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Aims Heart failure (HF) and atrial fibrillation (AF) frequently coexist and are both associated with increased levels of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP). It is known that AF impairs the diagnostic accuracy of NT‐proBNP for HF. The aim of the present study was to compare the diagnostic and predictive accuracy of NT‐proBNP for HF and AF in stable outpatients with cardiovascular risk factors. Methods and results Data were obtained from the DIAST‐CHF trial, a prospective cohort study that recruited individuals with cardiovascular risk factors and followed them up for 12 years. Data were validated in three independent population‐based cohorts using the same inclusion/exclusion criteria: LIFE‐Adult (n = 2869), SHIP (n = 2013), and SHIP‐TREND (n = 2408). Serum levels of NT‐proBNP were taken once at baseline. The DIAST‐CHF study enrolled 1727 study participants (47.7% female, mean age 66.9 ± 8.1 years). At baseline, patients without AF or HF (n = 1375) had a median NT‐proBNP of 94 pg/mL (interquartile range 51;181). In patients with AF (n = 93), NT‐proBNP amounted to 667 (215;1130) pg/mL. It was significantly higher than in the first group (P 50% [n = 38; 603 (175;1070) pg/mL] and those without HF (P = 1.0). Receiver‐operating characteristic curves of NT‐proBNP showed a similar area under the curve (AUC) for the detection of AF at baseline (0.84, 95% CI [0.79–0.88]) and for HF with EF 50% was significantly lower (0.61 [0.56–0.65]) than for AF (P = 0.001). During follow‐up, AF was newly diagnosed in 157 (9.1%) and HF in 141 (9.6%) study participants. NT‐proBNP was a better predictor of incident AF during the first 2 years (AUC: 0.79 [0.75–0.83]) than of newly diagnosed HF (0.59 [0.55–0.63]; P 50% is very limited.

Objectives The aims of our study were to describe the effect of the COVID-19 pandemic and lockdown on primary care in Germany regarding the number of consultations, the prevalence of specific reasons for consultation presented by the patients, and the frequency of specific services performed by the GP. Methods We conducted a longitudinal observational study based on standardised GP interviews in a quota sampling design comparing the time before the COVID-19 pandemic (12 June 2015 to 27 April 2017) with the time during lockdown (21 April to 14 July 2020). The sample included GPs in urban and rural areas 120 km around Hamburg, Germany, and was stratified by region type and administrative districts. Differences in the consultation numbers were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the administrative districts and GP practices. Results One hundred ten GPs participated in the follow-up, corresponding to 52.1% of the baseline. Primary care practices in 32 of the 37 selected administrative districts (86.5%) could be represented in both assessments. At baseline, GPs reported 199.6 ± 96.9 consultations per week, which was significantly reduced during COVID-19 lockdown by 49.0% to 101.8 ± 67.6 consultations per week (p p Conclusions We observed a dramatic reduction of the number of consultations in primary care. This effect was independent of age, sex and specialty of the GP and independent of the practice location in urban or rural areas. Consultations for complaints like low back pain, gastrointestinal complaints, vertigo or fatigue and services like house calls/calls at nursing homes, wound treatments, pain therapy or screening examinations for the early detection of chronic diseases were particularly affected.

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

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.

OBJECTIVES There is a lack of studies identifying the correlates of institutionalization specifically among the oldest old. Therefore, our aim was to fill this gap in knowledge. METHODS Cross-sectional data (Follow up wave 9; n = 633 observations in the analytical sample) were used from the multicenter prospective cohort study "Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" Correlates of institutionalization among the oldest old-Evidence from a multicenter cohort study. The sample consists of primary care patients aged 86 years and over (mean 90.5 years, SD: 2.9 years). Sociodemographic and health-related independent variables were included in our regression model. Institutionalization was defined as living in a nursing home or an old-age home (not including assisted living facilities). RESULTS Out of the 633 participants, 502 individuals (79.3%) did not live in an institutionalized setting, whereas 73 individuals (20.7%) lived in an institutionalized setting. Multiple logistic regressions showed that the likelihood of institutionalization increased with being divorced/widowed/single (compared to being married; OR: 5.35 [95% CI: 1.75-16.36]), the presence of social isolation (OR: 2.07 [1.20-3.59]), more depressive symptoms (OR: 1.11 [1.01-1.23]), increased cognitive impairment (OR: 1.67 [1.31-2.15]) and higher levels of frailty (OR: 1.48 [1.07-2.06]). CONCLUSION The study findings identified various sociodemographic and health-related factors associated with institutionalization among the oldest old. Longitudinal studies are required to gain further insights into these associations.

Zusammenfassung Zielsetzung In vorangegangenen Untersuchungen der KarMed-Studie konnte gezeigt werden, dass Arztinnen in facharztlicher Weiterbildung mit Kindern im Vergleich zu ihren mannlichen Kollegen langsschnittlich eine absinkende Berufsverlaufszufriedenheit aufweisen – querschnittlich nach vier Jahren Weiterbildung jedoch die hochsten Werte fur Lebenszufriedenheit aufwiesen. In der vorliegenden Studie sollte untersucht werden, ob die unterschiedlichen Verlaufe der Berufsverlaufs- und Lebenszufriedenheit durch den Elternstatus bedingt werden oder ob es sich, getrennt nach Geschlecht, umgekehrt verhalt. Methode Die Daten wurden jahrlich im Rahmen der Forschungsstudie KarMed erhoben (2008-2016; vgl. https://www.uke.de/kliniken-institute/institute/allgemeinmedizin/forschung/karriereverl%C3%A4ufe-von-%C3%A4rztinnen-und-%C3%A4rzten-w%C3%A4hrend-der-fach%C3%A4rztlichen-weiterbildung.html ). Abgebildet wird ein Langsschnitt zu den Befragungen im Zeitraum von zwei bis funf Jahren nach dem Praktischen Jahr (T2 bis T5). Zur longitudinalen Analyse wurden zeitverzogerte Pfadmodelle (cross-lagged panel design) berechnet. Ergebnisse Es findet sich ein inverser Zusammenhang zwischen der Berufsverlaufszufriedenheit und dem Elternstatus fur Arztinnen im Vergleich zu Arzten in facharztlicher Weiterbildung. Arztinnen mit einer niedrigen Berufsverlaufsverlaufszufriedenheit bekommen eher Kinder als Arztinnen mit einer hohen Berufsverlaufszufriedenheit; bei Arzten erhoht der Elternstatus kausal die Berufsverlaufszufriedenheit. Fur Arztinnen, nicht aber fur Arzte, sagt das Ausmas der Lebenszufriedenheit den Elternstatus vorher. Schlussfolgerung Die vorliegenden Ergebnisse weisen auf strukturelle Ungleichheiten zwischen Arzten und Arztinnen hin, die Anpassungen der Weiterbildungsbedingungen vor Beginn des Elternstatus dringend erforderlich erscheinen lassen. Zukunftige Studien sollten ein mutterschutzbedingtes partielles Beschaftigungsverbot sowie die von Arzten in Anspruch genommenen Elternzeiten mitberucksichtigen.

Background Depression in older adults is becoming an increasing concern. As depressive symptoms change over time, it is important to understand the determinants of change in depressive symptoms. The aim of our study is to use a longitudinal study design to explore the predictors of change, remission and incident depression in older patients with multimorbidity. Methods Data from the MultiCare cohort study were used. The cohort studied 3,189 multimorbid general practice patients aged 65-85. Data were collected during personal interviews. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS-15). Predictors of change in depressive symptoms were determined using multivariate linear regression, while multivariate logistic regression was used to analyze predictors of remission and incident depression. Models included depressive symptoms at baseline and follow-up, socio-demographics and data on health status and social support. Results Overall, 2,746 participants with complete follow-up data were analyzed. Mean age was 74.2 years, 59.2% were female, and 11.3% were classified as depressed at baseline. Burden of multimorbidity and social support were statistically significant predictors in all regression analyses. Further predictors of change in depressive symptoms were: income, pain, nursing grade, self-rated health and self-efficacy. Limitations The sample size for prediction of remission limited statistical certainty. Assessment of depressive symptoms using GDS-15 differs from routine clinical diagnoses of depression. Conclusions Predictors of change in depressive symptoms in older multimorbid patients are similar to those predicting remission and incident depression, and do not seem to differ significantly from other older patient populations with depressive symptoms.

Background The elderly population deals with multimorbidity (three chronic conditions) and increasinged drug use with age. A comprehensive characterisation of the medication – including prescription and over-the-counter (OTC) drugs – of elderly patients in primary care is still insufficient. Objectives This study aims to characterise the medication (prescription and OTC) of multimorbid elderly patients in primary care and living at home by identifying drug patterns to evaluate the relationship between drugs and drug groups and reveal associations with recently published multimorbidity clusters of the same cohort. Methods MultiCare was a multicentre, prospective, observational cohort study of 3189 multimorbid patients aged 65 to 85 years in primary care in Germany. Patients and general practitioners were interviewed between 2008 and 2009. Drug patterns were identified using exploratory factor analysis. The relations between the drug patterns with the three multimorbidity clusters were analysed with Spearman-Rank-Correlation. Results Patients (59.3% female) used in mean 7.7 drugs; in total 24,535 drugs (23.7% OTC) were detected. Five drug patterns for men (drugs for obstructive pulmonary diseases (D-OPD), drugs for coronary heart diseases and hypertension (D-CHD), drugs for osteoporosis (D-Osteo), drugs for heart failure and drugs for pain) and four drug patterns for women (D-Osteo, D-CHD, D-OPD and drugs for diuretics and gout) were detected. Significant associations between multimorbidity clusters and drug patterns were detectable (D-CHD and CMD: male: ρ = 0.376, CI 0.322–0.430; female: ρ = 0.301, CI 0.624–0.340). Conclusion The drug patterns demonstrate non-random relations in drug use in multimorbid elderly patients and systematic associations between drug patterns and multimorbidity clusters were found in primary care.

