Collaboration among health care providers is intended to dissolve boundaries between the sectors of health care systems. The implementation of adequate augmentative and alternative communication (AAC) care of people without natural speech depends highly on collaboration among multiple stakeholders such as speech and language pathologists, teachers, or physicians. This paper examines existing barriers to and facilitators of collaboration from a stakeholder perspective. Five heterogeneous focus group interviews were conducted with N= 32 stakeholders including speech and language pathologists, AAC consultants, teachers, employees of sheltered workshops, parents, and relatives of AAC users, and other educational professionals (e.g., employees of homes for persons with disabilities) at three AAC counseling centers in Germany. Interview data were analyzed by structured qualitative content analysis. The results show very different experiences of collaboration in AAC care. Factors were identified that can have both positive and negative effects on the collaboration between all stakeholders (e.g., openness toward AAC, knowledge about AAC, communication between stakeholders). In addition, stakeholderspecific influencing factors, such as working conditions or commitment to AAC implementation, were identified. The results also reveal that these factors may have an impact on the quality of AAC care. Overall, the results indicate that good collaboration can contribute to better AAC care and that adequate conditions such as personnel, and time-related resources, or financial conditions need to be established to facilitate collaboration.
ZusammenfassungDie COVID-19 Pandemie hat nicht nur massive Auswirkungen auf das gesellschaftliche Leben und das Gesundheitssystem, sondern auch auf die Rahmenbedingungen der Versorgungsforschung. Der Einfluss der Pandemie auf Forschungsprozesse, Methoden und die persönliche Situation der Forschenden ist bisher kaum empirisch untersucht. Geleitet von der Frage, wie Forschungsprozesse und Methoden an die Herausforderungen durch COVID-19 angepasst werden und wie Forschende den Einfluss der Pandemie auf ihre persönliche Situation wahrnehmen, wurde von Juni bis Juli 2021 eine Online-Befragung unter Versorgungsforschenden durchgeführt. Die Ergebnisse zeigen, dass sich bei einem Großteil der Forschungsprojekte Verzögerungen aufgrund von Problemen bei der Rekrutierung und/oder der Datenerhebung ergeben haben. Von den Antwortenden, die bereits Daten seit Beginn der Pandemie (März 2020) erhoben hatten, konnten knapp zwei Drittel die Datenerhebung in der ursprünglich geplanten Form nicht umsetzen und es wurde vor allem auf digitale Zugänge und Erhebungsmethoden gesetzt. Die Auswertung der Freitexte zeigte, dass die Pandemie sich auf alle Phasen des Forschungsprozesses massiv auswirkt: Zentrale Herausforderungen sind unter anderem der erschwerte Zugang zum Feld, Probleme bei der Erreichung der Fallzahlen und die Sorge um die Datenqualität. In Bezug auf die persönliche Situation beklagen Forschende die Einschränkung persönlicher Kontakte, die damit einhergehende fehlende Sichtbarkeit und gleichzeitig profitieren sie von den niedrigschwelligen digitalen Kontaktmöglichkeiten. Insgesamt zieht die Studie eine erste Bilanz des Einflusses der COVID-19 Pandemie auf die Versorgungsforschung und -forschende. Sie zeigt, dass nach dem ersten „Schock“ mit dem ersten Lockdown im März 2020 durchaus pragmatische und dabei häufig innovative Wege gefunden wurden, Projekte auch unter den Bedingungen der Pandemie durchzuführen. Die in diesem Kontext verstärkte Nutzung von digitalen Kommunikations- und Erhebungsformen bringt zahlreiche Herausforderungen, jedoch auch methodische Impulse mit sich.
