Handbook Integrated Care Amelung, Volker; Stein, Viktoria; Goodwin, Nicholas ...
2017, 2017-06-30
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Gives profound insight into the main ideas and concepts of integrated care. It offers a managed care perspective with a focus on patient orientation, efficiency, and quality by applying widely ...recognized management approaches to the field of health care. The handbook also provides international best practices and shows how integrated care does work throughout various health systems. The delivery of health and social care is characterised by fragmentation and complexity in most health systems throughout the world.
Evidence shows that living with diabetes mellitus type 1 (T1DM) in adolescent age is particularly challenging and difficult to manage. A high level of health literacy is important to prevent and ...avoid debilitating complications. Despite the increasing prevalence and incidence of T1DM by adolescent and the large use of digital health interventions, little is known about the association between this use and health literacy. This systematic review provides an overview on the impact of digital health interventions for adolescents with type 1 diabetes on health literacy and derive recommendations for further research.
Electronic searches were performed in five databases in Medline (Medline, PubMed + via PubMed), The Cochrane Library, EMBASE (via Ovid), Web of Science and PsycINFO from 2011 to 2021. In addition, grey literature searches were conducted in Google Scholar, OAlster and Trip. Relevant studies that have been missed by electronic and hand-searching strategies were searched in the reference lists of all included studies. The review followed PRISMA guidelines. Two researchers independently screened abstracts for initial eligibility and applied the inclusion and exclusion criteria to the relevant full-text articles. Quality was assessed using the tools RoB2 Cochrane, ROBINS I, NOS (Newcastle-Ottawa Scale), CASP (Critical Appraisal Skills Programme) for primary studies and Amstar-2 for secondary studies.
Out of 981 studies, 22 were included in the final review. Most primary studies included in this review were judged as moderate overall risk of bias or with some concerns and most of the secondary studies as critically low quality reviews. Our findings suggest that the interplay of health care providers (HCP) and patients through social media helps the management of the disease. This corroborates Bröder et al.' (2017) dimension of 'communication and interactions' in their concept of health literacy.
For adolescents with T1DM, social media may be a specific and beneficial intervention for an improved communication and interaction with their HCP. Further research should investigate what specific form of social media suits best for which adolescents.
The study protocol was registered on the 15th of November 2021 on Prospero (reg. NR: CRD42021282199).
The extend of lung disease remains the most important prognostic factor for survival in patients with cystic fibrosis (CF), and lack of adherence is the main reason for treatment failure. Early ...detection of deterioration in lung function and optimising adherence are therefore crucial in CF care. We implement a randomized controlled trial to evaluate efficacy of telemonitoring of adherence, lung function, and health condition in combination with behavior change interventions using innovative digital technologies.
This is a multi-centre, randomized, controlled, non-blinded trial aiming to include 402 patients ≥ 12 years-of-age with CF. A standard-of-care arm is compared to an arm receiving objective, continuous monitoring of adherence to inhalation therapies, weekly home spirometry using electronic devices with data transmission to patients and caring physicians combined with video-conferencing, a self-management app and professional telephone coaching. The duration of the intervention phase is 18 months. The primary endpoint is time to the first protocol-defined pulmonary exacerbation. Secondary outcome measures include number of and time between pulmonary exacerbations, adherence to inhalation therapy, changes in forced expiratory volume in 1 s from baseline, number of hospital admissions, and changes in health-related quality of life. CF-associated medical treatment and care, and health care related costs will be assessed by explorative analysis in both arms.
This study offers the opportunity to evaluate the effect of adherence interventions using telemedicine capable devices on adherence and lung health, possibly paving the way for implementation of telemedicine in routine care for patients with CF.
This study has been registered with the German Clinical Trials Register (Identifier: DRKS00024642, date of registration 01 Mar 2021, URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024642 ).