The heterogeneity in the operationalisation of successful ageing (SA) hinders a straightforward examination of SA associations and correlates, and in turn, the identification of potentially modifiable predictors of SA. It is unclear which SA associations and correlates influence all facets of the SA construct, and whether psychosocial reserve models developed in neuropathological ageing research can also be linked to SA. It was therefore the aim of this study to disentangle the effect of various previously identified SA associations and correlates on (1) a general SA factor, which represents the shared underpinnings of three SA facets, and (2) more confined, specific factors, using bifactor modelling. The associations and correlates of three recently validated SA operationalisations were compared in 2478 participants from the German AgeCoDe study, aged 75 years and above. Based on participants’ main occupation, cognitive reserve (CR) and motivational reserve (MR) models were built. Younger age, male gender, more education, higher socio-economic status, being married or widowed, as well as more physical exercise and cognitive activities in old age were found to correlate positively with the general SA factor, indicating a simultaneous effect on all aspects of SA. Smoking and ApoE-ε4 were related only to the physiological facet of SA. CR models were significantly related to the general SA factor. Among all SA associations and correlates, proxy indicators of lifelong cognitive activity and physical exercise showed the strongest effects on SA. Future intervention studies should assess the influence of the preservation of active lifestyle across the life span on SA. Electronic supplementary material The online version of this article (10.1007/s10433-020-00593-4) contains supplementary material, which is available to authorised users.

Background Given increasing incidence of cognitive impairment and dementia, further understanding of modifiable factors contributing to increased healthspan is crucial. Extensive literature provides evidence that physical activity (PA) delays the onset of cognitive impairment; however, it is unclear whether engaging in PA in older adulthood is sufficient to influence progression through cognitive status categories. Method Applying a coordinated analysis approach, this project independently analyzed 14 longitudinal studies (NTotal = 52 039; mean baseline age across studies = 69.9–81.73) from North America and Europe using multistate survival models to estimate the impact of engaging in PA on cognitive status transitions (nonimpaired, mildly impaired, severely impaired) and death. Multinomial regression models were fit to estimate life expectancy (LE) based on American PA recommendations. Meta-analyses provided the pooled effect sizes for the role of PA on each transition and estimated LEs. Results Controlling for baseline age, sex, education, and chronic conditions, analyses revealed that more PA is significantly associated with decreased risk of transitioning from nonimpaired to mildly impaired cognitive functioning and death, as well as substantially longer LE. Results also provided evidence for a protective effect of PA after onset of cognitive impairment (eg, decreased risk of transitioning from mild-to-severe cognitive impairment; increased likelihood of transitioning backward from severe-to-mild cognitive impairment), though between-study heterogeneity suggests a less robust association. Conclusions These results yield evidence for the importance of engaging in PA in older adulthood for cognitive health, and a rationale for motivating older adults to engage consistently in PA.

Objectives Previous studies have observed protective effects of high mental demands at work on cognitive functioning and dementia risk. However, it is unclear what types of demands drive this effect and whether this effect is subject to a person's genetic risk. We investigated to what extent eight different types of mental demands at work together with the APOE e4 allele, a major risk gene for late-onset Alzheimer's disease, affect cognitive functioning in late life. Methods/design The population-based German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe, n=2,154) followed cognitively healthy individuals aged 75 years and older in seven assessment waves. Cognitive functioning was assessed via the mini-mental status examination. Results Mixed-effects modeling (adjusted for education, gender, marital status, stroke, depression, and diabetes) indicated that participants who had an occupational history of working in jobs with high compared to low demands in 'Language & Knowledge', 'Pattern detection', 'Information processing', and 'Service' had a slower cognitive decline. APOE e4-allele carriers had an accelerated cognitive decline, but this decline was significantly smaller if they had a medium compared to a low level of demands in contrast to non-carriers. Conclusions Our longitudinal observations suggest that cognitive decline could be slowed by an intellectually enriched lifestyle even in risk gene carriers. Fostering intellectual engagement throughout the life-course could be a key prevention initiative to promote better cognitive health in old age. This article is protected by copyright. All rights reserved.

Background In most countries, the general practitioner (GP) is the first point of contact in the healthcare system and coordinator of healthcare. However, in Germany it is possible to consult an outpatient specialist even without referral. Coordination by a GP might thus reduce health expenditures and inequalities in the healthcare system. The study describes the patients’ willingness/commitment to use the GP as coordinator of healthcare and identifies regional and patient-related factors associated with the aforementioned commitment to the GP. Methods Cross-sectional observational study using a standardised telephone patient survey in northern Germany. All counties and independent cities within a radius of 120 km around Hamburg were divided into three regional categories (urban areas, environs, rural areas) and stratified proportionally to the population size. Patients who had consulted the GP within the previous three months, and had been patients of the practice for at least three years were randomly selected from medical records of primary care practices in these districts and recruited for the study. Multivariate linear regression models adjusted for random effects at the level of federal states, administrative districts and practices were used as statistical analysis methods. Results Eight hundred eleven patients (25.1%) from 186 practices and 34 administrative districts were interviewed. The patient commitment to a GP attained an average of 20 out of 24 possible points. Significant differences were found by sex (male vs. female: + 1.14 points, p p = 0.043), education (high vs. low: − 1.74, p p = 0.004), regional category (urban areas: − 0.85, p = 0.022; environs: − 0.80, p = 0.045) and healthcare utilisation (each GP contact: + 0.30, p p = 0.018). Professional situation and age were not significantly associated with the GP commitment. Conclusion On average, the patients’ commitment to their GP was relatively strong, but there were large differences between patient groups. An increase in the patient commitment to the GP could be achieved through better patient information and targeted interventions, e.g. to women or patients from regions of higher urban density. Trial registration The study was registered in ClinicalTrials.gov (NCT02558322).

Background Psychological distress has a negative impact on the prognosis and quality of life for patients with heart failure. We investigated the association between psychological distress and the patients’ adherence to medical treatment (medication adherence) and self-care advice (lifestyle adherence) in heart failure. We further examined whether there are different factors associated with low medication compared to low lifestyle adherence. Method This secondary analysis of the RECODE-HF cohort study analyzed baseline data of 3099 primary care heart failure patients aged 74 ± 10 years, 44.5 % female. Using multivariable regression, factors relating to medication and lifestyle adherence were investigated in order to estimate the extent to which these factors confound the association between psychological distress and adherence. Results Psychological distress was significantly associated with poorer medication adherence but not with lifestyle adherence after controlling for confounders. We identified different factors associated with medication compared to lifestyle adherence. A higher body mass index, a less developed social network, living alone, fewer chronic co-morbidities and unawareness of the heart failure diagnosis were only related to lower lifestyle adherence. Higher education was associated with poorer medication adherence. Male sex, younger age, lower self-efficacy and less familiar relation with the general practitioner were common factors associated with both lower medication and lifestyle adherence. Conclusion Promising factors for increasing medication adherence (reduction of psychological distress) and lifestyle adherence (explaining the patient his/her heart failure diagnosis more than once and increase in the patients’ self-efficacy), which were found in this cross-sectional study, must be further investigated in longitudinal studies.

Background Patient and public involvement (PPI) is increasingly required in mental health services research. To empower patients to actively address depression, the GET.FEEDBACK.GP study evaluates a patient-targeted feedback intervention after depression screening using the Patient Health Questionnaire (PHQ-9). Objective To refine the patient-targeted feedback from a previous study within a participatory research team (PRT) by conducting workshops to investigate patients' needs and preferences for feedback. To evaluate the process and outcome of PPI. Design Patient and public involvement was carried out on the levels of collaboration and consultation. A PRT of patient partners and researchers planned and conducted three workshops with patients. Patients' needs were investigated using a focus group. Participants prioritized needs, discussed feedback drafts and evaluated two drafts using cognitive debriefings. Researchers of the PRT communicated the results at project level. PPI was evaluated using the Public and Patient Engagement Evaluation Tools (PPEET). Setting and participants A purposeful sampling of N = 12 patients with experiences of depression participated in at least one workshop. Results Relevant content-related needs about feedback (eg no distinction between severe and moderate symptoms), recommendations for action and patient-relevant information were considered. Needs for comprehensible, valuing, nonstigmatizing language and design elements (eg dimensional bar) were implemented. Workshops and PRT were positively evaluated. Discussion and conclusions Patient and public involvement influenced the content, wording and design of the feedback. Strengths include two levels of PPI, methodical diversity and purposeful sampling. Limitations include the lack of inclusion of patients who are unaware of their depression. The evaluated PPI concept can be useful for future studies.

