1
|
Søndergaard SF, Andersen AB, Frederiksen K. APN nurses' core competencies for general clinical health assessment in primary health care. A scoping review. Scand J Caring Sci 2024; 38:258-272. [PMID: 38246856 DOI: 10.1111/scs.13235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/28/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND The field of Advanced Practice Nursing (APN) has developed over the past six decades. However, the definition of roles and responsibilities of APN nurses seem to be contested due to both a lack of a clear definition of the concept and to institutional and cultural barriers that restrict the nurses' opportunities to practise to the full extent of their competencies. AIM The objective of this scoping review was to identify, examine and conceptually map the available literature on APN nurses' core competencies for general health assessment in primary health care. METHOD We performed a scoping review, following the methodological guidance for reporting as it is described by the Joanna Briggs Institute (JBI). Furthermore, the PRISMA-ScR statement and checklist for reporting scoping reviews were followed. Guiding the initial process for the search, we used the Population, Concept and Context mnemonic (PCC) to clarify the focus and context of the review. RESULTS We found three areas of core competencies on which APN nurse draw in performing general health assessments in primary health care: (1) 'Collaborative, leadership and management skills' (2) 'Person-centred nursing care skills' and (3) 'Academic and educational skills'. Furthermore, we found that the three areas are interrelated, because it is crucial that APN nurses draw on collaborative competencies related to leadership and management to meet the service users' needs and deliver high-quality and person-centred care. CONCLUSION There is a need for a more specific investigation into how APN nurses' core competencies play a role during general health assessments of patients in primary care. We suggest an evaluation of what works for whom in what circumstances looking into the interrelation between competencies, skills and knowledge when an APN nurse performs a general health assessment in a primary healthcare setting.
Collapse
Affiliation(s)
- Susanne Friis Søndergaard
- Section for Nursing and Health Care, Institute for Public Health, Aarhus University, Aarhus, Denmark
| | - Anne Bendix Andersen
- VIA University College, School of Nursing and Research Centre for Health and Welfare Technology, Viborg, Denmark
| | - Kirsten Frederiksen
- Section for Nursing and Health Care, Institute for Public Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
2
|
Wolf F, Krause M, Meißner F, Rost L, Bleidorn J, Dierks MT, Kuschick D, Kuempel L, Toutaoui K, Riens B, Schmidt K, Heintze C, Döpfmer S. [Attitudes of general practitioners and medical practice assistants towards the delegation of medical services: Results of a survey in Berlin, Brandenburg and Thuringia]. DAS GESUNDHEITSWESEN 2023; 85:1115-1123. [PMID: 38081173 PMCID: PMC10713333 DOI: 10.1055/a-2158-8982] [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] [Indexed: 12/18/2023]
Abstract
INTRODUCTION The delegation of tasks and responsibilities from general practitioners (GPs) to medical practice assistants (MPAs) can contribute to ensuring primary care in Germany. The aim of the study was to collect and analyze attitudes and procedures of GPs and MPAs regarding the delegation of physician-related tasks and activities. METHODOLOGY A self-designed, piloted questionnaire was sent to all GPs listed within the regional Associations of Statutory Health Insurance Physicians (KV) in Thuringia, Berlin, and Brandenburg (n=5,516) and their MPAs. Participants were asked to indicate which physician-related activities were already delegated and on which occasions further delegations could be considered. RESULTS 890 GPs (response rate: 16.1%) and 566 MPAs participated in the written survey. The participants were predominantly female and most of them worked in urban areas. Numerous activities, such as medical history taking, triage, Disease Management Program (DMP) controls, vaccinations and home visits, have already been delegated. The willingness to delegate further tasks (e. g., follow-up prescriptions and referrals, independent takeover of simple consultations, assessing the necessity of physician consultation) was high. CONCLUSION The survey showed a high level of willingness of both occupational groups to delegate physician-related activities to MFAs. An expansion seems possible under certain conditions. Many activities have already been delegated to MPAs in primary care practices. Our survey provides suggestions regarding further tasks suitable for delegation, some of which go beyond the delegation agreement valid in Germany.
