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Waeschle RM, Epperlein T, Demmer I, Hummers E, Quintel Q. Intersectoral cooperation between university hospitals and physicians in private practice in Germany- where the potential for optimization lies. BMC Health Serv Res 2024; 24:497. [PMID: 38649877 PMCID: PMC11034040 DOI: 10.1186/s12913-024-10963-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Intersectoral cooperation between physicians in private practice and hospitals is highly relevant for ensuring the quality of medical care. However, the experiences and potential for optimization at this interface from the perspective of physicians in private practice have not yet been systematically investigated. The aim of this questionnaire survey was to record participants' experiences with regard to cooperation with university hospitals and to identify the potential for optimizing intersectoral cooperation. METHODS We performed a prospective cross-sectional study using an online survey among practising physicians of all disciplines offering ambulatory care in Germany. The link to a 41-item questionnaire was sent via mail using a commercial mail distributor in which 1095 practising physicians participated. Baseline statistics were performed with SurveyMonkey and Excel. RESULTS A total of 70.6%/722 of the responding physicians in private practice rated cooperation with university hospitals as satisfactory. Satisfaction with the quality of treatment was confirmed by 87.2%/956 of the physicians. The subjectively perceived complication rate in patient care was assessed as rare (80.9%/886). However, the median waiting time for patients in the inpatient discharge letter was 4 weeks. The accessibility of medical contact persons was rated as rather difficult by 52.6%/577 of the physicians. A total of 48.6%/629 of the participants considered better communication as an equal partner to be an important potential for optimization. Likewise, 65.2%/714 participants wished for closer cooperation in pre- and/or post inpatient care. CONCLUSION The following optimization potentials were identified: timely discharge letters, clear online presentations of clinical contacts, improved accessibility by telephone, introduction or further development of a referral portal, regular intersectoral training and/or "get-togethers", regular surveys of general practitioners and implementation of resulting measures, further development of cross-sectoral communication channels and strengthening of hospital IT.
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Affiliation(s)
- R M Waeschle
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
| | - T Epperlein
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - I Demmer
- Department of General Practice, University Medical Centre Göttingen, Göttingen, Germany
| | - E Hummers
- Department of General Practice, University Medical Centre Göttingen, Göttingen, Germany
| | - Q Quintel
- Department of Anaesthesiology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
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Bossert J, Ludwig M, Wronski P, Koetsenruijter J, Krug K, Villalobos M, Jacob J, Walker J, Thomas M, Wensing M. Lung cancer patients' comorbidities and attendance of German ambulatory physicians in a 5-year cross-sectional study. NPJ Prim Care Respir Med 2021; 31:2. [PMID: 33510177 PMCID: PMC7844218 DOI: 10.1038/s41533-020-00214-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/07/2020] [Indexed: 12/16/2022] Open
Abstract
The majority of lung cancer patients are diagnosed with an advanced stage IV, which has short survival time. Many lung cancer patients have comorbidities, which influence treatment and patients’ quality of life. The aim of the study is to describe comorbidities in incident lung cancer patients and explore their attendance of ambulatory care physicians in Germany. In the observed period, 13,111 persons were first diagnosed with lung cancer (1-year incidence of 36.4 per 100,000). The mean number of comorbidities over 4 quarters was 30.77 ± 13.18; mean Charlson Comorbidity Index was 6.66 ± 2.24. In Germany, ambulatory care physicians most attended were general practitioners (2.6 quarters with contact within 4 quarters). Lung cancer was diagnosed by a general practitioner in 38% of the 13,111 incident patients. The average number of ambulatory care physician contacts over 4 quarters was 35.82 ± 27.31. High numbers of comorbidities and contacts in ambulatory care are common in patients with lung cancer. Therefore, a cross-sectoral and interdisciplinary approach is required for effective, patient-centred care. This was a 5-year cross-sectoral study, based on the InGef research database, which covers anonymized health insurance data of 7.2 million individuals in Germany. Incident lung cancer patients in a 5-year period (2013–2017) were identified. Descriptive statistics were calculated for sociodemographic characteristics, comorbidities, and attendance of ambulatory care physicians.
