@book {1293, title = {Sterbeverf{\"u}gung praxisbezogen}, series = {Umfassende juristische und medizinische Information zum Sterbeverf{\"u}gungsgesetz}, year = {2023}, publisher = {{\"A}rztekammer f{\"u}r K{\"a}rnten und {\"O}sterreichisches Institut f{\"u}r Allgemeinmedizin ({\"O}IfAM)}, organization = {{\"A}rztekammer f{\"u}r K{\"a}rnten und {\"O}sterreichisches Institut f{\"u}r Allgemeinmedizin ({\"O}IfAM)}, abstract = {

Umfassende juristische und medizinische Information zum Sterbeverf{\"u}gungsgesetz

Inhalt:
Selbstbestimmtes Sterben in {\"O}sterreich
Die Sterbeverf{\"u}gung
Hilfeleistung i. S. d. StVfG
Die {\"a}rztliche Aufkl{\"a}rung gem. StVfG: Umfang, Dokumentation, Das {\"a}rztliche Aufkl{\"a}rungsgespr{\"a}ch,
Das Pr{\"a}parat, Die Begleitmedikation, etc.
Medizinisches Fachpersonal als Hilfe leistende Person
Die Totenbeschau
Verweise und Links

https://www.allmed.at/info-arzt/dfp-fortbildung/fachthemen/stvf-praxis

}, author = {Stefanie Fasching and Wilfried M. Tschiggerl} } @mastersthesis {1006, title = {Community-oriented Primary Care in Austria: Status Quo and Prospects for the Future}, volume = {Master in Public Health (MPH)}, year = {2020}, month = {11/2020}, pages = {67}, school = {Medizinische Universit{\"a}t Graz}, type = {Masterarbeit}, address = {Graz}, abstract = {

Hintergrund: Die st{\"a}rkere Integration des Public Health-Ansatzes in die
Prim{\"a}rversorgung erlebt derzeit wieder mehr internationale Aufmerksamkeit.
Gemeinde-orientiere Prim{\"a}rversorgung (COPC) ist ein bekannter Ansatz, um
dies zu erreichen. Diese Arbeit soll analysieren, inwieweit COPC bereits in der
Prim{\"a}rversorgung in {\"O}sterreich etabliert ist und welche wesentlichen Barrieren
und Ressourcen f{\"u}r eine St{\"a}rkung dieses Ansatzes bestehen.

Methoden: Es wurde ein Scoping Review von wissenschaftlicher Literatur zu
COPC in {\"O}sterreich durchgef{\"u}hrt und prim{\"a}rversorgungsrelevante
Grundsatzpapiere und Gesetze auf Gemeinde-Orientierung hin durchsucht.
Zudem wurden 13 semi-strukturierte Interviews mit Prim{\"a}rversorger*innen,
Projektmanager*innen und Wissenschaftler*innen gef{\"u}hrt und mittels
thematischer Inhaltsanalyse untersucht, um gemeinde-orientierte Aspekte in
existierenden Projekten sowie relevante Barrieren und Ressourcen f{\"u}r COPC zu
identifizieren.

Ergebnisse: Es findet sich kaum {\"o}sterreich-spezifische, peer-reviewte Literatur
zu COPC und kaum gezielte Erw{\"a}hnungen von Gemeinde-orientierung in den
untersuchten Dokumenten. Zwar existieren gemeinde-orientierte Projekte in
{\"O}sterreich, diese vermissen jedoch meist wesentliche Elemente von COPC.
Haus{\"a}rzt*innen k{\"o}nnen einen wesentlichen Beitrag zum Gelingen solcher
Projekte leisten. Jedoch fehlt ihnen oft das notwendige Team sowie der einfache
Zugang zu nachhaltiger Finanzierung. Zudem basieren viele Projekte auf
Ehrenamtlichkeit.

Schlussfolgerungen: Gemeinde-orientierung der Prim{\"a}rversorgung ist in
{\"O}sterreich nicht systematisch implementiert. Um diesen Ansatz zu st{\"a}rken
braucht es daher systemische Anstrengungen, zum Beispiel durch die
Einbindung von Gemeinde-orientierung in den Versorgungsauftrag und die
Erleichterung der Bildung von lokalen Prim{\"a}rversorgungsteams. Eine
strukturierte Anbindung an das bereits gut etablierte Netzwerk der {\textquotedblleft}Gesunden
Gemeinden{\textquotedblright} w{\"a}re ein rasch umsetzbarer erster Schritt.

}, keywords = {Community, COPC, Prim{\"a}rversorgung, Primary Health Care}, author = {Sebastian Huter and Jan DeMaeseneer and Florian Stigler} } @article {428, title = {Allgemeinmedizin bietet einen Ort, der soziale Ungleichheit reduziert}, year = {2017}, publisher = {{\"A}rzte Krone}, keywords = {Hausarztmedizin}, author = {Rabady, Susanne} } @article {432, title = {Allseits Zufriedenheit}, year = {2017}, publisher = {{\"A}rzte Krone}, author = {Barbara Degn and Silke Eichner} } @article {548, title = {Clinical presentation and management of stable coronary artery disease in Austria.}, journal = {PLoS One}, volume = {12}, year = {2017}, month = {2017}, pages = {e0176257}, abstract = {

BACKGROUND: Cardiovascular disease is the main cause of death in Austria. However, no systematic information exists regarding characteristics and treatments of contemporary patients with stable coronary artery disease (CAD) in Austria. We assembled two retrospective physicians{\textquoteright} databases to describe demographics, clinical profiles, and therapeutic strategies in patients with stable CAD. In addition, we compared patient profiles of secondary care internists and hospital-based cardiologists with those of general practitioners in a primary care setting outside of hospital.

METHODS: The study population was identified from retrospective chart review of 1020 patients from 106 primary care physicians in Austria (ProCor II registry), and was merged with a previous similar database of 1280 patients under secondary care (ProCor I registry) to yield a total patient number of 2300.

RESULTS: Female patients with stable CAD were older, had more angina and/or heart failure symptoms, and more depression than males. Female gender, type 2 diabetes mellitus, higher CCS class and asthma/COPD were predictors of elevated heart rate, while previous coronary events/revascularization predicted a lower heart rate in multivariate analysis. There were no significant differences with regard to characteristics and management of patients of general practitioners in the primary care setting versus internists in secondary care.

CONCLUSIONS: Characteristics and treatments of unselected patients with stable ischemic heart disease in Austria resemble the pattern of large international registries of stable ischemic heart disease, with the exception that diabetes and systemic hypertension were more prevalent.

}, keywords = {Aged, Aged, 80 and over, Austria, Coronary Artery Disease, Female, Heart Rate, Humans, Male, Middle Aged, Retrospective Studies}, issn = {1932-6203}, doi = {10.1371/journal.pone.0176257}, url = {http://dx.doi.org/10.1371/journal.pone.0176257}, author = {Pichlh{\"o}fer, Otto and Maier, Manfred and Badr-Eslam, Roza and Ristl, Robin and Zebrowska, Magdalena and Lang, Irene M} } @article {430, title = {An das Ministerium}, year = {2017}, publisher = {{\"A}rzte Krone}, keywords = {Gesundheitsreform}, author = {Oliver Lammel} } @article {442, title = {Diagnostic protocols{\textemdash}A consultation tool still to be discovered}, journal = {Journal of evaluation in Clinical Practice}, year = {2017}, keywords = {consultation, Diagnostic}, author = {Waltraud Fink and Gustav Kamenski and M. Konitzer} } @article {431, title = {Die "neue" Ausbildung zur Allgemeinmedizin}, year = {2017}, publisher = {{\"A}rzte Krone}, keywords = {{\"A}AO 2015}, author = {Jan Katzbeck} } @article {426, title = {Editorial: GHZ Enns - endlich er{\"o}ffnet}, year = {2017}, publisher = {{\"A}rzte Krone}, author = {Hockl, Wolfgang} } @article {425, title = {Editorial: Zeitenwende}, year = {2017}, publisher = {{\"A}rzte Krone}, keywords = {Editorial}, author = {Reinhold Glehr} } @article {529, title = {Eine Exploration des Glaubens an gesundheitsf{\"o}rderliche Effekte von alkoholhaltigen Getr{\"a}nken und der Risikoeinsch{\"a}tzung des eigenen Trinkverhaltens}, volume = {Doktor der gesamten Heilkunde (Dr. med. univ.)}, year = {2017}, pages = {99}, publisher = {Medizinische Universit{\"a}t Wien}, type = {Diplomarbeit}, address = {Wien}, abstract = {

Einleitung

Die\  Diplomarbeit\  handelt\  zum\  einen\  vom\  Glauben\  an positive Effekte moderaten\  Alkoholkonsums\  und\  zum\  anderen\  von\  der\  eigenen\  Risikoeinsch{\"a}tzung. Moderater Alkoholkonsum ist eindeutig mit einer reduzierten kardiovaskul{\"a}ren Mortalit{\"a}t assoziiert {\textendash} was zur H{\"a}lfte einer Erh{\"o}hung von HDL im Blut zugeschrieben wird. Es sollte untersucht\  werden,\  welches\  Wissen\  {\"u}ber\  positive\  Effekte\  von\  Alkohol\  besteht,\  und erstmals eine Evaluierung der pers{\"o}nlichen Risikoeinsch{\"a}tzung der Bev{\"o}lkerung erfolgen.

Methoden

Die\  Datenerhebung\  erfolgte\  mittels\  Fragebogenerhebung\  innerhalb {\"O}sterreichs\  in\  38\  Ordinationen\  von\  AllgemeinmedizinerInnen\  bei\  insgesamt\  428 TeilnehmerInnen.\  Die\  positiven\  Auswirkungen\  wurden dabei\  anhand\  von\  11 K{\"o}rperfunktionen/Organsystemen\  untersucht\  und\  die\  eigene\  Risikoeinsch{\"a}tzung\  an\  die aktuellen Empfehlungen des Bundesministeriums f{\"u}r Gesundheit angepasst.

Ergebnisse

29,1\% bzw. 19,6\% der TeilnehmerInnen glauben an einen positiven Effekt von Wein auf Herz/Gef{\"a}{\ss}e oder die Lebenserwartung. 21,1\% gaben sogar an, dass sie\  glauben,\  ihr\  momentaner\  Wein-Konsum\  w{\"u}rde\  sich positiv\  auf ihre\  Gesundheit auswirken. Bei Bier glauben 11,5\%\  an einen positiven Effekt auf die Nieren. Es konnten Unterschiede\  zwischen\  den\  Geschlechtern\  im\  Konsumverhalten\  und\  in\  der Risikoeinsch{\"a}tzung gezeigt werden: Bei Letzterem sch{\"a}tzen Frauen ihr Risiko zu 39,75\% (f{\"u}r Wein), 42,92\% (f{\"u}r Bier) oder 53,0\% (beides) falsch ein {\textendash} M{\"a}nner zu 17,43\%, 28,70\% bzw. 31,4\%. Es konnte auch gezeigt werden, dass bis zu 11,1\% (f{\"u}r Wein) bzw. 18,9\% (f{\"u}r Bier) der ProbandInnen Wein oder Bier nicht als Alkohol auffassen. Das Konsumverhalten ist\  dabei\  mit\  dem\  Lifestyle\  assoziiert,\  genauso\  wie die\  Risikoeinsch{\"a}tzung:\  Bei\  Wein betr{\"a}gt die OR f{\"u}r das Rauchen 1,90 (Frauen) bzw. 4,44 (M{\"a}nner).

