Gesundheitswesen [JOURNAL]
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200 papers
[Barriers to and facilitating factors in school entry examination with SOPESS: Development of an online training to enhance basic diagnostic skills (KOMET-SEU project)].
Jaščenoka JC, Maurer J, Sierpinski T … +2 more , Diefenbach C, Daseking M
Gesundheitswesen · 2025 Jun · PMID 40185149 · Publisher ↗
The preschool health examination makes a significant contribution in terms of both individual and population medicine to positively shaping the long-term future of children starting school. To gain optimal benefit from t...
The preschool health examination makes a significant contribution in terms of both individual and population medicine to positively shaping the long-term future of children starting school. To gain optimal benefit from the examination data, it is necessary that the examination process with SOPESS (social pediatric screening) is standardized. However, practical experience from the public health service has shown that the data collected to date indicates medium to high method-related heterogeneity at the level of the SOPESS raw value totals, which can have a negative impact on the validity of the data.The aim is to identify barriers to and facilitating factors for the implementation of SOPESS and to reduce method-related heterogeneity by providing a customized training measure. This project was realized in two studies. In study 1, 56 employees from 21 child and adolescent health service departments were interviewed by telephone about possible barriersto and facilitating factors in the implementation of SOPESS. These results were then used to design an online training to strengthen basic diagnostic skills, which was tested in study 2 with 25 persons in an initial application phase (piloting) and evaluated and adapted regarding various factors (e. g. practical relevance and suggestions for improvement).In Study 1, a central cause of the method-related heterogeneity was identified as the deviation of those carrying out the tests from the standardized test instructions. In the evaluation, there were uncertainties in the assessment of the visuomotor tasks. A video-based presentation of a standardized examination could prove to be beneficial to enhance the basic diagnostic skills of the examiners in the long term. In study 2, the results of the piloting of the online training were positive: Almost all persons (22 of 25) rated the online training as relevant to practice regarding the implementation and evaluation of the SOPESS and believed it would improve the quality of implementation of the SOPESS.The online training was then comprehensively evaluated in an application phase in North Rhine-Westphalia and Rhineland-Palatinate. Following completion of the evaluation phase, the online training is to be adapted and offered on a broad scale to enhance the diagnostic skills of employees in the departments of child and adolescent health service in the long-term, and support the collection of valid data as part of preschool health examination.
[Use of qualitative evidence syntheses in health services research in German-speaking countries: results of an online survey].
Herrler A, Lentsch V, Eisenmann Y … +1 more , Möhler R
Gesundheitswesen · 2026 Mar · PMID 40185148 · Publisher ↗
Qualitative evidence syntheses (QES) can answer qualitative research questions across different studies and thus offer an important part in the collection of evidence. While QES are a common set of methods internationall...
Qualitative evidence syntheses (QES) can answer qualitative research questions across different studies and thus offer an important part in the collection of evidence. While QES are a common set of methods internationally, they appear to be little used in health services research in the German-speaking countries to date.The aim of the study was to analyse the current use of QES in health services research in the German-speaking countries in order to draw conclusions for their establishment.An online survey was conducted by the subgroup Qualitative Evidence Syntheses in the German Network Health Services Research. The survey was aimed at health services researchers in German-speaking countries. Among other things, experiences with QES as well as barriers and support factors during implementation were surveyed. The data were analysed using descriptive statistics and content-structuring qualitative content analysis.A total of n=103 people took part in the survey, n=45 of whom had already been involved in QES. They had used QES to analyse the perspectives of target groups, to describe and evaluate health care, to (further) develop models and concepts and to implement and evaluate interventions. The participants referred to the high added value of QES, particularly due to its practical relevance, as well as to methodological difficulties in implementation and the desire for better training programmes.Qualitative evidence syntheses offer a potential that is still underutilised in health services research and can be particularly useful in the development and evaluation of interventions and the investigation of contexts and complexity.
[Predetermined breaking points and recommendations for action in development of digital prevention services in public health: a practical example].
Bickmann P, Froböse I, Grieben C
Gesundheitswesen · 2026 Mar · PMID 40185147 · Publisher ↗
Digital prevention is essential for a sustainable healthcare system in Germany, with health insurance companies playing a key role. Despite promising approaches in research, studies indicate that hybrid and digital preve...
