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.

[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.

Varicose veins are a risk factor for deep venous thrombosis in general practice patients.

Background: The role of varicose veins (VV) as a risk factor for development of deep venous thrombosis (DVT) is still controversial. The aim of this study in primary care was to determine the impact of varicosity as a potential risk factor for developing DVT.

Patients And Methods: During the observation period between 01-Jan-2008 and 01-Jan-2011, all cases with VV (ICD code I83.

Palliative patients cared for at home by PAMINO-trained and other GPs - health-related quality of life as measured by QLQ-C15-PAL and POS.

Background: To maintain patients' quality of life is one of the major goals in palliative home care provided by general practitioners (GPs). GPs need adequate training to care for palliative patients. The paper seeks to evaluate whether a specific training in Germany (PAMINO) has any improving impact on the care of palliative patients and their health-related quality of life.

The importance of social support for people with type 2 diabetes - a qualitative study with general practitioners, practice nurses and patients.

Objective: Social support is an important element of family medicine within a primary care setting, delivered by general practitioners and practice nurses in addition to usual clinical care. The aim of the study was to explore general practitioner's, practice nurse's and people with type 2 diabetes' views, experiences and perspectives of the importance of social support in caring for people with type 2 diabetes and their role in providing social support.

Methods: Interviews with general practitioners (n=10) and focus groups with practice nurses (n=10) and people with diabetes (n=9).

Technical support and delegation to practice staff - status quo and (possible) future perspectives for primary health care in Germany.

Background: Primary health care in industrialized countries faces major challenges due to demographic changes, an increasing prevalence of chronic diseases and a shortage of primary care physicians. One approach to counteract these developments might be to reduce primary care physicians' workload supported by the use of health information technology (HIT) and non-physician practice staff. In 2009, the U.

Gender disparities in diabetes and coronary heart disease medication among patients with type 2 diabetes: results from the DIANA study.

Background: Coronary heart disease (CHD) is one of the most common long-term complications in people with type 2 diabetes. We analyzed whether or not gender differences exist in diabetes and CHD medication among people with type 2 diabetes.

Methods: The study was based on data from the baseline examination of the DIANA study, a prospective cohort study of 1,146 patients with type 2 diabetes conducted in South-West Germany.

Identifying factors associated with experiences of coronary heart disease patients receiving structured chronic care and counselling in European primary care.

Background: Primary care for chronic illness varies across European healthcare systems. In patients suffering from coronary heart disease (CHD), factors associated with patients' experiences of receiving structured chronic care and counselling at the patient and practice level were investigated.

Methods: In an observational study comprising 140 general practices from five European countries (Austria, Germany, the Netherlands, Switzerland and the United Kingdom), 30 patients with Coronary Heart Disease (CHD) per practice were chosen at random to partake in this research.

Gender differences in healthcare utilization of patients with diabetes.

Objectives: To examine gender differences in healthcare utilization including outpatient and inpatient medical care for patients with type 2 diabetes mellitus (T2DM), despite participation in T2DM-specific disease management programs (DMP-DM).

Study Design: Baseline data from a cohort study in southwest Germany including 1146 patients with T2DM recruited between October 2008 and March 2010 were used.

Methods: After bivariate analyses, multivariate Poisson and logistic regression models were used to estimate the effect of sex on the number of general practitioner (GP) and medical specialist appointments, prescribed medications, hospitalizations, and inpatient rehabilitations, with additional consideration of glycemic control levels.

Medication non-adherence and poor glycaemic control in patients with type 2 diabetes mellitus.

Aims: Our main aim was to analyse gender differences in the association of adherence and poor glycaemic control (PGC) in a cohort of patients with type 2 diabetes mellitus in Germany.

Methods: Baseline data of the DIANA-study, a prospective cohort study of type 2 diabetes mellitus patients in South-West Germany, were analysed. Information on medication adherence and factors related to PGC was obtained by self-administered questionnaire.

Barriers to guideline implementation and educational needs of general practitioners regarding heart failure: a qualitative study.

Objectives: A clinical practice guideline (CPG) contains specifically developed recommendations that can serve physicians as a decision aid in evidence-based practice. The implementation of heart failure (HF) CPGs represents a challenge in general practice. As part of the development of a tailored curriculum, aim of this study was to identify barriers of guideline adherence and needs for medical education (CME) in HF care.

Train the Trainer for general practice trainer - a report of the pilot within the programme Verbundweiterbildung plus.