Diskussion

Alkohol, und dabei insbesondere Wein, wird in seinen Risiken stark untersch{\"a}tzt und der Glaube an positive Effekte darf deshalb keinesfalls unreflektiert von der Bev{\"o}lkerung {\"u}bernommen werden. Frauen vertragen circa ein Drittel weniger Alkohol als M{\"a}nner, und schneiden bei der eigenen Risikoeinsch{\"a}tzung schlecht ab. Ein F{\"u}nftel der ProbandInnen\  versteht\  Bier\  sogar\  nicht\  als\  Alkohol. Es\  scheint\  angebracht,\  die Risikoeinsch{\"a}tzung\  und\  den Glauben\  an\  positive\  Effekte\  auf\  Herz/Gef{\"a}{\ss}e\  in\  einer gr{\"o}{\ss}eren Follow-Up-Studie zu reevaluieren.

}, keywords = {Alkohol}, author = {Christoph Balber}, editor = {Kathryn Hoffmann} } @article {532, title = {Einfluss einer karzinogenen Umweltbelastung auf Malignome und andere chronische Erkrankungen}, volume = {Doktorin der gesamten Heilkunde (Dr. med. univ.)}, year = {2017}, publisher = {Medizinische Universit{\"a}t Wien}, type = {Diplomarbeit}, address = {Wien}, abstract = {

Hintergrund

Durch eine 1924 stillgelegte Teer- und Holzimpr{\"a}gnierungsfabrik entstand in einem ca. 11 Hektar gro{\ss}en Areal in Angern an der March eine Kontamination von Boden, Luft und Grundwasser mit polyzyklischen aromatischen Kohlenwasserstoffen, BTEX, phenolischen Kohlenwasserstoffen, Arsen und Cadmium.

Ziel der Diplomarbeit

Ziel dieser Diplomarbeit war es, die Malignominzidenz jener Personen, die am Standort der ehemaligen Teerfabrik oder im Gebiet der Schadstoffahne wohnen, mit jener der restlichen Bev{\"o}lkerung der Gro{\ss}gemeinde Angern in einer toxikologisch-epidemiologischen Studie zu vergleichen. Zus{\"a}tzlich wurde die Inzidenz von kardialen Erkrankungen, Hypertonie, Diabetes mellitus, Asthma, koronarer Herzkrankheit, Depression, Insult, Schilddr{\"u}senfunktionsst{\"o}rungen und neurologischen Erkrankungen erhoben, um diese mit publizierten Daten zu spezifischen Krankheitsinzidenzen und -pr{\"a}valenzen zu vergleichen.

Methodik

Durch retrospektive Datenanalyse aus den elektronischen und schriftlichen Krankenakten der Allgemeinpraxis des Gemeindearztes wurde die kumulative Tumorinzidenz dieser zwei Bev{\"o}lkerungsgruppen {\"u}ber 35 Jahre im Sinne einer Kohortenstudie verglichen. Im betroffenen Areal wurden 695 Exponierte identifiziert, als Gesamtzahl der Probanden wurde 4393 festgelegt. Die Inzidenzen chronischer Erkrankungen wurden in gleicher Weise erhoben und mit publizierten Erkrankungsraten f{\"u}r Allgemeinpopulationen verglichen.

Ergebnisse

Es zeigte sich kein signifikanth{\"o}heres Auftreten der einzelnen Krebserkrankungen im kontaminierten Gebiet. Die kumulierten Inzidenzen von KHK, Hypertonie, Demenz, Diabetes, Insult, Parkinson, Linksschenkelblock, Vorhofflimmern, Cardiomyopathie, Herzinsuffizienz, Multiple Sklerose, Guillan-Barr{\'e}-Syndrom, Depression und Hypothyreose lagen tendenziell {\"u}ber dem zu erwartenden Wert in der Allgemeinbev{\"o}lkerung.

Diskussion

{\"U}ber keinen der m{\"o}glichen Aufnahmewege scheinen bei den exponierten Bewohnern die Schadstoffe die kanzerogene Schwellendosis erreicht zu haben. Ob die erh{\"o}hten kumulativen Inzidenzen der nicht-malignen Erkrankungen, deren Vergleichbarkeit mit allgemeinen Pr{\"a}valenzen schwierig zu bewerten ist, auf zuf{\"a}lliger H{\"a}ufung basieren, oder ob sie Auswirkungen der Exposition mit den vorgefundenen Schadstoffen sind, sollte Gegenstand von weiteren klinischen Studien sein.

}, author = {Caroline Czasch}, editor = {Gustav Kamenski and Manfred Maier} } @article {530, title = {Erstsymptomatik, Fr{\"u}herkennung und Diagnosestellung von Malignomen in der Allgemeinpraxis}, volume = {Doktor der gesamten Heilkunde (Dr. med. univ.)}, year = {2017}, pages = {68}, publisher = {Medizinische Universit{\"a}t Wien}, type = {Diplomarbeit}, address = {Wien}, abstract = {

Hintergrund

Ein\  starkes und\  effizientes\  Prim{\"a}rversorgungssystem ist essentiell f{\"u}r die Gesundheit einer Bev{\"o}lkerung.\  Trotz\  des\  facharztlastigen\  Systems\  in\  {\"O}sterreich\  ist\  die Allgemeinpraxis\  meist\  die\  erste\  Anlaufstelle\  bei\  Symptomen\  und\  Zeichen gef{\"a}hrlicher Erkrankungen wie Malignomen, die aufgrund ihrer hohen Mortalit{\"a}t einen ernstzunehmenden Aspekt\  in\  der allgemeinmedizinischen\  Diagnostik\  darstellen.\  Oft zeigen vor\  allem\  h{\"a}ufige
Tumorein der Hausarztpraxis typische Erstsymptome. Ziel dieser Arbeit war die Darstellung der\  h{\"a}ufigsten\  Erstsymptome\  und\  Zeichen\  von\  Krebsf{\"a}llen\  in\  der\  Allgemeinpraxis\  Dr. Kamenski,\  die\  Einteilung\  in\  definierte
diagnostische\  Gruppen\  sowie\  die\  Ermittlung\  des Durchschnittsalters bei verschiedenen Krebsdiagnosen.

Methodik

Es\ \ \  handelt\ \ \  sich\ \ \  um\ \ \  eine\ \ \  retrospektive\ \ \  Auswertung\ \ \  von\ \ \  Daten\ \ \  aus Dokumentationsarchiven der Praxis Dr. Kamenski. Eingeschlossen waren alle Krebspatienten der Praxis von 1981 bis 2015 (n=560). Es wurden Geburtsjahr der Patienten, Tumorlokalisation und Alter der Patienten bei Diagnose ausgelesen und deskripitiv aufbereitet, au{\ss}erdem wurde jeder\  Fall\  einer\  diagnostischen Gruppe\  zugeordnet und die\  Ergebnisse mit\  geeigneten deskriptiv-statistischen und grafischen Methoden dargestellt.

Ergebnisse

Es gab 270 Malignome bei m{\"a}nnlichen und\  290 bei weiblichen Patienten. Im Schnitt waren es 16-17 Krebs diagnosen pro Jahr. Im Zeitraum ab 2001 gab es bei steigender Patientenzahl 33\%\  mehr\  Krebsdiagnosen als davor. Die\  gr{\"o}{\ss}te Gruppe von Patienten zeigte Symptome, die\  zumindest\  begr{\"u}ndeten\  Verdacht\  auf\  ein\  Malignom\  hervorriefen\  (diagn. Gruppe 3, 38\%). Hohen Malignomverdacht l{\"o}sten 26\% der F{\"a}lle aus (inkl. Hauttumore). Die h{\"a}ufigsten Tumorlokalisationen bei M{\"a}nnern waren Darm (17\%), Prostata (15\%) und Lunge (13\%),\  bei\  Frauen\  waren\  es\  Brust\  (24\% ),\  Darm\  (12\%),\  Uterus\  und\  Lunge\  (je\  7\%). Das Durchschnittalter bei Diagnose war 66,9 bei M{\"a}nnern und 67,1 bei Frauen.

Schlussfolgerungen

Kolorektale Karzinome wiesen h{\"a}ufig lokal-charakteristische Symptome und Zeichen auf, wohingegen sich Bronchuskarzinome meist\  mit uncharakteristischer Erstsymptomatik pr{\"a}sentierten. Mamma- und Prostatakarzinome wurden haupts{\"a}chlich durch Screening\  und ihre Lokalsymptomatik diagnostiziert. Es\  ist\  aufgrund\  dieser\  Studie\  nicht m{\"o}glich auszusagen, ob einzelne konkrete Symptome eine erh{\"o}hte Wahrscheinlichkeit f{\"u}r eine bestimmte Krebserkrankung hatten.

}, keywords = {Malignome}, author = {Bernhard Schneider}, editor = {Gustav Kamenski and Manfred Maier} } @article {531, title = {Forschungsfragen aus Hausarztpraxen}, volume = {Doktor der gesamten Heilkunde (Dr. med. univ.)}, year = {2017}, month = {03/2017}, pages = {75}, publisher = {Medizinischen Universit{\"a}t Graz}, type = {Diplomarbeit}, address = {Graz}, abstract = {

Einleitung

Versorgungsforschung als interdisziplin{\"a}rer Forschungsansatz, der die Prozesse, Ergebnisse und Rahmenbedingungen von Gesundheitsversorgung mit wissenschaftlichen Methoden untersucht, wird zunehmend auch in Hausarztpraxen durchgef{\"u}hrt. In der Mehrzahl werden die zu beforschenden Gegenst{\"a}nde den Haus{\"a}rztinnen und Haus{\"a}rzten (H{\"A}) von dritter Seite vorgegeben; weniger {\"u}blich ist es, dass H{\"A} in den Prozess, Forschungsfragen zu generieren, eingebunden werden. Verschiedentlich konnte gezeigt werden, dass eine fr{\"u}he und aktive Einbindung der teilnehmenden H{\"A} in den Forschungsprozess die Motivation der H{\"A} zur Teilnahme an Forschungsprojekten deutlich steigern konnte.

Methode

F{\"u}r die vorliegende Arbeit wurden alle (1015) steirischen H{\"A} mittels eines ersten Fragebogens angeschrieben und gebeten, f{\"u}r sie relevante Forschungsfragen bzw. -themen zu nennen. Diese Vorschl{\"a}ge wurden hinsichtlich ihrer Formulierung als Forschungsfrage oder -thema, ihrer Machbarkeit und des Vorliegens von Ergebnissen aus wissenschaftlicher Forschung durch ein Expertengremium beurteilt. Die so identifizierten, machbaren Fragestellungen wurden mittels semistrukturierter Interviews mit den die Frage stellenden H{\"A} entsprechend dem PICO Schema umformuliert, strukturiert und erneut vom Expertengremium hinsichtlich Ihrer Relevanz f{\"u}r einen Wissenszuwachs der Allgemeinmedizin priorisiert. Die 10 als am relevantesten eingestuften Forschungsfragen wurden danach mittels eines zweiten Fragebogens allen steirischen H{\"A} vorgelegt und von diesen hinsichtlich ihrer Relevanz f{\"u}r den haus{\"a}rztlichen Alltag auf einer vierstufigen Skala bewertet.

Ergebnisse

Die 133 von den H{\"A} genannten Forschungsthemen und -fragen setzten sich aus 105 allgemeinen Themen und 28 konkreten Forschungsfragen zusammen, welche inhaltlich kategorisiert und vom Expertengremium gesichtet wurden. 17 davon wurden als machbar im Hinblick auf wissenschaftliche Beantwortbarkeit durch ein Forschungsprojekt bewertet und strukturiert. Nach einer erneuten Sichtung der nun strukturierten Fragen wurden 10 Forschungsfragen durch das Expertengremium als am relevantesten hinsichtlich eines Erkenntnisgewinns f{\"u}r die Allgemeinmedizin eingesch{\"a}tzt und an alle 1015 steirischen H{\"A} gesendet. 14,7 \% der angeschriebenen H{\"A} nahmen an der Reihung nach Praxisrelevanz dieser Fragen teil und bewerteten die Frage nach der Sinnhaftigkeit eines Gatekeeping -Systems im Gegensatz zur freien Facharztwahl und der Bewertung einer medikament{\"o}sen vs. Einer Pphysiotherapeutischen Therapie bei R{\"u}ckenschmerzen im Hinblick auf die Reduktion der Krankenstandstage als am relevantesten.

