Internal consistency of the readiness for interprofessional learning scale in German health care students and professionals.

BACKGROUND: The implementation of a bachelor degree in "Interprofessional Health Care" at the University of Heidelberg, Germany has fostered the need to evaluate the impact of this innovative programme. The Readiness for Interprofessional Learning Scale (RIPLS) was developed by Parsell and Bligh (1999) to assess student's attitudes towards interprofessional education. The RIPLS consists of 19 items and four subscales were identified by McFadyen (J Interprof Care19:595-603, 2005): "teamwork and collaboration", "negative professional identity", "positive professional identity" and "roles and responsibilities". The RIPLS has been translated into a number of languages and used in a variety of different educational settings. A German version of the RIPLS was not available. Aim of the study was the translation of the RIPLS into German and testing of internal consistency. METHODS: The RIPLS was translated to German according to international guidelines and its psychometric properties were assessed in two online surveys with two different samples a) health care graduates and b) health care students. Descriptive analysis (mean, SD, corrected item-total correlation) of the Readiness for Interprofessional Learning Scale - German (RIPLS-D) was performed for item characteristics and Cronbach's Alpha was calculated for internal consistency of overall and subscales of the RIPLS-D. RESULTS: Each sample consisted of 76 datasets. Reliability for the RIPLS-D overall scale was 0.83 in both samples. The subscales displayed internal consistency between 0.42 and 0.88. Corrected item-total correlation showed low values in two subscales in the sample of graduates. CONCLUSIONS: While the overall RIPLS-D scale is reliable, several subscales showed low values and should be used with caution to measure readiness for interprofessional learning in the German health care context. Internal consistency of the instrument does not seem to be given in health care professionals at different stages of their professional career. In particular the sub-scale "roles and responsibilities" was problematic. For these reasons, the RIPLS-D cannot be recommended for use to assess this concept.

Use of home remedies: a cross-sectional survey of patients in Germany.

BACKGROUND: Reliable information regarding patient knowledge of home remedies and the types of health problems patients use them for is scarce. Nevertheless, anecdotal evidence indicates that home remedies are used by patients for managing minor health problems and that this can be sufficient for symptom management while the body recovers from minor health problems. The aim of the presented study was to explore patient use of home remedies in Germany. METHODS: A questionnaire was developed and pretested in a pilot study phase. The revised questionnaire was comprised of questions about general knowledge and experienced efficiency of home remedies, the use of home remedies for common health problems and socio-demographic data. Patients were recruited via randomly selected addresses of general practitioners (GPs) in three regions of Germany (Heidelberg, Erfurt and Hanover and surrounding areas). The questionnaire was handed out in the waiting area of GP practices. The data was analyzed descriptively. RESULTS: 480 of 592 patients from 37 GP practices were included, according to a response rate of 81%. Based on the survey results, home remedies were widely known and used by about 80% of our respondents (on average 22 different home remedies were used per person). The most frequently used home remedies were steam-inhalation, hot lemon drink, honey, chamomile tea and chicken soup. 80% of respondents tried home remedies before pharmaceutical options. Information about home remedies was most commonly gained from family members, rather than from written guides, media or GPs. CONCLUSIONS: These results provide an initial overview on the use of home remedies from the patient's perspective in a German context. Bearing in mind the high use of home remedies that was reported by patients in the study, it is highly likely that GPs in Germany may need to advise patients on their use of home remedies during consultations. To this end, given the scarcity of reliable information on home remedies, further research is needed.

A brief patient-reported outcome instrument for primary care: German translation and validation of the Measure Yourself Medical Outcome Profile (MYMOP).

