[The manual "Problematic use and dependence of prescipted drugs" in daily routine care - a study among participants in a training to qualify in "primary addiction treatment"]. / Der Leitfaden "Medikamente - schädlicher Gebrauch und Abhängigkeit" im ärztlichen Arbeitsalltag. Eine Studie unter Kursteilnehmern zum Erwerb der Zusatzweiterbildung "Suchtmedizinische Grundversorgung".

BACKGROUND: To strengthen the position of physicians regarding problematic use and dependence of prescripted drugs a manual was issued by the German Medical Association in 2007.  A study among participants in a training to qualify in "primary addiction treatment" was conducted. The utilisation of the manual, its relevance for routine care and self-estimated changes in drug prescription were examined. METHODS: All 542 participants in training courses between 1.9.2008 and 31.12.2009 were asked about participation in a survey 12 weeks later. A number of 267 took part in this investigation. RESULTS: A proportion of 60,7 % among GPs that received the manual dealt with them beyond the training course. From 178 physicians, who confirmed the provision of drug prescription, a number of 56 stated changes in their drug prescription. A higher probabilty for changes in drug prescription was given in case of a high percentage of new informations that could be culled from the manual. CONCLUSION: The interest for the manual beyond the training course and the amount of self-estimated changes in drug prescription should encourage to use this within training measures in a systematic way.

[Physician's advice and treatment of smokers]. / Arztliche Beratung und Behandlung von Rauchern.

This article describes the health effects of smoking and smoking cessation. The doctor's office provides advantages for the counseling and treatment of smokers, such as continuous patient contacts, the option to address smoking in the context of smoking-related diseases, ubiquitous and low-threshold access to health care, therefore, offering equal access to lower socioeconomic classes. However, barriers exist for the implementation of smoking-related counseling in private practice due to the lack of reimbursement, insufficient qualification, lack of available time as well as lack of patients' motivation. Moreover, in the German healthcare system tobacco dependency has not yet been acknowledged as a treatment-demanding disease. Existing obstacles should be overcome by adjustment of reimbursement schemes for private practice and hospitals as well as reimbursement for smoking cessation medication proven to be effective for tobacco-dependent smokers. The German Medical Association has established a training program for doctors who want to become active in smoking cessation and has developed printed material for the counseling of smokers in private practice.

[Shared decision making]. / Shared Decision Making. Gemeinsame Entscheidungsfindung aus Patientenperspektive.

BACKGROUND AND OBJECTIVE: The demand for integration of patients in medical decisions becomes more and more obvious. Little is known about whether patients are willing and ready to share therapeutic decisions. So far information is lacking, whether existing communication skills of both -- patients and physicians -- are sufficient for shared decision making (SDM). This paper presents new data on patients perspectives regarding SDM. METHODS: Standardized survey of 3058 German speaking people (1565 females, 1493 males), aged 18-79 years, a population based random sample of an access panel (pool of german households available for specific surveys) regarding the following topics: medical decision making in practice, communication skills and behaviour of physicians. RESULTS: A majority of patients approved the model of SDM. However, some subgroups of patients, especially older patients, were less interested in the concept of SDM. Necessary communication skills which may help patients to participate in decision making were used rather scarcely. Patients who approved the model of SDM more often experienced a common and trustful exchange of information. CONCLUSION: Most patients favour the concept of SDM. The communication skills necessary for this process are to be promoted and extended. Research on patients' preferences and their participation in health care reform should be intensified. Academic and continuous medical education should focus on knowledge transfer to patients.

[Risks, chances and perspectives of restricting the free choice of doctors by patients]. / Risiken, Chancen und Perspektiven einer Beschränkung der freien Arztwahl.

Population surveys regarding free access to primary care physicians and medical specialists focus on selected aspects of public opinion. They are helpful but not sufficient in answering the relevant question: 'What are appropriate and efficient ways of access to the health care system?'. More important than survey results would be options for practical decisions by the patients themselves, based on a system offering different possibilities of choice. Competent piloting by 'gatekeepers' would need a problem- oriented and patient-centred medical education for primary-care physicians, starting during medical education and training and continuing throughout the professional medical careers. It should focus on three additional issues: New, alternative and unbiased ways of access to medical care should be developed, tried and evaluated to ensure beneficial use of the full potential of our health care system.