Collapse
Affiliation(s)
- Florian Wolf
- Institut für Allgemeinmedizin, Universitätsklinikum
Jena, Jena, Germany
| | - Markus Krause
- Institut für Allgemeinmedizin, Universitätsklinikum
Jena, Jena, Germany
| | - Franziska Meißner
- Institut für Allgemeinmedizin, Universitätsklinikum
Jena, Jena, Germany
| | - Liliana Rost
- Institut für Allgemeinmedizin, Universitätsklinikum
Jena, Jena, Germany
| | - Jutta Bleidorn
- Institut für Allgemeinmedizin, Universitätsklinikum
Jena, Jena, Germany
| | - Marius Tibor Dierks
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| | - Doreen Kuschick
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| | - Lisa Kuempel
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| | - Kahina Toutaoui
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| | - Burgi Riens
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| | - Konrad Schmidt
- Institut für Allgemeinmedizin, Universitätsklinikum
Jena, Jena, Germany
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Heintze
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Döpfmer
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
3
|
Kuschick D, Dierks MT, Grittner U, Heintze C, Kümpel L, Riens B, Rost L, Schmidt K, Schulze D, Toutaoui K, Wolf F, Döpfmer S. Patient perspective on task shifting from general practitioners to medical practice assistants - a quantitative survey in Germany. BMC PRIMARY CARE 2023; 24:248. [PMID: 38007435 PMCID: PMC10675968 DOI: 10.1186/s12875-023-02211-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Various developments result in increasing workloads in general practices. New models of care and a restructuring of the division of tasks could provide relief. One approach is to extend the delegation of medical tasks from general practitioners (GPs) to medical practice assistants (MPAs). So far, there has been a lack of information about specific situations in which patients are willing to be treated exclusively by MPAs. METHODS In three German federal states, patients who visited a general practice were surveyed exploratively and cross-sectionally with a self-designed, paper-based questionnaire. The data were analysed descriptively and multivariate. A mixed binary logistic regression model was calculated to account for cluster effects at practice level (random intercept model). The dependent variable was patients' acceptance of task delegation. RESULTS A total of 1861 questionnaires from 61 general practices were included in the analysis. Regarding the current problem/request, a total of 30% of respondents could imagine being treated only by MPAs. Regarding theoretical reasons for consultation, more than half of the patients agreed to be treated by MPAs. According to the regression model, MPAs were preferred when patients were younger (10-year OR = 0.84, 95%-CI [0.75, 0.93]) or had a less complicated issue (OR = 0.44, 95%-CI [0.26, 0.8]). For four current problems/requests ("acute complaints" OR = 0.27, 95%-CI [0.17, 0.45], "routine health check" OR = 0.48, 95%-CI [0.3, 0.79], "new problem" OR = 0.13, 95%-CI [0.06, 0.28], "known problem" OR = 0.16, 95%-CI [0.1, 0.27]) patients prefer to be treated by GPs instead of MPAs. DISCUSSION For the first time, statements could be made on patients' acceptance of task delegation in relation to current and theoretical reasons for treatment in general practices in Germany. The discrepancy in response behaviour on a theoretical and individual level could be explained by different contexts of questions and differences at practice level. Overall, patients seem to be open to increased delegation of medical tasks, depending on the reason for treatment. Selection and response biases should be considered in the interpretation. CONCLUSION The results are not completely opposed to an extension of task delegation. Further interventional studies could provide information on the possible effects of expansion of delegable tasks.
Collapse
Affiliation(s)
- Doreen Kuschick
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice and Family Medicine, Charitéplatz 1, Berlin, 10117, Germany.
