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Contains fulltext : 249015.pdf (Publisher’s version ) (Open Access) OBJECTIVE: The aim of this study was to analyse accredited study programmes of health services research in Germany at Master's degree level regarding their structural data and content. METHODS: Using a descriptive qualitative design, all included plans of study courses, module handbooks and descriptions of the Master's degree programmes were analysed. RESULTS: The Master's degree programmes were similar in their structural elements as well as in their content of education. They aim at enhancing competences related to the areas of health services research to identify health care needs and to develop, initiate, evaluate and critically assess innovative care strategies across disciplines. DISCUSSION: Although the content is similar, the study programmes focus on specific aspects that allow students to choose a certain programme depending on their preferences. A next step can be the development of a core curriculum that takes into consideration further findings and the discourse of different stakeholders.

Hintergrund: Häufige Exazerbationen bei Patienten mit chronisch-obstruktiver Lungenerkrankung (COPD) führen zu einer starken Inanspruchnahme des stationären Sektors, die durch eine angemessene Versorgung im ambulanten Sektor reduziert werden könnte. Dabei ist zunächst der Hausarzt [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: In der medizinischen Primärversorgung kommt Hausärzt:innen eine Schlüsselrolle zu, jedoch befindet sich die ambulante Versorgung in einem Strukturwandel: Es lassen sich weniger Hausärzt:innen in einer eigenen Praxis nieder. Bis 2035 werden deutschlandweit 11.000 unbesetzte [zum vollständigen Text gelangen Sie über die oben angegebene URL]

The National Cancer Plan emphasises the importance of medical communication and calls for its integration into medical education and training. In this context, the Milestone Communication Approach meets the communicative challenges in dealing with lung cancer patients. Interprofessional tandems, consisting of doctors and nurses, conduct structured conversations at defined moments with patients and their relatives. The concept aims at shared decision making, continuity in the care of lung cancer patients and the early integration of palliative care. During the symposium on the Heidelberg Milestone Communication in January 2020, recommendations on the care situation of lung cancer patients in advanced stages were developed. In addition, the further adaptability of HeiMeKOM to other settings and hospitals and to other diseases was discussed as well as the possibility of implementing such a concept in standard care. This article presents the experiences, best practice examples and recommendations discussed during the symposium in order to enable their extrapolation to other similarly oriented projects. The long-term goal is to transfer the milestone concept to other hospital, primarily certified lung cancer centers, and to ensure permanent funding. For further dissemination of the concept and, above all, to have it established in standard care, health policy awareness and support are required in addition to the integration of the concept in competence catalogues of continuing medical and nursing education.Der Nationale Krebsplan hebt die Bedeutung der ärztlichen Kommunikation hervor und fordert deren Integration in die medizinische Aus- und Weiterbildung. In diesem Sinne begegnet das Konzept der Heidelberger Meilenstein Kommunikation den besonderen Herausforderungen im Umgang mit Lungenkrebspatientnnen mit einem interprofessionellen, strukturierten und vorausschauenden Ansatz. Interprofessionelle Tandems, bestehend aus ÄrztInnen und Pflegefachpersonen, führen gemeinsam strukturierte Gespräche zu definierten Zeitpunkten im Erkrankungsverlauf mit LungenkrebspatientInnen und deren Angehörigen durch. Das Konzept zielt auf Sensitivität im Hinblick auf die Präferenzen der PatientInnen und hat die vorausschauende gemeinsame Entscheidungsfindung, Kontinuität in der Betreuung von LungenkrebspatientInnen sowie das frühe Erkennen und Behandeln palliativer Erkrankungsstadien zum Ziel. Im Rahmen eines abschließenden Symposiums zur Heidelberger Meilenstein Kommunikation (30.–31.01.2020) wurden Empfehlungen zur Versorgungssituation von LungenkrebspatientInnen im fortgeschrittenen Stadium erarbeitet. Darüber hinaus wurden die weiterführende Übertragbarkeit von HeiMeKOM in andere Settings und Kliniken und auf andere Erkrankungen sowie die Möglichkeit der Abbildung eines solchen Konzeptes in der Regelversorgung diskutiert. Dieser Artikel stellt die im Rahmen des Symposiums diskutierten Erfahrungen, Best Practice Beispiele und Empfehlungen vor, um deren Übertragbarkeit auf andere, ähnlich ausgerichtete Projekte zu ermöglichen. Langfristig angestrebt wird die Übertragung des Meilenstein-Konzeptes in andere Kliniken, vorrangig zertifizierte Lungenkrebszentren sowie die Überführung in eine dauerhafte Finanzierung. Für die Weiterverbreitung dieser therapeutischen Innovation und vor allem für die Überführung in die Regelversorgung ist neben der Integration des Konzeptes in Kompetenzkataloge der ärztlichen Weiterbildung sowie der Pflegefortbildung v. a. gesundheitspolitische Unterstützung erforderlich.

