[Advancing standards for the development of evidence-based health information for consumers: Needs and priorities among members of the Network for Evidence-based Medicine]

BACKGROUND

The Good Practice Guidelines for health information, Good Health Information Austria and Guideline Evidence-based Health Information are established resources for developing evidence-based health information in the German-speaking regions. The aim of this project was to capture challenges in applying these standards in practice, identify gaps and development needs and gain insights for their further development.

METHODS

In December 2020, members of the working group for patient information and involvement of the Network for Evidence-based Medicine were invited to share their experiences and needs in applying German standards for evidence-based health information through an online survey focussing on open questions (part 1: needs assessment). The feedback was analysed using qualitative content analysis and presented in a workshop at the EbM Congress 2021 with the goal of specifying the feedback from the needs assessment and discussing ideas for the further development of the standards (part 2: specification). In the final step, a second survey was conducted in February 2023 to prioritize the identified topics by the working group members (part 3: prioritization). The results were analysed descriptively.

RESULTS

Among the 41 participants, only 23% considered the standards to be sufficient, and only 55% found their application in the development of information to be easy or rather easy. The needs assessment and workshop (n=46) helped to identify various areas of action. With regard to the application of the standards, the following challenges were identified: lack of user orientation, content gaps, methods and risk communication. Gaps in the standards were identified regarding formats, content, and the connection to healthcare provision. For the advancement of the standards ideas for additional content, stakeholder involvement, and improvement of the usability of the standards were identified. In the prioritization survey, the topic areas, "presenting benefits and harms" and "content beyond treatments (in particular, diagnostics and prognosis)" were considered to be the most important (n=36).

DISCUSSION

Among members of the working group for patient information and involvement of the German Network for Evidence-based Medicine, a high demand has been identified for the further development of standards for creating evidence-based health information. In addition to content development, the integration of existing documents and tools should also be considered, including products issued by other institutions. The success of advancing the standards also depends on improving their applicability - for example through an attractive online platform. The results are limited by the sample which only included members of the EbM Network's patient information and participation working group and a limited response rate.

CONCLUSIONS

The needs assessment showed that the currently established standards and recommendations for the development of evidence-based health information in the German-speaking regions represent important cornerstones but need to be expanded to answer more practice-oriented questions. The challenges and proposed solutions stated by the participants can help further develop the standards. The prioritization can be used to set priorities for the development of the standards, guide the order of possible work packages and allocate resources.

[Nursing skill levels and implementation of Advanced Nursing Practice in Austria: A cross-sectional study]

Nursing skill levels and implementation of Advanced Nursing Practice in Austria: A cross-sectional study Abstract: Background: New fields of practice are emerging under the concept of "Advanced Nursing Practice" (ANP) that offer specialised care provided by nurses who hold master's degrees. In Austria, nurses are currently being trained as Advanced Practice Nurses (APN). Aim: The project aimed to investigate which advanced nursing practice tasks according to the Hamric model are undertaken by nurses at different levels of qualification in Austria. Methods: Certified nurses did participate in a cross-sectional survey through an online questionnaire based on the Role Delineation Model and tailored to the Austrian context. The tasks were assigned based on the Hamric model and were tested and evaluated descriptively according to the qualification level through factor analysis. Results: Completed data was available from 105 participants, among them 80% with undergraduate education, 20% with a master's degree. A tendency in the results showed that the level of qualification was related to the activities carried out. The higher the academic degree, the more activities were performed in the field of leadership. The central ANP-competencies, research and education, are rather weak among all respondents. Conclusion: The results show that activities corresponding to the competencies of an ANP are performed by a heterogeneous group of nurses. Conditions and a standardized understanding of ANP need to be established in order to offer a professional practice that matches the competency profile.

[Practice and challenges of delegating medical tasks in the interprofessional everyday work of inpatient healthcare in Germany - An exploratory survey]

BACKGROUND

The delegation of medical tasks (DMT) plays a significant role in the everyday practice of inpatient care but also presents a potential challenge in interprofessional collaboration. Assessing the conditions of DMT in everyday work is crucial to identify areas for optimization.

METHODS

In a nationwide exploratory study, physicians, nursing and allied health professionals working for inpatient care facilities were surveyed regarding various aspects of DMT using a standardized online questionnaire.

RESULTS

The majority of the 757 participants (64.9% physicians), perceived DMT to be both economically and time-efficient (88.5% agreement) and in the best interest of patients (74%). For 78.7% of the respondents, DMT represents a potential conflict in their daily work, depending on the quality of interprofessional communication. Inadequate staffing was identified as a barrier to a broader implementation of DMT by 83.8% of participants. 63.2% of the participants considered their knowledge of legal aspects related to DMT to be at least good (participants with less than 5 years of professional experience: 52.6%). Physicians primarily acquire relevant knowledge through professional practice (71.3% vs. non-physicians 39.5%).

