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Background: Health information is a prerequisite for informed choices–decisions, made by individuals about their own health based on knowledge and in congruence with own preferences. Criteria for development, content and design have been defined in a corresponding guideline. However, no instruments exist that provide reasonably operationalised measurement items. Therefore, we drafted the checklist, MAPPinfo, addressing the existing criteria with 19 items. Objectives: The current study aimed to validate MAPPinfo. Methods: Five substudies were conducted subsequently at the Martin Luther University Halle-Wittenberg, Germany and the Medical University of Graz, Austria: (1) to determine content validity through expert reviews of the first draft, (2) to determine feasibility using 'think aloud' in piloting with untrained users, (3) to determine inter-rater reliability and criterion validity through a pretest on 50 health information materials, (4) to determine construct validity using 50 developers' self-declarations about development methods as a reference standard, (5) to determine divergent validity in comparison with the Ensuring Quality Information for Patients (EQIP) (expanded) Scale. The analyses used were qualitative methods and correlation-based methods for determining both inter-rater reliability and validity. Results: The instrument was considered by experts to operationalise the existing guidelines convincingly. Health and nursing science students found it easy to understand and use. It also had good interrater reliability (mean of T coefficients =.79) and provided a very good estimate of the reference standard (Spearman's rho =.89), implying sound construct validity. Finally, comparison with the EQIP instrument revealed important and distinct areas of similarities and differences. Conclusions: The new instrument is ready for use as a screening instrument without the need for training. According to its underpinning concept the instrument exclusively comprises items which are justified by either ethics or research evidence, implying negligence of not yet evidence based, however, potentially important criteria. Further research is needed to complete the body of evidence-based criteria, aiming at an extension of the guideline and MAPPinfo. Trial registration number: AsPredicted22546; date of registration: 24 July 2019. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) represents a significant challenge to health care systems around the world. A well-functioning primary care system is crucial in epidemic situations as it plays an important role in the development of a system-wide response. Methods: 2,187 Austrian and German GPs answered an internet survey on preparedness, testing, staff protection, perception of risk, self-confidence, a decrease in the number of patient contacts, and efforts to control the spread of the virus in the practice during the early phase of the COVID-pandemic (3rd to 30th April). Results: The completion rate of the questionnaire was high (90.9%). GPs gave low ratings to their preparedness for a pandemic, testing of suspected cases and efforts to protect staff. The provision of information to GPs and the perception of risk were rated as moderate. On the other hand, the participants rated their self-confidence, a decrease in patient contacts and their efforts to control the spread of the disease highly. Conclusion: Primary care is an important resource for dealing with a pandemic like COVID-19. The workforce is confident and willing to take an active role, but needs to be provided with the appropriate surrounding conditions. This will require that certain conditions are met. Registration: Trial registration at the German Clinical Trials Register: DRKS00021231. [ABSTRACT FROM AUTHOR]

Background: The health status, health awareness and health behavior of persons with a migration background often differ from the autochthonous population. Little is known about the proportion of patients with a migration background (PMB) that participate in primary care studies on oral antithrombotic treatment (OAT) in Germany, and whether the quality of their antithrombotic care differs from patients without a migration background. The aim of this paper was to use the results of a cluster-randomized controlled trial (PICANT) to determine the proportion of PMB at different stages of recruitment, and to compare the results in terms of sociodemographic characteristics and antithrombotic treatment. Methods: This study used screening and baseline data from the PICANT trial on oral anticoagulation management in GP practices. For this analysis, we determined the proportion of PMB during the recruitment period at stage 1 (screening of potentially eligible patients), stage 2 (eligible patients invited to participate in the trial), and stage 3 (assessment of baseline characteristics of patients participating in the PICANT trial). In addition, we compared patients in terms of sociodemographic characteristics and quality of anticoagulant treatment. Statistical analysis comprised descriptive and bivariate analyses. Results: The proportion of PMB at each recruitment stage declined from 9.1% at stage 1 to 7.9% at stage 2 and 7.3% at stage 3). A lack of German language skills led to the exclusion of half the otherwise eligible PMB. At stages 1 and 3, PMB were younger (stage 1: 70.7 vs. 75.0 years, p<0.001; stage 3: 70.2 vs. 73.5 years, p = 0.013), but did not differ in terms of gender. The quality of their anticoagulant care was comparable (100.0% vs. 99.1% were receiving appropriate OAT, 94.4% vs. 95.7% took phenprocoumon, or warfarin, and the most recent INR measurement of 60.8% vs. 69.3% was within their individual INR range). Conclusions: In the potentially eligible population and among participants at baseline, the quality of anticoagulant care was high in all groups of patients, which is reassuring. To enable the inclusion of more PMB, future primary care research on OAT in Germany should address how best to overcome language barriers. This will be challenging, particularly because the heterogeneity of PMB means the resulting sample sizes for each specific language group are small. Trial registration: Current Controlled Trials ISRCTN41847489. [ABSTRACT FROM AUTHOR]

