40 results on '"Schulz-Rothe S"'
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2. Multimedikation bei älteren Menschen an der Schnittstelle ambulanter und stationärer Versorgung – Studienprotokoll der Interventionsentwicklung der HYPERION-Studie
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Brueckle, MS, Dinh, TS, Klein, AA, Rietschel, L, Mergenthal, K, Engler, J, Schulz-Rothe, S, Brosse, F, Petermann, J, Voigt, K, and van den Akker, M
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ddc: 610 ,Medicine and health - Abstract
Hintergrund: Ältere Menschen mit Multimedikation und komplexen Versorgungsbedürfnissen stellen eine zentrale Herausforderung für das Gesundheitssystem dar. Insbesondere bei Krankenhauseinweisung und -entlassung entstehen Versorgungsprobleme durch mangelnde Informationskontinuität. [zum vollständigen Text gelangen Sie über die oben angegebene URL]
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- 2021
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3. Medikamentenbezogener Informationsfluss bei Krankenhauseinweisungen und -entlassungen – Schwierigkeiten und Lösungsansätze aus Sicht von Beteiligten
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Klein, AA, Dinh, TS, Rietschel, L, Brueckle, MS, Brosse, F, Petermann, J, Schulz-Rothe, S, Mergenthal, K, Engler, J, van den Akker, M, and Voigt, K
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ddc: 610 ,Medicine and health - Abstract
Hintergrund: An der Schnittstelle zwischen ambulanter und stationärer Versorgung kommt es vor allem bei Patient*innen mit komplexen Versorgungsbedürfnissen häufig zu einer unzureichenden Informationskontinuität bzgl. der Medikation. Dies kann zu vermeidbaren Schwierigkeiten [zum vollständigen Text gelangen Sie über die oben angegebene URL]
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- 2021
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4. Interprofessionelle Versorgung von Patienten mit rheumatoider Arthritis aus hausärztlicher Sicht: Ergebnisse einer Querschnittserhebung
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Schneider, E., Petersen, J.J., Schulz-Rothe, S., Gerlach, F.M., Rossmanith, T., Siebenhofer, A., Mergenthal, K., and Publica
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Ziel der Studie: Bei der Behandlung von Patienten mit rheumatoider Arthritis sind Haus- und Fachärzte, Pflegedienste, Ergo- und Physiotherapeuten sowie verschiedene andere Berufsgruppen beteiligt. Ziel dieser Studie ist eine Beschreibung dieser interprofessionellen Kooperationen in der alltäglichen Versorgungspraxis aus hausärztlicher Sicht. Methodik: Mittels einer Querschnittserhebung wurden von Februar bis September 2017 die Kooperationen von Hausärzten (n=121 in 68 Praxen) in Hessen und Rheinland-Pfalz mit verschiedenen anderen Versorgern erfasst. Diese Querschnittserhebung war in die prospektive Kohortenstudie PANORA (Prävalenz von Anti-CCP-Antikörpern bei Patienten mit neuen Beschwerden am Bewegungsapparat) integriert. Der verwendete Fragebogen für Hausärzte enthielt geschlossene Fragen zu Soziodemografie, Häufigkeit, Gewichtung und Bewertung der bestehenden Kooperationen. Die erhobenen Daten wurden deskriptiv ausgewertet. Ergebnisse: Bei Betrachtung der von Hausärzten übernommenen Aufgaben, gaben mehr als 70% der Ärzte an bei der Betreuung ihrer Patienten mit rheumatoider Arthritis ""oft"" die Koordination der Medikamente, Gespräche über die Diagnose und Laborkontrollen durchzuführen. Die häufigste Kooperation mit der größten Wichtigkeit und einer geringen Zufriedenheit ergab sich mit den Rheumatologen. Als zweithäufigste Kooperation und hoher Wichtigkeit wurde die Kooperation mit den Physiotherapeuten bewertet. Die höchste Zufriedenheit wurde mit der Zusammenarbeit mit Pflegediensten beschrieben. Schlussfolgerung: Die vorliegende Studie zeigt, dass Hausärzte bei der Versorgung von Patienten mit rheumatoider Arthritis in jedem Stadium der Versorgung verschiedene Versorgungsaufgaben übernehmen und dabei unterschiedlich häufig mit anderen Versorgern zusammenarbeiten. Insbesondere die Zusammenarbeit mit den Rheumatologen und den Physiotherapeuten ist den Hausärzten wichtig. Jedoch wurde die Kooperation mit Rheumatologen als unzureichend und verbesserungswürdig beurteilt.
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- 2021
5. Aufgabenteilung im hausärztlichen Praxisteam bei der Durchführung von Versorgungsstudien
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Mergenthal, K., Schulz-Rothe, S., Siebenhofer, A., Gerlach, F.M., Dauth, S., Petersen, J.J., and Publica
- Abstract
Hintergrund. Geschultes Praxispersonal ist maßgeblich an einer erfolgreichen Patientenrekrutierung und optimalen Durchführung von allgemeinmedizinischen Versorgungsstudien beteiligt. Bislang ist wenig darüber bekannt, welche Aufgaben Medizinische Fachangestellte (MFA) im Rahmen einer Studiendurchführung in der allgemeinmedizinischen Praxis unter Alltagsbedingungen übernehmen. Methoden Mittels einer Querschnitterhebung wurde 2017 bei MFA die Arbeitsteilung bei hausärztlichen Studien erhoben. Die Befragung erfolgte während einer Praxisvisite zur Schulung des Praxispersonals im Rahmen einer prospektiven Kohortenstudie und beinhaltete unter anderem die Abfrage nach Erfahrungen mit früheren Versorgungsstudien. Die erhobenen Daten wurden deskriptiv ausgewertet. Ergebnisse. Die MFA übernahmen einen Großteil der administrativen Aufgaben, viele davon im direkten Kontakt mit Patient*innen, wie z.B. Vereinbarung von Terminen (81 %), Einsammeln von Fragebögen (74 %), Einholen der Unterschrift (59 %) oder Versand der Einladungen (55 %). Nach Angaben der MFA waren die Überprüfung der Ein- und Aussschlusskriterien und das Führen von Aufklärungsgesprächen in jeweils 30 % rein ärztliche Tätigkeit, in 21 % (Ein-/Ausschlusskriterien) bzw. 26 % (Aufklärungsgespräche) wurde dies von Ärzt*in und MFA gemeinsam durchgeführt, in 29 % bzw. 28 % führten die MFA dies nach eigenen Angaben alleine durch. Schlussfolgerungen Nicht nur administrative Aufgaben, sondern auch ein Teil der Informationsvermittlung und Aufklärungsarbeit scheint in den Händen der MFA zu liegen. Ärzt*innen und MFA benötigen dafür eine Basisschulung in Guter Klinischer Praxis (GCP), bei der auf die Aufgabenteilung explizit einzugehen ist.
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- 2021
6. Schulung von Medizinischen Fachangestellten bei hausärztlichen Forschungsprojekten. Wissensgewinn und Unterschiede zwischen einer Präsenzschulung und dem Selbststudium eines Schulungshandbuches
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Mergenthal, K., Schulz-Rothe, S., Siebenhofer, A., Gerlach, F.M., Rossmanith, T., Petersen, J.J., and Publica
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Hintergrund Beim Start neuer Studien stehen Forschungseinrichtungen oft vor der Frage, wie die Schulung von Praxisteams effektiv und ressourcenschonend gestaltet werden kann. Wir untersuchten, ob die Schulung von Medizinischen Fachangestellten (MFA) zu einem Wissenszuwachs führt und ob eine Präsenzschulung im Vergleich zum Selbststudium von Schulungsmaterialien Unterschiede aufzeigt. Methoden Im Rahmen einer allgemeinmedizinischen Studie sollten die MFA entweder eine Präsenzschulung vor Ort oder im Selbststudium das Handbuch mit den gleichen Themen bearbeiten. Der Wissensstand wurde mit sechs Fragen (Summenscore 0-30 Punkte, Pkt.) erhoben und mittels nichtparametrischer Tests verglichen. Ergebnisse An den Schulungen nahmen 73 MFA teil, der Mittelwert (MW) im Wissenstest betrug vor der Schulung 19,96 Pkt., danach 25,62 Pkt. (p < 0,001). Von 106 MFA mit Selbststudium hatten 27 % (n = 29) das Handbuch nicht gelesen (MW 19,83 Pkt.). Bei den restlichen MFA betrug der MW je nach Intensität des Handbuchstudiums zwischen 21,60 und 25,40 Pkt. Die MFA nach der Schulung (n = 73) zeigten einen signifikant höheren Wissensstand als die MFA mit Selbststudium (n = 77) (p < 0,001). Schlussfolgerungen Im Vergleich bietet die Präsenzschulung einen signifikant höheren Wissensstand, zudem wurde beim Selbststudium gut ein Viertel der Teilnehmer nicht erreicht. Für weitere zeiteffektive Optionen sollten die Möglichkeiten von Videoedukationen und Webinaren zur Schulung der Praxisteams geprüft werden.
