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Schillen P, Dehnen A, In der Schmitten J, Kersting C, Mortsiefer A, Hemming B, Heistermann P, Neumann A, Dehnen D. [Physician assistants as a future model in primary care: Experiences, needs, potentials and barriers]. Z Evid Fortbild Qual Gesundhwes 2023; 182-183:44-52. [PMID: 37775356 DOI: 10.1016/j.zefq.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION In the coming decades, demographic change will dramatically increase health care needs, especially for general practitioners (GPs). However, there is a shortage of young primary care physicians, with signs of (impending) underuse already becoming apparent in rural and structurally weak areas. Innovative care concepts are needed to counteract this development and ensure the future of primary care. In addition to medical assistants (MFA), academically trained physician assistants (PAs) could be considered for more demanding delegation tasks and be involved in direct patient care under the responsibility of a physician in the practice team. In England, the Netherlands and the USA, PAs have been a part of the health care systems for many years. RESEARCH QUESTIONS 1) What are the potentials for delegation/possibilities for PAs working in primary care practices in contrast to medical assistants? 2) What structural requirements are necessary to regularly integrate PAs in primary care practices? METHODS After preliminary interviews with PA experts and primary care researchers and practitioners (n=29), four expert interviews (n=4) with GPs and PAs were performed in a case analysis in order to elicit experiences with PAs in family practice. Based on this, three focus groups were conducted with GPs and practice staff (n=15) to discuss the extent, the need and the willingness to delegate physician services to PAs, as well as existing barriers. After transcription, analyses were performed using qualitative content analysis according to Mayring. RESULTS The participants acknowledged the potential to reduce physician workloads and showed a high willingness to delegate tasks. Practical examples suggest that a clearly defined delegation of medical tasks to PAs, e.g. participation in infection consultations, is possible after only a few weeks working in family practices. Thus, the cooperation between GPs, PAs and medical assistants can be successful. Uncertainties exist regarding the legal possibilities and limits of delegation as well as the current and future financial reimbursement of PAs. DISCUSSION The legal and financial framework for the utilization of PAs in ambulatory care should be reliably clarified as well as transparently communicated so that the considerable potentials of delegating tasks to academically trained staff, e.g. PAs, especially in the GP sector, can be exploited in the future. CONCLUSION Participation of PAs in the GP team could be key to overcoming the often threatening or already existing under-provision of medical care in structurally weak regions.
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Affiliation(s)
- Philip Schillen
- Institut für Allgemeinmedizin, Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland.
| | - Alessia Dehnen
- Institut für Allgemeinmedizin, Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland
| | - Jürgen In der Schmitten
- Institut für Allgemeinmedizin, Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland
| | - Christine Kersting
- Lehrstuhl für Allgemeinmedizin II und Patientenorientierung in der Primärversorgung, Institut für Allgemeinmedizin und Ambulante Gesundheitsversorgung (IAMAG), Universität Witten/Herdecke, Witten, Deutschalnd
| | - Achim Mortsiefer
- Lehrstuhl für Allgemeinmedizin II und Patientenorientierung in der Primärversorgung, Institut für Allgemeinmedizin und Ambulante Gesundheitsversorgung (IAMAG), Universität Witten/Herdecke, Witten, Deutschalnd
| | - Bernd Hemming
- Deutscher Hochschulverband Physician Assistant e.V. (DHPA), Köln, Deutschland; Fliedner Fachhochschule, Düsseldorf, Deutschland
| | - Peter Heistermann
- Deutscher Hochschulverband Physician Assistant e.V. (DHPA), Köln, Deutschland; Fliedner Fachhochschule, Düsseldorf, Deutschland
| | - Anja Neumann
- Lehrstuhl für Medizinmanagement, Fakultät für Wirtschaftswissenschaften, Universität Duisburg-Essen, Deutschland
| | - Dorothea Dehnen
- Institut für Allgemeinmedizin, Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland
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Kitkowska A, Ahlin K. Improving Well-Being in Schools - Lessons Learned from IoT Experts. Stud Health Technol Inform 2023; 302:666-670. [PMID: 37203774 DOI: 10.3233/shti230232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The Internet of Things (IoT) is a source of knowledge about the surrounding environment and people in such an environment. The insights collected by IoT can provide the knowledge needed to improve people's health and overall well-being. Schools are one environment where IoT is scarcely applied, yet, it is expected that this is where children and teenagers spend most of their time. Drawing on previous findings, this paper presents preliminary results from qualitative inquiry investigating how and what IoT-based solutions could support health and well-being in elementary educational settings.
