[Facilitating Interprofessional Collaboration in Nursing Homes: Effects of a Complex Model Intervention (CoCare) to Improve On-Site Medical Care. Results of a Controlled Study with Pre-Post Measurement]. / Können die Maßnahmen der komplexen Modellintervention CoCare die Zusammenarbeit von Pflegekräften und Ärzt*innen in Pflegeheimen verbessern? Ergebnisse einer kontrollierten Studie mit Prä-Post-Messung.

AIM: The model project "CoCare - Extended coordinated medical care in long-term care homes" (funding: Innovation Committee of the Federal Joint Committee) aspired to improve on-site medical care in nursing homes by introducing a new form of care. Participating nursing homes implemented a number of intervention elements designed to facilitate interprofessional collaboration. We surveyed nursing staff and attending physicians as part of the project's summative evaluation. METHODS: The intervention group (IG) participated in our survey once before the implementation of the intervention (T0) as well as 12 months after implementation had started (T1). The control group (CG), in which residents received usual treatment ("usual care"), completed one survey. We investigated whether IG participants rated interprofessional collaboration more positively after the intervention, and attempted to detect advantages in their assessment at T1 as compared to the CG. Additionally, we analyzed if IG participants perceived improvements in on-site medical care from T0 to T1 and to what extent they evaluated the intervention and its components as beneficial. RESULTS: N=836 participants (678 nursing staff and 158 physicians) took part in the surveys. IG nursing staff demonstrated significant improvements in assessment of interprofessional collaboration from T0 to T1, while we found only partially significant improvements among IG physicians. Additionally, IG nursing staff rated interprofessional collaboration significantly better at T1 as compared to the CG. No such differences were found in the physician sample. Both nursing staff and physicians in the IG indicated significant improvements in on-site medical care after the intervention was implemented. They rated the overall intervention as overwhelmingly beneficial. Both professions found the regularly scheduled, weekly ward rounds and the appointment of fixed contact points particularly valuable. CONCLUSION: The implementation of the "CoCare" measures can improve nursing staff's and physicians' assessments of interprofessional collaboration and on-site medical care. However, participation in the survey was limited, especially among physicians, which reduced the statistical power of calculations.

Barriers and facilitators for implementation of a complex health services intervention in long-term care homes: a qualitative study using focus groups.

BACKGROUND: With rising numbers of elderly people living in nursing homes in Germany, the need for on-site primary care is increasing. A lack of primary care in nursing homes can lead to unnecessary hospitalization, higher mortality, and morbidity in the elderly. The project CoCare ("coordinated medical care") has therefore implemented a complex health intervention in nursing homes, using inter alia, regular medical rounds, a shared patient medical record and medication checks, with the aim of improving the coordination of medical care. This study reports upon the results of a qualitative study assessing the perceived barriers and facilitators of the implementation of CoCare by stakeholders. METHODS: Focus group interviews were held between October 2018 and November 2019 with nurses, general practitioners and GP's assistants working or consulting in a participating nursing home. A semi-structured modular guideline was used to ask participants for their opinion on different aspects of CoCare and which barriers and facilitators they perceived. Focus groups were analyzed using qualitative content analysis. RESULTS: In total, N = 11 focus group interviews with N = 74 participants were conducted. We found six themes describing barriers and facilitators in respect of the implementation of CoCare: understaffing, bureaucracy, complexity, structural barriers, financial compensation, communication and collaboration. Furthermore, participants described the incorporation of the intervention into standard care. CONCLUSION: Barriers perceived by stakeholders are well known in the literature (e.g. understaffing and complexity). However, CoCare provides a good structure to overcome barriers and some barriers will dissolve after implementation into routine care (e.g. bureaucracy). In contrast, especially communication and collaboration were perceived as facilitators in CoCare, with the project being received as a team building intervention itself. TRIAL REGISTRATION: WHO UTN: U1111-1196-6611; DRKS-ID: DRKS00012703 (Date of Registration in DRKS: 2017 Aug 23).