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- 2020
7. Kooperationen zwischen rheumatologischen und allgemeinmedizinischen Fachärzten bei der Versorgung von Patienten mit Rheumatoider Arthritis aus hausärztlicher Sicht
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Mergenthal, K, Schulz-Rothe, S, Siebenhofer, A, Gerlach, FM, Rossmanith, T, and Petersen, JJ
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ddc: 610 ,610 Medical sciences ,Medicine - Abstract
Hintergrund: Für viele chronisch Erkrankte hängt der Behandlungserfolg von gelungenen Kooperationen ab, so auch bei der Versorgung von Patienten mit Rheumatoider Arthritis. Unklar ist, wie Hausärzte unterschiedliche Merkmale einer wirksamen Kooperation mit Rheumatologen bewerten und wie[zum vollständigen Text gelangen Sie über die oben angegebene URL], 53. Kongress für Allgemeinmedizin und Familienmedizin
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- 2019
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8. Rheumatologe oder Hausarzt? Wie gestaltet sich die Versorgung von Patienten mit Rheumatoider Arthritis aus Sicht der Hausärzte? Ergebnisse einer Versorgungsstudie bei Hausärzten im Mixed-Methods-Design
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Mergenthal, K, Schulz-Rothe, S, Schneider, E, Siebenhofer, A, and Petersen, JJ
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ddc: 610 ,610 Medical sciences ,Medicine - Abstract
Einleitung: Rheumatoide Arthritis (RA) bedeutet für viele Betroffenen Funktionseinbußen und Beeinträchtigung der Lebensqualität. Die interdisziplinäre Leitlinie der DGR empfiehlt eine Zusammenarbeit von Haus- und Fachärzten. Nahezu 100% der gesetzlich Versicherten [zum vollständigen Text gelangen Sie über die oben angegebene URL], 46. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh), 32. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh), Wissenschaftliche Herbsttagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR)
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- 2019
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9. Interdisziplinäre Versorgung von Patienten mit rheumatoider Arthritis aus Sicht der Hausärzte – Ergebnisse einer Querschnittsstudie
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Schneider, E, Schulz-Rothe, S, Petersen, JJ, Siebenhofer-Kroitzsch, A, and Mergenthal, K
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ddc: 610 ,Kooperation ,Rheumatoide Arthritis ,Verbesserungsbedarf ,610 Medical sciences ,Medicine - Abstract
Hintergrund: Die leitliniengerechte Behandlung von Patienten mit rheumatoider Arthritis sieht eine interdisziplinäre Versorgung durch Haus- und Fachärzte, Therapeuten und medizinische Einrichtungen vor. Unklar ist, wie sich diese Kooperationen im hausärztlichen Praxisalltag darstellen.[zum vollständigen Text gelangen Sie über die oben angegebene URL], 52. Kongress für Allgemeinmedizin und Familienmedizin
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- 2018
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10. 'Den ganzen Menschen im Blick!?' Rolle der Hausärzte bei der Versorgung von Menschen mit Rheumatoider Arthritis – Ergebnisse einer qualitativen Befragung im Rahmen der PANORA-Studie unter Nutzung der Pictor Technique
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Mergenthal, K, Schulz-Rothe, S, Siebenhofer-Kroitzsch, A, Gerlach, FM, and Petersen, JJ
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Rolle der Hausärzte ,ddc: 610 ,Rheumatoide Arthritis ,qualitative Erhebung mit Pictor Technique ,610 Medical sciences ,Medicine - Abstract
Hintergrund: Rheumatoide Arthritis (RA) bedeutet für viele Betroffene Funktionseinbußen und Beeinträchtigungen der Lebensqualität. Zur optimalen Patientenversorgung wird eine interprofessionelle Zusammenarbeit empfohlen. Unklar ist, welche Rolle Hausärzte im Versorgungsgeschehen[zum vollständigen Text gelangen Sie über die oben angegebene URL], 52. Kongress für Allgemeinmedizin und Familienmedizin
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- 2018
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11. Wie unterscheidet sich die Qualität der oralen Antikoagulation mit Vitamin-K-Antagonisten in deutschen Hausarztpraxen? – Ergebnisse der cluster-randomisierten PICANT-Studie (Primary Care Management for Optimized Antithrombotic Treatment
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Mertens, C, Siebenhofer-Kroitzsch, A, Berghold, A, Pregartner, G, Ulrich, LR, Mergenthal, K, Kemperdick, B, Schulz-Rothe, S, Rauck, S, Harder, S, Gerlach, FM, and Petersen, JJ
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INR-Einstellung ,ddc: 610 ,Primärversorgung im Team ,Orale Antikoagulation ,610 Medical sciences ,Medicine - Abstract
Hintergrund: Die Versorgung von Patienten mit oraler Antikoagulation (OAK) erfolgt in Deutschland häufig durch Hausarztpraxen. Unter Alltagsbedingungen kann die Einstellungsqualität durch patienten- und praxisabhängige Faktoren variieren. Fragestellung: Führt eine komplexe[zum vollständigen Text gelangen Sie über die oben angegebene URL], 52. Kongress für Allgemeinmedizin und Familienmedizin
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- 2018
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12. Wissenszuwachs von Medizinischen Fachangestellten (MFA) im Rahmen der PANORA-Studie - Ergebnisse einer quantitativen Prä-Post-Erhebung
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Mergenthal, K., Schulz-Rothe, S., Siebenhofer-Kroitzsch, A., Gerlach, F. M., and Petersen, J. J.
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Medizinische Fachangestellte ,Wissenszuwachs ,Präsenzschulung ,ddc: 610 ,610 Medical sciences ,Medicine - Abstract
Hintergrund: Eine frühzeitige Einbindung von Praxisteams in hausärztliche Versorgungsstudien erlaubt geschultem Praxispersonal u.a. Patienten gezielt zu informieren und kann infolgedessen die Patientenrekrutierung und Studienzielerreichung optimieren. Diesbezüglich existieren keine Schulungskonzepte;[zum vollständigen Text gelangen Sie über die oben angegebene URL], 52. Kongress für Allgemeinmedizin und Familienmedizin
- Published
- 2018
13. Wirksamkeit eines hausarztpraxisbasierten Case Managements zur Optimierung der oralen Antikoagulation – Ergebnisse der Cluster randomisierten PICANT-Studie
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Siebenhofer-Kroitzsch, A, Petersen, JJ, Ulrich, LR, Mergenthal, K, Kemperdick, B, Rauck, S, Schulz-Rothe, S, Gerlach, FM, Pregartner, G, and Berghold, A
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ddc: 610 ,orale Antikoagulation ,610 Medical sciences ,Medicine ,Case Management ,medizinische Fachangestellte - Abstract
Hintergrund: Die Einnahme von Antithrombotika stellt eine effiziente Vorbeugung gegen Thrombosen und Embolien dar. Eine Optimierung des Medikationsmanagements ist erforderlich, um den therapeutisch gewünschten Effekt zu erzielen und unerwünschte Arzneimittelwirkungen zu vermeiden. Fragestellung:[zum vollständigen Text gelangen Sie über die oben angegebene URL], 51. Kongress für Allgemeinmedizin und Familienmedizin
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- 2017
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14. Einführung in die Cluster randomisierte PICANT-Studie: Methoden, Rekrutierung und Repräsentativität von Studienteilnehmern
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Petersen, J. J., Ulrich, L. R., Mergenthal, K., Kemperdick, B., Rauck, S., Schulz-Rothe, S., Gerlach, F. M., Pregartner, G., Berghold, A., and Siebenhofer-Kroitzsch, A.
