Ärztlicher Bereitschaftsdienst in Deutschland: Befragung von Bereitschaftsdienstärzten zur gegenwärtigen Situation (Kritische Aussagen)

Frankenhauser-Mannuß, Julia; Goetz, Katja; Scheuer, Markus; Szescenyi, J.; Leutgeb, Rüdiger

doi:10.1055/s-0034-1367020

Cited by 5 publications

(5 citation statements)

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“…This is in line with findings reported by Briggs et al [ 34 ]. In this context, low contacts to specialists and the OOHC seem to be not surprising due to the fact that NH visits by specialists are—depending on their specialization—insufficient in Germany [ 35 , 36 ] and the financial compensation for participating in the OOHC is criticized as too low by physicians [ 13 ]. Both facts may contribute to the low presence/relevance of these physicians in the management of NHRs’ health changes.…”

Section: Discussionmentioning

confidence: 99%

“…Elderly care physicians as in the Netherlands, for example [ 12 ] are an exception. In the case of health deteriorations outside of GPs’ working hours, nursing staff can contact out-of-hour health care services (OOHC) in which every practicing physician is legally obliged to participate [ 13 ]. In Germany, the OOHC can be called by the nationwide phone number “116 117”.In life-threatening cases, the Emergency Medical Service (EMS) is responsible and can be contacted to send out an ambulance (“112”).…”

Section: Introductionmentioning

confidence: 99%

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Unplanned hospital transfers from nursing homes: who is involved in the transfer decision? Results from the HOMERN study

2020

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Background Emergency department visits and hospital admissions are common among nursing home residents (NHRs) and seem to be higher in Germany than in other countries. Yet, research on characteristics of transfers and involved persons in the transfer decision is scarce. Aims The aim of this study was to analyze the characteristics of hospital transfers from nursing homes (NHs) focused on contacts to physicians, family members and legal guardians prior to a transfer. Methods We conducted a multi-center study in 14 NHs in the regions Bremen and Lower Saxony (Northwestern Germany) between March 2018 and July 2019. Hospital transfers were documented for 12 months by nursing staff using a standardized questionnaire. Data were derived from care records and perspectives of nursing staff and were analyzed descriptively. Results Among 802 included NHRs, n = 535 unplanned hospital transfers occurred of which 63.1% resulted in an admission. Main reasons were deterioration of health status (e.g. fever, infections, dyspnea and exsiccosis) (35.1%) and falls/accidents/injuries (33.5%). Within 48 h prior to transfer, contact to at least one general practitioner (GP)/specialist/out-of-hour-care physician was 46.2% and varied between the NHs (range: 32.3–83.3%). GPs were involved in only 34.8% of transfer decisions. Relatives and legal guardians were more often informed about transfer (62.3% and 66.8%) than involved in the decision (21.8% and 15.1%). Discussion Contacts to physicians and involvement of the GP were low prior to unplanned transfers. The ranges between the NHs may be explained by organizational differences. Conclusion Improvements in communication between nursing staff, physicians and others are required to reduce potentially avoidable transfers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Unplanned hospital transfers from nursing homes: who is involved in the transfer decision? Results from the HOMERN study

2020

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“…In 2015, approximately 110,000 of these physicians who worked in regular care -thereof 35,100 GPs and 11,500 internists worked additional in OOHC, except for doctors’ with chronic diseases and in-patient physicians [ 6 ]. A recent study with German GPs views on the situation in OOHC reported on critical issues, in particular highlighting that OOHC is one primary factor making the role as a GP in Germany unattractive [ 7 ]. Unfortunately, there are no data available which show the workload of physicians who worked in OOHC and regular care.…”

Section: Introductionmentioning

confidence: 99%

Job satisfaction and stressors for working in out-of-hours care – a pilot study with general practitioners in a rural area of Germany

