Explore the vast range of titles available.

Background Cardiovascular diseases (CVD) are the leading cause of death worldwide, with lifestyle-related risk factors such as unhealthy diet, physical inactivity or smoking playing a crucial role. Patient-centred care, which actively engages patients in setting and achieving their health goals, has become increasingly important in treatment and prevention. The Goal Attainment Scaling (GAS) provides a structured method to assess individual goal attainment and satisfaction. This study examines the frequency, attainment, and satisfaction with health goals among patients with at least one lifestyle-related risk factor for CVD within the DECADE intervention. The primary objective of the DECADE intervention was to improve patients’ self-management to reduce their cardiovascular disease risk. One part of the study involved assessing health goals. Methods The cluster-randomised controlled DECADE study consisted of four study arms. The intervention groups (IG) received evidence-based health materials (IG1) and/or patient-centred follow-up consultations (IG2 and IG3). The control group (CG) received at the beginning (t0) of the intervention and after 12 months (t2) a CVD risk assessment like the intervention groups. The analysis sample comprises n  = 712. Health goals, their attainment (6-point Likert scale, 0 = not achieved at all/worse than before to 5 = more achieved than before), and satisfaction with goal attainment (5-point Likert Scale, 1 = very satisfied – 5 = very dissatisfied) took place after 6 months (t1) and t2. GAS values were analysed using means, medians and group differences using Kruskal-Wallis tests. Results The participants reported a median of six health goals at t1 and t2. The most frequently set goals were healthy diet, regular physical activity, and weight reduction. While most patients reported achieving healthy diet and physical activity goals, weight reduction was less frequently attained. Despite largely attaining their goals (median t1 =2.74 [0.33-5.00]; median t2 =2.71 [0.00–5.00]), patients reported that they were only partially satisfied with their results (median t1 =2.80 [1.00–5.00]; median t2 =2.75 [1.00–5.00]). Patients receiving follow-up consultations (IG2 and IG3) showed significantly higher GAS scores at t2 than those in groups without consultations (CG and IG1) (median IG2 =2.80; median IG3 =2.86 vs. median CG =2.50; median IG1 =2.58, p  = 0.004). No gender- or income-specific differences were found, but regional differences emerged: Patients in Dresden had significantly higher GAS scores and were more satisfied compared to those in Hamburg and Freiburg ( p  < 0.001). Conclusion The findings highlight the potential of patient-centred consultations and the promotion of individual health goals in the treatment and in the prevention of CVD. Follow-up consultations positively influence goal attainment, emphasizing the need for structured patient-centred communication. Interestingly achieving health goals did not correspond to satisfaction of the patients. Trial registration The DECADE-study is registered in the German Clinical Trials Register (DRKS-ID: DRKS00025401; Trial registration date: 2021/06/21) and in the International Clinical Trials Registry Platform (ICTRP): https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00025401 .

Social prescribing (SP) is a patient pathway by which healthcare professionals connect patients with other sources of support, groups, or activities within their community. The awareness, practice, and perception of SP among GPs across Europe remains unclear. To explore the awareness, practice, and perception of GPs on SP in the WONCA Europe region. An anonymous, cross-sectional online survey was distributed through a snowballing system, mailing lists, and at three international conferences in 2022/2023 to explore GPs' awareness, practice, and perception of SP. The questionnaire in English contained 21 open and closed questions. Of the 208 participating GPs from 33 countries, 116 (56%) previously heard of 'social prescribing' and 66 (32%) regularly referred patients to community activities through a formal system. These 66 GPs reported different funding sources and varied activities, with an average of four activities and physical exercise being the most prevalent. Among them, 25 (38%) knew about national or local SP awareness campaigns. Of these 25, 17 (68%) agreed that SP increases their job satisfaction and 21 (84%) agreed that it has a positive impact on their patients. Variations in SP awareness and referral practice were evident across and within countries. Despite disparities in awareness and referral practice as well as a diversity of activities and funding sources, most GPs who actively referred patients and were informed about SP campaigns agreed that SP positively impacts them and their patients.

