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Background Venous leg ulcers (VLU) have a prevalence of 1–2% in developed countries, and affected patients are severely and long-term impaired in daily activities, work, and social participation. Evidence-based outpatient treatment based on compression therapy is frequently not implemented. The “Ulcus Cruris Care” project was established to develop a disease management concept to improve outpatient treatment for patients with VLU in German primary care. For this purpose, a multifaceted intervention was conceived consisting of an online training for general practitioners and medical assistants, standardized treatment recommendations, e-learning and print-based information for patients, and a software support for case management. The main aims of the Ulcus Cruris Care intervention are to promote standardized treatment according to current scientific knowledge, to facilitate case management for VLU patients exerted by medical assistants, and to support patient education and participation in the treatment process. The UCC trial was designed to evaluate the effectiveness of the Ulcus Cruris Care intervention. Methods The UCC trial is a prospective cluster-randomized controlled multicenter trial. Fifty GP practices are intended to be recruited and randomized 1:1 to intervention or control arm. Patients with venous leg ulcers will be recruited by participating GP practices, to include a total of 63 patients in each arm. The primary outcome is time to ulcer healing. Secondary outcomes comprise number and sizes of ulcers, recurrence, pain intensity according to the visual analog scale, health-related quality of life according to EQ-5D-5L, depressiveness according to Patient Health Questionnaire (PHQ-9), patient satisfaction according to the Patient Assessment of Chronic Illness Care (PACIC-5A) query, and adherence to VLU treatment. The outcome analysis of the UCC trial is accompanied by a health economic analysis and a process evaluation. Discussion The UCC trial will evaluate whether the Ulcus Cruris Care intervention may lead to faster wound healing, higher health-related quality of life, and lower use of medical resources. If the intervention turns out to have a positive impact on assessed outcomes, comprehensive implementation in primary care may be considered. Trial registration The trial protocol (version 1 as of July 19, 2021) has been registered in the German Clinical Trials Register on August 30, 2021 (DRKS00026126).

IntroductionThe VESPEERA programme is a multifaceted programme to enhance information transfer between general practice and hospital across the process of hospital admission, stay and discharge. It was implemented in 7 hospitals and 72 general practices in Southern Germany. Uptake was heterogeneous and overall low. A process evaluation aimed at identifying factors associated with the implementation of the VESPEERA programme.MethodsThis was a qualitative study using semi-structured interviews in a purposeful sample of health workers in hospitals and general practices in the VESPEERA programme. Qualitative framework analysis using the Consolidated Framework for Implementation Research was performed and revealed the topic of previous and new routines to be protruding. Inductive content analysis was used for in-depth examination of stages in the process of staying in a previous or falling into a new routines.ResultsThirty-six interviews were conducted with 17 participants from general practices and 19 participants from hospitals. The interviewees were in different stages of the implementation process at the time of the interviews. Four stages were identified: Stage 1,’Previous routine and tension for change’, describes the situation in which VESPEERA was to be implemented and the factors leading to the decision to participate. In stage 2,’Adoption of the VESPEERA programme’, factors that influenced whether individuals decided to employ the innovation are relevant. Stage 3 comprises ‘Determinants for falling into and staying in the new VESPEERA-routine’ relates to actual implementation and finally, in stage 4, the participants reflect on the success of the implementation.ConclusionsThe individuals and organisations participating in the VESPEERA programme were in different stages of a process from the previous to the new routine, which were characterised by different determinants of implementation. In all stages, organisational factors were main determinants of implementation, but different factors emerged in different implementation stages. A low distinction between decision-making power and executive, as well as available resources, were beneficial for the implementation of the innovation.Trial registrationDRKS00015183 on DRKS / Universal Trial Number (UTN): U1111-1218–0992.

