID patients emerged out of the statements of both groups.The results support an interdisciplinary, intersectoral and interprofessional stepped-care concept for long COVID in Germany with PCPs as the first contact persons, integration of specialized contact points and knowledge transfer. Therefore, it appears to be both reasonable and appropriate to establish regional networks with links between regional outpatient medical care structures and the university medical sector.

ObjectiveDespite available effective treatments for mental health disorders, few patients in need receive even the most basic care. Integrated telepsychiatry services may be a viable option to increase access to mental healthcare. The aim of this qualitative process evaluation embedded in a randomised controlled feasibility trial was to explore health providers’ experiences with a mental healthcare model integrating mental health specialist video consultations (MHSVC) and primary care.MethodsA qualitative process evaluation focusing on MHSVC in primary care was conducted. In 13 semistructured interviews, we assessed the experience of all mental health specialists, primary care physicians and medical assistants who participated in the trial. A thematic analysis, focusing on the implementation, mechanisms of impact and context, was applied to investigate the data.ResultsConsidering (1) the implementation, participants evaluated the consultations as feasible, easy to use and time saving. Concerning (2) the mechanisms of impact, the consultations were regarded as effective for patients. Providers attributed the patients’ improvements to two key aspects: the familiarity of the primary care practice and the fast access to specialist mental healthcare. Mental health specialists observed trustful therapeutic alliances emerging and described their experience as comparable to same-room care. However, compared with same-room care, specialists perceived the video consultations as more challenging and sometimes more exhausting due to the additional effort required for establishing therapeutic alliances. Regarding (3) the intervention’s context, shorter travel distances for patients positively affected the implementation, while technical failures, that is, poor Internet connectivity, emerged as the main barrier.ConclusionsMHSVCs in primary care are feasible and successful in improving access to mental healthcare for patients. To optimise engagement and comfort of both patients and health providers, future work should focus on empirical determinants for establishing robust therapeutic alliances with patients receiving MHSVC (eg, leveraging non-verbal cues for therapeutic purposes).Trial registration numberDRKS00015812; Results.

ZusammenfassungPsychische Störungen stellen einen erheblichen Belastungsfaktor für den Einzelnen sowie die gesamte Gesellschaft dar. Erster und in den meisten Fällen einziger Ansprechpartner im Gesundheitssystem ist der Hausarzt. Die Überweisung von Patienten in zeitnahe spezialisierte psychosomatische oder psychotherapeutische Behandlung erweist sich jedoch aufgrund vieler Probleme, insbesondere in ländlichen Gebieten, als schwierig. Zu diesen Problemen zählen etwa lange Wartezeiten, die steigende Prävalenz psychosomatischer und somatopsychischer Komorbidität, altersbedingte Immobilität und patientenseitige Stigmatisierungserwartung. Im Sinne des Integrated Health Care Ansatzes stellt die diagnostische und therapeutische Adressierung psychischer Störungen durch Psychotherapeuten direkt in der Hausarztpraxis ein effektives Versorgungsmodell dar. Hier vorgestellt wird ein telemedizinisches Therapiekonzept für Menschen mit depressiven und ängstlichen Erkrankungen. Im Zentrum steht die Erprobung psychotherapeutischer Videokonsultationen innerhalb der Hausarztpraxis. Es soll ein Überblick über das Therapiekonzept gegeben sowie Ergebnisse zur Umsetzungsbereitschaft des Modells bei niedergelassenen Psychotherapeuten dargestellt werden.

Background Integrated mental health care models that provide rapid access to video consultations with mental health specialists for primary care patients are a promising short-term, low-threshold treatment option and may reduce waiting times for specialist care. This qualitative study, nested within a randomized feasibility trial, aimed to explore participants’ views on this type of care model, its influence on the lived experience of patients, and barriers and facilitators for its delivery. Methods In five primary care practices, 50 adults with depression and/or anxiety were randomly assigned to either an integrated care model (maximum of five video consultations with a mental health specialist) or usual care (primary care or another treatment option). Prior to obtaining the trial results, interviews were held with participants who had received video consultations. Interviews were transcribed and analysed thematically. Results Twenty of the 23 patients who received video consultations participated in the interviews. Patients engaged well with the care model and reported positive effects on their most pressing needs, while denying safety concerns. Generally, they perceived the usability of video consultations as high, and temporary connectivity failures were not considered a substantial barrier. We identified two key mechanisms of impacts on the patients’ lived experience: fast access to specialist mental healthcare and the emerging rapport with the specialist. In particular, patients with no prior mental healthcare experience indicated that familiarity with the primary practice and their physician as a gatekeeper were important facilitators of proactive treatment. Conclusions From the patients’ perspective, mental health care models integrating video consultations with mental health specialists into primary care are linked to positive lived experiences. Our findings imply that primary care physicians should promote their role as gatekeepers to (1) actively engage patients, (2) apply integrated care models to provide a familiar and safe environment for conducting mental health care video consultations, and (3) be able to regularly assess whether certain patients need in-person services. Scaling up such models may be worthwhile in real-world service settings, where primary care physicians are faced with high workloads and limited specialist services. Trial registration DRKS00015812.

