Rationale, design and conduct of a comprehensive evaluation of a primary care based intervention to improve the quality of life of osteoarthritis patients. The PraxArt-project: a cluster randomized controlled trial [ISRCTN87252339] ; study protocol

Background: Osteoarthritis (OA) has a high prevalence in primary care. Conservative, guideline orientated approaches aiming at improving pain treatment and increasing physical activity, have been proven to be effective in several contexts outside the primary care setting, as for instance the Arthritis Self management Programs (ASMPs). But it remains unclear if these comprehensive evidence based approaches can improve patients' quality of life if they are provided in a primary care setting. Methods/Design: PraxArt is a cluster randomised controlled trial with GPs as the unit of randomisation. The aim of the study is to evaluate the impact of a comprehensive evidence based medical education of GPs on individual care and patients' quality of life. 75 GPs were randomised either to intervention group I or II or to a control group. Each GP will include 15 patients suffering from osteoarthritis according to the criteria of ACR. In intervention group I GPs will receive medical education and patient education leaflets including a physical exercise program. In intervention group II the same is provided, but in addition a practice nurse will be trained to monitor via monthly telephone calls adherence to GPs prescriptions and advices and ask about increasing pain and possible side effects of medication. In the control group no intervention will be applied at all. Main outcome measurement for patients' QoL is the GERMAN-AIMS2-SF questionnaire. In addition data about patients' satisfaction (using a modified EUROPEP-tool), medication, health care utilization, comorbidity, physical activity and depression (using PHQ-9) will be retrieved. Measurements (pre data collection) will take place in months I-III, starting in June 2005. Post data collection will be performed after 6 months. Discussion: Despite the high prevalence and increasing incidence, comprehensive and evidence based treatment approaches for OA in a primary care setting are neither established nor evaluated in Germany. If the evaluation of the presented approach reveals a clear benefit it is planned to provide this GP-centred interventions on a much larger scale

E-Learning in family medicine education : faculty support in a community clerkship ; an evaluation

E-Learning soll im Rahmen der allgemeinmedizinischen Ausbildung von Medizinstudierenden erprobt werden. Ein zielgruppenspezifisches, multimodulares Online-Angebot begleitet Medizinstudenten des 10. Semesters während ihres dezentralen Praktikums in hausärztlichen Praxen. Folgende Lehrziele werden angestrebt: (1) Einführung in das E-Learning, (2) Klinische Allgemeinmedizin - Online-Modul, (3) Chronic Care Online-Modul, (4) Online-Bewerbung. Die systematische Evaluation zeigt, dass E-Learning die Kommunikation der Studierenden untereinander und mit der universitären Lehreinheit während des Praktikum fördert. Auf der Grundlage der in diesem Pilotversuch gewonnenen Erfahrungen erscheint die Kombination mit Präsenzunterricht (Blended Learning) eine vielversprechende Option für die allgemeinmedizinische Ausbildung zu sein.E-learning was planned as a test for medical students within their curriculum of family medicine. A multi-modular onlineoffer specific to the target group accompanies the 10th term medical students during their peripheral practical courses in family practices. Teaching objectives are as follows: (1) Introduction into e-learning, (2) clinical general medicine - onlinemodule, (3) chronic care online-module, (4) online-application. The systematic evaluation shows that e-learning promotes the communication of students both among themselves and with the university during their practical courses. On the basis of the experiences from this pilot test the combination with blended learning seems to be a promising option for medical education

E-Learning: Aktueller Stand und Chancen in der Allgemeinmedizin Frankfurt a.M. 08. - 09. Juli 2005 : vom Kongress zum Netzwerk "ELA" (E-Learning in der Allgemeinmedizin)

Kongressbericht: Auf der Tagung der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin e.V. (DEGAM) 2004 entstand die Idee, E-Learning-Aktivitäten in der Allgemeinmedizin sichtbar zu machen und zu bündeln. Ein Kongress sollte die allgemeinmedizinischen Vertreter aus Lehre und Forschung sowie Industrievertreter zusammenbringen, um das Spektrum der Möglichkeiten und laufende Projekte kennen zu lernen. Mit motivierten Referenten, über 60 aktiven Teilnehmern und einem positiven Feedback, kann der Kongress in Frankfurt am 8. und 9. Juli 2005 als erster dieser Art in Deutschland als erfolgreich bezeichnet werden

ELSID-diabetes study-evaluation of a large scale implementation of disease management programmes for patients with type 2 diabetes. Rationale, design and conduct : a study protocol

