Structural Barriers In The Context Of Opiate Substitution Treatment In Germany - A Survey Among Physicians In Primary Care

Background Opiate substitution treatment (OST) is the most widely used treatment for opioid dependence in Germany with substantial long-term benefits for the patient and for society. Due to lessened restrictive admission criteria, the number of registered OST patients in Germany has increased continuously in the recent years, whereas the number of physicians providing OST has remained constant. Previous data already indicated a deteriorating situation in the availability or quality of OST delivered and that structural barriers impede physicians in actively providing OST. The present survey among a sample of primary care physicians in Germany aimed to identify and assess potential structural barriers for the provision of health care in the context of OST. Methods An anonymous written questionnaire was sent out to a sample of 2,332 physicians across Germany providing OST. Physicians contacted were identified through databases of the Federal State Chambers of Physicians and/or of the Federal Associations of Statutory Health Insurance Physicians. Data obtained were analysed descriptively. Results The response rate was 25,5% and the majority of 596 physicians sampled viewed substantial problems in terms of the regulatory framework of OST care in the German context. Furthermore, financial remuneration, insufficient qualification, as well as inadequate interdisciplinary cooperation in the treatment of comorbidities of opiate substituted patients were regarded as problematic. The number of physicians providing OST in Germany is expected to substantially decrease in the near future. Conclusion Despite less restrictive admission criteria for OST in Germany, the legal regulation framework for OST is still a limiting factor through raising concerns on the provider and consumer side to be unable to adhere to the strict rules. To avoid future shortages in the provision of OST care on the system level in Germany, revisions to the legal framework seem to be necessary. In regards to adequate care for drug use-related infectious diseases and psychiatric comorbidities commonly found in opiate substituted patients, efforts are required to improve professional qualifications of physicians providing OST as well as respective interdisciplinary collaboration

Psychiatric disorders and health service utilization in unemployed youth

Aim: Youth unemployment is associated with increased levels of anxiety, depression, alcohol abuse, reduced self-esteem and satisfaction with life. Up to date data based on standardized psychiatric diagnostic assessments in adolescent or young adult unemployment is very scarce. To our knowledge, this study has, for the first time, assessed both Axis-I (non-personality) and Axis-II (personality) psychiatric disorders and related constructs in a preselected sample of unemployed individuals. Subjects and methods: Subjects were aged 16–24 and lived in the large urban region of Essen, Germany. They were referred by case managers of the vocational services centre to the on-site psychiatric out-patient unit. SCID-I and II were administered to assess DSM-IV diagnoses. Symptom Checklist 90 R, Beck Depression Inventory and Client Sociodemographic Service Receipt Inventory were used to measure severity of psychopathology and health service utilization. Results: In all, 98% of the unemployed young adults suffered from mental disorders. Mood and anxiety disorders were the most common Axis-I disorders (47.9 and 33.4%). Altogether, 58.2% of probands met diagnostic criteria for a personality disorder; a borderline personality disorder accounted for one half of these disorders. Despite a 49% rate of Axis-I and II comorbidity and severe psychopathology, the majority of subjects were untreated and mental health service utilization in general was low. The diagnosis of a personality disorder was related to a 2.7-fold risk of dropping out of job reintegration programmes. Conclusion: Unemployed young adults referred for a psychiatric assessment have a high rate of both Axis-I and II disorders, which need to be considered upon planning individual-based vocational rehabilitation programs

Criteria for the successful completion of medical dissertations – A multicenter study

Objective: In order to acquire the academic title “doctor” in Germany, it is essential to complete a dissertation. A high number of publications at German universities are based on medical dissertations. The reasons why some dissertations are successfully accomplished and why some are not completed – despite far-reaching consequences – have been barely investigated to date

Benefits and pitfalls of scientific research during undergraduate medical education

Objective: The integration of scientific research into medical education is a widely discussed topic. Most research training programs are offered on a voluntary basis. In Germany, it is mandatory to complete a doctoral thesis to obtain the academic title “doctor”. The reasons why students start a dissertation project and the influence of this project on their undergraduate studies and later career choices are not well known

Lectures based on cardinal symptoms in undergraduate medicine - effects of evaluation-based interventions on teaching large groups

