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In recent years, public perceptions of patient safety have evolved significantly, driven by media coverage, healthcare reforms, and greater awareness during the coronavirus disease 2019 (COVID-19) pandemic. The present study aimed to examine trends in public perceptions of patient safety, knowledge and self-efficacy in Germany during this pandemic between 2019 and 2023. A repeated cross-sectional study was conducted, using data from TK Monitor of Patient Safety. TK Monitor of Patient Safety in a nationwide survey assessing public perceptions of safety in medical treatment and diagnosis. Self-reported data were collected annually from a randomly selected sample of 1,000 different adults aged 18 and older residing in Germany. Statistical analyses included descriptive statistics, chi-square tests, and linear regressions for trend analyses. Our results revealed high perceived patient safety risk during the years of the study. Up to one third of respondents considered it very likely or somewhat likely that patients would be harmed when receiving medical treatment in hospital or ambulatory care, with lower perceived levels of risk before the COVID-19 pandemic. Regarding perceived prevalence of preventable adverse events, over half of respondents considered it very likely or somewhat likely that an illness of theirs would be diagnosed incorrectly, or that they would contract a nosocomial infection, at some stage in their lives. The majority of respondents considered themselves overall well informed about patient safety and reported higher levels of self-efficacy with regard to error prevention before and after the pandemic than during it. Given the facts that patient safety remains an important issue and that the German public perceives the level of patient safety risk but also of patient safety knowledge, and self-efficacy as high, actively involving patients in safety initiatives is essential for shaping positive public perception.

ObjectivesTo explore perceptions of digitalisation and patient safety from the view of the German general public and related sociodemographic factors.DesignCross-sectional survey.SettingA nationwide survey was undertaken in 2024, using data from the Techniker Krankenkasse (TK) Monitor of Patient Safety. The TK Monitor of Patient Safety is an annual survey of the population on the state of patient safety in medical care.Participants1000 German adults (18 years and older).Primary and secondary outcome measuresOrdinal logistic regression analyses were performed to investigate the associations among sociodemographic factors (age, gender, education and household income) and perceptions on digitalisation and patient safety.ResultsThe majority of respondents expected benefits from digital applications in healthcare. Over half of the respondents (58%) believed that artificial intelligence (AI) can help reduce complications and errors, while 49% of the respondents believed that the use of AI poses serious new risks for the healthcare sector. The results showed that sociodemographic variables are important factors influencing patient safety perceptions of digitalisation and AI. Female, older, less educated and/or lower-income individuals were less likely to perceive benefits from digital care applications and AI.ConclusionsIn our study, the German public appears to view digital technologies and AI as tools both for improving patient safety and as potential risk factors. Our findings also highlight the importance of analysing sociodemographic factors to identify specific disparities in how different groups are affected by digitalisation. Such analysis is essential for developing targeted strategies that mitigate current patient safety risks, ensuring that digital health solutions are equitable and safe across all demographic groups.

Background Patient safety has become a priority issue in health policy strategies in Germany in the last several years, and is especially important in the era of climate change. This study aimed to assess public perceptions about the patient safety impact of climate change and the demographic and socioeconomic factors influencing patient perception in Germany. Methods A cross-sectional study was conducted in Germany in 2023, using data from the TK Monitor of Patient Safety. The TK Monitor of Patient Safety is a national survey of the population on the state of safety in medical care. Self-reported data were collected from 1,000 randomly selected adults living in Germany. Demographic and socioeconomic variables were regressed on climate change perception using an ordinal logistic regression approach. Results Our results revealed that half of respondents are concerned about climate change affecting their health and 40% of the respondents would like to have climate-sensitive health counseling by their general practitioner. The results showed that demographic variables, such as gender and age, and socioeconomic variables, such as education level and income, are important factors influencing the perception of climate change-related patient safety risks. However, no association was found between urban/rural residence and patient perception. Conclusions Our study highlights patient safety as a public health concern in the era of climate change. The German public appears to view climate change as harmful to patient safety. Our findings also show that it is necessary to carry out diagnoses focused on demographic and socioeconomic factors to determine which aspects should be strengthened through programs aimed at reducing patient safety risks associated with climate change.

Background Climate change is one of the greatest health threats, yet many medical schools fail to adequately teach students about its impact. This article describes the development and implementation of an online elective in planetary health education. Methods The online elective was designed for medical students in the clinical study term and delivered in a blended learning format. It features presentations, lectures, and transformative online teaching methods including a flipped classroom with final reflection, peer role-play for simulation of climate-sensitive health counseling, producing infographics, and problem-based activities. A pre-/post-course survey was conducted at the medical faculty of Goethe University Frankfurt for the years 2021 to 2024 and used to assess how effectively the elective contributed to participants’ knowledge, beliefs, behaviors, and attitudes about the impact of climate change on health. Results Overall, participants rated the elective extremely positively. They were very satisfied with the design and content of the elective. The course effectively enhances self-reported knowledge of climate-related health effects and management while strengthening students’ confidence in their role in climate protection. Intentions to apply new knowledge in medical practice and in one's own daily life significantly increased. Participants recommended incorporating the topic into the regular curriculum. Conclusions The success of this pilot is evidence in favor of integrating climate change-related health topics into the medical curriculum, while the results provide insights useful to future research and development of online planetary health courses.

