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Zusammenfassung Einleitung Die COVID-19-Pandemie wirkt sich auch auf die medizinische Versorgung anderer Erkrankungen aus. Differenziert zwischen patient:innen- und anbieter:innenseitigen Gründen wurde untersucht, inwieweit Personen mit chronischen Erkrankungen vom Aussetzen medizinischer Versorgungsleistungen betroffen sind. Methoden Es wurde eine Querschnittstudie auf Datenbasis der Kohortenstudie Hamburg City Health Study (HCHS) durchgeführt. Die Studienpopulation bestand aus allen HCHS-Teilnehmer:innen (Stichprobe der Bevölkerung Hamburgs, 45–74 Jahre) zwischen April 2020 und November 2021. Über das „COVID-19-Modul“ der HCHS wurde die Inanspruchnahme von Versorgungsleistungen erhoben. Als Grunderkrankungen wurden u. a. Herz-Kreislauf‑, Nieren- und Lungenerkrankungen, Krebs und Diabetes mellitus betrachtet. Die Daten wurden deskriptiv und multivariat in logistischen Regressionen ausgewertet. Ergebnisse Von 2047 Teilnehmer:innen hatten 47,9 % mindestens eine Vorerkrankung. 21,4 % der Personen mit Vorerkrankungen hatten mindestens eine Versorgungsleistung ausgesetzt oder eine Terminabsage erhalten. 15,4 % gaben an, von sich aus auf einen Arztbesuch verzichtet zu haben. Fachärztliche Leistungen (Anteil 43,8 %) entfielen häufiger als hausärztliche (16,6 %). Nach Adjustierung für Alter, Geschlecht und Bildung erwiesen sich Lungen- (OR 1,80; p p Diskussion Gesundheitspolitik und Medien stehen vor der Herausforderung, mit Ängsten in der Bevölkerung vor einer Infektion so umzugehen, dass notwendige Versorgungsleistungen dadurch nicht vermieden werden.

Subjective cognitive decline (SCD) and depressive symptoms (DS) frequently co-occur prior to dementia. However, the temporal sequence of their emergence and their combined prognostic value for cognitive decline and dementia is unclear.Temporal relationships of SCD, DS and memory decline were examined by latent difference score modeling in a high-aged, population-based cohort (N = 3217) and validated using Cox-regression of dementia-conversion. In 334 cognitively unimpaired SCD-patients from memory-clinics, we examined the association of DS with cognitive decline and with cerebrospinal fluid (CSF) Alzheimer's disease (AD) biomarkers.In the population-based cohort, SCD preceded DS. High DS were associated with increased risk of dementia conversion in individuals with SCD. In SCD-patients from memory-clinics, high DS were associated with greater cognitive decline. CSF Aß42 predicted increasing DS.SCD typically precedes DS in the evolution to dementia. SCD-patients from memory-clinics with DS may constitute a high-risk group for cognitive decline.Subjective cognitive decline (SCD) precedes depressive symptoms (DS) as memory declines. Emerging or persistent DS after SCD reports predict dementia. In SCD patients, more amyloid pathology relates to increasing DS. SCD patients with DS are at high risk for symptomatic progression.

Background The huge increase of refugees to Germany caused a great challenge to the health system. We aimed to examine the level of patient-centredness in medical consultations with refugee patients, aided by video interpreters in primary care walk-in clinics (PCWC) in Hamburg. Methods Videotaped consultations (N = 92) of 83 patients from 2017 to 2018 were analysed. Two raters used the Measure of Patient-Centered Communication (MPCC) and the International Classification of primary care (ICPC-2). MPCC scores with regard to patients’ reason for seeking medical care and the procedures taken were explored using variance analyses adjusted for age, gender, and the duration of the consultation. The duration was further explored by Pearson correlations. Results Patient-centredness of all consultations on average was 64% (95% CI 60–67) according to MPCC, with health-related issues affecting the results. The highest level of patient-centredness was achieved in psychological health issues with 79% (65–94), the lowest in respiratory ones with 55% (49–61). Longer consultations resulted in higher MPCC scores. Conclusions The level of patient-centredness varied in the addressed health issues as well as in the duration of the consultation. Despite the variation, video interpreting in consultations supports a solid patient-centredness. Practice implications We recommend the use of remote video interpreting services for outpatient healthcare to support patient-centred communication and to fill the gap of underrepresentation of qualified interpreters on site, regarding a high diversity of spoken languages.