Contains fulltext : 282771.pdf (Publisher’s version ) (Closed access) INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. Publisher: Abstract available from the publisher. ger

Background Conducting a process evaluation is essential to understand how health interventions work in different healthcare settings. Particularly in the case of complex interventions, it is important to find out whether the intervention could be carried out as planned and which factors had a beneficial or hindering effect on its implementation. The aim of this study is to present the detailed protocol of the process evaluation embedded in the controlled implementation study CCC-Integrativ aiming to implement an interprofessional counselling program for cancer patients on complementary and integrative health care (CIH). Methods This mixed methods study will draw upon the “Consolidated Framework for Implementation Research” (CFIR) combined with the concept of “intervention fidelity” to evaluate the quality of the interprofessional counselling sessions, to explore the perspective of the directly and indirectly involved healthcare staff, as well as to analyze the perceptions and experiences of the patients. The qualitative evaluation phase consists of analyzing audio-recorded counselling sessions, as well as individual and group interviews with the involved persons. The quantitative evaluation phase applies questionnaires which are distributed before (T0), at the beginning (T1), in the middle (T2) and at the end (T3) of the intervention delivery. Discussion This protocol provides an example of how a process evaluation can be conducted parallel to a main study investigating and implementing a complex intervention. The results of this mixed methods research will make it possible to identify strengths and weaknesses of the team-based intervention, and to target more specifically the key factors and structures required to implement healthcare structures to meet patients’ unmet needs in the context of CIH. To our knowledge, this study is the first applying the CFIR framework in the context of interprofessional CIH counselling, and its results are expected to provide comprehensive and multidisciplinary management of cancer patients with complex supportive healthcare needs.

Hintergrund: Krankenhauseinweisungen und -entlassungen stellen Brüche in der Patientenversorgung dar, die sich negativ auf Wiederaufnahmeraten, Versorgungskosten und die gesundheitsbezogene Lebensqualität auswirken können. Strukturierte Interventionen, die aus mehreren Komponenten bestehen, [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: Es gibt Hinweise, dass Hausärzt*innen seltener als früher kleine chirurgische Eingriffe praktizieren. Fragestellung: Ziele dieser Studie waren, Vorerfahrungen und chirurgische Kompetenzen von Ärzt*innen in Weiterbildung Allgemeinmedizin (ÄiW) zu erheben, [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: In den letzten 15 Jahren lässt sich ein Wandel im hausärztlichen Berufsbild beobachten: Neben einer Feminisierung der Medizin, einer sinkenden Wochenarbeitszeit bei Ärzt:innen und einem veränderten Stellenwert des Berufs im Leben von Mediziner:innen, zeigt sich dieser [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: Viele Covid-19-PatientInnen wenden sich zuerst und hauptsächlich an ihre Hausarztpraxis. Die Versorgung von häuslich isolierten Covid-19-Patientinnen stellt die Hausarztpraxen vor Herausforderungen. Um die Hausarztpraxen hierbei zu unterstützen, wurde das softwaregestützte [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: Krankenhausentlassungen stellen nach wie vor eine Herausforderung für die Patientenversorgung dar. Mehrkomponenteninterventionen, die zu verschiedenen Zeitpunkten rund um den Krankenhausaufenthalt ansetzen, können zur Verbesserung der Versorgung beitragen. Fragestellung: [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund/Fragestellung: An der Bewältigung der COVID-19-Pandemie sind verschiedene Akteure des Gesundheitswesens beteiligt. Laut Kassenärztlicher Vereinigung wurden in Deutschland 86% der COVID-19-Patient*innen bislang ambulant versorgt. Weltweit ist das komplexe Einwirken[zum vollständigen Text gelangen Sie über die oben angegebene URL], Who cares? – EbM und Transformation im Gesundheitswesen; 22. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin

Contains fulltext : 243578.pdf (Publisher’s version ) (Closed access) OBJECTIVES: The aim of this study was to give an early snapshot of primary care strategies that were implemented to cope with the early period of the COVID-19 pandemic in Baden-Wuerttemberg (Germany). METHODS: In June 2020, all 271 outpatient SARS-CoV-2 contact points, established by the National Association of Statutory Health Insurance Physicians (16 centers for testing, 204 specialized family practices, 51 Outpatients Corona Centers), and a randomly generated sample of 400 primary care practices of Baden-Wuerttemberg were invited to take part in a paper-based questionnaire. The data were gathered anonymously and analysed descriptively. RESULTS: Out of those invited, n=63 (15.8%) primary care practices and n=92 (33.9%) SARS-CoV-2 contact points participated; 78.7% of the primary care practices cooperated with SARS-CoV-2 contact points (n=48). In all, 92.1% had implemented a compulsory registration by phone for patients with (suspected) COVID-19 (n=58) and 81% offered consultation exclusively by phone or video in case of a mild courses (n=51). The new outpatient SARS-CoV-2 contact points were established in collaboration with several stakeholders, mainly led by primary care physicians (n=76, 82.6%) and almost 50% of these were established in March 2020 (n=42, 48.3%). The most commonly reported method of registration was regulated mainly by primary care practices (n=88, 95.7%) and public health departments (n=74, 80.4%). In 92.4% (n=85) of cases, it was possible to register by phone. The consultation response was most commonly given in the form of oral information to the patient (n=65, 77.4%). Less then 50% of the SARS-CoV-2 contact points used standardized sheets for registration, documentation and consultation. The assessment of future primary care structures for (suspected) COVID-19 patients were heterogeneous. CONCLUSIONS: Effort, improvisation and collaboration were required for a successful and rapid implementation of measures for primary care during the initial period of the COVID-19 pandemic. Impulses for ongoing development of primary care strategies during a pandemic can be derived out of these results.

Background: The task of the Competence Centers for vocational training (KW) is to increase the attractiveness and quality of vocational (=post-graduate) training in general practice. For this purpose, they offer, among other things, a structured seminar program for post-graduate trainees in general practice (GP-trainees). During the Covid-19 pandemic the seminar program of the KWBW-Verbundweiterbildungplus® in Baden-Württemberg was converted to digital formats. The goal of the paper is to evaluate the acceptance by the GP-trainees and lecturers, to describe experiences with the conversion to e-learning and to derive recommendations with regard to the future orientation of seminar programs in post-graduate as well as continuing medical education. The implementation was based on a modified Kern-cycle and aimed at offering eight teaching units of 45 minutes each to a large number of GP-trainees. It tried to maintain the high quality of content and education as well as the interactive character of the previous seminars. For this purpose, the events were designed as synchronous webinars (six units) with asynchronous preparation and post-processing (two units) according to the flipped classroom method. The evaluation by the participating GP-trainees and lecturers was performed online using a multi-center developed and pre-piloted questionnaire.Results and discussion: N=101 GP-trainees participated in the evaluation of five individual seminar days in the second quarter of 2020 (response rate 97%). 58% (N=59) of the trainees were satisfied or very satisfied with the implementation. 82% (n=83) rated pre-tasks as helpful. 99% (n=100) would participate in an online seminar again. For 52% (n=53) of the trainees, the attitude towards e-learning had changed positively. The main advantages mentioned were no travel, save in time and costs as well as increased flexibility. The main disadvantages mentioned were less personal interaction and technical obstacles. The high acceptance of the new digital format showed the fundamental potential of e-learning in continuing medical education. The experiences can be a source of inspiration for other departments and KW. However, it also shows that important goals of KW, such as the personal interaction of the peer group, could not be achieved. In the future, it is important to develop a suitable mix of presence and digital formats with the aim to improve the attractiveness as well as sustainability of continuing medical education. Hintergrund: Um die Attraktivität und Qualität der Weiterbildung in der Allgemeinmedizin zu steigern, bieten die Kompetenzzentren Weiterbildung (KW) u.a. ein strukturiertes Seminarprogramm für Ärztinnen und Ärzte in Weiterbildung (ÄiW) an. Im Zuge der Covid-19-Pandemie wurde das Seminarprogramm der KWBW-Verbundweiterbildungplus® in Baden-Württemberg auf digitale Formate umgestellt. Ziel der Arbeit ist es, die Akzeptanz bei ÄiW und Dozierenden zu evaluieren, die Erfahrungen bei der Umstellung auf E-Learning zu beschreiben und daraus Empfehlungen abzuleiten im Hinblick auf die zukünftige Ausrichtung von Seminarprogrammen in der Facharztweiterbildung. Die Umsetzung orientierte sich an einem modifizierten Kern-Zyklus und hatte zum Ziel, einer großen Zahl von ÄiW weiterhin acht Unterrichtseinheiten (UE) à 45 min anbieten zu können und dabei die hohe inhaltliche und didaktische Qualität sowie den interaktiven Charakter der bisherigen Seminare beizubehalten. Dazu wurden die Veranstaltungen als synchrone Webinare (sechs UE) mit asynchroner Vor- und Nachbereitung (zwei UE) im Sinne der flipped classroom Methode konzipiert. Die Evaluation durch die teilnehmenden ÄiW und Dozierenden erfolgte online mittels eines multizentrisch entwickelten und vorab pilotierten Fragebogens.Ergebnisse und Diskussion: An der Evaluation der fünf Einzelseminartage im zweiten Quartal 2020 nahmen N=101 ÄiW teil (Rücklauf 97%). 58% (N=59) der ÄiW waren mit der Umsetzung zufrieden oder sehr zufrieden. 82% (N=83) empfanden die Vorbereitungsaufgaben als hilfreich. 99% (N=100) würden erneut an einem Online-Seminar teilnehmen. Bei 52% (N=53) der ÄiW hat sich die Einstellung gegenüber E-Learning positiv geändert. Vorteile ergäben sich v.a. durch den Wegfall der Anreise, Zeit- und Kostenersparnisse sowie eine erhöhte Flexibilität. Als nachteilig wurden insbesondere der geringere persönliche Austausch und technische Hürden genannt. Die hohe Akzeptanz des neuen digitalen Formats zeigt das grundsätzliche Potenzial von E-Learning in der ärztlichen Weiterbildung. Die Erfahrungen können Impulsgeber für andere Fachbereiche und KW sein. Allerdings zeigt sich auch, dass wichtige Ziele der KW, wie der persönliche kollegiale Austausch, damit nicht erreicht werden können. Für die Zukunft gilt es, eine geeignete Mischung aus Präsenz und digitalen Formaten zu entwickeln mit dem Ziel, die ärztliche Weiterbildung noch attraktiver und zukunftsfähiger zu gestalten.