Background: Diabetes model projects in different regions of Germany including interventions such as quality circles, patient education and documentation of medical findings have shown improvements of HbA1c levels, blood pressure and occurrence of hypoglycaemia in before-after studies (without control group). In 2002 the German Ministry of Health defined legal regulations for the introduction of nationwide disease management programs (DMP) to improve the quality of care in chronically ill patients. In April 2003 the first DMP for patients with type 2 diabetes was accredited. The evaluation of the DMP is essential and has been made obligatory in Germany by the Fifth Book of Social Code. The aim of the study is to assess the effectiveness of DMP by example of type 2 diabetes in the primary care setting of two German federal states (Rheinland-Pfalz and Sachsen-Anhalt). Methods/Design: The study is three-armed: a prospective cluster-randomized comparison of two interventions (DMP 1 and DMP 2) against routine care without DMP as control group. In the DMP group 1 the patients are treated according to the current situation within the German-Diabetes-DMP. The DMP group 2 represents diabetic care within ideally implemented DMP providing additional interventions (e.g. quality circles, outreach visits). According to a sample size calculation a sample size of 200 GPs (each GP including 20 patients) will be required for the comparison of DMP 1 and DMP 2 considering possible drop-outs. For the comparison with routine care 4000 patients identified by diabetic tracer medication and age (> 50 years) will be analyzed. Discussion: This study will evaluate the effectiveness of the German Diabetes-DMP compared to a Diabetes-DMP providing additional interventions and routine care in the primary care setting of two different German federal states

E-Learning in der ALLGEMEINmedizinischen Aus-, Fort- und Weiterbildung : Erfahrungen aus der Allgemeinmedizin

Kurzfassung Vortrag: Fächerübergreifende Lehre und verpflichtende Fortbildung (CME) für Ärzte erfordern innovative Lernmethoden. Eine Lösung wird teilweise in der Nutzung elektronischer Medien gesehen. Unklar ist jedoch, wie konkret eine Umsetzung in der Aus-, Fort- und Weiterbildung im Fach Allgemeinmedizin bisher erfolgte, welche Chancen und Möglichkeiten es gibt und wie die weitere Entwicklung aussehen kann. Um einen Überblick über die aktuellen E-Learning-Aktivitäten zu erhalten, formierte sich eine universitäts- und bundesländerübergreifende Initiative. In drei Phasen soll die Grundlage für die Entwicklung einer Strategie für die effektive Nutzung elektronischer Lehr- und Lernmedien für das Fach Allgemeinmedizin geschaffen werden: Phase 1 - Nationales Expertentreffen (Juli 2005 in Frankfurt): Diskussion von Erfahrungen, Problemen und Möglichkeiten des Einsatzes elektronischer Medien in der Allgemeinmedizin. Phase 2 - Gründung eines Netzwerks: Zusammenarbeit, Koordination und gegenseitige Unterstützung bei der Entwicklung von E-Learning-Modulen. Phase 3 - Evaluation von E-Learning in der Allgemeinmedizin: systematische qualitative und quantitative Untersuchungen. Im Rahmen eines Workshops sollen die Erfahrungen aus dem Expertentreffen mit Lehrenden und Fortbildenden aus anderen Fachbereichen diskutiert werden. Kooperationen über die Allgemeinmedizin hinaus können weitere Synergien schaffen. Der Workshop dient dem Austausch über Chancen und Limitationen entsprechender Angebote

EXPLORING THE POTENTIALS OF PATIENT-GENERATED HEALTH DATA FOR THE TREATMENT OF DEPRESSION

Patient-generated health data (PGHD) enables healthcare professionals to get deeper insights into patients with depression, thus offering the opportunity to improve their treatment. However, due to the variety and methods for collecting PGHD, not all types are relevant for healthcare professionals in depression care. To identify relevant types of PGHD for the treatment of depression, we conducted a qualitative focus group study with 13 healthcare professionals and follow-up interviews. The study\u27s key findings include relevant identified PGHD concerning their collection effort. In addition, the results show a clear preference for PGHD that both have strong connections to depressive symptoms and use passive collection methods, such as sleep data and activity levels. With this article, we contribute to the usage of PGHD in clinical settings and thus create a better understanding of relevant types of PGHD for the treatment of depression

Psychometric evaluation and Rasch analyses of the German Overall Anxiety Severity and Impairment Scale (OASIS-D)

The Overall Anxiety Severity and Impairment Scale (OASIS) is a 5-item self-report measure that captures symptoms of anxiety and associated functional impairments. This study evaluates a German version (OASIS-D) that was administered to a convenience sample of 1398 primary care patients of whom 419 were diagnosed with panic disorder with/without agoraphobia. Psychometric properties were analyzed using classical test theory as well as probabilistic test theory. Factor analyses suggested a unitary (latent) factor structure. The internal consistency was good to excellent. Convergent as well as discriminant validity with other self-report measures was found. A sum score (range 0–20) of ≥ 8 emerged as optimal cut-score for screening purposes. A difference score of ≥ 5 was indicative of reliable individual change. A Rasch analysis of local item independence suggested response dependency between the first two items. Rasch analyses of measurement invariance detected noninvariant subgroups associated with age and gender. Analyses of validity and optimal cut-off score were solely based on self-report measures, which may have introduced method effects. In sum, the findings support the transcultural validity of the OASIS and indicate its applicability to naturalistic primary care settings. Caution is warranted when using the scale to compare groups that differ in age or gender