Background: Since 2008 the Verbundweiterbildung(plus) programme of the Competence Centre General Practice Baden-Wuerttemberg offers continual improvement with regards to content and structure of general practice training. The programme uses the didactical concept of the CanMEDs competencies, which were developed in Canada, as a postgraduate medical training framework. Train the trainer (TTT)-programmes are an additional important element of these contentual optimisations of postgraduate training.

PalliPA: How can general practices support caregivers of patients at their end of life in a home-care setting? A study protocol.

Background: The care of patients with a life-threatening, progressive and far advanced illness in a home-care setting requires appropriate individual care and requires the active support of family caregivers. General practice teams are usually the primary care givers and first contact and are best placed to offer support to family caregivers and to recognise and respond to the burden of care giving on family members. The aim of this project is to develop a best practice model for engaging with and supporting family caregivers.

Primary care physicians' experiences with case finding for practice-based care management.

Objectives: The identification of patients most likely to benefit from care management programs-case finding-is a crucial determinant of their effectiveness regarding improved health outcomes and reduced costs. Until now, research has mainly focused on claims data-based case finding. This study aimed to explore how primary care physicians (PCPs) select patients for practice based care management and how risk prediction may complement their case finding.

The impact of perceived social support and sense of coherence on health-related quality of life in multimorbid primary care patients.

This study explores the impact of perceived social support and sense of coherence as positive resources for health-related quality of life in multimorbid primary care patients. We analysed cross-sectional survey data on health-related quality of life (EQ-5D), perceived social support (FSozU-K22), sense of coherence (SOC-L9), social demographics and self reported morbidity of 103 multimorbid patients from 10 general practices in Germany. A multiple linear regression model was used to determine the impact of social support and sense of coherence on the health-related quality of life while controlling for age, sex, educational level, marital status and number of chronic conditions.

Can a feedback report and training session on medication counseling for general practitioners improve patient satisfaction with information on medicines?

Background: Regular intake of medicines prevents hospitalization and improves treatment outcomes in patients with chronic diseases; however, requires good patient-physician communication. Yet, this communication is often insufficient and characterized by misunderstandings. This paper aimed to explore whether a training session on medication counseling for general practitioners (GPs) can improve patient satisfaction about information on medicines.

Adaptation and psychometric properties of the PACIC short form.

Objectives: The Patient Assessment of Chronic Illness Care (PACIC) is a widely used instrument to evaluate the quality and patient-centeredness of chronic illness care based on the Chronic Care Model (CCM). It is a validated and reliable instrument which consists of 20 items. Additionally, a short form with 11 items was developed.

Expenditure of chronic venous leg ulcer management in German primary care: results from a population-based study.

The aim of the study was to determine the demand on health service utilisation and to estimate the therapeutical costs caused by patients with chronic leg ulcer (CLU) in German primary care. A population-based case-control study was conducted using electronic medical records of 116 059 patients extracted from the CONTENT primary care database of Heidelberg, Germany, between April 2007 and March 2010. The drug and non drug prescription rates among patients with CLU were analysed by means of a unified German identification key and compared with those of patients with chronic venous insufficiency (CVI) without CLU.

Patterns of multimorbidity in primary care patients at high risk of future hospitalization.

Care management is seen as a promising approach to address the complex care needs of patients with multimorbidity. Predictive modeling based on insurance claims data is an emerging concept to identify patients likely to benefit from care management interventions. We aimed to identify and explore patterns of multimorbidity in primary care patients with high predicted risk of future hospitalizations in order to develop a primary care-based care management intervention.

Tearing down walls: opening the border between hospital and ambulatory care for quality improvement in Germany.

The hospital benchmarking system in Germany was originally introduced to detect unintended consequences of reimbursement based on diagnosis-related groups. The new nationwide SQG programme aims to provide information on quality and outcomes of health care provided in hospital, ambulatory specialist and primary care settings, including the healthcare delivery across different sectors. In 2010 the topics for indicator development were cataract surgery, cervical conization, colectoral cancer and percutaneous coronary interventions or coronary angiography.

Predictors of health-related quality of life in patients at risk for cardiovascular disease in European primary care.

Background: Cardiovascular risk management plays an important role in primary care. In patients at high risk for cardiovascular diseases (CVD) lifestyle and, where appropriate, medical interventions are recommended in guidelines. Health-related quality of life (HRQoL) is an important outcome in clinical practice.