Background Depression and anxiety are more prevalent in patients with heart failure (HF) than in the general population and reduce quality of life (QoL); therefore, clinical guidelines recommend screening HF patients for depression/anxiety. Objective We investigated, whether the general practitioners’ (GPs) awareness of patients’ symptoms of depression and/or anxiety (psychosocial distress) was associated with a change in QoL. Methods In this prospective observational study, we recruited 3,129 primary care HF patients in Germany. Patients completed baseline and 12-month follow-up questionnaires. Their GPs were interviewed. We identified 666 patients with psychosocial distress and compared 2 groups by analysis of covariance: 235 patients with psychosocial distress whose GP was aware of the psychosocial distress and 431 patients with psychosocial distress whose GP was unaware of such distress. Primary outcome was the change in QoL, assessed by the EQ-5D visual analogue scale. Results Patients with psychosocial distress showed lower baseline QoL than those without (45.9 vs 64.1; P < 0.001). Within the patients with psychosocial distress, the GPs’ awareness of psychosocial distress was not associated with improvement of QoL (F = 1.285; P = 0.258) or remission of psychosocial distress (odds ratio = 0.887; P = 0.608). Conclusion We found no association between the GPs’ awareness of psychosocial distress and change in QoL. Although data for effective treatments of depression in HF are currently insufficient, psychosocial distress strongly impairs the QoL in HF patients. These findings might influence the development of clinical practice guidelines in HF.

ZusammenfassungMehrere Studien belegen den hohen beruflichen Stress von Ärzten und Ärztinnen bis hin zu Burnout-Symptomen. Untersucht In der vorliegenden Studie wurde das Belastungserleben von Ärzten und Ärztinnen im längsschnittlichen Verlauf der fachärztlichen Weiterbildung untersucht. Dazu wurde der Frage nachgegangen, wie sich das Burnouterleben unter Berücksichtigung von Gratifikationskrisen von Beginn bis zum Ende der Weiterbildung an innerhalb von 6 Jahren verändert und ob es jeweils einen Einfluss von Geschlecht und Elternstatus gibt. Die Datenerhebung erfolgte im Rahmen der KarMed Studie. Eingesetzt wurden das Maslach Burnout Inventar (MBI-HSS (MP)) und der Effort-Reward-Imbalance Fragebogen (ERI). Die theoretischen Annahmen wurden in allgemeinen linearen Modellen und allgemeinen linearen gemischten Modellen mit Meßwiederholungsdesign statistisch überprüft. Es bestand ein hoher Zusammenhang zwischen dem Ausgangsniveau der Belastung zu Beginn der Weiterbildung und dem Belastungserleben zum Ende der Weiterbildung. Gratifikationskrisen hatten einen signifikanten Einfluss auf die Sub-Skala emotionale Erschöpfung des MBI, nicht aber auf die Subskalen persönliche Leistungsfähigkeit und Depersonalisation. Signifikante Zeiteffekte fanden sich auf allen 3 Sub-Skalen des MBI, mit signifikanten Geschlechtseffekten auf den Subskalen emotionale Erschöpfung und Depersonalistaion. Der Elternstatus weist unter Berücksichtigung der Burnout-Verlaufswerte und Gratifikationskrisen keinen signifikanten Einfluss auf das Burnouterleben auf. Die theoretischen Implikationen und die praktischen Konsequenzen für die Gesundheitsförderung von ÄrztInnen werden ebenso diskutiert wie die Begrenzungen der Untersuchung.

Objectives:To examine the impact of determinants of incident dementia in three different old age groups (75–79, 80–84, 85+years) in Germany.Design:Multicenter prospective AgeCoDe/AgeQualiDe cohort study with baseline and nine follow-up assessments at 1.5-year intervals.Setting:Primary care medical record registry sample.Participants:General practitioners’ (GPs) patients aged 75+years at baseline.Measurements:Conduction of standardized interviews including neuropsychological assessment and collection of GP information at each assessment wave. We used age-stratified competing risk regression models (accounting for the competing event of mortality) to assess determinants of incident dementia and age-stratified ordinary least square regressions to quantify the impact of identified determinants on the age at dementia onset.Results:Among 3027 dementia-free GP patients,n= 704 (23.3%) developed dementia during the 13-year study period. Worse cognitive performance and subjective memory decline with related worries at baseline, and the APOE ε4 allele were associated independently with increased dementia risk in all three old age groups. Worse cognitive performance at baseline was also associated with younger age at dementia onset in all three age groups. Other well-known determinants were associated with dementia risk and age at dementia onset only in some or in none of the three old age groups.Conclusions:This study provides further evidence for the age-specific importance of determinants of incident dementia in old age. Such specifics have to be considered more strongly particularly with regard to potential approaches of early detection and prevention of dementia.

Zusammenfassung Zielsetzung In der vorliegenden Arbeit wurde im Langsschnitt untersucht, inwiefern die angenommene Verzogerung des Abschlusses und die subjektive Einschatzung der Qualitat der Weiterbildung mit einer Veranderung der Berufsverlaufszufriedenheit von Arzten und Arztinnen in der Facharztausbildung zusammenhangen. Methode Die untersuchten Daten wurden in der Forschungsstudie KarMed erhoben. Die erste Erhebung (T0) wurde 2008/2009 am Ende des Praktischen Jahres durchgefuhrt. Abgebildet wird ein Langsschnitt zur Befragung im Zeitraum von drei bis funf Jahren nach dem Praktischen Jahr (T3 bis T5). Zur longitudinalen Analyse wurden Hierarchisch Lineare Modelle und zeitverzogerte Pfadmodelle eingesetzt. Die Analysen wurden kontrolliert fur Geschlecht, Elternstatus und Fachdisziplin. Ergebnisse Pfadanalysen ergaben, dass eine positive Berufsverlaufszufriedenheit einen kleinen bis mittleren kausalen positiven Effekt auf die subjektiv wahrgenommene Qualitat der Weiterbildung hatte. Eine angenommene Verzogerung der Weiterbildung hatte einen kleinen signifikanten kausalen negativen Effekt auf die Berufsverlaufszufriedenheit und eine hohere Berufsverlaufszufriedenheit hatte einen kleinen signifikanten kausalen negativen Effekt auf die Verzogerung der Weiterbildung. Das Geschlecht sagte die Berufsverlaufszufriedenheit von Eltern mit Kindern vorher. Demnach sank die Zufriedenheit bei Arztinnen mit Kindern gegenuber Arzten mit Kindern im Verlauf der Weiterbildung signifikant ab. Die Fachdisziplin wies keinen signifikanten Effekt auf die Berufsverlaufszufriedenheit auf. Schlussfolgerung Wenn Arzte mit ihrem Beruf zufrieden sind, dann schatzen sie subjektiv auch die Qualitat der Weiterbildung positiver ein. Die angenommene Verzogerung der Weiterbildung und die Berufsverlaufszufriedenheit hangen reziprok miteinander zusammen. Die Bedarfslage zur Verbesserung der facharztlichen Weiterbildung scheint insbesondere bei Arztinnen mit Kindern gegeben zu sein.

Background Old age is accompanied by a higher risk of losing a spouse. This study aims to longitudinally investigate the effect of widowhood on depression severity with a special focus on sex differences. We examine depression before and after widowhood in men and women separately to investigate which sex is at greater risk after losing a spouse. Methods Data came from the AgeDifferent.de platform, which includes three pooled old age cohort studies. In order to examine factors associated with depression over time, we applied a linear hybrid mixed-effects regression model for the overall sample and analysed additional separate models for men and women. Results Of 2470 respondents (mean age at baseline 79.2 (SD 3.64) years), 1256 were men. In total, 209 men and 332 women experienced spousal bereavement after baseline. In general, both sexes showed higher depression severity after widowhood. However, there were significant sex differences. Widowed men were more prone to subsequent depression than widowed women. In terms of depression severity, widowed men differed significantly compared to non-widowed men; however, this was not the case for women. Limitation We harmonized three cohort studies which used different measurement scales for depression and different recruitment procedures. Conclusion Our study showed that although both genders suffer from losing a spouse, men are more prone to subsequently develop depressive symptoms. Raising the awareness among practitioners for sex-specific differences as well as developing tailored interventions for both widowed men and women should be considered.

In den Notaufnahmen wachst die Arbeitsbelastung durch Patienten ohne medizinischen Notfall. Unterstutzungsangebote aus dem ambulanten Sektor haben sich noch nicht ausreichend etabliert. Um festzustellen, inwieweit es sich bei Patienten in Notaufnahmen um echte medizinische Notfalle handelt, sollen Patienten mit mindestens 2 und solche mit maximal 1 chronischen Erkrankung verglichen werden. Zudem sollen Einflussfaktoren auf die vorherige Inanspruchnahme ambulanter Strukturen identifiziert werden. Die Studienklientel stammt aus der Querschnittsstudie „PiNo-Nord“. In 5 Notaufnahmen wurden zwischen 10/2015 und 07/2016 alle „nicht sofort“ oder „nicht sehr dringend“ Behandlungsbedurftigen interviewt. Die Datenanalyse erfolgte explorativ und mithilfe multivariater logistischer Regression. Die 293 Patienten mit ≥2 chronischen Erkrankungen stellten verglichen mit den 847 Patienten mit max. 1 chronischen Erkrankung etwa genauso haufig einen medizinischen Notfall dar. Konsultationsanlasse (und Entlassungsdiagnosen) waren v. a. Traumata am Bewegungsapparat (33 %, n = 293 vs. 42 %, n = 847) oder der Haut (11 %, n = 293 vs. 13 %, n = 847). In beiden Gruppen spielten die haus- oder facharztliche Versorgung sowie diagnostische oder Behandlungsmoglichkeiten fur das Aufsuchen der Notaufnahme selten eine Rolle. Starkste Pradiktoren fur eine vorherige ambulante Behandlung waren langere Beschwerdedauer, subjektiv hohe Behandlungsdringlichkeit, mindestens zwei chronische Erkrankungen und eine den Bewegungsapparat betreffende Konsultation. In beiden Patientengruppen wurde kein Anhaltspunkt fur unnotiges Aufsuchen der Notaufnahme gefunden. Zum grosten Teil werden vorab ambulante Strukturen genutzt und die Notaufnahme nur bei tatsachlichem medizinischen Notfall aufgesucht.