Background: Many women suffer from anemia during their pregnancy. Austria, a central European country, has an instituted mandatory prenatal care system and therein two anemia screening tests (before end of week 16 and in weeks 25-28) are scheduled. Epidemiological data on the prevalence of anemia in pregnant women in Austria are missing. Methods: We analysed data from Styria, an Austrian federal state, to determine the prevalence of anemia diagnosed in pregnant women aged 15-45 years with at least one examination in the first and second time period using the cut-off hemoglobin (Hb) concentration of 11 g/dl as recommended by the World Health Organisation (WHO). Sensitivity analyses for cut-off values with 10.5 and 7 g/dl (severe anemia) were performed. The STROBE checklist was applied for this retrospective cohort study. Results: The study included anemia screening tests from 25,922 women during 31,429 pregnancies from 2006-2014. Anemia was diagnosed in either time period in 13.7% (95% confidence interval (CI) 13.4-14.1) of pregnancies, in the first time period in 2.2% (95% CI 2.0-2.2), and in the second time period in 13.0% (95% CI 12.6-13.4). The annual age-adjusted anemia prevalence showed no change over time. Reducing the cut-off value to 10.5 g/dl resulted in an anemia prevalence in either time period of 5.6% (95% CI 5.3-5.8). The pattern of a higher prevalence in the second time period remained unchanged. Severe anemia (Hb <7 g/dl) was diagnosed in four pregnancies (0.01%). Conclusion: The estimated anemia prevalence of around 14% in pregnant women in Styria (Austria) is stable over the observed time window (2006-2014) and almost all are diagnosed in the second test period (in weeks 25-28). It seems that in a developed country like Austria the first examination (before week 16) is not mandatory for pregnancy care. However, in other countries where a high prevalence of anemia is common due to risk factors such as malaria and HIV, early screening in pregnancy might be very important. [ABSTRACT FROM AUTHOR]

Purpose: To examine whether applying case management in general practices reduces thromboembolic events requiring hospitalization and major bleeding events (combined primary outcome). Secondary endpoints were mortality, frequency and duration of hospitalization, severe treatment interactions, adverse events, quality of anticoagulation, health-related quality of life and intervention costs, patients’ assessment of chronic illness care, self-reported adherence to medication, GP and HCA knowledge, patient knowledge and satisfaction with shared decision-making. Methods: Cluster-randomized controlled trial undertaken at 52 general practices in Germany with adult patients with a long-term indication for oral anticoagulation. The complex intervention included training for healthcare assistants, information and quality circles for general practitioners and 24 months of case management for patients. Assessment was after 12 and 24 months. The intention-to-treat population included all randomized practices and patients, while the per-protocol analysis included only those that received treatment without major protocol violations. Results: The mean (SD) age of the 736 patients was 73.5 (9.4) years and 597 (81.1%) had atrial fibrillation. After 24 months, the primary endpoint had occurred in 40 (11.0%) intervention and 48 (12.9%) control patients (hazard ratio 0.83, 95% CI 0.55 to 1.25; P = .37). Patients’ perceived quality of care, their knowledge, and HCAs’ knowledge, had improved significantly at 24 months. The other secondary endpoints did not differ between groups. In the intervention group, hospital admissions were significantly reduced in patients that received treatment without major protocol deviations. Conclusions: Even though the main outcomes did not differ significantly, the intervention appears to have positively influenced several process parameters under ‘real-world conditions’. [ABSTRACT FROM AUTHOR]