Gesundheitswesen [JOURNAL]
Sun
200 papers
[UV protection in climate change: health policy relevance and necessary framework conditions].
Buhr Y, Hübner IM, Breitbart EW
Gesundheitswesen · 2026 Jun · PMID 40425168 · Publisher ↗
Skin cancer is the most common type of cancer in Germany. Over 330,000 new cases are diagnosed every year and the trend is rising. The main risk factor for the development of skin cancer is UV radiation. Higher temperatu...
Skin cancer is the most common type of cancer in Germany. Over 330,000 new cases are diagnosed every year and the trend is rising. The main risk factor for the development of skin cancer is UV radiation. Higher temperatures, more hot days, more extreme weather events as well as increase in UV radiation are expected throughout Germany in the future. The federal government has therefore passed the Federal Climate Adaptation Act, which obliges the federation, federal states and local authorities to deal with the consequences of climate change and to plan adaptation measures. Particular attention is paid to human health, with the reduction of heat stress and UV-related diseases such as skin cancer being prioritized. Priming the population should be prepared for heat and UV radiation by 2030. In order to develop effective strategies, cooperation between science, politics and practice is necessary. The UV-protection colloquium brought together various stakeholders to exchange current findings and define strategies. It was concluded that a joint commitment at all levels is necessary in order to integrate UV protection into climate adaptation strategies. Concrete suggestions for municipal UV protection included making the UV index visible, creating shaded areas, adapting daily routines to avoid UV exposure at peak times and comprehensive information campaigns. These measures can help to significantly reduce UV exposure among the public. For successful implementation, various stakeholders must cooperate to raise awareness of UV protection and protect the health of the population. It is crucial that UV protection is considered indispensable in the development of heat protection measures and is incorporated into all municipal climate adaptation strategies. An integrated approach should be developed to replace existing individual measures where appropriate.
[Opportunities, barriers and optimization needs of the examination of children in the 4th year of life in Saxony: a qualitative survey of physicians, day care professionals and parents].
Görres C, Seibel A, Schwenke M … +6 more , Korebrits C, Anders C, Genuneit J, Pantenburg B, Riedel-Heller SG, Löbner M
Gesundheitswesen · 2026 Feb · PMID 40389224 · Publisher ↗
The Kita examination in Saxony, conducted in the fourth year of life, is a medical service offered by the pediatric and adolescent medical service in Saxony (KJÄD). The objective of this examination is to identify early...
The Kita examination in Saxony, conducted in the fourth year of life, is a medical service offered by the pediatric and adolescent medical service in Saxony (KJÄD). The objective of this examination is to identify early support needs in children before they start school and to initiate appropriate measures. The objective of this study is to analyze the Kita examination in Saxony with regard to the current personnel, structural, and technical framework conditions from the perspective of the physicians of the KJÄD, daycare professionals, and parents.This study uses a qualitative design. A total of n=13 telephone interviews were conducted: n=5 with physicians, n=4 with parents, and n=4 with daycare professionals. The interviews were based on semi-structured guidelines and were recorded as audio files. The recordings were then fully transcribed and analyzed using Mayring's qualitative content analysis method and MAXQDA software.The findings indicated that, in the view of all participants, the Kita examination plays a pivotal role in the early identification of support needs for school. One perceived advantage of the examination process was that it occured in a familiar environment. The presence of daycare professionals during the examination was perceived as a positive aspect. The dissemination of information via analog or digital media could be enhanced to facilitate greater accessibility for underserved families and encourage their participation in the Kita examination.The Kita examination plays a pivotal role in early intervention, offering a valuable, readily accessible supplement to the standard 'U' examinations conducted in pediatricians' practices.
Telemedicine in paediatrics: acceptance and satisfaction from parents' perspective.
Heimbuch S, Tischler L, Beyer A … +4 more , Jordan Y, Pfeuffer N, Krause H, van den Berg N
Gesundheitswesen · 2025 Dec · PMID 40389223 · Publisher ↗
The telemedical networking of children's clinics of varying sizes and specializations can support healthcare close to home, especially in rural regions with structural limitations. A Regional Tele-Paediatric Network was...
