[Transfer of the AGnES concept to the regular German health-care system: legal evaluation, reimbursement, qualification]. / Uberführung des AGnES-Konzeptes in die Regelversorgung: Juristische Bewertung, Vergütung, Qualifizierung.

INTRODUCTION: According to an amendment of German social security legislation, the AGnES concept of delegation of certain tasks of medical care, especially house calls, by general practitioners (GPs) to qualified practice employees (AGnES employees), will be transferred into the regular German health care system from January 2009 onward. The concept was developed to support GPs in regions with imminent gaps in primary care. METHODS: Patient data, the specifically delegated and all other activities carried out by the AGnES employees in the AGnES projects were digitally documented. Additionally, the participating GPs, AGnES employees and patients underwent a set of standardised interviews. A curriculum to qualify the AGnES employees and to define the requirements needed was developed. A legal assessment of all delegated activities was carried out, and an economical model to calculate the necessary allowance was calculated. RESULTS: In seven model projects in four federal states in Germany, 11,228 house calls were carried out involving 1,424, mostly multimorbid, patients (mean age: 78.6 years). A modular structured curriculum, considering the basic education and acquired competences, was developed. It allows for an individual qualification of the AGnES employees. The result of the legal assessment was the central relevance of the qualification of the practice employees according to the AGnES curriculum as the essential condition for carrying out the entire range of activities of the AGnES concept. The economic model revealed euro 21.58 for a house call by an AGnES employee. The underlying model referred to underserved regions. CONCLUSION: A successful transfer of the AGnES concept with a high standard of quality into regular health-care depends on several factors. Of particular importance is the specific qualification of the practice employees, which is a central legal condition for the delegation of medical tasks from GPs to AGnEs employees. A second determining factor is also an adequate reimbursement within the catalogus of the statutory health insurances.

High-pressure STM of the interaction of oxygen with Ag(111).

To identify surface phases that could play a role for the epoxidation of ethylene on Ag catalysts we have studied the interaction of Ag(111) with O(2) at elevated pressures. Experiments were performed using high-pressure scanning tunneling microscopy (STM) at temperatures between 450 and 480 K and O(2) pressures in the mbar range. Below p(O(2)) approximately 1 mbar the surface largely showed the structure of bare Ag(111). At p(O(2)) above approximately 1 mbar the (4 x 4)O structure and the closely related (4 x 5 radical 3)rect structure were observed. The findings confirm theoretical predictions that the (4 x 4)O structure is thermodynamically stable at the oxygen partial pressure of the industrial ethylene oxide synthesis. However, in other experiments only a rough, disordered structure was observed. The difference is caused by the chemical state of the STM cell that depends on the pretreatment and on previous experiments. The surface was further analyzed by X-ray photoelectron spectroscopy (XPS). Although these measurements were performed after sample transfer to ultra-high vacuum (UHV), so that the surface composition was modified, the two surface states could still be identified by the presence of carbonate or a carbonaceous species, and by the absence or presence of a high-binding energy oxygen species, respectively. It turns out that the (4 x 4)O structure only forms under extremely clean conditions, indicating that the (4 x 4)O phase and similar oxygen-induced reconstructions of the Ag(111) surface are chemically unstable. Chemical reactions at the inner surfaces of the STM cell also complicate the detection of the catalytic formation of ethylene oxide.