Digital health intervention offers the potential to enhance health literacy, which is crucial for effective diabetes management, especially among adolescents. Diabetes is a major global public health ...issue, leading to devastating complications and increasing mortality rates. The incidence of type 1 diabetes mellitus (T1DM) is also on the rise, particularly among adolescents, necessitating multisectoral strategies to combat this disease. This study explores the perceptions of adolescents with T1DM in Germany regarding digital health interventions, with the aim of improving healthcare by addressing specific needs and guiding future research.
This study employed a qualitative approach using semi-structured individual interviews with adolescents with T1DM (
= 20) aged 14 to 18 years old in Germany to explore their perspectives on digital interventions for health literacy promotion. The study adopted content analysis according to Kuckartz et al. and the research followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Ethical considerations were paramount and data were rigorously analyzed using coding and iterative processes to ensure data quality and reliability.
The findings indicate that within three prominent domains, namely the utilization of digital health intervention for accessing and comprehending information, facilitating peer-to-peer interactions, and enhancing physician-patient communication and interaction, digital health interventions are either underutilized or insufficiently deployed. In addition, a notable observation is the apparent lack of patient-centered approaches for adolescents with T1DM in relation to digital health interventions and health literacy.
In order to enhance the utilization of digital health interventions and enhance health literacy it is essential to focus on capacity building through a patient-centered approach, to promote digital health literacy, and foster the cultivation of a participatory culture. The outcomes of this study offer valuable insights that can inform practical applications, further research endeavors, and influence policymaking.
Abstract Background Over the past few years, students in Germany have been dropping out of medical school at increasing rates, and the number of physicians choosing to work abroad or in non-medical ...professions has been growing. A recent study (the “Ramboll Study”) commissioned by the Health Ministry concluded that German physicians’ dissatisfaction with existing monetary and non-monetary incentive systems during training and subsequent practice was the main reason for these trends. Among those physicians who have remained in the workforce, there is a similar dissatisfaction, reflected in part by a general strike in 2006 by German physicians in favour of higher wages and better working conditions. Objective To better understand the decision-making process of physicians which is highly determined by the satisfaction they experience in their work life and to extract the factors that contribute to their satisfaction. Methods We surveyed all physicians who spent more than 50% of their time in patient care (and less than 50% in research) at the teaching hospital of the Hannover Medical School (839, after exclusion of pre-test participants). Based on existing satisfaction studies, we designed a self-administered questionnaire that contained 28 items, including items measuring several dimensions of physician job satisfaction; the monetary and non-monetary incentives the physicians experienced in the recent past; other job-related potential confounding factors and socio-demographic questions. Respondents were asked to rate each job satisfaction item on five-point Likert scales regarding both satisfaction with and importance of the item. Data were analysed using descriptive statistics, factor and correlation analyses. Results and discussion Our data suggest that non-monetary factors are important determinants of physician job satisfaction, perhaps more important than monetary incentives that may augment or reduce physicians’ base incomes. Factor analysis revealed seven principal factors of which decision-making and recognition , continuous education and job security , administrative tasks and collegial relationships were highly significant, specialized technology and patient contact were significant and research and teaching and international exchange were not significant in contributing to physician job satisfaction. Conclusion This study sheds light to the underlying factors that contribute to physician job satisfaction in Germany, and it provides insights into the reasons for physicians leaving medical practice. In order for a health system to recruit and retain physicians, it may be necessary for a system's physician strategy to shift from focusing primarily on hard, monetary and compensation-related factors to a broader focus that incorporates the soft, non-monetary factors. The implementation of policies and management practices that reduce the time burden on physicians, and enhance physicians’ participation in the development of patient care management processes and in managerial decisions that affect patient care appears to be crucial. The result will be increased job satisfaction among physicians, which is important to the future recruitment and retention of doctors, as well as to the productivity and quality of the services provided by this essential component of our medical care systems.