The telemedical networking of children's clinics of varying sizes and specializations can support healthcare close to home, especially in rural regions with structural limitations. A Regional Tele-Paediatric Network was implemented in Mecklenburg-Western Pomerania and North Brandenburg (innovation fund project RTP-Net). This study examines the question of how participating parents accepted and evaluated this form of care.Parents of paediatric patients at a participating clinic were invited to take part in the study during the observation period 02.2021 to 03.2023 study. A mixed-methods approach was used that comprised a standardized questionnaire. The interviews were transcribed, categorized according to Kuckartz and subjected to descriptive evaluation. Between 12.2023 to 02.2024, telephone interviews were conducted with parents who had agreed to be recontacted.A total of 507 cases (403 patients) were included in the RTP-Net. Data from 138 questionnaires were analyzed. 74.5% of parents found that the use of telemedicine was helpful for the treatment of their child; 88.1% could imagine that telemedicine could supplement paediatric healthcare in the future. Parents interviewed over the telephone (n=11) rated telemedicine services positively. The main advantages mentioned were saving in time and distance, availability of specialist expertise and avoidance of long waiting times. There were concerns about the lack of physical contact between telemedicine doctor and patient.Parents show a high level of acceptance of telemedicine and trust in the provision of telemedical services. Telemedicine can help parents to avoid the burden of long journeys and waiting times and improve access to specialist medical expertise. In order to improve the acceptance and satisfaction of parents, it is important to inform them about the results if the telemedical advice was based on a doctor-to-doctor consultation.
[Potentially avoidable visits to the physician's office: an exploratory observational study].
Geraedts M, Pham C
Gesundheitswesen · 2026 Jun · PMID 40389222 · Publisher ↗
BACKGROUND: In order to harmonize supply and demand in the outpatient sector, current figures are needed on the number of visits to physicians' offices and their rationale. Since the introduction of partially flat-rate r...
BACKGROUND: In order to harmonize supply and demand in the outpatient sector, current figures are needed on the number of visits to physicians' offices and their rationale. Since the introduction of partially flat-rate remuneration in the outpatient sector in 2008, only uncertain estimates are possible on the basis of billing data. OBJECTIVE: On the basis of direct observation in physicians' offices, the number and reasons for visits to the physician's office are to be recorded and their potential avoidability estimated. METHODS: In 11 GP practices (4 practices), general specialist practices (6 practices) and specialized specialist practices (1 practice), all visits to the physician's office in a given week were documented with regard to the reason for and type of contact as well as the age and gender of the patients. To this number, the practices added the patients' utilization of the services in the entire quarter and previous quarter as well as the total number of all cases seen in the practice per quarter. Frequencies and differences in relation to practice types, age groups and gender were analyzed descriptively and using Chi tests. RESULTS: A total of 3266 practice contacts (57% by women, 43% by men) were recorded. There were 2.9 visits to GPs and 1.9 visits to specialists per patient per quarter. In the case of GPs, 40% of patients aged<60 years visited the practice because of an acute illness, while the leading reason for patients aged 60+was to collect a referral or prescription (50%). The most prominent reason for visits to a specialist was the monitoring of chronic illnesses for younger patients (36%) and older patients (51%). Explicit contact with a GP was made by 58% of those under 60 and 32% of those over 59, while 70 and 73%, respectively of such patients saw a specialist. Extrapolated, every citizen had 16.9 contacts with a physician's office per year. CONCLUSION: The explorative study provides indications of the extent of avoidable contacts with physicians' offices, in that half of the contacts with over 59-year-olds were only to collect prescriptions, findings etc. and 41% of contacts with specialists were routine check-ups, the necessary frequency of which is unclear.
[Clinical Crisis Intervention in the Somatic Setting: A Scoping Review].
Batzoni H, Witzmann M
Gesundheitswesen · 2026 Jan · PMID 40378871 · Publisher ↗
Patients, relatives and staff ('second victims') often experience stressful events in the clinical setting, such as deaths, serious diagnoses or acts of violence, which can lead to stress and crises. The aim of the scopi...
