Explore the vast range of titles available.

The patients' active participation in their medical care is important for patients with chronic diseases. Measurements of patient activation are needed for studies and in clinical practice. This study aims to validate the Patient Activation Measure 13 (PAM13-D) in German-speaking primary care patients. This international cross-sectional multicentre study enrolled consecutively patients from primary care practices in three German-speaking countries: Germany, Austria, and Switzerland. Patients completed the PAM13-D questionnaire. General Self-Efficacy scale (GSE) was used to assess convergent validity. Furthermore Cronbach's alpha was performed to assess internal consistency. Exploratory factor analysis was used to evaluate the underlying factor structure of the items. We included 508 patients from 16 primary care practices in the final analysis. Results were internally consistent, with a Cronbach's alpha of 0.84. Factor analysis revealed one major underlying factor. The mean values of the PAM13-D correlated significantly (r = 0.43) with those of the GSE. The German PAM13 is a reliable and valid measure of patient activation. Thus, it may be useful in primary care clinical practice and research.

Background Health-related social problems are common in primary care. Different care models integrating medical and non-medical services in primary care have been tested and established nationally and internationally, such as social prescribing, social work in primary care, health kiosks and integrated primary care centres. The aim of our study was to explore the perspective of general practitioners (GPs) working in Germany on these four care models regarding their meaningfulness and if they would like to use them. Secondary objective was to explore factors influencing this assessment. Methods We conducted a survey of a representative sample of GPs working in Germany. The questionnaire included questions on the assessment of the care models’ meaningfulness and whether the GPs would like to use them. The analysis was carried out descriptively and using linear regression. Results One thousand four hundred thirty-nine GPs took part in the survey. Social prescribing and social work in primary care were rated as the most meaningful concepts. Over 65% of the GPs believed that using at least one of the care models would be beneficial. One in four GPs would even welcome the idea of integrating their practice into an integrated primary care center. Older age and male gender were associated with a more negative assessment of the care models. Conclusions German GPs consider integrating medical and non-medical services in primary care to be meaningful, yet they are somewhat skeptical about its practical implementation in daily practice. However, younger GPs in Germany are significantly more receptive to these models. Trial registration German Register of Clinical Studies (DRKS-ID: DRKS00032585; Registration Date: September 1, 2023).

Ageing societies and urbanization are global phenomena that pose new challenges for care delivery. It is important to create a scientific evidence base to prepare for these changes. Hence, the aim of our study was to assess which research agenda older adults living in an urban environment in Germany suggest. A total of 1000 participants aged 65 years or older from five different neighborhoods of Berlin were randomly chosen and were sent a single item questionnaire allowing them to freely propose research topics regarding ageing well in the city. Codes were developed inductively and clustered into categories. In a second stage, these results were discussed with the participants and local stakeholders in a workshop and video calls. 102 persons suggested 18 research topics in 6 categories: health, living environment, social issues, mobility, and accessibility to information and communication. Proposed research topics ranged from accessibility of health care, green spaces and recreational means to social involvement and loneliness. There is a substantial interest of older adults for research regarding their living situation. Research projects and local urban planning committees are encouraged to invite older adults to participate and integrate their perspectives suggested by older adults.

Social prescribing (SP) aims to provide targeted psychosocial support and close the gap between medical and non-medical services. This review assesses the effectiveness of community-based SP interventions. We performed a systematic review and qualitative synthesis of interventional studies of community referral interventions focused on facilitating psychosocial support. We considered health-related endpoints, other patient reported outcomes, or health care utilization. Six databases, grey literature, and additional trials registers were searched. Results were screened in a two-step process, followed by data extraction, each by two independent reviewers. If data permitted such, effect sizes were calculated. Risk of bias was assessed with the EPHPP and the Cochrane RoB2 tools. We identified 68 reports from 53 different projects, three were controlled studies. Uncontrolled studies with shorter time frames frequently reported positive effects. This could largely not be seen in controlled settings and for longer follow-up periods. Designs, populations, and outcomes evaluated were heterogeneous with high risk of bias for most studies. Current evidence suggests positive effects of SP on a variety of relevant endpoints. Due to quality deficits in the available studies, scope for conclusions concerning clinical relevance and sustainability is limited. Further methodologically rigorous controlled trials are needed.

