610 Medizin, Gesundheit
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Background
Uncomplicated urinary tract infections (UTI) are common in general practice and usually treated with antibiotics. This contributes to increasing resistance rates of uropathogenic bacteria. A previous trial showed a reduction of antibiotic use in women with UTI by initial symptomatic treatment with ibuprofen. However, this treatment strategy is not suitable for all women equally. Arctostaphylos uva-ursi (UU, bearberry extract arbutin) is a potential alternative treatment. This study aims at investigating whether an initial treatment with UU in women with UTI can reduce antibiotic use without significantly increasing the symptom burden or rate of complications.
Methods
This is a double-blind, randomized, and controlled comparative effectiveness trial. Women between 18 and 75 years with suspected UTI and at least two of the symptoms dysuria, urgency, frequency or lower abdominal pain will be assessed for eligibility in general practice and enrolled into the trial. Participants will receive either a defined daily dose of 3 × 2 arbutin 105 mg for 5 days (intervention) or fosfomycin 3 g once (control). Antibiotic therapy will be provided in the intervention group only if needed, i.e. for women with worsening or persistent symptoms. Two co-primary outcomes are the number of all antibiotic courses regardless of the medical indication from day 0–28, and the symptom burden, defined as a weighted sum of the daily total symptom scores from day 0–7. The trial result is considered positive if superiority of initial treatment with UU is demonstrated with reference to the co-primary outcome number of antibiotic courses and non-inferiority of initial treatment with UU with reference to the co-primary outcome symptom burden.
Discussion
The trial’s aim is to investigate whether initial treatment with UU is a safe and effective alternative treatment strategy in women with UTI. In that case, the results might change the existing treatment strategy in general practice by promoting delayed prescription of antibiotics and a reduction of antibiotic use in primary care.
Background
In Germany, up to 50% of nursing home residents are admitted to a hospital at least once a year. It is often unclear whether this is beneficial or even harmful. Successful interprofessional collaboration and communication involving general practitioners (GPs) and nurses may improve medical care of nursing home residents. In the previous interprof study, the six-component intervention package interprof ACT was developed to facilitate collaboration of GPs and nurses in nursing homes. The aim of this study is to evaluate the effectiveness of the interprof ACT intervention.
Methods
This multicentre, cluster randomised controlled trial compares nursing homes receiving the interprof ACT intervention package for a duration of 12 months (e.g. comprising appointment of mutual contact persons, shared goal setting, standardised GPs’ home visits) with a control group (care as usual). A total of 34 nursing homes are randomised, and overall 680 residents recruited. The intervention package is presented in a kick-off meeting to GPs, nurses, residents/relatives or their representatives. Nursing home nurses act as change agents to support local adaption and implementation of the intervention measures. Primary outcome is the cumulative incidence of hospitalisation within 12 months. Secondary outcomes include admissions to hospital, days admitted to hospital, use of other medical services, prevalence of potentially inappropriate medication and quality of life. Additionally, health economic and a mixed methods process evaluation will be performed.
Discussion
This study investigates a complex intervention tailored to local needs of nursing homes. Outcomes reflect the healthcare and health of nursing home residents, as well as the feasibility of the intervention package and its impact on interprofessional communication and collaboration. Because of its systematic development and its flexible nature, interprof ACT is expected to be viable for large-scale implementation in routine care services regardless of local organisational conditions and resources available for medical care for nursing home residents on a regular basis. Recommendations will be made for an improved organisation of primary care for nursing home residents. In addition, the results may provide important knowledge and data for the development and evaluation of further strategies to improve outpatient care for elderly care-receivers.