Schlussfolgerung

Das Ergebnis d{\"u}rfte einerseits durch die aktuellen gesundheitspolitischen Diskussionen zur {\"a}rztlichen Prim{\"a}rversorgung der {\"o}sterreichischen Bev{\"o}lkerung zu erkl{\"a}ren sein; dar{\"u}ber hinaus ist f{\"u}r H{\"A} die Wirksamkeit bestimmter therapeutischer Ma{\ss}nahmen bei einem h{\"a}ufigen Beratungsanlass im Hinblick auf die Dauer der Arbeitsunf{\"a}higkeit relevant. Beide Fragestellungen betonen dar{\"u}ber hinaus das Bewusstsein der H{\"A} f{\"u}r die durch sie verursachten Folgekosten im Sozialsystem. In einem n{\"a}chsten Schritt sollen die als {\"a}u{\ss}erst relevant bewerteten Fragen hinsichtlich ihrer Beantwortbarkeit (Literaturrecherche, Fortbildung {\"u}ber ggf. existierende Leitlinien, Forschungsprojekt im Rahmen einer Studie) methodisch kategorisiert und in weiterer Folge bearbeitet werden.

}, author = {Michael Orso}, editor = {Andrea Siebenhofer-Kroitzsch and Stephanie Poggenburg} } @article {427, title = {GHZ Enns - Die Haus{\"a}rzte}, year = {2017}, publisher = {{\"A}rzte Krone}, keywords = {Prim{\"a}rversorgung}, author = {Silke Eichner} } @article {457, title = {[Health disorders and their prevalence in two primary care practices from the perspective of different coding].}, journal = {Wien Med Wochenschr}, volume = {167}, year = {2017}, month = {2017 Oct}, pages = {320-332}, abstract = {

Family practices provide medical care for the majority of health problems. This already highlights the importance of primary health care with respect to quantity. A detailed five-year survey of cases in two rural practices gives insight into everyday practice. During the whole period of this year{\textquoteright}s prevalence survey, 24,541 or 32,605 episodes of care were recorded in a mean practice population of 1500 or 1700 persons, respectively. The frequency rates of more than 500 different health problems show a typical Pareto distribution. This distribution of the cases characterizes the subject of general practice/family medicine and essentially determines handling illness in practice. Lack of a common technical language, with regard to the classification of health disorders, becomes evident when comparing the practices. An issue whose impact on medical care, education and research should be further investigated.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Austria, Child, Child, Preschool, Clinical Coding, Cross-Sectional Studies, Episode of Care, Female, Health Surveys, Humans, Male, Middle Aged, Morbidity, Primary Health Care, Referral and Consultation, Rural Health Services, Young Adult}, issn = {1563-258X}, doi = {10.1007/s10354-017-0567-1}, url = {http://link.springer.com/article/10.1007/s10354-017-0567-1}, author = {Fink, Waltraud and Kasper, Otto and Kamenski, Gustav} } @article {452, title = {Interventions to reduce inappropriate polypharmacy: Implications for research and practice.}, journal = {Maturitas}, volume = {97}, year = {2017}, month = {2017 Mar}, pages = {66-68}, issn = {1873-4111}, doi = {10.1016/j.maturitas.2016.12.007}, author = {Johansson, Tim and Flamm, Maria and S{\"o}nnichsen, Andreas and Schuler, Jochen} } @article {527, title = {Primary Health Care Modelle in Tirol {\textendash} Erhebung und Analyse innovativer Ans{\"a}tze}, volume = {Doktor der gesamten Heilkunde (Dr. med. univ.)}, year = {2017}, month = {01/2017}, pages = {128}, publisher = {Medizinische Universit{\"a}t Innsbruck}, type = {Diplomarbeit}, address = {Innsbruck}, abstract = {

Zielsetzung

Die {\"o}sterreichische Bundes-Zielsteuerungskommission (BZ) hat ein Konzept zur Reformierung des bestehenden Primary Health Care Systems\  (PHCS)\  beschlossen. Die bestehenden Modelle der Allgemeinmedizin sollen im Rahmen dieser Reform verbessert und die Prim{\"a}rversorgung gest{\"a}rkt werden. Ziel der vorliegenden Arbeit ist es, innovative Modelle und Arbeitsweisen in der\  Prim{\"a}rversorgung\  des\  Bundeslandes Tirol\  zu\  erheben und in Relation zu den geplanten Ma{\ss}nahmen zu stellen. Dar{\"u}ber hinaus sollen die Meinungen und W{\"u}nsche der AllgemeinmedizinerInnen (AM) zu Verbesserungen einflie{\ss}en. Die Ergebnisse der Arbeit sollen eine Pr{\"u}fungsbasis zur Umsetzbarkeit des Reformkonzeptes in Tirol bieten.

Methoden

Um\  die\  bestehenden Modelle erheben und analysieren zu k{\"o}nnen wurde unter dem Titel INNOVAMT (Innovative allgemeinmedizinische Modelle in Tirol) eine prospektive Querschnittstudie in Form einer Onlineumfrage unter den niedergelassenen AM im Bundesland\  Tirol (n=572) durchgef{\"u}hrt. Die Auswertung\  erfolgte\  mittels Methoden der deskriptiven Statistik. Letztlich wurden 87 der 572 AM (ca. 15\%) in die Stichprobe inkludiert. Zur Vergleichbarkeit der\  Modelle wurde ein Innovationsscore eingef{\"u}hrt, welcher die Kernelemente des Konzeptes der BZ enth{\"a}lt.

Ergebnisse

Die\  Erhebung zeigt, dass in Tirol bereits heute\  ein\  relativ\  hohes\  Ma{\ss}\  an Interdisziplinarit{\"a}t besteht. Mehr als die H{\"a}lfte der Praxisteams umfassen neben OrdinationsassistentInnen auch mindestens eine weitere Berufsgruppe. Dennoch bestehen Unterschiede bei der Umsetzung innovativer Merkmale im Sinne der Reformpl{\"a}ne,\  vor allem abh{\"a}ngig vom Stadt-Land-Verh{\"a}ltnis. Zwischen dem entwickelten Innovationsscore und der erhobenen Zufriedenheit sowie zwischen der Zusammenarbeit und r{\"a}umlicher N{\"a}he lassen sich\  keine deutlichen Zusammenh{\"a}nge feststellen. Die gr{\"o}{\ss}te Unzufriedenheit der AM besteht in der Administration, der Finanzierung sowie der Wertsch{\"a}tzung des Berufsbildes.

Schlussfolgerung

Einerseits besteht der Wunsch nach Gruppenpraxen, andererseits jedoch gibt es eine negative Erwartungshaltung bez{\"u}glich PHC-Zentren. Verbesserungsw{\"u}rdig ist die Verf{\"u}gbarkeit insbesondere\  an Wochenenden, Tagesrandzeiten und in der Nacht. Niedrige Zufriedenheitswerte bieten Verbesserungspotenziale f{\"u}r die prim{\"a}re Gesundheitsversorgung in Tirol.

}, keywords = {PHC}, author = {Raphael Bertsch}, editor = {Herbert Bachler} } @article {545, title = {Reform der Prim{\"a}rversorgung in {\"O}sterreich}, journal = {Wien Med Wochenschr}, year = {2017}, month = {12/2017}, type = {Original Article}, abstract = {

Within the Austrian health care reform, a new policy is generally proposed to strengthen primary care (PC). The aim of this study was to illustrate the status quo in the Tyrolean PC system and to provide the opportunity to examine the reform feasibility. Therefore, a prospective cross-sectional study was performed among licensed GPs in Tyrol, using an online questionnaire. The results of the survey among 87 GPs show that only 20\% of Tyrolean PC settings already fulfill the coreteam availabilty described in the reformplans. However, there are differences between urban and rural areas. The highest dissatisfaction was detected in the fields of administration, financing and appreciation of PC. Primarily there is a request by the GPs for implementation of group practices. Only few concerns about the proposed PC centers were noticed. It seems necessary to improve availability, especially outside the core times and during the night.

}, keywords = {Gesundheitsreform, Prim{\"a}rversorgung, Primary Health Care}, doi = {10.1007/s10354-017-0613-z}, url = {https://link.springer.com/article/10.1007/s10354-017-0613-z}, author = {Herbert Bachler and Raphael Bertsch} } @article {359, title = {10 Minuten pro Patient?!}, year = {2016}, publisher = {{\"A}rzte Krone}, author = {Maria Wendler}, editor = {Bernhard Panhofer and Matthias K{\"o}lbl} } @article {336, title = {Alkohol 2020}, year = {2016}, publisher = {{\"A}rzte Krone}, keywords = {Alkohol, Integrierte Versorgung, Sucht} } @article {288, title = {Allgemeinmedizinische Lehrpraxis {\textendash} quo vadis?}, year = {2016}, publisher = {{\"A}rzte Krone}, keywords = {Lehrpraxis}, author = {Reinhold Glehr} } @article {320, title = {{\"A}rzte mit Herz und Hirn}, year = {2016}, publisher = {{\"A}rzte Krone}, keywords = {WONCA}, author = {Christofer Patrick Reichel} } @book {416, title = {Bachler H., Fischer Ch., et al}, series = {Allgemeinmedizin, Leitfaden f{\"u}r Famulatur, AMPOL, KPJ und Turnus}, number = {ISBN: 978-3-200-04466-1}, year = {2016}, edition = {6.} } @article {292, title = {Berufsperspektive Vertretungsarzt}, year = {2016}, publisher = {{\"A}rzte Krone}, author = {Cornelia Croy} } @article {321, title = {Das war der WONCA-Europe-Kongress 2016 in Kopenhagen}, year = {2016}, publisher = {{\"A}rzte Krone}, keywords = {Editorial, Erfahrungsbericht, WONCA}, author = {Christoph Dachs} } @article {301, title = {Der Facharzt f{\"u}r Allgemeinmedizin und Familienmedizin {\textendash} warum es ihn ben{\"o}tigt}, year = {2016}, publisher = {{\"A}rzte Krone}, author = {Thomas Jungblut} } @article {326, title = {Die Herausforderungen der jungen Allgemeinmedizin im Jahr 2016 {\textendash} {\"u}berall gleich?}, year = {2016}, publisher = {{\"A}rzte Krone}, author = {Maria Wendler} } @article {300, title = {Easy Access Allgemeinmedizin?! {\textendash} Die universit{\"a}re Allgemeinmedizin in {\"O}sterreich}, year = {2016}, publisher = {{\"A}rzte Krone}, keywords = {Universit{\"a}t}, author = {Maria Wendler} } @article {291, title = {EbM-Guidelines: Psychiatrische Exploration und Behandlungsorganisation bei Jugendlichen}, year = {2016}, publisher = {{\"A}rzte Krone}, author = {Kari Pylkk{\"a}nen and Bernhard Panhofer} } @article {335, title = {Editorial 17-2016}, year = {2016}, publisher = {{\"A}rzte Krone}, keywords = {Gesundheitsreform, PHC}, author = {Rabady, Susanne} } @article {290, title = {ELGA ante portas}, year = {2016}, publisher = {{\"A}rzte Krone}, author = {Rabady, Susanne} } @article {533, title = {Fragebogenerhebung zur Evaluierung des quantitativen und inhaltlichen Forschungsinteresses und m{\"o}glicher hemmender und f{\"o}rdernder Faktoren der Allgemeinmediziner_innen in der Steiermark}, volume = {Doktor der gesamten Heilkunde (Dr. med. univ.)}, year = {2016}, month = {01/2016}, pages = {77}, publisher = {Medizinischen Universit{\"a}t Graz}, type = {Diplomarbeit}, address = {Graz}, abstract = {

Einleitung

Nachhaltige\  und\  effiziente Versorgungsforschung\  ben{\"o}tigt\  die\  aktive\  Mitarbeit forschungswilliger Haus{\"a}rztinnen und Haus{\"a}rzte (HA). {\"O}sterreich steht im internationalen\  Vergleich zur{\"u}ck und\  besitzt\  kein\  fl{\"a}chendeckendes\  und\  zentralorganisiertes\  Forschungspraxen-Netzwerk. In dieser Studie soll daher untersucht werden, wie viele der steirischen Allgemeinmediziner/innen an der Forschung in ihrem Gebiet interessiert sind, wie sie\  soziodemografisch\  beschaffen\  sind,\  welche\  hemmenden\  und\  motivierenden\  Faktoren f{\"u}r die Forschung existieren und welche Forschungsthemen aus der Sicht der HA relevant sind.