| | - Marius Tibor Dierks
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice and Family Medicine, Charitéplatz 1, Berlin, 10117, Germany
| | - Ulrike Grittner
- Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Institute of General Practice and Family Medicine, Bachstraße 18, Jena, 07743, Germany
| | - Christoph Heintze
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice and Family Medicine, Charitéplatz 1, Berlin, 10117, Germany
| | - Lisa Kümpel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice and Family Medicine, Charitéplatz 1, Berlin, 10117, Germany
| | - Burgi Riens
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice and Family Medicine, Charitéplatz 1, Berlin, 10117, Germany
| | - Liliana Rost
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, Berlin, 10117, Germany
| | - Konrad Schmidt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice and Family Medicine, Charitéplatz 1, Berlin, 10117, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, Berlin, 10117, Germany
| | - Daniel Schulze
- Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Institute of General Practice and Family Medicine, Bachstraße 18, Jena, 07743, Germany
| | - Kahina Toutaoui
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice and Family Medicine, Charitéplatz 1, Berlin, 10117, Germany
| | - Florian Wolf
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, Berlin, 10117, Germany
| | - Susanne Döpfmer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice and Family Medicine, Charitéplatz 1, Berlin, 10117, Germany
| |
Collapse
|
4
|
Klatt T, Baltes M, Friedrichs J, Langer G. [The role of nurses in pharmaceutical care in Germany: A qualitative analysis]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 176:31-41. [PMID: 36642623 DOI: 10.1016/j.zefq.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/17/2022] [Accepted: 10/25/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND In 13 European countries, laws have been passed that allow nurses to prescribe medicines, but mostly within a limited framework and with a doctor involved. Germany is not among these countries. Only the prescription of medical aids has already been included into the development of extended nursing competencies. We investigated the views of the health care professions involved (doctors, pharmacists and nurses) regarding the role of nurses in pharmaceutical care. METHOD We conducted 22 semi-structured interviews with 23 members of the three professional groups involved in the European research project DeMoPhaC. These data collected in Germany were analysed using qualitative content analysis. Five main categories were developed. RESULTS Pharmaceutical care by nurses can be described within the following main categories: 1. Knowledge and competences, 2. Patient care, 3. Communication, 4. Multi-professional team and 5. System. The communication between the professional groups involved and with patients and caregivers is of particular importance. Interaction in the multi-professional team is just as crucial. Pharmaceutical care takes place within the health system which sets the framework and often boundaries as well. The current and ideally conceived roles of nurses are seen differently in the respondents' respective contexts. Between the professional groups there is both agreement and dissent on the topics addressed. However, the development of nursing roles requires collaborative and transparent processes in teams and organisations. Particularly in the hospital setting, the participants saw a great need for change in order to achieve cooperation at eye level. DISCUSSION The results show that nurses play their role in the complex field of pharmaceutical care under very heterogeneous circumstances. The empowerment of nurses, which was called for by some participants, cannot be achieved from within the professional group alone. Cooperation from all the players involved is needed. The development of nursing roles in the medication process with simultaneous expansion of qualifications and competences can contribute to making the nursing role more attractive. Clear role models promote the transparency of processes for all involved. If all players know what they can expect of nurses, tasks can be redistributed in the multiprofessional team. CONCLUSION The above-mentioned diversity of perspectives can be a resource for development and individual solutions. However, it can also be interpreted negatively as a sign of uncertainty and less standardised ways of working. In view of the data evaluated here, the prescription of medicines by non-medical professionals remains a distant goal for developments in the German health care system. First of all, structures and processes are required that permanently guarantee safe pharmaceutical care with equal participation of all relevant stakeholders.
Collapse
Affiliation(s)
- Thomas Klatt
- Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, Halle (Saale), Deutschland.