How do nurses and physicians assess inter-professional collaboration in long-term care homes? A survey study.

AIMS: To assess inter-professional collaboration between nurses and physicians in long-term care facilities and to determine if there are differences between subgroups of nurses. DESIGN: A cross-sectional questionnaire survey was carried out between January 2018 and January 2020. METHODS: 408 health professionals (345 nurses, 63 physicians) from 37 nursing homes in Baden-Wuerttemberg (Germany) participated in the survey. For data collection, the "Team-Scale" and "Work Situation Questionnaire for nurses/physicians" instruments were used. Furthermore, five self-generated items were employed assessing how ward rounds and documentation are implemented. For the evaluation, descriptive analyses, one-way variance analyses (ANOVAs) and a multilevel analysis were performed. RESULTS: Inter-professional teamwork was rated positively overall. However, the nursing staff usually gave more critical assessments than the physicians (for example, regarding mutual appreciation). Critical assessments could be used to initiate constructive change processes.

Systematic development of practice guidelines for psychological interventions in stroke rehabilitation.

Purpose: We aimed to develop evidence-based practice guidelines that can support decision-making in individual cases and be used by a multidisciplinary team in stroke rehabilitation.Materials and methods: We conducted a literature search (step 1), and a survey of all neurological rehabilitation facilities in Germany concerning their structural working conditions and current practices (step 2). Based on this information, we drafted a first version of the practice guidelines, and discussed them with a group of experts (step 3). We also consulted concurrently with senior psychologists, head physicians (step 4), and patients after stroke (step 5). We revised the guidelines until consensus on the final version was reached (step 6).Results: Referring to the ICF for guidance, the practice guidelines comprise of psychological recommendations in five problem areas ("Participation - Major Aims of Rehabilitation", "Cognition", "Affect & Behavior", "Risk Factors", and "Specific Problems & Aspects"), and provide preliminary remarks on general frame conditions and procedural requirements. The practice guidelines were widely accepted by head psychologists and physicians of in- and outpatient neurological rehabilitation with an average agreement of 97% (range: 88-100%).Conclusions: Our practice guidelines include detailed recommendations for psychological interventions that can guide individual decision-making by a multidisciplinary team. Specific aspects to foster implementation were considered, and attempts were made to promote their dissemination.Implications for RehabilitationWe developed practice guidelines for psychological interventions in rehabilitation after stroke based on the best available evidence.The practice guidelines include detailed recommendations for psychological interventions that can guide individual decisions by a multidisciplinary team.The practice guidelines are highly specific, and have been widely agreed upon by a group of experts from different professions as well as by researchers, patients, and clinicians (average agreement: 97%).The practice guidelines offer knowledge on different areas of psychological impairment, can help guide diagnostic and therapeutic procedures for individual patients, and thus, improve standard care in neurological rehabilitation.

[What do rehabilitation patients expect from a telemedicine cardiac rehab aftercare? Results from interviews with rehabilitation patients]. / Welche Erwartungen haben Rehabilitanden an eine telemedizinische kardiologische Reha-Nachsorge? Ergebnisse aus Interviews mit Rehabilitanden.

