1
|
Braun J, Specker C, Schulze-Koops H, Haase I, Kötter I, Hoyer B, Aringer M, Krusche M, Voormann A, Wagner U, Krause A. [Position paper of the German Society of Rheumatology e.V. (DGRh) regarding the situation of advanced training in the discipline of rheumatology in Germany]. Z Rheumatol 2023; 82:615-620. [PMID: 37335384 DOI: 10.1007/s00393-023-01349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 06/21/2023]
Affiliation(s)
- J Braun
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- c/o Praxis Dr. Karberg, Schlossstr. 110, 12163, Berlin, Deutschland
- Ruhr Universität Bochum, Bochum, Deutschland
| | - C Specker
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, KEM | Evangelische Kliniken Essen-Mitte gGmbH, Essen, Deutschland
| | - H Schulze-Koops
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Deutschland
| | - I Haase
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Hiller Forschungszentrum, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - I Kötter
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Immunologie am Klinikum Bad Bramstedt und Sektion für Rheumatologie und Entzündliche Systemerkrankungen in der III. Medizin des Universitätsklinikum Eppendorf (UKE), Hamburg, Deutschland
| | - B Hoyer
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Sektion Rheumatologie und Exzellenzzentrum für Entzündungsmedizin, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität, Kiel, Deutschland
| | - M Aringer
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Abteilung Rheumatologie, Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - M Krusche
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Immunologie am Klinikum Bad Bramstedt und Sektion für Rheumatologie und Entzündliche Systemerkrankungen in der III. Medizin des Universitätsklinikum Eppendorf (UKE), Hamburg, Deutschland
| | - A Voormann
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland.
| | - U Wagner
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Bereich Rheumatologie an der Klinik für Endokrinologie, Nephrologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - A Krause
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| |
Collapse
|
2
|
Gall S, Kiltz U, Kobylinski T, Andreica I, Vaupel K, Waldecker C, Baraliakos X, Braun J. Patient knowledge about biosimilars and satisfaction with the education provided by rheumatologists or nurse specialists in a biosimilar multiswitch scenario – The perception study. Semin Arthritis Rheum 2022; 57:152119. [DOI: 10.1016/j.semarthrit.2022.152119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022]
|
3
|
Kuhlmann E, Bruns L, Hoeper K, Witte T, Ernst D, Jablonka A. [Health workforce development in rheumatology : A mapping exercise and wake-up call for health policy]. Z Rheumatol 2022; 81:717-729. [PMID: 34003376 PMCID: PMC8129704 DOI: 10.1007/s00393-021-01012-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Health workforce shortage in German rheumatology has been identified as a healthcare service and delivery problem. Health policy has increased staffing targets, yet effective intervention strategies are lacking. This research aimed to systematically map the rheumatology workforce to improve the evidence for interventions and explore possibilities for more effective health workforce management. METHODS The WHO National Health Workforce Accounts provided a conceptual framework for the mapping exercise. Four major sets of indicators were selected, comprising staffing levels, health labor market flows, composition and education/training. A comparison of age groups and time series was applied to explore trends. Public statistics and other secondary sources served our analysis using descriptive methodology. RESULTS In Germany there are 1076 physicians specialized in internal medical rheumatology. Absolute numbers have nearly doubled (91%) since 2000 but with a strong demographic bias. Between 2000 and 2019 numbers markedly increased in the group aged 50 years and older but only by 9% in the younger group under 50 years; since 2010 the group aged 40-50 years even faces a decrease. In 2019, the absolute numbers of rheumatologists in retirement age exceeded those aged 40 years and under. Since 2015 an expanding workforce trend has overall flattened but this was strongest in the hospital sector; the numbers in resident training did not show any relevant growth. CONCLUSION Health workforce trends reveal that an available number of rheumatologists cannot meet new health policy planning targets. There is a need for effective health workforce management, focusing on innovation in resident training, improved task delegation and gender equality.
Collapse
Affiliation(s)
- Ellen Kuhlmann
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Luzia Bruns
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Kirsten Hoeper
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
- Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover, Deutschland
| | - Torsten Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Diana Ernst
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Alexandra Jablonka
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| |
Collapse
|
4
|
Benesova K, Hansen O, Sander O, Feuchtenberger M, Nigg A, Voigt A, Seipelt E, Schneider M, Lorenz HM, Krause A. [Further development of regional early care-Many roads lead to Rome : Developmental stages of four established rheumatological early care concepts in different regions of Germany]. Z Rheumatol 2022; 81:445-462. [PMID: 35670879 PMCID: PMC9171475 DOI: 10.1007/s00393-022-01220-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/25/2022]
Abstract
In order to shorten the prognostically relevant waiting time until diagnosis and initiation of appropriate treatment in inflammatory rheumatic diseases, rheumatological centers in many regions across Germany have established and continuously developed specific early care concepts. Evaluated models from Altötting·Burghausen, Berlin Buch, Düsseldorf and Heidelberg and their developmental stages as a response to internal and external challenges are presented in this overview. The transparent publication of the developmental steps and the exchange of experiences aim at promoting new early care concepts in other regions and continuing the joint dialogue for improvement of the early detection and quality of care of inflammatory rheumatic diseases in Germany.
