Klinische Qualitätssteuerung – ein praktischer Versuch in der Hausarztpraxis am Beispiel der Influenzaimpfung

Klinische Qualitätssteuerung (KQS) meint ein Qualitätsmanagement im klinischen Bereich. Vermutlich aufgrund der Coronapandemie meldeten sich im Jahr 2020 deutlich mehr influenzaimpfwillige Patient*innen als in den Vorjahren, sodass sich abzeichnete, dass für Hochrisikopatient*innen nicht ausreichend Impfdosen zur Verfügung stehen würden. Um dem Problem zu begegnen, setzten wir einen KQS-Zyklus in Gang. Bei diesem Artikel handelt es sich explizit nicht um eine wissenschaftliche Arbeit, sondern um die exemplarische Beschreibung einer Priorisierung und einer KQS als Beispiel, zur Anregung und zur Diskussion. Wir erstellten folgenden Prozess: 1. Evaluation des Ist-Zustands; 2. Priorisierung der Patient*innen, die sich als impfwillig gemeldet hatten, und Impfung der Hochrisikogruppe zuerst; 3. Identifikation, telefonische Kontaktierung und Impfung der Hochrisikopatient*innen, die sich nicht selbstständig als impfwillig gemeldet hatten. Patient*innen über 60-Jahre mit chronisch obstruktiver Lungenerkrankung (COPD) wurden als Indikatorgruppe gewählt. Zunächst waren nur 3 (8 %) unserer 38 COPD-Patient*innen gegen Influenza geimpft. Nach Priorisierung und Impfung der Hochrisikogruppe in der Liste der Impfwilligen waren 25 (66 %) der insgesamt 38 COPD-Patient*innen geimpft. Nach telefonischer Einladung und Aufforderung waren zuletzt 28 (74 %) der 38 Patient*innen geimpft. Dies entspricht einer Steigerung der Impfquote der über 60-jährigen COPD-Patient*innen von 8 % auf 74 % und damit nahezu dem Zielwert der Weltgesundheitsorganisation (WHO). Hausärzt*innen müssen sich gelegentlich mit Ressourcenknappheit auseinandersetzen und sich mit Strategien beschäftigen, ihr zu begegnen. Unter anderem in diesem Zusammenhang bietet sich eine KQS in der Hausarztpraxis an. Die Praxisverwaltungssysteme (PVS) sollten für diesen Zweck von Seiten der Hersteller benutzerfreundlicher gestaltet werden

"What else to say?" – Primary health care in times of COVID-19 from the perspective of German general practitioners: an exploratory analysis of the open text field in the PRICOV-19 study

Background The international collaboration study PRICOV-19 –Primary Health Care in times of COVID-19 aims to assess the impact of the COVID-19 pandemic on the organisation of primary health care. The German part focuses on the subjective perceptions of general practitioners on primary health care and the impact of political measures during the second wave of the COVID-19 pandemic. Within this survey, the “open text field” of the questionnaire was utilised remarkably frequently and extensively by the respondents. It became clear that the content that was named needed to be analysed in an exploratory manner. Accordingly, this paper addresses the following question: What preoccupies general practitioners in Germany during COVID-19 that we have not yet asked them enough? Methods The data collection took place throughout Germany from 01.02.2021 to 28.02.2021with a quantitative online questionnaire consisting of 53 items arranged across six topics as well as an “open text field” for further comments. The questionnaire’s open text field was analysed following the premises of the qualitative content analysis. Results The topics discussed by the respondents were: insufficient support from health policies, not being prioritised and involved in the vaccination strategy, feeling insufficient prepared, that infrastructural changes and financial concerns threatened the practice, and perceiving the own role as important, as well as that health policies affected the wellbeing of the respondents. One of the main points was the way general practitioners were not sufficiently acknowledged for their contribution to ensuring high-quality care during the pandemic. Discussion German general practitioners perceived their work and role as highly relevant during the COVID-19 pandemic. In controversy with their perception, they described political conditions in which they were the ones who contributed significantly to the fight against the pandemic but were not given enough recognition

Has the COVID-19 Pandemic Led to Changes in the Tasks of the Primary Care Workforce? An International Survey among General Practices in 38 Countries (PRICOV-19)

peer reviewedThe COVID-19 pandemic has had a large and varying impact on primary care. This paper studies changes in the tasks of general practitioners (GPs) and associated staff during the COVID-19 pandemic. Data from the PRICOV-19 study of 5093 GPs in 38 countries were used. We constructed a scale for task changes and performed multilevel analyses. The scale was reliable at both GP and country level. Clustering of task changes at country level was considerable (25%). During the pandemic, staff members were more involved in giving information and recommendations to patients contacting the practice by phone, and they were more involved in triage. GPs took on additional responsibilities and were more involved in reaching out to patients. Problems due to staff absence, when dealt with internally, were related to more task changes. Task changes were larger in practices employing a wider range of professional groups. Whilst GPs were happy with the task changes in practices with more changes, they also felt the need for further training. A higher-than-average proportion of elderly people and people with a chronic condition in the practice were related to task changes. The number of infections in a country during the first wave of the pandemic was related to task changes. Other characteristics at country level were not associated with task changes. Future research on the sustainability of task changes after the pandemic is needed

Lessons learned : how did the pandemic initiated innovations in family medicine to ensure high-quality care?

