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Stengel S, Gölz L, Kolb J, Tarbet K, Völler S, Koetsenruijter J, Szecsenyi J, Merle U. First insights into multidisciplinary and multispecialty long COVID networks-a SWOT analysis from the perspective of ambulatory health care professionals. Front Med (Lausanne) 2023; 10:1251915. [PMID: 38020101 PMCID: PMC10665561 DOI: 10.3389/fmed.2023.1251915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Multidisciplinary and multispecialty approaches with central integration of primary care, individualized long-term rehabilitative care, and multidisciplinary care pathways are recommended by international consortia to face the challenges of care of long COVID. Two regional long COVID networks-Rhein-Neckar (RN) and Ludwigsburg (LU) have emerged as ad hoc examples of best practice in Southern Germany. The aim of the community case study is to provide first insights into the experiences of the networks. Methods The exploratory observational study was conducted between April and June 2023, focusing on an observation period of just under 24 months and using a document analysis supported by MAXQDA and SWOT analysis with ambulatory health care professionals in two online group discussions. Results The document analysis revealed that both networks have defined network participants who have agreed on common goals and patient pathways and have established ways of communicating, organizing, and collaborating. Both networks agreed on a primary care-based, multidisciplinary and multispecialty approach. The main differences in realization emerged in LU as a focus on the ambulatory setting and very concrete application to individual patients, while RN showed a focus on an intersectoral character with participation of the specialized university hospital sector, knowledge transfer and a supra-regional approach with the involvement of the meso and macro level. The SWOT analysis (n = 14 participants, n = 6 male, 7 physicians (4 disciplines), 7 therapists (5 professions)) showed strengths such as resulting collaboration, contribution to knowledge transfer, and improvement of care for individual patients. As barriers, e.g., lack of reimbursement, high efforts of care, and persistent motivation gaps became apparent. Potentials mentioned were, e.g., transferability to other diseases such as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, promotion of addressing a "difficult topic" and promotion of intersectoral care concepts; risks mentioned were, e.g., limited network resources and negative effects on the development of other structures. Conclusion Resulting implications for practice and research address a call to policy makers and funders to support further research to find out what generalizable results regarding usefulness, effectiveness, and efficiency including transferability to other post-infectious diseases can be derived.
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Affiliation(s)
- Sandra Stengel
- Department of General Practice and Health Services Research, Faculty of Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Lea Gölz
- Department of General Practice and Health Services Research, Faculty of Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Karin Tarbet
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefanie Völler
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Jan Koetsenruijter
- Department of General Practice and Health Services Research, Faculty of Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Faculty of Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
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Stengel S, Hoffmann M, Koetsenruijter J, Peters-Klimm F, Wensing M, Merle U, Szecsenyi J. Versorgungsbedarfe zu Long-COVID aus Sicht von Betroffenen und Hausärzt*innen – eine Mixed-Methods-Studie aus Baden-Württemberg. ZEITSCHRIFT FÜR EVIDENZ, FORTBILDUNG UND QUALITÄT IM GESUNDHEITSWESEN 2022; 172:61-70. [PMID: 35717309 PMCID: PMC9212842 DOI: 10.1016/j.zefq.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/31/2022] [Accepted: 02/22/2022] [Indexed: 11/21/2022]
Abstract
Hintergrund Ansätze zur Bewältigung der medizinischen Versorgung von Long-COVID sind weltweit multidisziplinär und beziehen die Primärversorgung ein. Ziel der Studie war die Erhebung von Erfahrungen und Ideen zur Weiterentwicklung der medizinischen Versorgung bei Long-COVID auf Seiten von Patient*innen (PAT) und Hausärzt*innen (HÄ). Methoden Zwischen dritter und vierter Welle der COVID-19-Pandemie in Deutschland (Juli – September 2021) wurde eine Mixed-Methods-Erhebung mittels schriftlichem Fragebogen mit geschlossenen und offenen Fragen unter HÄ und PAT in zwei benachbarten Kreisen (Stadt- und Landkreis) in Baden-Württemberg durchgeführt. Auf Seiten der HÄ erfolgte eine papierbasierte, anonymisierte Vollerhebung, auf Seiten der symptomatischen Long-COVID-PAT eine anonymisierte Online-Fragebogenerhebung mit Bekanntmachung der Studie über mehrere Rekrutierungswege. Die Freitexte wurden mittels qualitativer Inhaltsanalyse, die quantitativen Ergebnisse vorwiegend deskriptiv ausgewertet. Ergebnisse Die Rückmeldungen von n = 72 HÄ (Rücklauf 12%) und n = 126 PAT zeigten in beiden Gruppen eine heterogene Bewertung mit Blick auf die Zufriedenheit mit der medizinischen Versorgung bei Long-COVID sowie die Wahrnehmung der Haltung gegenüber PAT und deren Erkrankung. Unsicherheit und der Umgang damit spielten in beiden Gruppen eine relevante Rolle. Das ärztliche Wissen wurde im Mittel mit 3,1 (Selbstbewertung HÄ) und 3,2 (PAT) auf einer fünfstufigen Likert-Skala (1 = „trifft nicht zu“; 5 = „trifft zu“) eingeschätzt. Aus den Aussagen beider Gruppen ergab sich der Wunsch nach einem strukturierten Gesamtkonzept mit kompetenten Anlaufstellen und einer Koordination der medizinischen Versorgung bei Long-COVID. Schlussfolgerung Die Ergebnisse stützen ein interdisziplinäres, intersektorales und interprofessionelles gestuftes Versorgungskonzept für Long-COVID in Deutschland mit HÄ als ersten Ansprechpartner*innen, Einbezug von Spezialanlaufstellen und Wissenstransfer. Die Etablierung regionaler Netzwerke mit Verknüpfung der regionalen ambulanten Versorgungsstrukturen und dem universitären medizinischen Sektor erscheint hierfür sinnvoll und wichtig.