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ddc: 610 ,orale Antikoagulation ,610 Medical sciences ,Medicine ,Case Management - Abstract
Hintergrund: Bei der oralen Antikoagulation (OAK) ist eine Optimierung des Medikationsmanagements erforderlich, um den therapeutisch gewünschten Effekt zu erzielen. Fragestellung: Ziel der Studie Primary Care Management for Optimized Antithrombotic Treatment (PICANT) war es, das Gerinnungsmanagement[zum vollständigen Text gelangen Sie über die oben angegebene URL], 51. Kongress für Allgemeinmedizin und Familienmedizin
- Published
- 2017
15. Direkte orale Antikoagulanzien (DOAK) - Therapiewechsel und deren Gründe im Rahmen der PICANT-Studie - Ergebnisse eines Mixed-Methods-Designs
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Mergenthal, K., Ulrich, L. R., Petersen, J. J., Siebenhofer-Kroitzsch, A., Rauck, S., Kemperdick, B., Schulz-Rothe, S., Ockelmann, C., and Harder, S.
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direkte orale Antikoagulanzien ,Gerinnungsmanagement ,ddc: 610 ,Mixed-Methods-Ansatz ,610 Medical sciences ,Medicine - Abstract
Hintergrund: Der bevorzugte Einsatz der DOAK zu Vitamin-K-Antagonisten (VKA) im Rahmen der oralen Antikoagulation wird weiterhin kontrovers diskutiert. Hausärzte betreuen einen Großteil der Patienten. In der cluster-randomisierte PICANT-Studie nahmen die Patienten zu Studienbeginn unterschiedliche[zum vollständigen Text gelangen Sie über die oben angegebene URL], 51. Kongress für Allgemeinmedizin und Familienmedizin
- Published
- 2017
16. Jeder 14. Patient zwischen 40 und 54 Jahren berichtet von Angehörigen ersten Grades mit Darmkrebs: Ergebnisse der Studie FRIDA.Frankfurt
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Plath, J., Koné, I., Hechtner, M., Schulz-Rothe, S., Güthlin, C., and Siebenhofer-Kroitzsch, A.
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Kolorektales Karzinom ,Krebsfrüherkennung ,ddc: 610 ,Screening ,610 Medical sciences ,Medicine ,familiäres Risiko - Abstract
Hintergrund: Eine familiäre Häufung von Kolorektalen Karzinomen (KRK) ist ein etablierter Risikofaktor für die Erkrankung. Angehörige von KRK-Patienten haben ein um etwa 10 Jahre nach vorn verschobenes Erkrankungsrisiko. Daten zur Häufigkeit von familiärem Risiko bei Personen[zum vollständigen Text gelangen Sie über die oben angegebene URL], 50. Kongress für Allgemeinmedizin und Familienmedizin
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- 2016
17. Die Rolle der Medizinischen Fachangestellten in der PICANT-Studie
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Nesseri, P, Ulrich, LR, Siebenhofer-Kroitzsch, A, Petersen, JJ, Kemperdick, B, Rauck, S, Schulz-Rothe, S, and Mergenthal, K
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ddc: 610 ,Delegation ,Gerinnungsmanagement ,Primärversorgung im Team ,610 Medical sciences ,Medicine - Abstract
Hintergrund: „Die Hausarztpraxis der Zukunft ist eine Teampraxis.“ So lautet nicht nur eine DEGAM Zukunftsposition, sondern auch viele Primärversorgungsstudien haben einen interventionellen Ansatz, bei dem ein Team aus Hausarzt[1] und Medizinischer Fachangestellten (MFA)[zum vollständigen Text gelangen Sie über die oben angegebene URL], 50. Kongress für Allgemeinmedizin und Familienmedizin
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- 2016
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18. Neue orale Antikoagulanzien (NOAK) – Gründe für einen Therapiewechsel und Verordnungsverhalten von Hausärzten im Rahmen der PICANT-Studie
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Ockelmann, C, Mergenthal, K, Ulrich, LR, Petersen, JJ, Kemperdick, B, Rauck, S, Schulz-Rothe, S, and Siebenhofer-Kroitzsch, A
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ddc: 610 ,Gerinnungsmanagement ,Neue orale Antikoagulanzien ,Hausarztpraxis ,610 Medical sciences ,Medicine - Abstract
Hintergrund: Der Einsatz der NOAK wie Dabigatran, Rivaroxaban und Apixaban im Vergleich zu Vitamin-K-Antagonisten (VKA) wird kontrovers diskutiert. Gerade für Hausärzte[1] ist die Thematik bedeutsam, da sie einen Großteil der dauerhaft antikoagulierten Patienten versorgen. In[zum vollständigen Text gelangen Sie über die oben angegebene URL], 50. Kongress für Allgemeinmedizin und Familienmedizin
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- 2016
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19. Validierung klinischer Endpunkte in der Versorgungsforschung am Beispiel der PICANT Studie
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Petersen, JJ, Sunnus, M, Mergenthal, K, Ulrich, LR, Rauck, S, Schulz-Rothe, S, Kemperdick, B, Gerlach, FM, and Siebenhofer-Kroitzsch, A
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Validierung ,ddc: 610 ,Methodische Qualität ,orale Antikoagulation ,610 Medical sciences ,Medicine - Abstract
Hintergrund: In allgemeinmedizinischen Versorgungsforschungsstudien ist es wichtig, Endpunkte valide zu erfassen. In der Literatur finden sich wenige Hinweise dazu, ob und wie genau klinische Endpunkte validiert werden und wie sich die Validierung auf die Inzidenz der Endpunkte auswirkt. Ziel der[zum vollständigen Text gelangen Sie über die oben angegebene URL], 50. Kongress für Allgemeinmedizin und Familienmedizin
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- 2016
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20. Umsetzung eines Best Practice-Modells zur Optimierung der oralen Antikoagulation in der Hausarztpraxis
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Momtahen, N, Mergenthal, K, Siebenhofer-Kroitzsch, A, Petersen, JJ, Kemperdick, B, Rauck, S, Schulz-Rothe, S, and Ulrich, LR
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ddc: 610 ,Gerinnungsmanagement ,Patientenzentrierte Versorgung ,Komplexe Intervention ,610 Medical sciences ,Medicine - Abstract
Hintergrund: Versorgungsforschungsstudien sollen neue interventionelle Ansätze unter Alltagsbedingungen untersuchen. In der cluster-randomisierten PICANT-Studie („Primary Care Management for Optimized Antithrombotic Treatment“) wurde 2012 bis 2015 untersucht, ob mit der Durchführung[zum vollständigen Text gelangen Sie über die oben angegebene URL], 50. Kongress für Allgemeinmedizin und Familienmedizin
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- 2016
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21. Auswirkungen eines Case Managements in der Hausarztpraxis auf das Wissen von Patienten zur oralen Antikoagulation
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Maikranz, V, Petersen, JJ, Ulrich, LR, Mergenthal, K, Schulz-Rothe, S, Kemperdick, B, Rauck, S, Gerlach, FM, and Siebenhofer-Kroitzsch, A
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ddc: 610 ,Patientenwissen ,orale Antikoagulation ,610 Medical sciences ,Medicine ,Case Management - Abstract
Hintergrund: Vorhofflimmern stellt die Hauptindikation für eine orale Antikoagulation dar. Die zur Therapie häufig genutzten Vitamin-K-Antagonisten haben eine geringe therapeutische Breite und können bei falscher Anwendung zu schwerwiegenden Komplikationen führen. Obwohl Patienten[zum vollständigen Text gelangen Sie über die oben angegebene URL], 50. Kongress für Allgemeinmedizin und Familienmedizin
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- 2016
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22. Wissenszuwachs durch komplexe Intervention? - Ergebnisse einer Befragung von Hausärztinnen und Hausärzten im Rahmen der PICANT-Studie
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Ulrich, L.-R., Mergenthal, K., Petersen, J.J., Kemperdick, B., Rauck, S., Schulz-Rothe, S., and Siebenhofer, A.