Material und Methoden

Im Rahmen einer bundeslandweiten Querschnittserhebung wurden\  alle\  niedergelassenen Allgemeinmediziner/innen der\  Steiermark\  unter\  Zuhilfenahme eines\  selbstentwickelten\  und\  standardisierten\  Fragebogens\  in\  einem\  Zeitrahmen\  von\  zwei Monaten\  befragt. Die\  statistische\  Analyse\  der\  erhobenen\  Daten\  erfolgte\  unterst{\"u}tzt\  durch "Statistical Product and Service Solutions" (SPSS) mittels deskriptiver Methoden.

Ergebnisse

Von 1015 angeschriebenen Allgemeinmediziner/innen (100\%) schickten 135 (13,3\  \%)\  den\  Fragebogen\  zur{\"u}ck.\  106\  (78\  \%)\  der\  Befragten\  waren\  prinzipiell\  bereit,\  an Forschungsprojekten\  in\  der\  eigenen Praxis teilzunehmen.\  Als\  motivierenden\  Faktor\  f{\"u}r eine Projektteilnahme nannten die Grundversorgenden in erster\  Linie die\  praktische Relevanz und N{\"u}tzlichkeit der gewonnen Evidenz f{\"u}r die t{\"a}gliche Versorgung von Patientinnen
und\  Patienten.\  Zus{\"a}tzlich\  soll\  die\  Forschung\  der\  Aufwertung\  und\  Weiterentwicklung\  der Allgemeinmedizin\  als\  eigene\  Fachdisziplin\  dienen\  und\  den\  Ausbau\  des\  pers{\"o}nlichen Netzwerkes, inklusive einem fachlichen Austausch mit Kolleginnen und Kollegen, beg{\"u}nstigen. Zeitmangel und hoher b{\"u}rokratischer Aufwand konnten als die zwei dominierenden Hemmfaktoren f{\"u}r die Forschung in der eigenen Praxis identifiziert werden. 66 HA formulierten 132 f{\"u}r sie interessante und relevante Forschungsfragen und Forschungsthemen.

Schlussfolgerung

Die Mehrheit der antwortenden steirischen HA sind zur aktiven Mitarbeit an Forschungsprojekten in der eigenen Praxis bereit. Das neu gegr{\"u}ndete IAMEV versteht\  sich\  als\  akademische\  Vertretung der Allgemeinmedizin und\  wird\  somit\  in\  Versorgungsforschungsfragen\  als\  erster\  Ansprechpartner\  der HA fungieren.\  Die\  Ergebnisse dieser\  Studie k{\"o}nnen die\  Erstellung\  von motivierenden Rahmenbedingungen\  f{\"u}r\  organisierte Forschung beg{\"u}nstigen.

}, author = {Manuel Reinisch}, editor = {Andrea Siebenhofer-Kroitzsch and Stephanie Poggenburg} } @article {289, title = {"Gehen Sie schwimmen" - Immer ein guter Tipp?}, year = {2016}, publisher = {{\"A}rzte Krone}, keywords = {Schwimmen, Sportmedizin}, author = {Ulrike Preiml} } @article {327, title = {GPTopia {\textendash} Family Medicine in 2084}, year = {2016}, publisher = {{\"A}rzte Krone}, author = {Maria Wendler} } @article {453, title = {Impact of strategies to reduce polypharmacy on clinically relevant endpoints: a systematic review and meta-analysis.}, journal = {Br J Clin Pharmacol}, volume = {82}, year = {2016}, month = {2016 Aug}, pages = {532-48}, abstract = {

AIM: The aim of the present study was to explore the impact of strategies to reduce polypharmacy on mortality, hospitalization and change in number of drugs.

METHODS: Systematic review and meta-analysis: a systematic literature search targeting patients >=65 years with polypharmacy (>=4 drugs), focusing on patient-relevant outcome measures, was conducted. We included controlled studies aiming to reduce polypharmacy. Two reviewers independently assessed studies for eligibility, extracted data and evaluated study quality.

RESULTS: Twenty-five studies, including 10 980 participants, were included, comprising 21 randomized controlled trials and four nonrandomized controlled trials. The majority of the included studies aimed at improving quality or the appropriateness of prescribing by eliminating inappropriate and non-evidence-based drugs. These strategies to reduce polypharmacy had no effect on all-cause mortality (odds ratio 1.02; 95\% confidence interval 0.84, 1.23). Only single studies found improvements, in terms of reducing the number of hospital admissions, in favour of the intervention group. At baseline, patients were taking, on average, 7.4 drugs in both the intervention and the control groups. At follow-up, the weighted mean number of drugs was reduced (-0.2) in the intervention group but increased (+0.2) in controls.

CONCLUSIONS: There is no convincing evidence that the strategies assessed in the present review are effective in reducing polypharmacy or have an impact on clinically relevant endpoints. Interventions are complex; it is still unclear how best to organize and implement them to achieve a reduction in inappropriate polypharmacy. There is therefore a need to develop more effective strategies to reduce inappropriate polypharmacy and to test them in large, pragmatic randomized controlled trials on effectiveness and feasibility.

}, keywords = {Aged, Drug-Related Side Effects and Adverse Reactions, Hospitalization, Humans, Inappropriate Prescribing, Outcome Assessment, Health Care, Polypharmacy, Practice Patterns, Physicians{\textquoteright}, Randomized Controlled Trials as Topic}, issn = {1365-2125}, doi = {10.1111/bcp.12959}, author = {Johansson, Tim and Abuzahra, Muna E and Keller, Sophie and Mann, Eva and Faller, Barbara and Sommerauer, Christina and H{\"o}ck, Jennifer and L{\"o}ffler, Christin and K{\"o}chling, Anna and Schuler, Jochen and Flamm, Maria and S{\"o}nnichsen, Andreas} } @article {534, title = {Innere Haltungen zum PSA-Screening - Erhebung mittels Fragebogen in einer Tiroler Kohorte}, volume = {Doktorin der gesamten Heilkunde (Dr. med. univ.)}, year = {2016}, pages = {78}, type = {Diplomarbeit}, keywords = {Prostatakarzionom, PSA}, author = {Magdalena Haslehner}, editor = {Herbert Bachler} } @article {325, title = {"Lasst uns die Qualit{\"a}t systematisieren"}, year = {2016}, publisher = {{\"A}rzte Krone}, keywords = {Editorial}, author = {Rabady, Susanne} } @article {536, title = {Opportunistisches- vs. Recall-System beim Zervixkarzinom-Screening}, volume = {Doktorin der gesamten Heilkunde (Dr. med. univ.)}, year = {2016}, pages = {54}, publisher = {Medizinische Universit{\"a}t Innsbruck}, type = {Diplomarbeit}, address = {Innsbruck}, keywords = {Cervixkarzinom}, author = {Theresa Drexel}, editor = {Christoph Fischer} } @article {337, title = {Randgruppenversorgung in der Ausbildung}, year = {2016}, publisher = {{\"A}rzte Krone}, keywords = {Community Medicine, COPC, Randgruppen}, author = {Sebastian Huter} } @booklet {562, title = {Schnittstellenmanagement bei der Hausstaubmilben-Allergie}, year = {2016}, keywords = {orp-publications}, author = {Elisabeth Brettlecker and Renate Hoffmann-Dorninger and Reinhart Jarisch and Johannes Neuhofer and Otto Pichlh{\"o}fer and Erwin Rebhandl and Gunter Sturm and Felix Wantke and Rudolf Schmitzberger} } @article {535, title = {Sprachbarrieren im Gesundheitswesen Schwierigkeiten und L{\"o}sungsans{\"a}tze am Beispiel der allgemeinmedizinischen Praxis}, volume = {Doktorin der gesamten Heilkunde (Dr. med. univ.)}, year = {2016}, pages = {111}, publisher = {Medizinische Universit{\"a}t Wien}, type = {Diplomarbeit}, address = {Wien}, author = {Reindl, Eva Maria}, editor = {Ruth Kutalek} } @article {322, title = {Taucherarztausbildung f{\"u}r Allgemeinmediziner {\textendash} eine interessante Kompetenzerweiterung}, year = {2016}, publisher = {{\"A}rzte Krone}, keywords = {Tauchmedizin}, author = {Ulrike Preiml} } @article {358, title = {Was hat die Welt mit uns zu tun?}, year = {2016}, publisher = {{\"A}rzte Krone}, author = {Christoph Dachs} } @article {360, title = {Was ist Familienmedizin (nicht) - Definition, Modelle und Grenzen der Familienmedizin}, year = {2016}, publisher = {{\"A}rzte Krone}, author = {Amanda Howe and Maria Wendler and Barbara Degn} } @conference {564, title = {The comparative effects of a Buddhist meditation retreat and vacation on mindfulness and measures of well-being.}, year = {2015}, abstract = {

*BACKGROUND: * Recovery from work through respite and vacations is necessary to maintain well-being and health and is essential to avoid a variety of negative health outcomes like burnout, chronic fatigue, psychosomatic diseases and longer sick-leave. To identify activities enhancing the duration of recovery effects are of interest. *METHODS: * A sample of Europeans and North Americans was invited to participate in the study. A questionnaire was electronically administered 10 days prior, 10 days after and 66 days after the retreat/vacation. Respondents in the meditation retreat group (n=60) were compared to vacation with meditation (n=40) and vacation without meditation (n=26). Measures were {\textquotedblleft}act with awareness{\textquotedblright} (10 items) and {\textquotedblleft}accept without judgment{\textquotedblright} (9 items), the {\textquotedblleft}fatigue assessment scale{\textquotedblright} (10 items), the {\textquotedblleft}perceived stress scale{\textquotedblright} (10 items) and the {\textquotedblleft}WHO-5 Well-being Index{\textquotedblright} (5 items). First, the retreat was compared with those individuals taking a vacation without meditating during vacation. Second, the retreat was compared with those individuals taking a vacation in which they did meditated. Within person contrast were calculated comparing assessment 1 \& 2 as well as assessment 1 \& 3. *RESULTS: * The total group time effect was significant for all variables between assessment times 1 \& 2 and 1 \& 3. The within-subject contrasts of retreat versus vacation without meditation showed a significant difference for act with awareness and accept without judgment at both time intervals and for perceived stress and emotional well being at time 3. *DISCUSSION: * Participation in a residential meditation retreat of 1-week or longer and leisure vacation with meditation, leads to significant stress reduction and increased mindfulness compared to leisure vacation alone. Our findings suggest benefits of mindfulness meditation on retreats and mindfulness meditation on vacation over vacation alone in promoting a more enduring, long-lasting, resilient response to daily stressors and improved, sustained psychological well-being.