Background: To improve interprofessional collaboration between registered nurses (RNs) and general practitioners (GPs) for nursing home residents (NHRs), the interprof ACT intervention package was developed. This complex intervention includes six components (e.g., shared goal setting, standardized procedures for GPs’ nursing home visits) that can be locally adapted. The cluster‑randomized interprof ACT trial evaluates the effects of this intervention on the cumulative incidence of hospital admissions (primary outcome) and secondary outcomes (e.g., length of hospital stays, utilization of emergency care services, and quality of life) within 12 months. It also includes a process evaluation which is subject of this protocol. The objectives of this evaluation are to assess the implementation of the interprof ACT intervention package and downstream effects on nurse–physician collaboration as well as preconditions and prospects for successive implementation into routine care.
Methods: This study uses a mixed methods triangulation design involving all 34 participating nursing homes (clusters). The quantitative part comprises paper‑based surveys among RNs, GPs, NHRs, and nursing home directors at baseline and 12 months. In the intervention group (17 clusters), data on the implementation of preplanned implementation strategies (training and supervision of nominated IPAVs, interprofessional kick‑off meetings) and local implementation activities will be recorded. Major outcome domains are the dose, reach and fidelity of the implementation of the intervention package, changes in interprofessional collaboration, and contextual factors. The qualitative part will be conducted in a subsample of 8 nursing homes (4 per study group) and includes repeated non‑participating observations and semistructured interviews on the interaction between involved health professionals and their work processes. Quantitative and qualitative data will be descriptively analyzed and then triangulated by means of joint displays and mixed methods informed regression models.
Discussion: By integrating a variety of qualitative and quantitative data sources, this process evaluation will allow comprehensive assessment of the implementation of the interprof ACT intervention package, the changes induced in interprofessional collaboration, and the influence of contextual factors. These data will reveal expected and unexpected changes in the procedures of interprofessional care delivery and thus facilitate accurate conclusions for the further design of routine care services for NHRs.
Catholic Ownership, Physician Leadership and Operational Strategies: Evidence from German Hospitals
(2022)
Previous research has revealed that Catholic hospitals are more likely follow a strategy of horizontal diversification and maximization of the number of patients treated, whereas Protestant hospitals follow a strategy of horizontal specialization and focus on vertical differentiation. However, there is no empirical evidence pertaining to this mechanism. We conduct an empirical study in a German setting and argue that physician leadership mediates the relationship between ownership and operational strategies. The study includes the construction of a model combining data from a survey and publicly available information derived from the annual quality reports of German hospitals. Our results show that Catholic hospitals opt for leadership structures that ensure operational strategies in line with their general values, i.e., operational strategies of maximizing volume throughout the overall hospital. They prefer part-time positions for chief medical officers, as chief medical officers are identified to foster strategies of maximizing the overall number of patients treated. Hospital owners should be aware that the implementation of part-time and full-time leadership roles can help to support their strategies. Thus, our results provide insights into the relationship between leadership structures at the top of an organization, on the one hand, and strategic choices, on the other.
Rich literature abounds concerning the clinical effectiveness of programs aiming to produce weight gain/obesity prevention outcomes. However, there is very little evidence on how these outcomes are produced, and what interplay of factors made those programs effective (or not) in the environment that produced those effects. This study aims to describe the application of realistic evaluation in the field of obesity prevention, as an approach to unravel those components that influence the capacity of a program to produce its effects and to examine its significance in an effort to understand those components. The concepts of critical realism have informed the development of an interview topic guide, while three European programs were selected as case studies after a rigorous selection process. In total, 26 in-depth semi-structured interviews were taken, paired with personal observation and secondary data research. Several grounded context-mechanisms-outcomes (CMO) configurations were described within the respective context of each location, with the mechanisms introduced from each project resulting in distinctive outcomes. This study highlights the potential of realistic evaluation as a comprehensive framework to explain in which contextual circumstances of each program’s effects are produced, how certain underlying mechanisms produce those effects, and how to explicitly connect the context and the acting mechanisms into distinct outcome patterns, which will ultimately form unique configuration sets for each of the analyzed projects.