Background Breast cancer and cervical cancer are among the most common cancers in women in Germany. Early detection examinations such as mammography and the cervical smear test (Pap-test) have been shown to contribute to the reduction in the mortality and/or incidence of these cancers and can be utilised free of charge by women in certain age groups as part of national screening programmes. Analyses show that the use of health services varies regionally, especially when comparing the federal states of the former German Democratic Republic (GDR, Eastern Germany) and the Federal Republic of Germany (FRG, Western Germany). This study investigated to what extent the utilisation of mammography examinations and Pap-tests by women differs in federal states of former GDR and FRG. Methods For this purpose, we analysed data from the nationwide health survey GEDA14/15 conducted by the Robert Koch Institute (RKI) in 2014 and 2015. We calculated weighted proportions and compared attendance between eastern and western German states by a Chi-Square-test. Additionally, we conducted regression analysis to adjust for socio-economic status, living environment and place of birth. Results 2,772 female participants aged 20–34 years were analysed for Pap-test attendance in the last two years and 4,323 female participants aged 50–69 years old were analysed for mammography screening attendance in the last two years. 50–69-year-old women in eastern German states were with 78.3% (95%-CI 75.3%, 81.2%) more likely to attend mammography screening than in western Germany with 73.4% (95%-CI 71.8%, 74.9%). Pap-test uptake was statistically significantly higher in the East of Germany with 83.3% (95%-CI 79.6%, 87.1%) compared to 77.5% (95%-CI 75.8%, 79.3%) in the West of Germany. This relationship was robust to adjusting for socio-economic status, living environment and place of birth. Conclusions Cultural influences and socialization in the GDR might explain the higher utilisation of these cancer screening examinations at least to some extent. This could have many reasons, for example a higher health awareness through education or a possible greater trust in medical structures and the associated higher compliance of women. These hypotheses should be further explored to increase the uptake of screening examinations by women in Germany.

Non-medical health related social problems are highly prevalent in primary care. Even though there is a wide range of non-clinical support and services available in German communities, which can potentially meet the needs of the affected patients, there are no formalized connections between these services and primary care. One potential solution is social prescribing (SP) providing general practitioners (GPs) with a non-medical referral option, which can accompany existing treatments to improve health and well-being. The goal of this trial is to test the feasibility of a randomized controlled trial and potential benefit of SP in the primary care setting in Germany. This trial is designed as a multi-center, two-armed, open, exploratory, individually randomized (2:1) controlled, pragmatic, feasibility trial. 300 adult patients presenting with one or more non-medical health-related social needs will be recruited in GP practices in Berlin and Brandenburg, Germany. Participants in the intervention group will receive a referral to a link worker. The link worker assesses the social needs, agrees on a goal and sets up an action plan together with the patient. The link worker then connects the patient to suitable non-clinical support and services in the community (e.g., volunteering opportunities). The GP is informed about the actions taken through a feedback form. Participants in the control group will receive treatment-as-usual plus a brochure with information about local offers of non-clinical support and services in the community. Follow-up per patient is 6 months with measurements at 3 and 6 months. Primary endpoint is the feasibility of the trial measured by (1) proportion of participants who have at least one appointment with the link worker (intervention arm only), (2) proportion of participants that drop out of the trial before the 6-month follow-up (both arms). Secondary endpoints include further feasibility endpoints (acceptability, practicality, demand), clinical endpoints such the health status and wellbeing, and a goal-based outcome for the intervention group. The trial is accompanied by a process evaluation, including qualitative episodic interviews with patients and stakeholders. Furthermore, a description of selected economic consequences of SP and its intervention costs will be conducted. This trial will assess the feasibility of implementing SP in the German primary care setting and will provide information and data necessary to plan a confirmatory trial. Implementing SP could be an adequate solution to address psychosocial problems in primary care. German Clinical Trials Registry, DRKS-ID: DRKS00034654. Registered on August 27th.2024. https://drks.de/search/en/trial/DRKS00034654.

Background For many patients, the general practitioner (GP) is the most important point of contact for obtaining information about a wide range of health topics. However, patients with different characteristics may seek health information from different sources, such as friends or the internet. The relationship between patient characteristics and preferences for information sources is understudied. We investigate which information sources are used by patients for health-related questions and how this relates to patients’ sociodemographics, health, and health literacy. Methods A stratified and population-based survey was conducted to investigate health information sources within the German population over 35 years (n = 4144). Sociodemographics, use of technology, health-related indicators, and health literacy (including self-efficacy and action planning), as well as questions regarding the ratings of multiple health-related information sources, were investigated in personal interviews and analyzed using logistic regression. Results In our study, GPs were the most important source of information for the patients, followed by medical specialists, pharmacists and the internet. Patient age and number of illnesses were associated with the choice of information source. Furthermore, action planning and self-efficacy for acquiring health knowledge were associated with the selected source of information. Conclusions Information provider appears to be an important role for GPs, particularly among old and chronically ill patients. GPs should have the specific capabilities to fill this role and should be trained and referred to accordingly. Self-efficacy and action planning for acquiring health knowledge are important patient factors doctors can use for brief inventions during consultations.

