Background Shared decision-making (SDM) is a key principle in asthma management, but continues to be poorly implemented in routine care. This study aimed to evaluate the impact of a SDM communication skills training for physicians treating patients with asthma on the SDM behaviors of physicians, and to analyze physician views on the training. Methods A mixed methods study with a partially mixed sequential equal status design was conducted to evaluate a 12 h SDM communication skills training for physicians treating patients with asthma. It included a short introductory talk, videotaped consultations with simulated asthma patients, video analysis in small group sessions, individual feedback, short presentations, group discussions, and practical exercises. The quantitative evaluation phase consisted of a before (t0) after (t1) comparison of SDM performance using the observer-rated OPTION 5 , the physician questionnaire SDM-Q-Doc, and the patient questionnaire SDM-Q-9, using dependent t-tests. The qualitative evaluation phase (t2) consisted of a content analysis of audiotaped and transcribed interviews. Results Initially, 29 physicians participated in the study, 27 physicians provided quantitative data, and 22 physicians provided qualitative data for analysis. Quantitative results showed significantly improved performance in SDM following the training (t1) when compared with performance in SDM before the training (t0) (OPTION 5 : t (26) = − 5.16; p < 0.001) (SDM-Q-Doc: t (26) = − 4.39; p < 0.001) (SDM-Q-9: t (26) = − 5.86; p < 0.001). The qualitative evaluation showed that most physicians experienced a change in attitude and behavior after the training, and positively appraised the training program. Physicians considered simulated patient consultations, including feedback and video analysis, beneficial and suggested the future use of real patient consultations. Conclusion The SDM communication skills training for physicians treating patients with asthma has potential to improve SDM performance, but would benefit from using real patient consultations.

Abstract. Background: The German Guideline on Screening, Diagnosis and Treatment of Alcohol Use Disorders aims to increase the uptake of evidence-based interventions for the early identification, diagnosis, prevention and treatment of alcohol-related disorders in relevant healthcare settings. To date, dissemination has not been accompanied by a guideline implementation strategy. The aim of this study is to develop tailored guideline implementation strategies and to field-test these in relevant medical and psycho-social settings in the city of Bremen, Germany. Methods: The study will conduct an impact and needs assessment of healthcare provision for alcohol use orders in Bremen, drawing on a range of secondary and primary data to: evaluate existing healthcare services; model the potential impact of improved care on public health outcomes; and identify potential barriers and facilitators to implementing evidence-based guidelines. Community advisory boards will be established for the selection of single-component or multi-faceted guideline implementation strategies. The tailoring approach considers guideline, provider and organizational factors shaping implementation. In field tests quality outcome indicators of the delivery of evidence-based interventions will be evaluated accompanied by a process evaluation to examine patient, provider and organizational factors. Outlook: This project will support the translation of guideline recommendations for the identification, prevention and treatment of AUD in routine practice and therefore contributes to the reduction of alcohol-related burden in Germany. The project is running since October 2017 and will provide its main outcomes by end of 2020. Project results will be published in scientific journals and presented at national and international conferences.

Background: Placement matching guidelines are promising means to optimize patient-centered care and to match patients' treatment needs. Despite considerable research regarding placement matching approaches to optimize alcohol abuse treatment, findings are inconclusive. Objectives: To investigate whether the use of patient-centered placement matching (PCPM) guidelines is more effective in reducing heavy drinking and costs 6 months after discharge from an inpatient alcohol withdrawal treatment compared to usu-al referral to aftercare. Secondary aims were to investigate whether age, gender, trial site or level of care (LOC) are moderators of efficacy and whether patients who were actually referred to the recommended LOC had better treatment outcomes compared to patients who were treated under-or overmatched. Methods: Design. Exploratory randomized controlled trial with measurements during withdrawal treatment and 6 months after initial assessment. Setting. Four German psychiatric clinics offering a 7-21 day inpatient qualified withdrawal program for patients suffering from alcohol dependence. Participants. From 1,927 patients who had a primary diagnosis of alcohol dependence and did not have organized aftercare when entering withdrawal treatment, 299 were invited to participate. Of those, 250 were randomized to the intervention group (IG, n = 123) or the control group (CG, n = 127). Intervention. The PCPM were applied to patients of the IG by feeding back a recommenda-Buchholz et al.tion to a LOC for aftercare that was calculated from the Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff of the treatment unit. Patients of the CG received a general feedback regarding their MATE interview on request. Measurements. The MATE, the Client Socio-Demographic and Service Receipt Inventory-European Version and the MATE-Outcomes were administered. Data were analyzed using generalized linear models. Results: In the intention-to-treat analysis, there were no significant differences between IG and CG regarding days of heavy drinking (incident risk ratio [IRR] 1.09; p = 0.640), direct (IRR 1.06; p = 0.779), indirect (IRR 0.77; p = 0.392) and total costs (IRR 0.89; p = 0.496). Furthermore, none of the investigated moderator variables affected statistically significant drinking or cost-related primary outcomes. Regardless of group allocation, patients who received matched aftercare reported significantly fewer days of heavy drinking than undermatched patients (IRR 2.09; p = 0.004). For patients who were overmatched, direct costs were significantly higher (IRR 1.79; p = 0.024), but with no additional effects on alcohol consumption compared to matched patients. Conclusions: While the use of PCPM failed to affect the actual referral to aftercare, our findings suggest that treating patients on the recommended LOC may have the potential to reduce days of heavy drinking compared to undertreatment and costs compared to overtreatment.

