Suchergebnisse

ZUSAMMENFASSUNG
Hintergrund Die vorliegende Studie untersucht die Beeinflussung der
Tätigkeit von Hausärzt*innen und
Orthopäd*innen durch die empfundene Regressgefahr und das
Ausmaß eigener Regresserfahrungen.
Methoden Einer bundesweiten Zufallsstichprobe von 1000
Hausärzt*innen und 1000 Orthopäd*innen wurde ein
4-seitiger Fragebogen mit Fragen zu Auswirkungen und Konsequenzen drohender
Regressgefahr bzw. tatsächlich erlebter Regresse zugesandt.
Ergebnisse Die Rücklaufquote betrug 41% bei den
Hausärzt*innen und 39% bei den
Orthopäd*innen. 47% der teilnehmenden
Hausärzt*innen und 55% der
Orthopäd*innen gaben an, dass sie die Regressgefahr im
Praxisalltag stark oder sehr stark beschäftige, 37 bzw. 47%,
dass ihr ärztliches Handeln dadurch stark bzw. sehr stark beeinflusst
werde. 51 bzw. 25% berichteten zumindest gelegentlich trotz gegebener
Indikation einer Verordnung von Arznei- oder Heilmitteln zu einem (anderen)
Spezialisten zu überweisen. 72% der teilnehmenden
Hausärzt*innen und 59% der
Orthopäd*innen wurden mindestens einmal in Regress genommen, 36
bzw. 19% bereits häufiger als dreimal. 18 bzw. 26% haben
ein Regressverfahren über mehr als 5000 € erlebt. Die emotionale
Belastung durch den schlimmsten Regress wurde von 72 bzw. 78% der
Betroffenen als stark oder sehr stark empfunden.
Schlussfolgerung Regressgefahr und Regresse wirken sich mitunter stark auf
die Tätigkeit von niedergelassenen Hausärzt*innen und
Orthopäd*innen aus. Regresse werden oft emotional belastend
empfunden und teilweise als niederlassungshemmend gesehen.

Abstract Background Governmental funding support is seen as a prerequisite for the growth of research in general practice. Several funding programs in the amount of € 13.2 Mio were introduced in Germany from 2002 to February 2012. We aim to provide an overview of publications reporting original data and systematic reviews from German academic family medicine published between 2000 and 2010. Methods Publications were identified by searching the database Scopus and screening publication lists of family medicine divisions or institutes. Papers had to report original primary research studies or systematic reviews; at least one of the authors had to be affiliated to a German academic family medicine division or institute. Results 794 articles were included. The number of publications increased steadily starting from 107 in the period from 2000 to 2003, to 273 from 2004 to 2007, and finally to 414 from 2008 to 2010. Less than 25% were published in English in the first period. This proportion increased to 60.6% from 2008 to 2010. Articles published in a journal without impact factor decreased from 59.8% to 31.9%. Nevertheless, even in the most recent period only 31.6% of all articles were published in a journal with an impact factor above 2. The median impact factor increased from 0 in the first period to 1.2 in the last. Conclusions The output of original research publications from academic research divisions and institutes for general practice in Germany greatly increased during the last decade. However, professionalism of German primary care research still needs to be developed.