Due to individual care needs, the provision of care to patients with two or more chronic diseases (multimorbidity) is described as complex. In addition, the number of chronically ill people is increasing, due in part to demographic changes which pose a challenge, especially for outpatient primary care. In order to fulfil patients' needs and to promote self-management as a central care element of chronically ill patients, the use of eHealth applications increases. TelePraCMan will be developed as one of these applications and includes a symptom-based electronic diary, which will be implemented in the established German disease management programme 'PraCMan'. This study is conducted as a part of the TelePraCMan project and aims to detect the needs of potential end users (physicians, medical assistants, patients).In the TelePraCMan development phase, an explorative cross-sectional study was conducted with potential end users of the TelePraCMan app (patients, physicians and medical assistants). For this purpose, a written survey was conducted in Baden-Wurttemberg between April 2019 and March 2020. The survey covered smartphone usage behaviour, technology affinity using the standardised questionnaire TA-EG, support network for technical questions and sociodemographic data.A total of n=202 patients (n=98), physicians (n=58) and medical assistants (n=43) participated in the survey. Concerning smartphone use, 78.2 % of the participants stated that the function used most frequently was writing short messages. Health apps were the least used function (9.6 %). Furthermore, patients (12.6 %) use health apps more often than medical assistants (10.3%) and doctors (4.4 %). Participants aged 50 and younger were found to have a higher affinity for technology (mean=3.20, SD=0.51) than participants over 50 years of age (mean=2.98, SD=0.67). Older, multimorbid respondents had a particularly low affinity for technology (mean=2.52, SD=0.69). 10.9 % of the over-fifties and 12.5 % of the multimorbid persons felt able to fix any technical problems on their own without help. Multimorbid participants over the age of 50 were observed to prefer personal support over internet-based support.On average, multimorbid respondents in the age group over 50 have a lower affinity for technology than respondents aged under 50 without multimorbidity. The most frequent negative attitude towards electronic devices is also found among patients over 50 years of age, who are expected to be the main target group of the TelePraCMan app. These findings can be used to derive requirements for the design and development of functions of the app, as well as accompanying measures, such as intuitive and simple user interface, a telephone hotline to support users, close consultation with users on the planned functions, and more.Based on this survey, we were able to determine the needs of the future target group of the TelePraCMan app. This is seen as a starting point for the development of an implementation strategy and the pilot testing of the app in primary care.

Objective: Despite available effective treatments for mental health disorders, few patients in need receive even the most basic care. Integrated telehealth services may be a viable option to increase access to mental health care. The aim of this qualitative process evaluation embedded in a randomized controlled feasibility trial was to explore health providers’ experiences with a mental health care model integrating mental health specialist video consultations (MHSVC) and primary care.Methods: A qualitative process evaluation focusing on MHSVC in primary care was conducted. In 13 semistructured interviews, we assessed the experience of all mental health specialists, primary care physicians, and medical assistants who participated in the trial. A thematic analysis, focusing on the implementation, mechanisms of impact, and context, was applied to investigate the data.Results: Considering (1) the implementation, participants evaluated the consultations as feasible, easy to use, and time-saving. Concerning (2) the mechanisms of impact, the consultations were regarded as effective for patients. Providers attributed the patients’ improvements to two key aspects: the familiarity of the primary care practice and the fast access to specialist mental healthcare. Mental health specialists observed trustful therapeutic alliances emerging and described their experience as comparable to same-room care. However, compared to same-room care, specialists perceived the video consultations as more challenging and sometimes more exhausting due to the additional effort required for establishing therapeutic alliances. Regarding (3) the intervention’s context, shorter travel distances positively affected the implementation, while technical failures, i.e. poor Internet connectivity, emerged as the main barrier.Conclusions: MHSVCs in primary care are feasible and successful in improving access to mental healthcare for patients. To optimize the engagement and comfort of both patients and health providers, future work should focus on empirical determinants for establishing robust therapeutic alliances with patients receiving video consultations (e.g., leveraging nonverbal cues for therapeutic purposes).