BACKGROUND: Measure Yourself Medical Outcome Profile (MYMOP) is a patient-generated outcome instrument capable of measuring effects from a wide range of health care interventions. This paper reports the translation of this instrument into German (MYMOP-D) and the assessment of validity and sensitivity to change for the MYMOP-D. The instrument was piloted in a German primary care context. METHODS: The translation process was conducted according to international guidelines. Recruited patients of both general practitioners and non-medical Complementary and Alternative Medicine (CAM) practitioners ("Heilpraktiker") in the German state of Baden-Wuerttemberg completed a questionnaire comprised of the MYMOP-D and the EQ-5D. Responses were analysed to assess construct validity. For assessing the instrument's sensitivity to change, patients received the MYMOP-D again after four weeks at which point they were also asked for their subjective views on change of symptoms. Correlation between MYMOP-D and EQ-5D and sensitivity to change as gradient in score change and as standardized response mean (SRM) were calculated. RESULTS: 476 patients from general practices and 91 patients of CAM practitioners were included. Construct validity of the MYMOP-D was given with a correlation of r = .47 with the EQ-5D. Sensitivity to change for subjective change of symptoms could only be analysed for improvement or no change of symptoms, as only 12 patients reported deterioration of symptoms. Results showed the expected smooth gradient with 2.2, 1.3, and 0.5 points of change for large, little improvement and no change, respectively. SRM for MYMOP-D Profile Score was 0.88. CONCLUSIONS: The MYMOP-D shows excellent construct validity. It is able to detect changes when symptoms in patients improve or remain unchanged. Deterioration of symptoms could not be evaluated due to too few data. With its brevity and simplicity, it might be an important tool for enhancing patient-centred care in the German health care context.

Evaluating the quality of colorectal cancer care across the interface of healthcare sectors.

BACKGROUND: Colorectal cancer (CRC) has a high prevalence in western countries. Diagnosis and treatment of CRC is complex and requires multidisciplinary collaboration across the interface of health care sectors. In Germany, a new nationwide established program aims to provide quality information of healthcare delivery across different sectors. Within this context, this study describes the development of a set of quality indicators charting the whole pathway of CRC-care including data specifications that are necessary to operationalize these indicators before practice testing. METHODS: Indicators were developed following a systematic 10 step modified 'RAND/UCLA Appropriateness Method' which involved a multidisciplinary panel of thirteen participants. For each indicator in the final set, data specifications relating to sources of quality information, data collection procedures, analysis and feedback were described. RESULTS: The final indicator set included 52 indicators covering diagnostic procedures (11 indicators), therapeutic management (28 indicators) and follow-up (6 indicators). In addition, 7 indicators represented patient perspectives. Primary surgical tumor resection and pre-operative radiation (rectum carcinoma only) were perceived as most useful tracer procedures initiating quality data collection. To assess the quality of CRC care across sectors, various data sources were identified: medical records, administrative inpatient and outpatient data, sickness-funds billing code systems and patient survey. CONCLUSION: In Germany, a set of 52 quality indicators, covering necessary aspects across the interfaces and pathways relevant to CRC-care has been developed. Combining different sectors and sources of health care in quality assessment is an innovative and challenging approach but reflects better the reality of the patient pathway and experience of CRC-care.

Predictors for half-year outcome of impairment in daily life for back pain patients referred for physiotherapy: a prospective observational study.

BACKGROUND AND OBJECTIVE: From observational studies, there is only sparse information available on the predictors of development of impairment in daily life for patients receiving physiotherapy. Therefore, our aim was to identify factors which predict impairment in daily life for patients with back pain 6 months after receiving physiotherapy. METHODS: We conducted a prospective cohort study with 6-month follow-up. Patients were enrolled for treatment in private physiotherapy practices. Patients with a first physiotherapy referral because of thoracic or low back pain, aged 18 to 65 years were included. Primary outcome impairment was measured utilising the 16-item version of the Musculoskeletal Function Assessment Questionnaire. Therapy was documented on a standardized form. Baseline scores for impairment in daily life, symptom characteristics, sociodemographic and psychosocial factors, physical activity, nicotine consumption, intake of analgesics, comorbidity and delivered primary therapy approach were investigated as possible predictors. Univariate and multiple linear regression analyses were performed. RESULTS: A total of 792 patients participated in the study (59% female, mean age 44.4 (SD 11.4), with 6-month follow-up results available from 391 patients. In univariate analysis 17 variables reached significance. In multiple linear regression identified predictors were: impairment in daily life before therapy, mental disorders, duration of the complaints, self-prognosis on work ability, rheumatoid arthritis, age, form of stress at work and physical activity. The variables explain 34% of variance (adjusted R(2), p<0.001). CONCLUSIONS: With minimal information available from observational studies on the predictors of development of back problems for physiotherapy patients, this study adds new knowledge for forming appropriate referral guidelines. Impairment in daily life before therapy, mental disorder as comorbidity and the duration of the complaints can be named as outstanding factors. The results of this study can be used to facilitate comparison of patient therapy goals with the prognosis in everyday practice.