Digital prevention is essential for a sustainable healthcare system in Germany, with health insurance companies playing a key role. Despite promising approaches in research, studies indicate that hybrid and digital prevention solutions are often short-lived, pointing to systematic challenges. This paper presents the development of a prevention app commissioned by a German health insurance company. The app promotes a health-oriented lifestyle through an integrated chatbot. The scientifically accompanied development process highlights the importance of user participation and emphasizes the challenges of the long-term implementation of digital prevention solutions. These include project communication, scientific monitoring, data protection requirements, and the technical infrastructure of the health insurance company. Practical insights provide recommendations for the development and a structural model for future projects is proposed. It focuses on the effective integration of expert knowledge from various fields, such as prevention and software development. This collaboration is more crucial than ever for the future use of AI in health prevention.
[History of ideas and psychiatric reform: Italy, Great Britain and Germany].
Becker T, Weinmann S, Gühne U
Gesundheitswesen · 2025 Jul · PMID 40179947 · Publisher ↗
Ideas and societal structure interact. This paper focuses on relationships between the history of ideas and mental health reform in Italy, Great Britain and Germany. The Italian reform process is based on the ideas of Je...
Ideas and societal structure interact. This paper focuses on relationships between the history of ideas and mental health reform in Italy, Great Britain and Germany. The Italian reform process is based on the ideas of Jean-Paul Sartre, Michel Foucault, phenomenology and Antonio Gramsci, with issues of human rights and social inclusion taking central stage; diagnostic concepts are (temporarily) put in brackets. In Great Britain, there is a strong tradition of empiricism coupled with Erving Goffman's institutional critique and analysis, evangelical (and Quaker) traditions of 'pauper and lunacy' politics, and high-quality evaluation of services. In (the Federal Republic of) Germany, Foucault, Goffman, anthropological-phenomenological psychiatry and international impulses are relevant. With its radical institutional critique and transformation towards comprehensive community care (in the face of tight finances), Italy's mental health reforms are impressive. In Great Britain there is a long-term orientation towards community mental health care, evidence-based services and a focus on patient rights (mixed with neoliberal elements in recent decades). In Germany, mental hospital reform was carried out based on the recommendations of a national Psychiatric Enquiry (White Paper, Psychiatrie-Enquête, 1975) but large psychiatric institutions are not closed, community psychiatric transformation is delayed. There is a recent surge of integrated care models with flexibility of care provision across the inpatient-community divide.
[Early dental visits - a systematic analysis of the information content of national dental child health records].
Rahbari K, Graetz C, Cyris M … +3 more , Sucherlan M, Dörfer CE, Geiken A
Gesundheitswesen · 2025 Nov · PMID 40174874 · Full text
Dental child health records have an informal character and act as a reminder of early dental visits (FU1a-c, FUPr, FLA). Long-term prevention should take place from newborns to the age of 6. However, each chamber area (n...
Dental child health records have an informal character and act as a reminder of early dental visits (FU1a-c, FUPr, FLA). Long-term prevention should take place from newborns to the age of 6. However, each chamber area (n=17) has its own dental child health record (n=14). The evaluation of the formalities and the content was the aim of this study.Fourteen dental child health records were evaluated by 12 dentists with different specializations (2 each in pediatric dentistry, periodontics, prosthetics, tooth preservation, orthodontics, no specialization) from July 1st, 2023 - November 30th, 2023. The dentists used a catalogue of criteria with 81 items. The validated criteria catalogue consisted of questions about quality (Witten List, DISCERN, Hamburg Model of Comprehensibility) and other relevant topics. A descriptive analysis and statistical evaluations (Kruskal-Wallis test, asymptomatic significance test), a correlation analysis of the quality of patient information (Spearman correlation), a binary logistic regression analysis of the variables specialization of the examiner (in pediatric dentistry/not in pediatric dentistry), gender (female/male), professional experience (≤7 years/>7 years) and chamber area (eastern/western chamber areas) were carried out.The dental child health record from Bremen/Schleswig-Holstein (identical) was rated best in terms of content median (25%/75% percentile): 100.50(100.00/101.75), the dental child health record of Brandenburg was rated the worst 69, 00(66.50/73.00); p>1.00). There was good correlation between DISCERN and the Hamburg Model of Comprehensibility (ρ=0.565 (p<0.001)). According to the regression analysis, only the chamber area showed a significant influence on the content (p<0.001).There was a strong discrepancy in the quality and quantity of the dental child health records. It is important to strive towards a standardized form and congruence in content similar to that which already exists for the children's medical examination booklets.