Background Social problems of patients such as family or work-related conflicts as well as financial difficulties affect the individual health situation and the treatment of diseases in general practice. General practitioners (GPs) would like to have direct access to professionals in social care services. In Germany, there are many different social care facilities for people with a wide range of social problems. As the social and health care systems hardly interact collaborations between social professionals (SPs) and GPs are rare exceptions. This study explored perspectives of GPs regarding their patients with social problems in combination with the perspectives of SPs. Aim of this study was to explore how a systematic interprofessional collaboration between GPs and SPs could be realised. Methods We carried out a participatory sequential qualitative study design consisting of two focus groups with GPs, two with SPs and two mixed-professional focus groups with GPs and SPs. The focus groups were conducted with semi-structured moderating guidelines and analysed with a qualitative content analysis approach using inductive and deductive categories. Results GPs view themselves as the first point of contact for their patients' social problems. For persistent social problems, they expressed a desire for support and SPs were willing to provide this. We developed a stepped care implementation model for a systematic cooperation consisting of nine collaboration strategies. These strategies included: index or website of social care services, referrals to the social care system, using flyers and posters of social care services, direct contact/hotline to local social care services, participation in meetings of social care facilities, involving physician assistants, external social care advice service in GP rooms, implementation in education and training and access to volunteers. Conclusions Our stepped care implementation model for a systematic cooperation of GPs and SPs could be a feasible need- and resource-oriented approach for the collaborative care of patients with social problems to improve their medical treatment in most western healthcare systems. GPs and SPs are ready to generate the necessary evidence for policy makers in high quality RCTs.

Summary Introduction Cardiovascular diseases (CVD) are the most common cause of death in Germany. General practitioners (GPs) have an important role in supporting patients in the prevention of CVD. The DECADE intervention was developed to encourage patients to improve self-management in order to prevent CVD, addressing both GPs and patients. This study focused on GPs attitudes towards patient activation and its relation to the level of activation on their patients, possible barriers according to lifestyle counselling and attitudes towards interprofessional consultations. Methods Questionnaire-based cross-sectional analysis was conducted within the DECADE-cRCT. GPs attitudes to patient activation was measured by using seven items of the Clinician Support for Patient Activation Measure (CS-PAM). The degree of activation of the patients was measured by Patient Activation Measure (PAM13-D). The Barriers and attitudes towards responsibilities for lifestyle counselling were assessed using self-generated items on a 5-point Likert scale. Association between CS-PAM and PAM13-D was analysed using a linear mixed model. Results 79/82 GPs responded. Mean CS-PAM score of GPs at baseline was 23.00 (range 13–27, max. 28). GPs reported lack of time, funding and uncertainty of the impact as main barriers to the routine implementation of lifestyle counselling. GPs see themselves as primarily responsible for conducting lifestyle counselling, but they also emphasize the importance of interprofessional cooperation. No significant correlations between CS-PAM and PAM13-D were found. Conclusion GPs perceive patient activation as important. Most GPs reported that they already provide lifestyle counselling as part of their routine practice. Overcoming the identified barriers in GPs lifestyle counselling is a prerequisite for effective and patient-centred consultation on cardiovascular risk factors. The interprofessional collaboration advocated by GPs could relieve the burden on GPs and thus reduce these barriers. Trial registrations The DECADE-study is registered in the German Clinical Trials Register (DRKS-ID: DRKS00025401; Trial registration date: 2021/06/21) and in the International Clinical Trials Registry Platform (ICTRP): https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00025401 .