[New ways in caring for patients with functional syndromes - interdisciplinary group intervention in the primary care setting: a qualitative study]. / Neue Wege in der Versorgung von Patienten mitfunktionellen Syndromen - Interdisziplinäre Gruppen-behandlung in der Hausarztpraxis: Eine qualitative Studie.

Interface problems between health care sectors hinder collaborative care in functional syndromes. The speciAL trial investigated a disorder-oriented group intervention conducted by the general practitioner (GP) and a psychosomatic specialist (PS) in the GP's office. To evaluate the GP-PS cooperation, our qualitative study analysed free text statements about collaborative group leading of all 18 intervention GPs. In the GPs' view, all sessions should structuredly be prepared and reviewed together for 20 min. Functions of the preparatory communication were gaining distance from daily business, attunement to the group and to each other, and preparing for the session topics. Functions of the communication after the sessions were professional exchange, reflection of the session and further treatment planning. The GPs saw the PS's role as a group leader and expert, their own role as a reference person for the patient, a link between all dimensions and a cotherapist. Crucial seemed a succeeding role splitting.

Diuretics for hypertension-reasons for a contradiction in primary care prescribing behavior: a qualitative study.

There has been a long international discussion on diuretics as first-line therapy for hypertension. In Germany, thiazide diuretics are very rarely prescribed in monotherapy and concurrently highly prescribed in fixed-combinations. The aim of this study was to approach the reasons for this inconsistency in primary care prescribing behavior. A qualitative study design consisting of single interviews with general practitioners (GPs) was chosen. Most GPs perceived diuretics as too weak to treat arterial hypertension effectively in monotherapy. In combination therapy, GPs expected to spare the dose and to offset certain side effects of other drugs. The convenient availability of diuretics in most fixed-dose combinations on the German drug market was seen as an important reason for their frequent prescription in combination therapy. Thus, the reasons given by the GPs differed from the main arguments of the academic debate. Dissemination strategies for guidelines should take the perceptions and opinions of practicing GPs into account.

Palliative patients cared for at home by PAMINO-trained and other GPs - health-related quality of life as measured by QLQ-C15-PAL and POS.

BACKGROUND: To maintain patients' quality of life is one of the major goals in palliative home care provided by general practitioners (GPs). GPs need adequate training to care for palliative patients. The paper seeks to evaluate whether a specific training in Germany (PAMINO) has any improving impact on the care of palliative patients and their health-related quality of life. METHODS: From September 2007 until June 2009, GPs and their palliative care patients with cancer participated in a study to evaluate palliative courses for GPs offered by a regional palliative care initiative (PAMINO). For a period of six months at most or until death, patients were asked monthly to judge their quality of life on the Quality of Life Questionnaire Core 15 Palliative (QLQ-C15-PAL) of the European Organization for Research and Treatment of Cancer (EORTC) and on the Palliative Care Outcome Scale (POS). The 'Overall quality of life' scale of the QLQ-C15-PAL takes values between 0 and 100 with higher values indicating a higher quality of life. The POS sum scale takes values between 0 and 40 with higher values indicating worse care outcomes. Patients cared for by PAMINO-trained GPs and patients cared for by other GPs (control group) are compared using t-tests for differences in group means. RESULTS: One hundred patients participated in the study; 96 patients filled out the questionnaires at least once. On the QLQ-C15-PAL, mean quality of life of the patient groups of PAMINO-trained and other GPs were 37.7 (SD = 25.5) and 39.4 (SD = 26.3) (p = .76), respectively. On the POS, respective mean values of 13.6 (SD = 5.8) and 12.0 (SD = 6.5) (p = .26) were given. Patients cared for by a PAMINO-trained GP did not report better quality of life and care outcomes than patients cared for by other general practitioners. CONCLUSIONS: Patients cared for by PAMINO-trained and other GPs in our study did not report differences in quality of life. Quality of life and care outcomes of all patients were better than of palliative patients in institutional or specialized care, emphasizing the ability of GPs to provide adequate care for these vulnerable patients. However, conclusions need to be drawn cautiously since the study had a small sample size. TRIAL REGISTRATION: Current Controlled Trials ISRCTN78021852.

