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Zusammenfassung Hintergrund Versorgungskonzepte, die zu einer Entlastung der pflegenden Angehörige beitragen, werden dringend benötigt. „Regional ununterbrochen betreut im Netz“ (RubiN), welches mit einem Care-und-Case-Management in Ärztenetzen die Versorgung von geriatrischen Patienten unterstützen soll, zielt auch darauf ab, Angehörige zu entlasten. Ziele waren daher die Entwicklung und psychometrische Überprüfung eines Fragebogens, der die Zufriedenheit und Akzeptanz mit der Versorgung durch ein Case Management (CM) aus Perspektive der Angehörigen erfasst. Methodik Es wurde ein „Mixed-methods“-Design zur Konzeptualisierung des Fragebogens gewählt. Neben der Entwicklung des Fragebogens anhand qualitativer Interviews sowie eigener Projekt- und Studienerfahrungen erfolgten die Pilotierung und anschließende psychometrische Überprüfung des Fragebogens in den 5 teilnehmenden RubiN-Ärztenetzen. Von Mai bis August 2020 fand die Befragung in den Ärztenetzen statt. Jedes der 5 beteiligten Ärztenetze erhielt ein Set mit je 50 Fragebogen für Angehörige. Das Fragebogenkonstrukt wurde psychometrisch überprüft. Ergebnisse Der konzipierte Fragebogen bestand aus 11 Items. Insgesamt nahmen 137 Angehörige an der Befragung teil (Rücklaufquote 55 %). Die Angehörigen waren mit der angebotenen Versorgung sehr zufrieden (78,1 %). Des Weiteren zeigten die Daten sehr geringe fehlende Werte auf. Die 11 Items des Fragebogens luden auf 2 Faktoren. Faktor 1 „Auswirkungen durch die Koordination“ wies eine interne Konsistenz von 0,843 und Faktor 2 „Erreichbarkeit“ eine interne Konsistenz von 0,683 auf. Diskussion Der Fragenbogen umfasst die Akzeptanz und Zufriedenheit der angebotenen Versorgungselemente für Angehörige mit einem geriatrischen CM und zeichnet sich mit 11 Items durch seine Kürze aus.

Purpose Coordinated care is important for the health and well-being of geriatric patients. However, continuity of care is lacking in many countries. Several studies have shown that case management can help to meet these requirements in health care and investigated positive effects. The project RubiN (Regional ununterbrochen betreut im Netz; Continuous care in a regional network) was developed to provide regional care- and case management for outpatient care of the elderly (age >70 years) in a primary care setting. The aim of this qualitative approach was to explore experiences and attitudes of geriatric patients towards the newly developed complex care- and case-management intervention RubiN. Patients and methods Qualitative interviews with a purposive sample of geriatric patients enlisted in the RubiN intervention networks were conducted. The collected data was transcribed and evaluated using qualitative content analysis. A deductive-inductive approach was used in generating thematic categories. Results Forty-four telephone interviews were performed. Two key categories were identified to describe patients' experiences regarding care delivered by a care- and case manager (CCM), namely "role of CCM" and "changes through RubiN". Results demonstrated that care performed by CCMs is perceived positively by geriatric patients. A main finding of this study was that geriatric patients experienced a sense of security through the care provided by CCMs. CCMs were perceived as highly competent people, having all the necessary skills to provide continuity of care. Conclusion This study illustrates the importance of trust between care provider and care recipient. It also shows that geriatric patients appreciate the continuous, professional care and structural and functional support provided by qualified CCMs.

Background Sleep disturbances are common in people with dementia. In nursing homes, this is frequently associated with residents’ challenging behavior and potentially with nurses’ burden. This study examined nurses’ burden associated with nursing home residents’ sleep disturbances. Methods A multicenter cross-sectional study was conducted. Nurses’ burden associated with residents’ sleep disturbances was assessed using the Sleep Disorder Inventory (SDI). Additionally, the proportion of nurses’ total burden associated with sleep disturbances of residents with dementia was assessed. A linear mixed regression model was used to investigate the association with nurses’, residents’ and institutional characteristics. Results One hundred eleven nurses from 38 nursing homes were included. 78.4% stated to be regularly confronted with residents’ sleep disturbances during nightshifts, causing distress. The mean proportion of nurses‘ total burden caused by residents‘ sleep disturbances was 23.1 % (SD 18.1). None of the investigated characteristics were significantly associated with nurses’ total burden. Conclusions Nurses report burden associated with sleep disturbances as common problem. There is a need to develop effective interventions for sleep problems and to train nurses how to deal with residents’ sleep disturbances.