Zusammenfassung Hintergrund Erworbene neurologische Erkrankungen mit zerebraler Beteiligung führen häufig zu Einschränkungen der Mobilität und damit auch zu einer erschwerten Teilhabe am gesellschaftlichen Leben. Daher ist die Ermöglichung und Verbesserung von Teilhabe eines der wichtigsten Ziele individuell abgestimmter Rehabilitationsmaßnahmen. Die Wiederherstellung der motorischen Funktionen hängt im Rehabilitationsverlauf nicht zuletzt von der vergangenen Zeit seit dem neurologischen Ereignis ab. Ziel Die vorliegende Untersuchung ging der Frage nach, ob die zu Beginn und am Ende einer komplexen interdisziplinären ambulanten neurologischen Rehabilitation routinemäßig eingesetzten Messinstrumente Veränderungen im Verlauf erfassen können und sich diese bei Personen mit akuten/subakuten und chronischen Geschehen unterscheiden. Methode Retrospektiv wurden die Daten im Zeitraum Januar 2004 bis Dezember 2014 aus dem Neuro Reha Team Pasing, München, ausgewertet. Neben demografischen Daten und der Diagnose wurden die Messergebnisse der Instrumente zur Einschätzung der Funktion der unteren Extremität erhoben. Die Berechnung der intra- und intergruppalen Mittelwertunterschiede in den Messergebnissen erfolgten mittels t-Tests für unabhängige Stichproben und Chi2-Tests. Ergebnisse Die Personen mit neurologischen Geschehen wurden im Mittel 82 ± 36 Tage behandelt. Bei allen eingesetzten Messinstrumenten zeigte sich eine signifikante Veränderung von Ausgangs- zu Endbefund. Bis auf den 10-Meter-Gehtest ergaben sich bei allen Messinstrumenten zwischen der akuten/subakuten und der chronischen Gruppe signifikante Unterschiede im Endbefund zugunsten der akuten/subakuten Gruppe. Schlussfolgerung Der routinemäßige Einsatz von Messinstrumenten in einem neurorehabilitativen Setting erlaubt zuverlässig das schnelle Erfassen von Veränderungen im Therapieverlauf sowohl bei Personen mit akutem/subakutem als auch chronischem neurologischen Geschehen.

Ein zentraler gesundheitspolitischer Diskussionspunkt ist der Fachkraftemangel im pflegerischen wie arztlichen Bereich. Fur die zukunftige Personalrekrutierung im Fach Anasthesiologie erscheint eine Analyse der geschlechtsspezifischen Personalentwicklung in den letzten Jahrzehnten wichtig. Hierfur fuhrten die Autoren eine vergleichende Analyse der Daten des Statistischen Bundesamtes der Fachserie 12 Reihe 7.3.1 und der Fachserie 12 Reihe 6.1.1 fur die Jahre 1994 bis 2015 aus. Hierbei wurde die Personalentwicklung im Fach Anasthesiologie mit der Entwicklung in der Gesamtheit der anderen Fachdisziplinen hinsichtlich des Anteils der Assistenzarztinnen und Assistenzarzte in Weiterbildung, der Facharztinnen und Facharzte, der Oberarztinnen und Oberarzte und der leitenden Arztinnen und Arzte sowie Chefarztinnen und Chefarzte verglichen. Die Personalentwicklung in der Anasthesiologie unterscheidet sich von anderen Disziplinen in zwei wesentlichen Punkten: (1) die Anasthesiologie zeichnet sich durch einen hohen Anteil an Facharztinnen und Facharzten ohne Oberarzt- oder Leitungsfunktion aus; (2) obwohl der Anteil der Frauen am gesamten arztlichen Personal in der Anasthesiologie wie in den anderen Fachern zunimmt, ist der Anteil der Frauen in leitenden Positionen im Fach Anasthesiologie unterdurchschnittlich. Die Anasthesiologie ist ein Fach, welches in den beiden letzten Jahrzehnten an Aufgaben und Personal gewachsen ist. Die relativ deutliche Zunahme an Weiterbildungsassistentinnen und -assistenten und v. a. Facharztinnen und Facharzten ohne Leitungsfunktion kann Ausdruck der zunehmenden Leistungsverdichtung in diesem Fach sein. Der im Vergleich zu anderen Fachdisziplinen geringere Frauenanteil in Leitungspositionen sollte zum Anlass genommen werden, auch im Hinblick auf Personalrekrutierung die Vereinbarkeit von Familie und Beruf im klinischen wie auch im wissenschaftlichen Bereich noch weiter zu unterstutzen.

Widowhood is common in old age, can be accompanied by serious health consequences and is often linked to substantial changes in social network. Little is known about the impact of social isolation on the development of depressive symptoms over time taking widowhood into account. We provide results from the follow-up 5 to follow-up 9 from the longitudinal study AgeCoDe and its follow-up study AgeQualiDe. Depression was measured with GDS-15 and social isolation was assessed using the Lubben Social Network Scale (LSNS-6). The group was aligned of married and widowed people in old age and education through entropy balancing. Linear mixed models were used to examine the frequency of occurrence of depressive symptoms for widowed and married elderly people depending on the risk of social isolation. Our study shows that widowhood alone does not lead to an increased occurrence of depressive symptoms. However, “widowed oldest old”, who are also at risk of social isolation, have significantly more depressive symptoms than those without risk. In the group of “married oldest old”, women have significantly more depressive symptoms than men, but isolated and non-isolated do not differ. Especially for people who have lost a spouse, the social network changes significantly and increases the risk for social isolation. This represents a risk factor for the occurrence of depressive symptoms.

Background Many patients consult their primary care physician with persistent somatic symptoms such as pain or sickness. Quite often these consultations and further diagnostic measures yield no medical explanation for the symptoms – patients and physicians are left in uncertainty. In fact, diagnostic and treatment barriers in primary care hinder timely health-care provision for patients suffering from persistent somatic symptoms (PSS). The significance of individual barriers is still unknown. We compare and quantify these barriers from the perspective of primary care physicians and identify subpopulations of primary care physicians who experience particular barriers as most severe. Methods We mailed a questionnaire to primary care physicians (PCP) in Germany and asked them which barriers they consider most important. We invited a random sample of 12,004 primary care physicians in eight federal states in Germany. Physicians provided anonymous mailed or online responses. We also mailed a postcard to announce the survey and a mail reminder. Main measures were Likert rating scales of items relating to barriers in the diagnosis and treatment of PSS in primary care. Information on demography and medical practice were also collected. Results We analyzed 1719 data sets from 1829 respondents. PCPs showed strongest agreement with statements regarding (1.) their lack of knowledge about treatment guidelines, (2.) their perceptions that patients with PSS would expect symptom relief, (3.) their concern to overlook physical disease in these patients, and (4.) their usage of psychotropic drugs with these patients. More experienced PCPs were better able to cope with the possibility of overlooking physical disease than those less experienced. Conclusions The PCPs in our survey answered that the obligation to rule out severe physical disease and the demand to relieve patients from symptoms belong to the most severe barriers for adequate treatment and diagnosis. Moreover, many physicians admitted to not knowing the appropriate treatment guidelines for these patients. Based on our results, raising awareness of guidelines and improving knowledge about the management of persistent somatic symptoms appear to be promising approaches for overcoming the barriers to diagnosis and treatment of persistent somatic symptoms in primary care. Trial registration German Clinical Trials Register (Deutschen Register Klinischer Studien, DRKS) https://www.drks.de/drks_web/setLocale_EN.do The date the study was registered: October 2nd 2017 The date the first participant was enrolled: February 9th 2018 DRKS-ID: DRKS00012942

According to the WHO, in a complex system, “there are so many interacting parts that it is difficult (…), to predict the behavior of the system based on knowledge of its component parts. “In countries without general practitioner (GP)-gatekeeping, the number of possible interactions and therefore the complexity increases. Patients may consult any doctor without contacting their GP. Family medicine core values, e.g., comprehensive care, and core tasks, e.g., care coordination, might be harder to implement and maintain. How are GPs perceived and how do they perceive themselves if no GP-gatekeeping exists? Does the absence of any GP-gatekeeping influence family medicine core values? A PubMed and Cochrane search was performed. The results are summarized in form of a narrative review. Four perspectives regarding the GP's role were identified. The GPs' self-perception regarding family medicine core values and tasks is independent of their function as gatekeepers, but they appreciate this role. Patient satisfaction is also independent of the health care system. Depending on the acquisition of income, specialists have different opinions of GP-gatekeeping. Policymakers want GPs to play a central role within the health care system, but do not commit to full gatekeeping. The GPs and policymakers emphasize the importance of family medicine specialty training. Further international studies are needed to determine if family medicine core values and tasks can be better accomplished by GP-gatekeeping. Specialty training should be mandatory in all countries to enable GPs to fulfill these values and tasks and to act as coordinators and/or gatekeepers.