[WHO clinical practice guidelines for influenza: an update].
Meixner J, Nußbaumer-Streit B, Sommer I
Gesundheitswesen · 2025 Jul · PMID 40169139 · Publisher ↗
Every year, more than one billion people around the world are infected with influenza, an acute infection of the respiratory tract. Influenza spreads from person to person through air, contaminated hands or objects. Anti...
Every year, more than one billion people around the world are infected with influenza, an acute infection of the respiratory tract. Influenza spreads from person to person through air, contaminated hands or objects. Antiviral and immunomodulatory drugs are available for treatment of patients and prophylaxis of exposed persons. Reverse transcription polymerase chain reaction (RT-PCR), nucleic acid amplification tests (NAATs) and rapid tests are available for the diagnosis of influenza. Objective The aim of this World Health Organization (WHO) guideline is to provide recommendations for the diagnosis, drug treatment and prophylaxis of influenza.This updated guideline has been developed in accordance with standards for trustworthy guidelines. The recommendations are based on systematic reviews on safety and effectiveness. They take into account the magnitude of benefits and harms of treatments, the reliability of the evidence, and the needs of patients and healthcare professionals.For non-severe influenza, there is a conditional recommendation to use baloxavir if the risk of severe illness is high. Antivirals are not recommended if the risk is low. There is also a strong recommendation against the use of antibiotics if bacterial co-infection is unlikely. Oseltamivir is conditionally recommended for severe influenza. Not recommended are peramivir and zanamivir, as well as macrolide antibiotics (in the absence of co-infection), mTOR inhibitors and plasma therapy, and corticosteroids. Baloxavir and oseltamivir are conditionally recommended for prophylaxis in asymptomatic persons who have been exposed to seasonal influenza viruses and would be at very high risk of becoming hospitalised. For zoonotic influenza, laninamivir and zanamivir are also conditionally recommended in addition to baloxavir and oseltamivir, regardless of individual risk. For diagnosis, the use of NAAT or digital immunoassay (DIA) for suspected non-severe influenza and nucleic acid amplification test (NAAT) for suspected severe influenza is recommended.
Methods for health economic evaluation of complex interventions in healthcare: current practice, challenges and guidance for future research.
Chernyak N, Mohebbi D, Alayli A … +13 more , Behrens J, Eckhardt H, Henschke C, Holle R, Kairies-Schwarz N, Liersch S, Möhler R, Müller D, Neumann A, Vomhof M, Zechmeister-Koss I, Köberlein-Neu J, Icks A
Gesundheitswesen · 2025 Oct · PMID 40164148 · Publisher ↗
Health economic methods can support the development and evaluation of new healthcare interventions by generating data on the resources used and relating these to a defined benefit. However, the standard methodology of he...
Health economic methods can support the development and evaluation of new healthcare interventions by generating data on the resources used and relating these to a defined benefit. However, the standard methodology of health economic evaluation that is usually used does not do justice to the high degree of complexity of interventions in healthcare. As a result, there is a lack of decision-relevant information, for example, on the preferences of the target group, on spillover effects on the part of carers, or on implementation costs and the role of different contexts in the implementation of interventions into routine care. The UK Medical Research Council's (MRC) standard-setting framework for complex interventions therefore emphasises the need to incorporate health economic aspects more strongly into all phases of the development and evaluation of complex interventions. To make this possible, the MRC's recommendations for expanding and adapting the standard methodology of health economic evaluation must be concretised and supplemented. Building on already established methodological procedures, recommendations should be developed and proposals for necessary further research formulated.
[Facilitators and Barriers to Implementing University Health Management: A Qualitative Study].
Paulsen L, Philipps L, Dold C … +1 more , Bucksch J
Gesundheitswesen · 2025 Aug · PMID 40164111 · Full text
Changes at German universities, such as an increasing workload and a shift towards competition, require investments in health promotion. University Health Management (UHM) aims to support the development of a health-prom...