Zusammenfassung Ziel Der Beitrag nimmt die Situation der hausärztlichen Medizin im digitalen Zeitalter in den Blick, um künftige Entwicklungsperspektiven zu erörtern und Handlungsmöglichkeiten aufzuzeigen. Methodik Es wurde ein strukturierter Verständigungsprozess unter Einbeziehung relevanter Stakeholder-Perspektiven durchgeführt, der sich konzeptioneller Ansätze und methodischer Elemente der Szenario-Technik bediente. Diese Technik ermöglicht auf der Grundlage einer empirisch informierten Analyse gegenwärtiger Sachlagen und Entwicklungstrends die Formulierung von Zukunftsszenarien und die Ableitung praktischer Handlungsempfehlungen. Ergebnisse In Verlängerung gegenwärtiger Tendenzen im Bereich der Ärzteschaft, der Patientinnen und Patienten, der technischen Entwicklung und des Gesundheitswesens wurden ein Best- und ein Worst-Case-Szenario zur hausärztlichen Medizin im Jahr 2050 entwickelt. Aus der Analyse und Erörterung der Szenarien ließen sich Handlungsempfehlungen für die Gegenwart ableiten. Schlussfolgerung Ausgehend von den entwickelten Szenarien formulieren wir zwölf Empfehlungen zur künftigen Stärkung einer hausärztlich-zentrierten Medizin, die eine flächendeckende, digital unterstützte holistisch-patientenorientierte Gesundheitsversorgung ermöglicht.

Background Older adults with multimorbidity represent a growing segment of the population. Metrics to assess quality, safety and effectiveness of care can support policy makers and healthcare providers in addressing patient needs. However, there is a lack of valid measures of quality of care for this population. In the MULTIqual project, 24 general practitioner (GP)-reported and 14 patient-reported quality indicators for the healthcare of older adults with multimorbidity were developed in Germany in a systematic approach. This study aimed to select, validate and pilot core sets of these indicators. Methods In a cross-sectional observational study, we collected data in general practices (n = 35) and patients aged 65 years and older with three or more chronic conditions (n = 346). One-dimensional core sets for both perspectives were selected by stepwise backward selection based on corrected item-total correlations. We established structural validity, discriminative capacity, feasibility and patient-professional agreement for the selected indicators. Multilevel multivariable linear regression models adjusted for random effects at practice level were calculated to examine construct validity. Results Twelve GP-reported and seven patient-reported indicators were selected, with item-total correlations ranging from 0.332 to 0.576. Fulfilment rates ranged from 24.6 to 89.0%. Between 0 and 12.7% of the values were missing. Seventeen indicators had agreement rates between patients and professionals of 24.1% to 75.9% and one had 90.7% positive and 5.1% negative agreement. Patients who were born abroad (− 1.04, 95% CI = − 2.00/ − 0.08, p = 0.033) and had higher health-related quality of life (− 1.37, 95% CI = − 2.39/ − 0.36, p = 0.008), fewer contacts with their GP (0.14, 95% CI = 0.04/0.23, p = 0.007) and lower willingness to use their GPs as coordinators of their care (0.13, 95% CI = 0.06/0.20, p p = 0.002) and were less willing to use their GP to coordinate their care (0.16, 95% CI = 0.10/0.21, p Conclusions The quality indicator core sets are the first brief measurement tools specifically designed to assess quality of care for patients with multimorbidity. The indicators can facilitate implementation of treatment standards and offer viable alternatives to the current practice of combining disease-related metrics with poor applicability to patients with multimorbidity.

