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Abstract
Background
Chronic heart disease affects millions of people worldwide and the prevalence is increasing. By now, there is an extensive literature on outpatient care of people with chronic heart disease. We aimed to systematically identify and map models of outpatient care for people with chronic heart disease in terms of the interventions included and the outcomes measured and reported to determine areas in need of further research.
Methods
We created an evidence map of published systematic reviews. PubMed, Cochrane Library (Wiley), Web of Science, and Scopus were searched to identify all relevant articles from January 2000 to June 2021 published in English or German language. From each included systematic review, we abstracted search dates, number and type of included studies, objectives, populations, interventions, and outcomes. Models of care were categorised into six approaches: cardiac rehabilitation, chronic disease management, home-based care, outpatient clinic, telemedicine, and transitional care. Intervention categories were developed inductively. Outcomes were mapped onto the taxonomy developed by the COMET initiative.
Results
The systematic literature search identified 8043 potentially relevant publications on models of outpatient care for patients with chronic heart diseases. Finally, 47 systematic reviews met the inclusion criteria, covering 1206 primary studies (including double counting). We identified six different models of care and described which interventions were used and what outcomes were included to measure their effectiveness. Education-related and telemedicine interventions were described in more than 50% of the models of outpatient care. The most frequently used outcome domains were death and life impact.
Conclusion
Evidence on outpatient care for people with chronic heart diseases is broad. However, comparability is limited due to differences in interventions and outcome measures. Outpatient care for people with coronary heart disease and atrial fibrillation is a less well-studied area compared to heart failure. Our evidence mapping demonstrates the need for a core outcome set and further studies to examine the effects of models of outpatient care or different interventions with adjusted outcome parameters.
Systematic review registration
PROSPERO (CRD42020166330).
What Skills Do Addiction-Specific School-Based Life Skills Programs Promote? A Systematic Review
(2022)
In school-based addiction prevention, life skills programs (LSPs) have been established since the 1990s. The scientific evidence regarding program effectiveness is in parts unclear. This review links life skills not to behavioral outcomes but to three facets of the self: the affective evaluative, the dispositional & dynamic, and the cognitive descriptive facet of the self. This complements the evidence on behavioral outcomes. In a systematic literature search we have identified drug-specific life skills programs in German language and their evaluation studies. We have mapped the instruments used to assess effectiveness of the LSP on three facets of the self, which are site of action of intrapersonal skills. We identified six comparable life skills programs that have been evaluated at least once. In five of these programs, different facets of life skills have been assessed with a total of 38 different measurement instruments. We found that improvements in affective evaluative and dispositional & dynamic facets of the self could be stimulated by LSPs, complementing previous evidence focusing on behavioral outcomes. Conclusion: Numerous instruments have been used that are not directly comparable but can be categorized by facets of the self. As a result, it is found that life skills programs can have an impact on building attitude and the shaping of intrapersonal skills. Interpersonal competencies such as communication skills and empathy have not been measured. Furthermore, a consensus on measurement instruments for life skills should be found.
Hintergrund
In der COVID-19-Pandemie ging die Versorgung nichtübertragbarer Erkrankungen zeitweise deutlich zurück, auch weil Menschen Angst vor einer Ansteckung hatten. Wir führen eine Bestandsaufnahme zur organisationalen Gesundheitskompetenz in der Regelversorgung nichtübertragbarer Erkrankungen in der ersten Welle der COVID-19-Pandemie durch und fragen: Inwiefern wurden Menschen mit gesundheitlichen Beschwerden dabei unterstützt, gesundheitskompetente Entscheidungen für oder gegen die Inanspruchnahme von Versorgungsleistungen zu treffen?
Methodik
Strukturierende Inhaltsanalyse der Internetpräsenzen der Mitglieder der Arbeitsgemeinschaft der Wissenschaftlich Medizinischen Fachgesellschaften (AWMF; n = 179), der kassen(zahn)ärztlichen Vereinigungen (K(Z)Ven; n = 38), ausgewählter Krankenkassen (n = 21), ausgewählter Behandlungseinrichtungen (n = 25) und überregionaler Anbieter von Gesundheitsinformationen (n = 5) zu Informationen und Angeboten zum Thema.
Ergebnisse
Die geprüften Internetpräsenzen informieren weitgehend rund um COVID-19, aber nur selten darüber, wie man sich bei einer (vermuteten) anderen Erkrankung in Bezug auf die Inanspruchnahme von Versorgungsleistungen verhält. 2 Portale von Anbietern von Gesundheitsinformationen, eine Krankenkasse, aber keine der KVen bieten explizite Entscheidungshilfen an. KVen weisen öfter, aber nicht durchgängig auf die generelle Möglichkeit von Videosprechstunden hin.