BACKGROUND Most people with common mental disorders, including those with severe mental illness, are treated in general practice. Video-based integrated care models featuring mental health specialist video consultations (MHSVC) facilitate the involvement of specialist mental health care. However, the potential uptake by general practitioners (GPs) is unclear. OBJECTIVE This mixed method preimplementation study aims to assess GPs’ intent to adopt MHSVC in their practice, identify predictors for early intent to adopt (quantitative strand), and characterize GPs with early intent to adopt based on the Diffusion of Innovations Theory (DOI) theory (qualitative strand). METHODS Applying a convergent parallel design, we conducted a survey of 177 GPs and followed it up with focus groups and individual interviews for a sample of 5 early adopters and 1 nonadopter. We identified predictors for intent to adopt through a cumulative logit model for ordinal multicategory responses for data with a proportional odds structure. A total of 2 coders independently analyzed the qualitative data, deriving common characteristics across the 5 early adopters. We interpreted the qualitative findings accounting for the generalized adopter categories of DOI. RESULTS This study found that about one in two GPs (87/176, 49.4%) assumed that patients would benefit from an MHSVC service model, about one in three GPs (62/176, 35.2%) intended to adopt such a model, the availability of a designated room was the only significant predictor of intent to adopt in GPs (β=2.03, SE 0.345, P CONCLUSIONS A significant proportion of GPs may function as early adopters and key stakeholders to facilitate the spread of MHSVC. Indeed, our findings correspond well with increasing utilization rates of telehealth in primary care and specialist health care services (eg, mental health facilities and community-based, federally qualified health centers in the United States). Future work should focus on specific measures to foster the intention to adopt among hesitant GPs.

Given the SARS-CoV2 crisis and the resulting constraints for face-to-face treatment, video consultations recently gained a major role in the delivery of health care services. Until now, most psychotherapists have gained little experience with conducting video consultations, not least because of poor possibilities for reimbursement from statutory health insurance. This article provides (1) an overview of the effectiveness of psychotherapy interventions delivered via video consultations, (2) guidance for setting up and conducting these consultations and (3) first experiences from a feasibility trial and from the provision in routine care in a hospital during the SARS-CoV2 crisis.

Background Many patients with mental disorders remain untreated. Video-based mental health care demonstrates comparable effectiveness to face-to-face treatments and is a promising mode for delivering specialized care within primary care. Nevertheless, professionals struggle with implementing video consultations in their daily practice. Specifically, little is known about mental health specialists’ acceptance of mental health video consultations in routine practice. The PROVIDE (ImPROving cross-sectoral collaboration between primary and psychosocial care: An implementation study on VIDEo consultations) project aims to improve cross-sectoral collaboration between primary and psychosocial care through implementing video consultations in primary care. To increase the uptake of video consultations, it is crucial to account for necessary prerequisites and to tailor interventions to the needs of the target group prior to implementation. Objective The aim of this study was to explore the acceptance of video consultations embedded in primary care from the perspectives of mental health specialists in Germany. Methods We conducted a qualitative, exploratory, preimplementation study in urban and rural counties. We conducted three semistructured focus groups with 11 mental health specialists. We used qualitative content analysis combining an inductive-deductive approach, applying the Tailored Implementation in Chronic Diseases (TICD) framework to the text material, which comprises individual health professional factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; social, political, and legal factors; and guideline factors. Results Against the background of long waiting times and a shortage of mental health specialists, especially in rural areas, participants valued video consultations as a potential means to improve access to mental health care. With respect to the TICD framework domains, the participants most often discussed individual health professional factors, followed by patient factors. All participants highlighted the importance of a trusting relationship between the patient and the therapist and doubted whether such a relationship could be established through video consultations (11/11, 100%). However, participants considered mental health specialist video consultations to be particularly suited for patients in rural areas, those with impaired mobility, and those who may otherwise remain untreated (6/11, 55%). Most participants expected video consultations to help the aforementioned patient groups avoid tedious searching for an available therapist and save on travel time and, therefore, improve access to specialized care for patients (7/11, 64%). Moreover, the participants expected video consultations to improve collaboration with the family physician (6/11, 55%). Finally, participants identified organizational aspects, such as reliable scheduling, the duration of the individual consultation (9/11, 82%), and reimbursement conditions (7/11, 67%), as key drivers for the acceptance and adoption of the model. Conclusions While mental health specialists expect video consultations to improve access to specialized care for some patients, they consistently wonder whether such consultations can establish a trusting patient-therapist relationship. When implementing video consultations, these concerns should be addressed by training providers in managing technology-based treatment settings, with extra consideration for fostering the patients’ and therapists’ engagement. Trial Registration German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one