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).

Contains fulltext : 248990.pdf (Publisher’s version ) (Open Access) INTRODUCTION: According to international literature, patients with cancer wish to have information on complementary and integrative healthcare (CIH). Medical guidelines recommend actively approaching patients with cancer discussing potential benefits and risks of individual CIH methods. While some CIH methods, for example, acupuncture and yoga, have been proven effective in high-quality studies, other CIH methods lack studies or bear the risk of interactions with chemotherapeutics, for example, herbal drugs. Therefore, an evidence-based interprofessional counselling programme on CIH will be implemented at four Comprehensive Cancer Centres in the federal state of Baden-Wuerttemberg, Germany. METHODS AND ANALYSIS: A complex intervention consisting of elements on patient, provider and system levels will be developed and evaluated within a multilayer evaluation design with confirmatory evaluation on patient level. Patients with a cancer diagnosis within the last 6 months will receive three individual counselling sessions on CIH within 3 months (=intervention on patient level). The counselling will be provided by an interprofessional team of medical and nursing staff. For this purpose, an intensive online training programme, a CIH knowledge database and an interprofessional team-building process were developed and implemented (=intervention on provider level). Moreover, training events on the basics of CIH are offered in the outpatient setting (=intervention on system level). Primary outcome of the evaluation at the patient level is patient activation measured (PAM) with the PAM-13 after 3 months. Secondary outcomes, for example, quality of life, self-efficacy and clinical parameters, will be assessed at baseline, after 3 months and at 6 months follow-up. The intervention group (n=1000) will be compared with a control group (n=500, treatment as usual, no CIH counselling. The outcomes and follow-up times in the control group are the same as in the intervention group. Moreover, the use of health services will be analysed in both groups using routine data. A qualitative-quantitative process evaluation as well as a health economic evaluation will identify relevant barriers and enabling factors for later roll-out. ETHICS AND DISSEMINATION: The study has been approved by the appropriate Institutional Ethical Committee of the University of Tuebingen, No. 658/2019BO1. The results of these studies will be disseminated to academic audiences and in the community. TRIAL REGISTRATION NUMBER: DRKS00021779; Pre-results.

Contains fulltext : 282889.pdf (Publisher’s version ) (Open Access) INTRODUCTION: The use of antibiotics in human medicine is partly responsible for the global increase in antibiotic resistance. Significant reductions in antibiotic prescribing were realised through educational campaigns, communication training and prescribing feedback. Based on data from the cluster-randomised CHANGE-3 trial, the present analysis focuses on the question of patient expectations for an antibiotic in acute respiratory infections. METHODS: 106 of 114 General Practitioner (GP) practices in Baden-Württemberg and Mecklenburg-Western Pomerania took part in the study. 4736 patients who visited the practices with acute respiratory infections from October 2018 to May 2019 filled out a questionnaire after the doctor's consultation. The analysis was descriptive. RESULTS: 16.7 % of patients with acute respiratory infections reported receiving antibiotics from their GP. 13.3 % of patients had hoped for an antibiotic and 5.5 % stated that they had asked their GP for an antibiotic prescription. The lowest prescription rate for antibiotics was reported by patients who had received a diagnosis of influenza from their GP. With specific diagnoses differentiated from uncomplicated respiratory tract infection, an increase in both the number of antibiotics hoped for and the number of antibiotics prescribed was observed. DISCUSSION: Patients still receive antibiotics more often than they actually hope for. On the part of GPs, prescriptions may still be written because of perceived pressure from patients, but this is not reflected in patient expectations. In addition to dealing openly with patients' expectations, strengthening patients' health literacy, mindful doctor-patient communication and offered opportunities for re-presentation in the case of specific diagnoses could further reduce the perceived pressure on GPs.

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.

The tokamak a configuration variable (TCV) continues to leverage its unique shaping capabilities, flexible heating systems and modern control system to address critical issues in preparation for ITER and a fusion power plant. For the 2019-20 campaign its configurational flexibility has been enhanced with the installation of removable divertor gas baffles, its diagnostic capabilities with an extensive set of upgrades and its heating systems with new dual frequency gyrotrons. The gas baffles reduce coupling between the divertor and the main chamber and allow for detailed investigations on the role of fuelling in general and, together with upgraded boundary diagnostics, test divertor and edge models in particular. The increased heating capabilities broaden the operational regime to include T (e)/T (i) similar to 1 and have stimulated refocussing studies from L-mode to H-mode across a range of research topics. ITER baseline parameters were reached in type-I ELMy H-modes and alternative regimes with `small' (or no) ELMs explored. Most prominently, negative triangularity was investigated in detail and confirmed as an attractive scenario with H-mode level core confinement but an L-mode edge. Emphasis was also placed on control, where an increased number of observers, actuators and control solutions became available and are now integrated into a generic control framework as will be needed in future devices. The quantity and quality of results of the 2019-20 TCV campaign are a testament to its successful integration within the European research effort alongside a vibrant domestic programme and international collaborations.

