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Geschke K, Wangler J, Klein F, Wuttke-Linnemann A, Farin-Glattacker E, Löhr M, Jansky M, Fellgiebel A. [DemStepCare: Risk-stratified support for primary care-based dementia care - evaluation from general practitioner's view]. PSYCHIATRISCHE PRAXIS 2024. [PMID: 38608668 DOI: 10.1055/a-2286-1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
OBJECTIVE The innovation fund project DemStepCare aimed to optimize multi-professional care through case management, risk stratification, and crisis outpatient clinic. Here, the evaluation results from the perspective of the general practitioners are presented. METHODS A quantitative survey was carried out at three time points regarding acceptance, benefit assessment and sensitivity to dementia of the general practitioners. In addition, qualitative interviews were conducted. RESULTS Satisfaction with the overall project was high. Added value and relief factors were perceived and more effective and stable dementia care was achieved through collaboration with case management. Physicians reported increased subjective competence in diagnostics and disease management. CONCLUSIONS The results confirm the benefit and effectiveness of DemStepCare from general practitioner's perspective.
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Affiliation(s)
- Katharina Geschke
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Mainz
- Zentrum für psychische Gesundheit im Alter (ZpGA), Landeskrankenhaus (AöR), Mainz
| | - Julian Wangler
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz
| | - Fabian Klein
- Stabsgruppe für Klinikentwicklung und Forschung, Psychiatrie - Psychotherapie - Psychosomatische Medizin/Neurologie - Innere Medizin, LWL-Klinikum Gütersloh
| | - Alexandra Wuttke-Linnemann
- Zentrum für psychische Gesundheit im Alter (ZpGA), Landeskrankenhaus (AöR), Mainz
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Zentrum für psychische Gesundheit, Universitätsklinikum Würzburg
| | - Erik Farin-Glattacker
- Sektion für Versorgungsforschung und Rehabilitationsforschung, Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Michael Löhr
- LWL-Klinikum Gütersloh, Akademisches Lehrkrankenhaus für Pflege- und Gesundheitsfachberufe der Fachhochschule der Diakonie, Gütersloh
| | - Michael Jansky
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz
| | - Andreas Fellgiebel
- Zentrum für psychische Gesundheit im Alter (ZpGA), Landeskrankenhaus (AöR), Mainz
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Agaplesion Elisabethenstift, Darmstadt
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Wangler J, Jansky M. Primary care involvement in clinical research - prerequisites, motivators, and barriers: results from a study series. Arch Public Health 2024; 82:41. [PMID: 38504310 PMCID: PMC10953082 DOI: 10.1186/s13690-024-01272-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/12/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Long-term reinforcement in the role of primary care and improvement the healthcare system as a whole requires the involvement of GPs in clinical research processes. However, many clinical studies fail due to failure to achieve sample population targets amongst GPs and their patients. This issue has been identified and discussed, but effective strategies to overcome it are still lacking. One of the reasons is that the positions, requirements, and experiences of GPs on participating in clinical research have hardly been examined up to now. METHODS The years 2021 and 2022 saw three quantitative and qualitative surveys amongst GPs in Germany with the aim of shedding light on the attitudes, experiences, and potential issues regarding the involvement of primary care in clinical research projects and participation in cluster-randomised controlled trials (cRCTs) in a general sense. This overview summarises and abstracts conclusions gained from the exploratory series of studies and compares the results with the current research situation. From here, this contribution will then develop an approach towards optimising the integration of GPs into clinical research. RESULTS Most of the GPs asked associated clinical research with opportunities and potential such as closing gaps in healthcare, using evidence-based instruments, optimising diagnostic and therapeutic management, and reinforcement of multiprofessional healthcare. Even so, many GPs unsure as to how far primary care in particular would stand to benefit from studies of this type in the long term. Respondents were also divided on willingness to participate in clinical research. GPs having already participated in Innovation Fund projects generally saw a benefit regarding intervention and cost-benefit relationship. However, some also reported major hurdles and stress factors such as excessive documentation and enrolment requirements, greater interference in practice routines, and sometimes poor integration into project processes such as in communication and opportunities to play an active role in the project. CONCLUSIONS Results from the studies presented provide indications as to how GPs perceive clinical research projects and cRCTs as a whole and from their existing project experience, and on the requirements that studies would have to meet for GPs to be willing to participate. In particular, making sure that clinical studies fully conform with GPs would play a major role; this especially applies to freedom to make medical decisions, limitation of documentation obligations, interference in regular practice routine, greater involvement in research planning, and long-term reinforcement in the role of primary care. Clinical research projects and cRCTs should be planned, designed, and communicated for clear and visible relevance to everyday primary care.