Zusammenfassung Ziel der Studie Ziel dieser Studie war es, einen Eindruck über die klinische Praxis der Indikationsstellung und Empfehlung für eine Postakutbehandlung aus dem qualifizierten Alkoholentzug zu gewinnen. Im Einzelnen wurde untersucht, welche möglichen Barrieren für die Empfehlung und Planung einer geeigneten Postakutbehandlung aus Sicht der verantwortlichen Mitarbeiterinnen und Mitarbeiter im qualifizierten Alkoholentzug bestehen. Weiterhin wurde erfasst, welche Kriterien für die Indikationsstellung für Postakutbehandlungen in der klinischen Praxis als relevant erachtet werden. Methodik Mit insgesamt 3 Erinnerungsrunden wurden 418 Kliniken mit dem Angebot einer stationären qualifizierten Alkoholentzugsbehandlung zu einer schriftlichen Befragung eingeladen. Die Teilnahme war sowohl online als auch schriftlich möglich und sollte von jeweils einem Mitarbeiter stellvertretend für die gesamte Station beantwortet werden. Die Befragung enthielt Fragen zu Barrieren für eine Weiterverweisung, der Bedeutung verschiedener Indikationskriterien sowie Fragen zur Einrichtungsstruktur. Ergebnisse Von 88 antwortenden Einrichtungen (21% Rücklauf), gaben 81 Behandlungsplätze für den qualifizierten Alkoholentzug an und wurden in die deskriptive Auswertung einbezogen. Die meisten Teilnehmer sahen lange Wartezeiten auf eine psychotherapeutische Weiterbehandlung (65,4%), Rehabilitation (48,1%), fehlende Behandlungsangebote für schwer beeinträchtigte Patienten (61,7%) sowie die Klärung der Kostenübernahme (45,7%) als starke Barriere für die Vermittlung in eine Postakutbehandlung. Für eine differentielle Indikationsstellung wurden symptombezogene Kriterien wie die Schwere der Abhängigkeit und das Rückfallrisiko mit einem Mittelwert über 5 auf einer 6stufigen Skala als besonders relevant erachtet. Schlussfolgerungen Die benannten Barrieren beziehen sich v. a. auf die Versorgungsorganisation und sollten vor dem Hintergrund aktueller struktureller Änderungen repliziert werden, um einen Vergleich zu ermöglichen. Eine stärkere Betonung auch teilhabeorientierter Kriterien für die Wahl einer Postakutbehandlung sollte angestrebt werden, um die Wiederherstellung der Teilhabe als langfristigem Behandlungsziel stärker zu betonen.

Background In the implementation of placement matching guidelines, feasibility has been concerned in previous research. Objectives of this process evaluation were to investigate whether the patient-centered matching guidelines (PCPM) are consistently applied in referral decision-making from an inpatient qualified withdrawal program to a level of care in aftercare, which factors affect whether patients actually receive matched aftercare according to PCPM, and whether its use is feasible and accepted by clinic staff. Methods The study was conducted as process evaluation within an exploratory randomized controlled trial in four German psychiatric clinics offering a 7-to-21 day qualified withdrawal program for patients suffering from alcohol dependence, and with measurements taken during detoxification treatment and six months after the initial assessment. PCPM were used with patients in the intervention group by feeding back to them a recommendation for a level of care in aftercare that had been calculated from Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff on the treatment unit. As measurements, The MATE, the Client Socio-Demographic and Service Receipt Inventory—European Version, a documentation form, the Control Preference Scale, and the Motivation for Treatment Scale were administered. A workshop for the staff at the participating trial sites was conducted after data collection was finished. Results Among 250 patients participating in the study, 165 were interviewed at follow-up, and 125 had received aftercare. Although consistency in the application of PCPM was moderate to substantial within the qualified withdrawal program (Cohen’s kappa ≥ .41), it was fair from discharge to follow-up. In multifactorial multinomial regression, the number of foregoing substance abuse treatments predicted whether patients received more likely undermatched (Odds Ratio=1.27; p=.018) or overmatched (Odds Ratio=0.78; p=.054) treatment. While the implementation process during the study was evaluated critically by the staff, they stated a potential of quality assurance, more transparency and patient-centeredness in the use of PCPM. Conclusions While the use of PCPM has the potential to enhance the quality of referral decision making within treatment, it may not be sufficient to determine referral decisions for aftercare. Trial Registration German Clinical Trials Register DRKS00005035. Registered 03/06/2013.