| | - Marion Baltes
- Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, Halle (Saale), Deutschland; Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Juliane Friedrichs
- Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, Halle (Saale), Deutschland; Klinik für Viszerale, Gefäß- und Endokrine Chirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Gero Langer
- Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, Halle (Saale), Deutschland
| |
Collapse
|
5
|
Wangler J, Jansky M. [Team players or lone fighters? Importance and utilization of practice staff in primary care dementia detection]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 169:75-83. [PMID: 35190285 DOI: 10.1016/j.zefq.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/11/2021] [Accepted: 12/19/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND General practitioners (GP) face major challenges in everyday practice when it comes to identifying dementia cases as early as possible under the condition of time and resource constraints. The involvement of the practice staff promises decisive advantages in detection and diagnosis. So far, there has been a lack of studies exploring the extent to which non-medical practice employees in general practices are integrated into dementia detection, what experiences they have had and how they assess their own potential to contribute to more efficient dementia detection. METHODS Between August 2020 and August 2021, a total of 64 semi-structured, audio-technically recorded individual / expert interviews were conducted with non-medical practice employees (medical assistants) in general practices in all German federal states (four interviewees per federal state). The interview transcripts were evaluated using a qualitative, structuring content analysis according to Mayring (Software MAXQDA 2020). RESULTS The GP team members show a high degree of willingness and motivation to support the doctor in identifying and diagnosing dementia; situations have been reported where their assistance has led to an earlier identification of people with dementia. Observation and detection of dementia patients are rarely based on systematic criteria. On the whole, only some GPs entrust their staff with tasks like this. A large portion of the interviewees expressed considerable uncertainty regarding the assessment of possible signs of incipient dementia, which corresponds to the fact that only a minority of the interviewees have ever completed further training with a focus on dementia. CONCLUSIONS Practice staff can provide invaluable support when it comes to the timely and consistent detection of incipient dementia in general practice. In addition to sensitizing GPs and optimizing practice management, targeted training with regard to geriatric issues will be instrumental in achieving this. Accordingly, more advanced training formats should be developed that are tailored to the perspective of practice employees and convey important dementia-specific diagnostics, action and communication skills.
Collapse
Affiliation(s)
- Julian Wangler
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Mainz, Deutschland.
| | - Michael Jansky
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Mainz, Deutschland
| |
Collapse
|
6
|
Henning E, Lücker P, Rädke A, Michalowsky B, Biedenweg B, Buchholz M, Wollny A, Drewelow E, Zorn D, Altiner A, Oppermann RF, Kohlmann T, Hoffmann W. [Qualification requirements for the re-delegation of medical activities to nursing professionals (with extended competencies)]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 169:59-66. [PMID: 35339414 DOI: 10.1016/j.zefq.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/19/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND For many years, the redistribution of tasks and thus a transfer of medical activities to nursing professionals with extended competencies has been discussed in Germany and is currently being regulated by the federal government. OBJECTIVES The aim of this study was to record the opinions of GPs and nurses on the qualification requirements for possible delegable and substitutable medical activities to nurses using the example of outpatient dementia care. METHOD In the context of a quantitative survey, the qualification requirements for the delegation of 30 different activities to nurses were collected from primary care physicians and nurses. A total of 1,634 questionnaires was distributed. The response rate was 28.0 % (primary care physicians: n=225, and nursing specialists: n=232). The analyses were carried out descriptively using SPSS software (version 25, IBM Corp., 2017). RESULTS 45.1% of the respondents said they needed additional qualification prior to such a task transfer. This need primarily relates to further training (37.3%). Those seeking a university education (36.2%), will either pursue a Bachelor's (15.6%) or a Master's degree (20.6%) to obtain the necessary qualification. CONCLUSION The results of this study can help define the activity profiles of academically qualified nursing professionals and inform the development of curricula for their university education. Furthermore, they will support the further development of the legal framework.
Collapse
Affiliation(s)
- Esther Henning
- Institut für Community Medicine, Abteilung Versorgungsepidemiologie und Community, Health, Universitätsmedizin Greifswald, Greifswald, Deutschland.