Background Continuity of care (COC) was shown to be associated with fewer hospitalizations. We aimed to evaluate whether COC was associated with intensive intervention(s) at the end of life (IEOL), a preference-sensitive outcome, in cancer patients. Methods The study is based on claims data of patients with incident use of anti-neoplastics in Switzerland. COC Index, Usual Provider Continuity score, Sequential Continuity index and Modified Modified Continuity Index were calculated based on consultations with the usual ambulatory care physician. Treatment intensity was evaluated in the last 6 months of life, and COC was evaluated in months 18–6 before death in those who died between 24 and 54 months after incident cancer. IEOL comprised life-sustaining interventions (cardiac catheterization, cardiac assistance device implantation, pulmonary artery wedge monitoring, cardiopulmonary resuscitation/cardiac conversion, gastrostomy, blood transfusion, dialysis, mechanical ventilator utilization and intravenous antibiotics) and measures specifically used in cancer patients (last dose of chemotherapy ≤14 days of death, a new chemotherapy regimen starting 14 days in hospital in the last month of life and death in an acute-care hospital). Results All COC scores were inversely associated with the occurrence of an IEOL, as were older age, homecare nursing utilization and density of ambulatory care physicians. For COC Index, odds ratio was 0.55 (95% confidence interval 0.37–0.83). Conclusions COC scores were consistently and inversely related to IEOL. The study supports efforts to improve COC for cancer patients at their end of life.

BackgroundSome hospital admissions of nursing home residents (NHRs) might be attributed to inadequate interprofessional collaboration. To improve general practitioner–nurse collaboration in nursing homes (NHs), we developed an intervention package (interprof ACT) in a previous study.ObjectiveTo assess the impact of interprof ACT on the proportion of hospitalisation and other clinical parameters within 12 months from randomisation among NHRs.MethodsMulticentre, cluster randomised controlled trial in 34 German NHs. NHRs of the control group received usual care, whereas NHRs in the intervention group received interprof ACT. Eligible NHs had at least 40 long-term care residents. NHs were randomised 1:1 pairwise. Blinded assessors collected primary outcome data.ResultsSeventeen NHs (320 NHRs) were assigned to interprof ACT and 17 NHs (323 NHRs) to usual care. In the intervention group, 136 (42.5%) NHRs were hospitalised at least once within 12 months from randomisation and 151 (46.7%) in the control group (odds ratio (OR): 0.82, 95% confidence interval (CI): [0.55; 1.22], P = 0.33). No differences were found for the average number of hospitalisations: 0.8 hospitalisations per NHR (rate ratio (RR) 0.90, 95% CI: [0.66, 1.25], P = 0.54). Average length of stay was 5.7 days for NHRs in the intervention group and 6.5 days in the control group (RR: 0.70, 95% CI: [0.45, 1.11], P = 0.13). Falls were the most common adverse event, but none was related to the study intervention.ConclusionsThe implementation of interprof ACT did not show a statistically significant and clinically relevant effect on hospital admission of NHRs.

Background: Homeless people in Germany are generally entitled to health care within the regular care system. However, due to their specific living conditions, they make little use of these services. In 2013, three specialist medical centres for the homeless (MCH) were opened in Hamburg to provide general health care. The aim of this abstract is to offer an overview of the specific health conditions and health care needs prevalent among the homeless and to discuss whether it is possible to link these patients up with the regular health care system. Methods: Medical data from 840 homeless patients as well as from a total of 1,982 consultations was obtained from 2013 until the end of 2014. In addition, the study evaluated data obtained in a questionnaire on the use of the regular health care system. Health insurance status and diagnosis were routinely documented and categorised using ICD 10 and ICPC-2. Subsequently, the diagnoses and reasons for consultations of homeless patients were compared with data from general practices (GP). Questionnaires on the use of the regular health care system were also evaluated. Results: The most frequent reasons for consultations in the first year were skin conditions (24%), musculoskeletal conditions (16%) and psychological disorders (14%). By comparison, the most frequent reasons for consultations in a general practice were musculoskeletal conditions (22%), conditions affecting the digestive system (14%) and skin conditions (12%). 35% of the homeless patients mentioned a lack of health insurance as the reason for “not making use of” the regular health care system, while ten percent reported that they were unable to visit a GP due to physical or psychological reasons. The longitudinal analysis over six years (2015–2020) showed that 53% of the patients attending the medical centre for the homeless had no medical insurance. Conclusion: The MCH mainly sees patients with medical conditions typical for the homeless cohort, namely skin diseases, wounds and injuries and behavioural disorders due to alcohol abuse. Health care for homeless patients is time-consuming and expensive. Chronic diseases that are equally present in general practice and specialist medical centres, such as diabetes mellitus, pose a great challenge. The lack of health insurance poses the greatest hurdle to the integration of the homeless into the regular health care system.