Diskussion
Für die meisten Patient*innen gab es damit keine gezielten Informationen zu dem Thema. Angesichts der Fortdauer der COVID-19-Pandemie gilt es, vorhandene vertrauenswürdige, qualitativ hochwertige Informations- und Beratungskapazitäten auszubauen und ihre Bekanntheit zu erhöhen, um gesundheitskompetente Entscheidungen auch in der Pandemie zu ermöglichen.
Objective
The aim of the current project was the development, implementation and evaluation of the programme, Motivational‐Volitional Intervention‐Movement After Breast Cancer (Mo‐Vo‐BnB), an intervention for the sustainable promotion of physical activity of breast cancer survivors.
Methods
In a multi‐stage interdisciplinary development process, the pedagogical‐didactic, psychological and physical evidence‐based programme was developed and implemented for women after breast cancer who were approved for medical rehabilitation and were minimally, physically active (<60 min/week). Train‐the‐trainer seminars were carried out for the implementation. Four sessions were implemented in two German clinics. The training quality, didactic methods and accompanying material were evaluated 6 weeks and 12 months after implementation by patients, trainers and project members (n = 127 evaluations).
Results
The standardised and published MoVo‐BnB programme can provide practical and quality training. Content and methods can be implemented according to the manual. Training quality, didactic methods, and accompanying materials were evaluated positively.
Conclusion
The results suggest that MoVo‐BnB is a useful standardised intervention for promoting the physical activity of breast cancer survivors. The demonstrated process is also suitable for other projects.
Clinical trial registration
German Clinical Trials Register (DRKS): DRKS00011122; Trial registration date: 2016 October 13.
Hintergrund
Die Anzahl multipel chronisch erkrankter Älterer steigt, und Multimorbidität geht mit hoher Inanspruchnahme von Gesundheitsleistungen einher. Um Selbstständigkeit und Verbleib in der Häuslichkeit zu erhalten, wird zunehmend ein integriertes Versorgungsmanagement eingesetzt. Zur Wirksamkeit in der Zielgruppe der multipel chronisch erkrankten Älteren liegen aber kaum belastbare Daten vor.
Ziel der Arbeit
Bewertung der Wirksamkeit von integriertem Versorgungsmanagement bei Erwachsenen und Abschätzung der Übertragbarkeit auf ältere, multimorbide Personen in Deutschland.
Methoden
Systematische Literaturrecherche in der Cochrane Library mit Einschluss von Cochrane-Reviews (CR) zu (a) den 13 häufigsten Gesundheitsproblemen im Alter, mit (b) Komponenten des integrierten Versorgungsmanagements bei (c) Erwachsenen jeden Alters. Experten schätzten die Übertragbarkeit der eingeschlossenen CR auf multipel chronisch erkrankte Ältere in Deutschland ein.
Ergebnisse
Aus 1412 Treffern wurden 126 CR eingeschlossen. Zur Endpunktkategorie Selbstständigkeit und funktionale Gesundheit zeigten 25 CR klinisch relevante Ergebnisse mit moderater Evidenzqualität. Folgende Interventionskomponenten wurden – unter Berücksichtigung identifizierter Barrieren – als übertragbar eingeschätzt und könnten für ein effektives, indikationsspezifisch integriertes Versorgungsmanagement multipel chronisch erkrankter Älterer herangezogen werden: (1) körperliche Aktivierung, (2) multidisziplinäre Interventionen, (3) das Selbstmanagement verstärkende Interventionen, (4) kognitive Therapieverfahren, (5) telemedizinische Interventionen und (6) Disease-Management-Programme.
Schlussfolgerungen
Die identifizierten Komponenten sollten in versorgungs- und patientennahen randomisierten kontrollierten Studien auf Wirksamkeit bei gebrechlichen Älteren geprüft werden.
Background
When parents want to make health-related decisions for their child, they need to be able to handle health information from a potentially endless range of sources. Early childhood allergy prevention (ECAP) is a good example: recommendations have shifted from allergen avoidance to early introduction of allergenic foods. We investigated how parents of children under 3 years old access, appraise and apply health information about ECAP, and their respective needs and preferences.
Methods
We conducted 23 focus groups and 24 interviews with 114 parents of children with varied risk for allergies. The recruitment strategy and a topic guide were co-designed with the target group and professionals from public health, education, and medicine. Data were mostly collected via video calls, recorded and then transcribed verbatim. Content analysis according to Kuckartz was performed using MAXQDA and findings are presented as a descriptive overview.
Results
Parents most frequently referred to family members, friends, and other parents as sources of ECAP information, as well as healthcare professionals (HCPs), particularly pediatricians. Parents said that they exchanged experiences and practices with their peers, while relying on HCPs for guidance on decision-making. When searching for information online, they infrequently recalled the sources used and were rarely aware of providers of “good” health information. While parents often reported trying to identify the authors of information to appraise its reliability, they said they did not undertake more comprehensive information quality checks. The choice and presentation of ECAP information was frequently criticized by all parent groups; in particular, parents of at-risk children or with a manifested allergy were often dissatisfied with HCP consultations, and hence did not straightforwardly apply advice. Though many trusted their HCPs, parents often reported taking preventive measures based on their own intuition.