Zusammenfassung
Ziel der Studie Im Rahmen des in Bayern festgestellten Katastrophenfalls
in der frühen Corona-Phase 2020 wurden sog.
Versorgungsärzt*innen (VÄ) für die ambulante
Versorgung etabliert. Ziel der vorliegenden Befragungen war eine Bewertung
dieser neu eingeführten, jedoch zeitlich begrenzten Position.
Methodik Im November 2020 wurde ein papierbasierter Fragebogen an alle 85
durch Internetrecherche identifizierbaren VÄ sowie an alle 197
hausärztlichen Lehrarztpraxen (HÄ) des Instituts für
Allgemeinmedizin und Versorgungsforschung der TU München verschickt. Die
Datenauswertung erfolgte deskriptiv und anonymisiert.
Ergebnisse Insgesamt konnten 75 (88%) VÄ und 156
(79%) HÄ eingeschlossen werden. 97% der VÄ und
67% der HÄ bewerteten die Einführung von VÄ als
sinnvoll, jedoch auch als Eingriff in die ärztliche Selbstverwaltung
(VÄ: 59% bzw. HÄ: 42%). 37% der
HÄ äußerten, VÄ sollten im weiteren Verlauf der
Pandemie möglichst vermieden werden. Bei intensiverem Kontakt zu
VÄ zeigten sich auf hausärztlicher Seite insgesamt
höhere Zustimmungswerte. Die Zusammenarbeit und Kommunikation mit
Politik, Behörden und Kassenärztlicher Vereinigung Bayerns
wurden von beiden Gruppen als schwierig und oft widersprüchlich
bewertet. Zu differenzieren ist, dass VÄ die Kooperation mit Politik und
Behörden auf lokaler Ebene, bspw. mit der Führungsgruppe
Katastrophenschutz, mehrheitlich als positiv beurteilten. Der Mangel an
Schutzausrüstung zu Pandemiebeginn wurde von beiden Befragungsgruppen
kritisch gesehen.
Schlussfolgerung Die Etablierung von VÄ in Bayern in der
frühen Corona-Phase 2020 wurde von fast allen VÄ und der
Mehrheit der befragten HÄ für sinnvoll erachtet. Für die
Zukunft scheint es notwendig, primärztliche Vertreter*innen
stärker und dauerhaft in Entscheidungsprozesse einzubeziehen und
bestehende Strukturen zu stärken.

Für Betriebe und Beschäftigte gilt es dabei gleichermaßen, sich den neuen Anforderungen zu stellen. Gefordert ist eine innovationsförderliche Gestaltung der Arbeitsverhältnisse, um flexibel auf Neuerungen reagieren zu können. Welche Möglichkeiten und Grenzen bei der Flexibilisierung von Arbeitszeit, Arbeitsentgelt und Arbeitsorganisation bestehen, ist Gegenstand dieses Handbuches. Das Werk bietet einen umfassenden Überblick über die arbeits- und sozialrechtlichen Rechtsfragen der derzeit gängigen innovativen Arbeitsformen. Die praxisgerechte Darstellung, eine Vielzahl von Beispielen und Hinweisen sowie zahlreiche Musterformulierungen machen es zu einem wertvollen Berater bei der Einführung und Umsetzung flexibler Arbeitsbedingungen. Der Herausgeber ist ordentlicher Professor für Bürgerliches Recht, Arbeitsrecht und Sozialrecht an der Universität zu Köln und geschäftsführender Direktor des Forschungsinstituts für Deutsches und Europäisches Sozialrecht. Er ist Autor der Lehrbücher Arbeitsrecht "Individualarbeitsrecht" und "Kollektivarbeitsrecht" sowie Herausgeber und Autor von "Der Arbeitsvertrag". Die Autoren sind bzw. waren Mitarbeiterinnen und Mitarbeiter des Instituts

Zusammenfassung
Ziel der Studie Die erste COVID-19-Pandemiewelle
(März–April 2020) hat die hausärztliche Versorgung vor
große Herausforderungen gestellt. Ziel der Studie war es zu untersuchen,
wie belastend HausärztInnen die Krisensituation zu Pandemiebeginn und im
weiteren Pandemieverlauf erlebt haben. Zusätzlich sollten
prädiktive Faktoren für das Überforderungsgefühl
identifiziert werden.
Methode Von August bis Oktober 2020 erfolgte eine Querschnittsbefragung
von Hausarztpraxen in vier Bundesländern zur Versorgungsrealität
sowie zu psychischen Belastungen im Rahmen der Coronapandemie. Insgesamt 6300
zufällig ausgewählte HausärztInnen wurden
angeschrieben.
Ergebnisse Die Rücklaufquote betrug 23%. 46% der
Teilnehmenden waren weiblich. 40% der Teilnehmenden gaben an, zu Beginn
der Pandemie unter einem großen oder sehr großen
Überforderungsgefühl gelitten zu haben, zum Befragungszeitpunkt
äußerten dies nur noch 10%. Mit steigender Anzahl der
COVID-19-PatientInnen nahm das Gefühl der Überforderung zu;
gleichzeitig stieg auch die selbst eingeschätzte Kompetenz,
COVID-19-PatientInnen zu versorgen. Unter anderem trugen eine hohe psychische
Belastung, hoher Organisationsaufwand, eine schlechte
selbsteingeschätzte Kompetenz bei der Versorgung von
COVID-19-PatientInnen und mangelnde Versorgung mit Schutzausrüstung zum
Überforderungserleben der HausärztInnen bei.
Schlussfolgerung Trotz anfänglicher Überforderung
fühlten sich HausärztInnen zunehmend kompetent in der Versorgung
von COVID-19-PatientInnen. Um HausärztInnen in Krisensituationen
zukünftig besser zu unterstützen, sollten organisatorische
Tätigkeiten möglichst vereinfacht werden, um das Augenmerk auf
die PatientInnenversorgung legen zu können.