Patients, relatives and staff ('second victims') often experience stressful events in the clinical setting, such as deaths, serious diagnoses or acts of violence, which can lead to stress and crises. The aim of the scoping review was to identify the existing literature on psychosocial support services in somatic clinics and associated differences, e. g. in the target group(s).Comprehensive database searches and hand searches were conducted (including CINAHL, BASE, MEDLINE via PubMed, Springer Medizin). Only English- and German-language articles dealing with psychosocial support services in somatic medicine were included.A total of 68 publications were included. The results showed a heterogeneity and complexity of psychosocial support services as well as an increased discussion of psychosocial stress in everyday clinical practice. Psychosocial support services were reported to contribute to psychological and emotional relief, improve mental health and increase patient safety. Furthermore, the implementation of comprehensive peer support programmes was demonstrated to engender annual savings in excess of €1.5 billion within the healthcare system.
[Long-Term Development of Competencies and Methods Using the Example of SOPESS as Part of Preschool Health Examinations - Background and Approaches of the KOMET-SEU Project].
Malonga Makosi D, Diefenbach C, Simon K … +9 more , Jaščenoka JC, Maurer J, Borrmann B, Sidhu NS, König J, Thyen U, Genuneit J, Daseking M, Urschitz MS
Gesundheitswesen · 2025 Jun · PMID 40355107 · Publisher ↗
Preschool health examination is one of the main tasks of the German public health service. The social-paediatric screening used in this process is SOPESS, the validated tool for assessing the developmental status of pres...
Preschool health examination is one of the main tasks of the German public health service. The social-paediatric screening used in this process is SOPESS, the validated tool for assessing the developmental status of preschool children. The results enable tracking of developmental abnormalities across regions and over time, as well as deriving individual and preventive action requirements. In practice, however, the data show relevant method-related heterogeneity across teams and public health services that cannot be explained solely by differences in the study population. This affects the data validity and their optimal use for regional prevention planning and health reporting.The KOMET-SEU project aimed, on the one hand, to assess and illustrate method-related heterogeneity and its causes, and to develp and evaluate an online training program, on the other, to strengthen public health service in its implementation and documentation of SOPESS, to reduce the data's heterogeneity and to support data usage.The project was based on the Public Health Action Cycle and used a logical model as a theoretical basis. To develop and evaluate the online training, quantitative and qualitative methods were combined. The objectives were achieved in four work packages (WP): WP 1 established the statistical basis for assessing and depiction of method-related heterogeneity. WP 2 used surveys done with employees of the public health services to examine the causes of heterogeneity and relevant contextual factors for data collection. In WP 3, that information was used to construct and test an online training program. WP 4 implemented that training in several public health services and evaluated its processes and effects. Detailed results of the WP can be found in this issue of "Das Gesundheitswesen".The mixed-methods approach and participatory intervention development should help strengthen the skills of the employees of public health services in using the SOPESS and expand examinational competences within the teams. Thus, the KOMET-SEU project could make an important contribution to supporting the public health service in the use of SOPESS data. Whether it will be possible to reduce the heterogeneity in the SOPESS data itself must be investigated further. The ground-work has been laid.
[Correction: Risk factors for a severe course of COVID-19 in a hotspot clinic during the first and second wave of the SARS-CoV-2 pandemic in Germany].
Richter S, Finkenzeller T, Uter W … +2 more , Drexler H, Wolfschmidt A
Gesundheitswesen · 2025 Apr · PMID 40334701 · Publisher ↗
Abstract loading — click title to view on PubMed.
Experiencing digital technologies: The importance of feeling safe in healthcare - A qualitative participatory design.
Minartz P, Vondeberg C, Obert L … +10 more , Bleck C, Hemming B, Vöcking M, Ose C, Znotka M, Cürlis D, Karrenbrock A, Oehmichen F, Heistermann P, Kuske S
Gesundheitswesen · 2025 Dec · PMID 40334673 · Publisher ↗
Digital technologies are increasingly used in healthcare. In this context, perceived safety plays a critical role in their acceptance and implementation. Previous research had focused more on data security or specific di...