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ddc: 610 ,610 Medical sciences ,Medicine - Abstract
Hintergrund: In der cluster-randomisierten PICANT-Studie wurde untersucht, ob mit einer komplexen Intervention zur Optimierung der oralen Antikoagulation (OAK) gerinnungsassoziierte Komplikationen bei betroffenen Patienten im Vergleich zur Regelversorgung reduziert werden können. Die Intervention[zum vollständigen Text gelangen Sie über die oben angegebene URL], 49. Kongress für Allgemeinmedizin und Familienmedizin
- Published
- 2015
23. Wissenszuwachs durch komplexe Intervention? - Ergebnisse einer Befragung von Medizinischen Fachangestellten (MFA) im Rahmen der PICANT-Studie
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Mergenthal, K., Ulrich, L.-R., Petersen, J.J., Kemperdick, B., Rauck, S., Schulz-Rothe, S., and Siebenhofer, A.
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ddc: 610 ,610 Medical sciences ,Medicine - Abstract
Hintergrund: In der cluster-randomisierten PICANT-Studie (Primary Care Management for Optimized Antithrombotic Treatment) wurde untersucht, ob mit der Durchführung einer komplexen Intervention zur Optimierung der oralen Antikoagulation (OAK) gerinnungsassoziierte Komplikationen bei betroffenen [zum vollständigen Text gelangen Sie über die oben angegebene URL], 49. Kongress für Allgemeinmedizin und Familienmedizin
- Published
- 2015
24. Bereitstellung einer evidenzbasierten Gesundheitsinformation zur Darmkrebs-Früherkennung für Personen mit familiärem Risiko – Qualitätsanspruch vs. Ressourcen im Rahmen der Studie 'FRIDA.Frankfurt'
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Plath, J, Steckelberg, A, Koné, I, Dahlhaus, A, Taubenroth, M, Schulz-Rothe, S, Rauck, S, and Siebenhofer, A
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ddc: 610 ,610 Medical sciences ,Medicine - Abstract
Hintergrund: Ziel der Querschnittstudie „FRIDA.Frankfurt“ ist die Identifikation von Personen im Alter von 40-54 Jahren mit familiärem Risiko für Kolorektale Karzinome (KRK) im hausärztlichen Setting. Es ist zu erwarten, dass etwa 10% (n=875) der zur familiären[for full text, please go to the a.m. URL], EbM zwischen Best Practice und inflationärem Gebrauch; 16. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin
- Published
- 2015
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25. Kostenstruktur eines hausarztbasierten Case Managements zur oralen Antikoagulation aus Sicht des Kostenträgers
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Ulrich, L. R., Mergenthal, K., Petersen, J. J., Kemperdick, B., Rauck, S., Schulz-Rothe, S., and Siebenhofer, A.
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Versorgungsforschung ,ddc: 610 ,Kosten-Analyse ,orale Antikoagulation ,610 Medical sciences ,Medicine - Abstract
Hintergrund: In der cluster-randomisierten PICANT-Studie wird untersucht, ob mit der Durchführung eines hausarztbasierten Case Managements zur Optimierung der oralen Antikoagulation (OAK) (Intervention) gerinnungsassoziierte Komplikationen bei betroffenen Patienten im Vergleich zur Regelversorgung[for full text, please go to the a.m. URL], 48. Kongress für Allgemeinmedizin und Familienmedizin
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- 2014
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26. FRIDA.Frankfurt - Familiäres Risiko für Darmkrebs - Früherkennung im hausärztlichen Setting [Studienprotokoll]
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Plath, J., Dahlhaus, A., Koné, I., Taubenroth, M., Schulz-Rothe, S., Rauck, S., Gerlach, F. M., and Siebenhofer, A.
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ddc: 610 ,610 Medical sciences ,Medicine ,Darmkrebs ,familiäres Risiko - Abstract
Hintergrund: Darmkrebs zählt in Deutschland zu den drei häufigsten Krebsarten und Krebstodesursachen [ref:1]. Eine familiäre Prädisposition erhöht das Risiko für Darmkrebs um den Faktor 2–4 [ref:2], [ref:3]. Aktuell existiert kein risikoadaptiertes[for full text, please go to the a.m. URL], 48. Kongress für Allgemeinmedizin und Familienmedizin
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- 2014
27. Informational continuity of medication management in transitions of care: Qualitative interviews with stakeholders from the HYPERION-TransCare study.
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Dinh TS, Hanf M, Klein AA, Brueckle MS, Rietschel L, Petermann J, Brosse F, Schulz-Rothe S, Klasing S, Muth C, Seidling H, Engler J, Mergenthal K, Voigt K, and van den Akker M
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- Humans, Health Personnel, Communication, Attitude of Health Personnel, Qualitative Research, Medication Therapy Management, Hospitalization
- Abstract
Background: The transition of patients between inpatient and outpatient care can lead to adverse events and medication-related problems due to medication and communication errors, such as medication discontinuation, the frequency of (re-)hospitalizations, and increased morbidity and mortality. Older patients with multimorbidity and polypharmacy are particularly at high risk during transitions of care. Previous research highlighted the need for interventions to improve transitions of care in order to support information continuity, coordination, and communication. The HYPERION-TransCare project aims to improve the continuity of medication management for older patients during transitions of care., Methods and Findings: Using a qualitative design, 32 expert interviews were conducted to explore the perspectives of key stakeholders, which included healthcare professionals, patients and one informal caregiver, on transitions of care. Interviews were conducted between October 2020 and January 2021, transcribed verbatim and analyzed using content analysis. We narratively summarized four main topics (stakeholders' tasks, challenges, ideas for solutions and best practice examples, and patient-related factors) and mapped them in a patient journey map. Lacking or incomplete information on patients' medication and health conditions, inappropriate communication and collaboration between healthcare providers within and across settings, and insufficient digital support limit the continuity of medication management., Conclusions: The study confirms that medication management during transitions of care is a complex process that can be compromised by a variety of factors. Legal requirements and standardized processes are urgently needed to ensure adequate exchange of information and organization of medication management before, during and after hospital admissions. Despite the numerous barriers identified, the findings indicate that involved healthcare professionals from both the inpatient and outpatient care settings have a common understanding., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Dinh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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28. Implementation and evaluation of a complex intervention to improve information availability at the interface between inpatient and outpatient care in older patients with multimorbidity and polypharmacy (HYPERION-TransCare) - study protocol for a pilot and feasibility cluster-randomized controlled trial in general practice in Germany.