}, keywords = {orp-publications}, author = {Otto Pichlh{\"o}fer and Adrienne Chang and Gerhard Blasche} } @article {11, title = {Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): study protocol for a cluster-randomised controlled trial.}, journal = {Implement Sci}, volume = {10}, year = {2015}, month = {2015 Jun 04}, pages = {82}, abstract = {

BACKGROUND: The majority of nursing home residents with dementia experience behavioural and psychological symptoms like apathy, agitation, and anxiety. According to analyses of prescription prevalence in Germany, antipsychotic drugs are regularly prescribed as first-line treatment of neuropsychiatric symptoms in persons with dementia, although guidelines clearly prioritise non-pharmacological interventions. Frequently, antipsychotic drugs are prescribed for inappropriate reasons and for too long without regular reviewing. The use of antipsychotics is associated with adverse events like increased risk of falling, stroke, and mortality. The aim of the study is to investigate whether a person-centred care approach, successfully evaluated in nursing homes in the United Kingdom, can be implemented in German nursing homes and, in comparison with a control group, can result in a clinically relevant reduction of the proportion of residents with antipsychotic prescriptions.

METHODS/DESIGN: The study is a cluster-randomised controlled trial comparing an intervention group (two-day initial training on person-centred care and ongoing training and support programme) with a control group. Both study groups will receive, as optimised usual care, a medication review by an experienced psychiatrist/geriatrician providing feedback to the prescribing physician. Overall, 36 nursing homes in East, North, and West Germany will be randomised. The primary outcome is the proportion of residents receiving at least one antipsychotic prescription (long-term medication) after 12~months of follow-up. Secondary outcomes are residents{\textquoteright} quality of life, agitated behaviour, as well as safety parameters like falls and fall-related medical attention. A health economic evaluation and a process evaluation will be performed alongside the study.

DISCUSSION: To improve care, a reduction of the current high prescription rate of antipsychotics in nursing homes by the intervention programme is expected.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT02295462.

}, keywords = {Accidental Falls, Antipsychotic Agents, Costs and Cost Analysis, Dementia, Drug Utilization, Germany, Homes for the Aged, Humans, Inservice Training, Mental Disorders, Nursing Homes, Patient-Centered Care, Psychomotor Agitation, Quality of Life, Research Design}, issn = {1748-5908}, doi = {10.1186/s13012-015-0268-3}, author = {Richter, Christin and Berg, Almuth and Fleischer, Steffen and K{\"o}pke, Sascha and Balzer, Katrin and Fick, Eva-Maria and S{\"o}nnichsen, Andreas and L{\"o}scher, Susanne and Vollmar, Horst Christian and Haastert, Burkhard and Icks, Andrea and Dintsios, Charalabos-Markos and Mann, Eva and Wolf, Ursula and Meyer, Gabriele} } @article {12, title = {The impact of preoperative testing for blood glucose concentration and haemoglobin A1c on mortality, changes in management and complications in noncardiac elective surgery: a systematic review.}, journal = {Eur J Anaesthesiol}, volume = {32}, year = {2015}, month = {2015 Mar}, pages = {152-9}, abstract = {

BACKGROUND: The risks associated with surgery are elevated in patients with diabetes mellitus. For this reason, preoperative diagnostics frequently include the measurement of blood glucose and haemoglobin A1c (HbA1c), but it is unclear whether these tests contribute to improved perioperative or postoperative outcomes.

OBJECTIVES: This systematic review aimed to evaluate the evidence that preoperative testing for blood glucose and HbA1c might influence the following outcome parameters: changes in clinical management; mortality; and the incidence of perioperative and postoperative complications in patients undergoing elective, noncardiac surgery.

DESIGN: We performed a systematic search of the literature from January 2001 to March 2013, thus updating a review carried out by the National Institute for Health and Clinical Excellence (NICE) up to the year 2001.

ELIGIBILITY CRITERIA: Controlled studies including cohort and case-control studies with a population of at least 60 patients were eligible.

RESULTS: The search retrieved 1346 records (including hand-search). Twenty-two studies met all inclusion criteria and were included in the review. Fifteen cohort and two case-control studies evaluated the effectiveness of preoperative blood glucose testing and nine studies the effectiveness of testing HbA1c. Four of the included studies evaluated both tests. There were no data derived from high-quality studies supporting routine preoperative testing for blood glucose or HbA1c in otherwise healthy adult patients undergoing elective noncardiac surgery. Only in vascular and orthopaedic surgery may screening identify patients at an increased risk.

CONCLUSION: Preoperative blood glucose testing and testing for HbA1c is not required in nondiabetic patients unless there are clinical sings arousing suspicion. Patients scheduled for vascular and orthopaedic surgery carry an elevated risk justifying preoperative testing for blood glucose or HbA1c as a screening tool.

}, keywords = {Biomarkers, Blood Glucose, Diabetes Mellitus, Elective Surgical Procedures, Glycated Hemoglobin, Humans, Orthopedic Procedures, Predictive Value of Tests, Preoperative Care, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Vascular Surgical Procedures}, issn = {1365-2346}, doi = {10.1097/EJA.0000000000000117}, author = {Bock, Matthias and Johansson, Tim and Fritsch, Gerhard and Flamm, Maria and Hansbauer, Bernhard and Mann, Eva and S{\"o}nnichsen, Andreas} } @article {413, title = {Physicians{\textquoteright} exodus: why medical graduates leave Austria or do not work in clinical practice.}, journal = {Wien Klin Wochenschr}, volume = {127}, year = {2015}, month = {2015 May}, pages = {323-9}, abstract = {

BACKGROUND: Austria has the highest number of medical graduates of all Organisation for Economic Co-operation and Development (OECD) countries in relation to its population size, but over 30\% choose not to pursue a career as physicians in the country.

OBJECTIVE AND RESEARCH DESIGN: This article describes under- and postgraduate medical education in Austria and analyses reasons for the exodus of physicians.

MEDICAL EDUCATION: In Austria, medicine is a 5- or 6-year degree offered at four public and two private medical schools. Medical graduates have to complete training in general medicine or a speciality to attain a licence to practice. While not compulsory for speciality training, board certification in general medicine has often been regarded as a prerequisite for access to speciality training posts.

ANALYSIS: Unstructured postgraduate training curricula, large amounts of administrative tasks, low basic salaries and long working hours present for incentives for medical graduates to move abroad or to work in a non-clinical setting. The scope of current reforms, such as the establishment of a new medical faculty and the implementation of a common trunk, is possibly insufficient in addressing the issue.

CONCLUSION: Extensive reforms regarding occupational conditions and the structure of postgraduate medical education are necessary to avoid a further exodus of junior doctors.

}, keywords = {Attitude of Health Personnel, Austria, Career Choice, Curriculum, Education, Medical, Graduate, Emigration and Immigration, Faculty, Medical, General Practice, Health Care Reform, Humans, Job Satisfaction, Licensure, Medical, Medicine, National Health Programs, Physician{\textquoteright}s Role, Specialty Boards, Students, Medical}, issn = {1613-7671}, doi = {10.1007/s00508-015-0786-7}, author = {Scharer, Sebastian and Freitag, Andreas} } @booklet {549, title = {Versorgungsmodell f{\"u}r Betroffene mit {Chronisch-Entz{\"u}ndlichen} Darmerkrankungen in Wien {\textendash} Interdisziplin{\"a}r konsentierte Versorgungspfade gem{\"a}{\ss} der Wiener Zielsteuerung Gesundheit}, year = {2015}, author = {Vogelsang, Harald and Maier, Manfred and Novacek, Gottfried and Feichtenschlager, Thomas and Pichlh{\"o}fer, Otto and Beyer, Anita and Gross, Evelyn and Linsbichler, Susanna and Sokele, Sigrid and Stift, Anton and Pichlbauer, Ernest G} } @article {14, title = {Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review.}, journal = {BMC Geriatr}, volume = {14}, year = {2014}, month = {2014 Jun 22}, pages = {80}, abstract = {

BACKGROUND: Residents of long-term care facilities have a high risk of acute care admission. Estimates of the frequency of inappropriate transfers vary substantially throughout the studies and various assessment tools have been used. The purpose of this study is to systematically review and describe the internationally existing assessment tools used for determining appropriateness of hospital admissions among long-term care residents.

METHOD: Systematic review of the literature of two databases (PubMed and CINAHL{\textregistered}). The search covered seven languages and the period between January 2000 and December 2012. All quantitative studies were included if any assessment tool for appropriateness of hospital and/or emergency department admission of long-term care residents was used. Two pairs of independent researchers extracted the data.

RESULTS: Twenty-nine articles were included, covering study periods between 1991 and 2009. The proportion of admissions considered as inappropriate ranged from 2\% to 77\%. Throughout the studies, 16 different assessment tools were used; all were based on expert opinion to some extent; six also took into account published literature or interpretation of patient data. Variation between tools depended on the concepts studied, format and application, and aspects evaluated. Overall, the assessment tools covered six aspects: specific medical diagnoses (assessed by n = 8 tools), acuteness/severity of symptoms (n = 7), residents{\textquoteright} characteristics prior to admission (n = 6), residents{\textquoteright} or families{\textquoteright} wishes (n = 3), existence of a care plan (n = 1), and availability or requirement of resources (n = 10). Most tools judged appropriateness based on one fulfilled item; five tools judged appropriateness based on a balance of aspects. Five tools covered only one of these aspects and only six considered four or more aspects. Little information was available on the psychometric properties of the tools.

CONCLUSIONS: Most assessment tools are not comprehensive and do not take into account residents{\textquoteright} individual aspects, such as characteristics of residents prior to admission and wishes of residents or families. The generalizability of the existing tools is unknown. Further research is needed to develop a tool that is evidence-based, comprehensive and generalizable to different regions or countries in order to assess the appropriateness of hospital admissions among long-term care residents.

}, keywords = {Emergency Service, Hospital, Humans, Long-Term Care, Patient Admission, Patient Transfer, Residential Facilities}, issn = {1471-2318}, doi = {10.1186/1471-2318-14-80}, author = {Renom-Guiteras, Anna and Uhrenfeldt, Lisbeth and Meyer, Gabriele and Mann, Eva} } @article {13, title = {Compliance with trial registration in five core journals of clinical geriatrics: a survey of original publications on randomised controlled trials from 2008 to 2012.}, journal = {Age Ageing}, volume = {43}, year = {2014}, month = {2014 Nov}, pages = {872-6}, abstract = {

OBJECTIVE: to assess the proportion of registered randomised controlled trials in five core clinical geriatric journals and to analyse whether registered study outcomes correspond with published outcomes.

DESIGN: survey of original papers published 2008 to 2012.

METHODS: two independent reviewers retrieved the sample through search in the web-based archives of Age and Ageing, the Journal of the American Geriatric Society, the American Journal of Geriatric Psychiatry, the Journal of the American Medical Directors Association and International Psychogeriatrics. Data extraction was performed by two independent reviewers using a pre-tested 13-item checklist. Registration status was checked and information provided in registers compared with information presented in the original publication. A third reviewer was consulted if no consensus could be reached.

RESULTS: the sample comprised 220 original publications on randomised controlled trials. A total of 140 (63.6\%) were registered. Registration was in accordance with the ICMJE requirements in 54 out of 140 registered trials (38.6\%). Less than one-third of registered papers (n = 40) reported on all study outcomes listed in the study register. In 74 out of the 80 non-registered trials, the missing registration was not declared in the publication. There was no consistent upward trend towards higher registration compliance throughout journals and years.

CONCLUSION: our survey shows that prospective trial registration and compliance between outcomes declared in the registry and reported in the publication is poor. Concerted action of authors, editors and peer-reviewers is overdue aimed to irreversibly implement the imperative of registration of randomised controlled trials and complete outcome reporting.