Digital technologies are increasingly used in healthcare. In this context, perceived safety plays a critical role in their acceptance and implementation. Previous research had focused more on data security or specific digital technologies. There has also been a lack of participatory approaches to consider and empower healthcare recipients (and relatives), providers, and technology experts to broaden the phenomenon.The aim of this study was to present a comprehensive perspective on the needs, influencing factors and related outcomes in the context of feeling safe with digital technologies in healthcare.A qualitative, exploratory, and participatory methodology was used with five guide-based focus group workshops. Each workshop explored one of five digital technology demonstrations provided at the beginning: (1) electronic health records (EHR), (2) robotics, (3) artificial intelligence (AI), (4) smart home, and (5) smart hospital. All participants were invited for a guide-based discussion. The study focused on the levels of 'involvement' and 'collaboration' by also empowering participation. The workshop target groups were actively involved in the development and execution of the workshops and were empowered. The data were analysed via a content analysis approach, with a mostly inductive procedure.Feeling safe was found to affect thoughts, emotions, and actions. For example, a higher level of perceived safety increased the acceptance of digital technologies, whereas a lower level of perceived safety decreased it. The corresponding needs and influencing factors differed in terms of their scope and focus depending on the context. The aspect of 'control' was most frequently addressed by all the target groups and was viewed as relevant in all the workshops. In general, digital technologies were viewed as supplements rather than substitutes for healthcare providers.This study extends beyond the current state of research on perceived safety and the use of digital technologies in healthcare by providing a comprehensive overview of the corresponding needs and influencing factors at various levels, such as the individual, community-organizational, and system-society levels. The perceived safety of healthcare recipients and providers related to digital technologies should be taken into consideration to achieve positive implementation outcomes.
[Process evaluation of the implementation of an online training package to strengthen methodological and diagnostic skills in the application of SOPESS (KOMET-SEU project)].
Diefenbach C, Makosi DM, Jaščenoka JC … +3 more , Kadel SB, König J, Urschitz MS
Gesundheitswesen · 2025 Jun · PMID 40306659 · Publisher ↗
An online training package was developed as part of the KOMET-SEU project in order to strengthen the methodological and diagnostic skills of employees in the child and youth health service in the implementation of social...
An online training package was developed as part of the KOMET-SEU project in order to strengthen the methodological and diagnostic skills of employees in the child and youth health service in the implementation of social-paediatric development screening for school readiness (SOPESS). The aims of the present study were assessment of success of implementation and process evaluation of the training package.The training package was made available to 17 public health departments in North Rhine-Westphalia and Rhineland-Palatinate by the Academy of Public Health Services. After an application phase of around four months, implementation quality, adoption, utilisation, evaluation, early indications of effectiveness, and the maintenance of the intervention were assessed partly quantitatively using an online questionnaire and partly qualitatively using telephone interviews.The sample comprised 105 employees of the child and youth health service in the questionnaire and 9 employees in the interviews. The training package was rated very positively in several aspects. For instance, 88% of the participants expressed satisfaction with the content of the training package. In terms of practical relevance, 91% of the participants rated the training package as helpful for the implementation and 90% as helpful for the appraisal of the SOPESS. The qualitative results also demonstrated good adoption and provided some indications of the effectiveness of the intervention. However, some personal uncertainties remained in the implementation of SOPESS even after the intervention.The training package was successfully implemented, well accepted by the target group and rated as helpful in several aspects. This good process data could provide the basis for effectively strengthening methodological and diagnostic skills in the implementation of SOPESS.
[Participatory development of practice guidelines for consistency in pandemic management approaches across local health authorities in Germany: results of a workshop based on semi-structured interviews].
Hoffmann K, Buck E, Eichinger M … +5 more , Kulczycki J, Richter H, Wendlinger R, Wrede B, Steinisch M
Gesundheitswesen · 2025 May · PMID 40306623 · Full text
The COVID-19 pandemic was associated with major challenges for the public health service in Germany including the need to adapt structures and management processes in local health authorities under time pressure. Compreh...