Leutgeb

Frankenhauser-Mannuß

Scheuer³

et al. 2018

BMC Fam Pract

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BackgroundChallenging work environment, high workload, and increasing physician shortages characterize current rural general practice in Germany and in most European Countries. These factors extend into Out-Of-Hours Care (OOHC). However, little research about potential stressors for general practitioners (GPs) in OOHC settings is available. This pilot study aimed to evaluate workload, different elements of job satisfaction and stressors for GPs in OOHC and to analyze whether these aspects are associated with overall job satisfaction.MethodsCross-sectional survey with a sample of 320 GPs who are working in OOHC was used to measure workload in OOHC, job satisfaction (using the Warr-Cook-Wall scale) and stressors with the effort-reward imbalance questionnaire. In order to assess associations between workload, job satisfaction and stressors at work we performed descriptive analyses as well as multivariable regression analyses.ResultsThe response rate was 40.9%. Over 80% agreed that OOHC was perceived as a stressor and 79% agreed that less OOHC improved job satisfaction. Only 42% of our sample were satisfied with their overall job satisfaction. The regression analysis showed that the modification of current OOHC organization was significantly associated with overall job satisfaction.ConclusionsOur results suggest that OOHC in the current form is a relevant stressor in daily work of rural GPs in Germany and one of the reasons for a decreasing overall job satisfaction. Strategic changes such as the implementation of structural reforms e.g. reducing frequency of OOHC duties for each GP and improving continuing professional development options related to OOHC are needed to address current workload challenges experienced by GPs providing OOHC in Germany.

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“…A total number of about 210 GPs to be invited to participate in the process evaluation will be expected [ 8 ]. Based on previous data, a response rate of 45% is assumed, reducing the sample size to about 95 GPs [ 20 – 22 ]. Qualitative x (I, O) x (O) x (I, O) x (I, O) GPs who participate in the main trial and agree to participate in the process evaluation.…”

Section: Methodsmentioning

confidence: 99%

Implementation, mechanisms of change and contextual factors of a complex intervention to improve interprofessional collaboration and the quality of medical care for nursing home residents: study protocol of the process evaluation of the interprof ACT intervention package

Steyer

Kortkamp

Müller

et al. 2022

Trials

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Background To improve interprofessional collaboration between registered nurses (RNs) and general practitioners (GPs) for nursing home residents (NHRs), the interprof ACT intervention package was developed. This complex intervention includes six components (e.g., shared goal setting, standardized procedures for GPs’ nursing home visits) that can be locally adapted. The cluster-randomized interprof ACT trial evaluates the effects of this intervention on the cumulative incidence of hospital admissions (primary outcome) and secondary outcomes (e.g., length of hospital stays, utilization of emergency care services, and quality of life) within 12 months. It also includes a process evaluation which is subject of this protocol. The objectives of this evaluation are to assess the implementation of the interprof ACT intervention package and downstream effects on nurse–physician collaboration as well as preconditions and prospects for successive implementation into routine care. Methods This study uses a mixed methods triangulation design involving all 34 participating nursing homes (clusters). The quantitative part comprises paper-based surveys among RNs, GPs, NHRs, and nursing home directors at baseline and 12 months. In the intervention group (17 clusters), data on the implementation of preplanned implementation strategies (training and supervision of nominated IPAVs, interprofessional kick-off meetings) and local implementation activities will be recorded. Major outcome domains are the dose, reach and fidelity of the implementation of the intervention package, changes in interprofessional collaboration, and contextual factors. The qualitative part will be conducted in a subsample of 8 nursing homes (4 per study group) and includes repeated non-participating observations and semistructured interviews on the interaction between involved health professionals and their work processes. Quantitative and qualitative data will be descriptively analyzed and then triangulated by means of joint displays and mixed methods informed regression models. Discussion By integrating a variety of qualitative and quantitative data sources, this process evaluation will allow comprehensive assessment of the implementation of the interprof ACT intervention package, the changes induced in interprofessional collaboration, and the influence of contextual factors. These data will reveal expected and unexpected changes in the procedures of interprofessional care delivery and thus facilitate accurate conclusions for the further design of routine care services for NHRs. Trial registration ClinicalTrials.gov NCT03426475. Registered on 07/02/2018.

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Ärztlicher Bereitschaftsdienst in Deutschland: Befragung von Bereitschaftsdienstärzten zur gegenwärtigen Situation (Kritische Aussagen)

Abstract: Based on reported views from survey respondents, urban and rural primary care service needs vary significantly and, therefore, different solutions are needed to improve out-of-hours primary care and optimise service quality.

Cited by 5 publications

References 6 publications

Unplanned hospital transfers from nursing homes: who is involved in the transfer decision? Results from the HOMERN study

Unplanned hospital transfers from nursing homes: who is involved in the transfer decision? Results from the HOMERN study

Job satisfaction and stressors for working in out-of-hours care – a pilot study with general practitioners in a rural area of Germany

Implementation, mechanisms of change and contextual factors of a complex intervention to improve interprofessional collaboration and the quality of medical care for nursing home residents: study protocol of the process evaluation of the interprof ACT intervention package

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