CONCLUSION

Across the different professional groups DMT was considered beneficial and serving the interests of patients. Targeted promotion of safe and cost-effective DMT should be incorporated into medical education. Achieving greater benefits from DMT requires explicit legal frameworks, effective communication within the team and, in particular, adequate staffing among the professional groups responsible for delegated tasks.

[Development of criteria for the prospective assessment of the need for updating guideline recommendations: The AGIL criteria]

BACKGROUND

Evidence-based guideline and vaccination recommendations should continuously be updated to appropriately support health care decisions. However, resources for updating guidelines are often limited. The aim of this project was to develop a list of criteria for the prospective assessment of the need for updating individual guideline or vaccination recommendations, which can be applied from the time a guideline or guideline update is finalised.

METHODS

In this article we describe the development of the AGIL criteria (Assessment of Guidelines for Updating Recommendations). The AGIL criteria were developed by experienced scientists and experts in the field of guideline development in a multi-step process. The five steps included: 1) development of an initial list of criteria by the project team; 2) online survey of guideline experts on the initial version of the criteria list; 3) revision of the criteria list based on the results of the online survey; 4) workshop on the criteria list at the EbM Congress 2023; 5) creation of version 1.0 of the AGIL criteria based on the workshop results.

RESULTS

The initial list included the following three criteria: 1) relevance of the question 2) availability of new relevant evidence, and 3) impact of potentially new evidence. The response rate of the online survey for fully completed questionnaires was 31.0% (N=195; 630 guideline experts were contacted by email). For 90.3% (n=176) of the respondents, the criteria list included all essential aspects for assessing the need for updating guideline recommendations. More than three quarters of respondents rated the importance of the three criteria as "very important" or "important" (criteria 1-3: 75.3%, 86.1%, 85.2%) and - with the exception of criterion 1 - comprehensibility as "very comprehensible" or "comprehensible" (criteria 1-3: 58.4%, 75.9%, 78.5%). The results of the online survey and the workshop generally confirmed the three criteria with their two sub-questions. The incorporation of all feedback resulted in the AGIL criteria (version 1.0), recapping: 1) relevance of the question regarding a) PICO components and b) other factors, e.g. epidemiological aspects; 2) availability of new evidence a) on health-related benefits and harms and b) on other decision factors, e.g. feasibility, acceptability; 3) impact of new evidence a) on the certainty of evidence on which the recommendation is based and b) on the present recommendation, e.g.

STRENGTH OF RECOMMENDATION

DISCUSSION

The moderate response rate of the online survey may have limited its representativeness. Nevertheless, we consider the response rate to be satisfactory in this research context. The inclusion of many experts in the online survey and the EbM Congress workshop is a strength of the project and supports the quality of the results.

CONCLUSIONS

The AGIL criteria provide a structured guidance for the prospective assessment of the need for updating individual guideline recommendations and other evidence-based recommendations. The implementation and evaluation of the AGIL criteria 1.0 in a field test is planned.

[Medical care in GP practices during the Covid-19 pandemic: A questionnaire-based survey among general practitioners and medical practice assistants asking for their opinion about changes, needs and burdens]

INTRODUCTION

The coronavirus pandemic did not only result in changes in the provision and utilization of health care services in general practice but also in an increased workload for physicians and medical practice assistants. The VeCo practice study retrospectively explores the experiences of both professional groups two years after the start of the pandemic.

METHODS

In March and April 2022, general practitioners and medical practice assistants in the three German federal states of Berlin, Brandenburg and Thuringia were asked to complete a paper-based questionnaire.

RESULTS

657 general practitioners and 762 medical practice assistants completed the questionnaire. Both professional groups agreed to statements indicating a reduction in regular health care provisions. Nevertheless, 74% of the physicians and 82.9% of the medical practice assistants considered the health care provided to their patients during the pandemic as good. This was only possible through considerable additional effort and stress. While more than half of both groups reported that work was still enjoyable, three quarters of both groups stated that the challenges arising from the pandemic outstripped their capacity. Both groups would like to receive more recognition from society (medical practice assistants 93.2%, general practitioners 85.3%) and from their patients (87.7% and 69.9%, respectively).

DISCUSSION

General practitioners and medical practice assistants reduced regular health care provision but were still able to maintain a good quality of care for their patients during the pandemic. It became clear that more appreciation and adequate financial compensation are necessary to ensure long-term sustainability of GP care.

