[Healthcare provision for asylum seekers in reception centres : Qualitative survey from the perspective of healthcare providers]. / Medizinische Versorgung von Asylsuchenden in Erstaufnahmeeinrichtungen : Eine qualitative Bestandsaufnahme aus Versorgungsperspektive.

During the time of increased in-migration of asylum seekers to Germany in 2015 and 2016, different models of healthcare provision were established in reception centres, often on an ad hoc basis and influenced by local actors. The goal of this study was to map different care models and identify challenges in the implementation of effective and needs-based health service structures.Data was generated through 13 semi-structured interviews and in an interactive workshop with group discussions. An analysis was conducted using a qualitative content analysis method. Participants were stakeholders from clinics in reception centres, including medical and healthcare personnel, administrators, representatives of public health offices and researchers.Different models of ambulatory care have formed as a response to the particular medical needs of asylum seekers and the complex context in which care takes place, often exceeding the simple offer of primary care. The facilities fundamentally differ with regard to objectives and organisational aspects, e.g. the responsible carrier, structure of human resources and the extent of health services provided. Shared challenges include planning needs-based care, the lack of shared guidelines and a lack of opportunities for exchange between the different actors working in the clinics. Action is required to transform ad hoc initiatives into resilient health care practices, particularly regarding structured and continued opportunities for exchange, as well as the development and implementation of nation-wide guidelines. Jointly developed areas for action and proposed solutions presented here can serve as a basis for further work in this area.

The impact of patient-held health records on continuity of care among asylum seekers in reception centres: a cluster-randomised stepped wedge trial in Germany.

INTRODUCTION: The aim of this study was to assess the effectiveness of a patient-held health record (PHR) for asylum seekers on the availability of health-related information. METHODS: An explorative, cluster-randomised stepped-wedge trial with reception centres as unit of randomisation was conducted. All reception centres (n=6) in two large administrative areas in South Germany with on-site health services were included. All physicians working at these centres were invited to participate in the study. The intervention was the implementation of a PHR. The primary outcome was the prevalence of written health-related information. Secondary outcomes were the physicians' dissatisfaction with the available written information and the prevalence of missing health-related information. All outcomes were measured at the level of patient-physician contacts by means of a standardised questionnaire, and analysed in logistic multi-level regression models. RESULTS: We obtained data on 2308 patient-physician contacts. The presence of the PHR increased the availability of health-related information (adjusted OR (aOR), 20.3, 95% CI: 12.74 to 32.33), and tended to reduce missing essential information (aOR 0.71, 95% CI: 0.39 to 1.26) and physicians' dissatisfaction with available information (aOR 0.5, 95% CI: 0.24 to 1.04). The availability of health-related information in the post-intervention period was higher (aOR 4.22, 95% CI: 2.64 to 6.73), missing information (aOR 0.89, 95% CI: 0.42 to 1.88) and dissatisfaction (aOR 0.43, 95% CI: 0.16 to 1.14) tended to be lower compared with the pre-intervention period. CONCLUSIONS: Healthcare planners should consider introducing PHRs in reception centres or comparable facilities. Future research should focus on the impact of PHRs on clinical outcomes and on intersectoral care. TRIAL REGISTRATION: ISRCTN13212716. Registered 24 November 2016. Retrospectively registered. http://www.isrctn.com/ISRCTN13212716.

To change or not to change - That is the question: A qualitative study of lifestyle changes following acute myocardial infarction.

Objective The purpose of this study was to investigate key factors related to lifestyle changes following acute myocardial infarction (AMI) by eliciting survivors' subjective needs for, attitudes towards and experiences with behaviour changes in their everyday life to improve future interventions promoting lifestyle changes. Methods Semi-structured interviews were conducted with 21 individuals who had recently experienced an AMI. The interviews were audio-recorded and transcribed verbatim. The data were analysed using qualitative content analysis. Results The data analysis revealed that lifestyle changes following AMI are influenced by a combination of individual (physical and psychological) and social factors that can be grouped into facilitators and barriers. The interviews indicated the need for more personalised information regarding the causes and risk factors of illness, the benefits of lifestyle changes and the importance of including significant others in lifestyle advice and education and of individualising support. Discussion Lifestyle change is a continuous process that is not completed within a few months after a cardiac event. Considering the identified themes when developing interventions to promote lifestyle changes following AMI may enhance the effectiveness and sustainability of such interventions.

Infectious disease screening in asylum seekers: range, coverage and economic evaluation in Germany, 2015.

Screening asylum seekers for infectious diseases is widely performed, but economic evaluations of such are scarce. We performed a policy analysis and economic evaluation of such screening in Germany, and analysed the effect of screening policies on cost differences between federal states. Of the 16 states, screening was compulsory for tuberculosis (TB) in asylum seekers ≥ 16 years of age in all states as well as in children < 16 years of age and pregnant women in six states, hepatitis B and enteropathogens in three, syphilis in two and human immunodeficiency virus (HIV) in one state. Of 441,899 asylum seekers, 88.0% were screened for TB, 22.9% for enteropathogens, 16.9% for hepatitis B, 13.1% for syphilis and 11.3% for HIV. The total costs for compulsory screening in 2015 were 10.3 million euros (EUR). Costs per case were highest for infections with Shigella spp. (80,200 EUR), Salmonella spp. (8,000 EUR), TB in those ≥ 16 years of age (5,300 EUR) and syphilis (1,150 EUR). States with extended screening had per capita costs 2.84 times those of states that exclusively screened for TB in asylum seekers ≥ 16 years of age (p < 0.0001, 95% confidence interval (CI): 1.96-4.10). Screening practices in Germany entailed high costs; evidence-based approaches to infectious disease screening are needed.