Collapse
Affiliation(s)
- K Benesova
- Innere Medizin V, Sektion Rheumatologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
| | - O Hansen
- Innere Medizin V, Sektion Rheumatologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
| | - O Sander
- Poliklinik und Funktionsbereich für Rheumatologie & Hiller Forschungszentrum Rheumatologie, UKD Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - M Feuchtenberger
- MVZ MED|BAYERN OST Altötting·Burghausen, Burghausen, Deutschland
| | - A Nigg
- MVZ MED|BAYERN OST Altötting·Burghausen, Burghausen, Deutschland
| | - A Voigt
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - E Seipelt
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - M Schneider
- Poliklinik und Funktionsbereich für Rheumatologie & Hiller Forschungszentrum Rheumatologie, UKD Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - H-M Lorenz
- Innere Medizin V, Sektion Rheumatologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
- ACURA Rheumazentrum Baden-Baden, Baden-Baden, Deutschland
| | - A Krause
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| |
Collapse
|
5
|
Thiele T, Beider S, Kühl H, Mielke G, Holz A, Hirsch S, Witte T, Hoeper K, Cossmann A, Happle C, Jablonka A, Ernst D. [Care of rheumatology patients during the lockdown in early 2020 : Telemedicine, delegation, patient satisfaction and vaccination behavior]. Z Rheumatol 2022; 81:157-163. [PMID: 33974131 PMCID: PMC8111653 DOI: 10.1007/s00393-021-01005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Telemedicine was implemented in outpatient care during the lockdown between March and May 2020. The aim of the study was to assess patients from a private practice and the university outpatient department with respect to patient satisfaction with telemedicine, COVID-19 worries and vaccination behavior and to compare the teleconsultation by a medical assistant for rheumatology (RFA) and a physician. METHODS Patients with rheumatoid arthritis, psoriatric arthropathy or spondylarthritis without treatment modifications since the previous presentation were offered a telemedical replacement appointment within the framework of this study in the case of appointment cancellation by the treating center. Participants were randomized to a telemedicine appointment by a physician or an RFA (RFA university only). The patient history was carried out by telephone and standardized using a questionnaire. The disease activity was determined using the modified clinical disease activity score (CDAI) and the BASDAI. Subsequently, all patients received a pseudonymized evaluation questionnaire. RESULTS In total 112/116 (96%) patients participated. Of these 88/112 (79%) returned the questionnaire. The RFAs conducted 19/112 (17%) of the telephone calls. The treatment was modified in 19/112 (17%) patients. Concerns about contracting COVID-19 correlated with high disease activity (p = 0.031) including the presence of painful joints (p = 0.001) and high pain levels (VAS ≥7, p = 0.009). These patients would have also cancelled their appointment themselves (p = 0.015). Patient satisfaction with the consultation was good (mean 4.3/5.0 modified FAPI) independent of the institution, the duration of the consultation and the consultation partner. Patients with a high pain intensity were the least satisfied (p = 0.036). Only 42/100 (38.2%) of the patients had been vaccinated against pneumococci and 59/100 (53.6%) against influenza. CONCLUSION Telemedical care within the framework of a telephone consultation is well-suited for selected patients. With respect to patient satisfaction the delegation of a telemedical consultation to an RFA is possible. There is a need for improvement with respect to the vaccination behavior.