Changes at German universities, such as an increasing workload and a shift towards competition, require investments in health promotion. University Health Management (UHM) aims to support the development of a health-promoting setting. While conceptual considerations emphasize promising success factors for UHM, empirical studies are lacking. The aim of this qualitative study is therefore to identify facilitators and barriers to the implementation of UHM from the perspective of experts.We interviewed 26 experts in guideline-based interviews regarding facilitators and barriers to implementing UHM. Data were analysed using content-analytical methods following Kuckartz, assisted by MAXQDA 2020 software.We identified eight factors that can be both supportive and inhibiting in the implementation of UHM: university leadership, health as a topic within universities, networks, collaboration and exchange, structural organization, target groups, financial resources, collaboration with health insurance providers, and state university laws. Additionally, individual supporting factors, such as adherence to guidelines for a healthy university, or barriers, such as a heterogeneous understanding of UHM and time constraints, influence the implementation.Various facilitators and barriers can be found when introducing UHM. These factors need to be considered within the diverse structures, historical backgrounds, and sizes of universities. Thus, there is no universal blueprint for the development and implementation of UHM. A uniform understanding of UHM and the integration of health into state-level university seem fundamental for the successful implementation of UHM.
[Recruitment of a cohort to investigate medical follow-up care after childhood cancer: Record-Linkage between the German Childhood Cancer Registry and statutory health insurance companies (VersKiKCohort)].
Merzenich H, Ihle P, Küpper-Nybelen J … +17 more , Lüpkes C, Bremensdorfer C, Aleshchenko E, Apfelbacher C, Trocchi P, Horenkamp-Sonntag D, Meier I, Dröge P, Ruhnke T, Marschall U, Klein M, Baust K, Calaminus G, Langer T, Swart E, Ronckers C, Spix C
Gesundheitswesen · 2025 Nov · PMID 40132977 · Publisher ↗
The VersKiK-study is based on a record-linkage between the German Childhood Cancer Registry (GCCR) and claims data from statutory health insurances (SHI) in order to investigate the frequency of late effects and long-ter...
The VersKiK-study is based on a record-linkage between the German Childhood Cancer Registry (GCCR) and claims data from statutory health insurances (SHI) in order to investigate the frequency of late effects and long-term medical care among pediatric cancer survivors.GCCR defined a basic population of approximately 50,000 former patients with cancer in childhood or adolescence (years of diagnosis 1991-2021) who survived until 1.1.2017. Encrypted GCCR identity data were stochastically linked with encrypted identity data from 13 SHI. For those cancer patients who could be identified in SHI records (study population), claims data covering 2017-2021 were added and combined with basic GCCR information on cancer diagnosis. A comparison between identified cancer patients and those who were not identified in SHI records was made to evaluate the representativeness of the study population for quantitative analyses.A total of 26,127 former childhood cancer patients were identified in SHI data. Since the participating SHI represent approximately two-thirds of the German population, the record linkage could be judged as satisfactory (84% matching rate). We found no significant differences between the study population and the non-matched group regarding age, sex, primary cancer diagnosis, and year of diagnosis.The identified study population is considered representative for survivors of childhood cancer in Germany.
[Waiting times for a second opinion appointment for tonsillectomy/tonsillotomy - a study of simulated patients].
Prediger B, Traxel L, Könsgen N … +2 more , Schäfer N, Pieper D
Gesundheitswesen · 2025 Oct · PMID 40112830 · Publisher ↗
Since December 2018, statutory health insured people with indication for tonsillectomy/tonsillotomy have the right to obtain a second opinion (SO) according to the SO directive. It is a legal requirement that the physi...
Since December 2018, statutory health insured people with indication for tonsillectomy/tonsillotomy have the right to obtain a second opinion (SO) according to the SO directive. It is a legal requirement that the physician providing the indication has to inform the patient about his/her right to obtain an SO. This has to be done usually at least 10 days before the procedure, but in any case in time for the patient to make a well-considered decision about seeking an SO. The aim was to assess waiting times for appointments with physicians to obtain an SO. In our study of simulated patients, all practices with physicians of the Associations of Statutory Health Insurance Physicians of North Rhine and Westphalia-Lippe providing SO (n=53 medical practices) were contacted via phone up to three times between January and February 2022. Using a standardized and piloted protocol, it was stated that there was an indication for a tonsillectomy/tonsillotomy and that the patient wanted to make an appointment for an SO. It was assessed how long the waiting time for an appointment would be, as well as whether it would be possible to obtain the appointment via video consultation and whether any further questions or details were provided during this telephone call (e. g. reference to documents to be brought along). Overall, 94.4% (50/53) of the medical practices could be reached. A great majority of them (92% (46/50)) offered an appointment in contrast to three medical practices that offered open consultation hours. The remaining practice offered both ways to obtain an SO. On average, a waiting time of 8.1 (Standard deviation 5.4) working days was needed for an appointment in the morning and 10.1 (standard deviation 5.9) for an appointment in the afternoon. The availability of the medical practices was high. In 31% of cases, it took longer than 10 days to obtain the SO. Nevertheless, the overall waiting times were short. In principle, patients should be provided with a timely appointment for an SO, which is possible within the Associations of Statutory Health Insurance Physicians of North Rhine and Westphalia-Lippe. The SO is very rarely offered via video consultation. However, this could possibly increase rural care.