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Abri D, Boll T. Expert's View on Central Components of the Actional Model of Older People's Coping with Health-Related Declines: A Pilot Study with Professional Caregivers. Integr Psychol Behav Sci 2023:10.1007/s12124-023-09761-4. [PMID: 37058218 DOI: 10.1007/s12124-023-09761-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/15/2023]
Abstract
Abri & Boll (2022) proposed the "Actional Model of Older People´s Coping with Health-Related Declines" to explain the use of various action alternatives of older persons for dealing with diseases, functional declines, activity limitations, and participation restrictions. It draws on a broad knowledge base: an action-theoretical model of intentional self-development, models of the use of assistive technologies (ATs) and medical services, qualitative studies on reasons for using or not-using ATs, and quantitative studies on older people's health-related goals. The present study aims to gather evidence to further refine this model by additionally relying on expert knowledge from professional caregivers serving older people. Six experienced geriatric nurses working in mobile care services or residential care facilities were interviewed about key components of the above model in relation to 17 older people aged 70 to 95 with stroke, arthrosis, or mild dementia. The results revealed additional goals of reducing or preventing health-related discrepancies beyond those already included in the model (e.g., moving without pain, doing things alone, driving a car again, social return). Moreover, new motivating or demotivating goals for using certain action possibilities were found (e.g., to be at home, to be alone, to rest, to motivate other older people). Finally, some new factors were identified from the biological-functional (e.g., illness, fatigue), technological (e.g., pain inducing ATs, maladaptive devices), and social contexts (e.g., lack of staff time) that are likely to promote or hinder the use of certain action possibilities. Implications for refining the model and future research are discussed.
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Affiliation(s)
- Diana Abri
- Department of Behavioural and Cognitive Sciences, Institute for Lifespan Development, Family, and Culture, University of Luxembourg, 11, Porte des Sciences, Esch-sur-Alzette, L-4366, Luxembourg.
| | - Thomas Boll
- Department of Behavioural and Cognitive Sciences, Institute for Lifespan Development, Family, and Culture, University of Luxembourg, 11, Porte des Sciences, Esch-sur-Alzette, L-4366, Luxembourg
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Heumann K, Kuhlmann M, Böning M, Tülsner H, Pocobello R, Ignatyev Y, Aderhold V, von Peter S. Implementation of open dialogue in Germany: Efforts, challenges, and obstacles. Front Psychol 2023; 13:1072719. [PMID: 36846479 PMCID: PMC9948650 DOI: 10.3389/fpsyg.2022.1072719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/20/2022] [Indexed: 02/11/2023] Open
Abstract
Purpose The Open Dialogue (OD) approach has been implemented in different countries worldwide. OD not only depends on therapeutic principles but also requires a distinct set of structural changes that may impede its full implementation. In Germany, OD is currently practiced in different mental health care settings across the country. Yet, full implementation of OD principles is limited due to the extreme structural and financial fragmentation of the German mental health care system. With this as a background, the aim of this study was to investigate the efforts, challenges and obstacles of OD implementation in Germany. Methods This article presents the German results from the international HOPEnDIALOGUE survey, supplemented with expert interview data. Thirty eight teams currently providing OD took part in the survey. Sixteen expert interviews were carried out with stakeholders from various care settings. Survey data were analyzed descriptively and the qualitative data were evaluated using a thematic analysis approach. Results While having to adapt to the fragmented German health care system, OD has been mainly implemented from outpatient service providers and stand-alone services. About half of the teams implemented OD under the conditions of cross-sectoral model contracts and, thus, are considerably limited when it comes to OD implementation. Altogether, OD is not implemented to its full extent in each of the institutions surveyed. Similarly, the expert interviews revealed various challenges that mainly relate to the realization of OD's structural principles, whereas the implementation of its therapeutic benefits remains less affected. However, these challenges have managed to lead to great commitment by single teams and a certain level of implementation of OD-related concepts. Conclusion OD in Germany can currently only be fully implemented under the cross-sectoral care model contract system that is often temporary, thus significantly hindering its continuous development. Any evaluation of OD's effectiveness in Germany thus needs to take into account the fragmented nature of the country's health care system and control for the multiple barriers that impede implementation. Reforms of the German health care system are also urgently needed to create more favorable conditions for the implementation of OD.