Zusammenfassung Hintergrund Der Begriff „Telemedizin“ beschreibt die Bereitstellung von medizinischen Dienstleistungen mit Hilfe von Informations- und Kommunikationstechnologien in einer Situation, in der die Beteiligten sich an unterschiedlichen Orten befinden. Wahrend in Forschungsprojekten in Deutschland telemedizinische Anwendungen noch haufig pilotiert werden, sind diese bisher selten Bestandteil der alltaglichen Versorgung geworden. Um Hinweise darauf zu finden, warum der Wissenstransfer in die Praxis bisher zogerlich gelingt, besteht die Notwendigkeit, telemedizinische Projekte nach implementierungswissenschaftlichen Aspekten zu untersuchen. Methode Es wurde eine systematische Recherche in den elektronischen Datenbanken PubMed, Web of Science und ACM Digital Library durchgefuhrt, indem diese mit einer komplexen Suchstrategie auf telemedizinische Projekte in Deutschland mit dem Fokus auf die Versorgung landlicher Regionen durchsucht wurden. Zur Bewertung und Einordung der Publikationen wurden die Kriterien und Domanen des Model for Assessment of Telemedicine (MAST) herangezogen. Ergebnisse Insgesamt wurden 336 Publikationen identifiziert, von denen letztendlich 16 in die Analyse eingeschlossen werden konnten. Ein Grosteil der eingeschlossenen Arbeiten befasst sich dem Krankheitsbild Schlaganfall und der Implementierung von Telemedizinnetzwerken. Die Analyse nach MAST zeigt, dass die meisten Publikationen wesentliche Betrachtungen bezuglich der Implementierung von telemedizinischen Projekten auslassen. Schlussfolgerung Publikationen zu telemedizinischen Projekten sind oft durch unsystematische Vorgehensweisen gepragt. Das MAST Instrument zeigt Moglichkeiten auf, wie die Betrachtungsweisen bei telemedizinischen Projekten zukunftig erweitert werden konnten, um die Nachhaltigkeit und die Realisierbarkeit dieser prototypischen telemedizinischen Anwendungen zu gewahrleisten.

Family caregivers play an essential role in healthcare for elderly people in primary care settings. The complexity of geriatric patients as well as the fragmentation of healthcare systems can lead to a burden for family caregivers, which can affect their physical and psychological health as well as social relationships, economic productivity and quality of caregiving. Care- and case-management offers a possibility to support, empower and navigate family caregivers through healthcare systems in order to reduce their own burden. The project RubiN (Continuous care in a regional network) was developed to provide regional care- and case-management for outpatient care of the elderly (age >70 years) in a primary care setting in Germany. The aim of this qualitative study was to explore experiences and attitudes of family caregivers of geriatric patients regarding the community-based care- and case-management intervention RubiN. Telephone interviews with a purposeful sample of 21 family caregivers enlisted in all RubiN networks were conducted between March and May 2020 and were followed by qualitative content analysis. The main categories, which emerged were namely: (1) current healthcare situation and (2) experiences with RubiN. Main findings suggest that participants in this study valued the provided support and experienced a sense of relief. However, some participants were disappointed with RubiN and the included support by care- and case-managers. A care- and case-management affected caregiving per se as well as the patient's and family caregiver's well-being. Important aspects contributing to these findings were a continuous relationship, training and expertise of the care- and case-managers. Establishing networks between the patients, family caregivers, care- and case-managers and healthcare providers were key components as well as a good explanation about RubiN itself for family caregivers. Therefore, a community-based care- and case-management can play an important role in detecting, facilitating and preventing family caregiver burden.

Background:Dementia guidelines propose the use of nonpharmacological interventions for sleep disturbances for older people. Based on available reviews, it seems most likely that multicomponent interventions have the strongest potential to be effective in improving sleep. However, a detailed description of multicomponent interventions is missing. This systematic review aims to identify, describe, and summarize multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents.Methods:This review followed established methodological frameworks for systematic evidence syntheses. A computerized search was conducted in December 2018, using the databases PubMed, CINAHL, Scopus, and Cochrane Library. Two independent reviewers assessed all search results to identify eligible studies and assessed studies’ methodological quality following the Cochrane Risk of Bias methodology for randomized controlled trials and the CASP Appraisal Checklist for controlled trials.Evaluation studies of any design investigating multicomponent interventions were included, except case studies. Components of included intervention programs were analyzed applying the TIDieR and CReDECI 2 criteria.Results:A total of 2056 studies were identified through the database search; ten publications about nine interventions met the inclusion criteria and were included in the review. The identified interventions can be summarized assigned to the categories “daytime activities,” “nighttime activities,” “staff training,” and “light exposure.” The approaches showed similarities and differences in procedures, materials, modes of delivery, intervention provider, and intervention period. None of the studies described any intended interactions between components or considered context characteristics in intervention modeling as well as internal and external facilitators or barriers influencing delivery of intervention. We identified positive or mixed positive effects for sleep-related outcomes for the mentioned categories.Conclusions:The analysis of included interventions demonstrates somehow promising results, although findings are difficult to interpret as interventions were not well described, and the challenges of developing and evaluating complex interventions were not sufficiently acknowledged.