Longitudinal analysis investigates period (P), often as years. Additional scales of time are age (A) and birth cohort (C) Aim of our study was to use ecological APC analysis for women breast cancer incidence and mortality in Germany. Nation-wide new cases and deaths were obtained from Robert Koch Institute and female population from federal statistics, 1999-2008. Data was stratified into ten 5-years age-groups starting 20-24 years, ten birth cohorts starting 1939-43, and two calendar periods 1999-2003 and 2004-2008. Annual incidence and mortality were calculated: cases to 100,000 women per year. Data was analyzed using glm and apc packages of R. Breast cancer incidence and mortality increased with age. Secular rise in breast cancer incidence and decline in mortality was observed for period 1999-2008. Breast cancer incidence and mortality declined with cohorts; cohorts 1950s showed highest incidence and mortality. Age-cohort best explained incidence and mortality followed by age-period-cohort with overall declining trends. Declining age-cohort mortality could be probable. Declining age-cohort incidence would require future biological explanations or rendered statistical artefact. Cohorts 1949-1958 could be unique in having highest incidence and mortality in recent time or future period associations could emerge relatively stronger to cohort to provide additional explanation of temporal change over cohorts.

BackgroundCompleted suicide (CS) is among the leading causes of death. Suicide attempts (SAs) are more frequent and are a significant contributor to overall morbidity. However, there is only few data on community-based suicide prevention using systemic approaches. We have implemented a communal suicide prevention program and tested whether it reduced the number of SA and CS.Methods“FraPPE” comprised measures proposed by previous studies: low-threshold outpatient services, a SA postvention, a hotline targeting individuals with suicidal intent, qualification of gatekeepers and general practitioners, and a campaign to refer SA cases to psychiatric services and antistigma campaigns. The intervention lasted for 25 months.ResultsFor CS, 7.7 cases per month were recorded during baseline, compared to 9 cases per month in the intervention phase. For SA, the numbers were 39.2 and 40.7, respectively. These numbers did not differ significantly. The most frequent diagnostic group was affective disorders, followed by substance use disorders. The average age was lower in the SA group. More males committed suicide (p < 0.001), whereas the sex ratio was balanced in SA.ConclusionsThe communal suicide prevention measures implemented in FraPPE did not reduce the number of suicides and SAs. This should be interpreted with caution, as a number of prevention measures were already executed in the region. Also, data were confounded by the COVID-19 pandemic. Our awareness campaign may also have reduced the dark field, leading to increased reporting. We thus propose to enact registries on suicidal behaviors, to obtain better data and develop new preventive measures.

Background Structured, comprehensive provision of primary care services has been shown to provide better outcomes in chronic disease management. In 2004, Germany introduced a programme of general practitioner (GP)-centred healthcare to strengthen the primary care sector. Crises such as pandemics, world conflict and climate events can result in significant challenges for the provision of routine healthcare requiring rapid reorganisation of existing models of care provision. The objective of this study was to assess the impact of the COVID-19 pandemic on the provision of chronic disease surveillance services and the treatment of patients with coronary artery disease (CAD) by GPs in the federal state of Baden-Württemberg, Germany over the years 2019-2020 to examine if the previously demonstrated benefits of GPCC participation were maintained throughout the COVID-19 pandemic. Methods Retrospective cohort study monitoring 170,466 CAD patients, conducted using biannually aggregated German insurance claims data (AOK-BaWü), comparing 2019 (pre-pandemic) with 2020 (COVID-19 pandemic), examining access (contacts), therapy (e.g. statin therapy), and clinical outcomes (acute myocardial infarction, angina pectoris, stroke, invasive procedures and pacemaker/defibrillator). Results Patients enrolled in the GP-centred care programme (GPCC) had more frequent cohort-specific contacts, increasing during the pandemic, compared to those receiving standard care. Statin prescriptions were higher in the GPCC group and appear to be maintained over the study period. GPCC participation has demonstrated lower risks of all listed clinical outcomes in comparison to standard care and these established advantages of GPCC participation with respect to clinical outcomes were maintained during 2020 despite the challenges of the COVID-19 pandemic. Conclusion Structured, comprehensive GP-centred care in Germany demonstrated resilience the challenges of the COVID-19 pandemic and was associated with better continuity of care for patients with coronary artery disease (CAD) and a maintained lower risk of CAD complications. These differences could be explained by the structured and comprehensive provision of primary care services and enhanced coordination with secondary care, allowing practices to maintain care effectively despite the challenges of the COVID-19 pandemic.