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Affiliation(s)
- Kolja Heumann
- Integrated Working Group “Mental Health”, Brandenburg Medical School, Brandenburg an der Havel, Germany,*Correspondence: Kolja Heumann, ✉
| | - Mira Kuhlmann
- Integrated Working Group “Mental Health”, Brandenburg Medical School, Brandenburg an der Havel, Germany
| | - Maike Böning
- Department of Psychology, University of Marburg, Marburg, Germany
| | - Helene Tülsner
- Department of Social Work, Alice Salomon University, Berlin, Germany
| | - Raffaella Pocobello
- National Research Council of Italy, Institute of Cognitive Sciences and Technologies, Rome, Italy
| | - Yuriy Ignatyev
- Department of Psychiatry and Psychotherapy, Immanuel Hospital Rüdersdorf, Brandenburg Medical School, Rüdersdorf, Germany
| | - Volkmar Aderhold
- Department of Psychiatry, Charité University Medicine, Berlin, Germany
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Immanuel Hospital Rüdersdorf, Brandenburg Medical School, Rüdersdorf, Germany
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Schott E, Schaller K, Mons U, Ouédraogo N. [Approaches to increase HPV vaccination rate in Germany - challenges and opportunities. A qualitative study]. Z Evid Fortbild Qual Gesundhwes 2022; 170:29-37. [PMID: 35490121 DOI: 10.1016/j.zefq.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/05/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In Germany, the prevalence of infections with the human papilloma virus (HPV) among women and men is high. High-risk HPV types can lead to certain types of cancer (e. g., cervical cancer). Vaccination against HPV infections associated with cancer and genital warts was introduced in Germany in 2007. Currently, HPV vaccination is recommended for girls and boys by the German Standing Committee on Vaccination. The vaccination rate, however, remains rather low, with rates below 50% in 15-year-old girls and of about 5% in 15-year-old boys in 2019. This suggests that new approaches are urgently needed to increase HPV vaccination coverage in Germany in the coming years. OBJECTIVES This qualitative study aimed at identifying opportunities and challenges related to the application and implementation of different approaches designed to increase HPV vaccination uptake among male and female adolescents in Germany according to expert views. MATERIALS AND METHODS From April to July 2020, 43 experts from the field of HPV vaccination in Germany were interviewed using a semi-standardized interview guide. The audiotaped interviews were transcribed and analyzed using qualitative content analysis by Udo Kuckartz. RESULTS AND CONCLUSION According to the experts interviewed the following would be the most promising approaches to increase HPV vaccination rates in Germany: educational measures, school vaccination programs, increasing participation in the adolescent health check-up "J1", reminder and recall systems. The most reasonable solution would be to pursue several approaches simultaneously. According to the experts, more political support with implementing strategies and reducing bureaucratic obstacles as well as an increase in cooperation between relevant stakeholders is required to achieve the effective implementation of these strategies.
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Affiliation(s)
- Evelyn Schott
- Stabsstelle Krebsprävention, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland; Medizinische Fakultät Heidelberg, Universität Heidelberg, Heidelberg, Deutschland
| | - Katrin Schaller
- Stabsstelle Krebsprävention, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Ute Mons
- Stabsstelle Krebsprävention, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland; Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Nobila Ouédraogo
- Stabsstelle Krebsprävention, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland.
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Witt S, Kristensen K, Wiegand-Grefe S, Boettcher J, Bloemeke J, Wingartz C, Bullinger M, Quitmann J. Rare pediatric diseases and pathways to psychosocial care: a qualitative interview study with professional experts working with affected families in Germany. Orphanet J Rare Dis 2021; 16:497. [PMID: 34838091 PMCID: PMC8626925 DOI: 10.1186/s13023-021-02127-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/14/2021] [Indexed: 01/06/2023] Open
Abstract
Background Rare diseases occur in early childhood and have a major impact on the quality of life of the affected children and their families. Their need for psychosocial support is considerable, but psychosocial care in Germany is still far from being part of routine care. We interviewed experts to explore how they describe the current pathways to psychosocial care, potential barriers and problems, and possibilities for improvements. Results We conducted telephone interviews with 49 experts working in somatic medicine, psychosocial medicine, patient organizations, child and youth welfare, and the educational sector. Interviews were transcribed and analyzed using focused interview analysis. Results document ways of access and facilities used by families to receive psychosocial care. The barriers described by the experts can be summarized on three levels: the family-organizational level, the family-psycho-emotional level, and finally, the structural system level. Accordingly, suggestions for improvement were directed at these levels. Conclusion Based on the experts' perspectives, there is ample room for improvement to facilitate the pathways to psychosocial care for children with rare diseases and their families. Unfortunately, there seems to be a long way to go before psychosocial care will be routinely provided. However, awareness of the issue among different professional groups is high, and numerous suggestions for improvement were made, including continuous expansion of services to all family members, strengthening of low-threshold services, simplifying application procedures, and more cooperation between different funding agencies as well as between different care providers.
