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Copyright of Journal der Deutschen Dermatologischen Gesellschaft is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Personality disorders are common, and often remain undiagnosed or are hidden by other psychiatric diagnoses such as anxiety or depression. Unusual behaviors include emotional instability, self-harming behavior, and difficulty building relationships. The diagnosis should be made by a specialist in a structured manner and communicated to the patient. Especially for borderline personality disorder the benefit of specific psychotherapy is evidence based. Drug therapies with psychotropic drugs should be avoided. A change in psychiatry is currently being observed in the area of personality disorders. The old way of thinking in terms of strict disease categories is increasingly being replaced by a dimensional description of mental disorders. How quickly this will happen and whether this new approach will be more successful than the old one remains to be seen. [ABSTRACT FROM AUTHOR]

Background: L‑thyroxine is one of the most frequently prescribed drugs in Germany. It is mainly used for the treatment of hypothyroidism. Based on prescription data, it can be assumed that L‑thyroxine is prescribed more frequently than is medically indicated. Objective: Are family doctors willing to reduce the dose or try to discontinue L‑thyroxine? Methods: At the annual conference of the Saxon Society of General Practice, a cross-sectional survey was carried out using a questionnaire. The questionnaire contained three constructed cases of patients whose L‑thyroxine therapy was to be assessed for the potential for change. Descriptive analysis of the quantitative data and qualitative content analysis were performed. Results: A total of 33 family doctors took part in the survey. Maintaining or even increasing the dose was most frequently favored. This was justified on the grounds of good adjustment to the current treatment, the presumed lack of disadvantages of a low-dose regimen, or the avoidance of complications of discontinuation. Reduction or discontinuation was rarely suggested and if so, it was advocated with reference to the lack of a medical indication. Conclusion: Even in the absence of a medical indication, participants were reluctant to change an existing therapy. This is consistent with findings from the existing literature. The assumption of avoiding subsequent illnesses, limited time for counseling sessions, and a lack of communication between prescribers have been identified as causes in other studies. However, there is evidence for benefits of deprescribing. More research is needed in this area in the German primary care sector. [ABSTRACT FROM AUTHOR]

Background: Studies show that child maltreatment is common in Germany. This has implications for the health care system in terms of identifying child maltreatment and initiating further intervention. Physicians in primary care have an important key function in this context. The aim of this study is to describe the awareness, perceived competence, and need for further training regarding this topic among physicians working in primary care in Germany. Materials and methods: Data derived from telephone calls (N = 59) made by physicians from outpatient internal medicine and general medicine to the Medical Child Protection Hotline in the period between July 2017 and December 2021 were analyzed. In addition, as part of a needs assessment for an e‑learning curriculum on psychosocial topics, a qualitative evaluation of semi-structured interviews was conducted with N = 15 family physicians, focusing on their experiences with identifying and managing cases of child maltreatment. Results: The data of the Medical Child Protection Hotline showed a relatively low number of calls from primary care physicians. Consultation concerns focused in particular on the further procedure in the context of child protection, existing examination findings and the conduct of interviews. Participants of the needs assessment indicated having had little experience with the topic so far, but uncertainties were mentioned with regard to the identification of child protection cases and the conduct of discussions with parents. Conclusion: These findings suggest moderate levels of awareness about child maltreatment among primary care physicians in Germany. The consultations via the Medical Child Protection Hotline reflected the challenges and uncertainties derived from the qualitative interviews. These findings indicate further training needs regarding identifying and managing child maltreatment in primary care. [ABSTRACT FROM AUTHOR]

Background: The geriatric basic assessment in primary care (pcGBA) is performed in patients aged 70 years and above, exhibiting geriatric-specific morbidity, with the aim of systematically recording everyday problems and functional impairments. There is currently limited knowledge regarding the utility of pcGBA, as well as perceptions, acceptance, and application at the primary care level. Study aims and questions: Which components of a geriatric assessment are considered meaningful by general practitioners (GPs) and medical assistants (MAs), what is reported to be performed by the respondents, and who carries out which measures? Materials and methods: The survey was conducted among GPs and their MAs listed within the regional Associations of Statutory Health Insurance Physicians in Thuringia, Berlin, and Brandenburg using a self-designed and pilot-tested questionnaire. The Manageable Geriatric Assessment (MAGIC) and the geriatric screening according to LACHS were used as content bases, adapted to the circumstances of primary care. A fictitious case scenario and dichotomous response options were provided for assessment. Results and conclusion: A total of 890 physicians (response rate 16.1%) and 566 MAs participated in the survey. The pcGBA is performed and assessed differently in participating GP practices. According to the respondents, assessments of the psychosocial situation (50.8%) and medication status (62.6%) would predominantly be performed by GPs, standardized tests more frequently by MAs. Not all recommended contents and provided services of the pcGBA are considered useful by GPs and MAs. [ABSTRACT FROM AUTHOR]