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Klein AA, Petermann J, Brosse F, Piller S, Kramer M, Hanf M, Dinh TS, Schulz-Rothe S, Engler J, Mergenthal K, Seidling HM, Klasing S, Timmesfeld N, van den Akker M, and Voigt K
- Abstract
Background: Despite attempts to improve the cross-sectoral flow of information, difficulties remain in routine healthcare. The resulting negative impact on continuity of care is often associated with poor health outcomes, especially in older patients. Our intervention aims to increase information availability with respect to medications and health conditions at the interface between inpatient and outpatient care and to contribute towards improving the quality of care in older patients. This pilot study focuses on feasibility and implementability., Methods: The idea of the complex intervention has been developed in a previous study. This intervention will be tested in a prospective, multicenter, cluster-randomized (via web tool), controlled pilot trial with two parallel study arms (intervention and control group). The pilot study will be conducted in 20 general practices in Hesse and Saxony (Germany) and include 200 patients (≥ 65 years of age with multimorbidity and polypharmacy) recruited by the practices. Practice staff and patients will be blinded. We will use qualitative and quantitative methods to assess the feasibility and implementability of the intervention and the study design in a process evaluation covering topics ranging from expectations to experiences. In addition, the feasibility of proposed outcome parameters for the future definitive trial will be explored. The composite endpoint will include health-related patient outcomes (hospitalization, falls, and mortality using, e.g., the FIMA questionnaire), and we will assess information on medications (SIMS questionnaire), symptoms and side effects of the medication (pro-CTCAE questionnaire), and health literacy (HLQ questionnaire). Data will be collected at study begin (baseline) and after 6 months. Furthermore, the study will include surveys and interviews with patients, general practitioners, and healthcare assistants., Discussion: The intervention was developed using a participatory approach involving stakeholders and patients. It aims to empower general practice teams as they provide patient-centered care and play a key role in the coordination and continuity of care. We aim to encourage patients to adopt an active role in their health care. Overall, we want to increase the availability of health-related information for patients and healthcare providers. The results of the pilot study will be used in the design and implementation of the future definitive trial., Trial Registration: The study was registered in DRKS-German Clinical Trials Register: registration number DRKS00027649 (date: 19 January 2022). Date and version identifier 10.07.2023; Version 1.3., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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29. Development of an intervention to improve informational continuity of care in older patients with polypharmacy at the interface between general practice and hospital care: protocol for a participatory qualitative study in Germany.
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Brueckle MS, Dinh TS, Klein AA, Rietschel L, Petermann J, Brosse F, Schulz-Rothe S, Gonzalez-Gonzalez AI, Kramer M, Engler J, Mergenthal K, Muth C, Voigt K, and van den Akker M
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- Aged, Hospitals, Humans, Patient Discharge, Pilot Projects, General Practice, Polypharmacy
- Abstract
Introduction: Older patients with multimorbidity, polypharmacy and related complex care needs represent a growing proportion of the population and a challenge for healthcare systems. Particularly in transitional care (hospital admission and hospital discharge), medical errors, inappropriate treatment, patient concerns and lack of confidence in healthcare are major problems that may arise from a lack of information continuity. The aim of this study is to develop an intervention to improve informational continuity of care at the interface between general practice and hospital care., Methods and Analysis: A qualitative approach will be used to develop our participatory intervention. Overall, 32 semistructured interviews with relevant stakeholders will be conducted and analysed. The stakeholders will include healthcare professionals from the outpatient setting (general practitioners, healthcare assistants, ambulatory care nurses) and the inpatient setting (clinical doctors, nurses, pharmacists, clinical information scientists) as well as patients and informal caregivers. At a series of workshops based on the results of the stakeholder analyses, we aim to develop a participatory intervention that will then be implemented in a subsequent pilot study. The same stakeholder groups will be invited for participation in the workshops., Ethics and Dissemination: Ethical approval for this study was waived by the Ethics Committee of Goethe University Frankfurt because of the nature of the proposed study. Written informed consent will be obtained from all study participants prior to participation. Results will be tested in a pilot study and disseminated at (inter)national conferences and via publication in peer-reviewed journals., Trial Registation Number: Clinical Trials Register: registration number DRKS00027649., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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30. [Interprofessional Care of Patients with Rheumatoid Arthritis from the Perspective of a General Practitioner Perspective: Results of a Cross-sectional Study].
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Schneider E, Petersen JJ, Schulz-Rothe S, Gerlach FM, Rossmanith T, Siebenhofer A, and Mergenthal K
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- Cross-Sectional Studies, Germany epidemiology, Humans, Prospective Studies, Arthritis, Rheumatoid diagnosis, Arthritis, Rheumatoid epidemiology, Arthritis, Rheumatoid therapy, General Practitioners
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Background: General practitioners, specialists, occupational and physical therapists, nursing services and other professional groups are all involved in the treatment of patients with rheumatoid arthritis. This study aims to describe interprofessional cooperation in daily ambulatory care from the perspective of a general practitioner., Methods: The cross-sectional study investigated cooperation between general practitioners (n=121 in 68 medical practices) and several other health care providers in Hesse and Rhineland Palatinate, Germany, from February to September 2017. It was part of the prospective cohort study PANORA (Prevalence of anti-cyclic citrullinated peptide (anti-CCP) positivity in patients with new onset of non-specific musculoskeletal symptoms). The questionnaire that was used contained closed-ended questions on socio-demographics and frequency of contact, and asked physicians to assess and weigh existing collaboration. Descriptive statistics were used for data analysis., Results: When caring for patients with rheumatoid arthritis, 70%, of the physicians often took responsibility for synchronizing medications, and discussing diagnoses and test results. The most frequent cooperation was with rheumatologists and was considered as highly important but the least satisfactory. The second most frequent cooperation was with physical therapists and this was also rated as very important. Physicians had highest level of satisfaction with their collaboration with the nursing services., Conclusion: This study shows that general practitioners perform several medical tasks when treating patients with rheumatoid arthritis. During the process, they work together with several health care providers to various degrees. Cooperation with rheumatologists and physical therapists is particularly important to general practitioners; cooperation with rheumatologists is considered inadequate and in need of improvement., Competing Interests: Das Institut für Allgemeinmedizin der Goethe-Universität ist Kooperationspartner in der PANORA-Studie, welche federführend vom Fraunhofer Institut IME durchgeführt und von Bristol – Meyer Squibb finanziert wird. Darüber hinaus geben die Autoren an, dass keine Interessenkonflikte bestehen., (Thieme. All rights reserved.)
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- 2021
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31. Differences in the quality of oral anticoagulation therapy with vitamin K antagonists in German GP practices - results of the cluster-randomized PICANT trial (Primary Care Management for Optimized Antithrombotic Treatment).
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Mertens C, Siebenhofer A, Berghold A, Pregartner G, Ulrich LR, Mergenthal K, Kemperdick B, Schulz-Rothe S, Rauck S, Harder S, Gerlach FM, and Petersen JJ
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- Administration, Oral, Adult, Female, Fibrinolytic Agents therapeutic use, Germany, Humans, International Normalized Ratio, Male, Middle Aged, Primary Health Care, Anticoagulants administration & dosage, General Practice, Quality of Health Care statistics & numerical data, Thrombolytic Therapy, Vitamin K antagonists & inhibitors
- Abstract
Background: In Germany, patients receiving oral anticoagulation (OAC) are often treated by general practitioners (GPs), and large proportions of patients receive vitamin K antagonists (VKAs). The quality of OAC in German GP practices, differences between various practices, and improvement potential through implementation of case management, have not yet been investigated satisfactorily. Based on results of a cluster-randomized controlled trial, we aimed to assess whether OAC quality can be improved, any variations between practices exist and determine practice- and patient-level factors., Methods: The PICANT trial (2012-2015) was performed in 52 GP practices in Hesse, Germany. Adult patients with long-term indication for OAC received best practice case management in the intervention group. International normalized ratio (INR) values were recorded from anticoagulation passes. The Rosendaal method was used to calculate Time in Therapeutic Range (TTR) at patient level, and mean pooling to obtain center-specific TTR (cTTR) at practice level. The quality of OAC was assessed by TTR and cTTR. Linear model analyses were used to investigate associations between practice-/ patient-level factors and TTR., Results: Inclusion of 736 patients (49.6% intervention and 50.4% control patients); 690 (93.8%) received phenprocoumon. Within 24 months, the TTR was 75.1% (SD 17.6) in the intervention versus 74.3% (SD 17.8) in the control group (p = 0.670). The cTTR averaged 75.1% (SD 6.5, range: 60.4 to 86.7%) in the intervention versus 74.3% (SD 7.2, range: 52.7 to 85.7%) in the control group (p = 0.668). At practice level, the TTR was significantly lower in practices with a male physician and certification in quality management. At patient level, the TTR was significantly higher in patients with moderate to high compliance, in men, and in patients that performed self-management. The TTR was significantly lower in patients with certain comorbidities, and who were hospitalized., Conclusions: The intervention did not effectively improve OAC quality compared to routine care. Quality of INR control was generally good, but considerable variation existed between GP practices. The variability indicates optimization potential in some practices. The demonstrated association between patient-level factors and TTR highlights the importance of considering patient characteristics that may impede achieving high quality therapeutic outcomes., Trial Registration: ISRCTN registry, ISRCTN41847489 , registered 27 February 2012.
