[Transfer-time and -rates from inpatient to outpatient care of mental ill persons in Baden Wurttemberg].

Objective: The time of transfer between discharge from inpatient mental health care and first contact to the outpatient sector is considered to be an indicator for continuity of care.

Methods: This indicator is assessed using health care claims data of one of the mayor health insurances in Baden-Wurttemberg, Germany.

Results: About 80 % of cases with the diagnosis of a defined mental disorder sought outpatient care at general or mental health practitioners within six months from discharge.

[How chronically ill patients evaluate their care: results of an evaluation study of the family doctor-centred health care model].

Considering the demographic development models for primary care have to be focused on chronic illness care especially. The so called "Hausarztzentrierte Versorgung" (HzV) in Baden-Wuerttemberg constitutes such a model of an implementation of family doctor-centred health care. For evaluation purposes the perspective of patients is of particular interest.

[Evaluation of family doctor centred medical care based on AOK routine data in Baden-Württemberg].

The agreement on family-doctor centred care (Hausarztzentrierte Versorgung, "HzV") pursuant to Sect. 73b, Volume V of the German Social Security Code became effective in Baden-Wuerttemberg, Germany, on July 1(st), 2008. This complex intervention, which is voluntary for both family doctors and patients, aims to strengthen the coordinative function of family practices.

[Family doctor-centred care in Baden-Wuerttemberg: concept and results of a controlled evaluation study].

Background And Research Question: Pursuant to Section 73b, volume V of the German Social Security Code (SGB V), the agreement on family doctor-centred care (HzV), which went into effect in Baden-Wuerttemberg on July 1, 2008, provides for spatially inclusive and comprehensive medical coverage. The most important elements of the agreement are: the voluntary registration of family practices and patients, the strengthening of the coordinative function of family practices, the fulfilment of certain training, quality and qualification requirements, the standardised remuneration system and the use of specified practice software for billing and the prescription of drugs. The aim of this complex intervention is to strengthen family medicine, improve health care, in particular for patients with chronic disease, and to limit primary health care costs while improving its quality wherever possible.

Health-related quality of life and risk factor control: the importance of educational level in prevention of cardiovascular diseases.

Background: This study aimed to describe and to analyse the importance of educational level for controlled risk factors and health-related quality of life (HRQoL).

Methods: This observational study was conducted in nine European countries (5632 patients in 249 practices). We compared patients with a low level of education (up to 9 years) with patients with a high level of education (>9 years), with regard to controlled cardiovascular disease risk factors and HRQoL.

Practice assistants in primary care in Germany - associations with organizational attributes on job satisfaction.

Background: Job satisfaction and organizational attributes in primary care teams are important issues as they affect clinical outcomes and the quality of health care provided. As practice assistants are an integral part of these teams it is important to gain insight into their views on job satisfaction and organizational attributes. The aim of this study was to evaluate the job satisfaction of practice assistants and the organizational attributes within their general practices in Germany and to explore the existence of possible associations.

[Patients' perspectives beyond sectoral borders between inpatient and outpatient care - patients' experiences and preferences along cross-sectoral episodes of care].

Aim: Patient perspective is crucial concerning health care and quality improvement. During episodes of care, patients come into contact with multidisciplinary health-care providers in inpatient and outpatient settings and are in a unique position to describe processes throughout the entire chain of care. The aim of this study was to identify patients’ experiences and preferences with fragmented cross-sectoral care to develop a patient-centred cross-sectoral quality-assessment instrument.

Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions.

Purpose: Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are seen as potentially avoidable with optimal primary care. Little is known, however, about how primary care physicians rate these hospitalizations and whether and how they could be avoided. This study explores the complex causality of such hospitalizations from the perspective of primary care physicians.

Family Doctors Seen through the Eyes of Specialists: A Qualitative Study.

Germany is facing a shortage of young family doctors. In search of possible reasons the aim of this study was to explore the perception of specialists on family doctors. Within a qualitative study 16 medical specialists from different fields in hospital and outpatient care setting were interviewed.

Evaluating the quality of colorectal cancer care across the interface of healthcare sectors.

Background: Colorectal cancer (CRC) has a high prevalence in western countries. Diagnosis and treatment of CRC is complex and requires multidisciplinary collaboration across the interface of health care sectors. In Germany, a new nationwide established program aims to provide quality information of healthcare delivery across different sectors.

Job satisfaction of practice assistants in general practice in Germany: an observational study.

Background: Job satisfaction of practice staff is important for optimal health care delivery and for minimizing the turnover of non-medical professions.

Objective: To document the job satisfaction of practice assistants in German general practice and to explore associations between job satisfaction, staff characteristics and culture in general practice organizations.

Methods: The study was based on data from the European Practice Assessment accreditation scheme for general practices and used an observational design.

Which practice characteristics are associated with the quality of cardiovascular disease prevention in European primary care?

Background: Prevention of cardiovascular diseases (CVD) is a major health issue worldwide. Primary care plays an important role in cardiovascular risk management (CVRM). Guidelines and quality of care measures to assess CVRM in primary care practices are available.