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Affiliation(s)
- Stefanie Witt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Kaja Kristensen
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Boettcher
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Janika Bloemeke
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Wingartz
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Bullinger
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Quitmann
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Takacs Haynes K, Rašković M(M. Living with Corruption in Central and Eastern Europe: Social Identity and the Role of Moral Disengagement. J Bus Ethics 2021; 174:825-845. [PMID: 34511671 PMCID: PMC8418456 DOI: 10.1007/s10551-021-04927-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED We examine corruption across three Central and Eastern Europe (CEE) countries (Hungary, North Macedonia and Slovenia) through a social psychology framework which integrates social identity theory, social cognitive theory and moral disengagement mechanisms. We illustrate how various social identities influence individual and collective action in terms of ethical behavior and corruption, thereby creating, maintaining and perpetuating petty, grand and systemic public/private corruption through triadic co-determination via cognition, behavior and the environment. Despite growing research on corruption normalization, less is known about the cognitive and behavioral mechanisms in ethical decision making, the cognitive workings of how individuals reconcile unethical behavior and the social psychological processes behind corruption in society and organizations. Expert interviews reveal internally conflicted multi-layered social identities perpetuating corruption, some embedded in nationalistic history and others tied to the European Union, which supports the divergent paths of CEE countries since the fall of communism. Some moral disengagement mechanisms are common across all three countries, while others are linked to specific circumstances. Social identity mechanisms feed into moral disengagement, which individuals draw upon to reconcile the conflict between unethical behavior and moral codes. Patterns of moral disengagement aggregate to the country level and explain normalization of corruption in CEE society and organizations. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10551-021-04927-9.
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Affiliation(s)
- Katalin Takacs Haynes
- Department of Business Administration, Lerner College of Business and Economics, University of Delaware, 210 Lerner Hall, Newark, DE 19716 USA
| | - Matevž (Matt) Rašković
- School of Marketing and International Business, Victoria University of Wellington, 23 Lambton Quay, Rutherford House, Level 11, 1115, 6011 Wellington, New Zealand
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Lee SM, Lee D. Opportunities and challenges for contactless healthcare services in the post-COVID-19 Era. Technol Forecast Soc Change 2021; 167:120712. [PMID: 33654330 PMCID: PMC7908833 DOI: 10.1016/j.techfore.2021.120712] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 05/03/2023]
Abstract
This study examines the opportunities and challenges involved with contactless healthcare services in the post-COVID-19 pandemic era. First, we reviewed the literature to analyze contactless or contact-free healthcare services that have been utilized in pre-and during the COVID-19 pandemic periods. Then, we interviewed medical experts and hospital administrators to gain knowledge about how healthcare providers are currently working to mitigate the spread of COVID and preparing for the post-pandemic period. Thus, we analyzed the evolution and utilization of contactless services during the three different time periods: pre-, during-, and post-COVID-19. The results indicated that in the post-COVID-19 era, a new normal of hybrid healthcare services would emerge. While some of the contactless services that have been practiced during the pandemic may revert to the traditional face-to-face services, those innovative contactless healthcare services that have been proven effective during the pandemic would be practiced or even advanced in the post-pandemic period due to the accelerating technological developments. This study suggests many potential opportunities and daunting challenges for healthcare institutions, policymakers, and consumers regarding the implementation of contactless services in the post-COVID-19 era.