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Affiliation(s)
- Julian Wangler
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg, University Mainz, Am Pulverturm 13, Mainz, 55131, Germany.
| | - Michael Jansky
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg, University Mainz, Am Pulverturm 13, Mainz, 55131, Germany
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Wangler J, Jansky M. Experiences with Innovation Fund healthcare models in primary care: a qualitative study amongst German general practitioners. Wien Med Wochenschr 2024; 174:53-60. [PMID: 35503146 PMCID: PMC10896771 DOI: 10.1007/s10354-022-00935-0] [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: 02/04/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
The Innovation Fund was set up in 2015 with the aim of improving medical care in the German statutory health insurance system. Primary care needs to be involved in testing interventions and new forms of care for effectiveness and inclusion in standard care. There has so far been hardly any research on how far Innovation Fund models accommodate the primary care setting, or on the experience general practitioners have had with these models. Between September 2021 and January 2022, 36 semi-standardized individual interviews were performed with general practitioners who had already participated in Innovation Fund projects. Eleven regional physician networks in Rhineland-Palatinate, Hesse, North Rhine-Westphalia, and Schleswig-Holstein were involved in the recruitment process. Most of the interviewees associated the Innovation Fund with potential and opportunity including intensification of application-oriented healthcare research, independent financing, and general healthcare involvement. Even so, many general practitioners were unsure as to how far primary care in particular would stand to benefit from the Innovation Fund in the long term. A mostly positive balance was drawn from participation in care models-benefit of intervention as well as cost-benefit ratio. However, some also reported hurdles and stress factors such as documentation requirements and disruption in everyday office routine. Innovation Fund projects will need to be suitable for general practitioners especially regarding medical decision-making leeway, limits to documentation requirements, preserving established office routine, greater involvement in research planning, and improvements to the primary care setting to encourage willingness to participate in Innovation Fund projects amongst general practitioners.
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Affiliation(s)
- Julian Wangler
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 13, 55131, Mainz, Germany.
| | - Michael Jansky
- Centre for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 13, 55131, Mainz, Germany
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Georgiou E(EZ, Prapiadou S, Thomopoulos V, Skondra M, Charalampopoulou M, Pachi A, Anagnostopoulou Α, Vorvolakos T, Perneczky R, Politis A, Alexopoulos P. Naming ability assessment in neurocognitive disorders: a clinician's perspective. BMC Psychiatry 2022; 22:837. [PMID: 36585667 PMCID: PMC9801565 DOI: 10.1186/s12888-022-04486-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Detecting impaired naming capacity is valuable in diagnosing neurocognitive disorders (ND). A. clinical practice- oriented overview of naming tests validated in ND is not available yet. Here, features of naming tests with validated utility in ND which are open access or available for purchase are succinctly presented and compared. METHODS Searches were carried out across Pubmed, Medline and Google Scholar. Additional studies were identified by searching reference lists. Only peer-reviewed journal articles were eligible. A narrative- and tabullar synthesis was used to summarize different aspects of the naming assessment instruments used in patients with ND such as stimuli type, administration time, assessment parameters and accessibility. Based on computational word frequency calculations, the tests were compared in terms of the average frequency of their linguistic content. RESULTS Twelve naming tests, relying either on visual or auditory stimuli have been validated in ND. Their content and administration time vary between three and 60 items and one and 20 minutes, respectively. The average frequency of the words of each considered test was two or lower, pointing to low frequency of most items. In all but one test, scoring systems are exclusively based on correctly named items. Seven instruments are open access and four are available in more than one language. CONCLUSIONS Gaining insights into naming tests' characteristics may catalyze the wide incorporation of those with short administration time but high diagnostic accuracy into the diagnostic workup of ND at primary healthcare and of extensive, visual or auditory ones into the diagnostic endeavors of memory clinics, as well as of secondary and tertiary brain healthcare settings.