The COVID-19 pandemic was associated with major challenges for the public health service in Germany including the need to adapt structures and management processes in local health authorities under time pressure. Comprehensively analyzing challenges based on the perspectives of public health service staff and developing practice guidelines could contribute to the long-term strengthening of the public health service in Germany. The present project utilized qualitative methods to capture experiences in pandemic management and, collaboratively with public health service staff, developed practice guidelines for establishing consistency in pandemic management approaches across local health authorities.Twenty-one semi-structured interviews were conducted with local health authority staff from Baden-Württemberg (BW), a federal state of Germany, on perceived barriers of and enabling factors for successful pandemic management (09/21-02/22). Interviews were analyzed using thematic content analysis. Fields of action emerging from the interviews were prioritized in bilateral discussions with eight representatives from local health authorities (05/22-06/22). For the prioritized field of action, a workshop was held with 16 participants from 11 local health authorities and the Ministry of Social Affairs, Health and Integration BW (SM BW) to develop practice guidelines (06/22).Qualitative content analyses revealed 22 fields of action to strengthen pandemic management. was prioritized for the workshop. During the workshop, the following practice guidelines were developed and agreed upon: (1) maintaining regular exchange between the heads of local health authorities and the SM BW, (2) establishing regular exchange between local health authorities at operational level, (3) developing a digital platform for knowledge exchange and collaboration and strengthening its regular use, (4) simplifying digital data exchange, and (5) involving local health authorities in drafting binding documents, including legal texts and uniform guidelines for the public health service.The collaboratively developed practice guidelines are directed equally at the operational level of the public health service and political decision-makers, providing specific starting points for strengthening pandemic management in public health service.
[Not Available].
Wildner M
Gesundheitswesen · 2025 May · PMID 40306622 · Publisher ↗
Abstract loading — click title to view on PubMed.
[Reasons for non-reproducibility of sociomedical assessments of performance capability in disability pension expert opinion reports].
Wuchter-Czerwony C, Rabura M, Gehrke J
Gesundheitswesen · 2025 Dec · PMID 40228534 · Publisher ↗
The German pension insurance continuously supervises the quality of disability pension expert opinion reports by a standardized peer review process. The current study analyses the concrete reasons of the peers for non-re...
The German pension insurance continuously supervises the quality of disability pension expert opinion reports by a standardized peer review process. The current study analyses the concrete reasons of the peers for non-reproducibility of sociomedical judgments concerning performance capability in these expert opinion reports.Free-text comments documented by peers in the peer review process 2021 of the German pension insurance with respect to shortcomings in the reproducibility of sociomedical judgments (n=569) were evaluated in a structured-inductive manner using Mayring's qualitative content analysis.Contentwise the reasons for the non-reproducibility of sociomedical judgments in these expert opinion reports comprise recurrent shortcomings in anamnesis/clinical assessment, specifically with respect to confirmation of diagnosis, as well as gaps/inconsistencies in the chain of arguments concerning sociomedical evaluation of performance capability.Identification of these reasons concretizes the complexity of the sociomedical evaluation process, allows sharpening of the content expectations towards the expert consultants and further sensitizes readers to assessment of the sociomedical key aspects in expert reports.
Assessing the time required for qualitative analysis: A comparative methodological study of coding interview data in health services research.
Ullrich C, Wensing M, Klafke N … +4 more , Fleischhauer T, Brinkmöller S, Poß-Doering R, Arnold C
Gesundheitswesen · 2025 Dec · PMID 40228533 · Publisher ↗
A reliable estimation of required resources is essential for sound research. So far, there have only been a few studies on researchers' time investment in qualitative studies. The aim of this study, therefore, was to pro...
