Feasibility of including patients with migration background in a structured heart failure management programme: A prospective case-control study exemplarily on Turkish migrants.

AIMS: Structured management programmes deliver optimized care in heart failure patients and improve outcome. We examined the feasibility of including patients with migration background speaking little or no German in a heart failure management programme. METHODS AND RESULTS: After adaption of script material and staff to Turkish language we aimed to recruit 300 Turkish and 300 German (control group) patients within 18 months using the operational basis of a local heart failure management programme for screening, contact and inclusion. Of 488 and 1,055 eligible Turkish and German patients identified through screening, 165 Turkish (34%) and 335 German (32%) patients consented on participation (p = 0.46). General practitioners contributed significantly more of the Turkish (84%) than of the German patients (16%, p<0.001). Contact attempts by programme staff were significantly less successful in Turkish (52%) than in German patients (60%, p = 0.005) due to significantly higher rate of missing phone numbers (36% vs 25%), invalid address data (28% vs 7%) and being unreachable by phone more frequently (39% vs 26%, all p<0.001). Consent rate was significantly higher in successfully contacted Turkish (63%) compared to German patients (50%, p<0.001). CONCLUSION: The inclusion of Turkish minority patients into a heart failure management programme is feasible with higher consent rate than in Germans. However, effort is high due to inherent logistic adaptions and barriers in identification and contacting of patients. TRIAL REGISTRATION: DRKS00007780.

Physicians' knowledge of and compliance with guidelines: an exploratory study in cardiovascular diseases.

BACKGROUND: Guidelines are one of the means by which health care organizations try to improve health care and lower its cost. Studies have shown, however, that guidelines are still not being adequately implemented. In this exploratory study, we examine the link between physicians' knowledge of and compliance with guidelines: specifically, guidelines for the treatment of three cardiovascular diseases (arterial hypertension, heart failure and chronic coronary heart disease [CHD]) in primary care. METHODS: We assessed primary care physicians' knowledge of the guidelines with a representative postal survey, using a questionnaire about the treatment of cardiovascular diseases (2500 questionnaires sent). We assessed the responding physicians' compliance with the guidelines by analyzing patient data from a sample of 30 of them for various indicators of compliance. Of these 30 physicians, 15 met our operational criteria for adequate knowledge of the guidelines, and 15 did not. RESULTS: 437 (40%) of the physicians knew the guidelines adequately. Physicians answered questions about chronic CHD in accordance with the guidelines more often than they did questions about arterial hypertension (74% versus 11%). Our exploratory analysis of guideline compliance revealed that physicians who knew the guidelines adequately performed no differently than physicians who did not with respect to 12 of the 16 compliance indicators. As for the remaining 4 compliance indicators, it turned out, surprisingly, that physicians who did not know the guidelines adequately performed significantly better than those who did. CONCLUSION: These preliminary findings imply that physicians' knowledge of guidelines does not in itself lead to better guideline implementation. Further studies are needed to address this important issue.

Dysfunction of an atrial septal defect occluder 8 years after implantation.

Catheter interventional treatment of atrial septal defect (ASD) is widely accepted. The ASD occluder system (ASDOS) is no longer a widely used device nowadays. However, it is implanted in a substantial number of patients. We report a case of severe left-to-right shunt 8 years after catheter interventional closure of an ASD with an ASDOS device. The shunt was due to a membrane perforation, while the arms of the device were not dislocated. Microscopy, microbiology, and histology could not establish a proper explanation for the dysfunction; so long-term follow-up investigation may be required in patients with an implanted ASDOS device.

[Physicians and the internet--a cross-sectional study against the background of guideline implementation]. / Arzte und Internet--eine Querschnittsuntersuchung vor dem Hintergrund der Leitlinienimplementierung.

The internet is an innovative medium for the implementation of current recommendations for diagnosis and therapy, e.g. by means of guidelines. In this context, evaluation of the internet is very important because traditional ways of implementation have been proved less effective. Therefore, we investigated the frequency of online access and individual utilisation of the internet among 13,547 family practitioners, internists and general practitioners using a questionnaire procedure. Furthermore, we asked for a personal grading of its current relevance in their daily practice. Out of 2,786 responders (20.6% response rate) 79% reported personal online access. 40% had online computer access in their office and 71% at home. 45% of the internists had online access in their office compared to 34% of general practitioners. Almost all physicians under the age of 40 years (94%) had personal online access in comparison to only 49% of those over 60 years. The average daily duration of internet usage was up to ten minutes in 61%, and 1.5% use the internet more than one hour per day. 46% of responders believe that the internet is an appropriate source for professional education, whereas it has little professional relevance for 38%. We conclude that the internet appears to be a useful medium for the implementation of guidelines. However, in subgroups with the most urgent need for current medical information the internet seems to be unsuitable as an implementation tool.