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Affiliation(s)
- Sang M Lee
- College of Business, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - DonHee Lee
- College of Business Administration, Inha University, 100 Inharo, Michuhol-gu, Incheon, South Korea
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Abstract
This study examines the opportunities and challenges involved with contactless healthcare services in the post-COVID-19 pandemic era. First, we reviewed the literature to analyze contactless or contact-free healthcare services that have been utilized in pre-and during the COVID-19 pandemic periods. Then, we interviewed medical experts and hospital administrators to gain knowledge about how healthcare providers are currently working to mitigate the spread of COVID and preparing for the post-pandemic period. Thus, we analyzed the evolution and utilization of contactless services during the three different time periods: pre-, during-, and post-COVID-19. The results indicated that in the post-COVID-19 era, a new normal of hybrid healthcare services would emerge. While some of the contactless services that have been practiced during the pandemic may revert to the traditional face-to-face services, those innovative contactless healthcare services that have been proven effective during the pandemic would be practiced or even advanced in the post-pandemic period due to the accelerating technological developments. This study suggests many potential opportunities and daunting challenges for healthcare institutions, policymakers, and consumers regarding the implementation of contactless services in the post-COVID-19 era.
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Affiliation(s)
- Sang M Lee
- College of Business, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - DonHee Lee
- College of Business Administration, Inha University, 100 Inharo, Michuhol-gu, Incheon, South Korea
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Borgmann LS, Waldhauer J, Bug M, Lampert T, Santos-Hövener C. [Improving access to migrant populations for epidemiological research-guided interviews with German experts]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1397-405. [PMID: 31650187 DOI: 10.1007/s00103-019-03036-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In Germany, reliable information on the health of people with migration background (PMB) is scarce. Therefore, the Robert Koch Institute initiated the project "Improving health monitoring in migrant populations (IMIRA)" to improve the inclusion of PMB into the federal health monitoring. OBJECTIVE The objective of this article is to identify challenges and strategies in accessing migrant populations with epidemiological research. MATERIAL AND METHODS A total of 24 guided interviews with experts from Germany were conducted. Experts were scientists from various disciplines with a research focus on migration, civil servants in the area of migration, and experts from the field. The interview focused on challenges and strategies regarding access to migrants in research. The written summaries of the interviews were analyzed. RESULTS Challenges in accessing PMB include language, sociodemographic and cultural barriers, fears, structural, and practical difficulties. Further challenges arise from the heterogeneity and motivation of the groups. Strategies to increase accessibility among PMB can be found in the research process, methods, communication, and diversity-sensitive research culture. Confidence-building is considered significant. DISCUSSION Experts report a variety of strategies that focus on addressing and including PMB directly: strengthening of participatory approaches, new forms of translation, and measures to increase trust in research should be the focus of future efforts. The willingness to participate in epidemiological research can be increased with appropriate strategies and thus data on the health of migrant populations can be improved sustainably.
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Armstrong S, Langlois A, Siriwardena N, Quinn T. Ethical considerations in prehospital ambulance based research: qualitative interview study of expert informants. BMC Med Ethics 2019; 20:88. [PMID: 31775727 PMCID: PMC6882313 DOI: 10.1186/s12910-019-0425-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/11/2019] [Indexed: 11/15/2022] Open
Abstract
Background Prehospital ambulance based research has unique ethical considerations due to urgency, time limitations and the locations involved. We sought to explore these issues through interviews with experts in this research field. Methods We undertook semi-structured interviews with expert informants, primarily based in the UK, seeking their views and experiences of ethics in ambulance based clinical research. Participants were questioned regarding their experiences of ambulance based research, their opinions on current regulations and guidelines, and views about their general ethical considerations. Participants were chosen because they were actively involved in, or in their expert capacity (e.g. law) expressed an interest in, ambulance based research. Results Fourteen participants were interviewed including principal investigators, researchers, ethicists and medical lawyers. Five major themes were identified: Capacity, Consent, Clinical Considerations, Consultation and Regulation. Questions regarding consent and capacity were foremost in the discussions as all participants highlighted these as areas for concern. The challenges and use of multiple consent models reflected the complexity of research in this environment. The clinical theme referred to the role of paramedics in research and how research involving ambulance services is increasingly informing improvements to patient care and outcomes and reducing the burden on hospital services. Most felt that, although current regulations were fit for purpose, more specific guidance on implementing these in the ambulance setting would be beneficial. This related closely to the theme of consultation, which examined the key role of ethics committees and other regulatory bodies, as well as public engagement. Conclusions By interviewing experts in research or ethics in this setting we were able to identify key concerns and highlight areas for future development such as improved guidance.
