[Digital innovation in medicine: the COVID-19 pandemic as an accelerator of "digital health"]

[Digital midwifery care during the COVID-19 pandemic in Germany-acceptance of mothers]

BACKGROUND

To ensure outpatient midwifery care during the COVID-19 pandemic, digital midwifery services were enabled for the first time in Germany in March 2020. The aim of the survey "Digital midwifery care in the context of the Covid-19 pandemic" was to conduct an initial evaluation of the newly introduced digital services from the perspective of the midwives and the users. This publication presents the results of the mothers' survey.

METHOD

In February and March 2021, a cross-sectional study with an online survey was conducted. Women insured with BARMER who gave birth to a healthy child between May and November 2020 were surveyed anonymously throughout Germany using an exploratively developed online questionnaire on the utilization, satisfaction, and potential of digital midwifery care in pregnancy and the postpartum period.

RESULTS

Feedback was provided by 1821 mothers. Around one third of the responding women had used digital midwifery services during pregnancy and/or the postpartum period and rated these services positively by over 80%. From the respondents' point of view, courses and counselling are very well suited whereas postpartum care often requires the midwife's presence. Advantages were seen in infection control and in saving time and travel.

CONCLUSION

The COVID-19 pandemic has become a catalyst for digitalization in midwifery care. The digital services were quickly implemented by freelance midwives and well accepted by women and can usefully complement the care provided in the presence of the midwife. The opportunity to utilize and further develop these offers should be taken.

A Vision of Future Healthcare: Potential Opportunities and Risks of Systems Medicine from a Citizen and Patient Perspective-Results of a Qualitative Study

Advances in (bio)medicine and technological innovations make it possible to combine high-dimensional, heterogeneous health data to better understand causes of diseases and make them usable for predictive, preventive, and precision medicine. This study aimed to determine views on and expectations of “systems medicine” from the perspective of citizens and patients in six focus group interviews, all transcribed verbatim and content analyzed. A future vision of the use of systems medicine in healthcare served as a stimulus for the discussion. The results show that although certain aspects of systems medicine were seen positive (e.g., use of smart technology, digitalization, and networking in healthcare), the perceived risks dominated. The high degree of technification was perceived as emotionally burdensome (e.g., reduction of people to their data, loss of control, dehumanization). The risk-benefit balance for the use of risk-prediction models for disease events and trajectories was rated as rather negative. There were normative and ethical concerns about unwanted data use, discrimination, and restriction of fundamental rights. These concerns and needs of citizens and patients must be addressed in policy frameworks and health policy implementation strategies to reduce negative emotions and attitudes toward systems medicine and to take advantage of its opportunities.

[Current developments on digitalization : Analysis of quality and economics in healthcare]

Hintergrund

Im deutschen Gesundheitssystem und damit auch im Fachgebiet der Urologie gewinnen ökonomische Rahmenbedingungen zunehmend an Bedeutung und parallel dazu werden digitale Anwendungen vermehrt eingesetzt.

Fragestellung

Die Fragestellung betrifft die gesundheitsökonomische Auseinandersetzung mit den Rahmenbedingungen der Digitalisierung im deutschen Gesundheitssystem sowie ausgewählter Anwendungsbereiche in der Urologie.

Material und Methoden

Das Gutachten des Sachverständigenrates zur Begutachtung der Entwicklung im Gesundheitswesen (SVR) wird analysiert und eine systematische Literaturanalyse zum Einsatz der strukturierten Befundung und Analyse ausgewählter Literatur zu telemedizinischen Anwendungen in der Urologie unter gesundheitsökonomischen Gesichtspunkten durchgeführt.

Ergebnisse

Als zentrale Hemmnisse bei der Digitalisierung des deutschen Gesundheitswesens identifiziert der SVR dessen Regulierung und Komplexität sowie den Umgang mit Datenschutz und -sicherheit. Der Einsatz strukturierter Befundung kann Qualität, Effektivität und Effizienz der Befundung in der Urologie steigern. Im Hinblick auf die Kosten können signifikante Einsparungen mit zunehmender Digitalisierung in der Medizin realisiert werden.

Schlussfolgerungen

Aus medizinischer und gesundheitsökonomischer Perspektive besteht bei der Ausgestaltung von Rahmenbedingungen für digitale Anwendungen im deutschen Gesundheitssystem hinsichtlich der Informationssicherheit und des Datenschutzes weiterer Gestaltungsbedarf. Bei zielgerichtetem Einsatz von digitalen Anwendungen wie der strukturierten Befundung und der Telemedizin können optimale Voraussetzungen für den zunehmenden Einsatz von künstlicher Intelligenz im Fachgebiet der Urologie geschaffen werden.

Higher Acceptance of Videotelephonic Counseling Formats in Psychosomatic Medicine in Times of the COVID-19 Pandemic

Background: Due to the COVID-19 pandemic, the healthcare system in general and psychosomatics in particular were forced to change counseling-specific services and break up established structures. At the beginning of 2020, phone as well as videotelephonic counseling options had to be quickly established. Methods: Patients (n = 278) of the department of psychosomatic medicine and psychotherapy at the University Hospital Tübingen were asked to complete an ad hoc questionnaire to assess the acceptance of the counseling format following each counseling session (office, phone, video) in the period between July 2020 and February 2021. Results: Satisfaction and acceptance of the three counseling formats (office, phone, video) were rated (1-6) on average as "good" to "very good" in the three subgroups (1.5 ± 0.9). Likewise, the "therapeutic relationship" scored high in all three subgroups in terms of establishing a strong therapeutic relationship (4.4 ± 1.5). "Hurdles" were rated as low and tolerable (1.8 ± 1.3). The global assessment of therapeutic contact was significantly better in the video group compared to phone and office consultation (p < 0.05). Predictor analyses showed that there was an influence of age, but not gender, on the acceptance of digital counseling formats in the present sample [F _{(1, 277)} = 4.50, p = 0.04]. Discussion & Conclusion: Digital consultation formats were perceived by patients as promising addition to the classic face-to-face setting. Digital formats (phone, video) were not generally preferred to face-to-face counseling, but especially video counseling was accepted and perceived with great satisfaction and acceptance. Accordingly, the additional use of digital counseling formats, especially video-telephony, could be an opportunity to enrich the existing structures also after the pandemic.