BackgroundHypertension is one of the key factors causing cardiovascular diseases. A substantial proportion of treated hypertensive patients do not reach recommended target blood pressure values. Shared decision making (SDM) is to enhance the active role of patients. As until now there exists little information on the effects of SDM training in antihypertensive therapy, we tested the effect of an SDM training programme for general practitioners (GPs). Our hypotheses are that this SDM training (1) enhances the participation of patients and (2) leads to an enhanced decrease in blood pressure (BP) values, compared to patients receiving usual care without prior SDM training for GPs.MethodsThe study was conducted as a cluster randomised controlled trial (cRCT) with GP practices in Southwest Germany. Each GP practice included patients with treated but uncontrolled hypertension and/or with relevant comorbidity. After baseline assessment (T0) GP practices were randomly allocated into an intervention and a control arm. GPs of the intervention group took part in the SDM training. GPs of the control group treated their patients as usual. The intervention was blinded to the patients. Primary endpoints on patient level were (1) change of patients’ perceived participation (SDM-Q-9) and (2) change of systolic BP (24h-mean). Secondary endpoints were changes of (1) diastolic BP (24h-mean), (2) patients’ knowledge about hypertension, (3) adherence (MARS-D), and (4) cardiovascular risk score (CVR).ResultsIn total 1357 patients from 36 general practices were screened for blood pressure control by ambulatory blood pressure monitoring (ABPM). Thereof 1120 patients remained in the study because of uncontrolled (but treated) hypertension and/or a relevant comorbidity. At T0 the intervention group involved 17 GP practices with 552 patients and the control group 19 GP practices with 568 patients. The effectiveness analysis could not demonstrate a significant or relevant effect of the SDM training on any of the endpoints.ConclusionThe study hypothesis that the SDM training enhanced patients’ perceived participation and lowered their BP could not be confirmed. Further research is needed to examine the impact of patient participation on the treatment of hypertension in primary care.Trial registrationGerman Clinical Trials Register (DRKS): DRKS00000125

Introduction: Integrated care solutions need supportive financial incentives. In this paper, we describe the financial architecture and operative details of the integrated pilot Gesundes Kinzigtal. Description of integrated care case: Located in Southwest Germany, Gesundes Kinzigtal is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications. The system serving around half of the population of the region is run by a regional health management company (Gesundes Kinzigtal GmbH) in cooperation with the physicians' network in the region (MQNK), a German health care management company with a background in medical sociology and health economics (OptiMedis AG) and with two statutory health insurers (among them is the biggest health insurer in Southwest Germany: AOK Baden-Württemberg). Discussion and (preliminary) conclusion: The shared savings contract between Gesundes Kinzigtal GmbH and the two health insurers, providing financial incentives for managers and health care providers to realize a substantial efficiency gain, could be an appropriate contractual base of Gesundes Kinzigtal's population health gain approach. This approach is based on the assumption that a more effective trans-sector organization of Germany's health care system and increased investments in well-designed preventive programmes will lead to a reduction in morbidity, and in particular to a reduced incidence and prevalence of chronic diseases. This, in turn, is to lead to a comparative reduction in health care cost. Although the comparative cost in the Kinzigtal region has been reduced from the onset of Gesundes Kinzigtal Integrated Care, only future research will have to demonstrate whether-and to what extent-cost reduction may be attributed to a real population health gain.

The data suggest a considerably higher risk of low back pain for nurses than for the reference population of clerks. Results, however, differ markedly when specific pain symptoms are considered. With respect to lumbago-sciatica and sciatica - which have to be regarded as indicators for possible disc herniation - the study group's relative risk is the most elevated (2.88 for point prevalence of lumbago-sciatica/sciatica). Adjusting the results for several confounders and covariates leads to still higher estimations of nurses' relative risk.

Low health literacy is associated with poorer health and quality of life. An open question is whether a regional integrated healthcare system whose management strives to enable and empower its members with regard to health issues can contribute to a higher level of health literacy in the population. Against this background, in a cross-sectional study we surveyed a random selection of members of an integrated healthcare system in southwestern Germany (n = 180). The standardized questionnaire included, inter alia, questions on health literacy and subjective health. In this sample we wanted to (1) determine the proportion of respondents with sufficient health literacy and (2) investigate whether the association between health literacy and quality of life and subjective health status—as found in other studies—can be replicated. In our sample a health literacy score could be calculated in 126 subjects (70%). A sufficient level of health literacy was detected in 62% of respondents. Confirming the findings of a meta-analysis based on international studies, we found moderate correlations between health literacy and quality of life (r = 0.41) and health literacy and subjective health status (r = 0.40); these correlations hardly decreased when we controlled for various sociodemographic characteristics. As the proportion of respondents with sufficient health literacy was higher in our sample than in comparable studies conducted in Germany, we may hypothesize that an integrated healthcare system like the one we surveyed could have contributed to increased health literacy in the population. Thus, it could be worthwhile to investigate this research question with a more rigorous study design and a larger sample.