Background: Interventional studies on polypharmacy often fail to significantly improve patient-relevant outcomes, or confine themselves to measuring surrogate parameters. Interventions and settings are complex, with many factors affecting results. The AdAM study’s aim is to reduce hospitalization and death by requiring general practitioners (GPs) to use a computerized decision-support system (CDSS). The study will undergo a process evaluation to identify factors for successful implementation and to assess whether the intervention was implemented as intended. Objective: To evaluate our complex intervention, based on the Medical Research Council’s guideline dimensions. Research Questions: We will assess implementation (reach, fidelity, dose, tailoring) by asking: (1) Who took part in the intervention (proportion of GPs using the CDSS, proportion of patients enrolled in them)? Information on GPs’ and patients’ characteristics will also be collected. (2) How many and which medication alerts were dealt with? (3) Was the intervention implemented as intended? (4) On what days did GPs use the intervention tool? Methods: The process evaluation is part of a stepped-wedge cluster-randomized controlled trial. Characteristics of practices, GPs and patients using the CDSS will be compared with the non-participating population. CDSS log data will be analyzed to evaluate how the number of medication alerts changed between baseline and 2 months later, and to identify the kind of alerts that were dealt with. Comparison of enrolled patients on weekdays versus weekends will shed light on GPs’ use of the CDSS in the absence or presence of patients. Outcomes will be presented using descriptive statistics, and significance tests will be used to identify associations between them. We will conduct subgroup analyses, including time effects to account for software improvements. Discussion: This study protocol is the basis for conducting analyses of the quantitative process evaluation. By providing insight into how GPs conduct medication reviews, the evaluation will provide context to the trial results and support their interpretation. The evaluation relies on the proper documentation by GPs, potentially limiting its explanatory power.

Polypharmacy is associated with a risk of negative health outcomes. Potentially inappropriate medications, interactions resulting from contradicting medical guidelines, and inappropriate monitoring, all increase the risk. This process evaluation (PE) of the AdAM study investigates implementation and use of a computerized decision-support system (CDSS). The CDSS analyzes medication appropriateness by including claims data, and hence provides general practitioners (GPs) with full access to patients’ medical treatments. We based our PE on pseudonymized logbook entries into the CDSS and used the four dimensions of the Medical Research Council PE framework. Reach, which examines the extent to which the intended study population was included, and Dose, Fidelity, and Tailoring, which examine how the software was actually used by GPs. The PE was explorative and descriptive. Study participants were representative of the target population, except for patients receiving a high level of nursing care, as they were treated less frequently. GPs identified and corrected inappropriate prescriptions flagged by the CDSS. The frequency and intensity of interventions documented in the form of logbook entries lagged behind expectations, raising questions about implementation barriers to the intervention and the limitations of the PE. Impossibility to connect the CDSS to GPs’ electronic medical records (EMR) of GPs due to technical conditions in the German healthcare system may have hindered the implementation of the intervention. Data logged in the CDSS may underestimate medication changes in patients, as documentation was voluntary and already included in EMR.

Background Monitoring spatial disease risk (e.g. identifying risk areas) is of great relevance in public health research, especially in cancer epidemiology. A common strategy uses case-control studies and estimates a spatial relative risk function (sRRF) via kernel density estimation (KDE). This study was set up to evaluate the sRRF estimation methods, comparing fixed with adaptive bandwidth-based KDE, and how they were able to detect ‘risk areas’ with case data from a population-based cancer registry. Methods The sRRF were estimated within a defined area, using locational information on incident cancer cases and on a spatial sample of controls, drawn from a high-resolution population grid recognized as underestimating the resident population in urban centers. The spatial extensions of these areas with underestimated resident population were quantified with population reference data and used in this study as ‘true risk areas’. Sensitivity and specificity analyses were conducted by spatial overlay of the ‘true risk areas’ and the significant (α=.05) p-contour lines obtained from the sRRF. Results We observed that the fixed bandwidth-based sRRF was distinguished by a conservative behavior in identifying these urban ‘risk areas’, that is, a reduced sensitivity but increased specificity due to oversmoothing as compared to the adaptive risk estimator. In contrast, the latter appeared more competitive through variance stabilization, resulting in a higher sensitivity, while the specificity was equal as compared to the fixed risk estimator. Halving the originally determined bandwidths led to a simultaneous improvement of sensitivity and specificity of the adaptive sRRF, while the specificity was reduced for the fixed estimator. Conclusion The fixed risk estimator contrasts with an oversmoothing tendency in urban areas, while overestimating the risk in rural areas. The use of an adaptive bandwidth regime attenuated this pattern, but led in general to a higher false positive rate, because, in our study design, the majority of true risk areas were located in urban areas. However, there is a strong need for further optimizing the bandwidth selection methods, especially for the adaptive sRRF.