In this first part of a 3-part discussion paper the working group "Qualitative Methods" in the German Network of Health Services Research (DNVF) identifies the potentials and opportunities qualitative research methods provide for health services research. Many research questions relevant for health services research require the use of qualitative methods. However, the potential of and need for qualitative research in health services research has not yet received sufficient attention from funding bodies. We discuss the applicability and importance of qualitative research for the field of health services research. We then move on to describe the key characteristics of qualitative research that need to be taken into account in health services research. We discuss characteristics such as open-ended (qualitative) data, interpretation of meanings, the search for contradictions, closeness to everyday life, openness towards change or modification of the research question and processes in the context of health services research. To ensure a high-quality approach in qualitative methods for the health services research, sufficient competency in methods and appropriate settings that account for the peculiarities of qualitative methods need to be developed. These include an appropriate time frame and sufficient and qualified personnel to conduct qualitative research. Qualitative research is not a research paradigm in itself rather it comprises of many different and diverging approaches. The goal of this paper is to show the diversity of qualitative research methods, its importance for health services research, and to open up the discussion on strategies for integrating qualitative methods into health services research.

Although drawing conclusions on the use of qualitative methods in German health services research from the analysis of conference abstracts is not possible, the overview we present demonstrates the diversity of methods used for data collection and analysis and showed that a few select methods are extensively used. One of the tasks a memorandum of qualitative health services research should accomplish is to highlight underutilized research methods, which may help to develop the potential of qualitative methodology in German health services research.

The third and final discussion paper of the German Network of Health Services Research's (DNVF) "Qualitative Methods Working Group" demonstrates methods for the evaluation and quality of qualitative research in health services research. In this paper we discuss approaches described in evaluating qualitative studies, including: an orientation to the general principles of empirical research, an approach-specific course of action, as well as procedures based on the research-process and criteria-oriented approaches. Divided into general and specific aspects to be considered in a qualitative study quality evaluation, the central focus of the discussion paper undertakes an extensive examination of the process and criteria-oriented approaches. The general aspects include the participation of relevant groups in the research process as well as ethical aspects of the research and data protection issues. The more specific aspects in evaluating the quality of qualitative research include considerations about the research interest, research questions, and the selection of data collection methods and types of analyses. The formulated questions are intended to guide reviewers and researchers to evaluate and to develop qualitative research projects appropriately. The intention of this discussion paper is to ensure a transparent research culture, and to reflect on and discuss the methodological and research approach of qualitative studies in health services research. With this paper we aim to initiate a discussion on high quality evaluation of qualitative health services research.

Health services researchers focus on the players, structures and impact of health care in "real life". They investigate how social aspects, financing, organizational structures, technologies and personal attitudes affect the process and outcomes of health care. Qualitative research methods are used here, which address how people act according to their unique living conditions (outside the context of experimental studies). Different methods of debriefing groups are essential for qualitative health services research. In 2 subsequent articles, we aim to outline the diverse facets and possible range of implementation of the above-mentioned methods, in order to highlight the potential of debriefing groups in health services research (focus groups or group discussions) using these methods. In the current article, we would like to encourage researchers to reflect on relevant topics such as the selection of an appropriate method, the planning and undertaking of investigations including sampling methods, and questions regarding ethics and privacy. A follow-up article (in preparation) will deal with theoretical considerations of the term "group", as well as with the process of moderating discussions, methods of analyzing data and (qualitative) online research.

Promotion of interdisciplinary cooperation is an important component for the improvement of the success of rehabilitation facilities.