PalliPA: How can general practices support caregivers of patients at their end of life in a home-care setting? A study protocol.

BACKGROUND: The care of patients with a life-threatening, progressive and far advanced illness in a home-care setting requires appropriate individual care and requires the active support of family caregivers. General practice teams are usually the primary care givers and first contact and are best placed to offer support to family caregivers and to recognise and respond to the burden of care giving on family members. The aim of this project is to develop a best practice model for engaging with and supporting family caregivers. FINDINGS: The project is framed as an exploratory trial for a subsequent implementation study, covering phases 0, I and II of the MRC (Medical Research Council) framework for development, design and evaluation of complex interventions. The project is a multi-method procedure and has two phases. In the first phase, which has already been completed, we used a reflective practice procedure where general practice teams were asked about how they currently deal with family caregivers. In the second phase, a participatory action research approach aims to improve identification and response to when support is necessary for family caregivers. Ten participating general practice teams each enrol 40 eligible patients and their family caregiver, to identify structures and tools feasible for use in their practice. Standardised self-reported questionnaires (Burden Scale for Family Caregivers and Quality of Life Questionnaire Core 15 Palliative) are being applied at study inclusion (prior to or during the implementation period) and after 6 and 12 months to explore implementation effects. Qualitative assessment of general practice teams' experiences will be triangulated with the quantitative evaluation of the implementation. DISCUSSION: This two-step approach, which is appropriate to primary palliative care in the German health care context, will enable general practice teams to develop feasible, acceptable and successful strategies for the implementation of best practice to successfully support family caregivers of patients at the end of life.

Can a feedback report and training session on medication counseling for general practitioners improve patient satisfaction with information on medicines?

BACKGROUND: Regular intake of medicines prevents hospitalization and improves treatment outcomes in patients with chronic diseases; however, requires good patient-physician communication. Yet, this communication is often insufficient and characterized by misunderstandings. This paper aimed to explore whether a training session on medication counseling for general practitioners (GPs) can improve patient satisfaction about information on medicines. METHODS: Within a seamless care project (HeiCare(®)), a questionnaire to assess patient satisfaction with information on medicines and other questions related to medication issues was distributed among 370 patients. Results were returned to physicians in a feedback report, discussed in a training session, and a subsequent second questionnaire was sent to patients. RESULTS: Patients showed a significant increase in satisfaction with overall information on medicines and with information on potential problems when experiencing medication counseling after their GP received a feedback report and/or training session. CONCLUSION: Individual feedback and training sessions can improve medication counseling and GPs' awareness of patients' attitudes toward medicines and thus increase patients' satisfaction with medicines information received. Regular feedback to the GP on patients' satisfaction with information and patients' beliefs in medicines can be obtained by patient surveys or by addressing these issues in regular medication counseling encounters. Physicians need to be trained to listen to patients' views and concerns on medication.

Patients' beliefs about medicines in a primary care setting in Germany.

OBJECTIVES: The aim of this study was to explore patients' beliefs about medicines by administering the German version of the Beliefs about Medicines Questionnaire (BMQ) in a primary care setting among chronically ill patients and to examine its psychometric properties. The BMQ assesses patients' beliefs about their individual prescribed medication as well as their beliefs about medicines in general. METHODS: A cross-sectional survey of 485 chronically ill patients was performed. The German version of the BMQ was evaluated in terms of internal consistency, validity and scale structure. To assess validity the Medication Adherence Report Scale (MARS-D) and the Satisfaction with Information about Medicines Scale (SIMS-D) were applied. RESULTS: The BMQ showed good internal consistency (Cronbach's α 0.79-0.83). Patients' belief about the specific necessity of their medicines correlated positively with the MARS-D (ρ = 0.202; P < 0.01). There were significant correlations in the predicted direction between the MARS-D and all the BMQ subscales with the exception of the General-Overuse subscale (ρ = -0.06; P = 0.30). Relationship to the SIMS-D was comparable to the original study. Factor analysis corroborated the scale structure. CONCLUSIONS: The BMQ is a suitable instrument to measure patients' beliefs in medicines in German primary care settings. Most patients in our sample had positive beliefs concerning the necessity of their medication. Their levels of concern were associated with higher non-adherence.