CONCLUSION

The subjective view of general practitioners and medical practice assistants on their health care provision shows that appreciation and adequate financial renumeration, particularly when working under most difficult conditions, are necessary to increase the attractiveness of a career in general practice, for both physicians and medical practice assistants.

[Students' perspective on generalized nursing education in Germany: Results of a nationwide online survey]

Students' perspective on generalized nursing education in Germany: Results of a nationwide online survey Abstract. Background: Generalized nursing education in Germany was introduced in 2020 as a reaction to changed care conditions. The reform's implementation is accompanied by a nationwide longitudinal survey with three surveys among students in generalized nursing education. Aims: We present results of the first survey round. The explorative approach provides data that allows insights into students' experiences and thus indicates adjustment opportunities. Method: The online survey used standardized questionnaires and was directed at students that had begun generalized nursing education in 2020. 1,267 students from 316 nursing schools in 15 German federal states participated in the first survey round. The survey recorded students' career choice motivations, learning experiences in nursing schools and practical placements, as well as contextual factors. Results: The students' career choice is mainly interest-driven (77.8%). The program is rated good to satisfactory (overall grade 2.45). Frequent and well-designed practical guidance and a transfer of information between nursing school and clinical placement appear important but insufficiently implemented. Data shows an increased need for support services. Conclusions: In addition to positive findings, the practical learning design and the dialogue between theory and practice appear challenging, while support services should be expanded.

[Is it feasible to conduct drug studies in general practice? - Results of a survey among investigating physicians and medical staff]

BACKGROUND

Pragmatic randomized controlled trials are able to make an essential contribution to the further development of evidence-based treatment recommendations for primary care patients. However, drug trials are regulated by specific guidelines and have not yet become a routine task in GP practices. Within the scope of a multi-center, double-blind, randomized controlled trial on treating urinary tract infections in women with and without antibiotics (REGATTA), the feasibility of pharmaceutical studies in GP practices was evaluated by means of a questionnaire sent out to participating physicians and practice nurses.

METHODS

Using a self-designed, non-validated questionnaire, the perspectives, attitudes and experiences of participating physicians and practice nurses were assessed anonymously. In this way, we identified both hindering and beneficial factors affecting the conduct of drug trials in German GP practices.

RESULTS

39 physicians and 48 practice nurses participated in the survey. 95 % of the physicians and 88 % of the practice nurses indicated that the implementation of drug trials with all their regulatory requirements is, in principle, possible in GP practices. In particular, the high amount of time and documentation necessary were identified as barriers. The implementation can be facilitated by formulating a research question that is relevant to practice and patients and by support from the study center.

CONCLUSION

Although participation in a drug trial is an additional burden in everyday practice, it is considered feasible and worthwhile by the GPs and practice nurses involved. Due to an assumed selection bias, the predominantly positive experiences of the respondents may be overestimated and transferable only to a limited extent.

[Involvement of employees, residents, and relatives in digital transformation at long-term care institutions for older adults - A cross-sectional survey]

Involvement of employees, residents, and relatives in digital transformation at long-term care institutions for older adults - A cross-sectional survey Abstract. Background: Long-term care institutions for older adults are currently undergoing a digital transformation process. But who are the decision-makers in this transformation process?

AIM

The aim of the study was to determine the role of employees, residents, and their relatives in the provision of the technical solutions used in long-term care institutions.

METHODS

The standardized online survey was conducted at 466 long-term care institutions throughout Switzerland. The respective managers were surveyed.

RESULTS

The majority of the managers surveyed saw more advantages than disadvantages in the use of technical solutions. Nevertheless, the results also show that while 52 % involve their staff in decisions about the acquisition of technology, only 11 % involve their residents, and 8 % involve the residents' relatives. This involvement depends on how much technology has been used so far and what leeway the managers themselves have in making such decisions.

CONCLUSIONS

It is apparent that residents and their relatives are involved very little in decision-making processes. This can mean that the organization's digital transformation ultimately depends on just one person, the manager, and that the wishes of the people who are directly affected by these technical innovations are not considered in such decisions.

[Evaluation of a future scenario concerning the use of big data applications to improve the care of people with rare diseases]

INTRODUCTION

In Germany there are about 4 million people living with a rare disease. Studies have shown that big data applications can improve diagnosis of and research on rare diseases more effectively. However, no concrete comprehensive concept for the use of big data in the care of people with rare diseases has so far been established in Germany. As part of the project "BIDA-SE", which is funded by the German Ministry of Health, a first scenario has been designed to show how big data applications can be usefully incorporated into the care of people with rare diseases.

