Quality indicators are widely used instruments of quality assurance measures to illustrate/document/take on record output variables. We here want to review and discuss the significance of quality indicators in outpatient integrated psychiatric care. Taking patient waiting time as an example, we want to discuss the challenges and difficulties to make clear statements about achievements in outpatient psychiatric care, and what parameters determine (or temper) these results and statements. As a conclusion, we strongly suggest early evaluation in the implementation of new ways and structures of patient care to prevent adverse outcomes by deficient or erroneous use of quality indicators.
Zusammenfassung. Die Methode der Simulation bietet Lernenden die Möglichkeit ein planmäßiges Vorgehen in einem geschützten Rahmen, durchdacht und schrittweise für eine beruflich relevante Situation auszuprobieren. Dabei lernen sie, sowohl die Vorgehensweise zielführend einzusetzen als dabei auch eigene Erfahrung durch die Handlungsform zu reflektieren und somit professionelle Kompetenzen weiter zu entwickeln. Wie kann dieser hohe Anspruch annäherungsweise erreicht werden? Überlegungen hierzu und Schritte zur Realisierung werden im Folgenden dargestellt.
Introduction: Numerous tools exist to detect potentially inappropriate medication (PIM) and potential prescribing omissions (PPO) in older people, but it remains unclear which tools may be most relevant in which setting. Objectives: This cross sectional study compares six validated tools in terms of PIM and PPO detection. Methods: We examined the PIM/PPO prevalence for all tools combined and the sensitivity of each tool. The pairwise agreement between tools was determined using Cohen’s Kappa. Results: We included 226 patients in need of care (median (IQR age 84 (80–89)). The overall PIM prevalence was 91.6 (95% CI, 87.2–94.9)% and the overall PPO prevalence was 63.7 (57.1–69.9%)%. The detected PIM prevalence ranged from 76.5%, for FORTA-C/D, to 6.6% for anticholinergic drugs (German-ACB). The PPO prevalences for START (63.7%) and FORTA-A (62.8%) were similar. The pairwise agreement between tools was poor to moderate. The sensitivity of PIM detection was highest for FORTA-C/D (55.1%), and increased to 79.2% when distinct items from STOPP were added. Conclusion: Using a single screening tool may not have sufficient sensitivity to detect PIMs and PPOs. Further research is required to optimize the composition of PIM and PPO tools in different settings.
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