Introduction: The metabolic routes altered in Alzheimer's disease (AD) brain are poorly understood. As the metabolic pathways are evolutionarily conserved, the metabolic profiles carried out in animal models of AD could be directly translated into human studies.Methods: We performed untargeted Nuclear Magnetic Resonance metabolomics in hippocampus of McGill-R-Thy1-APP transgenic (Tg) rats, a model of AD-like cerebral amyloidosis and the translational potential of these findings was assessed by targeted Gas Chromatography-Electron Impact-Mass Spectrometry in plasma of participants in the German longitudinal cohort AgeCoDe.Results: In rat hippocampus 26 metabolites were identified. Of these 26 metabolites, nine showed differences between rat genotypes that were nominally significant. Two of them presented partial least square-discriminant analysis (PLS-DA) loadings with the larger absolute weights and the highest Variable Importance in Projection (VIP) scores and were specifically assigned to nicotinamide adenine dinucleotide (NAD) and nicotinamide (Nam). NAD levels were significantly decreased in Tg rat brains as compared to controls. In agreement with these results, plasma of AD patients showed significantly reduced levels of Nam in respect to cognitively normal participants. In addition, high plasma levels of Nam showed a 27% risk reduction of progressing to AD dementia within the following 2.5 years, this hazard ratio is lost afterwards.Discussion: To our knowledge, this is the first report showing that a decrease of Nam plasma levels is observed couple of years before conversion to AD, thereby suggesting its potential use as biomarker for AD progression.

Background To develop an aide memoire for patients diagnosed with advanced non-oncological chronic diseases, the KOPAL conversation guide, to foster interprofessional counselling between GPs and specialist palliative home care teams. Methods As part of the multi-centre, two-arm, cluster randomised controlled KOPAL study, the draft of the conversation guide was discussed and consented in three focus groups with 4 patients, 7 health care providers, and 5 stakeholders. Results The final version of the KOPAL conversation guide contains eight key topics: living with the illness, physical situation, emotional situation, personal situation, social situation, information and communication, control and autonomy, emergency management. Each topic refers to different general points, which are listed on top of the respective thematic section. The conversation should start by addressing the patient’s today’s well-being and end by asking for the patient’s main topic based on the discussed issues. Conclusions The KOPAL conversation guide is a broad evaluation and communication tool that covers potential palliative care (PC) needs of non-oncological patients and provides a basis for interprofessional case planning and counselling. Applying the KOPAL conversation guide may help to bridge the communicative gap between general and specialist PC professionals and between professionals and patients.

Autonomy (defined as self-governance; not equivalent to independence) is relevant to well-being and psychological functioning. However, there is a lack of research on individuals aged >85 years and their perception of autonomy when receiving informal care. This study aims to answer the question if and how the receipt of informal care is associated with perceived autonomy of individuals aged over 85 years.A cross-sectional study was conducted with data from follow-up 9 of the AgeQualiDe study (2015/2016), which is a multi-centric prospective cohort study in Germany. The analytical sample included 570 participants aged >85 years and with a score of ≥ 19 on the Mini-Mental-State-Examination. Perceived autonomy was assessed with the Perceived Autonomy in Old Age Scale. Receipt of care was assessed as performance of at least one care task (help with basic and instrumental activities of daily living, and supervision) by relatives or friends. Sociodemographic information, mental health, functional level and receipt of professional ambulatory care were controlled for.Unadjusted and adjusted linear regression analyses indicated a significant negative association between receipt of informal care and perceived autonomy. The results remained stable in sensitivity analyses; no significant interaction effect was found for gender or education.Findings indicate that informal care recipients aged >85 years perceive lower autonomy compared to those not receiving care. Additional or other forms of support, and improving the care relationship and communication might be considered to support autonomy of care recipients aged >85 years.