Potentially avoidable and ambulatory care sensitive hospitalisations among forced migrants: a protocol for a systematic review and meta-analysis.

INTRODUCTION: There is an increasing number of forced migrants globally, including refugees, asylum seekers, internally displaced persons and undocumented migrants. According to international law, forced migrants should enjoy access to health services free of discrimination equivalent to the host population, but they face barriers to healthcare worldwide. This may lead to a delay in care and result in preventable hospital treatment, referred to as potentially preventable hospitalisation (PPH) or ambulatory care sensitive hospitalisation (ACSH). There is as yet no overview of the prevalence of PPH in different countries and groups of forced migrants, and it is unknown whether the concept has been used among these migrant groups. We aim to systematically review the evidence (1) on the prevalence of PPH among forced migrants and (2) on differences in the prevalence of PPH between forced migrants and the general host population. METHODS AND ANALYSIS: A systematic review will be conducted searching databases (PubMed/MEDLINE, Web of Science/Knowledge, Cochrane Library, CINAHL, Google Scholar) and the internet (Google). INCLUSION CRITERIA: observational studies on forced migrants reporting PPH or ACSH with or without comparison groups published in the English or German language. EXCLUSION CRITERIA: studies on general migrant groups or hospitalisations without clear reference to avoidability. STUDY SELECTION: titles, abstracts and full texts will be screened in duplicate for eligibility. Data on the prevalence of PPH/ACSH among forced migrants, as well as any reported prevalence differences between host populations, will be systematically extracted. Quality appraisal will be performed using standardised checklists. The evidence will be synthesised in tabular form and by means of forest plots. A meta-analysis will be performed only among homogeneous studies (in terms of design and population). ETHICS AND DISSEMINATION: Ethical clearance is not necessary (secondary research). The results will be disseminated via publication in open access journals, conferences and public media. PROSPERO REGISTRATION NUMBER: CRD42016037081.

Bridging the gap between patient needs and quality indicators: a qualitative study with chronic heart failure patients.

BACKGROUND: The German National Disease Management Guideline (NDMG) on chronic heart failure (CHF) derived nine clinical quality indicators (QIs) to enable assessment of quality of health care in patients with CHF. These QIs epitomize an evidence-based and somatic point of view of guided treatment, but little is known about the experiences and views of patients with their guideline-based treatment across multiple health care sectors. OBJECTIVE: The purpose of this qualitative study was to explore patient perspectives on guided treatment of CHF across multiple health care sectors. Furthermore, it was investigated to what extent patient perspectives are represented by the QIs of the German NDMG. METHODS: Using a qualitative approach, semistructured interviews were carried out with 17 CHF patients. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using qualitative content analysis. RESULTS: Patient-identified needs focused primarily on aspects like the doctor-patient relationship, communication, quality of individual-tailored information, and professional advice. Patients perceived shortcomings in processes of care such as communication and cooperation across health care sectors, especially at the transition between hospital and outpatient care. DISCUSSION: From the patient perspectives, the QIs do represent relevant somatic and clinical aims for quality measurement. However, deficits were identified, especially related to communication and cooperation across health care sectors. Given the fact that the inclusion of patient perspectives in quality improvement processes provides an important contribution to patient-centered health care, possible approaches for QI development such as direct and indirect patient involvement or generic vs disease-specific patient-related QIs should be the subject of future discussions.

Involving patients in detecting quality gaps in a fragmented healthcare system: development of a questionnaire for Patients' Experiences Across Health Care Sectors (PEACS).

OBJECTIVE: The purpose of this study was to develop and validate a generic questionnaire to evaluate experiences and reported outcomes in patients who receive treatment across a range of healthcare sectors. DESIGN: Mixed-methods design including focus groups, pretests and field test. SETTING: The patient questionnaire was developed in the context of a nationwide program in Germany aimed at quality improvements across the healthcare sectors. PARTICIPANTS: For the field test, 589 questionnaires were distributed to patients via 47 general practices. MAIN MEASUREMENTS: Descriptive item analyzes non-responder analysis and factor analysis (PCA). Retest coefficients (r) calculated by correlation of sum scores of PCA factors. Quality gaps were assessed by the proportion of responders choosing a response category defined as indicating shortcomings in quality of care. RESULTS: The conceptual phase showed good content validity. Four hundred and seventy-four patients who received a range of treatment across a range of sectors were included (response rate: 80.5%). Data analysis confirmed the construct, oriented to the patient care journey with a focus on transitions between healthcare sectors. Quality gaps were assessed for the topics 'Indication', including shared-decision-making (6 items, 24.5-62.9%) and 'Discharge and Transition' (10 items; 20.7-48.2%). Retest coefficients ranged from r = 0.671 until r = 0.855 and indicated good reliability. Low ratios of item-non-response (0.8-9.3%) confirmed a high acceptance by patients. CONCLUSIONS: The number of patients with complex healthcare needs is increasing. Initiatives to expand quality assurance across organizational borders and healthcare sectors are therefore urgently needed. A validated questionnaire (called PEACS 1.0) is available to measure patients' experiences across healthcare sectors with a focus on quality improvement.