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Affiliation(s)
- Stephanie Armstrong
- School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK.
| | - Adele Langlois
- School of Social and Political Science, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Niroshan Siriwardena
- Professor of Primary and Pre-hospital Healthcare, Community and Health Research Unit School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Tom Quinn
- Emergency, Cardiovascular and Critical Care Research Group, Kingston University and St George's, University of London, 6th Floor, Hunter Wing Cranmer Terrace, London, SW17 0RE, UK
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Jansky M, Owusu-Boakye S, Nauck F. "An odyssey without receiving proper care" - experts' views on palliative care provision for patients with migration background in Germany. BMC Palliat Care 2019; 18:8. [PMID: 30665379 PMCID: PMC6341678 DOI: 10.1186/s12904-019-0392-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/09/2019] [Indexed: 11/30/2022] Open
Abstract
Background Migrants seem to be underrepresented in palliative care in Germany. Access barriers and challenges in care remain unclear. We aimed to provide a comprehensive insight into palliative care for migrants, using expert interviews. Methods Interviews with experts on palliative and general health care for migrants were audiotaped and transcribed. Data analysis followed a qualitative content analysis method for expert interviews proposed by Meuser and Nagel. Results In total, 13 experts from various fields (palliative and hospice care, other care, research and training) were interviewed. Experts identified access barriers on the health care system and the patient level as well as the sociopolitical level. Services don’t address migrants, who may use parallel structures. Patients may distrust the health care system, be oriented towards their home country and expect the family to care for them. In care, poor adaptation and inflexibility of health care services regarding needs of migrant patients because of scarce resources, patients’ preferences which may contradict professionals' values, and communication both on the verbal and nonverbal level were identified as the main challenges. Conflicts between patients, families and professionals are at risk to be interpreted exclusively as cultural conflicts. Palliative care providers should use skilled interpreters instead of family interpreters or unskilled staff members, and focus on training cultural competence. Furthermore, intercultural teams could enhance palliative care provision for migrants. Conclusions Though needs and wishes of migrant patients are often found to be similar to those of non-migrant patients, there are migration-specific aspects that can influence care provision at the end of life. Migration should be regarded as a biographical experience that has a severe and ongoing impact on the life of an individual and their family. Language barriers have to be considered, especially regarding patients' right to informed decision making. The reimbursement of interpreters in health care remains an open question. Electronic supplementary material The online version of this article (10.1186/s12904-019-0392-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maximiliane Jansky
- Clinic for Palliative Medicine, University Medical Center Goettingen, Robert Koch-Str. 40, 37075, Goettingen, Germany.
| | - Sonja Owusu-Boakye
- Clinic for Palliative Medicine, University Medical Center Goettingen, Robert Koch-Str. 40, 37075, Goettingen, Germany
| | - Friedemann Nauck
- Clinic for Palliative Medicine, University Medical Center Goettingen, Robert Koch-Str. 40, 37075, Goettingen, Germany
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Prodinger B, Taylor P. Improving quality of care through patient-reported outcome measures (PROMs): expert interviews using the NHS PROMs Programme and the Swedish quality registers for knee and hip arthroplasty as examples. BMC Health Serv Res 2018; 18:87. [PMID: 29415714 PMCID: PMC5803859 DOI: 10.1186/s12913-018-2898-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient reported outcome measures (PROMs) have been integrated in national quality registries or specific national monitoring initiatives to inform the improvement of quality of care on a national scale. However there are many unanswered questions, such as: how these systems are set up, whether they lead to improved quality of care, which stakeholders use the information once it is available. The aim of this study was to examine supporting and hindering factors relevant to integrating patient-reported outcome measures (PROMs) in selected health information systems (HIS) tailored toward improving quality of care across the entire health system. METHODS First, a systematic search and review was conducted to outline previously identified factors relevant to the integration of PROMs in the selected HIS. A social network analysis was performed to identify networks of experts in these systems. Second, expert interviews were conducted to discuss and elaborate on the identified factors. Directive content analysis was applied using a HIS Evaluation Framework as the frame of reference. This framework is structured into four components: Organization, Human, Technology, and Net benefits. RESULTS The literature review revealed 37 papers for the NHS PROMs Programme and 26 papers for the SHPR and SKAR: Five networks of researchers were identified for the NHS PROMs Programme and 1 for the SHPR and SKAR. Seven experts related to the NHS PROMs Programme and 3 experts related to the SKAR and SHPR participated in the study. The main themes which revealed in relation to Organization were Governance and Capacity building; to Human: Reporting and Stakeholder Engagement; to Technology: the Selection and Collection of PROMs and Data linkage. In relation to Net benefits, system-specific considerations are presented. CONCLUSION Both examples succeeded in integrating PROMs into HIS on a national scale. The lack of an established standard on what change PROMs should be achieved by an intervention limits their usefulness for monitoring quality of care. Whether the PROMs data collected within these systems can be used in routine clinical practice is considered a challenge in both countries.