[Establishing psychiatry as a field of municipal policy].
Albers M
Gesundheitswesen · 2025 Jul · PMID 40097025 · Publisher ↗
How did psychiatry develop as a field of municipal politics in Germany? Decisive prerequisites for this can be found in the reform psychiatry of the early 20th century, but above all in the socio-medical reform movement...
How did psychiatry develop as a field of municipal politics in Germany? Decisive prerequisites for this can be found in the reform psychiatry of the early 20th century, but above all in the socio-medical reform movement of the Weimar period, when municipal health authorities set up counselling and support services for mentally ill people. These were instrumentalised by National Socialism for its racist extermination programme, and it was not until the psychiatric reform that began in the 1970s that these approaches were taken up again. The far-reaching responsibilities of the municipal authorities, which had already been established in the Weimar period, supported the resurgence of an active organisation of the local psychiatric care system by the municipal health authorities. With its own social psychiatric services, the task of coordinating psychiatry and structures such as psychosocial working groups, health conferences and community psychiatric associations, psychiatry has become a field of active municipal policy with the goal of an inclusive society.
[Intercultural competence in healthcare - a narrative review of definitions, quality criteria and the effectiveness of training measures].
Hinse M, Roll S, David M … +2 more , Sehouli J, Willich SN
Gesundheitswesen · 2026 Feb · PMID 40081413 · Publisher ↗
Around a quarter of the German population has a migrant background. There are some differences in the healthcare provided to migrants and their successor generations compared to people without a migrant background. The a...
Around a quarter of the German population has a migrant background. There are some differences in the healthcare provided to migrants and their successor generations compared to people without a migrant background. The aim of this review was to show the different definitions of intercultural competence (ICC), the different target groups of doctors and nursing staff given ICC training courses, and the extent to which the effectiveness of these courses can be assessed with the help of existing quality criteria.Relevant publications were found by searching PubMed, reviewing the references and literature databases of the participating authors and additionally using Google and Researchgate web searches. Both German- and English-language publications were included in the search.There are several definitions and explanations of ICC, some of which differ, but most of of them include the aspects of cultural awareness, cultural knowledge, cultural sensitivity, cultural interaction and cultural understanding. Previous studies show different target groups for ICC training and a methodologically heterogeneous assessment of the effectiveness of these measures.There is a great need for methodologically sound studies using standardised and objectifiable criteria for the evaluation of intercultural training. Further development of measures, guidelines and political framework conditions would be important for patients, professionals, organisations and associations.
[Physicians' documentation behaviour and (non-)fulfillment of quality indicators in outpatient care of children and adolescents - A qualitative analysis].
Müller T, Mehl C, de Cruppé W … +2 more , Bachmann C, Geraedts M
Gesundheitswesen · 2025 Nov · PMID 40081412 · Publisher ↗
The research project "Evaluation of quality of care in routine outpatient care for common childhood and adolescent diseases" (QualiPäd) measures the quality of care for seven common somatic and psychiatric diseases in ch...
The research project "Evaluation of quality of care in routine outpatient care for common childhood and adolescent diseases" (QualiPäd) measures the quality of care for seven common somatic and psychiatric diseases in children and adolescents based on a set of consensual and evidence-based quality indicators developed specifically for this purpose. Analyses of patient files of pediatricians, general practitioners and child and adolescent psychiatrists showed that in some cases, due to lack of information in the patient records, fullfillment of some of the quality indicators could not be measured or the degree of fulfillment of the quality indicators was found to be low. Therefore, the aim of the present study was to identify system-, physician- and patient-related factors that influence documentation in patient records as well as (non)fulfillment of quality indicators.Three specialist-specific focus group interviews were conducted with physicians (8 pediatricians, 5 general practitioners, 2 child and adolescent psychiatrists) already involved in the study. Interview guides were developed to pick up the previous results of the study and to enable discussions on the interpretation of results as well as possible influencing factors at different levels. The interviews were transcribed and content-analyzed using MAXQDA software.The following factors were identified that appeared to influence treatment, documentation, and therefore (non)fulfillment of quality indicators: Patient characteristics (e. g., age, disease burden), demands of everyday practice (e. g., time pressure), treatment continuity (e. g., cared for by several providers), preference for experiential knowledge instead of quality indicators/guidelines, and an individual approach to documentation behavior (e.g, short reports as a personal thought support). In addition, participants criticized the approach to quality measurement via indicators and patient records.The physicians we interviewed decide individually how to proceed and what to document when treating common medical conditions in children and adolescents. In some cases, this is in clear contrast to the documentation requirements for calculating quality indicators, which means that quality measurement based on patient records is only possible to a limited extent.