IntroductionThe current practice of service delivery in Germany for people with complex communication needs (CCN) who are in need of augmentative and alternative communication (AAC) is characterised by diverse problems, including a lack of clarity in the responsibilities of the service providers involved. To address these issues a new service delivery model has been put in place, implemented in three AAC counselling centres for patients with a particular health insurance across Germany. The implementation of a new service delivery model aims to improve individualised service delivery. The model goes beyond standard care by adding case management, counselling, AAC training and, if needed, AAC therapy. This study aims to evaluate the effectiveness of this complex intervention.Methods and analysisIn consideration of the complexity of the new service delivery model, formative and summative evaluation will be conducted. The formative evaluation will provide data based on qualitative and quantitative assessments of the competences and perspectives of all involved stakeholders, including a proxy measurement of persons with CCN. The summative evaluation will include a controlled study design as the new service delivery model will be compared against the service delivery in an existing contract and against data gathered from caregivers of AAC users provided with standard care. With the exception of the individual interviews the data will be collected from proxies—that is, informal and formal caregivers.Ethics and disseminationData collection, storage and evaluation meet the currently valid data protection regulations. Consultation by the responsible data protection officer of the Oldenburg Medical School and a positive vote from its Ethics Committee were obtained prior to the start of the study. Dissemination strategies include the presentation of the obtained data and results in the form of publications and at conferences.Trial registration numberDRKS00013628.
ObjectiveTo examine interrelations between care-related burden on informal caregivers and their proxy assessments of outcomes in people without natural speech.DesignA cross-sectional survey.SettingData were collected in January 2019 from a postal survey of informal caregivers of people without natural speech who are insured by a large regional health insurance company in the German federal state of Lower Saxony.Participantsn=714 informal caregivers of people without natural speech of all ages and with various underlying disabilities were identified and contacted via the health insurance company. Data from n=165 informal caregivers (26.4%) were obtained.Main outcome measuresCaregiver burden (self-reported, Burden Scale for Family Caregivers), pragmatic communication skills of people without natural speech (proxy report, self-developed), health-related quality of life of people without natural speech (proxy report, DISABKIDS Chronic Generic Measure - DCGM-12) and functioning of people without natural speech (proxy report, WHO Disability Assessment Schedule 2.0).ResultsThe analyses revealed significant associations between caregiver burden on the one hand and both proxy-reported health-related quality of life (b=−0.422; p≤0.001) and functioning (b=0.521; p≤0.001) on the other. Adding caregiver burden to the regression model leads to a substantial increase in explained variance in functioning (R² Model 1=0.349; R² Model 2=0.575) as well as in health-related quality of life (R² Model 1=0.292; R² Model 2=0.460).ConclusionsCaregiver burden should be considered an important determinant when informal caregivers report outcomes on behalf of people without natural speech. Longitudinal studies are recommended to better understand the burdens experienced by caregivers when supporting people without natural speech.Trial registration numberDRKS00013628.
PurposeLike other European countries, Germany is facing regional physician shortages, which have several consequences on patient care. This study analyzes how hospitals perceive physician shortages and which strategies they adopt to address them. As a theoretical framework, the resource dependency theory is chosen.Design/methodology/approachThe authors conducted 20 semi-structured expert interviews with human resource officers, human resource directors, and executive directors from hospitals in the northwest of Germany. Hospitals of different ownership types, of varying sizes and from rural and urban locations were included in the sample. The interviews were analyzed by using qualitative content analysis.FindingsThe interviewees reported that human resource departments in hospitals expand their recruiting activities and no longer rely on one single recruiting instrument. In addition, they try to adapt their retaining measures to physicians' needs and offer a broad range of employment benefits (e.g. childcare) to increase attractiveness. The study also reveals that interviewees from small and rural hospitals report more difficulties with attracting new staff and therefore focus on recruiting physicians from abroad.Practical implicationsSince the staffing situation in German hospitals will not change in the short term, the study provides suggestions for hospital managers and health policy decision-makers in dealing with physician shortages.Originality/valueThis study uses the resource dependency theory to explain hospitals' strategies for dealing with healthcare staff shortages for the first time.
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