Conclusion
One suggestion to react upon the many criticisms expressed by parents regarding who and how provides ECAP information is to integrate central ECAP recommendations into regular child care counseling by HCPs—provided that feasible ways for doing so are identified. This would assist disease prevention, as parents without specific concerns are often unaware of the ECAP dimension of issues such as nutrition.
Organizational health literacy in German hospitals: a cross-sectional survey among hospital managers
(2024)
Abstract
Background
Organizational health literacy (OHL) describes conditions and measures in healthcare institutions to enable patients to make good health-related decisions. By providing easy access to and appropriate communication of understandable information to use and navigate the facility, healthcare organizations can contribute to strengthening patients’ health literacy and self-management. The extent of OHL implementation in German hospitals remains largely unknown. This study aims to fill this gap in our knowledge by investigating OHL-related activities reported by hospital managers.
Methods
Between November and December 2022, we conducted a national online survey among medical, nursing and administrative hospital managers with hospitals that operate more than 50 beds. The data were collected via the health literate health care organization ten item questionnaire (HLHO-10) and supplemented by sociodemographic questions and an open-ended question. We applied variance and correlation analyses to investigate the data.
Results
Of 3,301 invited hospital managers, 371 participated in the survey (response rate 11%). The overall mean score for HLHO-10 was 4.6 (SD = 1.1) on a 7-point Likert scale, indicating a moderate level of OHL implementation. Hospital managers stated that hospitals concentrate on helping patients find their way around and communicating the costs of treatment transparently and clearly; conversely, that active patient participation in the design and evaluation of health information is rare in care settings, and that health information is seldom provided to patients through a range of media. For the practical implementation of the OHL, most hospital managers mentioned activities regarding communication standards, such as providing information materials.
Conclusions
Given their unique position as hubs of human interaction, hospitals provide an ideal opportunity to promote the adoption of OHL. By actively involving patients, hospitals can better tailor their approaches to meet patient needs and preferences. Compared to studies from oncology centres in Germany and 20 Italian hospitals, the average HLHO-10 score of this study is lower. While some aspects of OHL are already embedded in inpatient care, it is imperative that OHL is thoroughly embedded in the hospitals’ organizational culture and plays a fundamental role in the daily operations of the institution. This could be done, for instance, by more explicitly addressing the topic of health literacy in staff communication training.
Zusammenfassung
Hintergrund
Organisationale Gesundheitskompetenz (OGK) beschreibt Bedingungen und Maßnahmen in Einrichtungen der Gesundheitsversorgung, wie z. B. Krankenhäusern, die Patient:innen dabei unterstützen sollen, gute gesundheitsbezogene Entscheidungen zu treffen. In der COVID-19-Pandemie waren auch Krankenhäuser gefordert, ihren Patient:innen den Zugang zu und den Umgang mit Gesundheitsinformationen und -dienstleistungen zu erleichtern.
Ziel
Zielsetzung des Beitrags ist eine Bestandsaufnahme der OGK-Aktivitäten in deutschen Krankenhäusern während der COVID-19-Pandemie. Fokussiert wird dabei der Vergleich der OGK-Aktivitäten in Krankenhäusern während und außerhalb pandemischer Zeiten.
Methodik
Zwischen November und Dezember 2022 wurde eine Online-Befragung von ärztlichen, pflegerischen und kaufmännischen Krankenhausleitungen durchgeführt. Die OGK wurde anhand des HLHO-10-Fragebogens erhoben, wobei dieser für die COVID-19-Pandemie erfolgreich adaptiert wurde (gute interne Konsistenz: α = 0,89). Die Auswertung erfolgte mit SPSS 28 mittels Varianz- und Korrelationsanalysen. Zudem bestand die Möglichkeit einer Freitextangabe zu OGK-Aktivitäten, welche mithilfe von MAXQDA und einer qualitativen Inhaltsanalyse ausgewertet wurden.
Ergebnisse
Von 3301 eingeladenen Krankenhausleitungen nahmen 328 an der Befragung teil (Rücklaufquote 10 %). Die Krankenhausleitungen geben an, dass in ihren Häusern während der Pandemie darauf geachtet wurde, dass sich Patient:innen einfach zurechtfinden. Jedoch ist eine aktive Einbindung von Patient:innen bei der Gestaltung und Evaluierung von Gesundheitsinformationen kaum umgesetzt. Zum Zeitpunkt der COVID-19-Pandemie wurden statistisch signifikant mehr Mitarbeitende zum Thema Gesundheitskompetenz geschult ( p < 0,001). Aus den Freitexten wird deutlich, dass die Befragten Optimierungsbedarf sehen, dem sie aufgrund mangelnder Ressourcen nur schwer nachkommen können.