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Affiliation(s)
- Birgit Prodinger
- University of Applied Sciences Rosenheim, Faculty for Applied Health and Social Sciences, Hochschulstr. 1, 83024 Rosenheim, Germany
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
| | - Paul Taylor
- CHIME, Institute of Health Informatics, 222 Euston Road, London, NW1 2DA UK
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Korber K, Becker C. Expert opinions on good practice in evaluation of health promotion and primary prevention measures related to children and adolescents in Germany. BMC Public Health 2017; 17:764. [PMID: 28969620 PMCID: PMC5625768 DOI: 10.1186/s12889-017-4773-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/19/2017] [Indexed: 11/10/2022] Open
Abstract
Background Determining what constitutes “good practice” in the measurement of the costs and effects of health promotion and disease prevention measures is of particular importance. The aim of this paper was to gather expert knowledge on (economic) evaluations of health promotion and prevention measures for children and adolescents, especially on the practical importance, the determinants of project success, meaningful parameters for evaluations, and supporting factors, but also on problems in their implementation. This information is targeted at people responsible for the development of primary prevention or health promotion programs. Methods Partially structured open interviews were conducted by two interviewers and transcribed, paraphrased, and summarized for further use. Eight experts took part in the interviews. Results The interviewed experts saw evaluation as a useful tool to establish the effects of prevention programs, to inform program improvement and further development, and to provide arguments to decision making. The respondents’ thought that determinants of a program’s success were effectiveness with evidence of causality, cost benefit relation, target-group reach and sustainability. It was considered important that hard and soft factors were included in an evaluation; costs were mentioned only by one expert. According to the experts, obstacles to evaluation were lacking resources, additional labor requirements, and the evaluators’ unfamiliarity with a program’s contents. It was recommended to consider evaluation design before a program is launched, to co-operate with people involved in a program and to make use of existing structures. Conclusion While in in this study only a partial view of expert knowledge is represented, it could show important points to consider when developing evaluations of prevention programs. By considering these points, researchers could further advance towards a more comprehensive approach of evaluation targeting measures in children and adolescents.
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Affiliation(s)
- Katharina Korber
- Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität, 80539, Munich, Germany. .,Institute for Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, 85764, Neuherberg, Germany.
| | - Christian Becker
- Institute for Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, 85764, Neuherberg, Germany
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15
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Broda A, Bieber A, Meyer G, Hopper L, Joyce R, Irving K, Zanetti O, Portolani E, Kerpershoek L, Verhey F, Vugt MD, Wolfs C, Eriksen S, Røsvik J, Marques MJ, Gonçalves-Pereira M, Sjölund BM, Woods B, Jelley H, Orrell M, Stephan A. Perspectives of policy and political decision makers on access to formal dementia care: expert interviews in eight European countries. BMC Health Serv Res 2017; 17:518. [PMID: 28774307 PMCID: PMC5543593 DOI: 10.1186/s12913-017-2456-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Methods Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4–7 experts (total N = 38). The interview guide addressed the topics “Complexity and Continuity of Care”, “Formal Services”, and “Public Awareness”. Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. Results The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness. Conclusions Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2456-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anja Broda
- Martin Luther University Halle-Wittenberg, Institute of Health and Nursing Sciences, Magdeburger Straße 8, D-06112, Halle (Saale), Germany.
