225 research outputs found
Leveraging Electronic Health Records to improve Patient Appointment Scheduling: A design-oriented Approach
As demand for healthcare services continues to increase, hospitals are under constant economic pressure to better manage patient appointments. It is common practice in clinical routine to schedule appointments based on average service times, resulting in overtime and waiting times for clinicians and patients. To address this problem, we propose a data-driven decision support system for scheduling patient appointments that accounts for variable service times. We take advantage of the growing amount of patient- and treatment-specific data collected in hospitals. Using a simulation study, we evaluate the decision support system on the practical example of a Gastroenterology facility. Our results demonstrate improved appointment scheduling efficiency compared to the approach currently in use
Unmet care needs in the oldest old with social loss experiences: results of a representative survey
Background: Loss experiences such as the loss of a spouse, a close relative or significant others become more likely in old age and may be strongly related to specific unmet health care needs. These unmet needs may often remain undetected and undertreated followed by a negative impact on well-being and social role functioning. The present study aims at exploring the relationship between loss experiences and specific unmet care needs in old age.
Methods: As part of the study âNeed assessment in the oldest old: application, psychometric examination and establishment of the German version of the Camberwell Assessment of Need for the Elderly (CANE)â, the adapted German version of the CANE was used in a population-representative telephone survey in a sample of 988 individuals aged 75+ years. Loss experiences within the last 12 months were assessed within the structured telephone survey. Descriptive and interferential statistical analyses were run in order to examine the association between loss experiences and occurring unmet care needs.
Results: Overall, 29.7% of the oldest old reported at least one social loss with other relatives losses being the most frequent (12.5%), followed by non-family losses (10.7%). A significant relationship between loss experiences and a higher number of unmet care needs was observed, especially for close family losses. Other risk factors for unmet care needs were age, marital status, depression, social support and morbidity.
Conclusions: This study provides, for the first time in Germany, data on the association between loss experiences and unmet needs. These findings may substantially contribute to the development of loss-specific interventions, effective treatment and health care planning for the bereaved elderly
What Comes after the Trial? An Observational Study of the Real-World Uptake of an E-Mental Health Intervention by General Practitioners to Reduce Depressive Symptoms in Their Patients
Unguided and free e-mental health platforms can offer a viable treatment and self-help
option for depression. This study aims to investigate, from a public health perspective, the real-world
uptake, benefits, barriers, and implementation support needed by general practitioners (GPs). The
study presents data from a spin-off GP survey conducted 2.5 years subsequent to a cluster-randomized
trial. A total of N = 68 GPs (intervention group (IG) GPs = 38, control group (CG) GPs = 30) participated
in the survey (response rate 62.4%). Data were collected via postal questionnaires. Overall,
66.2% of the GPs were female. The average age was 51.6 years (SD = 9.4), and 48.5% of the GPs
indicated that they continued (IG) or started recommending (CG) the e-mental health intervention
under real-world conditions beyond the trial. A number of benefits could be identified, such as ease
of integration and strengthening patient activation in disease management. Future implementation
support should include providing appealing informational materials and including explainer videos.
Workshops, conferences, and professional journals were identified as suitable for dissemination.
Social media approaches were less appealing. Measures should be taken to make it easier for health
care professionals to use an intervention after the trial and to integrate it into everyday practice
Indicators for Healthy Ageing - A Debate
Definitions of healthy ageing include survival to a specific age, being free of chronic diseases, autonomy in activities of daily living, wellbeing, good quality of life, high social participation, only mild cognitive or functional impairment, and little or no disability. The working group Epidemiology of Ageing of the German Association of Epidemiology organized a workshop in 2012 with the aim to present different indicators used in German studies and to discuss their impact on health for an ageing middle-European population. Workshop presentations focused on prevalence of chronic diseases and multimorbidity, development of healthy life expectancy at the transition to oldest-age, physical activity, assessment of cognitive capability, and functioning and disability in old age. The communication describes the results regarding specific indicators for Germany, and hereby contributes to the further development of a set of indicators for the assessment of healthy ageing
Internet-Based Cognitive Behavior Therapy Only for the Young? A Secondary Analysis of a Randomized Controlled Trial of Depression Treatment
Background: Late-life depression is a major public health concern, driving the
development of complementary treatment options. This study investigates the
effectiveness and acceptability of internet-based Cognitive Behavioral Therapy (iCBT) in
older individuals (60+ years) compared to younger age groups.
Materials and Methods: Secondary analysis of a cluster-randomized controlled trial with
647 (18â82 years; mean 43.9) mild to moderately severe depressed primary care patients
receiving either iCBT + treatment as usual (TAU) or TAU alone. Severity of depression was
measured by the Beck Depression Inventory (BDI-II) at baseline, 6 weeks and 6 months.
Intention-to-treat analysis in three age groups (18â39 years, n = 264; 40â59 years, n =
300; 60+ years, n = 83) was performed, using mixed-effects regression models to quantify
treatment effect.