A reliable estimation of required resources is essential for sound research. So far, there have only been a few studies on researchers' time investment in qualitative studies. The aim of this study, therefore, was to provide an empirical account of the estimation of timescales of qualitative analysis.In this methodological study, time expenditure was documented and compared for the focused coding of transcripts of semi-structured interviews within five qualitative studies in health services research. Data were analyzed descriptively by means of absolute frequencies.Across studies, focused coding was assessed in 94 interviews with a total interview duration of 52 hours and 44 minutes. The number of interviews per study ranged from n=11 to n=27, with a mean duration of 36 minutes. Total coding time amounted to 76 hours, with a mean of 32 min per interview. Coding time per interview time ratio ranged from 0.75 to 1.52 minutes. On average, the time spent on focused coding roughly corresponds to the duration of the interviews. Focused coding tended to get quicker over time, though variation among studies was high.The results of this study provide a reference for estimating timescales of qualitative analysis and highlights the importance of considering factors such as composition of data and researchers' experience and involvement. In a specific research project, this effort must be balanced against the objective of the analysis, including the desired accuracy, detail and depth. Further research is needed to specify how specific parameters (i. e. nature of the study population, method of data analysis and use of concepts and theories) affect coding in qualitative analysis.
[The greatest potential for reducing the workload of physicians through digital care applications (DiPAs) lies within the age group of 50 to 65 years].
Müller D, OʼSullivan JL, Schulz M … +3 more , Nieporte T, Jonas B, Erhart M
Gesundheitswesen · 2026 Apr · PMID 40228532 · Publisher ↗
The first digital care application (DiPA) was expected to be approved in 2024 for use by individuals in need of care who live at home. DiPAs must demonstrate benefits like improved mobility, cognitive and communicative s...
The first digital care application (DiPA) was expected to be approved in 2024 for use by individuals in need of care who live at home. DiPAs must demonstrate benefits like improved mobility, cognitive and communicative skills, and self-care abilities. They can provide direct care or support caregiving relatives. If effective, DiPAs could reduce the need for home visits by medical professionals, easing their workload. This study identifies the age group that could benefit most from DiPAs, using data from digital health application (DiGA) prescriptions as an indicator.Using billing data from ambulatory physicians under §295 SGB V, we determined the number of adults in Germany insured under statutory health insurance for whom a DiGA prescription was billed by their ambulatory physicians between March 2021 and December 2022. The fourth quarter of 2022, with the highest number of available DiGAs, was compared with home visit data using corresponding billing codes.The billing of DiGA prescriptions from ambulatory physicians increased from 6,660 in the second quarter of 2021 to 32,546 in the fourth quarter of 2022. DiGAs were more commonly prescribed to younger and middle-aged adults, peaking at ages 30 and 56, while home visits were more frequent among older adults, peaking at ages 61 and 83.The steady rise in DiGA prescriptions suggests growing acceptance among physicians and patients. This trend, particularly among younger and middle-aged adults, indicates that DiPAs could also gain acceptance. The second age peak for DiGA prescriptions pertains to the age group of approximately 50 to 65 years, which overlaps with the first age peak for home visits. Therefore, DiPAs should focus on the 50-65 age group for maximum physician workload relief, with later adjustments made for older age groups. Involving stakeholders in development could enhance trust.
[Definition of consolidated disease groups for a population-based system to classify morbidity-related healthcare needs: PopGroup].
Tsatsaronis C, Klemt M, Kinder K … +5 more , Langenberger B, Braun A, Grobe TG, Busse R, Quentin W
Gesundheitswesen · 2025 Apr · PMID 40228501 · Full text
OBJECTIVE: In recent years there has been an increased demand for a morbidity-oriented approach in the planning of healthcare facilities in Germany. Population-based classification systems, which already exist in various...