METHODS

The aim of the present study was to evaluate this scenario with regard to acceptance, (clinical) benefits, economic aspects, and limitations and barriers to its implementation. To evaluate the scenario, an online survey was conducted in Germany in October/November 2019 amongst a total of N = 9 physicians, N = 69 patients with rare diseases/patient representatives, N = 14 IT experts and N = 21 health care researchers. The online questionnaire consisted of both standardized, validated questions taken from already tested survey instruments and additional questions which were constructed on the basis of a preceding literature analysis. The evaluation of the survey was primarily descriptive, with a calculation of frequencies, mean values and standard deviations.

RESULTS

The results of the evaluation show that the scenario has been accepted by a majority of all groups surveyed (physicians, patients/patient representatives, IT experts and health care researchers). From the point of view of physicians, patients/patient representatives and health care researchers, the scenario has the potential to accelerate the diagnosis and initiation of therapy and to improve cross-sectoral treatment. From the physician's and health care researcher's perspective, investments in the application presented in the scenario would be profitable. Financing the scenario would, however, require adjusting the reimbursement situation. The limitations and barriers identified by all groups for a medium-term implementation of the scenario can be grouped into seven thematic areas where action is needed: (1) financing and investment, (2) data protection and data security, (3) standards/data sources/data quality, (4) acceptance of technology, (5) integration into the daily work routine, (6) knowledge about availability as well as (7) habits and preferences/physician's role.

DISCUSSION

With the present study, a first interdisciplinary, practical scenario using big data applications was evaluated with regard to acceptance, benefits and limitations/barriers. The scenario is widely accepted among the majority of all surveyed target groups and is considered (clinically) useful, although legal, organisational and technical barriers still need to be overcome for its medium-term implementation. The evaluation results contribute to the derivation of recommendations for action to ensure the medium-term implementation of the scenario and to channel access to the Centres for Rare Diseases in the future.

CONCLUSION

Many activities have been initiated at a national level to improve the health care situation of people with rare diseases. The scenario developed in the "BIDA-SE" project complements these research activities and illustrates how big data applications can be usefully implemented into practice to improve the diagnosis and therapy of people with rare diseases in a sustainable way.

[Geriatric care in rural areas: Results from two standardized surveys of care providers]

BACKGROUND

Due to a growing elderly population the number of age-related diseases increases and thus the need for geriatric care. In rural areas with low population density and few healthcare providers there is a risk of inadequate care.

AIM OF THE STUDY

The aim of our investigation was to identify gaps in care and preferred improvement approaches in rural areas from the perspective of local care providers.

METHODS

1,545 healthcare providers from two rural regions were surveyed on the care situation (assessment according to the German school grading system), improvement approaches and problems (simple frequencies). The participants' answers were categorized and analyzed by their work location according to the central-place concept of high-order, middle-order and lower-order (basic) centers.

RESULTS

348 healthcare providers participated (response rate: 22.5 %). The outpatient and inpatient care situation in geriatrics was rated "satisfactory" on average. Geriatric care is most often jeopardized by long waiting times for specialist treatment (71.0 %). Significant differences in the rating were found in the coverage of geriatric care by inpatient care (p=0.0018) and the accessibility of medical facilities by public transport (p=<0.001). These were better rated in the higher-order centers. The preferred approach to improve care was intersectoral networking (62.3 %) among care providers.

CONCLUSIONS

In rural areas, supply problems in geriatrics exist, in particular accessibility and waiting times in middle-order and basic centers. Solutions of regional, intersectoral and interprofessional care were approved by a majority of the participants.

Comorbidity of chronic back pain and depression in Germany: Results from the GEDA study, 2009 and 2010

BACKGROUND

Depression and chronic back pain are two common disabling diseases. Studies suggest an association of both conditions. We aimed to determine sex- and age-specific prevalences of depression, chronic back pain and the combination of both. Furthermore, influencing factors and resulting consequences were analyzed.

METHODS

Data was derived by pooling two representative cross-sectional telephone surveys "German Health Update (GEDA)" 2009 and 2010 including 43,312 adults. Self-reported physician-diagnosed chronic somatic diseases including diagnosed depression and chronic back pain in the past 12 months were assessed. Age- and sex-specific prevalence was calculated. Logistic regression was used to examine their association and identify influencing factors. Sick days, missed workdays and doctor visits were compared for single disease vs. comorbidity.

RESULTS

12-month prevalence for diagnosed depression was 6.7 %, for chronic back pain 21.1 %, and the comorbidity of both was 3.0 %. An association of depression and chronic back pain was found for both sexes and all age groups. The characteristics "female sex", "being 50-64 years of age", "low socioeconomic status" and "low social support" increased the likelihood of comorbid depression and chronic back pain. Comorbid depression and chronic back pain increased the number of sick days, missed workdays and doctor visits significantly.