ZusammenfassungDer vorliegende Beitrag ist die Fortsetzung des – ebenfalls im Rahmen der Arbeitsgruppe Qualitative Methoden des Deutschen Netzwerks Versorgungsforschung (DNVF) e.V. entstandenen – ersten Artikels zu Gruppendiskussionen in der Versorgungsforschung. Beginnend mit theoretischen Überlegungen zum Gruppenbegriff wird spezifisches Wissen über Gruppen im Allgemeinen und das Verhalten einzelner Gruppenmitglieder im Besonderen zugrunde gelegt, welches sich insbesondere für die Gestaltung und Interpretation von Interaktionsprozessen im Gruppenkontext relevant zeigt. Es folgen Abschnitte mit Auseinandersetzungen zur Prozesshaftigkeit von Gruppendiskussionen, zu Moderationsstilen und -techniken sowie Reflexionen über mögliche Analysegegenstände und -verfahren. Dabei wird auch die Darstellung von Ergebnissen und Textpassagen diskutiert, in denen das Interaktionsgefüge mehrerer Diskussionsteilnehmer_innen sichtbar wird. Schließlich werden Einblicke in die Besonderheiten, Potenziale und Herausforderungen der Erhebung über Online-Plattformen gewährt. Zusammen geben beide Artikel einen Überblick über die wichtigsten Aspekte der Anwendung von Gruppendiskussionen im Bereich der Versorgungsforschung.

Background: Recent guidelines for the management of hypertension focus on treating patients according to their global cardiovascular risk (CVR), rather than strictly keeping blood pressure, or other risk factors, below set limit values. The objective of this study is to compare the effect of a simple versus a complex educational intervention implementing this new concept among General Practitioners (GPs). Methods/design:A prospective longitudinal cluster-randomised intervention trial with 94 German GPs consecutively enroling 40 patients each with known hypertension. All GPs then received a written manual specifically developed to transfer the global concept of CVR into daily General Practice. After cluster-randomisation, half of the GPs additionally received a clinical outreach visit, with a trained peer discussing with them the concept of global CVR referring to example study patients from the respective GP. Main outcome measure is the improvement of calculated CVR six months after intervention in the subgroup of patients with high CVR (but no history of cardiovascular disease), defined as 10-year-mortality ≥ 5% employing the European SCORE formula. Secondary outcome measures include the intervention's effect on single risk factors, and on prescription rates of drugs targeting CVR. All outcome measures are separately studied in the three subgroups of patients with 1. high CVR (defined as above), 2. low CVR (SCORE < 5%), and 3. a history of cardiovascular disease. The influence of age, sex, social status, and the perceived quality of the respective doctor-patient-relation on the effects will be examined.Discussion: To our knowledge, no other published intervention study has yet evaluated the impact of educating GPs with the goal to treat patients with hypertension according to their global cardiovascular risk. However, recent guidelines on hypertension [4][5][6], and on both primary and secondary cardiovascular prevention [7] emphasise that rather than to focus on single risk factors, intensity of care should focus on the global cardiovascular risk (CVR) of an individual patient. Global cardiovascular risk is an arithmetical compound of age, sex, and the known cardiovascular risk factors, and can be approximated by means of various risk calculators. If pharmacological risk factor treatment promises a relative risk reduction of some 25% [8,9], or possibly up to 80% in combination therapy [10], then a relevant absolute risk reduction is only possible where there is a relevant absolute risk to begin with. According to the concept of global cardiovascular risk, therefore, pharmacological treatment is only recommended for patients with a cardiovascular 10-year-mortality at or above 5%. The essence of this paradigmatic change is that treatment efforts and resources should be concentrated on where the (high) cardiovascular risk is: "treat risk, not risk factors" [11]. For general practitioners (GPs), this concept is of particular interest because it firstly focuses efforts and resources on high-risk patients, s...

To better understand why cooperation between health care professionals is still often problematic, we carried out 25 semistructured face-to-face expert interviews with physicians and nurses in different rural and urban areas in northern Germany. Using Mayring’s qualitative content analysis method to analyze the data collected, we found that doctors and nurses interpreted interprofessional conflicts differently. Nursing seems to be caught in a paradoxical situation: An increasing emphasis is placed on achieving interprofessional cooperation but the core areas of nursing practice are subject to increasing rationalization in the current climate of health care marketization. The subsequent and systematic devaluation of nursing work makes it difficult for physicians to acknowledge nurses’ expertise. We suggest that to ameliorate interprofessional cooperation, nursing must insist on its own logic of action thereby promoting its professionalization; interprofessional cooperation cannot take place until nursing work is valued by all members of the health care system.