IntroductionCardiovascular diseases are the most common cause of death in Germany and among the most frequent reasons for encounters in primary care. Most patients with cardiovascular risks (CVRs) have difficulties implementing health-promoting behavioural changes. In this study, a complex intervention containing evidence-based patient materials and structured follow-up consultations are intended to strengthen patients’ self-management to improve health behaviour.Methods and analysisIn this cluster randomised controlled trial, we investigate the effects of the intervention \"Decision aid, action planning and follow-up support for patients to reduce the 10-year risk of cardiovascular diseases\" (DECADE) using a 2×2 design. All patients, including the control group (CG), receive a CVR calculation. Three intervention groups (IGs) receive one or both of two different components of the DECADE intervention: IG1 (patient materials), IG2 (follow-up consultations) and IG3 (patient materials and follow-up consultations). The study was planned to be conducted with 77 general practitioners in 3 German regions and a target sample size of 924 patients. The observation period for each patient amounts to 12 months with three patient surveys: baseline (t0), after 6 and 12 months (t1 and t2). The primary outcome is patient activation (Patient Activation Measure 13 (PAM13-D)) at t1. Secondary outcomes include PAM13-D at t2 and further patient-reported and clinical outcomes at t1 and t2. We will also analyse the cost-effectiveness of the intervention, the degree of usage and satisfaction with the intervention.Ethics and disseminationThe study was first approved by the lead ethics committee of the University of Freiburg on 15 April 2021 (vote number: 21-1078) and subsequently by the other ethics committees in the study regions (Ethics committee of medical association Baden-Württemberg (B-F-2021-078), Ethics Committee of the Technische Universität Dresden, Dresden (BO-EK-251052021), Ethics Committee of the State Chamber of Physicians of Saxony (EK-BR-92/21-1), Ethics Committee of the Hamburg Medical Association (2021-200013-BO-bet)). Informed consent is required for patients to participate in the study. The results of this study will be published in peer-reviewed journals and presented at congresses by the DECADE team. The DECADE lead management will communicate the results to the funder of this study.Trial registration numberGerman Clinical Trials Register, DRKS00025401 (registration date: 21 June 2021); International Clinical Trials Registry Platform, DRKS00025401.

Background In Germany, homeless people are entitled to health care within the regular health care system. However, due to their specific living conditions they make little use of these services. In 2013, three Medical centres for the homeless (MCH) were opened in Hamburg to provide general health care. This study aims to analyse the consultation reasons and diagnoses prevalent among the homeless in comparison to regular primary care patients. It also examines the means and obstacles of integrating the homeless into Germany’s regular health care system. Methods From 2013 to 2014, routine medical data of all patients of the MCH consenting to participate in the study were analysed descriptively, in particular consultation reasons (categorised by ICPC-2), ICD-10 diagnoses and data on health insurance status and the use of the regular health care system. Consultation reasons and diagnoses of homeless patients were compared descriptively with data from regular general practices. Additionally, anonymous data on patient numbers, gender and insurance status was exported from the MCH’s software and analysed descriptively for the years 2013 to 2020. Results A total of 840 homeless patients in 2013 and 2014 gave consent to the evaluation of consultation reasons and diagnoses. The most frequent consultation reasons in the MCH in 2013 were skin conditions (24%), musculoskeletal conditions (16%) and psychological disorders (14%), in GP practices these were musculoskeletal conditions (22%), conditions affecting the digestive system (14%) and skin conditions (12%). Essential (primary) hypertension, diabetes mellitus type 2 and back pain are among the top-10-diagnoses in GP practices, as well as in MCH. With regard to the other top-10-diagnoses, there are clear differences between GP practices and MCH: “Psychological behavioural disorder due to alcohol” and diagnoses in connection with trauma, skin infections and acute respiratory infections stand out in MCH. 35% of the homeless patients reported a lack of health insurance as the reason for “not making use of” the regular health care system, while 10% reported they were unable to visit a regular general practitioner due to physical or psychological reasons. In the years 2013–2020 46% to 73% of the 8.380 MCH patients had no health care insurance. Conclusion Patients consulting the MCH suffer from medical conditions typical for the homeless, namely skin diseases, wounds, injuries and behavioural disorders due to alcohol abuse, but also from “typical” symptoms in regular GP care as cough or lower back symptoms. Consultation reasons mostly are acute illnesses. Chronic diseases are equally present in regular GP and MCH patients, but pose a great challenge for the homeless among other things due to their irregular contact with the health care system. The lack of health insurance poses the greatest hurdle to the integration of the homeless into the regular health care system.

Social Prescribing is a mechanism by which primary care team members can refer patients to community groups to improve their health and well-being. It integrates health, social care, and community, allowing patients to actively improve their health and well-being by participating in community initiatives and activities. These activities have traditionally been part of community life in European countries, and the benefits need to be consistently recognized.