The use of complementary and alternative Medicine (CAM) has increased over the past two decades in Europe. Nonetheless, research investigating the evidence to support its use remains limited. The CAMbrella project funded by the European Commission aimed to develop a strategic research agenda starting by systematically evaluating the state of CAM in the EU. CAMbrella involved 9 work packages covering issues such as the definition of CAM; its legal status, provision and use in the EU; and a synthesis of international research perspectives. Based on the work package reports, we developed a strategic and methodologically robust research roadmap based on expert workshops, a systematic Delphi-based process and a final consensus conference. The CAMbrella project suggests six core areas for research to examine the potential contribution of CAM to the health care challenges faced by the EU. These areas include evaluating the prevalence of CAM use in Europe; the EU cititzens' needs and attitudes regarding CAM; the safety of CAM; the comparative effectiveness of CAM; the effects of meaning and context on CAM outcomes; and different models for integrating CAM into existing health care systems. CAM research should use methods generally accepted in the evaluation of health services, including comparative effectiveness studies and mixed-methods designs. A research strategy is urgently needed, ideally led by a European CAM coordinating research office dedicated to fostering systematic communication between EU governments, the public, charitable and industry funders, researchers and other stakeholders. A European Centre for CAM should also be established to monitor and further a coordinated research strategy with sufficient funds to commission and promote high quality, independent research focusing on the public's health needs and pan-European collaboration. There is a disparity between highly prevalent use of CAM in Europe and solid knowledge about it. A strategic approach on CAM research should be established to investigate the identified gaps of knowledge and to address upcoming health care challenges.