| | - Petra Lücker
- Institut für Community Medicine, Abteilung Versorgungsepidemiologie und Community, Health, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Anika Rädke
- Deutsches Zentrum für Neurodegenerative Erkrankungen DZNE e.V., Greifswald, Deutschland
| | - Bernhard Michalowsky
- Deutsches Zentrum für Neurodegenerative Erkrankungen DZNE e.V., Greifswald, Deutschland
| | - Bianca Biedenweg
- Institut für Community Medicine, Abteilung Methoden der Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Maresa Buchholz
- Institut für Pflegewissenschaft und Interprofessionelles Lernen, Universitätsmedizin, Greifswald, Greifswald, Deutschland
| | - Anja Wollny
- Institut für Allgemeinmedizin der Universitätsmedizin Rostock, Rostock, Deutschland
| | - Eva Drewelow
- Institut für Allgemeinmedizin der Universitätsmedizin Rostock, Rostock, Deutschland
| | - Daniela Zorn
- Fachbereich Gesundheit, Pflege, Management der Hochschule Neubrandenburg, Neubrandenburg, Deutschland
| | - Attila Altiner
- Institut für Allgemeinmedizin der Universitätsmedizin Rostock, Rostock, Deutschland
| | - Roman F Oppermann
- Fachbereich Gesundheit, Pflege, Management der Hochschule Neubrandenburg, Neubrandenburg, Deutschland
| | - Thomas Kohlmann
- Institut für Community Medicine, Abteilung Methoden der Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Wolfgang Hoffmann
- Institut für Community Medicine, Abteilung Versorgungsepidemiologie und Community, Health, Universitätsmedizin Greifswald, Greifswald, Deutschland
| |
Collapse
|
7
|
Drewelow E, Altiner A, Biedenweg B, Buchhholz M, Henning E, Hoffmann W, Kohlmann T, Lücker P, Michalowsky B, Oppermann RF, Rädke A, Zorn D, Wollny A. [Task sharing in outpatient dementia care - Focus groups with GPs and nurses]. Pflege 2021; 35:215-222. [PMID: 34814707 DOI: 10.1024/1012-5302/a000851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Task sharing in outpatient dementia care - Focus groups with GPs and nurses Abstract. Background: Caring for people with dementia (PWD) is challenging for the health system and family carers and can only be managed through interprofessional medical and nursing care. AIM The AHeaD study investigated attitudes of general practitioners (GPs) and nurses towards the transfer of activities previously performed by GPs to advanced nurses in the outpatient care of PWDs. METHODS In four focus group discussions with 10 GPs and 13 nurses, qualitative content analysis was used to investigate attitudes towards the transfer of certain tasks and to identify opportunities and barriers to their introduction. RESULTS GPs primarily preferred the transfer of nursing activities such as blood sampling, assessments, their monitoring or follow-up prescriptions for nursing aids. "Classical" medical tasks (e. g. diagnosis of diseases, initial prescription of medication) are still seen in the hands of GPs. Nurses demanded more appreciation and recognition for the relationship between GPs and nurse and criticised the lack of trust and insufficient communication. Both sides pointed to tight time budgets that were hardly oriented towards the actual needs of the PWD. CONCLUSIONS The implementation of a redistribution of tasks requires the creation of legal and financial framework conditions, time resources, concrete task descriptions as well as a stronger cooperation between the professional groups involved. Innovative concepts could contribute to the sensible use of the resources GP and nurses and strengthen the care of PWDs.
Collapse
Affiliation(s)
- Eva Drewelow
- Institut für Allgemeinmedizin der Universitätsmedizin Rostock, Rostock
| | - Attila Altiner
- Institut für Allgemeinmedizin der Universitätsmedizin Rostock, Rostock
| | - Bianca Biedenweg
- Institut für Community Medicine, Abteilung Methoden der Community Medicine der Universitätsmedizin Greifswald, Greifswald
| | - Maresa Buchhholz
- Institut für Community Medicine, Abteilung Methoden der Community Medicine der Universitätsmedizin Greifswald, Greifswald
| | - Esther Henning
- Institut für Community Medicine, Abteilung Methoden der Community Medicine der Universitätsmedizin Greifswald, Greifswald
| | - Wolfgang Hoffmann
- Institut für Community Medicine Abteilung Versorgungsepidemiologie und Community Health der Universitätsmedizin Greifswald, Greifswald
| | - Thomas Kohlmann
- Institut für Community Medicine, Abteilung Methoden der Community Medicine der Universitätsmedizin Greifswald, Greifswald
| | - Petra Lücker
- Institut für Community Medicine Abteilung Versorgungsepidemiologie und Community Health der Universitätsmedizin Greifswald, Greifswald
| | | | - Roman F Oppermann
- Fachbereich Gesundheit, Pflege, Management der Hochschule Neubrandenburg, Neubrandenburg
| | - Anika Rädke
- Deutsches Zentrum für Neurodegenerative Erkrankungen DZNE e. V., Greifswald
| | - Daniela Zorn
- Fachbereich Gesundheit, Pflege, Management der Hochschule Neubrandenburg, Neubrandenburg
| | - Anja Wollny
- Institut für Allgemeinmedizin der Universitätsmedizin Rostock, Rostock
| |
Collapse
|