}, keywords = {Geriatrics, Guideline Adherence, Guidelines as Topic, Humans, Periodicals as Topic, Publication Bias, Randomized Controlled Trials as Topic, Registries, Research Design}, issn = {1468-2834}, doi = {10.1093/ageing/afu086}, author = {Mann, Eva and Nguyen, Natalie and Fleischer, Steffen and Meyer, Gabriele} } @article {195, title = {Der Hausarzt in der Notfallversorgung: Eine Ist-Stand Analyse und daraus resultierende M{\"o}glichkeiten}, volume = {Doktor der gesamten Heilkunde (Dr. med. univ.)}, year = {2014}, month = {10/2014}, pages = {72}, publisher = {Medizinischen Universit{\"a}t Graz}, type = {Diplomarbeit}, address = {Graz}, abstract = {

Ausgangslage

Die Steiermark verf{\"u}gt {\"u}ber ein gut strukturiertes, fl{\"a}chendeckendes Notarztwesen aus bodengebundenen und luftgest{\"u}tzten Notarztsystemen. In Anbetracht der Ver{\"a}nderungen im Gesundheitswesen, stellt sich jedoch die Frage, ob k{\"u}nftig ein, vor allem auf Spitals{\"a}rztInnen basierendes Notarztsystem, noch sichergestellt werden kann. Im Sinne der Optimierung der Rettungskette sollte daher bereits fr{\"u}hzeitig auf professionelle {\"a}rztliche Hilfe am Notfallort durch niedergelassene {\"A}rztinnen und {\"A}rzte f{\"u}r Allgemeinmedizin zugegriffen werden.

Fragestellung

Bis dato gibt es in der Steiermark keine landesweiten Daten zur Bereitschaft von niedergelassenen Haus{\"a}rztInnen an der {\"o}rtlichen Notfallversorgung mitzuarbeiten, sowie zu deren notfallmedizinischen Kompetenzen. Weiters fehlen Daten {\"u}ber eventuell ben{\"o}tigte Voraussetzungen, um k{\"u}nftig die Mitarbeit an der {\"o}rtlichen Notfallversorgung optimieren zu k{\"o}nnen.

Methoden

905 niedergelassene {\"A}rztinnen und {\"A}rzte f{\"u}r Allgemeinmedizin wurden per E-Mail zur Teilnahme an einer Online Umfrage aufgerufen und war von Februar bis Ende M{\"a}rz 2014 {\"u}ber den AGN Web-Server abrufbar.

Ergebnisse

Der R{\"u}cklauf belief sich auf 235 auswertbare Frageb{\"o}gen, was einer R{\"u}cklaufquote von 25,97\% entspricht. Betrachtet man die Geschlechterverteilung so sind 76 weiblich (32,34\%) und 159 m{\"a}nnlich (67,66\%), mit einem Durchschnittsalter von 51 Jahren. Die Bereitschaft an der {\"o}rtlichen Notfallversorgung mitzuarbeiten ist landesweit gegeben und im l{\"a}ndlichen Raum (83,1\%) h{\"o}her als in den Bezirkshauptst{\"a}dten bzw. st{\"a}dtischen Ballungsr{\"a}umen (16.9\%). Die notfallmedizinischen Kenntnisse im Bereich ven{\"o}ser Zugang bzw. der Masken-Beutel-Beatmung werden als {\quotedblbase}sehr gut{\textquotedblleft} bzw. {\quotedblbase}gut{\textquotedblleft} angegeben. Nachbesserungsbedarf wird bei der endotrachealen Intubation, bei der parenteralen Opiatanwendung und Sedierung gesehen.

Schlussfolgerungen

Die Optimierungsm{\"o}glichkeiten werden vor allem im Bereich der sinnvollen Einbindung, insbesondere beim zeitlichen Vorteil gegen{\"u}ber dem Rettungsdienst, gesehen. Die barrierefreie Zusammenarbeit zwischen den Haus{\"a}rztInnen, den Rettungsorganisationen und Krankenh{\"a}usern wird in Zukunft eine gro{\ss}e Rolle spielen. Zielgerichtete Fortbildungsm{\"o}glichkeiten und gemeinsame Trainings sowie eine effiziente und faire Finanzierung z{\"a}hlen zu den notwendigen Verbesserungen, um k{\"u}nftig die {\"o}rtliche Notfallversorgung zu optimieren.

}, keywords = {Notfallversorgung, Prim{\"a}rversorgung}, author = {Zimmermann, Florian F}, editor = {Prause, Gerhard and Sch{\"o}rghuber, Michael} } @article {197, title = {Die Rolle der AllgemeinmedizinerInnen als erste Anlaufstelle im {\"o}sterreichischen Gesundheitssystem}, volume = {Doktor der gesamten Heilkunde (Dr. med. univ.)}, year = {2014}, month = {06/2014}, pages = {84}, publisher = {Medizinische Universit{\"a}t Wien}, type = {Diplomarbeit}, address = {Wien}, abstract = {

Hintergrund

Die {\"O}sterreichische Prim{\"a}rversorgung, und damit auch die Allgemeinmedizin, gilt als schwach ausgepr{\"a}gt und aufgrund systembedingt fehlender Koordinations-mechanismen in ihrer Rolle als erste Anlaufstelle f{\"u}r alle Gesundheitsanliegen stark vom Verhalten der Patientinnen und Patienten abh{\"a}ngig. Die hohe Inanspruchnahme von Fach-{\"a}rztinnen und Fach{\"a}rzten und von Spitalsambulanzen legt nahe, dass die Allgemeinmedizin nicht routinem{\"a}{\ss}ig die erste Anlaufstelle darstellt, genauere Daten dazu fehlen jedoch.

Methoden

Um zu erfassen, wie stark die Allgemeinmedizin als erste Anlaufstelle gesehen wird, wurden im Rahmen der QUALICOPC-Studie erhobene Daten von 1598 Patientinnen und Patienten und 184 Allgemeinmedizinerinnen und Allgemeinmedizinern aus ganz {\"O}sterreich analysiert. Anhand von Fallvignetten wurde die Rolle der Allgemeinmedizin als erste Anlaufstelle erfasst und auf Unterschiede zwischen st{\"a}dtischen und l{\"a}ndlichen Regionen analysiert. Patientinnen und Patienten wurden zus{\"a}tzlich nach ihrem Erstkontaktverhalten befragt. Erstkontaktverhalten, Ansichten der Patientinnen und Patienten und die Wahrnehmung der {\"A}rztinnen und {\"A}rzte wurden untereinander auf Korrelation gepr{\"u}ft.

Ergebnisse

Zumindest 85,9\% der Patientinnen und Patienten haben eine {\"A}rztin oder einen Arzt f{\"u}r Allgemeinmedizin zu der oder dem sie normalerweise zuerst gehen. Innerhalb von 12 Monaten haben 80\% mindestens einmal selbstst{\"a}ndig fach{\"a}rztliche Hilfe und 25,5\% eine Notaufnahme in Anspruch genommen. Die Allgemeinmedizin wird h{\"a}ufig als erste Anlaufstelle f{\"u}r Gr{\"u}nde wie Magenschmerzen (83,7\%) oder Routineuntersuchungen (83,5\%) angegeben. Seltener traf dies f{\"u}r psychosoziale und fachspezifischere Probleme wie etwa Sehkraftverschlechterung (29,4\%) zu. Es zeigten sich signifikante Unterschiede zwischen st{\"a}dtischen und l{\"a}ndlichen Regionen in einer Mehrzahl der F{\"a}lle. Die Erstkontaktrolle wurde in Gebieten mit niedrigem Urbanit{\"a}tsgrad fast durchwegs h{\"o}her bewertet. Die Ansichten der Patientinnen und Patienten korrelierten signifikant mit den Wahrnehmungen der {\"A}rztinnen und {\"A}rzte (r=0,122; p\<0,001), wie auch mit dem Erstkontaktverhalten (r=0,105; p\<0,001).

Schlussfolgerung

Die Allgemeinmedizin wird f{\"u}r einige prim{\"a}rversorgungsrelevante Fragestellungen nicht als erste Anlaufstelle gesehen. Um die Erstkontaktrolle der Allgemeinmedizin zu st{\"a}rken und die damit verbundenen positiven Effekte zu erreichen, sollten die Gr{\"u}nde daf{\"u}r genauer untersucht und bei Reformen ber{\"u}cksichtigt werden.

}, keywords = {Erstkontakt, Prim{\"a}rversorgung, QUALICOPC}, url = {http://media.obvsg.at/AC10776510}, author = {Sebastian Huter}, editor = {Kathryn Hoffmann and Manfred Maier} } @article {194, title = {Interdisziplin{\"a}re Zusammenarbeit von Haus{\"a}rztinnen und Haus{\"a}rzten in {\"O}sterreich}, volume = {Doktorin der gesamten Heilkunde (Dr. med. univ.)}, year = {2014}, month = {07/2014}, pages = {68}, publisher = {Medizinische Universit{\"a}t Wien}, type = {Diplomarbeit}, address = {Wien}, abstract = {

Hintergrund

In der Prim{\"a}rversorgung erlangen Werte wie Patient/innenzentriertheit, Kontinuit{\"a}t in der Betreuung sowie Koordination durch das Gesundheitssystem immer mehr an Bedeutung. Eine M{\"o}glichkeit um diesen Anforderungen in Zukunft gerecht werden zu k{\"o}nnen, ist interdisziplin{\"a}re Zusammenarbeit. Nicht nur effektive Kommunikation unter den {\"A}rzt/innen, sondern auch das Arbeiten in interdisziplin{\"a}ren Ordinationsteams gemeinsam mit verschiedensten medizinischen Berufsgruppen stellen eine Option dar, mit dem Patienten/der Patientin im Mittelpunkt die Qualit{\"a}t der Versorgung zu verbessern. Ziel der Diplomarbeit war es zu erfassen, in wie weit interdisziplin{\"a}re Zusammenarbeit im Setting Allgemeinmedizin in {\"O}sterreich stattfindet.

Methodik

Im Rahmen der QUALICOPC-Studie, einer europaweiten Querschnittsstudie in 34 L{\"a}ndern, wurden in {\"O}sterreich Daten von 184 Allgemeinmediziner/innen und 1791 Patient/innen gesammelt. Mit Hilfe von drei standardisierten Frageb{\"o}gen wurde die Situation der Prim{\"a}rversorgung erfasst. Im Zuge dieser Diplomarbeit wurde die statistische Auswertung f{\"u}r {\"O}sterreich in Bezug auf die interdisziplin{\"a}re Zusammenarbeit mittels SPSS 19.0 durchgef{\"u}hrt.

Ergebnisse

Es zeigte sich, dass 19,7\% der 160 (f{\"u}r die Auswertung herangezogenen) Allgemeinmediziner/innen sich mehr als einmal pro Monat mit einem/einer Angeh{\"o}rigen einer anderen medizinischen Berufsgruppe treffen. 15,7\% konsultieren mehr als einmal pro Monat einen Facharzt/eine Fach{\"a}rztin einer anderen Disziplin. Die Ordinationsteams bestehen in {\"O}sterreich zu 67,1\% aus dem Allgemeinmediziner/der Allgemeinmedizinerin mit einem/r Vertreter/in einer anderen medizinischen Berufsgruppe, in den meisten F{\"a}llen einem/einer Ordinationsgehilfen/-gehilfin. 17,1\% der teilnehmenden Praxen bestanden aus einem interdisziplin{\"a}ren Team im Sinne von Hausarzt/Haus{\"a}rztin plus mehr als eine andere medizinische Berufsgruppe.

Diskussion

Wie aus den Daten klar ersichtlich wurde, gibt es in {\"O}sterreich noch genug Optimierungsm{\"o}glichkeiten, im Rahmen derer Interdisziplinarit{\"a}t noch gef{\"o}rdert und gest{\"a}rkt werden sollte, vor allem eine interdisziplin{\"a}re Zusammensetzung der Ordinationsteams w{\"a}re ein Schritt in Richtung umfassende patient/innenzentrierte Betreuung.