Despite critical voices lectures are still an important teaching format in current medical curricula. With the curricular reform at Hamburg Medical Faculty in the year 2004, all subject specific lectures were replaced by cardinal symptom oriented lectures (LSV) in the new clinical curriculum. LSVs are taught throughout all six thematic blocks in years three to five. Since regular student evaluations after each thematic block seemed to demand improvement of the LSVs, this study was carried out using evaluations of individual LSVs by the participating students and by trained auditors (final year students and academic staff). Based on these evaluations feedback containing the individual evaluation data was given in written form to the lecturers combined with information material on planning an LSV using modern didactic techniques. In a second evaluation period, the effects of this intervention were studied. Only small improvements in the LSVs’ quality were noted regarding the level of marks achieved. When individual items were evaluated, especially the didactic quality, significant improvements were noticeable. Overall, on the basis of individual items students ranked the quality of the LSVs significantly higher than trained auditors during the first evaluation period. This effect was no longer seen after the second evaluation period. The inter rater reliability among the auditors was very good. This study shows that regular quality assurance is needed on the structural levels and for staff to accompany the process of embedding teaching formats into curricular concepts. Further investigation is needed to determine the adequate frequency of evaluation and the format of feedback to guarantee sustainable effects of the didactic quality of lectures

Der Internetauftritt deutscher medizinischer Fakultäten – eine Übersicht [Homepages of German medical faculties – an overview]

[english] Introduction: The Internet represents a central communication medium for patients and physicians. Some national information is available regarding the design of physicians‘ homepages and patient requirements regarding homepages of physicians in private practice. To date, no data are available for homepages of medical faculties and their users‘ needs.Methods: In 2008 the homepages of the 36 German medical faculties were analyzed according to a catalogue of 128 criteria assigned to five domains which had been developed from the literature. Structure, content and extent were compared. Results: The homepages covered the criteria to a very different extent. The best homepage reached 80%, the worst only 26% of the achievable points. The mean was slightly above 50% . Faculties addressed mainly applicants and students as their target groups, less frequently lecturers and alumni.Conclusion: This study shows differences in quality and quantity of the „teaching section“ on websites of medical faculties. The results allow faculties to use the criteria to adjust their websites with regard to addressing the relevant target groups of students, applicants, lecturers and alumni comprehensively.<br>[german] Einleitung: Für Ärzte und Patienten stellt das Internet ein zentrales Informationsmedium im Gesundheitswesen dar. Es liegen national einige Informationen zur Gestaltung einer Arzthomepage und zu Patientenwünschen an den Internetauftritt eines niedergelassenen Arztes vor. Für Internetauftritte medizinischer Fakultäten und die Bedürfnisse ihrer Zielgruppen gibt es bislang keine Daten.Methoden: In 2008 wurden die Internetauftritte der 36 Medizinischen Fakultäten anhand von über 100 aus der Literatur entwickelten Kriterien erfasst, die fünf Bereichen zugeordnet wurden. Aufbau, Inhalt und Umfang wurden miteinander verglichen. Ergebnisse: Die Internetauftritte deckten die Kriterien in sehr unterschiedlichem Umfang ab. Der beste Auftritt erreichte 80%, der schlechteste lediglich 26% der erreichbaren Punkte, im Mittel wurde gut die Hälfte der Kriterien erfüllt. Die Fakultäten bedienten vor allem Studienbewerber und Studierende als Zielgruppen, weniger die Lehrenden und Alumni. Schlussfolgerung: Die vorliegende Studie zeigt Qualitäts – und Quantitätsunterschiede der Lehrbereiche der Internetauftritte medizinischer Fakultäten. Die Ergebnisse bieten den Fakultäten anhand der Kriterien die Möglichkeit, ihre Internetauftritte zu überarbeiten, um den relevanten Zielgruppen der Studierenden, Studieninteressierten, Lehrenden und Absolventen eine umfassende Informationsplattform zu bieten

Needlestick and sharps injuries at a German university hospital: epidemiology, causes and preventive potential – a descriptive analysis

ObjectivesTo analyze the number, epidemiology and circumstances of needlestick and sharps injuries (NSSI) and exposures to body fluids and to identify further preventive measures to improve the occupational safety of health care workers (HCW).Material and MethodsSetting: German university tertiary-care referral center. Retrospective study based on injury documentation sheets of the hospital’s staff and faculty health service and, if given, on reports by continuity doctors and by the accident and emergency department in January 2014–June 2016.ResultsAltogether, 567 injuries were registered with a significant decrease of cases over the study period. The majority of accidents occurred in the operating theater (35%). Stress, time pressure, overstrain, carelessness and distraction were found to be the main reasons for injuries. At least 30% of the cases were preventable, mainly by wearing personal protective equipment (PPE), by proper disposal of an item and by early replacement of overfilled sharps containers (SC). In 20% of the cases involving an item, the injury was caused by a safety-engineered device (SED). Almost one-third of these injuries were attributable to an improper use of the SED.ConclusionsDespite many efforts made to reduce their number, NSSI still occur. Health care workers and students should be offered regular trainings to be sensitized to this topic and to learn the appropriate use of SED. Moreover, organizational measures must be taken, such as the provision of suitable PPE and safe SC. Strategies need to be established to improve the working conditions and reduce the stress level of HCW