[Patient care in an out-of-hours care practice - a descriptive study of the CONTENT project]. / Die medizinische Versorgung in einer kassenärztlichen Bereitschaftsdienstzentrale - Eine deskriptive Studie aus dem CONTENT-Projekt.

BACKGROUND: Little published research is available about the content of out of hours care (OOHC) in Germany. CONTENT is a project of the University Hospital Heidelberg to build up a morbidity registry for ambulatory health care. One of the participating practices of the network is a rural OOHC centre. The study reports exemplarily on the work of this practice. METHODS: The design of the study is cross-sectional. One of the 2 available CONTENT practice-softwares was used for data retrieval. The softwares allow for classifying reasons for encounter (RFE), health problems (diagnoses) and processes of care with the International Classification of Primary Care (ICPC-2). Furthermore the softwares allow for pseudonymised data export. RESULTS: A 3-year period with 15 886 patient contacts of 9 542 patients (65.9% female) is described. Close to 8% of the population in the catchment area visited the practice at least once in a year. Medium age of the patients was 42 years (range 0-104). The groups of the 25-44-year-old and the 45-64-year-old patients formed together 43% of all contacts. The most frequent RFE were: fever (5.8%), sore throat (4.8%), cough (4.8%), earache (3.9%) and insect bites (3.6%). Frequencies of these RFEs differed considerably between the age groups. With the help of the data, resulting diagnoses and care processes can be described in detail. CONCLUSION: This study describes, for the first time in Germany, the work of an OOHC practice. Data capture to accomplish this was feasible within existing practice software and without much extra work. If more OOHC practices would participate in the CONTENT project a more representative picture of OOHC in Germany could be established.

Antibiotics in urinary-tract infections. Sustained change in prescribing habits by practice test and self-reflection: a mixed methods before-after study.

BACKGROUND The German guideline recommends trimethoprim (TMP) for the treatment of uncomplicated lower-urinary-tract infections (uLUTI) in primary care. In the authors' research network, the participating general practitioners (GPs) were asked why they prescribe mostly quinolones instead. The GPs stated the perception of a high rate of therapy failure of TMP and strongly rejected the guideline. OBJECTIVE To examine prescribing behaviour for uLUTI and whether a practice test of TMP might effect a change in prescribing habits. METHODS The study was conducted using observational and qualitative elements. A first focus-group (n=6) assessed reasons for current prescribing behaviour. In a 3-month practice test, patients with uLUTI were prescribed TMP (150 mg twice for 3 days). In a second focus group, the GPs (n=12) were presented with the results of the practice test. RESULTS The first focus group revealed that prescribing was mainly driven by former hospital training and what was perceived as common therapy. GPs felt no need to change a successful regimen. In the practice test, TMP had a success rate of 94% (84 episodes of uLUTI). The second focus group revealed that the practice test had strongly changed opinions in favour of TMP. Self-reflection and ownership of data acquisition were seen as major contributions for change in prescribing. After the test period, TMP remained the antibiotic most often prescribed. CONCLUSION Internal evidence and peer-group opinion are strong determinants for clinical decisions. A self-conducted practice test, together with self-reflection in a peer group, strongly supports the process of change.

[Hospital referrals from the general practitioner's perspective - a descriptive analysis based on the CONTENT morbidity register]. / Krankenhauseinweisungen aus hausärztlicher Perspektive - eine deskriptive Analyse auf Basis des CONTENT-Morbiditätsregisters.

BACKGROUND: Hospital referrals cause high costs in the health-care system. Information on hospital referrals from general practices in Germany is sparse. As a starting point for further research we describe the characteristics of hospital referrals and referred patients. METHODS: In the CONTENT project (CONTinuous morbidity registration Epidemiologic NeTwork) the data sets of the patients of 23 general practices were gathered with the help of a modified electronic patient record system. The data of 49,423 patients (yearly contact group 2007) were analysed. RESULTS: Approximately 4% of the patients were referred to a hospital. Most frequent diagnoses (International Classification of Primary Care) were: D75 "malignant neoplasm colon/rectum", K74 "ischaemic heart disease with angina" and L90 "osteoarthrosis of knee". Patients referred to hospital had a higher comorbidity (p<0.0001), higher contact frequencies (p<0.0001), higher prescribing rates (p<0.0001) and were older (p<0.0001) than patients not referred to hospitals. Variations of the referral rates over the year and the week were dependent on parallel variations of the contact frequencies between doctors and patients. CONCLUSION: Patients referred to hospital from general practice are older and have a higher morbidity than patients not referred. Hospital referrals to rule out diseases with a potentially dangerous course as a means of managing uncertainty seem to be the most effective field under control of general practitioners to reduce hospital referrals.