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1.
ZFA: Zeitschrift für Allgemeinmedizin ; 98(2):48-53, 2022.
Article in German | Academic Search Complete | ID: covidwho-1716538

ABSTRACT

Background: In the early phase of the COVID-19 pandemic in spring 2020, so-called regional medical coordinators (RMCs) were deployed in Bavaria as part of the declared state of emergency in districts and independent cities to coordinate ambulatory care. The experiences were examined in an evaluation project. One aim of the project was to use the data collected to develop recommendations for supporting ambulatory care in future pandemics. Methods: First, cross-sectional surveys of RMCs and general practitioners (GPs) were conducted in parallel, as well as an interview-based qualitative survey of RMCs, GPs and representatives of authorities and the Bavarian Association of Statutory Health Insurance Physicians (BASHIP). Afterwards, based on the empirical data collected and taking into account available publications and reports, recommendations for decision-makers were developed in a sequential process. Results: The main recommendations are a greater consideration of ambulatory care in catastrophic and emergency situations as well as in the updating of existing emergency and pandemic plans;establishment of systematic advisory and feedback structures for policy-makers and authorities with the involvement of experienced, ambulatory physicians to avoid frictional losses;more efficient use of the existing strength in ambulatory care;pre-definition of persons, responsibilities and tasks on state, district and county level;ensuring adequate supporting infrastructure so that advisory physicians can act efficiently. Conclusions: Although the recommendations were developed in the context of an evaluation project of the Bavarian RMC concept, they could be helpful for future pandemic and emergency situations, also nationwide and outside official disaster situations, if adapted to local conditions. (English) [ FROM AUTHOR] Hintergrund: In der ersten Phase der COVID-19-Pandemie im Frühjahr 2020 wurden in Bayern im Rahmen des ausgerufenen Katastrophenfalls in Landkreisen und kreisfreien Städten sogenannte Versorgungsärzt* innen (VÄ) eingesetzt, um die ambulante Versorgung zu koordinieren. Die Erfahrungen mit diesem Ansatz wurden in einem Evaluationsprojekt untersucht. Ein Ziel des Projektes war es, auf Basis der erhobenen Daten über den Versorgungsarztansatz hinausgehende Empfehlungen zur Unterstützung der ambulanten Versorgung in zukünftigen Pandemien zu erarbeiten. Methoden: Zunächst erfolgten Querschnittsbefragungen von Versorgungsund Hausärzt*innen sowie eine interviewbasierte qualitative Befragung von Versorgungs-, Hausärzt*innen und Vertreter*innen von Behörden und der Kassenärztlichen Vereinigung Bayerns. Auf Basis der erhobenen Daten wurden in einem sequenziellen Prozess Empfehlungen für Entscheidungsträger*innen erarbeitet. Ergebnisse: Hauptempfehlungen sind eine stärkere Berücksichtigung der ambulanten Versorgung in Katastrophen- und Notfallsituationen sowie bei der Aktualisierung vorhandener Katastrophenund Pandemiepläne;der Aufbau systematischer Beratungsund Feedbackstrukturen für Politik und Behörden unter Einbindung erfahrener niedergelassener Ärzt*innen zur Vermeidung von Reibungsverlusten;eine effizientere Nutzung der vorhandenen Stärke des ambulanten Bereichs;Personen, Zuständigkeiten und Aufgaben für die Ebenen Land, Bezirk, Kreis vorab festlegen;angemessene, unterstützende Infrastruktur sicherstellen, damit beratende Ärzt*innen effizient agieren können. Schlussfolgerungen Obwohl die Empfehlungen im Rahmen einer Evaluation des bayerischen Versorgungsarztansatzes entstanden sind, könnten sie, an die lokalen Gegebenheiten angepasst, auch bundesweit und außerhalb des offiziellen Katastrophenfalles für zukünftige Pandemie- und Notfallpläne hilfreich sein. (German) [ FROM AUTHOR] Copyright of ZFA: Zeitschrift für Allgemeinmedizin is the property of Deutscher Aerzte-Verlag GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