BACKGROUND: Rehabilitation aftercare programs can enable patients with cardiovascular disease to sustain and improve achievements made during their rehabilitation. However, not every patient is able to attend outpatient aftercare programs, especially if they interfere with professional or social responsibilities. Telemedical alternatives could provide those patients with longer durations or varying degrees of aftercare, regardless of location or time restriction. The present study aimed to investigate what cardiovascular rehabilitation patients expect from a telemedical aftercare program. METHODS: Data was collected in individual semi-structured interviews with cardiovascular rehabilitation patients, where subjects were asked about their expectations towards a telemedical aftercare program. To identify groups of associated topics, the results obtained were analyzed using qualitative content analysis. RESULTS: Nine cardiovascular rehabilitation patients were interviewed (8 male, 1 female). None of the respondents had ever taken part in a telemedical aftercare program; however, eight out of the nine patients indicated their willingness to participate in such a program. Patients preferred telephone-based aftercare programs where they could speak with a member of staff familiar with the patient's clinical picture, circumstances and goals. Some respondents wanted additional web-based services or services via text message. CONCLUSIONS: Overall, the option of telemedical aftercare was viewed favorably by rehabilitation patients as long as the program included personal contact with a healthcare provider. Respondents preferred interaction via familiar media, especially by phone. Low-threshold experiences with new technologies may help overcome reservations and facilitate acceptance of innovative telemedical services in rehabilitation patients. Personal interaction with an attending member of staff should occur throughout aftercare programs, at least occasionally or during initial the stage.

A complex health services intervention to improve medical care in long-term care homes: study protocol of the controlled coordinated medical care (CoCare) study.

BACKGROUND: Deficits in general and specialized on-site medical care are a common problem in nursing homes and can lead to unnecessary, costly and burdensome hospitalizations for residents. Reasons for this are often organizational obstacles (such as lack of infrastructure or communication channels) and unfavorable compensation structures, which impede the implementation of adequate medical care. The purpose of this study is to evaluate a complex intervention aiming to improve the coordination of medical care in long-term care nursing homes in Germany. The project aims to optimize the collaboration of nurses and physicians in order to reduce avoidable hospital admissions and ambulance transportations. METHODS/DESIGN: In a prospective controlled trial, nursing home residents receiving a complex on-site intervention are compared to residents receiving care/treatment as usual. The study will include a total of around 4000 residents in approximately 80 nursing homes split equally between the intervention group and the control group. Recruitment will take place in all administrative districts of Baden-Wuerttemberg, Germany. The control group focuses on the administrative district of Tuebingen. The intervention includes on-site visits by physicians joined by nursing staff, the formation of teams of physicians, a computerized documentation system (CoCare Cockpit), joint trainings and audits, the introduction of structured treatment paths and after-hours availability of medical care. The project evaluation will be comprised of both a formative process evaluation and a summative evaluation. DISCUSSION: This study will provide evidence regarding the efficacy of a complex intervention to positively influence the quality of medical care and supply efficiency as well as provide cost-saving effects. Its feasibility will be evaluated in a controlled inter-regional design. TRIAL REGISTRATION: WHO UTN: U1111-1196-6611 ; DRKS-ID: DRKS00012703 (Date of Registration in DRKS: 2017/08/23).

Intervention policies and social security in case of reduced working capacity in the Netherlands, Finland and Germany: a comparative analysis.

OBJECTIVES: Working age disability is a major challenge for policymakers in European countries. This pertains to both occupational reintegration and social benefits for work incapacity. In many states reforms have been initiated aimed at reducing disability scheme inflow and fostering return to work. Our study was motivated by the question as to which aspects of these reforms seem to have been effective. METHODS: Three different approaches were utilized: case vignettes, interviews and expert workshops in the respective countries (Netherlands and Germany in 2012; Finland in 2015), and a systematic search for relevant studies on occupational reintegration was performed. RESULTS: We found considerable differences as to the assessment of work incapacity and resulting monetary benefits in the three countries. Also, organisation and practices of occupational reintegration vary from one country to another. Major differences concern (1) the timing of interventions, (2) employer responsibility and workplace involvement, (3) incentives and sanctions and (4) organisational and procedural issues. CONCLUSIONS: Our results may partly explain why some reform strategies have been more successful than others, and thus contribute to the further development of social and labour policies in Europe.

Development of practice guidelines for psychological interventions in the rehabilitation of patients with oncological disease (breast, prostate, or colorectal cancer): Methods and results.