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Affiliation(s)
- Eliza ( Eleni-Zacharoula) Georgiou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Savvina Prapiadou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Vasileios Thomopoulos
- grid.11047.330000 0004 0576 5395Large-Scale Machine Learning & Cloud Data Engineering Laboratory (ML@Cloud-Lab), Faculty of Computer Engineering & Informatics, School of Engineering, University of Patras, Patras, Greece
| | - Maria Skondra
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Marina Charalampopoulou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Asimina Pachi
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Αlexandra Anagnostopoulou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece ,General Hospital of Zakynthos “Saint Dionysios”, Zakynthos, Greece
| | - Theofanis Vorvolakos
- grid.12284.3d0000 0001 2170 8022Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Robert Perneczky
- grid.5252.00000 0004 1936 973XDivision of Mental Health in Older Adults and Alzheimer Therapy and Research Center, Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany ,grid.7445.20000 0001 2113 8111Ageing Epidemiology (AGE) Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology and Medicine, London, UK ,grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany ,grid.452617.3Munich Cluster for Systems Neurology (SyNergy), Munich, Germany ,grid.11835.3e0000 0004 1936 9262Sheffield Institute for Translational Neurosciences (SITraN), University of Sheffield, Sheffield, UK
| | - Antonios Politis
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece ,grid.21107.350000 0001 2171 9311Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins Medical School, Baltimore, USA
| | - Panagiotis Alexopoulos
- Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece. .,Global Brain Health Institute, Medical School, Trinity College Dublin, The University of Dublin, Dublin, Republic of Ireland. .,Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany. .,Patras Dementia Day Care Center, Corporation for Succor and Care of Elderly and Disabled - FRODIZO, Patras, Greece.
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Wangler J, Jansky M. [The German Innovation Fund and primary care-What expectations and experiences do general practitioners have with regard to participating in innovative care models?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:697-705. [PMID: 35476151 PMCID: PMC9132806 DOI: 10.1007/s00103-022-03533-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND In 2015, the German Innovation Fund was established to promote improvements in the quality of medical care. In order for new care models and interventions to be tested and incorporated into standard care in the future, primary care must be included. OBJECTIVES The study explores general practitioners' (GPs') attitudes, participation-relevant expectations, and experiences with regard to Innovation Fund projects. METHODS Between July and October 2021, all 13,170 general practitioners in Baden-Württemberg, Hesse, and Rhineland-Palatinate were invited to take part in an online survey. Included in the evaluation were 3556 completed questionnaires (response rate: 27%). In addition to the descriptive analysis, a t-test on independent samples was used to determine significant differences between two groups. RESULTS Of the respondents, 83% were familiar with the Innovation Fund. Most of the respondents associate it with opportunities and potential (including intensification of application-oriented healthcare research, independent financing, and inclusion of primary care). Nevertheless, many GPs are unsure to what extent primary care can benefit from the Innovation Fund in the longer term. When it comes to willingness to participate in Innovation Fund studies, the respondents are divided. Respondents who have already participated in such projects (24%) draw a positive balance (benefit of the intervention, cost-benefit ratio). However, hurdles and stress factors are also reported, such as documentation requirements and interventions in practice processes. CONCLUSIONS In order to increase the attractiveness of the Innovation Fund for GPs, it is important to ensure that projects are fully compliant with primary care, especially with regard to the scope of medical decision-making, the limitation of documentation obligations, the guarantee of practice routines, a greater involvement in research planning, and an upgrading of the GP setting.
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Affiliation(s)
- Julian Wangler
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Deutschland.
| | - Michael Jansky
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Deutschland
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Wangler J, Jansky M. Slowing dementia symptoms - a qualitative study on attitudes and experiences of general practitioners in Germany. Eur J Gen Pract 2022; 28:32-39. [PMID: 35249437 PMCID: PMC8903749 DOI: 10.1080/13814788.2022.2037550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is currently no cure for dementia but general practitioners (GPs) have therapeutic options available to counteract the progression of mild cognitive impairment, including drug and non-drug treatment. So far, few studies have investigated treatment strategies preferred by GPs. OBJECTIVES This study aimed to gain an overview of GPs' attitudes towards influencing the progression of dementia, their involvement regarding dementia prevention and perceived effective approaches. It also elucidated the challenges experienced by GPs and desired optimisation measures towards reinforcing secondary prevention. METHODS Between June 2020 and March 2021, 64 semi-standardised interviews amongst GPs were conducted in all federal states of Germany. Thirty interviews were carried out in person and 34 by phone. The data were analysed according to qualitative content analysis. RESULTS Many interviewees see great importance in secondary dementia prevention and believe they could make an effective contribution, some of them using non-drug approaches. GPs play a role in guiding patients and relatives towards support services. Some doctors consider drug treatment as the only option towards influencing the progression of dementia, showing low expectations on self-efficacy. Interdisciplinary collaboration is a frequent challenge, which often conflicts with a coherent treatment strategy. CONCLUSION Many GPs feel confident about influencing the progression of dementia and believe they can intervene effectively, using various (non-drug) treatment measures and referrals to support services. GPs perceive challenges, including obstacles in interdisciplinary collaboration and negative impacts after drug administration. To improve the conditions for GP intervention, it depends on expanding interdisciplinary collaboration and care strategies.