Results: No age differences in the effectiveness of iCBT were found. Patients in the
intervention group consistently showed a greater reduction in depression severity than
controls in all three age groups and at both follow-ups. Effect sizes ranged from d = 0.30
(40â59 years, 6 weeks) to d = 1.91 (60+ years, 6 months). Uptake of the intervention was
banded around 70% with no differences between age groups (cÂČ = 0.18, p = .915). The
mean number of completed modules increased with age (cÂČ = 18.99, p = .040).
Discussion: iCBT is equally effective in both younger and older individuals, thus providing
a valuable complementary element of routine late-life depression care.
Clinical Trial Registration: DRKS-ID: DRKS00005075 https://www.drks.de/drks_web/
navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS0000507
Determinants of Willingness to Pay for Health Insurance in GermanyâResults of the Population-Based Health Study of the Leipzig Research Centre for Civilization Diseases (LIFE-Adult-Study)
Objective: To investigate which factors are associated with the willingness to pay (WTP)
for health insurance.
Methods: The analysis (n = 1,248 individuals) is based on data of a large
population-based studyâthe Health Study of the Leipzig Research Centre for Civilization
Diseases (LIFE-Adult-Study). With regard to WTP for health insurance, a contingent
valuation method with a payment card was used. Several explanatory variables were
included. For example, personality factors (in terms of agreeableness, conscientiousness,
extraversion, neuroticism, and openness to experience) were assessed using the
NEO-16 Adjective Measure.
Results: Average WTP for health insurance per month equaled about e240 which
corresponds to âŒ14% of household net equivalent income. Multiple regressions showed
that an increased WTP was associated with lower age (ÎČ = â1.7, p < 0.001), higher (log)
household net equivalent income (ÎČ = 153.6, p < 0.001), higher social support (ÎČ = 2.0,
p < 0.05), and private health insurance (ÎČ = 131.1, p < 0.001). Furthermore, an increased
WTP for health insurance was associated with higher openness to experience (ÎČ = 10.1,
p < 0.05), whereas it was not associated with agreeableness, conscientiousness,
extraversion, and neuroticism.
Conclusion: The quite large amount of average WTP for health insurance may suggest
that individuals accept current contributions to health insurances and would probably accept higher contributions. While previous studies mainly focused on individuals in late
life, we identified a link between socioeconomic, health-related factors, and personality
factors (in terms of openness to experience) and WTP in the general adult population
The course of pain intensity in patients undergoing herniated disc surgery: a 5-year longitudinal observational study
Objectives: The aims of this study are to answer the following questions (1) How does the pain intensity of lumbar and cervical disc surgery patients change within a postoperative time frame of 5 years? (2) Which sociodemographic, medical, work-related, and psychological factors are associated with postoperative pain in lumbar and cervical disc surgery patients? Methods: The baseline survey (T0; n = 534) was conducted 3.6 days (SD 2.48) post-surgery in the form of face-to-face interviews. The follow-up interviews were conducted 3 months (T1; n = 486 patients), 9 months (T2; n = 457), 15 months (T3; n = 438), and 5 years (T4; n = 404) post-surgery. Pain intensity was measured on a numeric rating-scale (NRS 0â100). Estimated changes to and influences on postoperative pain by random effects were accounted by regression models. Results: Average pain decreased continuously over time in patients with lumbar herniated disc (Wald ChiÂČ = 25.97, p<0.001). In patients with cervical herniated disc a reduction of pain was observed, albeit not significant (ChiÂČ = 7.02, p = 0.135). Two predictors were associated with postoperative pain in lumbar and cervical disc surgery patients: the subjective prognosis of gainful employment (p<0.001) and depression (p<0.001). Conclusion: In the majority of disc surgery patients, a long-term reduction of pain was observed. Cervical surgery patients seemed to benefit less from surgery than the lumbar surgery patients. A negative subjective prognosis of gainful employment and stronger depressive symptoms were associated with postoperative pain. The findings may promote multimodal rehabilitation concepts including psychological and work-related support
Valuing end-of-life care:translation and content validation of the ICECAP-SCM measure
Background: The evaluation of care strategies at the end of life is particularly important due to the globally increasing proportion of very old people in need of care. The ICECAP-Supportive Care Measure is a self-complete questionnaire developed in the UK to evaluate palliative and supportive care by measuring patientâs wellbeing in terms of âcapabilityâ. It is a new measure with high potential for broad and international use. The aims of this study were the translation of the ICECAP-Supportive Care Measure from English into German and the content validation of this version.
Methods: A multi-step and team-based translation process based on the TRAPD model was performed. An expert survey was carried out to assess content validity. The expert panel (nâ=â20) consisted of four expert groups: representative seniors aged 65+, patients aged 65+ living in residential care, patients aged 65+ receiving end-of-life care, and professionals in end-of-life care.
Results: The German version of the ICECAP-Supportive Care Measure showed an excellent content validity on both item- and scale-level. In addition, a high agreement regarding the length of the single items and the total length of the questionnaire as well as the number of answer categories was reached.
Conclusions: The German ICECAP-SCM is a valid tool to assess the quality of life at the end of life that is suitable for use in different settings. The questionnaire may be utilized in multinational clinical and economic evaluations of end-of-life care
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