| | - Anja Bieber
- Martin Luther University Halle-Wittenberg, Institute of Health and Nursing Sciences, Magdeburger Straße 8, D-06112, Halle (Saale), Germany
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, Institute of Health and Nursing Sciences, Magdeburger Straße 8, D-06112, Halle (Saale), Germany
| | - Louise Hopper
- Dublin City University, School of Nursing and Human Sciences, Dublin, Ireland
| | - Rachael Joyce
- Dublin City University, School of Nursing and Human Sciences, Dublin, Ireland
| | - Kate Irving
- Dublin City University, School of Nursing and Human Sciences, Dublin, Ireland
| | - Orazio Zanetti
- IRCCS S. Giovanni di Dio "Fatebenefratelli", Brescia, Italy
| | | | - Liselot Kerpershoek
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Claire Wolfs
- Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Siren Eriksen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Oslo, Norway
| | - Janne Røsvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Maria J Marques
- CEDOC, Chronic Diseases Research Center, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Manuel Gonçalves-Pereira
- CEDOC, Chronic Diseases Research Center, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Britt-Marie Sjölund
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Bob Woods
- Bangor University, Dementia Services Development Centre, Bangor, UK
| | - Hannah Jelley
- Bangor University, Dementia Services Development Centre, Bangor, UK
| | - Martin Orrell
- Nottingham University, Institute of Mental Health, Nottingham, UK
| | - Astrid Stephan
- Martin Luther University Halle-Wittenberg, Institute of Health and Nursing Sciences, Magdeburger Straße 8, D-06112, Halle (Saale), Germany
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Kleemann J, Baysal G, Bulley HNN, Fürst C. Assessing driving forces of land use and land cover change by a mixed-method approach in north-eastern Ghana, West Africa. J Environ Manage 2017; 196:411-442. [PMID: 28334680 DOI: 10.1016/j.jenvman.2017.01.053] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/04/2017] [Accepted: 01/23/2017] [Indexed: 06/06/2023]
Abstract
Land use and land cover change (LULCC) is the result of complex human-environmental interactions. The high interdependencies in social-ecological systems make it difficult to identify the main drivers. However, knowledge of key drivers of LULCC, including indirect (underlying) drivers which cannot be easily determined by spatial or economic analyses, is essential for land use planning and especially important in developing countries. We used a mixed-method approach in order to detect drivers of LULCC in the Upper East Region of northern Ghana by different qualitative and quantitative methods which were compared in a confidence level analysis. Viewpoints from experts help to answer why the land use is changing, since many triggering effects, especially non-spatial and indirect drivers of LULCC, are not measurable by other methodological approaches. Geo-statistical or economic analyses add to validate the relevance of the expert-based results. First, we conducted in-depth interviews and developed a list of 34 direct and indirect drivers of LULCC. Subsequently, a group of experts was asked in a questionnaire to select the most important drivers by using a Likert scale. This information was complemented by remote sensing analysis. Finally, the driver analysis was compared to information from literature. Based on these analyses there is a very high confidence that population growth, especially in rural areas, is a major driver of LULCC. Further, current farming practice, bush fires, livestock, the road network and climate variability were the main direct drivers while the financial capital of farmers and customary norms regarding land tenure were listed as important indirect drivers with high confidence. Many of these driving forces, such as labour shortage and migration, are furthermore interdependent. Governmental laws, credits, the service by extension officers, conservational agriculture and foreign agricultural medium-scale investments are currently not driving land use changes. We conclude that the mixed-method approach improves the confidence of findings and the selection of most important drivers for modelling LULCC, especially in developing countries.
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Affiliation(s)
- Janina Kleemann
- Karlsruhe Institute of Technology, Institute of Meteorology and Climate Research, Atmospheric Environmental Research (IMK-IFU), Kreuzeckbahnstraße 19, 82467 Garmisch-Partenkirchen, Germany; University of Bonn, Center for Development Research (ZEF), Walter-Flex-Str. 3, 53113 Bonn, Germany.
| | - Gülendam Baysal
- University of Bonn, Center for Development Research (ZEF), Walter-Flex-Str. 3, 53113 Bonn, Germany.
| | - Henry N N Bulley
- (Geography & GIScience), Department of Social Sciences, Human Services & CRJ, BMCC, City University of New York, New York, NY 10007, United States.
| | - Christine Fürst
- Martin Luther University Halle-Wittenberg, Institute for Geosciences and Geography, Sustainable Landscape Development, Von-Seckendorff-Platz 4, 06120 Halle, Germany.
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