2.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-305096

ABSTRACT

Background: This study aimed to investigate the knowledge, attitudes, behaviors, and vaccine hesitancy of people with migratory backgrounds among Turkish- and German-speaking patients in Munich regarding the COVID-19 pandemic. Methods: Primary outcomes were the intention to get vaccinated for COVID-19 and COVID-19 knowledge levels (25 true/false items). Other variables included demographics, attitudes to COVID-19 and vaccination (7 items), and behaviors regarding COVID-19 (7 items). The attitude and behavior questions had 5-point Likert scales. Of the 10 Turkish-speaking family physicians in Munich, 6 agreed to administer Turkish or German questionnaires to consecutive patients during February 2021. Participants with either citizenship, country of origin, native language, or place of birth being non-German were categorized as “Having a migratory background.” Data from 420 respondents were analyzed. Results: Women constituted 41.4% (n=174), the mean age was 42.2±15.5 years, 245 (58.3%) preferred the Turkish questionnaire, 348 (82.9%) had a migratory background, and 197 (47.9%) intended to be vaccinated. The mean knowledge, attitude, and behavior scores were 21.5±3.2 (max=25), 3.7±0.8 (max=5), and 4.0±0.5 (max=5). While 42.3% (n=145) of the participants with a migratory background considered getting vaccinated, this proportion was 76.5% (n=52) for non-immigrant Germans (Chi-square=26.818, p<0.001). Non-migratory background (Odds Ratio (OR): 3.082), high attitude scores (OR: 2.877), male sex (OR: 2.185), years of schooling (OR: 1.064), and age (OR: 1.022) were positively associated with vaccination intention. Conclusions: We suggest initiating or supporting projects run by persons or groups from inside the immigrants targeting to elaborate and change their vaccination attitudes.

3.
Gesundheitswesen ; 84(2): 97-106, 2022 Feb.
Article in German | MEDLINE | ID: covidwho-1684153

ABSTRACT

BACKGROUND: During the state of emergency in Bavaria in the early Corona phase 2020, some physicians in ambulatory care were appointed as regional medical coordinators (RMCs). The aim of the present study was to evaluate this newly introduced but temporary position. METHODS: In November 2020, a paper-based questionnaire was sent out to all 85 RMCs who could be identified through an internet research and to all 197 teaching practices of the Institute of General Practice and Health Services Research at the Technical University of Munich. The data analysis was descriptive and anonymised. RESULTS: Overall, 75 (88%) RMCs and 156 (79%) general practitioners (GPs) were included. 97% of the RMCs and 67% of the GPs assessed the introduction of RMCs in ambulatory care as reasonable, but also as an intervention concerning the self-administration of physicians (RMCs: 59% and GPs: 42%). 37% of the GPs stated that RMCs should be avoided as far as possible in future pandemic situations. Overall, GPs with more intensive contact to an RMC showed higher levels of agreement. Both groups rated the collaboration and communication strategies of politics, authorities and the Bavarian Association of Statutory Health Insurance Physicians as difficult and often contradictory. However, most of the RMCs assessed the cooperation with politics and authorities at the local level as positive. The lack of medical protective equipment at the beginning of the pandemic was judged critically by both groups of the respondents. CONCLUSIONS: The establishment of RMCs in the early Corona phase 2020 in Bavaria was considered sensible by almost all RMCs and the majority of the surveyed GPs. For the future, it seems necessary to involve primary care physicians more intensively and permanently in decision-making processes and to strengthen existing structures.