An intent of the Patient Protection and Affordable Care Acts (ACA), also know as Obama Care, was to slow the expenditure growth in the public Medicare-System by shifting the accountability for health ...care outcomes and costs to the provider. For this purpose, provider were allowed to form networks, which would then take accountability for a defined population - Accountable Care Organizations (ACOs). Ten years after the introduction of ACOs, this paper looks at the impact of ACOs both on quality of care and costs of care to assess if ACOs can be a model of care delivery for Germany.
In a mixed-method approach, a rapid review was conducted in Health System Evidence and PubMed. This was supported with further papers identified using the snowballing-technique. After screening the abstracts, we included articles containing information on cost- and/or quality impact of US-Medicare-ACOs. The findings of the rapid review were challenged with 16 ACO-experts and stakeholder in the USA.
In total, we included 60 publications which incorporated 6 reports that were either conducted directly by governmental institutions or ordered by them, along with 3 previous reviews. Among these, 31 contained information on costs of care, 18 contained information on quality of care and 11 had information on both aspects. The publications show that ACOs reduced costs of of care. Cost reductions were achieved compared to historic costs, to populations not cared for in ACOs, and counterfactuals. Quality of care stayed the same or improved.
ACOs contributed to slowing the cost growth in US Medicare without compromising quality of care. Thus, a transferal of this model of care to Germany should be considered. However, various policies have led to ACOs failing to unleash their full potential. Against this background, and against the background of stark differences between US Medicare and the German health care system, a critical reflection of the necessary policies underlying ACOs-like structures in Germany, needs to be undertaken.
Zusammenfassung Hintergrund Für Jugendliche, die als „digital natives“ gelten und an Typ-1-Diabetes (T1D) leiden, bieten digitale Interventionen die Möglichkeit, Gesundheitskompetenz zu stärken. Die ...COVID-19-Pandemie („coronavirus disease 2019“) hat die Implementierung digitaler Interventionen beschleunigt. Jedoch bleibt die Frage offen, ob sie umfassend in der diabetologischen Versorgung integriert werden können oder randständig genutzt werden. Ziel der Arbeit Das Ziel dieser Studie ist der Vergleich der Perspektiven von Ärzt:innen und Jugendlichen mit T1D hinsichtlich des Einsatzes digitaler Interventionen zur Stärkung der Gesundheitskompetenz. Methoden Die Studie basiert auf dem Vergleich von 2 separaten qualitativen Primärstudien zu digitalen Interventionen bei Jugendlichen mit T1D. Die Daten wurden durch halbstrukturierte Einzelinterviews erhoben. Die erste Studie untersuchte die Ansichten von Ärzt:innen ( n = 12), während die zweite Studie die Perspektiven betroffener Jugendlicher mit T1D ( n = 20) betrachtete. Beide Studien wurden separat analysiert und verwenden die COREQ-Checkliste von Tong et al. (2007). Ergebnisse Es wurden zwei relevante Themen aus den Studien identifiziert und verglichen: Peer-to-peer-Beziehungen und die Nutzung digitaler Interventionen in der Kommunikation zwischen Ärzt:innen und Jugendlichen mit T1D. Die Ergebnisse deuten darauf hin, dass es Unstimmigkeiten in der Bewertung, der empfundenen Nutzung und des Mehrwerts der digitalen Interventionen gibt. Schlussfolgerung Jugendliche mit T1D und Ärzt:innen schätzen den Stellenwert von Peer-to-peer-Beziehungen und Kommunikation und Interaktion zwischen Ärzt:innen und Patient:innen sehr unterschiedlich ein. Diese Unterschiede haben wiederum Implikationen auf die Nutzung von digitalen Gesundheitstechnologien und deren Förderung von Gesundheitskompetenz.