Hintergrund: In Anbetracht aller Entwicklungen der Forschung und Praxis der Gesundheitsförderung seit der Ottawa Charta (1986) baute sich im Sinne des dritten Ziels „Vermitteln und Vernetzen“ die Vernetzung der Akteur_innen im Kontext der Gesundheit in unterschiedlichen Settings und somit auch an Hochschulen stetig aus. So entstanden neben dem bundesweiten Arbeitskreises Gesundheitsfördernder Hochschulen (AGH) vor allem seit dem Präventionsgesetz im Jahre 2015 auf regionaler Ebene unterschiedliche Netzwerke zur Gesundheitsförderung an Hochschulen. Elementares Ziel der regionalen, aber auch überregionalen Netzwerke ist die Vernetzung der Akteur_innen des betrieblichen und studentischen Gesundheitsmanagements aus den unterschiedlichen Hochschulen Deutschlands und die dadurch verbesserte Förderung der Gesundheit von Studierenden (2.9 Millionen) und Beschäftigten (760.000) an Hochschulen. Zur in dieser Arbeit spezifisch betrachteten regionalen Netzwerkarbeit zur Gesundheitsförderung an Hochschulen und deren Vorgehensweisen liegen noch keine empirischen Befunde vor.
Ziel der Erhebung: Ziel der qualitativen Erhebung war die Identifikation der Vorgehensweisen der regionalen Netzwerke zur Gesundheitsförderung an Hochschulen, wobei die Netzwerke in ihren dynamischen Prozessen und Strukturen als multikomplexe Kommunikationssysteme verstanden werden. Weitere Forschungsfragen beschäftigten sich mit der Bedeutung der Evaluation und den Nachhaltigkeitsstrategien der Netzwerke.
Methodik: Mit Hilfe eines qualitativen leitfadengestützten Vorgehens wurden Vertreter_innen von insgesamt sieben der acht regionalen Netzwerke zur Gesundheitsförderung an Hochschulen im Rahmen eines digitalen Interviews befragt. Als Auswertungsmethode wurde die qualitative Inhaltsanalyse nach Mayring (2015) genutzt.
Ergebnisse: Regionale Netzwerke zur Gesundheitsförderung zeichnen sich durch komplexe Kommunikations- und Arbeitsstrukturen aus. Durch niedrigschwellige und partizipative Arbeitsweisen, z. B. durch die Planung und Durchführung der Netzwerktreffen mit den Mitgliedshochschulen, ergeben sich für die im Fokus stehenden interdisziplinären Akteur_innen unterschiedliche Chancen und Synergieeffekte zur Weiterentwicklung der Gesundheitsförderung. Trotz einiger Überschneidungen agieren die untersuchten regionalen Netzwerke in zentralen Aspekten nicht einheitlich, sondern gestalten die Arbeit abhängig von den gegebenen Strukturen individuell.
Schlussfolgerungen: Regionale Netzwerke zur Gesundheitsförderung an Hochschulen sind dynamische, partizipative und interdisziplinäre Kommunikations- und Arbeitssysteme in denen etablierte Mechanismen der Netzwerkarbeit und Gesundheitsförderung (z. B. Partizipation) dem offenen, innovativen und agilen Charakter eines Netzwerks gegenüberstehen. In diesem Kontinuum nehmen die regionalen Netzwerke gemeinsam mit den Mitgliedern dynamische Entwicklungen wahr und entwickeln zukunftsfähige Lösungen für die Gesundheitsförderung an deutschen Hochschulen.
Background: Continuity of care is associated with many benefits for patients and health care systems. Therefore measuring care coordination - the deliberate organization of patient care activities between two or more participants - is especially needed to identify entries for improvement. The aim of this study was the translation and cultural adaptation of the Medical Home Care Coordination Survey (MHCCS) into German, and the examination of the psychometric properties of the resulting German versions of the MHCCS-P (patient version) and MHCCS-H (healthcare team version).
Methods: We conducted a paper-based, cross-sectional survey in primary care practices in three German federal states (Schleswig-Holstein, Hamburg, Baden-Württemberg) with patients and health care team members from May 2018 to April 2019. Descriptive item analysis, factor analysis, internal consistency and convergent, discriminant and predictive validity of the German instrument versions were calculated by using SPSS 25.0 (Inc., IBM).