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- 2019
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32. Primary care management for patients receiving long-term antithrombotic treatment: A cluster-randomized controlled trial.
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Siebenhofer A, Ulrich LR, Mergenthal K, Berghold A, Pregartner G, Kemperdick B, Schulz-Rothe S, Rauck S, Harder S, Gerlach FM, and Petersen JJ
- Subjects
- Administration, Oral, Aged, Aged, 80 and over, Cluster Analysis, Endpoint Determination, Female, Fibrinolytic Agents administration & dosage, Fibrinolytic Agents adverse effects, General Practice, Germany, Hemorrhage etiology, Hospitalization, Humans, Male, Medication Adherence, Middle Aged, Outcome Assessment, Health Care, Patient Medication Knowledge, Patient Satisfaction, Quality of Life, Thromboembolism etiology, Time Factors, Case Management, Fibrinolytic Agents therapeutic use, Primary Health Care
- Abstract
Purpose: To examine whether applying case management in general practices reduces thromboembolic events requiring hospitalization and major bleeding events (combined primary outcome). Secondary endpoints were mortality, frequency and duration of hospitalization, severe treatment interactions, adverse events, quality of anticoagulation, health-related quality of life and intervention costs, patients' assessment of chronic illness care, self-reported adherence to medication, GP and HCA knowledge, patient knowledge and satisfaction with shared decision-making., Methods: Cluster-randomized controlled trial undertaken at 52 general practices in Germany with adult patients with a long-term indication for oral anticoagulation. The complex intervention included training for healthcare assistants, information and quality circles for general practitioners and 24 months of case management for patients. Assessment was after 12 and 24 months. The intention-to-treat population included all randomized practices and patients, while the per-protocol analysis included only those that received treatment without major protocol violations., Results: The mean (SD) age of the 736 patients was 73.5 (9.4) years and 597 (81.1%) had atrial fibrillation. After 24 months, the primary endpoint had occurred in 40 (11.0%) intervention and 48 (12.9%) control patients (hazard ratio 0.83, 95% CI 0.55 to 1.25; P = .37). Patients' perceived quality of care, their knowledge, and HCAs' knowledge, had improved significantly at 24 months. The other secondary endpoints did not differ between groups. In the intervention group, hospital admissions were significantly reduced in patients that received treatment without major protocol deviations., Conclusions: Even though the main outcomes did not differ significantly, the intervention appears to have positively influenced several process parameters under 'real-world conditions'., Competing Interests: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Juliana J. Petersen has been a co-investigator in the PANORA study (‘Prevalence of anti-cyclic citrullinated peptide (CCP) positivity in patients with new non-specific onset of musculoskeletal symptoms, possibly related to early rheumatoid arthritis in general practices in Germany’), which is being conducted by the Fraunhofer Institute and financed by Bristol‐Meyer Squibb. She is employed by the Institute of General Practice of Goethe-University Frankfurt and has never personally received financial remuneration from a pharmaceutical company. Karola Mergenthal is employed as project manager in the PANORA study. She has also never personally received financial remuneration from a pharmaceutical company. Andrea Siebenhofer received funding from the Federation of Austrian Social Insurance Institutions (HVB) for the preparation of a systematic review on self-management of oral anticoagulation in 2014 and was financed by ROCHE Diagnostics to carry out a study on self-management of oral anticoagulation from 2002-2005. Sebastian Harder has received honoraria for scientific lectures from Boehringer Ingelheim GmbH, Pfizer GmbH, Daiichi Sankyo GmbH, and Bayer AG. The other authors declare no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
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- 2019
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33. Colorectal cancer stage at diagnosis in migrants and non-migrants: a cross-sectional analysis of the KoMigra Study in Germany.
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Dahlhaus A, Siebenhofer A, Guethlin C, Taubenroth M, Albay Z, Schulz-Rothe S, Singer S, and Plath J
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- Cross-Sectional Studies, Germany, Humans, Neoplasm Staging, Colorectal Neoplasms epidemiology, Delayed Diagnosis, Transients and Migrants
- Abstract
Background: Colorectal cancer is one leading cause of cancer-related morbidity and mortality. Its prognosis depends largely on tumour stage at diagnosis. Migration status was associated with late stage at diagnosis in some studies, yet results are inconsistent., Methods: The cross-sectional study "The Diagnostics of Colorectal Carcinoma in Migrants and Non-Migrants in Germany" (KoMigra) investigated the association between migration background and tumour stage of colorectal cancer at diagnosis in a large German urban area. Patient variables were collected via a survey translated into nine languages. Data on tumour stage were extracted from medical records., Results: 437 patients could be recruited for analysis. Explorative logistic regression yielded no significant difference for tumour stage "I" versus "II-IV" according to the tumour classification "Union Internationale Contre le Cancer" (UICC) between migrants and non-migrants. Although the odds of a higher tumour stage were consistently higher in migrants than non-migrants, the effect estimates had wide confidence intervals. In descriptive analyses, migrants reported symptoms more often and for longer time than non-migrants. This was especially true for patients with poor proficiency of German., Conclusions: Migration background was not significantly associated with advanced tumour stage at diagnosis. However, the effect of poor language proficiency should be explored further., Competing Interests: Dr. Singer reports financial activities outside the submitted work: grants and personal fees from Pfizer and Lilly as well as personal fees from Bristol-Myers Squibb and from Boehringer-Ingelheim. All other authors declare no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)
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- 2018
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34. Utilization of colonoscopy and colonoscopic findings among individuals aged 40-54 years with a positive family history of colorectal cancer: a cross-sectional study in general practice.
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Plath J, Siebenhofer A, Haug U, Koné I, Hechtner M, Blumenstein I, Schulz-Rothe S, Gerlach FM, and Guethlin C
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- Adult, Colonoscopy standards, Cross-Sectional Studies, Early Detection of Cancer methods, Female, General Practice standards, Germany, Guideline Adherence statistics & numerical data, Humans, Male, Medical History Taking standards, Medical History Taking statistics & numerical data, Middle Aged, Practice Guidelines as Topic, Colonoscopy statistics & numerical data, Colorectal Neoplasms diagnostic imaging, Early Detection of Cancer statistics & numerical data, General Practice statistics & numerical data, Patient Acceptance of Health Care statistics & numerical data
- Abstract
Guidelines recommend early colonoscopy for individuals with a positive family history of colorectal cancer (CRC), but little is known about the utilization of colonoscopy and the frequency of colorectal neoplasms among younger affected individuals in Germany. The aim of this study was to determine the utilization of colonoscopy and the frequency of colorectal neoplasms in this risk group. We conducted a cross-sectional study in a general practice setting. Patients aged 40-54 years with at least one first-degree relative with CRC were identified, counseled on their increased risk, and referred to colonoscopy if they decided to undergo this procedure. We assessed the reported utilization of colonoscopy before study participation with a questionnaire and obtained results of colonoscopies performed during the study period from colonoscopy reports. Out of 484 patients with a positive family history of CRC, 191 (39.5%) fulfilled the inclusion criteria and participated in the study: 54% reported that at least one colonoscopy had been performed before study participation. Out of 191 participants, 86 (45%) underwent a colonoscopy during study period. No CRC was found, but 16.3% had any adenoma, and 7.0% had advanced adenomas. Overall, 155 (82%) study participants underwent a colonoscopy either before or during the study period. The utilization of colonoscopies among participants was remarkably high even before study participation. This rate increased up to 82% after counseling by general practitioners. A relevant number of participants had (advanced) adenomas. It appears worthwhile to involve general practitioners in identifying and counseling younger individuals with familial risk for CRC.