Katholische Hochschulen stehen im Spannungsfeld zwischen Chancen durch Alleinstellung und Risiken durch ihre Kirchenzugehörigkeit. Mit Blick auf ihr Managementgeschehen untersucht Samuel Scherer, ob ihre Strukturen und Prozesse in Verbindung mit den von ihnen kommunizierten Werten stehen. Als theoretische Bezüge nutzt er neben Luhmanns Systemtheorie die Organisationsethik nach Heller und Krobath und entwickelt ein Selbstbewertungsinstrument in der Logik des EFQM-Modells. Damit regt er eine Reflexion entsprechend der Organisationsethik an und ermöglicht Organisationen, eine Standortbestimmung ihres eigenen ethischen Reifegrades vorzunehmen.

Objective: Longitudinal studies investigating the link between social support and functional decline are limited among the oldest old. Thus, the aim of this study was to examine whether changes in social support are associated with functional decline among the oldest old longitudinally using panel regression models. Methods: Longitudinal data from 3 waves (waves 7, 8, and 9) of a multicenter prospective cohort study covering primary care patients aged ≥85 years were used. In the analytical sample, n equaled 624 individuals. The validated Lawton and Brody Instrumental Activities of Daily Living (IADL) scale and the well-established Barthel Index (ADL) were used to quantify functional status. The psychometrically sound Lubben Social Network Scale was used to measure social support. Several potential confounders such as age, marital status, cognitive decline, or depressive symptoms were included in the fixed effects (FE) regression models. Results: Linear FE regressions showed that a decrease in social support is associated with functional decline (IADL: β = 0.03, p < 0.05; ADL: β = 0.27, p < 0.05) in men but not in women. With IADL as outcome measure, the interaction term (sex × social support) achieved statistical significance (p < 0.01). With regard to covariates, functional decline (IADL and ADL) was consistently associated with increasing age, an increase in the number of chronic conditions (except for women [ADL]), and cognitive decline (except for men [ADL]). Furthermore, functional decline (ADL) was associated with an increase in depressive symptoms. Discussion: Our findings highlight the meaning of social support for functional status among the oldest old. Finding ways to sustain social support in highest age may be a promising approach in order to postpone functional decline.

Aims: Heart failure (HF) is the most common primary inpatient diagnosis in Germany. We examined temporal trends of HF hospitalization within Germany focusing on regional differences. Methods and results: We analysed aggregated data of more than 320 million hospitalizations in Germany from 2000 to 2017. Temporal trends of HF-related parameters were analysed, focusing on regional differences between the federal states. The absolute number of HF-related hospitalizations throughout Germany increased continuously and almost doubled (from 239 694 to 464 724 cases, +94%) with the relative increase being higher in East Germany compared with West Germany (119% vs. 88%). These regional differences persisted after age standardization with 609 and 490 cases per 100 000 population, respectively. The length of stay decreased continuously across Germany (from 14.3 to 10.2 days; −29%), while the total number of HF-related hospital days increased by 51% in East Germany and 35% in West Germany. In 2017, HF remained the leading cause of in-hospital death (8.9% of all cases), with a markedly higher rate in East vs. West Germany (65 vs. 43 deaths per 100 000 population). Conclusions: Heart failure remains the most common cause of hospitalization and in-hospital death throughout Germany. The increase in HF-related morbidity and mortality was much higher in East Germany compared with West Germany during the observation period. A more detailed understanding of these striking disparities 30 years after the German reunification requires further investigations. There is an urgent need for action with regard to stronger control of risk factors and improvement of both chronic HF management and healthcare structures. CA Extern

