BackgroundSchizophrenia and bipolar disorder are characterized by a high disease burden. Antipsychotic medication is an essential part of the treatment. However, non-adherence is a major problem. Our aim was to examine potential determinants of non-adherence for patients with severe mental disorders.MethodsBaseline data of the study “Post stationary telemedical care of patients with severe psychiatric disorders” (Tecla) were used. Medication adherence was assessed with the Medication Adherence Report Scale German version (MARS-D). A logistic regression was calculated with age, sex, education, employment status, level of global functioning, social support and intake of typical and atypical antipsychotics as predictors.ResultsN = 127 participants were included in the analysis (n = 73 men, mean age 42 years). The mean MARS-D Score was 23.4 (SD 2.5). The most common reason for non-adherence was forgetting to take the medicine. Significant positive determinants for adherence were older age (OR 1.02, 95% CI 1.011–1.024, p < 0.0001), being employed (OR 2.46, 95% CI 1.893–3.206, p < 0.0001), higher level of global functioning (overall measure of how patients are doing) (OR 1.02, 95% CI 1.012–1.028, p < 0.0001), having social support (OR 1.02, 95% CI 1.013–1.026, p < 0.0001), and intake of typical antipsychotics (OR 2.389, 95% CI 1.796–3.178, p < 0.0001). A negative determinant was (female) sex (OR 0.73, 95% CI 0.625–0.859, p = 0.0001).ConclusionsEspecially employment, functioning and social support could be promising targets to facilitate adherence in patients with schizophrenia or bipolar disorder.Trial registrationThis study is retrospectively registered at the German Clinical Trials Register with the trial registration number DRKS00008548 at 21/05/2015.

Background Healthcare workers (HCW) are at increased risk of infection with SARS-CoV-2. Vulnerable patient populations in particular must be protected, and clinics should not become transmission hotspots to avoid delaying medical treatments independent of COVID. Because asymptomatic transmission has been described, routine screening of asymptomatic HCW would potentially be able to interrupt chains of infection through early detection. Methods A systematic search was conducted in the Cochrane COVID-19 Study Register, Web of Science and WHO COVID‐19 Global literature on coronavirus with regard to non-incident related testing of healthcare workers using polymerase chain reaction on May 4th 2021. Studies since January 2020 were included. An assessment of risk of bias and representativeness was performed. Results The search identified 39 studies with heterogeneous designs. Data collection of the included studies took place from January to August 2020. The studies were conducted worldwide and the sample size of the included HCW ranged from 70 to 9449 participants. In total, 1000 of 51,700 (1.9%) asymptomatic HCW were tested positive for SARS-CoV-2 using PCR testing. The proportion of positive test results ranged between 0 and 14.3%. No study reported on HCW-screening related reductions in infected person-days. Discussion and conclusions The heterogeneous proportions might be explained by different regional incidences, lock-downs, and pre-analytical pitfalls that reduce the sensitivity of the nasopharyngeal swab. The very high prevalence in some studies indicates that screening HCW for SARS-CoV-2 may be important particularly in geographical regions and pandemic periods with a high-incidence. With low numbers and an increasing rate of vaccinated HCW, a strict cost–benefit consideration must be made, especially in times of low incidences. Since we found no studies that reported on HCW-screening related reductions in infected person-days, re-evaluation should be done when these are available.

Background Costs for the provision of regional hospital care depend, among other things, on the population density and the maximum reasonable distance to the nearest hospital. In regions with a low population density, it is a challenge to plan the number and location of hospitals with respect both to economic efficiency and to the availability of hospital care close to residential areas. We examined whether the hospital landscape in rural regions can be planned on the basis of a regional economic model using the example which number of paediatric and obstetric wards in a region in the Northeast of Germany is economically efficient and what would be the consequences for the accessibility when one or more of the three current locations would be closed. Methods A model of linear programming was developed to estimate the costs and revenues under different scenarios with up to three hospitals with both a paediatric and an obstetric ward in the investigation region. To calculate accessibility of the wards, geographic analyses were conducted. Results With three hospitals in the study region, there is a financial gap of €3.6 million. To get a positive contribution margin for all three hospitals, more cases have to be treated than the region can deliver. Closing hospitals in the parts of the region with the smallest population density would lead to reduced accessibility for about 8% of the population under risk. Conclusions Quantitative modelling of the costs of regional hospital care provides a basis for planning. A qualitative discussion to the locations of the remaining departments and the implementation of alternative healthcare concepts should follow.

Due to the increase of incident and prevalent cancer cases, the number of hospital days and sickness costs will increase. The results of the analyses show an increase of medical care services in the outpatient sector.

Background Patients of geriatrics are often treated by several health care providers at the same time. The spatial, informational, and organizational separation of these health care providers can hinder the effective treatment of these patients. Objective This study aimed to develop a regional health information exchange (HIE) system to improve HIE in geriatric treatment. This study also evaluated the usability of the regional HIE system and sought to identify barriers to and facilitators of its implementation. Methods The development of the regional HIE system followed the community-based participatory research approach. The primary outcomes were the usability of the regional HIE system, expected implementation barriers and facilitators, and the quality of the developmental process. Data were collected and analyzed using a mixed methods approach. Results A total of 3 focus regions were identified, 22 geriatric health care providers participated in the development of the regional HIE system, and 11 workshops were conducted between October 2019 and September 2020. In total, 12 participants responded to a questionnaire. The main results were that the regional HIE system should support the exchange of assessments, diagnoses, medication, assistive device supply, and social information. The regional HIE system was expected to be able to improve the quality and continuity of care. In total, 5 adoption facilitators were identified. The main points were adaptability of the regional HIE system to local needs, availability to different patient groups and treatment documents, web-based design, trust among the users, and computer literacy. A total of 13 barriers to adoption were identified. The main expected barriers to implementation were lack of resources, interoperability issues, computer illiteracy, lack of trust, privacy concerns, and ease-of-use issues. Conclusions Participating health care professionals shared similar motivations for developing the regional HIE system, including improved quality of care, reduction of unnecessary examinations, and more effective health care provision. An overly complicated registration process for health care professionals and the patients’ free choice of their health care providers hinder the effectiveness of the regional HIE system, resulting in incomplete patient health information. However, the web-based design of the system bridges interoperability problems that exist owing to the different technical and organizational structures of the health care facilities involved. The regional HIE system is better accepted by health care professionals who are already engaged in an interdisciplinary, geriatric-focused network. This might indicate that pre-existing cross-organizational structures and processes are prerequisites for using HIE systems. The participatory design supports the development of technologies that are adaptable to regional needs. Health care providers are interested in participating in the development of an HIE system, but they often lack the required time, knowledge, and resources.