Allgemeinmedizin zeichnet sich als generalistische medizinische Disziplin auch durch seinen holistischen Zugang aus. In den letzten Jahren ist der Begriff Coaching ein vielfaltig verwendeter und zunehmend prasenter, der zunehmend auch im Gesundheitsbereich verwendet wird. Ziel des Beitrags war es, der Frage nachzugehen, wie Coaching aus der Perspektive der Allgemeinmedizin zu definieren ist und welche Konsequenzen daraus fur die Versorgung abzuleiten sind. Es wurde ein systematisches Review mit den Schlusselwortern „coaching“, „health coaching“, „resilience coaching“, „primary care“, „family medicine“ and „family physician“ in PubMed, Web of Science und EMBASE sowie eine Handrecherche durchgefuhrt. Insgesamt wurden 2370 Publikationen gesichtet, von denen drei zur Beantwortung der Fragestellung herangezogen werden konnten. Eine einheitliche Definition zu Coaching existiert nicht. Ublicherweise wird damit ein klientenbezogener Prozess bezeichnet, der darauf abzielt, vom Klienten definierte Ziele zu erreichen. Coaching soll dazu befahigen, sich aktiver fur die Verbesserung der eigenen Gesundheit einzusetzen. Hierzu wird eine Vielzahl von Methoden verwendet, die teilweise bereits von Allgemeinarzten verwendet werden. Ohne es so zu benennen werden Coaching Methoden in der Allgemeinmedizin schon angewendet. Es gibt Hinweise darauf, dass es weitere Methoden gibt, die erfolgreich in der hausarztlichen Patientenversorgung eingesetzt werden konnen. Eine weitere wissenschaftliche Evaluation dieser Methoden erscheint vielversprechend.

Objective The aim of this systematic review was to identify quality indicators (QI) developed for health care for refugees. Methods We conducted a systematic review of international QI databases such as the Agency for Health care Research and Quality in addition to a systematic search in PubMed, Cochrane library and Web of Science, using the terms “refugee” and “quality indicator”, complemented by a search in reference lists and grey literature. All papers which included QIs for refugees, especially for health care were included. In a first step all existing QIs were screened for their relevance to refugees. In a second step, all health care QIs were extracted. In a final step, these health care QIs were classified into process, structure and outcome indicators. Results Of 474 papers, 23 were selected for a full-text review. Of these 23 publications, 6 contained 115 QIs for health and health care for refugees. The main health care topics identified were reproductive health, health care service and health status. Conclusions Most indicators were indicators for outcome and structure quality, the smallest group were process indicators. Within the area of refugee health care, most QIs that have been found were QIs regarding reproductive health. QI databases do not yet include indicators specifically related to refugees.

BACKGROUND Sleep disturbances and insomnia occur frequently in people with dementia and are associated with a number of problems for affected persons, relatives, and carers. OBJECTIVE Considering the lack of high-quality data especially from Germany, this study aimed to determine the prevalence of sleep disturbances and possible associated factors with in German nursing home residents. METHODS Multicenter cross-sectional study. Nursing homes in Northern Germany were randomly selected from nursing home registers and contacted consecutively. All residents with cognitive impairment living in the nursing homes were included. Data collection took place between June and December 2017. In addition to the characteristics of nursing homes, nurses, and residents, sleep disturbances of residents with dementia were assessed using the Sleep Disorder Inventory (SDI). Descriptive statistics were applied for prevalence assessment. A generalized linear mixed model was used to investigate associated factors. RESULTS 38 nursing homes and 1,187 residents with cognitive impairment were included in the study. Sleep disturbances were reported for 23% of residents with pronounced differences between centers, ranging from 0-85%. The prescription of psychotropic drugs (OR 4.47; 95% CI 3.06-6.43; p