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- 2018
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35. [Who Should Provide Persons with Familial Risk of Colorectal Cancer with Information on Early Detection? - The View of those Affected].
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Plath J, Siebenhofer A, Schulz-Rothe S, and Güthlin C
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- Adult, Cross-Sectional Studies, Female, Germany, Humans, Male, Middle Aged, Patient Education as Topic, Risk Assessment, Colorectal Neoplasms genetics, Early Detection of Cancer, Genetic Predisposition to Disease
- Abstract
Background: Colonoscopy is recommended for persons with a familial risk of colorectal cancer (CRC) before they reach 55 years of age. The aim of this analysis was to ask affected persons aged 40-54 years whether they had found out about early detection of CRC and from which institutions and media they would like to obtain such information., Methods: Analysis of data from a cross-sectional study: In a general practice setting, those with a positive family history of CRC were asked to provide written information., Results: In total, 191 persons with a positive family history of CRC participated in the study: 59.6% had already found out about early detection of CRC. Out of this, 67.0% had received information from their physicians. Most of the participants wanted information on early detection of CRC to be provided by the general practitioner (98.9% completely or mostly agree), and by health insurers (74.5% completely or mostly agree). The participants would rather not prefer to receive information from public institutions such as the public health department (69.5% not or mostly not agree) and private organizations such as self-help groups (80.9% not or mostly not agree). Approximately half would prefer to receive such information via TV. More men than women would prefer to source such information from the internet (completely or mostly agree: 66.7 vs. 43.8%), or newspapers and magazines (completely or mostly agree: 53.6 vs. 41.8%)., Conclusion: A survey in a general practice setting found that more than half of persons with familial risk of CRC had already obtained information on early detection. The setting of the survey on preferred information sources possibly encouraged participants to put general practitioners in the first place. Furthermore, the results of this nationwide unique cohort of persons aged 40-54 with a familial risk of CRC show that their information-seeking behavior was not more pronounced than average and that men and women can be provided with information in different ways., Competing Interests: Frau Prof. Siebenhofer hat 2014 und 2015 insgesamt zweimalig als Vertreterin der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM) als Expertin an vom Netzwerk gegen Darmkrebs organisierten Treffen zur Weiterentwicklung der Darmkrebsfrüherkennung teilgenommen. Die weiteren Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)
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- 2018
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36. Does a complex intervention increase patient knowledge about oral anticoagulation? - a cluster-randomised controlled trial.
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Maikranz V, Siebenhofer A, Ulrich LR, Mergenthal K, Schulz-Rothe S, Kemperdick B, Rauck S, Pregartner G, Berghold A, Gerlach FM, and Petersen JJ
- Subjects
- Administration, Oral, Aged, Atrial Fibrillation complications, Cluster Analysis, Female, Follow-Up Studies, Germany epidemiology, Humans, Incidence, Male, Middle Aged, Retrospective Studies, Stroke epidemiology, Stroke etiology, Time Factors, Anticoagulants administration & dosage, Atrial Fibrillation drug therapy, Family Practice methods, Patient Education as Topic, Self Care methods, Stroke prevention & control
- Abstract
Background: Oral anticoagulation therapy (OAT) is a challenge in general practice, especially for high-risk groups such as the elderly. Insufficient patient knowledge about safety-relevant aspects of OAT is considered to be one of the main reasons for complications. The research question addressed in this manuscript is whether a complex intervention that includes practice-based case management, self-management of OAT and additional patient and practice team education improves patient knowledge about anticoagulation therapy compared to a control group of patients receiving usual care (as a secondary objective of the Primary Care Management for Optimised Antithrombotic Treatment (PICANT) trial)., Methods: The cluster-randomised controlled PICANT trial was conducted in 52 general practices in Germany, between 2012 and 2015. Trial participants were patients with a long-term indication for oral anticoagulation. A questionnaire was used to assess knowledge at baseline, after 12, and after 24 months. The questionnaire consists of 13 items (with a range of 0 to 13 sum-score points) covering topics related to intervention. Differences in the development of patient knowledge between intervention and control groups compared to baseline were assessed for each follow-up by means of linear mixed-effects models., Results: Seven hundred thirty-six patients were included at baseline, of whom 95.4% continued to participate after 12 months, and 89.3% after 24 months. The average age of patients was 73.5 years (SD 9.4), and they mainly suffered from atrial fibrillation (81.1%). Patients in the intervention and control groups had similar knowledge about oral anticoagulation at baseline (5.6 (SD 2.3) in both groups). After 12 months, the improvement in the level of knowledge (compared to baseline) was significantly larger in the intervention group than in the control group (0.78 (SD 2.5) vs. 0.04 (SD 2.3); p = 0.0009). After 24 months, the difference between both groups was still statistically significant (0.6 (SD 2.6) vs. -0.3 (SD 2.3); p = 0.0001)., Conclusion: Since this intervention was effective, it should be established in general practice as a means of improving patient knowledge about oral anticoagulation., Trial Registration: Current controlled trials ISRCTN41847489 ; Date of registration: 13/04/2012.
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- 2017
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37. Frequency of a positive family history of colorectal cancer in general practice: a cross-sectional study.
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Plath J, Siebenhofer A, Koné I, Hechtner M, Schulz-Rothe S, Beyer M, Gerlach FM, and Guethlin C
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- Adult, Cross-Sectional Studies, Female, Germany epidemiology, Humans, Kidney Neoplasms epidemiology, Kidney Neoplasms genetics, Male, Medical History Taking, Middle Aged, Nuclear Family, Ovarian Neoplasms epidemiology, Ovarian Neoplasms genetics, Pedigree, Prevalence, Stomach Neoplasms epidemiology, Stomach Neoplasms genetics, Urethral Neoplasms epidemiology, Urethral Neoplasms genetics, Uterine Cervical Neoplasms epidemiology, Uterine Cervical Neoplasms genetics, Colonic Polyps epidemiology, Colonic Polyps genetics, Colorectal Neoplasms epidemiology, Colorectal Neoplasms genetics, General Practice statistics & numerical data
- Abstract
Background: Evidence on the frequency of a positive family history of colorectal cancer (CRC) among individuals aged <55 years is lacking. General practice setting might be well suited for the identification of individuals in this above-average risk group., Objective: To determine the frequency of a reported positive family history of CRC among patients aged 40 to 54 years in a general practice setting., Methods: We conducted a cross-sectional study in 21 general practices in Germany. Patients aged 40 to 54 years were identified by means of the practice software and interviewed by health care assistants using a standardized four-item questionnaire. Outcome was occurrence of a positive family history of CRC, defined as at least one first-degree relative (FDR: parents, siblings, or children) with CRC. Further measurements were FDRs with CRC / colorectal polyps (adenomas) diagnosed before the age of 50 and occurrence of three or more relatives with colorectal, stomach, cervical, ovarian, urethel or renal pelvic cancer., Results: Out of 6723 participants, 7.2% (95% confidence interval [CI] 6.6% to 7.8%) reported at least one FDR with CRC and 1.2% (95% CI 0.9% to 1.5%) reported FDRs with CRC diagnosed before the age of 50. A further 2.6% (95% CI 2.3% to 3.0%) reported colorectal polyps in FDRs diagnosed before the age of 50 and 2.1% (95% CI 1.8% to 2.5%) reported three or more relatives with entities mentioned above., Conclusion: One in 14 patients reported at least one FDR with CRC. General practice should be considered when defining requirements of risk-adapted CRC screening., (© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2017
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38. Positive family history of colorectal cancer in a general practice setting [FRIDA.Frankfurt]: study protocol of a of a cross-sectional study.
