Search

Hintergrund und Stand (inter)nationaler Forschung: Zu Beginn der Coronapandemie haben einige Forscher*innenteams den Einbezug von Patient*innen und anderen Stakeholdern in die Forschung aufgrund der Annahme, dass Patient*innen an digitalen Partizipationsformaten nicht interessiert sind [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: In der Entwurfsfassung der neuen Ärztlichen Approbationsordnung (BMG 2021) ist die Stärkung des Fachs Allgemeinmedizin ein ausgewiesenes Ziel. Unter diesen Vorzeichen startete in Bielefeld im Oktober 2021 ein neuer Modellstudiengang mit dem Schwerpunkt ambulante Versorgung/Allgemeinmedizin. [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Structured management programs have been developed for single diseases but rarely for patients with multiple medications. We conducted a qualitative study to investigate the views of stakeholders on the development and implementation of a polypharmacy management program in Germany. Overall, we interviewed ten experts in the fields of health policy and clinical practice. Using content analysis, we identified inclusion criteria for the selection of suitable patients, the individual elements that should make up such a program, healthcare providers and stakeholders that should be involved, and factors that may support or hinder the program's implementation. All stakeholders were well aware of polypharmacy-related risks and challenges, as well as the urgent need for change. Intervention strategies should address all levels of care and include all concerned patients, caregivers, healthcare providers and stakeholders, and involved parties should agree on a joint approach.

Evidence-based clinical guidelines generally consider single conditions, and rarely multimorbidity. We developed an evidence-based guideline for a structured care program to manage polypharmacy in multimorbidity by using a realist synthesis to update the German polypharmacy guideline including the following five methods: formal prioritization in focus groups; systematic guideline review of evidence-based multimorbidity/polypharmacy guidelines; evidence search/synthesis and recommendation development; multidisciplinary consent of recommendations; feasibility test of updated guideline. We identified the need for a better description of the target group, decision support, prioritization of medication, consideration of patient preferences and anticholinergic properties, and of healthcare interfaces. We conducted a systematic guideline review of eight guidelines and extracted and synthesized recommendations using the Ariadne principles. We also included 48 systematic reviews. We formulated and agreed upon 34 recommendations for the revised guideline. During the feasibility test, guideline use enabled 57% of GPs to identify problems, leading to medication changes in 49% and self-assessed improvement in 56% of patients. Although 58% of GPs felt that it was too long, 92% recommended it. Polypharmacy should be systematically reviewed at least annually. Patients, family members, and healthcare professionals should monitor and adjust it using prospective process validation, taking into account patient preferences and agreed treatment goals., Beteiligte Organisation: The Evita Study Group

Hintergrund und Stand (inter)nationaler Forschung: Mit dem Practice Change and Development Modell (PCM) wurde nachhaltiger Wandel von Arztpraxen konzeptualisiert. Praxen werden als komplexe, adaptive Systeme verstanden, die durch vier sich wechselseitig beeinflussende Faktoren determiniert werden: Innere [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: 2013 erschien die erste evidenzbasierte Leitlinie (AWMF-S2e-Niveau) „Multimedikation“. Im Rahmen der vorgesehenen Aktualisierung wurde zugleich ein Upgrade auf AWMF S3 Niveau geplant und im Rahmen des EVITA-Projekts (Evidenzbasiertes Multimedikations-Programm mit Implementierung [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Background/research question: The unpredictable disease trajectories of older patients with multimorbidity require earlier patient-clinician communication regarding preferences for end-of-life (EoL) care. To offer support to clinicians and assist this patient population, we aimed to conduct a mixed-methods[for full text, please go to the a.m. URL], Who cares? – EbM und Transformation im Gesundheitswesen; 22. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin

Background: Cumulative anticholinergic exposure, also known as anticholinergic burden, is associated with a variety of adverse outcomes. However, studies show that anticholinergic effects tend to be underestimated by prescribers, and anticholinergics are the most frequently prescribed potentially inappropriate medication in older patients. The grading systems and drugs included in existing scales to quantify anticholinergic burden differ considerably and do not adequately account for patients’ susceptibility to medications. Furthermore, their ability to link anticholinergic burden with adverse outcomes such as falls is unclear. This study aims to develop a prognostic model that predicts falls in older general practice patients, to assess the performance of several anticholinergic burden scales, and to quantify the added predictive value of anticholinergic symptoms in this context. Methods: Data from two cluster-randomized controlled trials investigating medication optimization in older general practice patients in Germany will be used. One trial (RIME, n = 1,197) will be used for the model development and the other trial (PRIMUM, n = 502) will be used to externally validate the model. A priori, candidate predictors will be selected based on a literature search, predictor availability, and clinical reasoning. Candidate predictors will include socio-demographics (e.g. age, sex), morbidity (e.g. single conditions), medication (e.g. polypharmacy, anticholinergic burden as defined by scales), and well-being (e.g. quality of life, physical function). A prognostic model including sociodemographic and lifestyle-related factors, as well as variables on morbidity, medication, health status, and well-being, will be developed, whereby the prognostic value of extending the model to include additional patient-reported symptoms will be also assessed. Logistic regression will be used for the binary outcome, which will be defined as “no falls” vs. “≥1 fall” within six months of baseline, as reported in patient interviews. Discussion: As the ability of different anticholinergic burden scales to predict falls in older patients is unclear, this study may provide insights into their relative importance as well as into the overall contribution of anticholinergic symptoms and other patient characteristics. The results may support general practitioners in their clinical decision-making and in prescribing fewer medications with anticholinergic properties.