Background Most people with common mental disorders, including those with severe mental illness, are treated in general practice. Video-based integrated care models featuring mental health specialist video consultations (MHSVC) facilitate the involvement of specialist mental health care. However, the potential uptake by general practitioners (GPs) is unclear. Objective This mixed method preimplementation study aims to assess GPs’ intent to adopt MHSVC in their practice, identify predictors for early intent to adopt (quantitative strand), and characterize GPs with early intent to adopt based on the Diffusion of Innovations Theory (DOI) theory (qualitative strand). Methods Applying a convergent parallel design, we conducted a survey of 177 GPs and followed it up with focus groups and individual interviews for a sample of 5 early adopters and 1 nonadopter. We identified predictors for intent to adopt through a cumulative logit model for ordinal multicategory responses for data with a proportional odds structure. A total of 2 coders independently analyzed the qualitative data, deriving common characteristics across the 5 early adopters. We interpreted the qualitative findings accounting for the generalized adopter categories of DOI. Results This study found that about one in two GPs (87/176, 49.4%) assumed that patients would benefit from an MHSVC service model, about one in three GPs (62/176, 35.2%) intended to adopt such a model, the availability of a designated room was the only significant predictor of intent to adopt in GPs (β=2.03, SE 0.345, P Conclusions A significant proportion of GPs may function as early adopters and key stakeholders to facilitate the spread of MHSVC. Indeed, our findings correspond well with increasing utilization rates of telehealth in primary care and specialist health care services (eg, mental health facilities and community-based, federally qualified health centers in the United States). Future work should focus on specific measures to foster the intention to adopt among hesitant GPs.

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.

BACKGROUND Many patients with mental disorders remain untreated. Video-based mental health care demonstrates comparable effectiveness to face-to-face treatments and is a promising mode for delivering specialized care within primary care. Nevertheless, professionals struggle with implementing video consultations in their daily practice. Specifically, little is known about mental health specialists’ acceptance of mental health video consultations in routine practice. The PROVIDE (ImPROving cross-sectoral collaboration between primary and psychosocial care: An implementation study on VIDEo consultations) project aims to improve cross-sectoral collaboration between primary and psychosocial care through implementing video consultations in primary care. To increase the uptake of video consultations, it is crucial to account for necessary prerequisites and to tailor interventions to the needs of the target group prior to implementation. OBJECTIVE The aim of this study was to explore the acceptance of video consultations embedded in primary care from the perspectives of mental health specialists in Germany. METHODS We conducted a qualitative, exploratory, preimplementation study in urban and rural counties. We conducted three semistructured focus groups with 11 mental health specialists. We used qualitative content analysis combining an inductive-deductive approach, applying the Tailored Implementation in Chronic Diseases (TICD) framework to the text material, which comprises individual health professional factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; social, political, and legal factors; and guideline factors. RESULTS Against the background of long waiting times and a shortage of mental health specialists, especially in rural areas, participants valued video consultations as a potential means to improve access to mental health care. With respect to the TICD framework domains, the participants most often discussed individual health professional factors, followed by patient factors. All participants highlighted the importance of a trusting relationship between the patient and the therapist and doubted whether such a relationship could be established through video consultations (11/11, 100%). However, participants considered mental health specialist video consultations to be particularly suited for patients in rural areas, those with impaired mobility, and those who may otherwise remain untreated (6/11, 55%). Most participants expected video consultations to help the aforementioned patient groups avoid tedious searching for an available therapist and save on travel time and, therefore, improve access to specialized care for patients (7/11, 64%). Moreover, the participants expected video consultations to improve collaboration with the family physician (6/11, 55%). Finally, participants identified organizational aspects, such as reliable scheduling, the duration of the individual consultation (9/11, 82%), and reimbursement conditions (7/11, 67%), as key drivers for the acceptance and adoption of the model. CONCLUSIONS While mental health specialists expect video consultations to improve access to specialized care for some patients, they consistently wonder whether such consultations can establish a trusting patient-therapist relationship. When implementing video consultations, these concerns should be addressed by training providers in managing technology-based treatment settings, with extra consideration for fostering the patients’ and therapists’ engagement. CLINICALTRIAL German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one