Background: In accordance with the guidelines of the Association of Scientific Medical Societies in Germany (AWMF), the DEGAM ("Deutsche Gesellschaft für Allgemeinmedizin") S1 guideline "Chronic pain" required updating. Methods: A selective nonsystematic literature search was performed and comments from the DEGAM guideline commission were obtained. Results: The content of the previous version can largely be maintained. The content was expanded, particularly in the areas of assessment, nondrug therapy approaches and self-care and opioid management. The short version was supplemented by a document with explanations and implementation aids. Conclusions: Chronic noncancer pain is a very common reason for consultation with a general practitioner (GP). Recommendations for action and instruments specifically for the GP setting are urgently needed. An upgrade of the guideline to S2 or S3 level and practical aids for joint decision-making for individual long-term patient support should be developed in the future. [ABSTRACT FROM AUTHOR]

Background: The attractiveness of general practice (GP) is increasing, as is evident in its growing popularity among students and the sharp rise in specialist certifications. However, in view of the future challenges at the GP level of care, there is a shortage of young doctors. It would thus be desirable if postgraduate training could be completed quickly, particularly in this area. Objective: The aim of this article is to improve the state of knowledge of the actual length of postgraduate training in general practice and to identify the motives for choosing this specialty and possible factors influencing postgraduate training length. Project description: The cross-sectional study conducted of general practitioners (GPs) after completion of the medical specialist examination (survey period January 2020 to September 2023, population 530 persons, response rate 50%, n=265) examines the decision-making processes and the individual course of postgraduate training as pursued by newly certified general practitioners (Fachärzt*innen für Allgemeinmedizin - FÄ AM) in Hesse, Germany. Results: Excluding lateral entrants (Quereinsteiger*innen), the respondents' length of postgraduate training was 8.88 years on average (SD=3.97, median 7.75 years, Q1=6.0, Q3=10.0). The main reasons stated for choosing the specialty were personal role models and experiences made while studying. The descriptive analysis of the data collected indicates that an early choice of specialization could be associated with a shorter length of postgraduate training. Conclusion: Positive experiences during medical studies can contribute to a doctor's decision in favor of a specialty and may possibly be a factor in shortening the subsequent length of postgraduate training. From a healthcare perspective, medical education and postgraduate training should therefore be more closely linked so that those starting postgraduate training in general practice have a firm specialty preference in mind more frequently in future. [ABSTRACT FROM AUTHOR]

Objective: In Germany, the rotation into the general practitioner's practice (GPP) as part of postgraduate medical training in general practice traditionally takes place at the end of the training period. The aim of this study was to explore possible subsequent effects of beginning training in the GPP from the perspective of general practitioners (GPs) and GP trainees. Methods: Nationwide, GPs and GP trainees were recruited who started specialization in GP in the GPP. Semi-structured telephone interviews were conducted between June and October 2022 using a self-developed interview-guide. The results were transcribed verbatim and analyzed using content analysis. Results: N=15 interviews were conducted, averaging 54 minutes (32-75 minutes) each (9 federal states, 4 GPs, 11 GP trainees). From the participants' perspective, advantages included close supervision, flat hierarchies, more time for preparation and follow-up, self-directed learning as well as higher basic salary and regular working hours. Positive effects mentioned were reinforcement in career choice, early understanding of workflow in GPP, early development of a GP attitude and strengthening of professional self-confidence. Disadvantages included initial uncertainty at the beginning of the profession and limited opportunities for peer exchange. In conclusion, all participants would recommend beginning specialization with a rotation in the GPP. Discussion: Starting in GGP allows GP trainees to learn about GP in a self-directed, research-oriented manner and based on consultations which enables early professional identity formation. GP trainees should avoid lack of collegial support by participating in a postgraduate training program. In a second step, GP trainers perspectives need to be assessed. Conclusion: Beginning GP postgraduate training with a rotation in GP is advantageous and should be structurally promoted. [ABSTRACT FROM AUTHOR]