The "Seminartage Weiterbildung Allgemeinmedizin" (SemiWAM): development, implementation and evaluation of a five-year, competence-based postgraduate programme in Bavaria

Introduction: Starting in 2013, a five-year, competence-based postgraduate programme, the "Seminartage Weiterbildung Allgemeinmedizin" (SemiWAM®) for continuing education in general practice, was developed and offered in Bavaria. This evaluation reports on the experiences of SemiWAM® after a first cycle.Material and methods: Process reflection based on the cycle of Kern: In addition to qualitative findings, results of the evaluation forms (mean values with standard deviation) are presented. The evaluation form contained questions on organisational issues, content of presentation, didactic preparation of the supervisor, transfer to real life practice as well as demographic variables. All questions were voted on a six-point Likert scale from "1=very satisfied" to "6=very dissatisfied".Results: The reflection showed three crucial entry points: Choosing "reason for encounter" as a content precondition to ensure target audience needs, the close didactic supervision of supervisor, and the continuous growth of supervisor team with newly qualified GP. The evaluation results for the overall assessment (MW 1.11-1.60), the didactic concept (MW 1.30-1.87), as well as the transfer into daily life practice (MW 1.48-2.35) reflect the high quality of the SemiWAM®. Discussion: The SemiWAM® curriculum presented can be easily transferred to comparable structures in Germany that accompany specialty training, such as the competence centres for residency training in general practice. The process evaluation based on the core cycle also provides important support for the agile implementation of these or similar programmes.Einleitung: Beginnend im Jahr 2013 wurde in Bayern ein fünfjähriges, kompetenzbasiertes, weiterbildungsbegleitendes Seminarcurriclum, die "Seminartage Weiterbildung Allgemeinmedizin" (SemiWAM®) für die Weiterbildung in der Allgemeinmedizin entwickelt und angeboten. Mit diesem Evaluationsbericht werden die Erfahrungen der SemiWAM® nach einem ersten Durchlaufen berichtet.Material und Methoden: Prozessreflexion auf Basis des Kern-Zyklus: Neben qualitativen Befunden werden Ergebnisse der Evaluation der Teilnehmenden (Mittelwerte mit Standardabweichung) dargestellt. Der Evaluationsbogen enthielt Fragen, u.a. zur Bewertung der Organisation, Inhalten und Art der Präsentation der Referierenden, der didaktischen Aufbereitung, des Transfers in die Weiterbildungspraxis sowie demographische Variablen. Alle Fragen wurden auf einer sechststufigen Likertskala von "1=sehr zufrieden" bis "6=sehr unzufrieden" abgestimmt.Ergebnisse: In der Prozessreflexion zeigten sich drei Stellschrauben als zielführend: Die Ausrichtung der Inhalte an Beratungsanlässen nah am Bedarf der Zielgruppe, die enge didaktische Supervision von Referierendenteams und die stetige Erweiterung des Referierendenteams durch junge Fachärztinnen und Fachärzte für Allgemeinmedizin. Die Evaluationsergebnisse für die Gesamtbewertung (MW 1,11-1,60), die didaktische Konzeption und Aufbereitung (MW 1,30-1,87) sowie den Transfer in die Weiterbildungspraxis (MW 1,48-2,35) spiegeln die hohe Qualität der SemiWAM®. Diskussion: Das vorgestellte Curriculum der SemiWAM® lässt sich zwanglos auf vergleichbare weiterbildungsbegleitende Strukturen in Deutschland wie die Kompetenzzentren Weiterbildung Allgemeinmedizin übertragen. Die Prozessevaluation auf Basis des Kern-Zyklus gibt zudem wichtige Hilfestellung in der agilen Umsetzung dieser oder ähnlicher Programme

A systematic review and meta-analysis of transdiagnostic interventions for common mental disorders in primary care

Objective In primary care, treating common mental disorders according to the ICD or DSM is challenging. A transdiagnostic approach may facilitate the management of mental health problems by treating across psychiatric diagnoses. This meta-analysis aims to identify and compare transdiagnostic interventions delivered in primary care and to determine the effectiveness of these interventions, focusing on common mental disorders. Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted by searching the databases Medline, Embase, Web of Science, and PsycINFO. Standardized mean differences (SMD) were calculated for the outcomes, and additional subgroup analyses were performed. Results From an initial set of 10,618 RCTs, 38 studies were included and retained for data extraction. Transdiagnostic interventions led to a significant reduction in symptoms of depression (SMD: −0.38) and anxiety (SMD: - 0.47). Treatment outcomes for somatoform disorders were not significant (SMD: - 0.22). About half of the interventions were provided by health professionals not specifically trained in psychotherapy; these interventions also proved to be effective (depression: SMD: −0.47; anxiety: −0.39). Conclusion This meta-analysis supports the use of transdiagnostic interventions for common mental disorders in primary care. Transdiagnostic interventions carried out by medical and health professionals not specifically trained in psychotherapy are feasible in PC, but emphasis should be placed on adequate training for them