Background: General practitioners (GPs) are reluctant to use codes that correspond to somatization syndromes.Aim: To quantify GPs' views on coding of medically unexplained physical symptoms (MUPS), somatoform disorders, and associated factors.Design and Setting: Survey with German GPs.Methods: We developed six survey items [response options “does not apply at all (1)”—“does fully apply (6)”], invited a random sample of 12.004 GPs to participate in the self-administered cross-sectional survey and analysed data using descriptive statistics and logistic regression analyses.Results: Response rate was 15.2% with N = 1,731 valid responses (54.3% female). Participants considered themselves familiar with ICD-10 criteria for somatoform disorders (M = 4.52; SD =.036) and considered adequate coding as essential prerequisite for treatment (M = 5.02; SD = 1.21). All other item means were close to the scale mean: preference for symptom or functional codes (M = 3.40; SD = 1.21), consideration of the possibility of stigmatisation (M = 3.30; SD = 1.35) and other disadvantages (M = 3.28; SD = 1.30) and coding only if psychotherapy is intended (M = 3.39; SD = 1.46). Exposure, guideline knowledge, and experience were most strongly associated with GPs' self-reported coding behaviour.Conclusions: Subjective exposure, guideline knowledge, and experience as a GP, but no sociodemographic variable being associated with GPs' subjective coding behaviour could indicate that GPs offer a relatively homogeneous approach to coding and handling of MUPS and somatoform disorders. Strengthening guideline knowledge and implementation, and practise with simulated patients could increase the subjective competence to cope with the challenge that patients with MUPS and somatoform disorders present.

Background: Only little evidence is available on disorientation, one of the most challenging symptoms of Alzheimer’s disease and related dementias. Objectives: The aim of this study was to investigate the prevalence of disorientation in older age in association with the level of cognitive status, personal characteristics, and life events. Methods: Three longitudinal population-based cohort studies on cognitive health of elderly adults were harmonized (LEILA 75 + , AgeCoDe/AgeQualiDe, AgeMooDe). Participants who completed a baseline and at least one follow-up assessment of cognitive functioning and who did not have stroke, Parkinson’s disease, atherosclerosis, kidney disease, and/or alcoholism were included in the analysis (n = 2135, 72.6% female, mean age 80.2 years). Data was collected in standardized interviews and questionnaires with the participant, a proxy informant, and the participant’s general practitioner. Results: Making three errors in the MMSE other than in the questions on orientation (MMSEwo) came with a probability of 7.8% for disorientation, making ten errors with a probability of 88.9%. A lower MMSEwo score (HR 0.75, CI 95 0.71–0.79, p

Background It is almost unknown whether the driving status is associated with HRQOL among individuals in highest age. Aims Based on a multicenter prospective cohort study, the objective of this study was to examine whether the driving status is associated with health-related quality of life (HRQOL) among the oldest old in Germany. Methods Cross-sectional data from follow-up wave 9 (n = 544) were derived from the “Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)” (AgeQualiDe). Average age was 90.3 years (± 2.7; 86 to 101 years). The current driver status (no; yes) was used in our analysis. The EuroQoL EQ-5D questionnaire was used to assess HRQOL in this study. Results Regression analysis showed that being a current driver was associated with the absence of problems in ‘self-care’ [OR 0.41 (95%-CI 0.17 to 0.98)], and ‘usual activities’ [OR 0.48 (0.26 to 0.90)], whereas it was not significantly associated with problems in ‘pain/discomfort’ [OR 0.82 (0.47 to 1.45)] and ‘anxiety/depression’ [OR 0.71 (0.36 to 1.39)]. Being a current driver was marginally significantly associated with the absence of problems in ‘mobility’ [OR 0.60 (0.34 to 1.06)]. While being a current driver was not associated with the EQ-VAS in the main model, it was positively associated with the driving status (β = 5.00, p Discussion Our findings provide first evidence for an association between driving status and HRQOL among the oldest old. Conclusions Future longitudinal studies are required to evaluate a possible causal relationship between driving status and HRQOL in very old individuals.

Objectives: This study aimed to examine aspects of help-seeking for psychological distress and its association with increased anxiety symptoms in the oldest old.Method: Baseline data from AgeQualiDe, a multicenter cohort study of people aged 85 and over recruited in primary care, were analyzed. Help-seeking for psychological distress (items from the Camberwell Assessment of Need for the Elderly) was analyzed using ordinal and logistic regression models as a function of increased anxiety symptoms (Geriatric Anxiety Inventory-Short Form ≥ 3), as well as relevant socio-demographic and health-related covariates.Results:N = 155 (18.1% of the sample) reported having experienced psychological distress recently and were thus included in the analysis. Among those, 26.5% reported experiencing increased anxiety symptoms. On a descriptive level, 76.8% sought informal, 29.0% sought formal, and 18.1% sought no help for psychological distress. In covariate-adjusted regression models, increased anxiety was significantly associated with increased use of informal support (OR: 2.92, 95% CI: 1.31-6.48), but was neither associated with formal (OR: 0.72, 95% CI: 0.26-1.97) nor no help-seeking (OR: 0.28, 95% CI: 0.08-1.05).Conclusion: A large proportion of those experiencing psychological distress sought support from informal sources in this study. Anxiety symptoms in the oldest old were associated with the increased use of informal support, but not formal support or no help-seeking. Training and support for people providing informal help to those with mental health problems should be promoted to reduce a possible burden. However, future research addressing underlying mechanisms is needed.

Background. Omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acids (PUFAs) may have different effects on cognitive health due to their anti- or pro-inflammatory properties. Methods. We aimed to prospectively examine the relationships between n-3 and n-6 PUFA contents in serum phospholipids with incident all-cause dementia and Alzheimer’s disease dementia (AD). We included 1264 non-demented participants aged 84 ± 3 years from the German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe) multicenter-cohort study. We investigated whether fatty acid concentrations in serum phospholipids, especially eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), alpha-linolenic acid (ALA), linoleic acid (LA), dihomo-γ-linolenic acid (DGLA), and arachidonic acid (AA), were associated with risk of incident all-cause dementia and AD. Results. During the follow-up window of seven years, 233 participants developed dementia. Higher concentrations of EPA were associated with a lower incidence of AD (hazard ratio (HR) 0.76 (95% CI 0.63, 0.93)). We also observed that higher concentrations of EPA were associated with a decreased risk for all-cause dementia (HR 0.76 (95% CI 0.61, 0.94)) and AD (HR 0.66 (95% CI 0.51, 0.85)) among apolipoprotein E ε4 (APOE ε4) non-carriers but not among APOE ε4 carriers. No other fatty acids were significantly associated with AD or dementia. Conclusions. Higher concentrations of EPA were associated with a lower risk of incident AD. This further supports a beneficial role of n-3 PUFAs for cognitive health in old age.

Purpose The first aim of this qualitative study was to identify general practitioners’ (GPs’) views on depression screening combined with GP-targeted feedback in primary care. The second aim was to determine the needs and preferences of GPs with respect to GP-targeted feedback to enhance the efficacy of depression screening. Methods A semistructured qualitative interview was conducted with officially registered GPs in Hamburg (Germany). Interviews were audio recorded and transcribed verbatim. An inductive approach was used to code the transcripts. Results Nine GPs (27 to 70 years; 5 male) from Hamburg, Germany, participated. Regarding depression screening combined with GP-targeted feedback, five thematic groups were identified: application of screening; screening and patient–physician relationships; GPs’ attitudes towards screening; benefits and concerns related to screening; and GPs’ needs and preferences regarding feedback. While the negative aspects of screening can be described in rather general terms (e.g., screening determines the mental health competence, screening threatens the doctor–patient relationship, revealing questions harm the patients), its advantages were very specific (e.g., promoting the identification of undetected cases, relief of the daily workload, wider communication channel to reach more patients). Standardized GP-targeted feedback of the screening results was perceived as helpful and purposeful. GPs preferred feedback materials that eased their clinical workload (e.g., short text with visuals, pictures, or images). Conclusion Addressing GPs’ needs is essential when implementing depression screening tools in clinical practice. To overcome prejudices and enhance the efficacy of screening, further education for GPs on the purpose and application on depression screening may be needed. Standardized GP-targeted feedback in combination with depression screening could be the missing link to improve the detection of depression in primary care.

Background From 2015 to 2016 Germany faced an influx of 1.16 million asylum seekers. In the state of Hamburg Primary Care walk-in clinics (PCWC) were commissioned at refugee camps because the high number of residents (57,000 individuals) could not be provided with access to regular healthcare services. Our study aims were (1) to describe the utilization of a PCWC by camp residents, (2) to compare episodes of continuous care with shorter care episodes and (3) to analyse which diagnoses predict episodes of continuous care in this setting. Methods A retrospective longitudinal observational study was conducted by reviewing all anonymized electronic medical records of a PCWC that operated from 4th November 2015 to 22nd July 2016 at a refugee camp in Hamburg. Episodes of care (EOC) were extracted based on the international classification of primary care-2nd edition (ICPC-2). Outcome parameters were episode duration, principal diagnoses, and medical procedures. Results We analysed 5547 consultations of 1467 patients and extracted 4006 EOC. Mean patient age was 22.7 ± 14.8 years, 37.3% were female. Most common diagnoses were infections (44.7%), non-communicable diseases (22.2%), non-definitive diagnoses describing symptoms (22.0%), and injuries (5.7%). Most patients (52.4%) had only single encounters, whereas 19.8% had at least one EOC with a duration of ≥ 28 days (defined as continuous care). Several procedures were more prevalent in EOC with continuous care: Blood tests (5.2 times higher), administrative procedures (4.3), imaging (3.1) and referrals to secondary care providers (3.0). Twenty prevalent ICPC-2-diagnosis groups were associated with continuous care. The strongest associations were endocrine/metabolic system and nutritional disorders (hazard ratio 5.538, p Conclusion A wide spectrum of acute and chronic health conditions could be treated at a GP-led PCWC with few referrals or use of medical resources. But we also observed episodes of continuous care with more use of medical resources and referrals. Therefore, we conclude that principles of primary care like continuity of care, coordination of care and management of symptomatic complaints could complement future healthcare concepts for refugee camps.