BACKGROUND Due to limited access to specialist services, most patients with common mental disorders (depression or anxiety, or both) usually receive treatment in primary care. More recently, innovative technology-based care models (eg, video consultations) have been proposed to facilitate access to specialist services. Against this background, the PROVIDE (Improving Cross-Sectoral Collaboration Between Primary and Psychosocial Care: An Implementation Study on Video Consultations) project aims to improve the provision of psychosocial care through implementing video consultations integrated into routine primary care. OBJECTIVE From the patients’ perspective, this qualitative preimplementation study explored (1) anticipated benefits from and (2) barriers to implementing mental health specialist video consultations embedded in primary care services and (3) prerequisites for interacting with therapists via video consultations. METHODS Using a purposive (ie, stratified) sampling strategy, we recruited 13 patients from primary care practices and a tertiary care hospital (psychosomatic outpatient clinic) for one-off semistructured interviews. In a computer-assisted thematic analysis, we inductively (bottom-up) derived key themes concerning the practicability of mental health specialist video consultations. To validate our results, we discussed our findings with the interviewees as part of a systematic member checking. RESULTS Overall, we derived 3 key themes and 10 subthemes. Participants identified specific benefits in 2 areas: the accessibility of mental health specialist care (shorter waiting times: 11/13, 85%; lower threshold for seeking specialist mental health care: 6/13, 46%; shorter travel distances: 3/13, 23%); and the environment in primary care (familiar travel modalities, premises, and employees: 5/13, 38%). The main barriers to the implementation of mental health video consultations from the patients’ perspective were the lack of face-to-face contact (13/13, 100%) and technical challenges (12/13, 92%). Notably, participants’ prerequisites for interacting with therapists (12/13, 92%) did not seem to differ much from those concerning face-to-face contacts. CONCLUSIONS Mental health service users mostly welcomed mental health specialist video consultations in primary care. Taking a pragmatic stance, service users, who are often frustrated about uncoordinated care, particularly valued the embedment of the consultations in the familiar environment of the primary care practice. With respect to interventional studies and implementation, our findings underscore the need to minimize technical disruptions during video consultations and to ensure optimal resemblance to face-to-face settings (eg, by training therapists in consistently reacting to nonverbal cues). CLINICALTRIAL German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one

Mental health conditions represent a significant burden to the individual as well as the society. Within the health care system, the general practitioner is the first and, in most cases, the only provider. Timely referral of patients to specialized care is often difficult due to several barriers, particularly in rural areas. These barriers comprise long waiting times, the rising prevalence of psychosomatic and somatopsychic comorbidity, immobility in the elderly and stigmatisation related to mental health conditions. Following the Integrated Health Care approach, diagnosis and therapy of mental health conditions by psychotherapists directly within the general practice constitute an effective care model. We present a care model that is based on a telemental treatment approach for depression and anxiety disorders. Central is the piloting of psychotherapeutic video consultations in the general practice. The following article provides an overview of the care model and provides results concerning the intent to adopt the model in office-based psychotherapists.Psychische Störungen stellen einen erheblichen Belastungsfaktor für den Einzelnen sowie die gesamte Gesellschaft dar. Erster und in den meisten Fällen einziger Ansprechpartner im Gesundheitssystem ist der Hausarzt. Die Überweisung von Patienten in zeitnahe spezialisierte psychosomatische oder psychotherapeutische Behandlung erweist sich jedoch aufgrund vieler Probleme, insbesondere in ländlichen Gebieten, als schwierig. Zu diesen Problemen zählen etwa lange Wartezeiten, die steigende Prävalenz psychosomatischer und somatopsychischer Komorbidität, altersbedingte Immobilität und patientenseitige Stigmatisierungserwartung. Im Sinne des Integrated Health Care Ansatzes stellt die diagnostische und therapeutische Adressierung psychischer Störungen durch Psychotherapeuten direkt in der Hausarztpraxis ein effektives Versorgungsmodell dar. Hier vorgestellt wird ein telemedizinisches Therapiekonzept für Menschen mit depressiven und ängstlichen Erkrankungen. Im Zentrum steht die Erprobung psychotherapeutischer Videokonsultationen innerhalb der Hausarztpraxis. Es soll ein Überblick über das Therapiekonzept gegeben sowie Ergebnisse zur Umsetzungsbereitschaft des Modells bei niedergelassenen Psychotherapeuten dargestellt werden.