OBJECTIVE: In recent years there has been an increased demand for a morbidity-oriented approach in the planning of healthcare facilities in Germany. Population-based classification systems, which already exist in various countries, are crucial for assessing regional healthcare needs. The PopGroup project aims to develop such a classification system (PopGrouper) for the German healthcare system and to test various applications. The PopGrouper assigns each individual to exactly one PopGroup based on clinical characteristics and healthcare needs. The initial phase of the PopGrouper development focused on grouping diagnoses into medically meaningful Consolidated Disease Groups (CDGs) to serve as the foundation for forming PopGroups. This article describes the formation and validation of CDGs, as well as the definition of a disease severity level to hierarchically rank the CDGs. METHODS: CDGs were formed using both medical expertise and analyses of claims data from the BARMER sickness fund. Pre-existing diagnosis groups (DxGs) defined for the German morbidity-based risk structure compensation scheme were used as the starting point. Initially, overarching Major Disease Categories (MDCs) were formed. Within MDCs, DxGs were grouped into CDGs based on predefined criteria. CDGs were validated by experts from scientific medical societies. Finally, a composite disease severity score was calculated based on three dimensions (mortality, costs, utilization) and severity levels from "very severe" to "very minor" were defined to classify CDGs. RESULTS: A total of 32 MDCs and 433 CDGs were defined and validated. Each CDG received a severity score. Based on this foundation, in the subsequent project phase, PopGroups were formed that took into consideration various diseases and combinations of diseases. CONCLUSION: CDGs and MDCs represent important initial steps in the PopGrouper development. The aggregation of diagnoses into a smaller number of medically meaningful groups also offers opportunities beyond the project, for instance for healthcare research, for the analysis of diseases, and for the identification of patient groups with similar characteristics.
[Not Available].
Wildner M
Gesundheitswesen · 2025 Apr · PMID 40228500 · Publisher ↗
Abstract loading — click title to view on PubMed.
[Organizational context for the work of emergency departments in Germany: status quo, assessment of effects, and need for change for optimized care].
Schmiedhofer M, Krüger D, Möckel M … +3 more , Henschke C, Ansmann L, Slagman A
Gesundheitswesen · 2026 Mar · PMID 40209765 · Publisher ↗
The functioning of emergency departments (ED) is considered an indicator of the effectiveness and efficiency of the healthcare system. In Germany, there is increasing pressure to improve emergency care. EDs are relativel...
The functioning of emergency departments (ED) is considered an indicator of the effectiveness and efficiency of the healthcare system. In Germany, there is increasing pressure to improve emergency care. EDs are relatively autonomous organizational units that interact with other levels within and outside the hospital organization. Based on a model of organization-related care research, the current state of emergency care is described and barriers to and facilitators of change are discussed.A narrative review was used that includes literature sources on organizational impacts on the functioning of EDs. Publications were considered that, in addition to the interface perspective, have a relevance to the current state as well as to the proposed changes from the legislature and other actors. These were assigned to the respective organizational levels and (potential) effects were described. The macro-meso-micro model of organization-related health services research serves as a heuristic.Insufficient consideration of interdependencies and interfaces between organizational actors and levels of emergency care facilitates friction and hinders care innovation. At the macro level of the healthcare system, structures, responsibilities and financing are regulated, which significantly impact functioning at the meso and micro levels. At the meso-level of the hospital, the role of the ED is influenced by the difficulty of controlling patient flows and the lack of Diagnoses Related Groups (DRGs) to cover the costs for outpatient emergency care. The micro-level of the ED has to prioritize treatment and is confronted with the challenges of "exit blocks" when there are indications for patient transfer. Previous reform efforts did not take this organizational complexity into account.Reform proposals must take into account the organizational complexity and interests that arises from interfaces, interactions and stakeholder interests. Organization-related health services research can examine the contextual conditions that affect emergency care in order to derive recommendations for health care innovations.
Transfer of a telemedicine intervention for mental disorders: a comparison between RCT results and regional routine care.
Boerkoel A, Stentzel U, Grabe HJ … +3 more , Janowitz D, Hoffmann W, van den Berg N
Gesundheitswesen · 2025 Dec · PMID 40209764 · Publisher ↗
Telemedicine for the treatment of depression and anxiety disorders was found to be successful in a randomised controlled trial (RCT); this intervention was then implemented in routine care in the Western Pomerania region...