[Free choice of doctors - an international comparison]. / Die freie Arztwahl - ein internationaler Vergleich.

The focus of this international comparison concerning the issue of free choice among primary care physicians and specialists is to learn from experiences in other countries. Two different types of health care systems are analysed: state-administered health systems such as in Finland and Great Britain or competition-based systems such as in Switzerland and the USA. In the countries outlined mentioned and other OECD nations (Organisation for Economic Co-Operation and Development) not described in this study, several restrictions of free choice among physicians can be observed. Restrictions are to be found when changing the general practitioner as well as in first contact to specialists. Both limitations do not seem to have a significant effect on the level of satisfaction of the population with health care in general. From an international perspective free choice of doctors seems to be an exception in health systems.

[Free choice of doctors in Germany in retrospect]. / Freie Arztwahl in Deutschland - eine historische Perspektive.

Due to discussions on the cost and quality of health care and a new legislation on the German statutory sickness insurance system in 1999, the free choice of doctors has recently become topical. To assess its legitimation for the German health care system, its history and the groups of interest involved should be taken into consideration. Before the period of industrialization no homogeneous pattern of the medical profession existed. In case of illness individuals who lived within reach and were known for their competence in disease matters were approached. However, industrialization destroyed existing social networks, and establishment of new structures of health care in rural as well as metropolitan areas became necessary. The government approached this challenge by structuring medical education, passing regulations on the settlement of doctors and promoting the foundation of statutory sickness funds. The Health Insurance Law of 1883 established a mandatory insurance system for a broad array of industries. As it was the sickness funds' responsibility to provide sufficient resources for medical care, a sick member was tied to the physician under contract with his insurance. After a rapid increase in practising physicians at the end of the 19(th) century, doctors' organisations were eager to gain access to the new market segment of insurance members by calling for the free choice of physicians. The Leipzig association (Hartmannbund) was founded in 1900 to organize strikes of doctors in order to get their goals accepted. After 30 years of conflicts an appeasement was achieved by a presidential emergency law in 1931. It transferred the responsibility for the provision of sufficient health care resources from the sickness funds to the newly created body of the Association of Sickness Fund Physicians (Kassenärztliche Vereinigung) and determined the patients' free choice among licensed sickness fund physicians.

[Evidence-based guidelines as tools for medical knowledge transfer. The work mode of the Medical Knowledge Network evidence.de]. / Evidenzbasierte Leitlinien als Instrumente des Wissenstransfers in die Praxis. Die Arbeitsweise des medizinischen Wissensnetzwerks evidence.de.

The amount of medical knowledge is growing with increasing speed. Physicians are confronted with more and more--and often useless--information. However, the time lag between the creation of new knowledge and its implementation into daily medical practice is often exceeding a decade. In view of these challenges the knowledge network of the medical faculty of the University Witten/Herdecke is focusing on two different tasks: It provides evidence based medical guidelines in a format that is meant for easy access and use in daily practice. It scientifically explores different ways of presenting and transferring evidence based guidelines in order to develop better and easier ways of implementation. National and international guidelines and studies are screened, evaluated, updated and adapted for its use in the academic network by a team of five university based physicians. In addition, clinical specialists as well as primary care physicians provide expertise for detailed scientific adaptations and for adequate implementation strategies. The implementation process of the guidelines among the faculty based primary care physicians is continuously monitored and evaluated. The main goal of this concept is to create a learning environment for the complex process of medical knowledge transfer.

[Social medicine in medical education exemplified by the Witten/Herdecke University]. / Sozialmedizin im Medizinstudium am Beispiel der Universität Witten/Herdecke.

In 1992 a problem-based curriculum was introduced into the Medical Faculty of the University of Witten/Herdecke (UWH). First experiences with this approach indicate that--for several reasons discussed--community related health issues have not been sufficiently addressed. Therefore, it is recommended to give students access to field experiences in community health. At the UWH this is accomplished by a community-related practicum which connects students with a variety of community health services. A parallel course discusses students' experiences in a problem based manner and population related studies are developed.