COVID-19 confronted general practices with unprecedented challenges to fulfil their key role for COVID-and non-COVID patients. These boosted the initiation of innovations to ensure high-quality care: for example, physical consultations were replaced by remote consultations and initiatives were set up to actively reach out to vulnerable patients. General practitioners and associated staff have also had to take up new tasks or take tasks over from others. Based on PRICOV-19, two research questions were central: To what extent have general practices initiated innovations during COVID-19? How can we explain its variation based on practice-and country characteristics? The PRICOV-19 study examined how general practices were organized in 38 countries during COVID-19. Thanks to its scale and multi-country design, PRICOV-19 can identify practice- and healthcare system characteristics associated with initiating innovations. In 2020-2021, over 5,000 general practices participated by filling in a validated questionnaire. Target group: Healthcare professionals, researchers, and policymakers focusing on primary care and quality of care Didactic Method: Interactive presentation on PRICOV-19 followed by small-group sessions to reflect and comment on some aspects. Afterwards, these results were resumed in a plenary session. Objectives: -Getting familiar with PRICOV-19, a multi-country cross-sectional study on the organization of general practice during COVID-19. -Getting an in-depth understanding of the results from different countries and their variation. -Reflecting on enablers and challenges to initiate innovations in general practice the respondents experienced in their own practice/country. -Gaining inspiration from the experiences and input of colleagues/experts

The quality of COPD care in German general practice—A cross-sectional study

Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a common health problem to be dealt with in primary care. Little is known about the quality of care provided for patients with COPD in Germany. Therefore, we wanted to assess the current quality of care delivered by a primary care network (PCN) for patients with COPD. Methods: A cross-sectional study was conducted in collaboration with a primary care network (PCN). All patients of the PCN aged 40 years and older with a diagnosis of COPD were identified through electronic health records (EHR). A set of quality indicators (QIs) developed in accordance with current COPD-guidelines were appraised through numerical data retrieved from the EHR. Results: In total, 2,568 patients with COPD were identified. Their mean age was 67 (SD±12) years, 49% were male. Thirty-five percent had a parallel diagnosis of asthma. There was no documentation of any spirometry for 54% of patients; 29% had a spirometry within the previous year. An influenza vaccination was documented for 37% within the preceding 12 months; 12% received a pneumococcal vaccination in the last 6 years. Smoking status was documented for 44% within the last year. Conclusion: The quality of care for patients with COPD in the PCN seemed suboptimal, despite the presence of a Disease Management Program (DMP). This finding is likely to apply widely to German general practice. Quality assessment through currently available EHR data was challenging due to non-standardized and insufficient documentation

'The measures taken by the government overburdened the daily practice' : insights of the PRICOV-19 study on German general practitioners in times of COVID-19

Background The international study PRICOV-19 aims to assess the impact of the COVID-19 pandemic on the organisation of primary health care. The German part focuses on German general practitioners during the second wave of the COVID-19 pandemic. This paper addresses the following research questions: (1) How were changes in tasks on primary care and patient treatment perceived by GPs?, (2) What was the role of GPs during the pandemic, and how was their wellbeing?, (3) How did GPs perceive health policy measures?, and, (4) What influenced the attitudes of GPs on health policy measures? Methods This study pursues a multi-country cross-sectional design. Data collection took place throughout Germany from 01.02. to 28.02.2021 with a quantitative online questionnaire consisting of 53 items. The questionnaire was analysed through descriptive and inferential analyses using correlation and multiple regression models. Results The response rate was 20.4% (n = 349). The respondents were mainly GPs (59.6%) in single practices (62.5%) with a mean work experience of 15 to 20 years. GPs experienced a change in their work and practice organisation (80.3%). They felt a high responsibility (70.6%) and found their work has become more meaningful to them (76%). They also saw a lack of political support (75.2%) and that the measures taken by the government overburdened the daily practice (66.4%). Not many GPs were at risk of being distressed (53.4%) but rated the health policies rather negatively (60%). The multiple regression showed, the more GPs were exposed to risk of distress, the worse they assessed the government's measures. Conclusion GPs perceived their work as relevant and felt confident they could fulfil their tasks, but noticed that health policy initially hardly supported the outpatient sector. Health policies should increase their competence in relation to primary care, ensure its needs and consider an active inclusion of GPs in preparedness plans

COVID-19 : threat or opportunity for quality improvement (QI) in primary care?