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Affiliation(s)
- Sandra Stengel
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung. Marsilius Arkaden, Heidelberg, Deutschland.
| | - Mariell Hoffmann
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung. Marsilius Arkaden, Heidelberg, Deutschland
| | - Jan Koetsenruijter
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung. Marsilius Arkaden, Heidelberg, Deutschland
| | - Frank Peters-Klimm
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung. Marsilius Arkaden, Heidelberg, Deutschland
| | - Michel Wensing
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung. Marsilius Arkaden, Heidelberg, Deutschland
| | - Uta Merle
- Universitätsklinikum Heidelberg, Klinik für Gastroenterologie, Infektionskrankheiten, Vergiftungen, Heidelberg, Deutschland
| | - Joachim Szecsenyi
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung. Marsilius Arkaden, Heidelberg, Deutschland
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Carothers BJ, Allen P, Walsh-Bailey C, Duncan D, Pacheco RV, White KR, Jeckstadt D, Tsai E, Brownson RC. Mapping the Lay of the Land: Using Interactive Network Analytic Tools for Collaboration in Rural Cancer Prevention and Control. Cancer Epidemiol Biomarkers Prev 2022; 31:1159-1167. [PMID: 35443033 PMCID: PMC9167755 DOI: 10.1158/1055-9965.epi-21-1446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/11/2022] [Accepted: 03/16/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cancer mortality rates in the United States are higher in rural than urban areas, especially for colorectal cancer. Modifiable cancer risks (e.g., tobacco use, obesity) are more prevalent among U.S. rural than urban residents. Social network analyses are common, yet rural informal collaborative networks for cancer prevention and control and practitioner uses of network findings are less well understood. METHODS In five service areas in rural Missouri and Illinois, we conducted a network survey of informal multisector networks among agencies that address cancer risk (N = 152 individuals). The survey asked about contact, collaborative activities, and referrals. We calculated descriptive network statistics and disseminated network visualizations with rural agencies through infographics and interactive Network Navigator platforms. We also collected feedback on uses of network findings from agency staff (N = 14). RESULTS Service areas had more connections (average degree) for exchanging information than for more time-intensive collaborative activities of co-developing and sustaining ongoing services and programs, and co-developing and sharing resources. On average, collaborative activities were not dependent on just a few agencies to bridge gaps to hold networks together. Users found the network images and information useful for identifying gaps, planning which relationships to establish or enhance to strengthen certain collaborative activities and cross-referrals, and showing network strengths to current and potential funders. CONCLUSIONS Rural informal cancer prevention and control networks in this study are highly connected and largely decentralized. IMPACT Disseminating network findings help ensure usefulness to rural health and social service practitioners who address cancer risks.
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Affiliation(s)
- Bobbi J. Carothers
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Peg Allen
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Dixie Duncan
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | | | | | | | - Edward Tsai
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
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Simpson VL, Hass ZJ, Panchal J, McGowan B. Understanding the Development, Evaluation, and Sustainability of Community Health Networks Using Social Network Analysis: A Scoping Review. Am J Health Promot 2021; 36:318-327. [PMID: 34865522 DOI: 10.1177/08901171211045984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Identify the scope of the literature which reports use of social network analysis to inform, support, or evaluate health promotion-focused community network/partnership development. DATA SOURCE A comprehensive search (not date-limited) of PubMed, CINAHL, Web of Science Core Collection, PsycInfo, and the Cochrane Library Database for Systematic Reviews. INCLUSION AND EXCLUSION CRITERIA Criteria for inclusion included published in the English language and used social network analysis to inform, support, or evaluate development of community networks/partnerships aiding health promotion efforts. Studies were excluded if they did not use social network analysis or were not focused upon health promotion. DATA EXTRACTION Three of the four authors extracted data using a summary chart to document information regarding study aims, target issue/population, methods, and key outcomes of the social network analysis. DATA SYNTHESIS The extracted data were qualitatively analyzed by 3 authors to categorize key social network analysis outcomes into categories. RESULTS Ninety-seven studies representing 9 geographical regions were included, with the majority (69) published after 2010. Key outcomes included the effectiveness of social network analysis to identify network characteristics, track network change over time, compare similar networks across locations, and correlate network attributes with outcomes. CONCLUSION Findings support the utility of social network analysis to inform, support, and evaluate development of sustainable health promotion-focused networks/partnerships.