Collapse
Affiliation(s)
- Thea Thiele
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Sonja Beider
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Henrik Kühl
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Gudrun Mielke
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Anna Holz
- Rheumatologische Facharztpraxis, Hildesheim, Deutschland
| | - Stefanie Hirsch
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Torsten Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Kirsten Hoeper
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
- Regionales kooperatives Rheumazentrum Niedersachsen e. V., Hannover, Deutschland
| | - Anne Cossmann
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Christine Happle
- Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Alexandra Jablonka
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Diana Ernst
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| |
Collapse
|
6
|
Kuhlmann E, Bruns L, Hoeper K, Richter M, Witte T, Ernst D, Jablonka A. Work situation of rheumatologists and residents in times of COVID-19 : Findings from a survey in Germany. Z Rheumatol 2021; 82:331-341. [PMID: 34535820 PMCID: PMC8448391 DOI: 10.1007/s00393-021-01081-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 11/28/2022]
Abstract
Background and objective The work situation is an important dimension of professional life and wellbeing, and a policy lever to strengthen recruitment and retention. This study aims to explore the work situation of physicians and residents in internal medical rheumatology, considering the impact of the coronavirus pandemic COVID-19. Methods A questionnaire-based online survey was conducted in early 2021 at the Hannover Medical School, supported by the German Society of Rheumatology. Target groups were all rheumatology physicians and residents in Germany. The main areas of investigation included work hours, task delegation, and collaboration; workload and mental health issues; discrimination and sexual harassment experiences; and the impact of COVID-19. Descriptive statistical analysis was performed for the standardized items and qualitative content analysis for the free-text information. Results The respondents (n = 101) expressed positive attitudes towards cooperation and task delegation to medical assistants, especially those specialized in rheumatology, while attitudes towards cooperation with GPs pointed to blockades. There was a strong mismatch between actual and desired work hours both in the group of women and in the group of men. 81% rated their workload as high or very high; every sixth rheumatologist has suffered from stress or burnout syndromes at least once in the past. Experiences of gender discrimination and sexual harassment/violence were frequently reported, mostly by women. COVID-19 was an amplifier of stress, with major stressors being digitalization and increased demand for communication and patient education. Conclusion There is an urgent need to improve the work situation of rheumatologists and reduce stress and mental health risks. Supplementary Information The online version of this article (10.1007/s00393-021-01081-5) includes the survey questionnaire in German.
Collapse
Affiliation(s)
- Ellen Kuhlmann
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Luzia Bruns
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Kirsten Hoeper
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover , Germany
| | - Marianne Richter
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover , Germany
| | - Torsten Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Diana Ernst
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Alexandra Jablonka
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| |
Collapse
|
7
|
Editorial. Z Rheumatol 2020; 79:39-40. [DOI: 10.1007/s00393-020-00858-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
8
|
Fiehn C, Baraliakos X, Edelmann E, Froschauer S, Feist E, Karberg K, Ruehlmann JM, Schuch F, Welcker M, Zinke S. [Current state, goals and quality standards of outpatient care in rheumatology: position paper of the Professional Association of German Rheumatologists (BDRh)]. Z Rheumatol 2020; 79:770-779. [PMID: 32926218 DOI: 10.1007/s00393-020-00872-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2020] [Indexed: 11/25/2022]
Abstract
Even in the era of modern guidelines, the treatment of rheumatic diseases is only as good as the framework of rheumatological care within which the treatment is carried out. The access to high-quality medical treatment for all patients is therefore essentially decisive for the prognosis of the patients. This article describes the current state of outpatient treatment in rheumatology and demonstrates which quality projects, such as treatment contracts, outpatient specialized medical treatment (ASV), digitalization and training as specialized rheumatological assistant (RFA), have been created in order to ensure the treatment of our patients. Furthermore, standards are defined that can guarantee a contemporary and guideline-conform treatment in outpatient rheumatological units. As an example it is an affirmation of the Professional Association of German Rheumatologists (BDRh) for ensuring optimal care for all rheumatology patients through early or emergency rheumatology clinics, treat to target, appropriate delegation of medical duties and diversification of treatment, thus an assurance of the quality and comprehensive treatment in rheumatology. The important topic of safeguarding the next generation of rheumatologists, which is indispensable for this, is also discussed.
Collapse
Affiliation(s)
- C Fiehn
- Rheumatologie Baden-Baden GbR, Tätigkeitsschwerpunkt Klinische Immunologie, Medical Center Baden-Baden, Beethovenstr. 2, 76530, Baden-Baden, Deutschland.
| | - X Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Bochum, Deutschland
| | - E Edelmann
- Rheumazentrum Bad Aibling-Erding, Bad Aibling, Deutschland
| | - S Froschauer
- Berufsverband Deutscher Rheumatologen e. V., Grünwald, Deutschland
| | - E Feist
- Rheumatologie, Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Deutschland
| | - K Karberg
- Praxis für Rheumatologie und Innere Medizin, Berlin, Deutschland
| | - J M Ruehlmann
- Praxis für Kinderheilkunde und Kinderrheumatologie, Göttingen, Deutschland
| | - F Schuch
- Rheumatologische Schwerpunktpraxis, Erlangen, Deutschland
| | - M Welcker
- MVZ für Rheumatologie, Planegg, Deutschland
| | - S Zinke
- Rheumatologische Schwerpunktpraxis, Berlin, Deutschland
| |
Collapse
|
9
|
[The further development of the curriculum rheumatological specialist assistant DGRh-BDRh-qualified medical assistant for rheumatology]. Z Rheumatol 2020; 79:45-46. [PMID: 32910205 DOI: 10.1007/s00393-020-00861-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|