Purpose - Getting familiar with the results of the PRICOV-19 study, a multi-country study on quality of care and patient safety in primary care in times of the COVID-19 pandemic. - Obtaining insight into the results of case studies in Norwegian nursing homes. - Reflecting on the threats and opportunities regarding quality of care the respondents experienced in their own practice and in general practice in their country. - Gaining inspiration from the experiences of colleagues and the input of experts to turn threats into opportunities. - Formulating a plan for QI in your own practice (structure, process, outcome) Context - Getting to know each other and the program of the workshop (10’) - Presentation of the results of the studies described above incl. what was identified as a threat /opportunity for QI in primary care and in the national health care system (15’) - Thematic small-group sessions: sharing experiences and reflecting on how the experienced threats could be turned into an opportunity (40’). The themes are: (1) patient safety; (2) integration of public health into primary care (3) equity and care for vulnerable population groups; (4) care for the caregiver; and (5) keeping up with guidelines in a rapidly changing world; (6) interprofessional collaboration - Plenary session with expert panel (20’) - Participants formulate a personal intention for action within the next three weeks. (5’) Participants are inspired to find solutions for the threats COVID-19 poses in their own working context and this is written down in a concrete plan for the near future. State of the art The COVID-19 pandemic presented primary care with unprecedented organizational and structural challenges, such as amended tasks like teleconsultations, intensive collaboration with services of secondary care and other general practices in the geographical area, and limited availability of resources in terms of staff members, infrastructure, and protective equipment. At the same time, these challenges can be opportunities for change and quality improvement in general practice

The Organization of Outreach Work for Vulnerable Patients in General Practice during COVID-19: Results from the Cross-Sectional PRICOV-19 Study in 38 Countries

The COVID-19 pandemic disproportionately affected vulnerable populations’ access to health care. By proactively reaching out to them, general practices attempted to prevent the underutilization of their services. This paper examined the association between practice and country characteristics and the organization of outreach work in general practices during COVID-19. Linear mixed model analyses with practices nested in countries were performed on the data of 4982 practices from 38 countries. A 4-item scale on outreach work was constructed as the outcome variable with a reliability of 0.77 and 0.97 at the practice and country level. The results showed that many practices set up outreach work, including extracting at least one list of patients with chronic conditions from their electronic medical record (30.1%); and performing telephone outreach to patients with chronic conditions (62.8%), a psychological vulnerability (35.6%), or possible situation of domestic violence or a child-rearing situation (17.2%). Outreach work was positively related to the availability of an administrative assistant or practice manager (p p < 0.01). Other practice and country characteristics were not significantly associated with undertaking outreach work. Policy and financial interventions supporting general practices to organize outreach work should focus on the range of personnel available to support such practice activities

Active outreach to vulnerable patients during COVID-19 : a common practice or exception in primary health care?

Introduction: The COVID-19 pandemic led directly and indirectly to an increased number of vulnerable population groups. General practitioners (GPs) were in the best position to identify vulnerable patients and limit the growth of health inequities. However, COVID-19 confronted GP practices with unprecedented structural and organizational challenges to provide high-quality care. Did GPs in Europe succeed in setting up outreach activities for maintaining their key role? Method: We used data from the PRICOV-19 study among GP practices in 38 European countries for the analyses. A scale on active outreach was constructed based on six items as the outcome variable. Using the software MLWin, multilevel Poisson analyses were performed on GP practices nested in countries. Results: The results showed a reliable 6-item scale on active outreach with an internal consistency coefficient of 0.69 (Cronbach alpha). According to preliminary analysis (using 2nd order PQL estimation) on 3,928 GP practices, the following practice characteristics were significantly negatively associated with the setup of outreach activities: monodisciplinarity (versus multidisciplinarity) and being a solo or duo GP practice (versus being a group practice). In addition, outreach activities were significantly more common in GP practices with above-average patients with chronic disorders. Conclusions: Further analyses are needed to verify and elaborate the current statements

Has the Covid-19 pandemic lead to changes in the tasks of the primary care workforce? An international survey among general practices

Introduction: The Covid-19 pandemic has had a huge impact on health care in general and primary care in particular. This impact varies by country, providing countries with opportunities to learn from each other. In this paper, we study changes in the tasks of GPs and staff during the times of Covid-19. Method: We used data from an international survey among GPs in 38 European countries, the PRICOV-19 Study. We constructed a scale for task changes based on six survey items and performed the multilevel analysis with GPs nested in countries. Results: Preliminary results show that the 6-item task changes scale is reliable at GP level – 0.77 – and at country level – 0.95. Clustering task changes at the country level is considerable – Intra Class Correlation=19.1 – so nearly 20% of the variation in the task changes scale is between countries, and 80% is between GP practices. The absence of staff due to Corona or quarantine and improved cooperation with neighboring practices during the pandemic is positively related to task changes. Conclusions: We are in the middle of data analysis and refrain from further conclusions now