BACKGROUND Although real-time mental health specialist video consultations have been proposed as an effective care model for treating patients with mental health conditions in primary care, little is known about their integration into routine practice from the perspective of family physicians. OBJECTIVE This study aimed to determine the degree to which family physicians advocate that mental health specialist video consultations can be integrated into routine primary care, where most patients with mental health conditions receive treatment. METHODS In a cross-sectional qualitative study, we conducted 4 semistructured focus groups and 3 telephonic interviews in a sample of 19 family physicians from urban and rural districts. We conducted a qualitative content analysis applying the Tailored Implementation in Chronic Diseases framework in a combined bottom-up (data-driven) and top-down strategy for deriving key domains. RESULTS Family physicians indicated that mental health specialist video consultations are a promising and practical way to address the most pressing challenges in current practice, that is, to increase the accessibility and co-ordination of specialized care. Individual health professional factors were the most frequently discussed topics. Specifically, family physicians valued the anticipated clinical outcomes for patients and the anticipated resources set for the primary care practice as major facilitators (16/19, 84%). However, family physicians raised a concern regarding a lack of facial expressions and physical interaction (19/19, 100%), especially in emergency situations. Therefore, most family physicians considered a viable emergency plan for mental health specialist video consultations that clearly delineates the responsibilities and tasks of both family physicians and mental health specialists to be essential (11/19, 58%). Social, political, and legal factors, as well as guideline factors, were hardly discussed as prerequisites for individual family physicians to integrate mental health specialist video consultations into routine care. To facilitate the implementation of future mental health specialist video consultation models, we compiled a checklist of recommendations that covers (1) buy-in from practices (eg, emphasizing logistical and psychological relief for the practice), (2) the engagement of patients (eg, establishing a trusted patient-provider relationship), (3) the setup and conduct of consultations (eg, reliable emergency plans), and (4) the fostering of collaboration between family physicians and mental health specialists (eg, kick-off meetings to build trust). CONCLUSIONS By leveraging the primary care practice as a familiar environment for patients, mental health specialist video consultations provide timely specialist support and potentially lead to benefits for patients and more efficient processes of care. Integration should account for the determinants of practice as described by the family physicians. CLINICALTRIAL German Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00012487

Zusammenfassung Hintergrund Das Programm Verbundweiterbildung plus (VWB plus ) Baden-Wurttemberg hat seit der Initiierung 2009 mehr als 600 Arzte in Weiterbildung (AiW) aufgenommen und inzwischen uber 100 Facharzte fur Allgemeinmedizin begleitet. Ein Kernelement der VWB plus Baden-Wurttemberg ist das Mentoring – die bedarfsgerechte Forderung und Beratung von AiW. Die vorliegende Analyse hat zum Ziel, die haufigsten Beratungsanlasse der AiW sowie Anforderungen an die Person des Mentors zu explorieren. Methoden Innerhalb des Zeitraums von Dezember 2009 bis Juli 2014 wurden 141 E-Mails der AiW der VWB plus Baden-Wurttemberg in die Auswertung eingeschlossen und mithilfe der qualitativen Inhaltsanalyse ausgewertet. Dabei wurden die Fragen der AiW zunachst thematisch geclustert und induktiv im Rahmen eines systematischen Reduktionsprozesses kategorisiert. Anschliesend erfolgte die inhaltsanalytische Analyse des Materials. Nicht ausgewertet wurden personliche Beratungsgesprache. Diese werden nach aktuellem Stand insgesamt durchschnittlich etwa drei Mal pro Tag von den Mentoren gefuhrt. Ergebnisse Von 32% der Teilnehmer der VWB plus Baden-Wurttemberg wurde eine Anfrage an die Mentoren des Programms gestellt. 38% der Zuschriften betrafen vor allem Fragen hinsichtlich Stellengesuchen, Bewerbungen sowie Arbeitsvertragen. In 30% der Falle wurde nach den Teilnahmebedingungen und Schulungsinhalten der VWB plus gefragt. Weitere Beratungsanlasse waren die Bereiche Weiterbildung im Allgemeinen (16%), Konfliktberatung (10%) sowie Beantragung von Fordergeldern (6%). Schlussfolgerungen Ein Mentoring-Programm erfordert breit qualifizierte und auf dem Gebiet der Allgemeinmedizin erfahrene Ansprechpartner. FAQ-Listen helfen, Routinefragen rasch zu klaren. Fur die Beantwortung individueller Anliegen und Beratung in Krisensituationen ist die personliche Betreuung durch einen Mentor notwendig.