Background Perceived high chronic stress is twice as prevalent among German general practitioners (GPs) and non-physician medical staff compared to the general population. The reasons are multi-factorial and include patient, practice, healthcare system and societal factors, such as multi-morbidity, the diversity of populations and innovations in medical care. Also, practice-related factors, like stressful patient-staff interactions, poor process management of waiting times and lack of leadership, play a role. This publicly funded study evaluates the effectiveness of the newly developed participatory, interdisciplinary, and multimodal IMPROVEjob intervention on improving job satisfaction among general practice personnel. The intervention aims at structural stress prevention with regard to working conditions and behavioural stress prevention for leaders and other practice personnel. Methods In this cluster-randomised controlled trial, a total of 56 general practices will be assigned to either (1) participation in the IMPROVEjob intervention or (2) the waiting-list control group. The IMPROVEjob intervention consists of the following elements: three workshops, a toolbox with supplemental material and an implementation period with regular contact to so-called IMPROVEjob facilitators. The first workshop, addressing leadership issues, is designed for physicians with leadership responsibilities only. The two subsequent workshops target all GP and non-physician personnel; they address issues of communication (with patients and within the team), self-care and team-care and practice organisation. During the 9-month implementation period, practices will be contacted by IMPROVEjob facilitators to enhance motivation. Additionally, the practices will have access to the toolbox materials online. All participants will complete questionnaires at baseline and follow up. The primary outcome is the change in job satisfaction as measured by the respective scale of the validated German version of the Copenhagen Psychosocial Questionnaire (COPSOQ, version 2018). Secondary outcomes obtained by questionnaires and - qualitatively - by facilitators comprise psychosocial working conditions including leadership aspects, expectations and experiences of the workshops, team and individual efforts and organisational changes. Discussion It is hypothesised that participation in the IMPROVEjob intervention will improve job satisfaction and thus constitute a structural and behavioural prevention strategy for the promotion of psychological wellbeing of personnel in general practices and prospectively in other small and medium sized enterprises. Trial registration German Clinical Trials Register: DRKS00012677. Registered on 16 October 2019. Retrospectively, https://www.drks.de/drks_web/navigate.do?navigationId=trial. HTML&TRIAL_ID = DRKS00012677.

This pilot study shows that DECADE can support patient activation. The effects can be expected to be stronger in a larger study and in comparison to usual care. If this can be confirmed, DECADE should be embedded in routine patient care.

ZusammenfassungMehr als die Hälfte der deutschen Bevölkerung hat Schwierigkeiten im Umgang mit Gesundheitsinformationen. Es ist eine wichtige Aufgabe der Versorgungsforschung zu untersuchen, wie sich die Professionen und Organisationen des Gesundheitssystems dieser Herausforderung stellen können. Das DNVF Memorandums Gesundheitskompetenz (Teil 1) nimmt Begriffsbestimmungen der individuellen und organisationalen Gesundheitskompetenz vor, präsentiert den nationalen und internationalen Forschungsstand und stellt ethische Aspekte der versorgungsbezogenen Gesundheitskompetenzforschung dar. Weiterhin wird die Relevanz der Gesundheitskompetenzforschung in verschiedenen Lebensphasen, bei unterschiedlichen Personengruppen sowie in verschiedenen Kontexten der Gesundheits- und Krankenversorgung erarbeitet. Vor diesem Hintergrund werden zentrale Forschungsgegenstände und zukünftige Forschungsdesiderata abgeleitet.

Similar to ‘Total Worker Health’ in the United States (USA), ‘Workplace Health Management’ in Germany is a holistic strategy to protect, promote, and manage employees’ health at the workplace. It consists of four subcategories. While the subcategories ‘occupational health and safety’ and ‘reintegration management’ contain measures prescribed by law, ‘workplace health promotion’ and ‘personnel development’ can be designed more individually by the companies. The present study focused on the current implementation of voluntary and legally required measures of the four subcategories, as well as companies’ satisfaction with the implementation. A total of N = 222/906 companies (small, medium, and big enterprises of one German county) answered a standardized questionnaire addressing the implementation of health-related measures, satisfaction with the implementation, and several company characteristics. In the subcategory ‘occupational health and safety’, 23.9% of the companies fulfilled all of the legally required measures, whereas in the category ‘reintegration management’, that rate amounted to 50.9%. There was a positive correlation between company size and the implementation grade, and as well between company size and the fulfilling of measures required by law. Companies tended to be more satisfied with higher implementation grades. Nevertheless, a surprisingly high proportion of the companies with poor implementation indicated satisfaction with the measures’ implementation.