Abstract Background For adolescents who are considered “digital natives” and suffer from type 1 diabetes (T1D), digital interventions offer the opportunity to strengthen health literacy. The coronavirus disease 2019 (COVID-19) pandemic accelerated the implementation of digital interventions. However, the question remains as to whether they can be comprehensively integrated into diabetology care or are used only marginally. Aim The aim of this study is to compare the perspectives of physicians and adolescents with T1D on the use of digital interventions to strengthen health literacy. Methods The study is based on the comparison of two separate qualitative primary studies on digital interventions in adolescents with T1D. Data were collected through semi-structured individual interviews. The first study examined the views of physicians ( n = 12), while the second study looked at the perspectives of adolescents with T1D ( n = 20). Both studies were analyzed separately and used the COREQ checklist by Tong et al. (2007). Results Two relevant themes from the studies were identified and compared: peer-to-peer relationships and the use of digital interventions in communication between physicians and adolescents with T1D. The results suggest that there are inconsistencies in the evaluation, the perceived use and the added value of digital interventions. Conclusion The importance of peer-to-peer relationships and communication between physicians and patients is rated differently by adolescents with T1D and physicians. These differences have implications for the use and promotion of digital health technologies to improve health literacy.
One of the central challenges in health policy is to ensure nationwide provision of primary healthcare services. However, it is not clear how the general public rates the current primary healthcare ...provision in their region. Furthermore, there is very little information on whether people are willing to make use of new models of care that could contribute to ensuring a nationwide provision of healthcare services. Thus, the objective of this study was to analyse the general public's ratings of the local primary healthcare provision as well as their acceptance of selected new models of care. Furthermore, potential differences in the ratings of the population between hard to serve regions and normal regions will be analysed.
Focus group discussions and a literature review were conducted in order to develop a questionnaire to elicit the expectations of the population concerning the local provision of primary healthcare as well as their acceptance of new models of care. A postal questionnaire was sent to a random sample of 2,000 persons in 8 regions in Lower Saxony.
The adjusted response rate of the postal survey was 51% (n=996). 97% of respondents saw a general practitioner regularly, with 5.4 visits per year on average. Patients could reach the practice in 13 min on average. Respondents predominantly rated the current healthcare provision as being good. However, the majority of respondents expected the local primary healthcare provision to deteriorate in the future. New models of care most preferred by the respondents were the delegation of medical tasks to non-medical professionals and mobility-oriented models. On the other hand, the provision of healthcare via telemedicine was rejected.
According to the results of this study, respondents believe that new models of care can play an important role in ensuring the nationwide provision of healthcare services. Introducing, at an early stage, those new models of care that people accept could contribute to ensuring a sustainable provision of primary healthcare services. Furthermore, the introduction of these new models of care could reduce the public's concerns regarding a worsening provision of primary healthcare services in their regions. Additionally, pilot projects with those new models of care that are rather rejected might increase acceptance with these models of care if they prove to be successful.
Introduction Adolescents with type 1 diabetes mellitus (T1D) require a high level of health literacy (HL) to prevent complications. It remains unclear what potential digital interventions have for ...promoting HL among adolescents with T1D, as viewed by physicians working with this target group. Additionally, it is unclear how the institutions (inpatient care and outpatient care) can support and facilitate the use of digital interventions to promote HL. Research design and methods An exploratory study was conducted using semistructured interviews with physicians (n=12) in Germany. The interview questions are based on a previous systematic review. The coding was conducted deductively and inductively using MAXQDA software. Subsequently, the interviews were analysed systematically through an iterative process of content analyses in line with Kuckartz et al . Results It was reported by the physicians that digital interventions are underused due to technical resources, lack of structural conditions, information and legal constraints. The utilisation of digital interventions to promote HL was heterogeneous and depended primarily on the willingness of the physicians. Communication strategy techniques were widely employed to motivate patients, an activity occurring mainly in-person, thus limiting the opportunity for the deployment of digital interventions. Conclusions To increase the use of digital interventions and improve HL, support for digital literacy skills could be implemented. Capacity building through patient-centred, interdisciplinary and participatory culture should be considered. The findings of this study can provide valuable insights for practice, research and policy.
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