Results: Response rates were 43% (n = 350) for patients and 34% (n = 141) for healthcare team members. In total, 300 patient questionnaires and 140 team member questionnaires could be included into further analysis. Exploratory factor analyses resulted in three domains in the MHCCS-D-P and seven domains in the MHCCS-D-H: “link to community resources”, “communication”, “care transitions”, and additionally “self-management”, “accountability”, “information technology for quality assurance”, and “information technology supporting patient care” for the MHCCS-D-H. The domains showed acceptable and good internal consistency (α = 0.838 to α = 0.936 for the MHCCS-D-P and α = 0.680 to α = 0.819 for the MHCCS-D-H).
As 77% of patients (n = 232) and 63% of health care team members denied to have or make written care plans, items regarding the “plan of care” of the original MHCCS have been removed from the MHCCS-D.
Conclusions: The German versions of the Medical Home Care Coordination Survey for patients and healthcare team members are reliable instruments in measuring the care coordination in German primary care practices. Practicability is high since the total number of items is low (9 for patients and 27 for team members).
Ausgangslage: Vor dem Hintergrund der vielfältigen Möglichkeiten des Settings Hochschule, die gesundheitlichen Belange von derzeit 719.203 Beschäftigten und 2,9 Millionen Studierenden zu gestalten und auf diese einzuwirken, bauen immer mehr Hochschulen interne Strukturen zur Gestaltung einer gesundheitsförderlichen Lehr-/ Lernumgebung auf. Besonders die Gesundheit von Studierenden ist in den vergangenen Jahren stärker in den Fokus gerückt, sodass Projekte des Studentischen Gesundheitsmanagements, die die Vermittlung von Gesundheitsförderung an alle Studierende als Aufgabe für den zukünftigen beruflichen Wirkungsbereich beabsichtigen, zunehmend vorangetrieben werden. Bislang gibt es jedoch keine empirischen Untersuchungen, die die MultiplikatorInnenrolle von AbsolventInnen in beruflichen Handlungsfeldern bestätigen.
Ziel der Studie: Ziel der Studie war es herauszufinden, ob und zu welchem Anteil die hochschulisch erworbenen Kompetenzen zum BGM bzw. zur BGF in den beruflichen Handlungsfeldern Anwendung finden und ob sich die AbsolventInnen als MultiplikatorInnen eigeninitiativ an der Gestaltung eines gesundheitsförderlichen Settings beteiligen.
Methoden: Im Rahmen einer als Querschnittsstudie angelegten AbsolventInnen-Befragung zum beruflichen Verbleib beteiligten sich n = 125 AbsolventInnen aus Studiengängen für Pflege- und Gesundheitsberufe. Die Auswertung und Diskussion der Ergebnisse fokussierte sich auf den Befragungsteil zum Betrieblichen Gesundheitsmanagement.
Ergebnisse: Die AbsolventInnen setzen insbesondere verhaltens- und verhältnisbezogene Maßnahmen in ihrem Berufsalltag um und fühlen sich durch ihr Studium gut darauf vorbereitet, Aufgaben zur Ausgangsbestimmung, Maßnahmenentwicklung sowie Evaluationen und Wirksamkeitsnachweise in Bereichen des Betrieblichen Gesundheitsmanagements bzw. der Betrieblichen Gesundheitsförderung zu übernehmen. Der Transfer des gesundheitsförderlichen Wissens und Handelns im Sinne der MultiplikatorInnenrolle zeigt jedoch Handlungsbedarf.
Schlussfolgerungen: Es bedarf einer vertiefenden Reflexion und Stärkung des persönlichen Selbstverständnisses und der professionellen Identität der Gesundheits- und Pflegeberufe mit Blick auf die Betriebliche Gesundheitsförderung unter Einbezug der kontextspezifischen Rahmenbedingungen der Hochschulen und des Gesundheitswesens.