Schlussfolgerung
Den Krankenhausleitungen ist bewusst, dass nicht alle Teilaspekte der OGK gleichmäßig gut umgesetzt sind. Es ist entscheidend, GK kontinuierlich in das organisatorische Handeln zu integrieren und dem Thema Priorität einzuräumen.
AbstractBackgroundWithin the ageing population of Western societies, an increasing number of older people have multiple chronic conditions. Because multiple health problems require the involvement of several health professionals, multimorbid older people often face a fragmented health care system. To address these challenges, in a two-group parallel randomized controlled trial, a newly developed care management approach (LoChro-Care) was compared with usual care.MethodsLoChro-Care consists of individualized care provided by chronic care managers with 7 to 16 contacts over 12 months. Patients aged 65 + with chronic conditions were recruited from inpatient and outpatient departments. Healthcare utilization costs are calculated by using an adapted version of the generic, self-reporting FIMA©-questionnaire with the application of standardized unit costs. Questionnaires were given at 3 time points (T0 baseline, T1 after 12 months, T2 after 18 months). The primary outcome was overall 3-month costs of healthcare utilization at T1 and T2. The data were analyzed using generalized linear models with log-link and gamma distribution and adjustment for age, sex, level of care as well as the 3-month costs of care at T0.ResultsThree hundred thirty patients were analyzed. The results showed no significant difference in the costs of healthcare utilization between participants who received LoChro-Care and those who received usual care, regardless of whether the costs were evaluated 12 (adjusted mean difference € 130.99, 95%CI €-1477.73 to €1739.71, p = 0.873) or 18 (adjusted mean difference €192.99, 95%CI €-1894.66 to €2280.65, p = 0.856) months after the start of the intervention.ConclusionThis study revealed no differences in costs between older people receiving LoChro-Care or usual care. Before implementing the intervention, further studies with larger sample sizes are needed to provide robust evidence on the cost effects of LoChro-Care.Trial registrationGerman Clinical Trials Register (DRKS): DRKS00013904, https://drks.de/search/de/trial/DRKS00013904; date of first registration 02/02/2018.
Zusammenfassung
Hintergrund
Offen ist, zu welchem Grad Krankenhäuser und Einrichtungen der Altenpflege in Deutschland ihren Klient:innen gute gesundheitsbezogene Entscheidungen ermöglichen, d. h. organisationale Gesundheitskompetenz (oGK) zeigen, und welche Aspekte im Detail für Identifikation von Ansatzpunkten zur Förderung der oGK essenziell sind.
Methodik
Grundlage bilden 3 unabhängig voneinander durchgeführte Forschungsprojekte: (1) Befragung von Krankenhäusern (KH) und Pflegeeinrichtungen (PE; EwiKo, 2021), (2) Befragung von KH (GK-KH, 2022) und (3) ein Konsensprozess zur Reduktion eines ausführlichen Selbstbewertungsinstrumentes (SAT-OHL-Hos v1.1; 2024). In (1) und (2) einbezogen wurden alle deutschen KH sowie die 1475 PE in Sachsen und Thüringen, eingesetzt wurde der HLHO-10 (Wertebereich 1 bis 7, hohe Werte = hohe oGK). Der Konsensprozess erfolgte im WHO-Netzwerk M‑POHL mit dem Ziel der Kürzung der 141 Indikatoren um etwa 2 Drittel unter Erhalt der Tiefe und Breite des Konzeptes in 3 Schritten: Priorisierung von Indikatoren auf nationaler Ebene, Zusammenführung nationaler Voten, Konsens in der internationalen Arbeitsgruppe.
Ergebnisse
Auswertbare Fragebögen liegen von 195 PE, 62 bzw. 291 KH vor (Rücklauf: 13,2 %, 3,2 % bzw. 11 %). Die Mittelwerte der 10 Standards des HLHO-10 liegen zwischen 3,5 und 5,7. Substanzielle Unterschiede zwischen KH und PE bestehen nicht. Der Konsensprozess führte zu einem auf 54 Items reduzierten Instrument, diskutiert wurde u. a., was länderübergreifend zu erwarten ist.
Diskussion
Erstmals liegen Daten zur oGK in der stationären Pflege vor, die selbsteingeschätzte oGK der befragten Einrichtungen liegt im mittleren bis guten Bereich, mit dem auf ca. ein Drittel gekürzten SAT-OHL-Hos steht ein „kurzes ausführliches“ und international vergleichend einsetzbares Instrument zur Verfügung, dessen empirische Prüfung ansteht.