[Change in the dental profession and the attitude of dental professionals towards dental care centers (ZMVZ)].
Gaillard P, Haak R, Glaesmer H
Gesundheitswesen · 2025 Oct · PMID 40081411 · Publisher ↗
The number of dental care centers (ZMVZ) in Germany has been increasing rapidly since 2015. This new form of practice is being discussed critically, especially when run by investors. This study analyzes the opinions and...
The number of dental care centers (ZMVZ) in Germany has been increasing rapidly since 2015. This new form of practice is being discussed critically, especially when run by investors. This study analyzes the opinions and attitudes towards ZMVZ of dentists practicing in Germany, focusing on age and gender differences in dentists' attitudes as well as different aspects of working for a ZMVZ.A total of 937 dentists throughout Germany (63% female, aged 23 to 77 years) were asked in an online survey via the LimeSurvey platform conducted in 2021/2022 about their attitudes towards ZMVZ, readiness to work in one of them and whether there was a basic willingness to change their workplace; 575 of these questionnaires were available for analysis.The critical view of ZMVZ, especially management by investors, was shared by most of the respondents. There were differences between the age groups. Younger respondents were more in favor of management by specialist colleagues, while older respondents had a more positive attitude towards investor-run ZMVZ. The oldest respondents also tended to agree with the statement that the ZMVZ would replace the traditional practice. In general, practitioners feared that they would not be able to practice freely. However, one-third of the surveyed dentists who were considering a job change could imagine working in a ZMVZ.This study provides an insight into the attitudes of practicing dentists towards ZMVZ as well as their willingness to work in one. Since the ZMVZ are becoming increasingly important, while at the same time are subject to debate, the present overview of the advantages and disadvantages from the perspective of those working in practice should help in clarifying the issues involved. They also demonstrate that, despite all the criticism, there are positive aspects, and a significant proportion of those surveyed could imagine working in a ZMVZ. Since the ZMVZ have become a relevant part of the dental care system, it is important to identify problems and potential areas for development in order to improve care of dental patients.
[Unmet Needs in Stroke Aftercare - A Survey of Stroke Survivors in Germany].
Franzisket C, Voigt C, Brinkmeier M … +2 more , Wagner M, Pries R
Gesundheitswesen · 2025 Aug · PMID 40081410 · Publisher ↗
Surviving stroke has become more common since implementing stroke units in Germany. Little information is available regarding life after stroke and unmet stroke survivors' needs in Germany. This survey is an attempt to c...
Surviving stroke has become more common since implementing stroke units in Germany. Little information is available regarding life after stroke and unmet stroke survivors' needs in Germany. This survey is an attempt to close some information gaps.The German Stroke Foundation developed an unmet needs questionnaire in German based on three validated stroke assessment tools covering different domains of life after stroke. The questionnaire was tested and finalized including stroke survivors' expertise. In May 2021, it was sent to more than 3,000 stroke survivors from the German Stroke Foundation database.A total of 979 completed responses could be included in the analysis (response rate 29%). The majority was male (56%) and the average age at the time of stroke was 56 years. Approximately 70% of the respondents reported at least one unmet need. Unmet needs were primary found in the following areas: further rehabilitation measures, remembering and concentrating, further therapeutic measures, and stiffness in arms, hands and/or legs (spasticity).This survey offers a better overview of stroke survivors' needs in Germany. Additional research is needed as unmet needs are not closely monitored in German stroke aftercare. Knowledge of these is important for individualized patient care and a good quality of life for those affected.
[INVADE: a real-life primary care long-term intervention program for brain health - results from 2013 to 2020].