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Affiliation(s)
- Jasmin Bossert
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Marion Ludwig
- InGef - Institute for Applied Health Research Berlin GmbH, Spittelmarkt 12, 10117, Berlin, Germany
| | - Pamela Wronski
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Jan Koetsenruijter
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Matthias Villalobos
- Department of Thoracic Oncology, University Hospital Heidelberg and Translational Lung Research Centre Heidelberg (TLRC-H), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Josephine Jacob
- InGef - Institute for Applied Health Research Berlin GmbH, Spittelmarkt 12, 10117, Berlin, Germany
| | - Jochen Walker
- InGef - Institute for Applied Health Research Berlin GmbH, Spittelmarkt 12, 10117, Berlin, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, University Hospital Heidelberg and Translational Lung Research Centre Heidelberg (TLRC-H), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Stichling K, Krause M, Ditscheid B, Hach M, Jansky M, Kaufmann M, Lehmann T, Meißner W, Nauck F, Schneider W, Schulz S, Vollmar HC, Wedding U, Bleidorn J, Freytag A. Factors influencing GPs' perception of specialised palliative homecare (SPHC) importance - results of a cross-sectional study. BMC Palliat Care 2020; 19:117. [PMID: 32746825 PMCID: PMC7401213 DOI: 10.1186/s12904-020-00603-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 06/24/2020] [Indexed: 11/29/2022] Open
Abstract
Background General Practitioners (GPs) are the main providers of primary palliative care (PPC). At the same time they are the main initiators of specialised palliative homecare (SPHC). In Germany, little is known about factors which influence GPs in their involvement of SPHC. Aim of our study is to identify factors that drive GPs to give value to and involve SPHC. Methods A cross-sectional survey was performed. In 2018, questionnaires were mailed to 6000 randomly selected GPs from eight German federal states, focusing on the extent of GPs’ palliative care activities and their involvement of SPHC. Results With a response rate of 19.4% and exclusion of GPs working in SPHC-teams, n = 1026 questionnaires were appropriate for analysis. GPs valued SPHC support as the most “important/very important” for both “technical/invasive treatment measures” (95%) and availability outside practice opening hours (92%). The most relevant factor influencing perceived SPHC-importance was GPs’ self-reported extent of engagement in palliative care (β = − 0.283; CI 95% = − 0.384;−0.182), followed by the perceived quality of utilised SPHC (β = 0.119; CI 95% = 0.048;0.190), involvement in treatment of palliative patients after SPHC initiation (β = 0.088; CI 95% = 0.042;0.134), and conviction that palliative care should be a central part of GPs’ work (β = − 0.062; CI 95% = − 0.116;−0.008). Perceived SPHC-importance is also associated with SPHC-referrals (β =0.138; p < 0.001). The lower the engagement of GPs in palliative care, the more they involve SPHC and vice versa. Conclusions GPs with low reported activity in palliative care are more likely to initialise SPHC for palliative care activities they do not deliver themselves for various reasons, which might mean that the involvement of SPHC is substitutive instead of complementary to primary palliative care. This finding and its interpretation should be given more attention in the future policy framework for (specialised) palliative homecare. Trial registration German Clinical Trials Register DRKS00014726, 14.05.2018.
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Affiliation(s)
- K Stichling
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - M Krause
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - B Ditscheid
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - M Hach
- German Working Group for SAPV, Berlin, Germany
| | - M Jansky
- Clinic for Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - M Kaufmann
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - T Lehmann
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - W Meißner
- Department of Palliative Care, Jena University Hospital, Jena, Germany
| | - F Nauck
- Clinic for Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - W Schneider
- Center for Interdisciplinary Health Research, University of Augsburg, Augsburg, Germany
| | - S Schulz
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - H C Vollmar
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.,Institute of General Practice and Family Medicine, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
| | - U Wedding
- Department of Palliative Care, Jena University Hospital, Jena, Germany
| | - J Bleidorn
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - A Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.
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Schneider E, Petersen JJ, Schulz-Rothe S, Gerlach FM, Rossmanith T, Siebenhofer A, Mergenthal K. [Interprofessional Care of Patients with Rheumatoid Arthritis from the Perspective of a General Practitioner Perspective: Results of a Cross-sectional Study]. DAS GESUNDHEITSWESEN 2020; 83:e1-e8. [PMID: 32557446 DOI: 10.1055/a-1152-4576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND General practitioners, specialists, occupational and physical therapists, nursing services and other professional groups are all involved in the treatment of patients with rheumatoid arthritis. This study aims to describe interprofessional cooperation in daily ambulatory care from the perspective of a general practitioner. METHODS The cross-sectional study investigated cooperation between general practitioners (n=121 in 68 medical practices) and several other health care providers in Hesse and Rhineland Palatinate, Germany, from February to September 2017. It was part of the prospective cohort study PANORA (Prevalence of anti-cyclic citrullinated peptide (anti-CCP) positivity in patients with new onset of non-specific musculoskeletal symptoms). The questionnaire that was used contained closed-ended questions on socio-demographics and frequency of contact, and asked physicians to assess and weigh existing collaboration. Descriptive statistics were used for data analysis. RESULTS When caring for patients with rheumatoid arthritis, 70%, of the physicians often took responsibility for synchronizing medications, and discussing diagnoses and test results. The most frequent cooperation was with rheumatologists and was considered as highly important but the least satisfactory. The second most frequent cooperation was with physical therapists and this was also rated as very important. Physicians had highest level of satisfaction with their collaboration with the nursing services. CONCLUSION This study shows that general practitioners perform several medical tasks when treating patients with rheumatoid arthritis. During the process, they work together with several health care providers to various degrees. Cooperation with rheumatologists and physical therapists is particularly important to general practitioners; cooperation with rheumatologists is considered inadequate and in need of improvement.
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Affiliation(s)
- Elke Schneider
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Frankfurt am Main
| | - Juliana J Petersen
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Frankfurt am Main
| | - Sylvia Schulz-Rothe
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Frankfurt am Main
| | | | - Tanja Rossmanith
- Institutsteil Translationale Medizin und Pharmakologie TMP, Fraunhofer Institut für Molekularbiologie und angewandte Ökologie IME, Frankfurt am Main
| | - Andrea Siebenhofer
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Frankfurt am Main.,Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Graz, Austria
| | - Karola Mergenthal
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Frankfurt am Main
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Weller D. A new year - and there's plenty in store for EJCC readers! Eur J Cancer Care (Engl) 2018; 27. [DOI: 10.1111/ecc.12816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- David Weller
- Centre for Population Health Sciences; University of Edinburgh; Edinburgh UK
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