Background Medical overuse is a common problem in health care. Preventing unnecessary medicine is one of the main tasks of General Practice, so called quaternary prevention. We aimed to capture the current opinion of German General Practitioners (GPs) to medical overuse.

IntroductionWith the medical focus on disease, the problem of overdiagnosis inevitably increases with ageing. Considering the functional health of patients might help to discriminate between necessary and unnecessary medicine. The International Classification of Functioning, Disability and Health (ICF) is an internationally recognised tool for describing functional health. However, it is too detailed to be used in primary care practices. Consequently, the aim of this study is to identify relevant codes for an ICF core set for community-dwelling older adults (75 years and above) in primary care.Methods and analysisThe study will follow the methodology proposed by the ICF Research Branch to identify relevant concepts from different perspectives: (1) Research perspective: A systematic review of studies focusing on functional health in old age will be conducted in different databases. Relevant concepts will be extracted from the publications. (2) Patients’ perspective: Relevant areas of functioning and disability will be identified conducting qualitative interviews and focus groups with community-dwelling older persons. The interviews will be transcribed verbatim and analysed using the documentary method of interpretation. (3) Experts’ perspective: An online survey with open-ended questions will be conducted. Answers will be analysed using the qualitative content analysis of Mayring. (4) Clinical perspective: A cross-sectional empirical study will be performed to assess the health status of community-dwelling older adults using the extended ICF checklist and other measurement tools.Relevant concepts identified in each study will be linked to ICF categories resulting in four preliminary core sets.Ethics and disseminationEthical approval for the study was obtained (90_17B). All participants will provide written informed consent. Data will be pseudonymised for analysis. Results will be disseminated by conference presentations and journal publications.Trial registration numberProjektdatenbank Versorgungsforschung Deutschland: VfD_17_003833, Clinicaltrials.gov: NCT03384732 and PROSPERO: CRD42017067784.

Rationale, aims, and objectives: Clinical practice guidelines (CPG) were introduced to summarize the best scientific evidence available. Thereby, CPG were meant to support evidence-based medicine (EBM). However, besides evidence, EBM also asks for patients' preferences and physicians' experiences to be considered when coming to therapeutic decisions. Thus, deviations from CPG recommendations are sometimes necessary when practicing EBM. We wanted to examine whether CPG support deviations from their recommendations when appropriate. For operationalization, we asked whether absolute effect sizes (AES) for benefit and/or harm of suggested therapies were provided along with the respective CPG recommendation.Methods: This systematic survey comprised the most common CPG on chronic coronary heart disease (CCHD) and type 2 diabetes mellitus (T2DM) from Englishand German-speaking countries. Only CPG recommendations on pharmacotherapy were evaluated. If AES of a recommended therapy were reported, we rated how easily findable they were within the CPG. Moreover, we assessed whether the CPG provided patient information material and whether this material supplied AES allowing patients to determine the effects to be expected. Results:In the 13 CPG surveyed, 144 recommendations on pharmacotherapy were identified. For 108 recommendations (75%), no AES for benefit and/or harm were reported. Thirty-one recommendations (22%) were accompanied by one or more AES for either benefit or harm. Along with five recommendations (3%), one or more AES for both benefit and harm were given. AES were considered easy to find for three of these 36 recommendations (8%). Patient information material was provided in three of the 13 CPG (23%) accounting for AES in one occasion only.Marc Morgott and Stefan Heinmüller contributed equally to this work and therefore wish to be regarded as joint first authors.Conclusion: Current CPG on T2DM and CCHD do not sufficiently offer AES for benefits and harms of recommended therapies. Thus, they lack satisfactory information to support deviations from CPG recommendations. Consequently, CPG in their present form do not adequately facilitate EBM. KEYWORDS abolute risk reduction, clinical decision making, evidence-based medicine, patient-centred care, practice guidelines as topic

Objective To explore relevant areas of functioning from the perspective of community-dwelling adults aged 75 years and over, in order to develop a Core Set of the International Classification of Functioning, Disability and Health (ICF) for community-dwelling older adults for use in primary care. Design Qualitative study using semi-structured interviews and focus groups. Participants A total of 27 community-dwelling older adults participated in the interviews and 24 of them in the focus groups. Methods Following the proposed methodology of the ICF Research Branch, this is 1 of 4 preparatory studies in the Core Set development process. Within the transcripts, concepts of functioning were identified, based on Mayring’s qualitative content analysis using deductive category assignment with the ICF being the category system. Results Overall 6,667 concepts were identified. Most were linked to the Activities and Participation component. The most frequently identified categories were “recreation and leisure” and “family relationships”. Conclusion Categories from all ICF chapters were identified, demonstrating the complexity and multidimensionality of the ageing process, with a special emphasis on the component Activities and Participation. This qualitative study provides a list of relevant categories from the perspective of community-dwelling elderly people, which will be used to develop a Core Set for older primary care patients. LAY ABSTRACT Physicians usually focus on diagnosing and treating diseases. In old age this might be less appropriate, and other biopsychosocial aspects (e.g. independent living) should also be considered. Therefore, we aim to develop an International Classification of Functioning, Disability and Health Core Set for older adults, which physicians can use to assess these aspects during consultations. In the development process several perspectives should be considered; one of them being the view of the target group. To explore this view, interviews and group discussions were conducted with community-dwelling adults aged 75 years and over. Almost 200 relevant aspects of functioning were identified. Leisure activities, family relationships and mobility were mentioned most often. Body functions, which are normally in the focus of physicians, seem to be less important to older adults. The results suggest that including biopsychosocial information in the consultation might help to better tailor medical interventions to the patients’ needs.