The study investigates the impact of the COVID-19 pandemic on health services with and without specific health care of COVID-19 patients through the eyes of leading physicians at the University Medical Center Hamburg-Eppendorf (UKE).From April 30 to May 12, 2020, four interviewers conducted 38 expert interviews via telephone, video or face-to-face by using a semi-standardized questionnaire. The standardized answers were analysed descriptively. The free text-answers were subject to a qualitative content analysis. The categories were analysed via quantitative frequency distributions.All chief physicians with responsibility for inpatient and outpatient health care at the UKE took part in this study (N=38). The leading physicians reported numerous changes regarding occupancy in the hospital, patient composition, work flows and diagnostic as well as therapeutic measures. Additionally, various arrangements were necessary to cover the needs of prevention, treatment and follow-up care as well as protection of staff. Measures showed, on the one hand, a strong reduction in occupancy and workload in most inpatient and outpatient clinics. On the other hand, the amount of work also increased by fundamental transitions of work flows, communication, staff structure and hygiene measures. Many respondents commented positively on the rapid and efficient setup of a digital communication structure. Partially, staff was strained by the pandemic itself and by the associated measures.The results of the study help to understand and assess the effects of the pandemic on health care, work flows and staff. The findings may support the specification and adaptation of prospective measures and processes for pandemic crisis situations. Future studies should investigate how staff beneath the highest executive level experienced and evaluated this crisis and consequences.Die Studie beschreibt die Auswirkungen der COVID-19-Pandemie mit Blick auf Bereiche mit und ohne spezifische Versorgung von COVID-19-Patientinnen und -Patienten aus Sicht der Klinikdirektorinnen und -direktoren am Universitätsklinikum Hamburg-Eppendorf (UKE).Im Zeitraum vom 30. April bis 12. Mai 2020 wurden mit den im UKE verantwortlichen Klinikdirektorinnen und -direktoren Interviews per Telefon, Video bzw. face-to-face mithilfe eines teilstandardisierten Fragebogens durchgeführt. Die standardisierten Antworten wurden deskriptiv analysiert. Freitextantworten wurden einer qualitativen Inhaltsanalyse unterzogen. Die entwickelten Kategorien wurden quantitativ nach Häufigkeiten analysiert.Alle leitenden Ärztinnen und Ärzte mit einer Verantwortung für die stationäre und ambulante Versorgung am UKE konnten für die Interviewstudie gewonnen werden (N=38). Diese berichten von gravierenden Veränderungen in der medizinischen Versorgung, v. a. im Bereich der Bettenbelegung, der Patientenzusammensetzung, den klinischen und Arbeitsprozessen sowie den diagnostischen und Behandlungsprozessen. Zusätzlich mussten viele neue Regelungen getroffen werden, um den Präventions-, Behandlungs- und Nachsorgebedarf von Patientinnen und Patienten sowie den Schutz der Mitarbeitenden zu gewährleisten. In den meisten klinischen Bereichen zeigte sich stationär wie ambulant phasenweise eine starke Reduktion in den Belegungszahlen und der Arbeitsauslastung. Teilweise stiegen aber auch Arbeitsaufwände, z. B. durch die Anpassung von Arbeitsabläufen, veränderte Kommunikations- und Personalstrukturen sowie zusätzliche Hygienemaßnahmen. Viele Befragte äußerten sich positiv über den effizienten Aufbau einer digitalen Kommunikationsstruktur. Das Personal war durch die Pandemie an sich, aber auch durch die damit verbundenen Maßnahmen vielseitig gefordert.Die Ergebnisse helfen, die Auswirkungen der aktuellen COVID-19-Pandemie auf die Versorgung und Arbeitsprozesse besser zu verstehen. Zudem können sie dabei unterstützen, zukünftig Maßnahmen für pandemische Krisensituationen noch besser anzupassen. Weitere Studien könnten untersuchen, wie die Mitarbeitenden unterhalb der Leitungsebene diese Krise und ihre Auswirkungen erlebt haben.

To describe health status and health state utilities measured by the EQ-5D-3L in a population-based sample of individuals aged 85 + in Germany, and to analyze associations with basic socio-demographic variables. Cross-sectional data from follow-up wave 7 (n = 761) of the German AgeCoDe Study were used. The EQ-5D-3L questionnaire was used to record problems in five health dimensions, its visual analogue scale (EQ VAS) was used to record self-rated health status, and the German EQ-5D-3L index was used to derive health state utilities. Mean age of respondents was 88.9 years (SD 2.9; range 85 to 100), 67.4% were female. 81.9% reported problems in at least one of the EQ-5D dimensions, with 15.3% reporting extreme problems. Most frequent were problems with pain/discomfort (64.8%), followed by mobility (62.5%), usual activities (42.6%), self-care (28.2%), and anxiety/depression (20.5%). Mean EQ VAS score was 62.4 (SD 18.8), and mean EQ-5D index was 0.77 (SD 0.24). Multiple regression analysis showed associations of problem frequency in various EQ-5D dimensions with age, gender, living situation, marital status, and education. The EQ VAS score was negatively associated with age (β = − 0.56; p

Background Some studies, mainly coming from the U.S., indicate disparities in heart failure (HF) treatment according to migration/ethnicity. However, respective results are inconsistent and cannot be transferred to other health care systems. Thus, we will address the following research question: Are there differences in the diagnosis and management of HF between patients with and without a Turkish migration background in Germany? Methods A factorial experimental design with video vignettes was applied. In the filmed simulated initial encounters, professional actors played patients, who consulted a primary care physician because of typical HF symptoms. While the dialog was identical in all videos, patients differed in terms of Turkish migration history (no/yes), sex (male/female), and age (55 years/75 years). After viewing the video, primary care physicians (N = 128) were asked standardized and open ended questions concerning their decisions on diagnosis and therapy. Results Analyses revealed no statistically significant differences (p Conclusions Our results indicate that are no significant inequalities in diagnosis and management of HF according to a Turkish migration background in Germany. Primary care physicians’ behaviour and medical decision making do not seem to be influenced by the migration background of the patients. Future studies are needed to verify this result and to address inequalities in HF therapy in an advanced disease stage.

Background: Treatment of depressive disorders in old age is hindered by several barriers. Most common are time pressure in primary care and latency for specialized therapeutic care. To improve treatment, the collaborative care approach GermanIMPACT was evaluated in a cluster-randomized controlled trial. Care managers offered a complex stepped-care intervention of monitoring, psychoeducation, and behavioral activation techniques. Twenty-six percent of the intervention group responds with a remission of depressive symptoms compared with 11% who received treatment as usual (TAU). The low-threshold intervention was more successful than TAU. Nevertheless, three-quarters did not respond with a remission. The aim of this study is to identify and describe the different types of utilization and of treatment response to understand what constitutes an effective intervention. Methods: Of 64 patients from the intervention group, we carried out problem-centered interviews with 26 patients from the intervention group. We analyzed the interviews using a qualitative type-building content analysis. For type construction, we performed a contrasting case comparison, regarding inductive and deductive categories of the intervention utilization and the symptom development. Results: The 26 participants' ages ranged from 62 to 87 years (mean = 72 years). Three participants were male. We identified five types of utilization, which differ primarily in the realization of pleasant activations, depending on own activity at the beginning and during the therapy: "activatable relief seekers," "active relief seekers," "active relaxation seekers," "passive problem-solving seekers," and "passive relief seekers." In the second typology, we analyzed four deductively determined types of treatment response responders, slight improvers, constant moderates, and non-responders. Patient-specific characteristics are a recent history of depression, an affinity for activities, supportive contacts, and limited comorbidity. In contrast, non-responders report contrary characteristics. Conclusion: Our two typologies emphasize that an effective intervention requires a match between intervention components and patient characteristics. We saw no intersections between utilization and treatment response. GermanIMPACT is an effective low-threshold intervention for moderately burdened patients, who are still capable of self-activation. An expansion of the intervention, especially for depression with a long history and comorbidities impairing mobility, could increase the effectiveness and improve the care situation of older people suffering from depression.

Background Studies investigating the longitudinal predictive value of burnout on both effort-reward imbalance (within the working place) and work-family conflict (between work and private life) in residents are lacking. Former cross-sectional studies showed an association of effort-reward imbalance and work family conflict with an elevated burnout risk in physicians. Methods Data acquisition was carried out within the multi-centric, longitudinal, and prospective “KarMed” study in Germany from 2009 until 2016. Yearly surveys including validated scales: the Maslach Burnout Inventory with its three subscales (emotional exhaustion, personal accomplishment, depersonalisation), the Work-Family Conflict Scale, and the Effort-Reward Imbalance Inventory. Further independent variables were gender and parental status.The analyses were based on general linear models and general linear mixed models with repeated measures designs. Results Significant time-fixed effects were found for all three subscales of the Maslach Burnout Inventory, with gender effects on the subscales emotional exhaustion and depersonalisation. The parental status had no significant effect on burnout. All estimated means for burnout during 6 years of post-graduate training were higher when work-family conflict and gratification crisis were taken into account. Personal accomplishment increased continuously over time as well showing neither gender differences nor influences by the parental status. Conclusions Personal accomplishments might act as a buffer compensating to some extent for the physicians’ stress experience. Given that burnout may be associated with poor patient care, there is a need to reduce burnout rates and their associated factors in resident physicians.