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Siebenhofer A, Plath J, Taubenroth M, Singer S, Hechtner M, Dahlhaus A, Rauck S, Schulz-Rothe S, Koné I, and Gerlach FM
- Subjects
- Adenoma blood, Adult, Colonoscopy, Colorectal Neoplasms blood, Cross-Sectional Studies, Early Detection of Cancer, General Practice, Germany, Health Surveys, Humans, Middle Aged, Occult Blood, Physician-Patient Relations, Preventive Medicine methods, Research Design, Risk Assessment, Adenoma diagnosis, Colorectal Neoplasms diagnosis, Family Health
- Abstract
Background: Although the risk of developing colorectal cancer (CRC) is 2-4 times higher in case of a positive family history, risk-adapted screening programs for family members related to CRC- patients do not exist in the German health care system. CRC screening recommendations for persons under 55 years of age that have a family predisposition have been published in several guidelines. The primary aim of this study is to determine the frequency of positive family history of CRC (1st degree relatives with CRC) among 40-54 year old persons in a general practitioner (GP) setting in Germany. Secondary aims are to detect the frequency of occurrence of colorectal neoplasms (CRC and advanced adenomas) in 1st degree relatives of CRC patients and to identify the variables (e.g. demographic, genetic, epigenetic and proteomic characteristics) that are associated with it. This study also explores whether evidence-based information contributes to informed decisions and how screening participation correlates with anxiety and (anticipated) regret., Methods/design: Prior to the beginning of the study, the GP team (GP and one health care assistant) in around 50 practices will be trained, and about 8,750 persons that are registered with them will be asked to complete the "Network against colorectal cancer" questionnaire. The 10% who are expected to have a positive family history will then be invited to give their informed consent to participate in the study. All individuals with positive family history will be provided with evidence-based information and prevention strategies. We plan to examine each participant's family history of CRC in detail and to collect information on further variables (e.g. demographics) associated with increased risk. Additional stool and blood samples will be collected from study-participants who decide to undergo a colonoscopy (n ~ 350) and then analyzed at the German Cancer Research Center (DKFZ) Heidelberg to see whether further relevant variables are associated with an increased risk of CRC. One screening list and four questionnaires will be used to collect the data, and a detailed statistical analysis plan will be provided before the database is closed (expected to be June 30, 2015)., Discussion: It is anticipated that when persons with a family history of colorectal cancer have been provided with professional advice by the practice team, there will be an increase in the availability of valid information on the frequency of affected individuals and an increase in the number of persons making informed decisions. We also expect to identify further variables that are associated with colorectal cancer. This study therefore has translational relevance from lab to practice., Trial Registration: German Clinical Trials Register DRKS00006277.
- Published
- 2015
- Full Text
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39. Anticoagulant treatment in German family practices - screening results from a cluster randomized controlled trial.
- Author
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Ulrich LR, Mergenthal K, Petersen JJ, Roehl I, Rauck S, Kemperdick B, Schulz-Rothe S, Berghold A, and Siebenhofer A
- Subjects
- Administration, Oral, Aged, Aged, 80 and over, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Benzimidazoles therapeutic use, Coumarins therapeutic use, Dabigatran, Female, Germany, Heart Diseases drug therapy, Heart Valve Prosthesis, Humans, International Normalized Ratio, Male, Mass Screening, Middle Aged, Morpholines therapeutic use, Pulmonary Embolism prevention & control, Pyrazoles therapeutic use, Pyridones therapeutic use, Rivaroxaban, Stroke etiology, Stroke prevention & control, Thiophenes therapeutic use, Thrombosis drug therapy, Venous Thromboembolism prevention & control, beta-Alanine analogs & derivatives, beta-Alanine therapeutic use, Anticoagulants therapeutic use, Family Practice standards, Guideline Adherence statistics & numerical data, Practice Guidelines as Topic, Process Assessment, Health Care, Thromboembolism prevention & control
- Abstract
Background: Oral anticoagulation (OAC) with coumarins and new anticoagulants are highly effective in preventing thromboembolic complications. However, some studies indicate that over- and under-treatment with anticoagulants are fairly common. The aim of this paper is to assess the appropriateness of treatment in patients with a long-term indication for OAC, and to describe the corresponding characteristics of such patients on the basis of screening results from the cluster randomized PICANT trial., Methods: Randomly selected family practices in the federal state of Hesse, Germany, were visited by study team members. Eligible patients were screened using an anonymous patient list that was generated by the general practitioners' software according to predefined instructions. A documentation sheet was filled in for all screened patients. Eligible patients were classified into 3 categories (1: patients with a long-term indication for OAC and taking anticoagulants, 2: patients with a long-term indication for OAC but not taking anticoagulants, 3: patients without a long-term indication for OAC but taking an anticoagulant on a permanent basis). IBM SPSS Statistics 20 was used for descriptive statistical analysis., Results: We screened 2,036 randomly selected, potentially eligible patients from 52 family practices. 275 patients could not be assigned to one of the 3 categories and were therefore not considered for analysis. The final study sample comprised 1,761 screened patients, 1,641 of whom belonged to category 1, 78 to category 2, and 42 to category 3. INR values were available for 1,504 patients of whom 1,013 presented INR values within their therapeutic ranges. The majority of screened patients had very good compliance, as assessed by the general practitioner. New antithrombotic drugs were prescribed in 6.1% of cases., Conclusions: The screening results showed that a high proportion of patients were receiving appropriate anticoagulation therapy. The numbers of patients with a long-term indication for OAC therapy that were not receiving oral anticoagulants, and without a long-term indication that were receiving OAC, were considerably lower than expected. Most patients take coumarins, and the quality of OAC control is reasonably high., Trial Registration: Current Controlled Trials ISRCTN41847489.
- Published
- 2014
- Full Text
- View/download PDF
40. Colorectal cancer stage at diagnosis in migrants versus non-migrants (KoMigra): study protocol of a cross-sectional study in Germany.
- Author
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Dahlhaus A, Guethlin C, Schall A, Taubenroth M, van Ewijk R, Zeeb H, Albay Z, Schulz-Rothe S, Beyer M, Gerlach FM, Blettner M, and Siebenhofer A
- Subjects
- Aged, Cross-Sectional Studies, Female, Germany ethnology, Health Services Accessibility economics, Humans, Male, Middle Aged, Neoplasm Staging, Prospective Studies, Surveys and Questionnaires, Colorectal Neoplasms diagnosis, Colorectal Neoplasms ethnology, Transients and Migrants
- Abstract
Background: In Germany, about 20% of the total population have a migration background. Differences exist between migrants and non-migrants in terms of health care access and utilisation. Colorectal cancer is the second most common malignant tumour in Germany, and incidence, staging and survival chances depend, amongst other things, on ethnicity and lifestyle. The current study investigates whether stage at diagnosis differs between migrants and non-migrants with colorectal cancer in an area of high migration and attempts to identify factors that can explain any differences., Methods/design: Data on tumour and migration status will be collected for 1,200 consecutive patients that have received a new, histologically verified diagnosis of colorectal cancer in a high migration area in Germany in the previous three months. The recruitment process is expected to take 16 months and will include gastroenterological private practices and certified centres for intestinal diseases. Descriptive and analytical analysis will be performed: the distribution of variables for migrants versus non-migrants and participants versus non-participants will be analysed using appropriate χ2-, t-, F- or Wilcoxon tests. Multivariable, logistic regression models will be performed, with the dependent variable being the dichotomized stage of the tumour (UICC stage I versus more advanced than UICC stage I). Odds ratios and associated 95%-confidence intervals will be calculated. Furthermore, ordered logistic regression models will be estimated, with the exact stage of the tumour at diagnosis as the dependent variable. Predictors used in the ordered logistic regression will be patient characteristics that are specific to migrants as well as patient characteristics that are not. Interaction models will be estimated in order to investigate whether the effects of patient characteristics on stage of tumour at the time of the initial diagnosis is different in migrants, compared to non-migrants., Discussion: An association of migration status or other socioeconomic variables with stage at diagnosis of colorectal cancer would be an important finding with respect to equal health care access among migrants. It would point to access barriers or different symptom appraisal and, in the long term, could contribute to the development of new health care concepts for migrants., Trial Registration: German Clinical Trials Register DRKS00005056.
- Published
- 2014
- Full Text
- View/download PDF
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