The CAMbrella coordination action was funded within the Framework Programme 7. Its aim is to provide a research roadmap for clinical and epidemiological research for complementary and alternative medicine (CAM) that is appropriate for the health needs of European citizens and acceptable to their national research institutes and healthcare providers in both public and private sectors. One major issue in the European research agenda is the demographic change and its impact on health care. Our vision for 2020 is that there is an evidence base that enables European citizens to make informed decisions about CAM, both positive and negative. This roadmap proposes a strategic research agenda for the field of CAM designed to address future European health care challenges. This roadmap is based on the results of CAMbrella's several work packages, literature reviews and expert discussions including a consensus meeting.We first conducted a systematic literature review on key issues in clinical and epidemiological research in CAM to identify the general concepts, methods and the strengths and weaknesses of current CAM research. These findings were discussed in a workshop (Castellaro, Italy, September 7-9th 2011) with international CAM experts and strategic and methodological recommendations were defined in order to improve the rigor and relevance of CAM research. These recommendations provide the basis for the research roadmap, which was subsequently discussed in a consensus conference (Järna, Sweden, May 9-11th 2012) with all CAMbrella members and the CAMbrella advisory board. The roadmap was revised after this discussion in CAMbrella Work Package (WP) 7 and finally approved by CAMbrella's scientific steering committee on September 26th 2012.Our main findings show that CAM is very heterogenous in terms of definitions and legal regulations between the European countries. In addition, citizens' needs and attitudes towards CAM as well as the use and provision of CAM differ significantly between countries. In terms of research methodology, there was consensus that CAM researchers should make use of all the commonly accepted scientific research methods and employ those with utmost diligence combined in a mixed methods framework.We propose 6 core areas of research that should be investigated to achieve a robust knowledge base and to allow stakeholders to make informed decisions. These are: Research into the prevalence of CAM in Europe: Reviews show that we do not know enough about the circumstances in which CAM is used by Europeans. To enable a common European strategic approach, a clear picture of current use is of the utmost importance. Research into differences regarding citizens' attitudes and needs towards CAM: Citizens are the driver for CAM utilization. Their needs and views on CAM are a key priority, and their interests must be investigated and addressed in future CAM research. Research into safety of CAM: Safety is a key issue for European citizens. CAM is considered safe, but reliable data is scarce although urgently needed in order to assess the risk and cost-benefit ratio of CAM. Research into the comparative effectiveness of CAM: Everybody needs to know in what situation CAM is a reasonable choice. Therefore, we recommend a clear emphasis on concurrent evaluation of the overall effectiveness of CAM as an additional or alternative treatment strategy in real-world settings. Research into effects of context and meaning: The impact of effects of context and meaning on the outcome of CAM treatments must be investigated; it is likely that they are significant. Research into different models of CAM health care integration: There are different models of CAM being integrated into conventional medicine throughout Europe, each with their respective strengths and limitations. These models should be described and concurrently evaluated; innovative models of CAM provision in health care systems should be one focus for CAM research. We also propose a methodological framework for CAM research. We consider that a framework of mixed methodological approaches is likely to yield the most useful information. In this model, all available research strategies including comparative effectiveness research utilising quantitative and qualitative methods should be considered to enable us to secure the greatest density of knowledge possible. Stakeholders, such as citizens, patients and providers, should be involved in every stage of developing the specific and relevant research questions, study design and the assurance of real-world relevance for the research. Furthermore, structural and sufficient financial support for research into CAM is needed to strengthen CAM research capacity if we wish to understandwhy it remains so popular within the EU. In order to consider employing CAM as part of the solution to the health care, health creation and self-care challenges we face by 2020, it is vital to obtain a robust picture of CAM use and reliable information about its cost, safety and effectiveness in real-world settings. We need to consider the availability, accessibility and affordability of CAM. We need to engage in research excellence and utilise comparative effectiveness approaches and mixed methods to obtain this data. Our recommendations are both strategic and methodological. They are presented for the consideration of researchers and funders while being designed to answer the important and implicit questions posed by EU citizens currently using CAM in apparently increasing numbers. We propose that the EU actively supports an EU-wide strategic approach that facilitates the development of CAM research. This could be achieved in the first instance through funding a European CAM coordinating research office dedicated to foster systematic communication between EU governments, public, charitable and industry funders as well as researchers, citizens and other stakeholders. The aim of this office would be to coordinate research strategy developments and research funding opportunities, as well as to document and disseminate international research activities in this field. With the aim to develop sustainability as second step, a European Centre for CAM should be established that takes over the monitoring and further development of a coordinated research strategy for CAM, as well as it should have funds that can be awarded to foster high quality and robust independent research with a focus on citizens health needs and pan-European collaboration. We wish to establish a solid funding for CAM research to adequately inform health care and health creation decision-making throughout the EU. This centre would ensure that our vision of a common, strategic and scientifically rigorous approach to CAM research becomes our legacy and Europe's reality. We are confident that our recommendations will serve these essential goals for EU citizens.

The use of complementary and alternative Medicine (CAM) has increased over the past two decades in Europe. Nonetheless, research investigating the evidence to support its use remains limited. The CAMbrella project funded by the European Commission aimed to develop a strategic research agenda starting by systematically evaluating the state of CAM in the EU. CAMbrella involved 9 work packages covering issues such as the definition of CAM; its legal status, provision and use in the EU; and a synthesis of international research perspectives. Based on the work package reports, we developed a strategic and methodologically robust research roadmap based on expert workshops, a systematic Delphi-based process and a final consensus conference. The CAMbrella project suggests six core areas for research to examine the potential contribution of CAM to the health care challenges faced by the EU. These areas include evaluating the prevalence of CAM use in Europe; the EU cititzens' needs and attitudes regarding CAM; the safety of CAM; the comparative effectiveness of CAM; the effects of meaning and context on CAM outcomes; and different models for integrating CAM into existing health care systems. CAM research should use methods generally accepted in the evaluation of health services, including comparative effectiveness studies and mixed-methods designs. A research strategy is urgently needed, ideally led by a European CAM coordinating research office dedicated to fostering systematic communication between EU governments, the public, charitable and industry funders, researchers and other stakeholders. A European Centre for CAM should also be established to monitor and further a coordinated research strategy with sufficient funds to commission and promote high quality, independent research focusing on the public's health needs and pan-European collaboration. There is a disparity between highly prevalent use of CAM in Europe and solid knowledge about it. A strategic approach on CAM research should be established to investigate the identified gaps of knowledge and to address upcoming health care challenges.