Bickel H, Nimmrichter B, Pürner K … +2 more , Sander D, Förstl H
Gesundheitswesen · 2025 Aug · PMID 40081409 · Full text
The primary care prevention program INVADE (INtervention project on VAscular brain diseases and Dementia in the district of Ebersberg) is intended to prevent stroke and dementia through systematic detection and evidence-...
The primary care prevention program INVADE (INtervention project on VAscular brain diseases and Dementia in the district of Ebersberg) is intended to prevent stroke and dementia through systematic detection and evidence-based treatment of modifiable vascular risk factors. The study reports on the results of an eight-year evaluation phase.Longitudinal study with non-randomized control group. AOK-insured patients over the age of 50 from the Bavarian district of Ebersberg were invited to participate in the project. The control group consisted of AOK-insured individuals of the same age-group from the district of Dachau. Primary clinical endpoints (mortality and long-term care dependency) and secondary endpoints (inpatient treatment due to cerebrovascular diseases) were based on the administrative data from the AOK. Analyses were carried out according to the principle "intention to treat".The intervention group (n=10,663) included 39.7% of insured persons who had enrolled in the program. Significant advantages were observed in the intervention group compared to the control group (n=13,225). Mortality was reduced by 6%, the incidence of long-term care by 10% and the prevalence of long-term care by 18.6%. There were about 190 fewer deaths and 260 fewer new cases of long-term care dependency than expected over a period of eight years. The prevalence of care dependency decreased by 1,600 years. The frequency of hospital treatment for cerebrovascular diseases, however, did not differ between the groups.Our results suggest that a real-life practice-based prevention program aimed at better control of vascular risk factors can possibly contribute to a reduction of care dependency and an increase in life expectancy.
[Duplicate capacities for specialized care: Contributions of the SHI-accredited and hospital-based physicians to selected parameters of specialist care].
Hahn U, Koch J, Kellner U
Gesundheitswesen · 2026 Mar · PMID 40074212 · Publisher ↗
Specialist care in Germany is provided by hospitals as well as by independent physicians with their own practices authorized to provide care within the framework of the Statutory Health Insurance (SHI). This duplicate ca...
Specialist care in Germany is provided by hospitals as well as by independent physicians with their own practices authorized to provide care within the framework of the Statutory Health Insurance (SHI). This duplicate capacities for specialized care, and in particular the SHI-specialist track has come under criticis. Based on publicly accessible secondary data sources (Federal Statistical Office, National Association of SHI Physicians and German Medical Association), this study analyzes and quantifies the relevance of the two tracks along the parameters density of the regional (number of facilities) and specialist (number of specialized departments and specialist practices) care network, distribution of specialists and case numbers. Differences by specialty and changes between 2012 and 2022 are determined according to the distribution of specialists to tracks. In 2022 the SHI-specialist track dominated in terms of the number of medical facilities (96% of all were attributed to them) and specialized departments und specialist practices (89%), with 86% of all outpatient / inpatient cases and 90% of all outpatient cases being handled by them. Slightly less than 50% were accounted for by outpatient specialists (by headcount) or full-time equivalents of SHI-specialists. The distribution of physicians varied greatly according to specialties, while the relative proportions by tracks compared to 2012 remained largely constant. As the data sources are not harmonized, conversions and compromises were partly necessary for processing and interpretation the parameter-specific data. However, in the interests of transparency, extrapolation and weighting (also with regard to differences in workload treating outpatients or inpatients) were avoided. Distortions resulting from availability and handling of the date are named by type and direction. However, they are subordinate compared to the data unambiguously interpretable. The dimensions of the reported results can be regarded as robust. Considering the clear dominance of the SHI-specialist track, centralization of specialist care at hospitals would be accompanied by considerable challenges. Prior to demanding reform, criticism of the duplicate capacities for specialized care should be substantiated by data, while its potential advantages is acknowledged in the scientific discussion.
[Allocation principles and the organization of tissue donation: ethical challenges and possible influence on the willingness to donate from the perspective of multidisciplinary experts].
Kirchner K, Lauerer M, Nagel E
Gesundheitswesen · 2025 Mar · PMID 40049212 · Publisher ↗
Due to the shortage of tissues and organs, numerous patients suffer from a reduced quality of life or even die. In political measures to increase the donation rate, tissue donation is often subsumed to organ donation, de...