CONCLUSION

The results show a strong association of depression and chronic back pain. The direction of association cannot be determined due to the cross-sectional design of the study. Identifying patients at risk for comorbid depression and chronic back pain early on might improve treatment and reduce the economic impact.

[Health insurance dentists' subjective perceptions of quality when implementing quality management in practice - results from a nationwide survey]

BACKGROUND

Statutory health insurance dentists working in private practice have a duty to maintain and improve the quality of dental care. An individual practice's approach to quality management (QM) can be made to reflect the practice's philosophy on quality and standards and can be adapted to the specific requirements of the practice setting they are meant to serve. This study set out to collect data on the subjective perceptions of quality that exist among German dentists, and to canvass their views on the process and benefits of implementing QM systems. In doing so, this study aimed to identify the incentives and obstacles that currently exist in relation to the implementation and further development of practice-based QM systems.

METHODS

As part of a nationally representative cross-sectional study, a random sample of 2,084 dentists was asked to complete a questionnaire on perceptions of quality and QM. The response rate was 40.3 % (n=838). The study's primary end point was defined as the surveyed dentists' interpretative description of quality. The study's secondary end point was defined as the dentists' subjective evaluations of the benefits of QM in the day-to-day management of their own practices. Responses to open-ended questions were analysed using content analysis, while quantitative questions were analysed using descriptive univariate analysis.

RESULTS

When analysing respondents' subjective perceptions of quality (primary end point), the following dimensions were revealed as highly significant: patient (mentioned by 31.4 % of the responders), quality of treatment (29.5 %) and staff (14.8 %). As far as the benefits of QM in the day-to-day management of the respondent's own practices (secondary end point) were concerned, these appeared to be linked to the ease of implementation of the organizational tools offered by QM systems: managing emergencies, team meetings and procedural check lists were ranked as "can be implemented to a reasonable degree" and "can be fully implemented" by 82.3 %, 80.2 % and 79.9 % of respondents, respectively. There appeared to be a disconnect between the respondents' subjective perceptions of quality and the benefits of QM as part of day-to-day practice management, with QM systems failing to reflect the respondents' subjective views on quality.

CONCLUSIONS

The perceptions of QM among German statutory health insurance dentists are generally positive but marked by a disconnect between aspects of quality currently measured by QM systems and the dentists' views on what is required in order to assess quality standards in relation to the dimensions "patient", "quality of treatment" and "staff". A targeted review of the tools offered by QM systems may lead to improved ease of implementation. If QM is to form an integral part of clinical practice, all future developments need to consider the dentists' subjective perceptions of quality and their attitudes towards QM.

[Prevention of sudden infant death as a task of nurses in neonatology – Evaluations and recommendations as a result of a cross-sectional survey]

BACKGROUND

The sudden infant death is a diagnosis by exclusion and a multifactorial event. Premature infants are at a high risk. They must be especially protected from additional risk factors. Prevention campaigns support the decrease of mortality rate. The study aims to demonstrate various aspects of procedure applied by nurses and within neonatal units in SIDS prevention and counseling.

SAMPLE AND METHODS

In the nine level 1 perinatal centres of a german federal state, the study aims to examine the neonatological nurse's knowledge of prevention aspects of sudden infant death. The aim is not only to contemplate the individual nurse, but also the institutional framework of the respective clinics is considered. The cross-sectional survey was done with help of a written survey.

RESULTS

165 nurses participated (160 female, four male, one unknown). Premature infants do not consistently get accustomed to the supine position. 33 percent of the nurses evaluate breastfeeding as very important. 74 percent regularly talk to parents about prevention. Half of the nurses do not record the counseling interviews.

CONCLUSION

Although evidence based recommendations to prevent sudden infant death exist they are not executed consequently. The motives for the inadequate implementation should be determined. Trainings should focus on the mediation of protective factors. Nurses should also demonstrate preventive interventions and support parents in putting these actions into practice.

[Potentials of cooperative quality management initiatives: BQS Institute projects, January 2010 - July 2013]

Alongside the projects of internal quality management and mandatory quality assurance there is a variety of quality driven projects across institutions initiated and run by various partners to continuously improve the quality of care. The multiplicity and characteristics of these projects are discussed on the basis of projects run by the BQS Institute between 2010 and 2013. In addition, useful interactions and linking with mandatory quality benchmarking and with internal quality management are discussed. (As supplied by publisher).