Objective: To aid the shortage of general practitioners (GPs) in Germany, since 2011 medical specialists from other fields may switch specialisation by undergoing a slim-lined training programme (lateral entry) into general practice (GP). Available published qualitative and quantitative data on lateral entrants (LEs) is scarce. Aim of the study was an explorative analysis of LEs in the competence centre for postgraduate medical education Baden-Wuerttemberg (KWBW). Methods: In 2016, a multicentric cohort study was initiated including all GP trainees entering the KWBW. Data from 2016 to 2022 was included (T0). A follow-up with graduates from the KWBW was performed once in 2023 (T1). Surveys at T0 and T1 were self-developed, piloted, and included questions on social demography, education, qualification, current training, working environment and professional plans. Dataset was analysed exploratively. Results: At T0, 884 GP trainees participated (response 95.2%). 23.8% of participants were LEs (N=210). Most LEs were specialists from anaesthesiology (34.8%), internal medicine (28.5%) and surgery (20.6%). LEs had been working in their previous specialty for a median of 3 years before starting GP-training. At T0, LEs were seven years older than their colleagues (p<0,001). The proportion of men among LEs was higher (34.3% vs 25.1%, p=0,009). LEs were more decisive to open their own GP practice (p=0,009). At T1, 48 LEs participated of which 92% were practising GPs (N=36). 64,5% considered themselves rural GPs and work in communities <20.000 people (N=36). LEs mainly choose GP because of its specific way of working, job dissatisfaction and personal motives such as opportunity to start a practice. Most LEs strongly agreed that they would switch to GP again. Discussion: LEs are a relevant party among GP trainees. Many LEs become self-employed and contribute essentially to providing primary care. Lateral entry attracts specialists, also from rural areas, seeking for professional satisfaction. This is why LEs should follow their new path within a regional competence centre providing GP specific courses, mentoring and a professional network. Conclusions: LEs graduating from KWBW have become an important pillar of primary care in Baden-Wuerttemberg. [ABSTRACT FROM AUTHOR]

Copyright of Prävention und Gesundheitsförderung is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Due to the shortage of midwives in Germany, it is not always possible to provide comprehensive basic postnatal care for young families. Therefore, it is quite likely that general practitioners (GP), who serve as the first contact person in all health matters in our health care system, will be increasingly consulted regarding questions on postnatal care in the future. Consequently, the aim of this qualitative study was to explore central competencies for the care of families in the postnatal phase. Methods: Midwives were questioned about their postnatal activities with the help of a semistructured questionnaire. Thereafter, the interviews were evaluated using the Mayring method. Results: Interviews were conducted with 25 midwives with an average age of 45 years. Knowledge about the (patho)physiological processes of the mother and child during the postnatal phase, a supportive basic attitude, and time are important elements in the work with young postnatal families. Additionally, it is important to obtain competences in psychosocial issues. Conclusion: The acquisition of competences for the postnatal phase appears to be useful for GPs. Among other aspects, creation of a good networking structure with other health professions is important. [ABSTRACT FROM AUTHOR]

Background: In face of demographic challenges and increasing needs, primary care in Germany could be guaranteed and even expanded by integration of further health professions. Current practice and core principles of family medicine must be included. Objective: With the help of multifarious professional perspectives, the aim was to develop a model for an interprofessional primary care center in Germany (HÄPPI). Materials and methods: In nine workshops, a multiprofessional working group of the Baden-Wuerttemberg Association for General Practice/Family Medicine developed the HÄPPI model. In 2023, nine interviews (45–60 min) with stakeholders and various health professions (attorney, medical assistant, medical insurance representative, general practitioner, nurse, physician assistant, social worker, physician specialist) were conducted to explore principles of successful collaboration in an interprofessional primary care (IPPC) team. Results: An IPPC team could expand primary care, foster patient-centered care, and improve care for the chronically ill. Challenges are seen especially in documentation, organization of team collaboration, and framework conditions such as imbursement and legal restrictions. Helpful approaches include standardized documentation and continuous team-oriented communication. By inclusion of these interview results, the aims and scopes of HÄPPI were identified and formulated and the HÄPPI model was summarized in a short and long version. Conclusion: A future-oriented and feasible model for primary care in Germany could be described at the end of a semistructured iterative process, which could be implemented in a stepwise manner. Integration of further health professions offers various opportunities and requires sufficient team collaboration and IT support, as well as leadership and change-management skills. [ABSTRACT FROM AUTHOR]

The provision of care for sexually transmitted infections (STIs) in Germany is not transparent, STIs are still associated with negative prejudices and patients would like to have a physician to talk to. The most common bacterial and parasitic STIs are usually asymptomatic in women and can lead to serious long-term sequelae if left untreated. A sexual history should be taken at each initial consultation as a minimum. Patients should also be offered an appropriate STI test and vaccination as a preventative measure. After change of partner or if engaging in more than five risk contacts per year, testing for human immunodeficiency virus (HIV) and STIs should be carried out using serological parameters and selfswabs. Testing can be billed on a budget-neutral basis. In addition to antibiotic therapy, partner testing, monitoring the success of therapy and abstinence recommendations should be considered. Targeted referral strategies should be developed to complement care provided by general practitioners. [ABSTRACT FROM AUTHOR]