Becoming a general practitioner--which factors have most impact on career choice of medical students?

BACKGROUND: In Germany, there is a shortage of young physicians in several specialties, the situation of general practitioners (GP) being especially precarious. The factors influencing the career choice of German medical students are poorly understood. This study aims to identify factors influencing medical students' specialty choice laying a special focus on general practice. METHODS: The study was designed as a cross-sectional survey. In 2010, students at the five medical schools in the federal state of Baden-Wuerttemberg (Germany) filled out an online-questionnaire. On 27 items with 5-point Likert scales, the students rated the importance of specified individual and occupational aspects. Furthermore, students were asked to assign their intended medical specialty. RESULTS: 1,299 students participated in the survey. Thereof, 1,114 students stated a current choice for a specialty, with 708 students choosing a career in one of the following 6 specialties: internal medicine, surgery, gynaecology and obstetrics, paediatrics, anaesthetics and general practice. Overall, individual aspects ('Personal ambition', 'Future perspective', 'Work-life balance') were rated as more important than occupational aspects (i.e. 'Variety in job', 'Job-related ambition') for career choice. For students favouring a career as a GP individual aspects and the factor 'Patient orientation' among the occupational aspects were significantly more important and 'Job-related ambition' less important compared to students with other specialty choices. CONCLUSIONS: This study confirms that future GPs differ from students intending to choose other specialties particularly in terms of patient-orientation and individual aspects such as personal ambition, future perspective and work-life balance. Improving job-conditions in terms of family compatibility and work-life balance could help to increase the attractiveness of general practice. Due to the shortage of GPs those factors should be made explicit at an early stage at medical school to increase the number of aspirants for general practice.

Lowering missing item values in quality-of-life questionnaires: an interventional study.

OBJECTIVE: Missing item values (MIV) often occur in quality-of-life (QoL) questionnaires. This study aimed to examine whether the use of introductory exemplary questions reduces the number of MIV and what patient-related factors influence effectiveness of such a QoL form training. METHODS: In a randomized controlled study in ten primary care practice settings, a total of 215 consecutively recruited patients with at least one chronic disease were requested to complete the Medical Outcomes Study 36 Items Short Form (SF-36) questionnaire, German version 1.0. Prior to filling out the QoL form, a sample of randomly selected patients answered three simple written questions similar in wording and appearance to the original SF-36 questionnaire. RESULTS: In total, 126 (58.6%) patients completed the SF-36 questionnaire without MIV. Despite MIV the forms of 46 (21.4%) patients were still computable, i.e., scoring of scales was possible after use of the standardized SF-36 imputation algorithm. After the imputation procedure, MIV significantly hampered generating computable sum scales in 29 (26.6%) of the control group and 14 (13.2%) of the interventional group (P < 0.05). A univariate analysis suggested no evidence that the number of MIV was reduced by the intervention. However, intervention led to a significant decrease of MIV in males but not in females. The education status affected the number of missing data independent of intervention. CONCLUSION: This cross-sectional study showed that the prior use of three self-created questions similar in wording and appearance to the SF-36 questionnaire significantly reduces MIV in male patients. School qualification of QoL respondents inversely correlated with the number of questionnaire MIV, but independent of education status all subjects did benefit from the QoL form training.

Case management for patients with chronic systolic heart failure in primary care: the HICMan exploratory randomised controlled trial.