Background: Type 2 diabetes represents an increasingly critical challenge for health policy worldwide. It absorbs massive resources from both patients and national economies to sustain direct costs of the treatment of type 2 diabetes and its complications and indirect costs related to work loss and wages. More recently, there are innovations based on remote control and personalised programs that promise a more cost-effective diabetes management while reducing diabetes-related complications. In such a context, this work attempts to update cost analysis reviews on type 2 diabetes, focusing on France and Germany, in order to explore most significant cost drivers and cost-saving opportunities through innovations in diabetes care. Although both countries approach care delivery differently, France and Germany represent the primary European markets for diabetes technologies. Methods: A systematic review of the literature listed in MEDLINE, Embase and EconLit has been carried out. It covered interventional, observational and modelling studies on expenditures for type 2 diabetes management in France or Germany published since 2012. Included articles were analysed for annual direct, associated and indirect costs of type 2 diabetes patients. An appraisal of study quality was performed. Results were summarised narratively. Results: From 1260 records, the final sample was composed of 24 papers selected according to predefined inclusion/exclusion criteria. Both France and Germany revealed a predominant focus on direct costs. Comparability was limited due to different study populations and cost categories used. Indirect costs were only available in Germany. According to prior literature, reported cost drivers are hospitalisation, prescriptions, higher HbA1c and BMI, treatment with insulin and complications, all indicators of disease severity. The diversity of available data and included costs limits the results and may explain the differences found. Conclusions: Complication prevention and glycaemic control are widely recognized as the most effective ways to control diabetes treatment costs. The value propositions of self-based supports, such as hybrid closed-loop metabolic systems, already implemented in type 1 diabetes management, are the key points for further debates and policymaking, which should involve the perspectives of caregivers, patients and payers.

Hintergrund und Stand (inter)nationaler Forschung: Die SARS-CoV-2 Pandemie stellt weltweit eine Bedrohung für die Gesundheit der Bevölkerung und die öffentlichen Gesundheitssysteme dar. Im Gegensatz zu den bisherigen Erfahrungen mit zeitlich begrenzten Epidemien und Pandemien (SARS-CoV,[zum vollständigen Text gelangen Sie über die oben angegebene URL], 19. Deutscher Kongress für Versorgungsforschung (DKVF)