Die Versorgung psychischer Storungen stellt eine grose Herausforderung fur das deutsche Gesundheitssystem dar. Wenn Mehrfachdiagnosen vorliegen, leiden die Betroffenen unter einer besonders hohen Krankheitslast. Innovative Behandlungsmodelle fur eine integrierte und gestufte Versorgung (Collaborative Care und Stepped Care) sind bisher nur hinsichtlich ihrer Wirksamkeit fur singulare Storungsbilder untersucht worden. Das Projekt „Integrierte und gestufte Versorgung psychischer Erkrankungen durch Uberwindung sektoraler Behandlungsbarrieren“ (COMET), welches vom Hamburger Netzwerk fur Versorgungsforschung (HAM-NET) von 2017 bis 2020 durchgefuhrt wird, untersucht ein innovatives, leitlinienorientiertes Versorgungsmodell zur Verbesserung der Versorgung von Menschen mit psychischen Storungen unter Einbezug moglicher Komorbiditaten. Dieses neue Stepped- und Collaborative-Care-Modell fur Patienten der Primarversorgung, das Hausarzte, Psychiater und Psychotherapeuten sowie Kliniken vernetzt, wird im vorliegenden Beitrag vorgestellt. Zur Implementierung und Forderung des Modells wurden leitliniengerechte Behandlungspfade, ein tabletgestutztes Programm fur Screening, Diagnostik und leitliniengerechte Behandlungsempfehlungen sowie eine webbasierte Terminvergabeplattform entwickelt. Die aus dem Projekt gewonnenen Erkenntnisse zur Effektivitat und Effizienz des Modells konnen die Entscheidung, ob das Modell zukunftig in die Gesundheitsversorgung ubertragen wird, unterstutzen. Damit konnte ein entscheidender Fortschritt im Hinblick auf eine starker integrierte und sektorenubergreifende Versorgung von Patienten mit psychischen Storungen gelingen.

Purpose: The study aim was to analyze whether ambulatory therapy of chronic stroke patients contains elements that specifically address "Activity and participation", and to what extent participation as a major goal in rehabilitation is realized in ambulatory care.Method: Qualitative and quantitative content analysis of standard therapy of 71 chronic stroke patients with upper limb impairment. 469 statements on therapy of 34 therapists were analyzed using data-driven and concept-driven coding based on the International Classification of Functioning, Disability and Health framework.Results: Almost half of therapy provided to stroke patients was related to "Upper extremity" (47.5%), as one out of seven identified main categories. Regarding International Classification of Functioning, Disability, and Health framework, 75.1% of therapeutic practices in ambulatory therapy covered "Body functions," but only 13.2% addressed "Activities and participation". Some statements contained specific therapeutic concepts (9.4%) or isolated notes (2.1%) and were not linkable to the International Classification of Functioning, Disability and Health framework.Conclusions: Ambulatory therapy of chronic stroke patients is related, in part, to participation. There is potential for an increase in participation by applying therapeutic approaches, which actively involve the patients in goal-setting and therapeutic exercises to specifically address activities and participation.Implications for rehabilitationTo realize participation as a major goal in the rehabilitation process ambulatory therapy of chronic stroke patients, one should focus on therapeutic approaches and exercises that specifically address activities and participation.Structured goal-setting, which actively involve patients, can be used to identify goals relevant to individual activities and participation.

OBJECTIVE Subjective cognitive decline (SCD), the earliest symptom in preclinical Alzheimer's disease (AD), is insufficient to identify individuals at risk for AD dementia. Therefore, we aimed to investigate whether function in instrumental activities of daily living (IADL) contributes to identification. METHODS We analysed data of cognitively unimpaired participants of the prospective German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe) and its extension, the Study on Needs, Health Service Use, Costs and Health-related Quality of Life in a Large Sample of Oldest-old Primary Care Patients (AgeQualiDe), collected over 10.5 years. Development of AD dementia was quantified as incidence rates (IRs) per 1000 person-years. Cox regression was used to assess the association of SCD and IADL function in regard to incident AD dementia. RESULTS Of 1467 included individuals, 792 (54.0%) reported SCD at baseline. Impaired IADL were present in 50 (3.4%) individuals. IR for AD dementia was highest in individuals with SCD and impaired IADL (49.7; 95% CI, 24.8-99.3). Unadjusted and adjusted Cox analyses revealed an increased AD dementia risk for individuals with SCD and impaired IADL (uHR = 6.1; 95% CI, 2.9-13.0; P

Background Initiatives such as “Choosing Wisely” in the USA and “Smarter Medicine” in Switzerland have published lists of widely overused health care services. The German initiative “Choosing Wisely Together (Gemeinsam Klug Entscheiden)” follows this example. The goal of our study was to prioritize important recommendations against the overuse and underuse of health care services. The final list of recommendations will be published in the German guideline “Protection against the overuse and underuse of health care”. Methods First, a multidisciplinary expert panel established a catalogue of prioritization criteria. Second, we extracted all the recommendations from evidence- and consensus-based German College of General Practice and Family Medicine (DEGAM) guidelines and National Health Care Guidelines (NVL). Third, the recommendations were rated by two independent panels (general practitioners and other health care professionals involved/not involved in guideline development). The prioritization process was finalized in a consensus conference held by DEGAM’s Standing Guideline Committee (SLK). Results Eleven prioritization criteria were established. A total of 782 recommendations were extracted and rated by 98 physicians and other health care professionals in a survey. In the voting process, more than 80% of the recommendations were eliminated. After the final consensus conference, twelve recommendations from DEGAM guidelines, nine DEGAM addenda and 17 NVL recommendations were chosen for inclusion in the guideline, for a total of 38 recommendations. Conclusion The selection procedure proved helpful in identifying the highest priority recommendations with which to combat the overuse and underuse of health care services. To date, in Germany there has been no attempt to compile such a list by using a systematic and transparent methodology. Hence, the guideline that results from this process can fill an important gap.

Psychosoziale Faktoren bei Herz-Kreislauferkrankungen sind zunehmend in das Bewusstsein von Patienten, Leistungserbringern und Kostentragern geruckt. Aufgrund der rasch anwachsenden Evidenz hat die Deutsche Gesellschaft fur Kardiologie ein Update des gleichnamigen Positionspapiers aus dem Jahr 2013 in Auftrag gegeben. Der Stand des Wissens zu den wichtigsten Herz-Kreislauferkrankungen wird synoptisch dargestellt und es werden Empfehlungen fur die Berucksichtigung psychosozialer Aspekte in der klinischen Praxis abgeleitet. Psychosoziale Faktoren wie niedriger sozialer Status, akuter oder chronischer Stress, Depression, Angst und Mangel an sozialer Unterstutzung sind mit einem erhohten Erkrankungsrisiko und mit einem ungunstigeren Krankheitsverlauf verknupft. Psychosoziale Belastungen und psychische Begleiterkrankungen sollten routinemasig erfasst werden, sodass sich ggf. gezielt weitere Diagnostik und Therapie anschliesen konnen. Allen Patienten soll ein Behandlungsangebot gemacht werden, das alters- und geschlechtsspezifische Aspekte sowie die individuellen Praferenzen der Patienten berucksichtigt. Multimodale Behandlungsansatze sollen Wissensvermittlung, Sport- und Bewegungstherapie, Motivationsforderung sowie Entspannungsverfahren bzw. Stressmanagement umfassen. Bei psychischer Komorbiditat sollen psychosomatische Grundversorgung sowie psychotherapeutische Interventionen und/oder Medikation angeboten werden. Bei guter Wirksamkeit auf psychische Symptome ist ein Effekt hinsichtlich der kardialen Prognose noch unklar. Bei der KHK, Herzinsuffizienz, arteriellen Hypertonie und bei Herzrhythmusstorungen besteht eine robuste Evidenz hinsichtlich der Bedeutung psychosozialer Faktoren, die eine Berucksichtigung in der kardiologischen Versorgung sinnvoll macht. Der Grad der Umsetzung in der klinischen Praxis ist jedoch defizitar und der Effekt psychotherapeutischer bzw. pharmakologischer Interventionen auf die Prognose ungewiss. Entsprechend werden sowohl weitere Behandlungsstudien als auch intensivierte Fort- und Weiterbildungsangebote gefordert.

Background Oldest-old persons frequently receive potentially inappropriate medication. Medication use takes place under the patients’ informal caregivers’ influence. We explored informal caregivers’ perspectives on medication of (relatively) independent oldest-old persons to identify starting points for safer medication prescription/handling. Methods In this exploratory qualitative interview study we interviewed 45 informal caregivers of 45 oldest-old persons (23 with potentially inappropriate medication/22 without potentially inappropriate medication). Interviews were recorded, transcribed and content analyzed (deductive/inductive coding). Results Interviewees had little knowledge about/influence on oldest-old persons’ medication, but declared to monitor oldest-old persons’ needs for assistance. They were unaware of the concept of potentially inappropriate medication but sometimes sensitive to substance dependency. Most informal caregivers were satisfied with the oldest-old persons’ medication and viewed medication as increasing the patients’ quality of life. Inadequate communication was found between informal caregivers and general practitioners. Conclusions Influence of informal caregivers on (relatively) independent oldest-old persons’ medication seems low. Stakeholders need to be aware that there is a transitional period where independency of oldest-old persons decreases and support needs increase which may be missed by (in-)formal caregivers or concealed by oldest-old persons. Monitoring patients’ medication competencies; measures supporting communication between informal caregivers and health care professionals; provision of educational and support resources for informal caregivers and the acceptance of oldest-old persons’ increasing assistance needs may increase medication safety.