Evidence that density shoulder broadening is dependent on high main-chamber neutral density is presented. Shoulder broadening does notoccur when the sources for main-chamber neutrals are minimized using divertor baffles and wide gaps to the first wall (similar to 3x the densitydecay length). Removing the baffles or reducing the gap to the inner wall both act to increase the density shoulder amplitude in otherwiseidentical TCV discharges. Radial turbulent transport is correlated with shoulder amplitude. (C) Published under an exclusive license by AIP Publishing

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.

Contains fulltext : 282769.pdf (Publisher’s version ) (Open Access) BACKGROUND: Chronic low back pain (CLBP) is one of the most common musculoskeletal disorders. Ambulatory care currently does not provide a structured multimodal approach, even though multimodal therapy is recommended. OBJECTIVES: The goal was to explore utilization of ambulatory health care resources concerning a multimodal therapy approach in the first year of CLBP and determine user types. MATERIALS AND METHODS: A two-step cluster analysis was executed with administrative data of 11,182 incident cases. The age was between 18 and 65 years and data of four consecutively quarters per patient were analyzed. With the administrative data from orthopedics, pain therapy, psychotherapy, exercise therapy, analgesics and opioids, clusters were determined. Further results were provided by variables of patients and the structure of care. RESULTS: The analysis reveals four user types: 39.7% used no specialist care and less exercise therapy; 37.3% used orthopedics; 15.6% used orthopedics and pain therapy; and 7.4% used orthopedics, pain therapy and/or psychotherapy. Characteristics for multimodal utilization were the following: female, high use of analgesics (m = 143.94 DDD), high use of opioids (m = 37.12 DDD), high costs of exercise therapy (m = 631.79 €), acupuncture, antidepressants, hospitalization, interdisciplinary case conference, and consult neurologists. In all, 60.4% of the study population received analgesics. CONCLUSIONS: The cluster analysis indicated differential user types. Approximately 23% of the study population receives the recommended multimodal therapy.

Background The increasing nursing shortages worldwide has focused attention on the need to find more effective ways to recruit and retain nurses. The aim of this study was to gain understanding of factors that keep German nurses in nursing and explore their perceptions of factors that contribute to nurses leaving or staying in the profession. Methods An explorative qualitative study was undertaken at four different hospitals (two university hospitals and two public hospitals) in Baden-Wuerttemberg, a state in South Germany. Semi-structured face-to-face or telephone interviews were conducted with 21 state-qualified nurses who had graduated from a German nursing program. Each interview was pseudonymized and transcribed. Transcripts were coded according to Qualitative Content Analysis with data structured into themes and subthemes. The study was reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist for qualitative research. Results Two themes emerged from the analysis and each theme had several subthemes: a) PUSH FACTORS i.e. factors that may push nurses to consider leaving the profession included limited career prospects, generational barriers, poor public image of nursing, and workplace pressures; b) PULL FACTORS i.e. factors that nurses wished for and could keep them in the profession included professional pride, improved remuneration, recognition of nursing, professionalisation, and improving the image of nursing as a profession. Conclusion The decision to leave or stay in nursing is influenced by a complex range of dynamic push and pull factors. Nurse Managers responsible for stabilizing the workforce and maintaining their health system will continue to have to navigate challenges until working conditions, appropriate wages and career development opportunities are addressed. A key to tackling nursing shortages may be focusing on pull factors and nurse managers listening in particular to the perspectives of junior nurses directly involved in patient care, as giving them opportunity to further develop professionally, reinforcing a strong and supportive workplace relationships, paying an appropriate salary, and improving the public image of nursing profession. Registration number The study has been prospectively registered (27 June 2019) at the German Clinical Trial Register (DRKS00017465).

Contains fulltext : 287308.pdf (Publisher’s version ) (Open Access) Considering the limited availability of dermatologists to perform live consultations in nursing homes, teledermatology could be used as a triage tool for selection of cases for which live consultations are considered to be of added value compared with teledermatology. This prospective, multicentre observational study aimed to determine the reasons for dermatology consultations in nursing homes and the estimated value of teledermatology as a triage tool, including potential predictors. Skin tumours were the most common reason (n = 161/270; 59.6%) for dermatology consultations in nursing homes. Dermatologists estimated that live consultations added value compared with teledermatology in 67.8% of cases (n = 183). Multivariable logistic regression showed that predictors for this added value of live consultations were: consultations because of a skin tumour; consultations during which a diagnostic or treatment procedure was performed; consultations during which a secondary diagnosis was made; and the dermatologist involved. These results indicate that using teledermatology as a triage tool potentially reduces the need for additional live consultations in one-third of patients, whereas live consultations are estimated to have added value over teledermatology in two-thirds of cases. To make optimal use of the limited capacity for live consultations by dermatologists, it could therefore be helpful if elderly care physicians use teledermatology more frequently.