[New ways in caring for patients with functional syndromes - interdisciplinary group intervention in the primary care setting: a qualitative study].

Interface problems between health care sectors hinder collaborative care in functional syndromes. The speciAL trial investigated a disorder-oriented group intervention conducted by the general practitioner (GP) and a psychosomatic specialist (PS) in the GP's office. To evaluate the GP-PS cooperation, our qualitative study analysed free text statements about collaborative group leading of all 18 intervention GPs.

[The Quality indicator project of the German college of general practice and family medicine (DEGAM): development of indicators based on the guidelines dementia, neck pain and sore throat].

A debate on the application of quality indicators (QIs) arose among the members of the German College of General Practitioners and Family Physicians (DEGAM) when two QI systems for ambulatory care (QISA and AQUIK) were published in a short time interval. A research question that emanated from this discussion was whether appropriate QI might be developed based on German general practice guidelines. In spring 2010, the DEGAM guideline committee (SLK) decided to conduct a project on guideline-based development of QIs using the DEGAM guidelines for dementia, neck pain and sore throat.

The influence of workload and health behavior on job satisfaction of general practitioners.

Background And Objectives: Workload, personal health behavior, and job satisfaction of the physicians are crucial aspects for the quality of care they provide. The aim of our study was to identify influencing factors on job satisfaction with regard to general practitioners' (GPs) characteristics such as age, gender, health behavior, body mass index (BMI), and workload.

Methods: A cross-sectional survey with a sample of 1,027 German GPs was used.

Secondary prevention in patients with coronary heart diseases: what factors are associated with health status in usual primary care?

Background: For patients with coronary heart diseases a substantial part of secondary prevention is delivered in primary care. Along with the growing importance of prevention, health-related quality of life (HRQoL) is an indicator of patient-centered care that has gained increased attention. Different approaches for reorganization in primary care have been associated with improvements in HRQoL.

Specific collaborative group intervention for patients with medically unexplained symptoms in general practice: a cluster randomized controlled trial.

Background: Patients with medically unexplained symptoms (MUS) are frequent in primary care and substantially impaired in their quality of life (QoL). Specific training of general practitioners (GPs) alone did not demonstrate sustained improvement at later follow-up in current reviews. We evaluated a collaborative group intervention.

Simultaneous development of guidelines and quality indicators -- how do guideline groups act? A worldwide survey.

Purpose: The purpose of this paper is to examine the question of how official bodies, health care organisations, and professional associations deal with the absence of a methodological gold standard for the simultaneous development of clinical practice guidelines and quality indicators, what procedures they use and what they feel are major strengths and limitations of their methods.

Design/methodology/approach: The authors conducted a web-based survey among 90 organisational members of the Guidelines International Network (G-I-N) representing 34 countries from Africa, America, Asia, Europe and Oceania. All organisational G-I-N members were invited to participate in the survey by following a link provided in the invitation e-mail.

Video-assisted feedback in general practice internships using German general practitioner's guidelines.

Introduction: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine.

Let's talk about medication: concordance in rating medication adherence among multimorbid patients and their general practitioners.

Background: Medication adherence can be essential for improving health outcomes. Patients with multiple chronic conditions, often receiving multiple medications, are at higher risk for medication nonadherence. Previous research has focused on concordance between patients and providers about which medication should be taken.

Diuretics for hypertension-reasons for a contradiction in primary care prescribing behavior: a qualitative study.

There has been a long international discussion on diuretics as first-line therapy for hypertension. In Germany, thiazide diuretics are very rarely prescribed in monotherapy and concurrently highly prescribed in fixed-combinations. The aim of this study was to approach the reasons for this inconsistency in primary care prescribing behavior.

The challenge of cardiovascular prevention in primary care: implications of a European observational study in 8928 patients at different risk levels.

Background: Cardiovascular prevention can be provided to patients at different risk levels. The aim of this study was to compare the quality of cardiovascular prevention provided in European primary care between patients with diagnosed coronary heart disease (CHD) and individuals at high risk due to known risk factors but not labelled with a diagnosis of cardiovascular disease (CVD). Additionally, we aimed to identify individual and practice factors to predict risk factor control.

Eligibility of patients with peripheral arterial disease for participation in a community-based walking exercise program: a single-centre experience.

Aim: Eligibility of patients with peripheral arterial disease (PAD) for exercise therapy is the most important requirement for predicting their training group adherence.

Methods: In this prospective, exploratory study over a period of 1 year, a total of 462 PAD patients of an angiological outpatient routine care setting were consecutively recruited to the study. As non-eligibility criteria for exercise therapy were defined: resting pain or gangrene (Fontaine stage III and IV PAD), the inability to complete treadmill exercise, or premature treadmill discontinuation due to non-vascular walking pain.

[Interprofessional education for patient-centred practice: development of outcome-focused competencies for a Bachelor Programme Interprofessional Health Care].

Objectives: Health care systems in Germany and around the world are faced with demographic change and the need of providing health services in increasingly complex health care surroundings. A highly qualified workforce is needed to face the challenges ahead and to coordinate health care. In addition, there is evidence that interprofessional education strengthens interprofessional collaboration which can lead to improved health outcomes.