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Affiliation(s)
| | - Zachary Joseph Hass
- Regenstrief Center for Healthcare Engineering Core Faculty, Schools of Nursing and Industrial Engineering, 311308Purdue University, West Lafayette, IN, USA
| | - Jitesh Panchal
- School of Mechanical Engineering, 311308Purdue University, West Lafayette, IN, USA
| | - Bethany McGowan
- Libraries and School of Information Studies, 311308Purdue University, West Lafayette, IN, USA
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Kemper‐Koebrugge W, Adriaansen M, Laurant M, Wensing M. Actions to influence the care network of home-dwelling elderly people: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:973-981. [PMID: 30637827 PMCID: PMC6850451 DOI: 10.1111/hsc.12714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 12/04/2018] [Accepted: 12/20/2018] [Indexed: 06/09/2023]
Abstract
Positive impact of care networks of home-dwelling elderly people may be based on several network mechanisms: navigation to resources, negotiation between participants and contagion of behaviours. Little is known about actions of participants-elderly people, informal caregivers or formal care providers-to activate such mechanisms and generate support. Aim of this study was to identify actions in relation to these network mechanisms. A cross-sectional qualitative study of 48 interviews with home-dwelling elderly people, informal caregivers and formal care providers in the eastern parts of the Netherlands was conducted between March and September 2016. A framework analysis on network mechanisms categorised actions. Actions were reviewed by network party and compared between networks to explore relations between actions and networks. Results showed that participants navigated through existing relations to seek support. Actions on negotiation were aimed at ameliorating existing relations. Few examples and no actions on contagion of behaviours were found. Actions seemed driven by incidents and existing relations. Elderly people rarely initiated actions, informal caregivers felt hampered by their position in the network. Consistent patterns of relations between actions and network characteristics did not emerge. We concluded that the full potential of network-based support of elderly people is probably underused. Particularly promising seem: navigating the neighbourhood for new informal care, using opposite opinions as a catalyst for change and bringing quality of life and dilemma's into dialogue in the network.
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Affiliation(s)
- Wendy Kemper‐Koebrugge
- Faculty of Health and Social StudiesHAN University of Applied SciencesNijmegenThe Netherlands
| | - Marian Adriaansen
- Faculty of Health and Social StudiesHAN University of Applied SciencesNijmegenThe Netherlands
| | - Miranda Laurant
- Faculty of Health and Social StudiesHAN University of Applied SciencesNijmegenThe Netherlands
- IQ Healthcare, Radboud University Nijmegen Medical Centre, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Michel Wensing
- IQ Healthcare, Radboud University Nijmegen Medical Centre, Radboud Institute for Health SciencesNijmegenThe Netherlands
- Department of General Practice and Health Services ResearchUniversity Hospital Heidelberg, Marsilius ArkadenHeidelbergGermany
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McKinlay E, Young J, Gray B. General practice and patients’ views of the social networks of patients with multimorbidity. J Prim Health Care 2018; 10:258-266. [DOI: 10.1071/hc17050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTION
For patients with multimorbidity to live well, they need the support of not only health professionals but family, friends and organisations. These social networks provide support, potentially enabling the formation of a Community of Clinical Practice approach to multimorbidity care.
AIM
This study aimed to explore general practice knowledge of the social networks of patients with multimorbidity.
METHODS
Social network maps were completed by both patients and general practice. The social network maps of 22 patients with multimorbidity were compared with corresponding social network maps completed by general practice staff.
RESULTS
In 60% (13/22) of the patients, general practice staff held a high or moderate knowledge of individual patients’ social networks. Information on social networks was recalled from staff memory and not systematically recorded in patients’ electronic health records.
DISCUSSION
Social network information is not routinely collected, recorded or used by general practice to understand the support available to patients with multimorbidity. General practice could take an active role in coordinating social network supporters for certain patient groups with complex multimorbidity. For these groups, there is value in systematically recording and regularly updating their social network information for general practice to use as part of a coordinated Community of Clinical Practice.
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