OBJECTIVE: The goal of this project was to develop evidence- and consensus-based practice guidelines for psychological interventions in the rehabilitation of patients with oncological disease (breast, prostate, or colorectal cancer). METHODS: First of all, we conducted a literature search and survey of all oncological rehabilitation centers in Germany (N = 145) to obtain a thorough perspective of the recent evidence, guidelines, the structural framework, and practice of psychological services in oncological rehabilitation. Next, an expert workshop was held with national experts from scientific departments, clinicians from rehabilitation centers, and patients. In this workshop, we drafted and agreed upon an initial version of the practice guidelines. Afterwards, the practice guidelines were sent to all head physicians and senior psychologists at oncological rehabilitation centers in Germany for approval (N = 280 questionnaires). In addition, key recommendations were discussed with a group of rehabilitation patients. Finally, the practice guidelines were revised by the expert panel and made available online to the public. RESULTS: The practice guidelines have been widely accepted by both the expert panel and the surveyed clinicians and patients. They include recommendations for psycho-oncological interventions that should be offered to all rehabilitation patients with breast, prostate, or colorectal cancer. They also comprise recommendations for specific problem areas concerning psychological functions, body functions, and environmental and personal factors. CONCLUSIONS: The practice guidelines provide detailed recommendations for high-quality psychosocial care in an oncological rehabilitation context. It is their aim to guide the multidisciplinary team, especially psychologists and physicians, in their daily practice.

Psychological interventions in the rehabilitation of patients with chronic low back pain: evidence and recommendations from systematic reviews and guidelines.

The purpose of the article is to summarize evidence and recommendations for psychological interventions in the rehabilitation of patients with chronic low back pain. We carried out a systematic literature search in several databases and on the websites of professional associations to identify relevant reviews and guidelines. In addition to the electronic search, a handsearch was carried out. Eligible publications were selected. We extracted and summarized both evidence for psychological interventions and recommendations on psychological diagnostics and interventions. Six systematic reviews and 14 guidelines were included. We collected recommendations and partially restricted evidence on the following psychological interventions: behavioural therapy, fear-avoidance training, stress management, relaxation therapy, patient education and back school. Most available evidence for psychological interventions in the rehabilitation of patients with chronic low back pain is of moderate to low quality. In addition, some of the older evidence is inapplicable to modern interventions using a biopsychosocial approach. Thus, high quality and current evidence is needed. The summary of guidelines shows that multimodal, multidisciplinary programmes including psychological interventions have become standard in the rehabilitation of patients with chronic low back pain. In most guidelines, however, there are no recommendations on which (psychological) intervention should be considered for which specific problem (problem-treatment pairs). Suggestions for future research and future guidelines are made.

Risk factors for chronic depression--a systematic review.

BACKGROUND: One of five patients with an acute depressive episode develops chronic depression. Risk factors for a current depressive episode to become chronic are insufficiently known. This review was conducted to examine which factors represent a risk factor for the development of chronic depression for patients diagnosed with a depressive episode. METHOD: Medline, Psycinfo, ISI Web of Science, CINHAL and BIOSIS Previews were searched up until September 2007, complemented by handsearching in the December 1987 to December 2007 issues of Journal of Affective Disorders and investigating reference lists of included articles and existing reviews. On the basis of a formal checklist, two investigators independently decided which studies to include or exclude. RESULTS: 25 relevant primary studies with a total of 5192 participants were included in the systematic review. Overall the methodological quality of the included studies was found to be sufficient. Data synthesis was performed via vote counting. The following risk factors were identified: younger age at onset, longer duration of depressive episode, and family history of mood disorders. Psychological comorbidity i.e. anxiety disorders, personality disorders and substance abuse, low level of social integration, negative social interaction and lower severity of depressive symptoms repeatedly appeared concurrently with chronic depression. LIMITATIONS: Most included studies were cross-sectional thus drawing causal conclusions with regard to risk factors proved to be difficult. CONCLUSION: Risk factors for a current depressive episode to become chronic were identified. To date only few significant longitudinal studies on this topic are available.