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Affiliation(s)
- Julian Wangler
- Centre for General and Geriatric Medicine, University Medical Centre Mainz, Mainz, Germany
| | - Michael Jansky
- Centre for General and Geriatric Medicine, University Medical Centre Mainz, Mainz, Germany
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Prerequisites for providing effective support to family caregivers within the primary care setting - results of a study series in Germany. BMC FAMILY PRACTICE 2021; 22:252. [PMID: 34937549 PMCID: PMC8697448 DOI: 10.1186/s12875-021-01601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/03/2021] [Indexed: 11/10/2022]
Abstract
Background General Practitioners are considered to be well placed to monitor home-care settings and to respond specifically to family caregivers. To do this, they must be sensitive to the needs and expectations of caregivers. In order to determine the current status of GP care in terms of the support given to family caregivers, a series of studies were conducted to gather the perspectives of both caregivers and GPs. The results are used to derive starting points as to which measures would be sensible and useful to strengthen support offered to family caregivers in the primary care setting. Methods Between 2020 and 2021, three sub-studies were conducted: a) an online survey of 612 family caregivers; b) qualitative interviews with 37 family caregivers; c) an online survey of 3556 GPs. Results Family caregivers see GPs as a highly skilled and trustworthy central point of contact; there are many different reasons for consulting them on the subject of care. In the perception of caregivers, particular weaknesses in GP support are the absence of signposting to advisory and assistance services and, in many cases, the failure to involve family caregivers in good time. At the same time, GPs do not always have sufficient attention to the physical and psychological needs of family caregivers. The doctors interviewed consider the GP practice to be well suited to being a primary point of contact for caregivers, but recognise that various challenges exist. These relate, among other things, to the timely organisation of appropriate respite services, targeted referral to support services or the early identification of informal caregivers. Conclusions GP practices can play a central role in supporting family caregivers. Caregivers should be approached by the practice team at an early stage and consistently signposted to help and support services. In order to support care settings successfully, it is important to consider the triadic constellation of needs, wishes and stresses of both the caregiver and the care recipient. More training and greater involvement of practice staff in the support and identification of caregivers seems advisable.
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Wangler J, Jansky M. [General practitioners, attitudes, procedures and challenges towards supporting family caregivers - results of a survey of primary care physicians]. Dtsch Med Wochenschr 2021; 147:e1-e12. [PMID: 34794181 PMCID: PMC8714302 DOI: 10.1055/a-1671-8621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND General practitioners are considered to be well suited when it comes to addressing the information and care needs of family caregivers. The aim of the present study is to examine how general practitioners assess their possibilities to support caregivers, what priorities they set and to what extent they experience challenges. METHODS AND PARTICIPANTS In the course of an online survey with a postal cover letter, a total of 3,556 GPs in in Baden-Württemberg, Hesse and Rhineland-Palatinate were interviewed between February and June 2021. Due to the exploratory approach of the study, only a descriptive data analysis was carried out. RESULTS 68 % of the GPs surveyed often deal with family caregivers in everyday practice; 77 % consider the GP's office to be well suited as the primary point of contact for family caregivers and care coordination. Often it is caregiving relatives who ask the GP about the issue of care (89 %). Frequent contents concern a deterioration in the care situation (75 %) and a change in the need for care (84 %); consultations in the initial phase of care are less common (40 %). There are differences between urban and rural doctors in the perception of the needs of caregivers and the setting of priorities. Rural doctors give more weight to proactive and psychosocial care, whereas doctors in urban regions rely on the specialist and support network. GPs experience various challenges while supporting caregivers, including the timely organization of suitable relief offers (87 %), the referral to suitable offers of help (79 %) or the early identification of informal caregivers (59 %). DISCUSSION GPs can play a central role in supporting family caregivers. A crucial prerequisite for this is that family caregivers are recognized and involved at an early stage. Consistent references to offers of help make it easier for family caregivers to organize care and to receive (psychosocial) support. In addition, it is important that GPs take into account the needs, desires and stresses of both caregivers and those being cared for.
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Affiliation(s)
- Julian Wangler
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz
| | - Michael Jansky
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz
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