Subject(s)
COVID-19 , General Practitioners , Ambulatory Care , Germany , Humans , SARS-CoV-2 , Surveys and Questionnaires
4.
BMC Infect Dis ; 21(1): 1214, 2021 Dec 06.
Article in English | MEDLINE | ID: covidwho-1555054

ABSTRACT

BACKGROUND: This study aimed to investigate the knowledge, attitudes, behaviors, and COVID-19 vaccine hesitancy of people with migratory backgrounds among Turkish- and German-speaking patients in Munich. METHODS: Primary outcomes were the intention to get vaccinated for COVID-19 and COVID-19 knowledge levels (25 true/false items). Other variables included demographics, attitudes to COVID-19 and vaccination (7 items), and behaviors regarding COVID-19 (7 items). The attitude and behavior questions had 5-point Likert scales. Of the 10 Turkish-speaking family physicians in Munich, six agreed to administer Turkish or German questionnaires to consecutive patients in February 2021. Furthermore, participants with either citizenship, country of origin, native language, or place of birth being non-German were categorized as "Having a migratory background." Data from 420 respondents were analyzed. RESULTS: Women constituted 41.4% (n = 174), the mean age was 42.2 ± 15.5 years, 245 (58.3%) preferred the Turkish questionnaire, 348 (82.9%) had a migratory background, and 197 (47.9%) intended to be vaccinated. The mean knowledge, attitude, and behavioral scores were 21.5 ± 3.2 (max = 25), 3.7 ± 0.8 (max = 5), and 4.0 ± 0.5 (max = 5). While 42.3% (n = 145) of the participants with a migratory background considered getting vaccinated, this proportion was 76.5% (n = 52) for non-immigrant Germans (Chi-square = 26.818, p < 0.001). Non-migratory background (odds ratio (OR): 3.082), high attitude scores (OR: 2.877), male sex (OR: 2.185), years of schooling (OR: 1.064), and age (OR: 1.022) were positively associated with vaccination intention. CONCLUSIONS: We suggest initiating or supporting projects run by persons or groups with immigrant backgrounds to attempt to elaborate and change their vaccination attitudes.


Subject(s)
COVID-19 Vaccines , COVID-19 , Adult , Cross-Sectional Studies , Female , Health Knowledge, Attitudes, Practice , Humans , Language , Male , Middle Aged , SARS-CoV-2
5.
NPJ Prim Care Respir Med ; 31(1): 46, 2021 11 25.
Article in English | MEDLINE | ID: covidwho-1537315

ABSTRACT

The study aimed to evaluate the diagnostic accuracy of contact history and clinical symptoms and to develop decision rules for ruling-in and ruling-out SARS-CoV-2 infection in family practice. We performed a prospective diagnostic study. Consecutive inclusion of patients coming for COVID-PCR testing to 19 general practices. Contact history and self-reported symptoms served as index test. PCR testing of nasopharyngeal swabs served as reference standard. Complete data were available from 1141 patients, 605 (53.0%) female, average age 42.2 years, 182 (16.0%) COVID-PCR positive. Multivariable logistic regression showed highest odds ratios (ORs) for "contact with infected person" (OR 9.22, 95% CI 5.61-15.41), anosmia/ageusia (8.79, 4.89-15.95), fever (4.25, 2.56-7.09), and "sudden disease onset" (2.52, 1.55-4.14). Patients with "contact with infected person" or "anosmia/ageusia" with or without self-reported "fever" had a high probability of COVID infection up to 84.8%. Negative response to the four items "contact with infected person, anosmia/ageusia, fever, sudden disease onset" showed a negative predictive value (NPV) of 0.98 (95% CI 0.96-0.99). This was present in 446 (39.1%) patients. NPV of "completely asymptomatic," "no contact," "no risk area" was 1.0 (0.96-1.0). This was present in 84 (7.4%) patients. To conclude, the combination of four key items allowed exclusion of SARS-CoV-2 infection with high certainty. With the goal of 100% exclusion of SARS-CoV-2 infection to prevent the spread of SARS-CoV-2 to the population level, COVID-PCR testing could be saved only for patients with negative response in all items. The decision rule might also help for ruling-in SARS-CoV-2 infection in terms of rapid assessment of infection risk.