BACKGROUND: Chronic (systolic) heart failure (CHF) represents a clinical syndrome with high individual and societal burden of disease. Multifaceted interventions like case management are seen as promising ways of improving patient outcomes, but lack a robust evidence base, especially for primary care. The aim of the study was to explore the effectiveness of a new model of CHF case management conducted by doctors' assistants (DAs, equivalent to a nursing role) and supported by general practitioners (GPs). METHODS: This patient-randomised controlled trial (phase II) included 31 DAs and employing GPs from 29 small office-based practices in Germany. Patients with CHF received either case management (n = 99) consisting of telephone monitoring and home visits or usual care (n = 100) for 12 months. We obtained clinical data, health care utilisation data, and patient-reported data on generic and disease-specific quality of life (QoL, SF-36 and KCCQ), CHF self-care (EHFScBS) and on quality of care (PACIC-5A). To compare between groups at follow-up, we performed analyses of covariance and logistic regression models. RESULTS: Baseline measurement showed high guideline adherence to evidence-based pharmacotherapy and good patient self-care: Patients received angiotensin converting enzyme inhibitors (or angiotensin-2 receptor antagonists) in 93.8% and 95%, and betablockers in 72.2% and 84%, and received both in combination in 68% and 80% of cases respectively. EHFScBS scores (SD) were 25.4 (8.4) and 25.0 (7.1). KCCQ overall summary scores (SD) were 65.4 (22.6) and 64.7 (22.7). We found low hospital admission and mortality rates. EHFScBS scores (-3.6 [-5.7;-1.6]) and PACIC and 5A scores (both 0.5, [0.3;0.7/0.8]) improved in favour of CM but QoL scores showed no significant group differences (Physical/Mental SF-36 summary scores/KCCQ-os [95%CI]: -0.3 [-3.0;2.5]/-0.1 [-3.4;3.1]/1.7 [-3.0;6.4]). CONCLUSIONS: In this sample, with little room for improvement regarding evidence-based pharmacotherapy and CHF self-care, case management showed no improved health outcomes or health care utilisation. However, case management significantly improved performance and key intermediate outcomes. Our study provides evidence for the feasibility of the case management model. TRIAL REGISTRATION NUMBER: ISRCTN30822978.

Assessing reported adherence to pharmacological treatment recommendations. Translation and evaluation of the Medication Adherence Report Scale (MARS) in Germany.

Objectives Patients' self-report of medicine taking is a feasible method of assessing their adherence to prescribed pharmacological treatment. Aim of this study was to assess whether the German version of the Medication Adherence Report Scale (MARS-D) is an appropriate instrument for measuring patient adherence. Methods After translation into German, the questionnaire was sent to 1488 patients with chronic diseases and patients with risk factors of cardiovascular disease. Reliability and validity of the MARS-D were assessed and compared with the psychometric properties of the original English version. The relationship between patients' characteristics and adherent behaviour was estimated using bivariate correlation and a linear regression model. Results The MARS-D was analysed if patients were taking medicines and the MARS-D was complete leaving 523 (35.1%) analysable questionnaires. Internal consistency of the MARS-D (Cronbach's alpha 0.60-0.69) was satisfactory and comparable to the English original (Cronbach's alpha 0.69-0.90). Test-retest reliability was satisfactory (Pearson's r 0.61-0.63), however, lower than in the English sample (r = 0.97). Convergent validity was low but showed statistical significance. Patient socio-demographic characteristics had weak influence on MARS-D score indicating high reported adherence for older patients (P < 0.05), patients with German mother tongue (P < 0.05) and high number of medicines (P < 0.01). Conclusions Preliminary psychometric evaluation of the MARS-D is encouraging. MARS-D is an appropriate measure to detect patients at risk of non-adherence. The MARS-D could be used in routine care to support communication about the medication taking behaviour, as self-report of non-adherent behaviour corresponds to the facts.

Referral practices in patients suffering from non-malignant chronic pain.

This paper presents the results of a prospective observational cohort study investigating referral practices to six specialized pain centres (SPCs) in 303 patients with headache (HD), low back pain (LBP), and neuropathic pain (NP). The study was divided into three parts. Part 1: The pain health care history (contacts with general practitioners and specialists, further referrals, time spans, therapies) before first contact with the SPC. Part 2: Reality of pain therapy and management in the SPC (patients' attrition, interdisciplinarity of therapy and novel therapeutic strategies instigated). Part 3: Follow-up and assessment of pain levels (NRS, SES), disability scores (PDI), QoL scores (SF 12), and anxiety and depression scores (HADS) at 0, 6 and 12 months. Using an ordinal linear regression model, factors predicting a good treatment outcome were identified. On average it took 3 years of pain symptoms before first consultation with GP. The median time period from the first pain sensations until the appointment in the SPC was 12 years. Nearly half of the referrals to specialists or SPCs were initiated by a non-professional. In the SPC the medication was changed in 71% of cases. Care was interdisciplinary in only 32%. At 6 and 12 months after the first contact with the SPC, only 20% of the patients had improved with respect to levels of pain and psychometric data. A high degree of chronicity, a history of pain-associated surgeries and low social support were negative predictors for treatment outcome.