}, keywords = {Allgemeinmedizin, Interdisziplin{\"a}re Zusammenarbeit, Prim{\"a}rversorgung, Public Health}, url = {http://media.obvsg.at/AC10776627}, author = {Katharina S{\"u}{\ss}}, editor = {Kathryn Hoffmann and Manfred Maier} } @article {287, title = {M{\"o}glichkeiten und Grenzen des Brustkrebsscreening}, year = {2014}, institution = {{\"O}sterreichische Gesellschaft f{\"u}r Allgemeinmedizin ({\"O}GAM)}, address = {Wien}, keywords = {Bias, Brustkrebs, Fr{\"u}herkennung, Mammakarzinom, Mammographie, Screening}, author = {Rabady, Susanne and Andrea Fried}, editor = {Gerald Gartlehner and Michael Stierer and Irmgard Schiller-Fr{\"u}hwirt and Andrea Siebenhofer-Kroitzsch and Herbert Bachler and Reinhold Glehr} } @booklet {370, title = {Traumberuf Hausarzt}, year = {2014}, abstract = {

In zukunftsweisenden Gesundheitssystemen hat die haus{\"a}rztliche Versorgung gro{\ss}e Bedeutung. In den weltweit stattfindenden Neuorientierungen ist der Blick derzeit in erster Linie auf die medizinische Grundversorgung gerichtet. Dementsprechend ist Allgemeinmedizin auch im Rahmen der in Diskussion befindlichen Reform des {\"o}sterreichischen Gesundheitssystems ebenfalls ein Hoffnungstr{\"a}ger geworden.
{\quotedblbase}Haus{\"a}rztin{\textquotedblleft} und {\quotedblbase}Hausarzt{\textquotedblleft} sind Begriffe, die in der Bev{\"o}lkerung einen guten Klang haben. Sie stehen f{\"u}r Vertrauen, N{\"a}he, Gesamtschau, Langzeitbeziehung, Familienbetreuung, freundschaftliche Beziehungen und {\"a}hnliches.
Gleichzeitig gibt es Botschaften der Geringsch{\"a}tzung, des Infragestellens und der Ger{\"u}chte um eine Abl{\"o}se niedergelassener haus{\"a}rztlicher T{\"a}tigkeit durch andere Versorgungsstrukturen. Lohnt es sich da, diesen Beruf zu ergreifen, ihm seine Ausbildung zu widmen und f{\"u}r sp{\"a}ter ein erf{\"u}lltes, gl{\"u}ckliches Leben zu erhoffen? Wem soll man in der F{\"u}lle des Geschriebenen, Geklagten und Bef{\"u}rchteten glauben?

In den universit{\"a}ren allgemeinmedizinischen Lehrpraxen und in von {\"A}rzten f{\"u}r Allgemeinmedizin gehaltenen Vorlesungen wird Studierenden vermehrt Wissen um generalistische Arbeit ebenso wie entsprechende praktische Fertigkeiten vermittelt. Medizinische Universit{\"a}ten beginnen zu verstehen, dass die medizinische Grund- und Langzeitversorgung und generalistische Arbeitsans{\"a}tze durchaus auch f{\"u}r die Forschung interessant sind.

In der postgraduale Ausbildung wird in K{\"u}rze der dreij{\"a}hrige Ausbildungsturnus zum Arzt f{\"u}r Allgemeinmedizin durch eine zeitgem{\"a}{\ss}ere Ausbildung ersetzt werden. Die Voraussetzung f{\"u}r die {\"U}bernahme eines den heutigen Anforderungen entsprechenden Versorgungsauftrages wird damit endlich geschaffen. Die Einf{\"u}hrung der verpflichtenden praktischen Ausbildung in einer allgemeinmedizinischen Lehrpraxis {\textendash} eine absolute Notwendigkeit {\textendash} steht kurz vor dem Beschluss. Die derzeit g{\"u}ltige Ausbildungszeit ist f{\"u}r eine moderne Allgemeinmedizin zu kurz, als {\quotedblbase}Wartezone{\textquotedblleft} f{\"u}r eine fach{\"a}rztliche Ausbildung in einem anderen Fach ist sie zu lang. Diese Ausbildung wird nun um wesentliche Teile, insbesondere aber um eine angemessene Lehrpraxiszeit erweitert. Die Verantwortlichen in immer mehr Bundesl{\"a}ndern bem{\"u}hen sich um eine bessere fi nanzielle Wertsch{\"a}tzung allgemeinmedizinischer T{\"a}tigkeit. In {\"a}hnlicher Weise kommen auch die organisatorischen Rahmenbedingungen bzw. die M{\"o}glichkeiten f{\"u}r verschiedene, dem heutigen Wirtschaftsverst{\"a}ndnis angepasste, besser lebbare Zusammenarbeitsformen in Bewegung. Nicht
zuletzt ist in diesen Diskussionen sp{\"u}rbar, dass verst{\"a}rkt auf die Lebensqualit{\"a}t von Haus{\"a}rztin und Hausarzt Bedacht genommen werden muss.

Dies alles stimmt positiv und soll junge {\"A}rztinnen und {\"A}rzte ermuntern, diesen sch{\"o}nen, vielf{\"a}ltigen und verantwortungsvollen Beruf zu ergreifen. In diesem Sonderheft {\quotedblbase}Traumberuf Hausarzt{\textquotedblleft} wird vieles im Detail angesprochen, nicht um die derzeitige Situation der Allgemeinmedizin allzu rosig darzustellen, aber um zu zeigen, dass Optimismus berechtigt ist, dass sich der haus{\"a}rztliche Beruf im Aufwind befi ndet und es sich lohnt, ihn anzustreben.

}, author = {Reinhold Glehr and Rabady, Susanne and Hockl, Wolfgang and Burghuber, Franz and Neuber, Nina-Maria and Cybulski, Martin and Heckenthaler, Walter and Wendler, Maria and Thomas Jungblut and Modler, Elisabeth and Hofbaur, Benedikt and Braunschmid, Karl and Thalhammer, Gottfried and Bernhard Panhofer and Kaiba, Wilfried and Croy, Cornelia} } @article {550, title = {Unregulated access to health-care services is associated with overutilization{\textemdash}lessons from Austria}, journal = {Eur. J. Public Health}, year = {2014}, issn = {1101-1262}, doi = {10.1093/eurpub/cku189}, url = {http://eurpub.oxfordjournals.org/content/early/2014/11/22/eurpub.cku189.abstract}, author = {Pichlh{\"o}fer, Otto and Maier, Manfred} } @article {302, title = {Analyse interpersoneller Aspekte der kontinuierlichen haus{\"a}rztlichen Betreuung {\textendash} Unterschiede zwischen chronisch und nicht-chronisch erkrankten PatientInnen}, volume = {Doktor der gesamten Heilkunde (Dr. med. univ.)}, year = {2013}, month = {01/2013}, pages = {86}, publisher = {Medizinische Universit{\"a}t Wien}, type = {Diplomarbeit}, address = {Wien}, abstract = {

Internationale Organe wie die Weltgesundheitsorganisation oder die Europ{\"a}ische Union sind bestrebt, die prim{\"a}re Gesundheitsversorgung und damit die medizinische Basis- oder Grundversorgung durch Haus{\"a}rztInnen und {\textendash} je nach Land {\textendash} auch durch speziell ausgebildetes Pflegepersonal zu st{\"a}rken. Daher wurde das europaweite Projekt QUALICOPC (Quality and costs of primary care in Europe) mit dem Ziel ins Leben gerufen, die medizinische Prim{\"a}rversorgung zu evaluieren. Diese Diplomarbeit stellt einen Teil dieser Evaluierung dar. Die QUALICOPC-Studie war eine epidemiologische Querschnittsstudie, die auf {\"o}sterreichischer Ebene von der Abteilung f{\"u}r Allgemein- und Familienmedizin der
Medizinischen Universit{\"a}t Wien koordiniert wurde. Etwas weniger als 1800 PatientInnen und 184 Haus{\"a}rztInnen haben an dieser Fragebogenerhebung teilgenommen. F{\"u}r diese Diplomarbeit wurde der Fokus auf die Fragen gelegt, welche sich damit besch{\"a}ftigen, in welchem Umfang sich PatientInnen eine kontinuierliche Betreuung w{\"u}nschen und ob sie
diese dann auch erhalten. Dar{\"u}ber hinaus hinterfragt diese Diplomarbeit inwieweit PatientInnen gesundheitsf{\"o}rdernde Ma{\ss}nahmen erfahren und wie hoch das Vertrauen der PatientInnen in ihre {\"A}rztInnen ist. Dabei wurde der Schwerpunkt insbesondere auf die Unterschiede zwischen chronisch kranken und nicht chronisch kranken PatientInnen gelegt.

Die Resultate dieser Studie zeichnen ein Bild {\"u}ber den Zustand der kontinuierlichen haus{\"a}rztlichen Betreuung in {\"O}sterreich. Dabei l{\"a}sst sich erkennen, dass bei den aufgeworfenen Fragen durchaus statistisch signifikante Unterschiede in den jeweiligen Subgruppen vorhanden sind auch wenn sicherlich Optimierungspotenzial besteht. Auff{\"a}llig war, dass nahezu 40\% der Befragten eine chronische Erkrankung angegeben haben und es den Anschein hat, als ob chronisch\  Kranke sich vermehrt eine kontinuierliche Betreuung w{\"u}nschen als dies bei nicht chronisch Kranken der Fall ist {\textendash} und diese letztlich auch bekommen. Auch die Frage nach der Gesundheitsf{\"o}rderung und dem Vertrauen in die {\"A}rztInnen wird von chronisch Kranken h{\"a}ufiger mit gr{\"o}{\ss}erer Zustimmung beantwortet.

Abstract

International organizations such as the World Health Organization and the European Union have made an effort to strengthen the sector of primary health care and thus basic medical and primary care provided by family physicians and, in some countries, by specially trained nurses. A European project called QUALICOPC (Quality and costs of primary care in Europe) was launched with the task of evaluating primary healthcare in Europe. This thesis constitutes a part of this evaluation. The QUALICOPC study is a cross-sectional epidemiological survey, the Austrian branch of which was conducted by the Department of General and Family Medicine at the Medical University of Vienna. Nearly 1800 patients and 184 general practitioners participated in this survey. This thesis focuses on three questions: [1] to what extent patients require continuous care and whether they actually receive it; [2] whether patients are offered health promotion services during their visit; and [3] what level of trust patients have in their physician. In each case, the differences between chronically ill and non-chronically ill patients are emphasized.

The results of this study provide insight into the state of the continuity of primary healthcare in Austria. The study yielded statistically significant differences among the respective subgroups, although there is certainly potential for further research. Almost 40\% of the participants had indicated that they had a chronic disease and were shown to seek a greater degree of continuous care as well as receive it than were non-chronically ill patients. Chronically ill patients were also offered a greater number of health promotion services and displayed a higher level of trust in their doctors than non-chronically ill patients.

}, keywords = {chronische Erkrankungen, Kontinuit{\"a}t, QUALICOPC}, author = {Dario Nedi{\'c}}, editor = {Manfred Maier and Kathryn Hoffmann} } @article {553, title = {Depression and anxiety among migrants in Austria: a population based study of prevalence and utilization of health care services.}, journal = {J Affect Disord}, volume = {151}, year = {2013}, month = {2013 Oct}, pages = {220-8}, abstract = {

BACKGROUND: Although migrants form a large part of the Austrian population, information about mental health of migrants in Austria is scarce. Therefore, we compared the prevalence of dysphoric disorders (depression and anxiety) and the corresponding utilization of health care services of Eastern European, western and other migrants with the non-migrant population in Austria.