LGBT* (lesbian, gay, bisexual, trans, others) individuals are known to experience poorer health and restricted access to healthcare compared to cisgender-heterosexual individuals. As General Practitioners (GPs) are a patient's first point of contact with the healthcare system in Germany, this study examines GPs' perspectives on LGBT healthcare. In this qualitative study, we conducted 19 semi-structured episodic interviews with GPs in urban and rural areas of Germany. The interviews were analysed using framework analysis. Our study shows LGBT* doctors feel more responsible for LGBT* healthcare than their cis-heterosexual colleagues. There is a perceived lack of knowledge and learning opportunities on LGBT* health needs for most interviewees. Cis-heterosexual GPs often feel unprepared to provide specific healthcare interventions to LGBT* patients and believe they lack the resources to improve their education on the topic. LGBT*-specific primary healthcare seems to be delivered by a small number of GP practices and primarily by LGBT* doctors. These LGBT* doctors recommend more widespread knowledge of LGBT* primary care and lives, to allow their colleagues to provide better care for these patients. There is a lack of knowledge on LGBT health needs and challenges among GPs in Germany, which needs to be addressed through structured training in medical school, and on a postgraduate level. This lack of knowledge leads to cis-heterosexual GPs feeling more insecure in providing care to LGBT* patients and LGBT* GPs providing a bigger share of LGBT* healthcare than their cis-heterosexual colleagues.

Background An increasing prevalence of having survived a myocardial infarction increases the importance of medical secondary prevention. Although preventive medication reduces mortality, prescribing and adherence are known to be frequently insufficient. General practitioners are the most important prescriber. However, their perspective on prescribing and medical non-adherence following myocardial infarction has not yet been explored. Thus, the aim of this study was to explore the general practitioners’ perspective on long-term care after myocardial infarction focussing on medical prevention. Methods In this qualitative interview study we conducted episodic interviews with sixteen general practitioners from rural and urban surgeries in Germany. Framework analysis with focus on general practitioners’ prescribing and patients’ non-adherence was performed. Results Almost all general practitioners reported following guidelines for myocardial infarction aftercare and prescribing the medication that was initiated in the hospital; however, they described deviating from guidelines because of drugs’ side effects or patients’ intolerances. Some questioned the benefits of medical secondary prevention for the oldest of patients. General practitioners perceived good adherence among their patients who had had an MI while they regarded their methods for assessing medical non-adherence as limited. They perceived diverse reasons for non-adherence, particularly side effects, patients’ freedom from symptoms and patients’ indifference to health. They attributed mainly negative characteristics, like lack of knowledge and understanding, to non-adherent patients. These characteristics contribute to the difficulty of convincing these patients to take medications as prescribed. General practitioners improved adherence by preventing side effects, explaining the medication’s necessity, facilitating intake and involving patients in decision-making. However, about half of the general practitioners reported threatening their patients with negative consequences of non-adherence. Conclusions General practitioners should be aware that discharge medication can be insufficient and thus, should always check hospital recommendations for accordance with guideline recommendations. Improving physicians’ communication skills and informing and motivating patients in an adequate manner, for example in simple language, should be an important goal in the hospital and the general practitioner setting. General practitioners should assess patients’ motivations through motivational interviewing, which no general practitioner mentioned during the interviews, and talk with them about adherence and long-term treatment goals regularly.

Background Urbanisation and ageing populations are global challenges for ageing well. This mixed-methods study examines the health and social needs of older adults in urban areas in Berlin, Germany and in Singapore, focusing on three key dimensions of healthy ageing and wellbeing: health, mobility, loneliness, and equity as a cross-cutting theme. Methods The design follows a mixed-methods approach combining a quantitative longitudinal cohort study with qualitative interviews. For the quantitative cohort study, a standardised survey is carried out via home visits with a random sample of n  = 1,050 adults aged 65 + years each in selected neighbourhoods in Berlin (three neighbourhoods) and Singapore (five neighbourhoods). The questionnaire comprises questions on health and health care utilization, neighbourhood, loneliness and social contacts, mobility and sociodemographic characteristics. Additionally, three functional tests (cognitive functioning, hand grip strength, and walking speed) are carried out with participants. Participants are followed-up after 12 months with a second survey interview. The survey data is linked with openly available geospatial data to allow for more in-depth study of the built-up and social environment and physical barriers in the selected neighbourhoods. For the qualitative component, walking interviews are conducted with n =50 people each in Berlin and Singapore focusing on older adults’ subjective perspective on health, mobility, green spaces and loneliness in their urban neighbourhood. The results of the different study components will be triangulated. Discussion The Ageing Well Study offers a valuable opportunity to assess the health and social needs of older adults in two distinct urban contexts. The mixed-methods design and utilization of multiple data sources enables an examination of the various dimensions of ageing well from disparate angles and perspectives. The extensive quantitative data set permits the examination of associations and interlinkages between the various dimensions of ageing well and the living environment, as well as the identification of changes over a 12-month period. By opting for home visits, participants with limited mobility are more likely to participate. Minor adaptations of the instruments and methods were implemented to best suit local context, administrative regulations, and feasibility at the study site. Trial registration The study has been registered prospectively at the German Register for Clinical Studies (DRKS) (DRKS00033043, registration date: 16th Nov 2023) which is part of the WHO International Clinical Trials Registry Platform (WHO ICTRP).