Zusammenfassung Hintergrund Das Konzept der Deutschen Gesellschaft fur Allgemeinmedizin und Familienmedizin (DEGAM) fordert Begleitseminare uber die gesamte Weiterbildungszeit, um allgemeinmedizin-spezifisches Wissen und Kompetenzen sowie eine Vernetzung und Identitatsbildung von Arzten in Weiterbildung (AiW) zu fordern. Seit 2009 werden solche Seminare im Rahmen der Verbundweiterbildung plus Baden-Wurttemberg (VWB plus Ba-Wu) angeboten. Ziel dieses Artikels ist es, die Entwicklungen der Schulungstage der VWB plus Ba-Wu zu beschreiben und daraus Implikationen fur sich deutschlandweit entwickelnde Verbundweiterbildungsprogramme abzuleiten. Methoden Von 2009 bis 2015 wurden die Daten aller Schulungstage deskriptiv analysiert. Dabei wurden die abgehaltenen Unterrichtseinheiten sowie die Anzahl der Dozenten und deren fachliche Qualifikation ermittelt. Von zwei Wissenschaftlern wurden die Seminarinhalte unabhangig voneinander kategorisiert und dem Kompetenzbasierten Curriculum Allgemeinmedizin (KCA) zugeordnet. Ergebnisse Bisher nahmen 600 AiW an einer Auftaktveranstaltung der VWB plus Ba-Wu teil. Es wurden insgesamt 1.116 Unterrichtseinheiten mit 160 unterschiedlichen Seminarthemen abgehaltenen, die das gesamte KCA und daruber hinaus weitere Themen abdeckten. Um die organisatorischen Ablaufe bewaltigen zu konnen, wurde eine grundlegende Umstrukturierung der Schulungstage sowie die Entwicklung einer spezifischen, elektronisch unterstutzenden Software notwendig. 56% der Seminare wurden von Facharzten bzw. AiW fur Allgemeinmedizin abgehalten. Die Veranstaltungen sowie der kollegiale Austausch wurden durchgehend (sehr) gut von den AiW bewertet. Schlussfolgerung Um Begleitseminare in Verbundweiterbildungsprojekten zielgruppen- und bedarfsgerecht auszurichten, ist es entscheidend, die Inhalte thematisch an allen drei Teilen des KCA – medizinische Expertise, Kompetenzen und Prozeduren - und damit spezifisch-allgemeinmedizinisch auszurichten. Ein Dozentenleitfaden soll zukunftig helfen, dass deutschlandweit einheitliche Standards fur Didaktik und Qualifikationen der Dozenten bekannt sind. Die steigende Nachfrage von Verbundweiterbildungsprojekten bedeutet komplexe Organisationsablaufe, die ab einer Teilnehmerzahl von ca. 200 einer Softwareunterstutzung bedurfen. Diese soll zukunftig noch weiterentwickelt werden vor allem in Hinblick auf eine Integration des KCA.