Telemedicine for the treatment of depression and anxiety disorders was found to be successful in a randomised controlled trial (RCT); this intervention was then implemented in routine care in the Western Pomerania region in Germany. This made it possible to investigate the effectiveness of the intervention under routine care conditions and compare it with the results of the RCT.For this retrospective controlled analysis, data from routine care (2011-2022) were analysed together with data from the previous RCT (2009-2010). A three-arm comparison (routine care, previous RCT intervention group, previous RCT control group) on the primary outcome of symptom severity (BSI-18) and a longitudinal analysis of the routine care data were conducted. The telemedical intervention was conducted in the university hospital's psychiatric outpatient clinic in north-eastern Germany. All adult patients with an ICD-10 diagnosis of depression, anxiety or somatoform disorders could participate after discharge from the hospital. The telemedicine sessions included structured verbal questionnaires and conversational therapy concerning treatment goals and tasks. Repeated measures Welch ANOVA with the BSI-18 Global Severity Index and subscales (depression, anxiety and somatisation) was performed. A multivariate regression was conducted on the longitudinal regular care data.The n=254 subjects in the telemedical care in routine care arm (181 women, mean [95%CI] age 45.5 [44.0-47.1] years; 6-month follow-up) showed a BSI-18 score improvement M=- 4.1 [-5.3,-2.9], F(2)=3.50, p<0.05 compared to the preceding RCT intervention arms (61 women, mean [95%CI] age 44.7 [41.7-47.6] years. Telemedical care showed a significant difference in BSI-18 scores over a 10-year follow-up: M=- 3.9 [-5.4,-2.5], p<0.0001.The positive results of the 2009 RCT were replicable in routine care. The more patient-centred approach resulted in improved outcomes in this telemedical intervention.
[Effect evaluation of an online training package to strengthen methodological and diagnostic skills in the application of SOPESS: A cluster randomised trial (KOMET-SEU project)].
Diefenbach C, Malonga Makosi D, Jaščenoka JC … +2 more , König J, Urschitz MS
Gesundheitswesen · 2025 Jun · PMID 40203888 · Publisher ↗
As part of the KOMET-SEU project, an online training package for the child and youth health service was developed to strengthen the skills regarding the implementation of the social-paediatric screening SOPESS and to inc...
As part of the KOMET-SEU project, an online training package for the child and youth health service was developed to strengthen the skills regarding the implementation of the social-paediatric screening SOPESS and to increase the quality and utilisation of SOPESS data. Evaluation of the process showed that the target group assessed the training package in positive terms. The aim of the present study was to evaluate the effects of the training package on skills and behaviour of employees of the child and youth health service.In a cluster randomised controlled trial, 34 public health departments in North Rhine-Westphalia and Rhineland-Palatinate were assigned to either an intervention or a waiting list control group. Effectiveness of the intervention was assessed using examiner competence (secondary outcome measure) and examiner behaviour (two primary outcome measures). The outcome measures were collected based on 94 items on a 4-point Likert scale using online questionnaires before and after the introduction of the training package. Linear mixed model analyses, adjusted for potential co-predictors, were conducted to examine the intervention effects.The analysis sample comprised 248 employees of the child and youth health service. With already high baseline levels in the outcome measures, there were no significant global intervention effects on examiner competence (B=0.15; SE=0.09; p=0.08) and examiner behaviour (B=- 0.01; SE=0.08; p=0.91 and B=0.06; SE=0.09; p=0.49). Only a tendency towards stronger effects in subgroups of examiners with little SOPESS experience was discernible.Despite good use and positive assessment by the target group, the training package led to a strengthening of skills and changes in the behaviour only of examiners with little experience. Whether this is sufficient to increase the quality and utilisation of the SOPESS data in the long term remains to be seen.
[Fifty years of psychiatric reform in Germany: East and West].
Zedlick D, Holke J, Rosemann M … +1 more , Obert K
Gesundheitswesen · 2025 Jul · PMID 40185150 · Publisher ↗
The development of psychiatric reform in Germany over the last 50 years has been characterized by a heterogeneity that should not be underestimated, as can also be observed in other European countries. The fact that the...
The development of psychiatric reform in Germany over the last 50 years has been characterized by a heterogeneity that should not be underestimated, as can also be observed in other European countries. The fact that the reform process in both the "old" Federal Republic of Germany and the former German Democratic Republic began quite belatedly was also due to the consequences of "euthanasia" during the National Socialist era and the delayed social and professional reappraisal of euthanasia. This article traces the major lines of development of the reform and outlines some of the current challenges in mental health services, especially community psychiatry.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe