[Patients' needs and expectations concerning prevention and health advice in primary care. Results from the EUROPREVIEW survey]. / Welche Erwartungen hinsichtlich Prävention und Gesundheitsberatung haben Patienten an ihre Hausärzte? Ergebnisse aus dem EUROPREVIEW--Patientensurvey.

BACKGROUND: The aim of the EUROPREVIEW study was to explore patients' beliefs about primary care prevention, to assess their needs to make changes in lifestyle and their willingness to receive support from GPs. METHODS: A cross-sectional survey was undertaken in 22 European countries with 10 practices each that consecutively included 40 patients between 30 and 70 years. Validity of the structured questionnaire was evaluated by pilot testing after translation und back-translation for every country. This explorative analysis compared German data on lifestyle factors like smoking, body weight and physical activity to those from other European countries. RESULTS: There were no differences in patients' needs for changes in unhealthy habits and the views of patients that GPs initiated a discussion on lifestyle factors. In Germany significantly less patients wish to receive advice by their GP [eating habits 41.1 (Germany %) vs. 66.6 (other countries %), physical activity 31.0 vs. 57.0, body weight 44.1 vs. 67.1, smoking 49.1 vs. 63.3, alcohol 43.5 vs. 55.9]. CONCLUSION: Further research should firstly adress the reasons for the low demand by German patients for health advice on lifestyle factors and, if necessary, secondly evaluate the opportunities for a better range of preventive services in primary care.

[Patients' perspectives beyond sectoral borders between inpatient and outpatient care - patients' experiences and preferences along cross-sectoral episodes of care]. / Die Patientenperspektive jenseits ambulant-stationärer Sektorengrenzen - Was ist Patientinnen und Patienten in der sektorenübergreifenden Versorgung wichtig?

AIM: Patient perspective is crucial concerning health care and quality improvement. During episodes of care, patients come into contact with multidisciplinary health-care providers in inpatient and outpatient settings and are in a unique position to describe processes throughout the entire chain of care. The aim of this study was to identify patients' experiences and preferences with fragmented cross-sectoral care to develop a patient-centred cross-sectoral quality-assessment instrument. METHOD: Patient perspective was analysed using qualitative focus-group methods. Patients were recruited from general practices if they had experienced cross-sectoral care. Focus group discussions were audiotaped, transcribed and analysed using ATLAS.ti software. Categories were extracted deductively according to a previously developed focus group guide and supplemented by inductive analyses. RESULTS: Patients identified quality gaps mainly concerning communication and coordination of care mostly along the cross-sectoral interfaces. Referrals and hospitalisations were characterised by redundant examinations and deficits in forwarding clinical findings. Support and organisation of follow-up care was rated to be improvable mainly during inpatient care and discharge. Patients identified also quality deficits concerning inpatient hygiene factors and changes of medication. Lack of transparency and responsibility within the entire chain of care caused anxiety and unstableness of patients. CONCLUSION: Patients' experiences provide important information to identify quality gaps along the entire chain of care. Study results can be used to develop a cross-sectoral patient-centred quality assessment instrument.

[HeiCare®: a project aiming to improve medication communication across health care sectors]. / HeiCare® : ein Projekt zur Verbesserung der sektorenübergreifenden Arzneimittelkommunikation.

BACKGROUND AND OBJECTIVE: Changes between health care sectors represent a critical phase in long-term pharmacotherapy. The aim of the Hei CARE(®) project was to close the communication gap at the interface between primary care physicians (PCP), hospital physicians and patients, and to improve quality and safety of pharmacotherapy. METHODS: Physicians who enrolled patients with long-term pharmacotherapy were able to participate in the Hei CARE(®) project. After enrolment the patient's medication was entered in the internet-based medication knowledge data base AiD PRAXIS and checked for medication interactions and optimized if necessary. At hospitalisation medication was transferred electronically to the hospital (AiD KLINIK(®)) and on discharge integrated in the discharge letter and faxed to the primary care physician (PCP). The project was evaluated using quantitative and qualitative methods. Hei CARE(®) -cases, in which medication was transferred electronically as planned, were compared with the other cases. PCPs' experiences were collected in focus groups. RESULTS: One thousand and three chronically ill patients of 56 primary care practices participated. 259 patients were hospitalized between October 2005 and March 2009 of which entrance and discharge medication were transferred both ways via the electronic prescribing platform in 67 cases. The number of changes in medication was reduced in comparison to the other cases. Participating PCPs reported positive changes through Hei CARE(®) as well as further potential for optimizing communication across health care sectors. CONCLUSION: Use of a common internet-based medication knowledge data base (Hei CARE(®) ) in both health care sectors reduced the number of changes in pharmacotherapy. Seamless care in chronically ill patients was thereby improved. The project also demonstrated that improving communication across health care sectors is a slow process.

Standardized documentation of drug recommendations in discharge letters--a contribution to quality management in cooperative care.

OBJECTIVES: To analyze the necessity and potential usefulness of a computerized physician order entry (CPOE) system in supporting the writing of pharmacotherapeutic recommendations in discharge letters. METHODS: Systematic analysis of drug recommendations in discharge letters of a hospital providing tertiary care, structured interviews with in-hospital prescribers, and focus groups with general practitioners who admit patients to this hospital. RESULTS: We analyzed 1800 randomly selected discharge letters, 1205 of which contained pharmacotherapeutic recommendations. The frequencies, structure, and quality of these recommendations varied considerably between departments. Nearly 16% of the recommendations contained both proprietary (brand) and non-proprietary names (active ingredient). Interviewed clinicians expressed interest in CPOE systems that check for contraindications and interactions between drugs, suggest cheaper products, and automatically insert active ingredients when omitted. The focus group sessions confirmed that the pharmacotherapeutic recommendations in current discharge letters do not effectively support daily clinical practice. CONCLUSIONS: Documenting active ingredients as well as brand names in drug therapy recommendations is currently not part of clinical practice. Computerized decision support can help to optimise the structure and communication of therapeutic information across interfaces and can be a quality factor with considerable influence on process quality, outcome quality, and costs of cooperative patient care.