Background: The implementation of telemedicine in mental health care advances rapidly. While web-based interventions such as online education materials or self-assessments demonstrate acceptable feasibility, little is known on implementation outcomes for web-based real-time interactions. However, particularly in thinly populated areas where the ageing population is faced with long distances to specialized care, telemedical services such as video consultations embedded in primary care constitute a promising alternative mode of treatment delivery to face-to-face consultation in specialized mental health care. Aim: The aim of this study was to identify the acceptance of and intent to adopt video consultations conducted by mental health specialists in a sample of general practitioners in Germany who generally were still unfamiliar with applying telemedicine. Design and setting: We conducted a mixed methods study, namely a cross-sectional sequential exploratory design, in one urban and four rural counties in Southern Germany. Method: We sent a mail survey comprising a simple 10-item questionnaire to all general practitioners licensed under the German statutory health insurance system in the five counties. Survey data were analysed by generating descriptive statistics. To gain a deeper understanding of the acceptance of and intent to adopt video consultations, we subsequently conducted semi-structured focus groups and interviews with 19 responding general practitioners which were then evaluated in a thematic analysis. Results: The mail survey response rate amounted to 22% 176 of 788 general practitioners. Approximately half of the respondents 49.4% indicated that they would generally support the office-embedded treatment of patients with mental disorders through video consultations carried out by mental health specialists. However, only 35.2% of all responding general practitioners would consider implementation in their own practice. The qualitative data analysis yielded heterogeneous findings: On the one hand, some general practitioners outlined the benefits of a rapid and easy accessible supply of mental health care and b much needed collaborative information exchange between general practitioners and their colleagues in mental health care. On the other hand, in the light of anticipated implementation efforts and potential demand on their resources, some interviewees could not identify any benefit from this integrated approach. Conclusion: General practitioners are generally open-minded towards video consultations embedded in primary care for treating mental health disorders, although a significant proportion of them were sceptical about implementing it in their own practice. Our results refer to a potential gap between acceptance and intent to adopt the suggested mode of treatment delivery. Given the potential benefits of video consultations for patients as indicated by results from initial interventional studies, at this point, we would recommend further pilot studies with a specific focus an raising the intent to adopt in general practitioners.

The German Society of General Practice and Family Medicine (DEGAM) has defined educational seminars during post-graduate training as a core element to improve trainees' specific knowledge and competencies. Furthermore, these seminars facilitate networking among trainees and support the process of identity formation in family medicine. Since its implementation in 2009, the Verbundweiterbildung(plus) Baden-Württemberg (VWB(plus) Ba-Wü) has offered educational seminars. Aim of this article is to analyse the content of these educational seminars and to derive implications for other family medicine training programmes in Germany.From 2009 to 2015, the data from all educational seminars was descriptively analysed. Furthermore, two researchers categorised the seminar contents independently of each other and assigned them to the competence-based curriculum for family medicine training (Kompetenzbasiertes Curriculum Allgemeinmedizin, KCA).Until 2015, 600 trainees participated in a starter seminar of the VWB(plus) Ba-Wü. In total, 1,116 teaching units and 160 different seminars covered all relevant topics of the KCA. A restructuring of organisational processes and seminars was necessary to handle the increase in the number of participants, including the development of specific software for electronic support. Of all these seminars, 56% were held by specialists or trainees in family medicine. The participating trainees rated the educational seminars in general and the possibility for networking as (very) good.The contents of the educational seminars included in family medicine training programs will have to be specifically based on family medicine and cover all relevant aspects of the KCA - medical expertise, competencies and procedures. In order to ensure a common standard concerning didactic methods and qualifications of teachers, a didactic guideline is to be developed. The increasing demand of family medicine training programmes requires (further) development of the software eSchoolab, including integration of the KCA.

More than 600 trainees in family medicine (FM trainees) have participated in the Verbundweiterbildung(plus) (VWB(plus)) since this rotation network programme has been implemented in 2009. Mentoring as need-based support and counselling is an essential element of this programme. The aim of this study was to identify FM trainees' most frequent reasons for counselling in order to explore the qualifications and requirements to be a mentor.141 e-mails written between December 2009 and July 2014 were analysed according to Mayring. This procedure generated thematic categories of common reasons for seeking counselling.32 % of all VWB(plus) participants asked mentors of the programme for advice. The most frequent questions (38 %) related to job vacancies, the application process and employment contracts. The second most common inquiries (30 %) referred to participation in the VWB(plus) as well as contents of education meetings within the VWB(plus). Other questions pertained to general aspects of postgraduate training in family medicine (16 %), individual conflict consulting (10 %) and funding applications (6 %).The results of the needs assessment survey reveal that a mentoring programme needs competent advisors with experience in family medicine. While FAQ lists are helpful in answering general questions, specific requests such as, for example, a personal crisis require individual counselling provided by a mentor.