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/Fragestellung/Problem: Für die Versorgungsforschung ist die Anwendung empirischer Forschungsmethoden konstitutiv. Der Themenbereich „Methodik und wissenschaftliches Arbeiten“ bildet so auch in allen sechs Masterstudiengängen einen zentralen Schwerpunkt [ref:1]. [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: Handlungsempfehlungen werden in der allgemeinmedizinischen Praxis oftmals langsam implementiert. Dabei spielen viele Faktoren wie beispielsweise Teamstrukturen und Informationsaustausch eine Rolle. Implementierungsstrategien sollten dies berücksichtigen, weshalb eine Exploration dieser [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: 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]

The Tokamak a Configuration Variable (TCV) has recently been equipped with gas baffles to increase its divertor closure for a broad range of divertor magnetic geometries. First experimental results reported in Reimerdes et al. (2021) demonstrated compatibility with a broad range of divertor magnetic geometries and confirmed the main design constraints of the baffles, in particular an increased divertor neutral pressure. The present article presents a more in-depths analysis and extended experiments of this first baffle assessment on the TCV boundary plasma. It is shown that the divertor neutral pressure increased following the installation of the baffles, as predicted by SOLPS-ITER and SolEdge2D-EIRENE simulations. Varying the divertor closure by changing the position of the plasma showed that the plasma equilibrium designed to assess the baffle effect was not far from the optimal trade-off between plasma plugging and recycling on the baffles. The baffles facilitate access to a partially detached regime in both L- and H-modes. In L-Mode, with the ion ∇ B -drift directed from the X-Point to the plasma core, a reduction of the line-averaged density detachment threshold by approximately 20% is observed at the outer target, while inner strike point detachment is only achieved in the presence of baffles. Multispectral imaging shows that the CIII front moves from the outer target towards the X-Point at a lower line-averaged plasma density, indicating a colder outer leg. In H-mode, the CIII front is generally located near the X-Point between the ELMs, while without baffles, N 2 -seeding is required to move the front up to that location.

Item does not contain fulltext BACKGROUND: We evaluated a team-based program of exercises for patients with panic disorder with or without agoraphobia (PDA) in primary care. METHODS: 419 patients with PDA (mean age 46.2 years, standard deviation 14.4 years; 74% female) were included in this cluster-randomized, controlled intervention trial. The patients were blinded with respect to their group assignment at baseline. Patients in the intervention group (36 primary-care practices, 230 patients) underwent a 23-week exercise program combined with case management, while patients in the control group (37 practices, 189 patients) received standard care. Symptoms of anxiety (according to the Beck Anxiety Inventory, BAI) at six months were the primary endpoint. Patients were followed up at six months (n = 338, 81%) and at twelve months (n = 318, 76%). The analysis was by intention to treat. RESULTS: Symptoms of anxiety improved to a significantly greater extent in the intervention group (p = 0.008). The intergroup dif- ference in the reduction of the BAI score (range: 0-63) was 3.0 points (95% confidence interval [-5.8; -0.2]) at six months and 4.0 points [-6.9; -1.2] at twelve months. In the intervention group, there was a significantly greater reduction in the frequency of panic attacks (p = 0.019), in avoidant behavior (p = 0.016), and in depressiveness (p

Item does not contain fulltext INTRODUCTION: For the treatment of anxiety disorders behavior therapy-oriented methods are recommended for primary care as well. Within the trial "Jena-PARADISE" a primary care practice team-supported exposure training for patients with panic disorder with or without agoraphobia was developed and evaluated. The present paper gives an overview of general practitioners' subjective views on the practicability, feasibility and effectiveness of this new intervention for both patients and GP teams. METHODS: Questions were operationalized based on Bellg's intervention fidelity framework. Fourteen GPs of the intervention group were sampled purposefully and interviewed in a semi-structured way. Generated data were analyzed following Mayring's content analysis approach. RESULTS: The treatment program was positively assessed among the GPs and seen as a useful therapeutic option for inadequately treated patients. The therapy elements 'psycho-education' and 'interoceptive exposure exercises' were described as feasible, while situational exercises and relapse prevention got a less positive rating. The active participation of the nurse in the treatment program was seen as supportive. CONCLUSION: From the GP perspective, the treatment program for patients with panic disorder and/or agoraphobia seems to be a viable therapeutic option in primary care.