Zusammenfassung Ziel der Studie Das Interesse an regionalen Gesundheitsanalysen hat in den letzten Jahren stetig zugenommen. Dies spiegelt sich national und international unter anderem in der Veröffentlichung von Gesundheitsatlanten als Mittel der Kommunikation wider. Ziel dieser Studie war es, die aktuell bestehenden Gesundheitsatlanten in Deutschland in einer vergleichenden Analyse zu untersuchen. Methodik Mittels der Internet-Suchmaschinen Google, Unbubble und Bing wurde eine systematische Online-Recherche vorgenommen. Dabei wurden im Vorfeld der Begriff „Atlas“ definiert und Suchbegriffe (z. B. Atlas, Gesundheit) sowie Einschlusskriterien (z. B. Zeitraum, Sprache) festgelegt. Zur Kategorisierung der Treffer wurden 12 Kategorien (z. B. Datengrundlage, Themen) und 89 Variablen (z. B. Epidemiologie, Arzneimittel) gebildet, denen die gefundenen Atlanten in einer Matrix zur Auswertung zugeordnet wurden. Ergebnisse Die Recherche hat 49 Arbeiten ergeben, die den Einschlusskriterien entsprechen. Allerdings handelt es sich dabei nur bei 16 um einen Atlas im Sinne der Definition. Die Anderen können als „Werke mit Karten“ eingestuft werden. Das Thema Epidemiologie wird in 30, Versorgungsforschung in 32 Fällen aufgegriffen. Gesundheitskosten und Prävention werden in 17 bzw. 16 Arbeiten thematisiert. Schlussfolgerung Die Studie hat eine Vielzahl von Gesundheitsatlanten identifizieren können. Allerdings lässt sich ein Großteil der Ergebnisse eher als ein Bericht mit Karte einordnen und nicht als Atlas. Dennoch zeigt sich der praktische Nutzen solcher Werke und damit einhergehend auch das Interesse an regionsspezifischen Fragen zur Gesundheit.

Hintergrund: Demenz stellt eine gesellschaftliche Herausforderung dar und wird dies in Zukunft in noch stärkerem Ausmaß tun. In der Versorgung von Menschen mit Demenz spielt die informelle Pflege eine zentrale Rolle. Informell Pflegende erbringen allerdings nicht nur Leistungen der Grundpflege,[zum vollständigen Text gelangen Sie über die oben angegebene URL], 17. Deutscher Kongress für Versorgungsforschung (DKVF)

Background Depression is one of the most common mental disorders in old age and is associated with various negative health consequences for the affected individual. Studies suggest that patients’ views on depression have an impact on help-seeking behaviour and treatment. It is thus important to investigate the patient’s perspective in order to ascertain optimum management of depression in late life. However, studies on depression and its treatment exploring the perspectives of primary care patients 75 years or older, are rare. Methods Qualitative data was collected in semi-structured interviews with 12 primary care patients 75 years of age or older with symptoms of depression. Data was analysed using qualitative content analysis. Results The study’s results show the multifaceted views on and treatment of depression in primary care patients 75 years of age or older. Some patients seemed well informed about depression and believed in the efficacy of different treatments, such as medications or psychotherapy. However, some individuals had misconceptions about depression and its treatments. Patients mentioned that they would rather avoid talking about depression within their social network, in part of fear of negative reactions. Furthermore, participants believed that other people had little understanding for people with depression. Patients had different views on the relevance of the general practitioner’s (GP) role in treating depression; some patients believed that the GP had little importance in the treatment of depression. Conclusions This study identified positive views of primary care patients 75 years of age or older towards depression as well as views that might hinder optimal treatments. Exemplary implications for an improved management of depression are: educating older adults about depression via age-specific information and having professionals encourage patients in believing that depression is a recognised disorder. Electronic supplementary material The online version of this article (10.1186/s12875-017-0684-3) contains supplementary material, which is available to authorized users.

Background Inadequate recruitment numbers for GPs in rural regions give cause for concern. Working in rural regions is less attractive among medical students because of strong associations concerning a higher workload, restriction of privacy and demands exceeding their competences. We aimed to explore perceptions of GPs working in urban versus rural regions to contrast these prejudices. Methods We conducted nine focus groups with GPs [female = 21, male = 44] from urban and rural regions, using a semi-structured guideline. Transcripts were content analyzed using deductive and inductive categories. Results Urban GPs perceived themselves as a provider of medical services and rural GPs as being a medical companion. Compared to urban GPs, GPs from non-urban regions portray themselves more strongly as a family physician that accompanies patients ‘from the cradle to the grave’ and is responsible for the treatment of any medical issue. They emphasized their close relationship with their patients. Rural GPs establish a close relationship with their patients and considered this as beneficial for the treatment relationship. This aspect seems to play a subordinate role for urban GPs. Conclusions GPs enjoy their work and the role they play in their patients’ lives. Being a rural GP was described very positively. Greater emphasis should be made on positive aspects of being a GP in rural regions, e.g. by university lectures given by rural GPs, campaigns emphasizing the positive aspects of working as a GP [in rural regions], promotion of work placements or incentives for working in rural general practices.

Der Beitrag befasst sich mit der Entwicklung der Arbeitszeiten und Arbeitszeitvorstellungen von Arztinnen und Arzten in Weiterbildung und untersucht, aus welchen Grunden Voll- bzw. Teilzeitmodelle praferiert werden. Datenbasis ist die KarMed-Studie, in deren Rahmen jahrliche postalische Befragungen von Absolventen des Medizinstudiums im Jahrgang 2008/2009 aus 7 medizinischen Fakultaten in Deutschland durchgefuhrt werden. Sie werden wahrend der gesamten Weiterbildungsdauer befragt. Die Rucklaufquote betrug 48 % im ersten Befragungsjahr, danach in allen Befragungen 85 % und mehr. Fur die Auswertung wurden deskriptive Statistiken und Regressionsanalysen angewandt. Es gibt deutliche Diskrepanzen zwischen den realen und den gewunschten Arbeitszeiten von Arztinnen und Arzten in Weiterbildung. Die Weiterbildung wird zumeist in Vollzeit absolviert, hinzu kommen Uberstunden, obwohl ein beachtlicher Anteil der Befragten eine Arbeit in Teilzeit praferiert. Arztinnen bevorzugen eher eine Teilzeittatigkeit als Arzte. Dasselbe gilt fur die Zeit nach der facharztlichen Anerkennung: Insbesondere Arztinnen mit Kind, Arztinnen, die in den alten Bundeslandern ausgebildet wurden und Arztinnen, die eine ambulante Tatigkeit anstreben, wunschen sich fur die Zukunft eine Teilzeitstelle. Auch bei den Mannern ist diese Tendenz uber die Jahre hinweg verstarkt zu beobachten. Trotz der grosen Zahl an Weiterzubildenden, die sich einen Teilzeitvertrag sowohl in der Weiterbildung als auch danach wunschen, ist die Realitat noch weit von derartigen Modellen entfernt. Fur die Zukunft wird deutlich, dass fur beide Geschlechter Masnahmen ergriffen werden sollten, die es erleichtern, das jeweils bevorzugte Arbeitszeitmodell fur den Einzelnen zu verwirklichen.

Zusammenfassung Hintergrund Untersucht wurden die Präferenzen von Ärztinnen und Ärzten in Weiterbildung in Bezug auf Tätigkeitssektor (ambulant/stationär) und die angestrebte Position im jeweiligen Sektor (Anstellung/Freiberuflichkeit bzw. fach-/ober-/chefärztliche Position) nach ihrer fachärztlichen Anerkennung. Im Fokus stehen dabei geschlechtsspezifische Unterschiede und Einfluss von Elternschaft. Methodik Jährliche standardisierte postalische Befragungen mit den Absolventinnen und Absolventen von medizinischen Fakultäten vom Praktischen Jahr bis nach vier Jahren Weiterbildung. Die Rücklaufquote betrug 48 % im 1. Jahr, in den Folgejahren stets 85 % und mehr. In allen Erhebungen waren ca. zwei Drittel der Befragten weiblich. Zur Datenauswertung wurden deskriptive Statistik und Regressionsanalysen angewandt. Ergebnisse Das Krankenhaus wird im Vergleich zur vertragsärztlichen Versorgung bevorzugt, auch wenn die Attraktivität des Krankenhauses über die vier Weiterbildungsjahre abnimmt. Die Entscheidung für oder gegen das Krankenhaus hängt mit der gewählten Disziplin zusammen. Ambulante Versorgung ist mit Möglichkeiten zur Teilzeittätigkeit assoziiert. In der vertragsärztlichen Versorgung wird von Männern eher eine Niederlassung, von Frauen zunehmend ein Angestelltenverhältnis präferiert. Personen mit Kind und Personen, die eine Vollzeittätigkeit in der ambulanten Versorgung anstreben, präferieren die Niederlassung in eigener Praxis. Im Krankenhaus streben vor allem Männer Positionen mit Leitungsfunktion an, Leitungsposition ist mit Vollzeittätigkeit assoziiert. Zukünftige Führungskräfte finden sich primär in Universitätskliniken. Folgerung Drei Tendenzen sind zu verzeichnen: Abneigung gegenüber Leitungspositionen, wachsendes Interesse an Teilzeitarbeit und wachsende Neigung zur Angestelltentätigkeit im ambulanten Sektor. Diese Tendenzen stellen eine Abkehr von traditionellen Leitbildern der medizinischen Profession dar. Die derzeitige Arbeitsmarktsituation erlaubt eine Realisierung dieser Präferenzen, damit einhergehenden Problemen der möglichen Unterversorgung muss deshalb von anderer Stelle entgegengewirkt werden. Ein Umdenken in der Geschlechterrollenverteilung ist kaum nachzuweisen.