Depressive disorders are highly prevalent among older adults (60+) in Europe. Activating these patients was a core component of the GermanIMPACT study, which evaluated collaborative care in a cluster-randomized primary care setting. The intervention group showed a significant improvement in PHQ-9 remission. The aim of this secondary analysis was to investigate which activities were planned and whether their implementation or non-implementation was associated with depressive symptoms (PHQ-9) after 12 months. Behavioural activation data were collected by the care managers. A categorization for activity type (collected as free text) and activity implementation status was developed. The association of successfully implemented activities, planned-not-implemented activities, and the number of activities per patient with the 12-month PHQ-9 total score was calculated using logistic regressions (adjusted for age, gender, living situation/baseline PHQ-9). A total 2188 activities were planned for 136 patients; 66% were successfully implemented. Mean age was 71 (±7) years (78% female; 52% living alone). Activities focusing on “self-care/spirituality” improved the PHQ-9 outcome (OR 1.540; p = 0.048), while planned-not-implemented activities overall worsened it (OR 1.16; p = 0.007). Patient activation is key to treating depressive symptoms in old age. Particularly ‘self-care/spirituality’ activities could be planned, and organizational activities should be closely supported.

Background The huge increase of refugees to Germany caused a great challenge to the health system. We aimed to examine the level of patient-centredness in medical consultations with refugee patients, aided by video interpreters in primary care walk-in clinics (PCWC) in Hamburg. Methods Videotaped consultations (N = 92) of 83 patients from 2017 to 2018 were analysed. Two raters used the Measure of Patient-Centered Communication (MPCC) and the International Classification of primary care (ICPC-2). MPCC scores with regard to patients’ reason for seeking medical care and the procedures taken were explored using variance analyses adjusted for age, gender, and the duration of the consultation. The duration was further explored by Pearson correlations. Results Patient-centredness of all consultations on average was 64% (95% CI 60–67) according to MPCC, with health-related issues affecting the results. The highest level of patient-centredness was achieved in psychological health issues with 79% (65–94), the lowest in respiratory ones with 55% (49–61). Longer consultations resulted in higher MPCC scores. Conclusions The level of patient-centredness varied in the addressed health issues as well as in the duration of the consultation. Despite the variation, video interpreting in consultations supports a solid patient-centredness. Practice implications We recommend the use of remote video interpreting services for outpatient healthcare to support patient-centred communication and to fill the gap of underrepresentation of qualified interpreters on site, regarding a high diversity of spoken languages.

Background Depression is not a normal side effect of aging, however it is one of the most prevalent mental health issues in later life, imposing a tremendous burden on patients, their families, and the healthcare system. We describe the experimental implementation of a collaborative, stepped-care model for the treatment of late-life depression (GermanIMPACT trial) in the German primary care context. GermanIMPACT was developed as an adaptation of a successful and widely used American model. The aim of the study is to evaluate the model’s applicability to the German primary care setting and its cost-effectiveness. Methods/Design The study will be conducted as a cluster-randomized controlled trial comparing the development of depressive symptoms in primary care patients who either receive treatment as usual (control arm) or treatment according to the GermanIMPACT model (intervention arm). In two German cities (Freiburg and Hamburg), a total of 60 general practice offices will be selected and randomized. Each general practice office will be asked to enroll five patients into the trial who are 60 years of age or older and who show moderate depressive symptoms in the scope of a diagnosed depressive episode, recurrent depressive disorder, or dysthymia. General practices in the control arm will provide treatment as usual; general practices in the intervention arm will work closely with a specially trained care manager and a supervising mental health specialist. Evidence-based elements of the treatment plan manual include patient education, identification and integration of positive activities into the daily routine, relapse prevention, and training of problem-solving techniques as needed. The intervention period per patient will be one year. Data will be collected at baseline, 6, and 12 months. Primary outcome is the patient-reported change of depressive symptoms (Patient Health Questionnaire, PHQ-9). Secondary outcomes include measures of quality of life, anxiety, depression-related behavior, problem-solving skills, resilience, and an overall economic evaluation of the program. Discussion The GermanIMPACT trial will provide evidence about the effectiveness, feasibility, and cost-effectiveness of collaborative stepped care in treating late-life depression in German primary care. Positive results will be a first step toward integrating specialized depression care managers into the primary care setting. Trial registration German Clinical Trials Register: DRKS00003589 (September 2012).