Subject(s)
COVID-19 , Adult , Clinical Decision Rules , Family Practice , Female , Humans , Prospective Studies , SARS-CoV-2
6.
PLoS One ; 16(10): e0258914, 2021.
Article in English | MEDLINE | ID: covidwho-1480460

ABSTRACT

BACKGROUND: Risk factors of severe COVID-19 have mainly been investigated in the hospital setting. We investigated pre-defined risk factors for testing positive for SARS-CoV-2 infection and cardiovascular or pulmonary complications in the outpatient setting. METHODS: The present cohort study makes use of ambulatory claims data of statutory health insurance physicians in Bavaria, Germany, with polymerase chain reaction (PCR) test confirmed or excluded SARS-CoV-2 infection in first three quarters of 2020. Statistical modelling and machine learning were used for effect estimation and for hypothesis testing of risk factors, and for prognostic modelling of cardiovascular or pulmonary complications. RESULTS: A cohort of 99 811 participants with PCR test was identified. In a fully adjusted multivariable regression model, dementia (odds ratio (OR) = 1.36), type 2 diabetes (OR = 1.14) and obesity (OR = 1.08) were identified as significantly associated with a positive PCR test result. Significant risk factors for cardiovascular or pulmonary complications were coronary heart disease (CHD) (OR = 2.58), hypertension (OR = 1.65), tobacco consumption (OR = 1.56), chronic obstructive pulmonary disease (COPD) (OR = 1.53), previous pneumonia (OR = 1.53), chronic kidney disease (CKD) (OR = 1.25) and type 2 diabetes (OR = 1.23). Three simple decision rules derived from prognostic modelling based on age, hypertension, CKD, COPD and CHD were able to identify high risk patients with a sensitivity of 74.8% and a specificity of 80.0%. CONCLUSIONS: The decision rules achieved a high prognostic accuracy non-inferior to complex machine learning methods. They might help to identify patients at risk, who should receive special attention and intensified protection in ambulatory care.


Subject(s)
Ambulatory Care , COVID-19 , Coronary Disease , Hypertension , Renal Insufficiency, Chronic , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , Coronary Disease/epidemiology , Coronary Disease/therapy , Dementia/epidemiology , Dementia/therapy , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , Female , Germany , Humans , Hypertension/epidemiology , Hypertension/therapy , Male , Middle Aged , Obesity/epidemiology , Obesity/therapy , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/therapy , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/therapy , Risk Assessment , Risk Factors
7.
Eur J Gen Pract ; 27(1): 176-183, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1328901

ABSTRACT

BACKGROUND: After the 'first wave' in spring 2020, opinions regarding the threat and measures against COVID-19 seemed to vary among German general practitioners (GPs). OBJECTIVES: To systematically investigate opinions and to identify subgroups of GPs sharing similar views. METHODS: A questionnaire was sent to all 210 practices accredited for undergraduate teaching of family medicine at the Medical Faculty of the Technical University of Munich. Questions addressed personal opinions regarding risks, dilemmas, restrictions and their relaxation associated with COVID-19, and personal fears, symptoms of depression and anxiety. Patterns of strong opinions ('archetypes') were identified using archetypal analysis, a statistical method seeking extremal points in the multidimensional data. RESULTS: One hundred and sixty-one GPs sent back a questionnaire (response rate 77%); 143 (68%) with complete data for all 38 relevant variables could be included in the analysis. We identified four archetypes with subgroups of GPs tending in the direction of these archetypes: a small group of 'Sceptics' (n = 12/8%) considering threats of COVID-19 as overrated and measures taken as exaggerated; 'Hardliners' (n = 34/24%) considering threats high and supporting strong measures; 'Balancers' (n = 77/54%) who also rated the threats high but were more critical about potentially impairing the quality of life of elderly people and children; and 'Anxious' GPs (n = 20/14%) tending to report more fear, depressive and anxiety symptoms. CONCLUSION: Among the participants in this survey, opinions regarding the threat and the measures taken against COVID-19 during the 'first wave' in Germany in spring 2020 varied greatly.


Subject(s)
Attitude of Health Personnel , COVID-19 , Communicable Disease Control , General Practitioners , Public Policy , Adult , Anxiety/psychology , Depression/psychology , Fear , Female , General Practitioners/psychology , Germany , Humans , Male , Middle Aged , Risk Assessment , SARS-CoV-2
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