Psychometric properties of a German version of the "Satisfaction with Information about Medicines Scale" (SIMS-D).

OBJECTIVE: The aim of this study was to translate the Satisfaction with Information about Medicines Scale (SIMS) into German and test its psychometric properties in a German primary care setting. The SIMS was developed to assess the extent to which patients feel they have received enough information about their medicines. METHODS: Three hundred seventy chronically ill patients were included in the study. The SIMS was translated to SIMS-D (German version) and evaluated in terms of acceptability, internal consistency, test-retest reliability, discriminant, and criterion-related validity. RESULTS: The SIMS-D showed good internal consistency (Cronbach's alpha 0.92) and adequate test-retest reliability (Pearson's r > 0.7). Relationships to external criteria regarding medication management were acceptable (Spearman's rho > 0.4). The SIMS-D was reasonably well accepted (return rate of 71%); however, older people produced more missing values when filling in the questionnaire. CONCLUSIONS: Preliminary evidence was given that the SIMS-D is a suitable instrument for measuring patient satisfaction with information about medicines in German primary care settings.

Impact of primary care-based disease management on the health-related quality of life in patients with type 2 diabetes and comorbidity.

OBJECTIVE: This study examined the effectiveness of the German diabetes disease management program (DMP) for patients with varying numbers of other medical conditions with respect to their health-related quality of life (HRQoL). RESEARCH DESIGN AND METHODS: A questionnaire, including the HRQoL-measured EQ-5D, was mailed to a random sample of 3,546 patients with type 2 diabetes (59.3% female). The EQ-5D score was analyzed by grouping patients according to those on a DMP and those receiving routine care. RESULTS: The analysis showed that participation in the DMP (P < 0.001), the number of other medical conditions (P < 0.001), and the interaction between the DMP and the number of other conditions (P < 0.05) had a significant impact on the EQ-5D score. CONCLUSIONS: Our findings suggest that the number of other medical conditions may have a negative impact on the HRQoL of patients with type 2 diabetes. The results demonstrate that the German DMP for type 2 diabetes may help counterbalance this effect.

Additional impact of concomitant hypertension and osteoarthritis on quality of life among patients with type 2 diabetes in primary care in Germany - a cross-sectional survey.

BACKGROUND: Patients with type 2 diabetes are likely to have comorbid conditions which represent a high burden for patients and a challenge for primary care physicians. The aim of this cross-sectional survey was to assess the impact of additional comorbidities on quality of life within a large sample of patients with type 2 diabetes in primary care. METHODS: A cross-sectional survey within a large sample (3.546) of patients with type 2 diabetes in primary care was conducted. Quality of life (QoL) was assessed by means of the Medical Outcome Study Short Form (SF-36), self reported presence of comorbid conditions was assessed and groups with single comorbidities were selected. QoL subscales of these groups were compared to diabetes patients with no comorbidities. Group comparisons were made by ANCOVA adjusting for sociodemographic covariates and the presence of depressive disorder. RESULTS: Of 3546 questionnaires, 1532 were returned, thereof 1399 could be analysed. The mean number of comorbid conditions was 2.1. 235 patients declared to have only hypertension as comorbid condition, 97 patients declared to have osteoarthritis only. Patients suffering from diabetes and hypertension reached similar scores like diabetic patients with no comorbidities. Patients with diabetes and osteoarthritis reached remarkable lower scores in all subscales. Compared to patients with diabetes alone these differences were statistically significant in the subscales representing pain and physical impairment. CONCLUSION: The impact of osteoarthritis as an often disabling and painful condition on QoL in patients with type 2 diabetes is higher than the impact of hypertension as common but often asymptomatic comorbidity. Individual care of patients with chronic conditions should aim at both improving QoL and controlling risk factors for severe complications.