ObjectivesIn order to reduce the use of emergency departments, computer-assisted initial assessment was implemented at the medical on-call service 116117. Our study assessed compliance and patient satisfaction.DesignCross-sectional observational postal survey.SettingMedical on-call service 116117 by eight Associations of Statutory Health Insurance Physicians in Germany.ParticipantsThe intervention was observed between January 2020 and March 2021. Minors and patients with invalid contact data were excluded. A random sample of eligible patients received standardised questionnaires by mail.Outcome measuresWe analysed associations of sociodemographic data, health status, previous service use, health literacy, and recommended settings with compliance and patient satisfaction by multivariable, multilevel logistic regression.InterventionsBased on symptoms and context factors, the computer software suggested service levels. Staff and patient discussed if higher levels were indicated, services were available and self-transport was possible. They then agreed on recommendations for treatment settings.ResultsOf 9473 contacted eligible patients, 1756 patients (18.5%) participated. Median age was 66 years (IQR=50–79), and 986 (59.0%) were women. At least one recommended setting was used by 1397 patients (85.4%). General practitioner (GP) practices were used by 143 patients (68.4%). Generally, better compliance was associated with lower depression levels (OR 1.59, 95% CI 1.17 to 2.17, p=0.003), fewer previous hospital stays (OR 2.02, 95% CI 1.27 to 3.23, p=0.003) and recommendations for any setting other than GP practices (OR 0.13, 95% CI 0.06 to 0.29, pConclusionsMost patients were compliant and satisfied. Lowest compliance and satisfaction were found in GP practices, but nonetheless, two of three patients with respective recommendations were willing to use this setting.Trial registration numberGerman Clinical Trials Register DRKS00017014.

Zusammenfassung Hintergrund Trotz einer hohen Zahl an Abschlüssen in der Humanmedizin ist in Deutschland immer häufiger von einem Ärztemangel die Rede. Ein Grund ist die schwierige Vereinbarkeit von Kliniktätigkeit und Familienleben, die vor allem Ärztinnen als Hauptgrund für die spätere Arbeit im nicht-kurativen Bereich nennen. Ziel der Arbeit Die vorliegende Arbeit befasst sich mit dem Einfluss des Elternstatus von Ärztinnen und Ärzten auf ihre Karriereentwicklung und das Belastungserleben am Ende der Weiterbildung. Darüber hinaus betrachtet werden die Auswirkungen von befristeten Arbeitsverträgen und erlebter Unterstützung durch den Partner auf das Belastungserleben. Material und Methoden Es wurden die Daten der KarMed-Studie, welche sich mit Karriereverläufen von Ärztinnen und Ärzten während der fachärztlichen Weiterbildung beschäftigt, ausgewertet. Die vorliegende Arbeit befasst sich mit der querschnittlichen Analyse des Erhebungszeitraums von Oktober 2015 bis Mai 2016. Zu diesem befanden sich 433 StudienteilnehmerInnen am Ende ihrer Weiterbildung. Eingesetzt wurden u. a. die Fragebögen Work-Family Conflict und Family-Work Conflict Skalen. Ergebnisse Ärztinnen mit Kind unterbrechen die Weiterbildung fünfmal häufiger als ihre Kolleginnen ohne Kind und achtzehnmal häufiger als Ärzte mit Kind. Ärztinnen mit Kind sowie Ärzte mit Kind weisen signifikant höhere Werte auf der Family-Work Conflict Skala auf, Ärztinnen ohne Kind hingegen höhere Werte auf der Work-Conflict Skala. Bei Ärzten zeigt sich kein signifikanter Unterschied auf der Work-Family Skala. Weder ein befristeter Arbeitsvertrag noch die Verteilung von Kinderbetreuung zwischen Ärztinnen/Ärzten und ihren Partnern/-rinnen haben einen signifikanten Einfluss auf das Belastungserleben zur Folge. Schlußfolgerung Es besteht ein Bedarf die Konflikte, die aus dem Familienleben auf das Arbeitsleben wirken insbesondere für Ärztinnen in Weiterbildung zu reduzieren.