Due to the shortage of tissues and organs, numerous patients suffer from a reduced quality of life or even die. In political measures to increase the donation rate, tissue donation is often subsumed to organ donation, despite considerable differences: For example, unlike organs, tissue transplants can be stored for up to five years and allocated internationally. Similarly, industrially processed tissue preparations can be sold commercially, whereas organs are subject to a trade ban. Tissue donation also differs from centrally organized organ donation in terms of decentralized organization. As the associated ethical challenges and possible influence on the willingness to donate have only been insufficiently investigated to date, these are the focus of this exploratory expert survey.We conducted qualitative interviews with 14 experts who are involved in the tissue donation process in different positions. In addition, we interviewed medical ethicists, lawyers and scientists. We evaluated the interviews with a structuring content analysis according to Mayring and performed a frequency analysis. In reporting, we followed the standards for qualitative studies.Altruism and the medical necessity of transplantation were cited as legitimation of tissue donation. Therefore, most experts were in favor of a commercial ban for all tissues. In case of a commercial use of tissues, a negative effect on the donation rate was feared. According to most experts, neither the possible commercial use of tissue transplants nor the decentralized organization of tissue donation or the international allocation of transplants are discussed in conversations with relatives, although some experts assume that they could have an impact on the willingness to donate. Furthermore, the general population is not sufficiently informed about the characteristics of tissue donation.The characteristics of tissue donation can influence the willingness to donate. At the same time, they are discussed neither in conversations with relatives nor in public communication. If the present results are confirmed in further studies, in the sense of an informed decision both in in discussions with relatives as well as in public communication, transparency must be created about the decision-relevant aspects.
Travel costs and ecologic imprint associated with different fractionation schedules in prostate cancer radiotherapy.
Wurschi GW, Graf M, Weimann S … +6 more , Mäurer M, Straube C, Medenwald D, Domschikowski J, Münter M, Pietschmann K
Gesundheitswesen · 2025 Dec · PMID 40043727 · Publisher ↗
Improving the sustainability and cost-effectiveness of healthcare systems has become increasingly relevant in times of climate change, energy transition, an aging population and skyrocketing social costs. The selection o...
Improving the sustainability and cost-effectiveness of healthcare systems has become increasingly relevant in times of climate change, energy transition, an aging population and skyrocketing social costs. The selection of an adequate fractionation schedule is of fundamental importance in the field of Radiation Oncology. We evaluated three internationally established fractionation schedules for definitive prostate cancer radiation therapy (RT) with respect to their ecological and health-economic impacts.We analyzed the data of 109 patients with prostate cancer, who underwent outpatient radiation therapy at Jena University Hospital in 2022. After determination of travel distances between their homes and the treatment facility, carbon dioxide (CO)-emissions and taxi costs were calculated for normofractionated RT (39 fractions, A), moderately hypofractionated RT (20 fractions, B) and ultrahypofractionated RT (5 fractions, C).Travel distances of 1616 km (A), 848 km (B) and 242 km (C) were calculated with corresponding costs ranging from 638 € (C) to 4255 € (A). According to the 2024 German physician's fee schedule, 9,604 € would be invoiced for medical treatment and transportation in (A), with transportation costs accounting for 44% of total treatment costs in normofractionated RT. The travel distance, CO-emissions and transportation costs could be reduced by up to 85% by hypofractionation.(Ultra-)hypofractionated radiation therapy for prostate cancer has great potential to lower healthcare costs and reduce environmental pollution. Given that and the non-inferiority of oncological outcome and toxicity, hypofractionation should appear beneficial from patient's and healthcare provider's point of view. Current reimbursement structures seem to be inappropriate regarding increased personnel and technical efforts required for highly precise dose application and might hinder comprehensive establishment of ultrahypofraktionated RT in Germany.
[Measures to increase the retention of migrant healthcare professionals in Germany: results from 14 years of research].
Jansen EM, Peppler L
Gesundheitswesen · 2025 Apr · PMID 40015327 · Publisher ↗
The shortage of physicians and nurses in the healthcare sector in Germany is often compensated by deployment of health professionals from abroad. However, this is accompanied by various challenges. These include, for exa...
The shortage of physicians and nurses in the healthcare sector in Germany is often compensated by deployment of health professionals from abroad. However, this is accompanied by various challenges. These include, for example, communication and language difficulties and a lack of understanding of administrative and bureaucratic processes. Using a narrative literature analysis combined with the presentation of our own research results, this article summarizes challenges in this area, based on results from nine years of research and a total of six research projects in this field. Furthermore, it proposes approaches to solutions that have proved to be successful in practice in Germany as well as in international settings.
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