Background: Up to 90% of sexually transmitted infections (STI) are asymptomatic and often diagnosed late in women, leading to serious sequelae. In the German healthcare system, there is no specifically responsible provider for sexual health counselling. Patients are also referred to general practitioners (GPs), who often feel insecure regarding this topic. Objective: This article describes and discusses concrete GP practices in STI care for women. Methods: Data were collected using semi-standardised guide-assisted interviews including case studies between 10/2020 and 09/2021 and analysed using qualitative content analysis. Based on a theoretical sampling approach, 13 GPs without an infectious disease focus and 6 GPs in infectiology-/human immunodeficiency virus (HIV)-focused practices were included. Results: Many GPs think that care is provided mainly by gynaecology. They rarely take a sexual history and focus more on the diagnosis and treatment of urinary tract infections. Some physicians, however, offer urine polymerase chain reaction (PCR) or vaginal self-smears and treatment for all STI except HIV. Options for financial remuneration and services offered by the public health authorities are rarely used, and asymptomatic patients often have to pay out-of-pocket. Conclusion: Although many patients seek STI care from GPs, this is currently insufficiently covered in Germany. Sexual history and diagnostic possibilities should play a more prominent role in GP education and training in the future. A screening strategy, clear responsibilities, and referral pathways could significantly reduce the burden on patients and doctors. [ABSTRACT FROM AUTHOR]

Background: With the new licensing regulations, scientific research is to be integrated more strongly into medical studies. Objectives: Therefore, it should be examined in the field of family medicine how the integration of scientific research with patients into the existing curriculum can be implemented by the students and how the teaching physicians accept this extension of the teaching. Materials and methods: For this purpose, the medical students should examine patients with allopurinol treatment in family practices. In addition to a personal interview with the patients, data should also be taken from the patients' files. The entries in the examination forms were then checked against the patient files for correct data entry. In addition, the teaching physicians were interviewed about the teaching project using a questionnaire. Results: In all, 35 students in 29 teaching practices participated in the teaching project. In seven teaching practices (25%), patients with gout treatment were examined as planned. Dichotomous items and questions about personal data were consistently documented correctly by the students. Errors in documentation were observed in more complex items, such as questions about previous medication or previous illnesses. The teaching physicians reported time and staffing problems and difficulties in recruiting patients. Conclusions: For successful integration of scientific research into an existing course, all teachers involved should meet with the scientific staff as early as possible and plan the future realisation of the scientific research together. [ABSTRACT FROM AUTHOR]

Background: Coding diagnoses is part of a physician's daily routine. Good coding quality has several functions; it is, for example, the basis for the remuneration of contract doctors. In the field of general medicine, this process can, however, pose a particular challenge, as diagnoses are naturally more often excluded than made. In addition, the process of diagnosing informs treatment., Methods: 23 semi-structured interviews were conducted with general practitioners from Schleswig-Holstein. The interviews were recorded with a dictaphone, pseudonymized, transcribed and then analyzed by content analysis according to Mayring., Results: 87 % (N = 20) of the participants were male, the mean age was 57 years, and the mean duration of work experience was 23 years. The ICD-10 (International Classification of Diseases) coding system was often criticized for not representing general medical practice and placing an increased administrative and time burden on physicians. At the same time, diagnostic pressure from external economic interests was perceived. Specifications of practice management systems or their additional programming options were used, among other things, to search for a code. Particular challenges arose in this context, e.g., complex clinical pictures and lack of time. Prescriptions without indication, among other things, have been made at the request of patients, due to a lack of time and concerns about doctor switching. In these cases, a diagnosis in the ICD-10 code that justified the therapy was sometimes used., Conclusions: The path leading from clinical findings to therapy and finally to the appropriate diagnostic code is a complex one, and it involves various influencing factors, including non-medical factors. These influencing factors must be taken into account in future secondary data analyses. The ICD-10 is not the ideal choice for mapping these processes in general medicine., (Copyright © 2024. Published by Elsevier GmbH.)

Objectives: The aim of the study was to explore the subjective views of general practitioners on the applicability of the Adult ADHD Self-Report Screening Scale for DSM-5 (ASRS-5) as a screening tool for attention-deficit/hyperactivity disorder (ADHD) in adults in general practice., Method: Eleven general practitioners, who had participated in the validation study of the German version of the ASRS-5, were interviewed. For this purpose, a semi-structured interview guide was designed using the Consolidated Framework for Implementation Research (CFIR). The interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis according to Kuckartz., Results: The ASRS-5 seems to work well in general medical practice. But there is evidence for a lack of knowledge about ADHD in adults among general practitioners and a demand for further training in this area. Moreover, insufficient possibilities for subsequent treatment after a positive ADHD screening were claimed., Discussion: In general medicine, the introduction of a screening using ASRS-5 in cases of clinical suspicion could be the first step towards improving the management of adult patients with ADHD., Conclusion: Optimizing the management of adults with ADHD requires additional information and training initiatives to support early diagnosis especially in the primary care setting, and to reveal treatment options and care concepts for adults with ADHD., (Copyright © 2024. Published by Elsevier GmbH.)