METHODS: We performed a telephone survey on a random sample of the general population of Austria aged 15 years and older (n=3509) between October 2010 and September 2011. Depression and anxiety were measured with the Patient Health Questionnaire-4 and utilization of health care services in the last 4 weeks was inquired.

RESULTS: 15.0\% of our sample had a migration background. Female migrants from Eastern Europe, first and second generation, had a higher prevalence of dysphoric disorders (29.7\% and 33.4\% respectively) than Austrian women (15.2\%) (p<0.001). The prevalence in the other migrant groups did not differ significantly from the Austrian population. There was no gender difference in dysphoric disorders in the Austrian population. After adjustment for age and chronic diseases, having a dysphoric disorder was associated with a higher utilization of health care services among migrant and Austrian women, but not among men.

LIMITATIONS: Because of the explorative nature of the study multiple testing correction was not performed. The reason for health care utilization was not assessed.

CONCLUSIONS: Mental health of female migrants from Eastern Europe should be studied in more detail; men could be an underserved group, both in migrants and Austrians.

}, keywords = {Adolescent, Adult, Aged, Anxiety, Austria, Data Collection, Delivery of Health Care, Depression, Female, Humans, Male, Middle Aged, Prevalence, Sex Factors, Transients and Migrants, Young Adult}, issn = {1573-2517}, doi = {10.1016/j.jad.2013.05.081}, url = {http://dx.doi.org/10.1016/j.jad.2013.05.081}, author = {Kerkenaar, Marlies M E and Maier, Manfred and Kutalek, Ruth and Lagro-Janssen, Antoine L M and Ristl, Robin and Pichlh{\"o}fer, Otto} } @conference {560, title = {Ecology of Care - health seeking behaviour of migrants in {Austria}}, booktitle = {The Ecology of Medical Care in Austria {\textendash} disease burden and the health seeking behaviour across levels of care in Austria}, year = {2013}, keywords = {orp-publications}, url = {https://docs.google.com/a/nordrandklinik.at/presentation/d/1Owughbs1V6AUYwbre6A4pCpLSLuSXHI38VBNSw1UcwU/edit$\#$slide=id.p}, author = {Otto Pichlh{\"o}fer and Manfred Maier and Ruth Kutalek and Wolfgang Spiegel} } @conference {565, title = {The Ecology of Medical Care in {Austria} {\textendash} disease burden and the health seeking behaviour across levels of care in {Austria}}, booktitle = {Abstracts of the 20\textsuperscript{th} WONCA World Conference {\textendash} Prague}, year = {2013}, keywords = {orp-publications}, author = {Otto Pichlh{\"o}fer and Ruth Kutalek and Wolfgang Spiegel and Manfred Maier} } @article {16, title = {Effectiveness of non-cardiac preoperative testing in non-cardiac elective surgery: a systematic review.}, journal = {Br J Anaesth}, volume = {110}, year = {2013}, month = {2013 Jun}, pages = {926-39}, abstract = {

Elective surgery is usually preceded by preoperative diagnostics to minimize risk. The results are assumed to elicit preventive measures or even cancellation of surgery. Moreover, physicians perform preoperative tests as a baseline to detect subsequent changes. This systematic review aims to explore whether preoperative testing leads to changes in management or reduces perioperative mortality or morbidity in unselected patients undergoing elective, non-cardiac surgery. We systematically searched all relevant databases from January 2001 to February 2011 for studies investigating the relationship between preoperative diagnostics and perioperative outcome. Our methodology was based on the manual of the Ludwig Boltzmann Institute for Health Technology Assessment, the Scottish Intercollegiate Guidelines Network (SIGN) handbook, and the PRISMA statement for reporting systematic reviews. One hundred and one of the 25 281 publications retrieved met our inclusion criteria. Three test grid studies used a randomized controlled design and 98 studies used an observational design. The test grid studies show that in cataract surgery and ambulatory surgery, there are no significant differences between patients with indicated preoperative testing and no testing regarding perioperative outcome. The observational studies do not provide valid evidence that preoperative testing is beneficial in healthy adults undergoing non-cardiac surgery. There is no evidence derived from high-quality studies that supports routine preoperative testing in healthy adults undergoing non-cardiac surgery. Testing according to pathological findings in a patient{\textquoteright}s medical history or physical examination seems justified, although the evidence is scarce. High-quality studies, especially large randomized controlled trials, are needed to explore the effectiveness of indicated preoperative testing.

}, keywords = {C-Reactive Protein, Elective Surgical Procedures, Hematocrit, Hemoglobins, Humans, Kidney Function Tests, Leukocyte Count, Liver Function Tests, Preoperative Care, Randomized Controlled Trials as Topic}, issn = {1471-6771}, doi = {10.1093/bja/aet071}, author = {Johansson, T and Fritsch, G and Flamm, M and Hansbauer, B and Bachofner, N and Mann, E and Bock, M and S{\"o}nnichsen, A C} } @article {15, title = {Information technology interventions to improve medication safety in primary care: a systematic review.}, journal = {Int J Qual Health Care}, volume = {25}, year = {2013}, month = {2013 Oct}, pages = {590-8}, abstract = {

PURPOSE: Improving medication safety has become a major topic in all clinical settings. Information technology (IT) can play an important role to prevent adverse drug events (ADEs), but data on the effectiveness of IT interventions are controversial. The objective of this paper is to provide a systematic review about the effects of IT interventions on medication safety in primary care.

DATA SOURCES: PubMed, International Pharmaceutical Abstracts, EMBASE, Cochrane Database of Systematic Reviews, handsearching reference lists from full-text articles.

STUDY SELECTION: Randomized controlled trials (RCTs), if interventions based on IT, performed in primary care and outcomes reported on medication safety. Data extraction Study characteristics and outcome data independently extracted by two reviewers. Disagreement resolved by discussion with a third reviewer.

RESULTS OF DATA SYNTHESIS: Out of 3918 studies retrieved, 10 RCTs met the inclusion criteria. Of the six studies evaluating computerized provider order entry (CPOE) with clinical decision support (CDS) only 3 studies effectively reduced unsafe prescribing. Both pharmacist-led IT interventions decreased the prescription of potentially inappropriate medication or unsafe prescribing in pregnancy. No reduction of ADEs was achieved by a web program or a TeleWatch system intervention.

CONCLUSION: Only 5 of 10 RCTs revealed a reduction of medication errors. CPOE with CDS was effective if targeted at a limited number of potentially inappropriate medications. The positive results of pharmacist-led IT interventions indicate that IT interventions with inter-professional communication appear to be effective. The unequivocal results of the included RCTs stress the necessity of rigorous evaluation prior to large-scale implementation.

}, keywords = {Humans, Medical Informatics, Medication Errors, Patient Safety, Primary Health Care, Quality Improvement}, issn = {1464-3677}, doi = {10.1093/intqhc/mzt043}, author = {Lainer, Miriam and Mann, Eva and S{\"o}nnichsen, Andreas} } @article {554, title = {Patient and preceptor attitudes towards teaching medical students in General Practice.}, journal = {BMC Med Educ}, volume = {13}, year = {2013}, month = {2013 Jun 07}, pages = {83}, abstract = {

BACKGROUND: Curricula in most western medical universities include teaching in the primary care setting as core elements. This affects GP-teachers, their patients and their interaction. Therefore, it was the aim of this study to assess the influence of the presence of medical students in the teaching practice on the attitudes of both GPs and patients.

METHODS: Seventy-four GP-preceptors were invited to answer an online survey. Patients attending consultations with a medical student present completed questionnaires either before the consultation (WR group) or immediately after consultation (AC group).

RESULTS: Fifty- nine preceptors completed the online survey. Physicians showed positive attitudes towards their activities as preceptors: 95\% expressed a positive attitude predominantly towards being a role model and to represent the discipline and for 64\% remuneration was not important. In 28 practices 508 questionnaires were completed by patients in the WR-group and 346 by the AC-group. Only 12\% (WR) and 7.2\% (AC) of patients expressed a preference for being seen by the doctor alone. While 16\% of doctors rated that confidentiality of the doctor-patient relationship is compromised, only 4.1\% (WR) and 1.7\% (AC) of patients felt so.

CONCLUSION: The motivation to be a preceptor is primarily driven by personal and professional values and not by economic incentives. Further, patients have even more positive attitudes than the preceptors towards the presence of students during their consultation. Reservations to teaching students in GP-practices are, therefore, unwarranted.

}, keywords = {Attitude, Attitude of Health Personnel, Curriculum, Education, Medical, Female, General Practice, General Practitioners, Humans, Male, Middle Aged, Patients, Preceptorship, Students, Medical, Surveys and Questionnaires}, issn = {1472-6920}, doi = {10.1186/1472-6920-13-83}, url = {http://dx.doi.org/10.1186/1472-6920-13-83}, author = {Pichlh{\"o}fer, Otto and T{\"o}nies, Hans and Spiegel, Wolfgang and Wilhelm-Mitter{\"a}cker, Andree and Maier, Manfred} } @article {17, title = {Prevalence and associations of potentially inappropriate prescriptions in Austrian nursing home residents: secondary analysis of a cross-sectional study.}, journal = {Wien Klin Wochenschr}, volume = {125}, year = {2013}, month = {2013 Apr}, pages = {180-8}, abstract = {

BACKGROUND: Potentially inappropriate prescriptions (PIP) are an important cause of adverse medication-related events and increases morbidity, hospitalization, and health care costs, especially in nursing home residents. However, little is known about the associations between PIP and residents{\textquoteright} characteristics.

OBJECTIVE: The aim of our study was to analyse the prevalence and associations of PIP with residents{\textquoteright} and facilities{\textquoteright} characteristics.

METHODS: We performed a secondary analysis of a cross-sectional study with 48 out of 50 eligible nursing homes and 1,844 out of 2,005 eligible residents in a defined rural-urban area in Austria. The Austrian list of potentially inappropriate medications was applied for the evaluation of inappropriate prescribing. Cluster-adjusted multiple regression analysis was used to investigate institutional and residents{\textquoteright} characteristics associated with PIP.

RESULTS: Mean cluster-adjusted prevalence of residents with at least one PIP was 70.3 \% (95 \% CI 67.2-73.4). The number of residents with at least one psychotropic PIP was 1.014 (55 \%). The most often prescribed PIP were Prothipendyl (25.9 \% residents), Lorazepam (14.5 \%) and Diclofenac (6.1 \%). Multiple regression analysis showed an inverse association of PIP with cognitive impairment and significant positive associations with permanent restlessness and permanent negative attitude. The associations of PIP with age and male gender were inconsistent. No significant associations were found for PIP and the ratio of staff nurses to residents.

CONCLUSIONS: Our study results confirm that PIP is highly prevalent in the nursing home population. These results urgently call for effective interventions. Initiatives and successful interventions performed in other countries could serve as examples for safer prescribing in residents in Austria.

}, keywords = {Adult, Age Distribution, Aged, Austria, Cognition Disorders, Comorbidity, Cross-Sectional Studies, Diclofenac, Female, Humans, Inappropriate Prescribing, Lorazepam, Male, Middle Aged, Nursing Care, Nursing Homes, Prescriptions, Prevalence, Psychomotor Agitation, Psychotropic Drugs, Risk Assessment}, issn = {1613-7671}, doi = {10.1007/s00508-013-0342-2}, author = {Mann, Eva and Haastert, Burkhard and B{\"o}hmdorfer, Birgit and Fr{\"u}hwald, Thomas and Iglseder, Bernhard and Roller-Wirnsberger, Regina and Meyer, Gabriele} } @article {196, title = {Priorit{\"a}ten von Patientinnen und Patienten im {\"a}rztlichen Gespr{\"a}ch in der Allgemeinmedizin: Eine Querschnittstudie in {\"O}sterreich im Rahmen des QUALICOPC Projektes}, volume = {Doktor der gesamten Heilkunde (Dr. med. univ.)}, year = {2013}, month = {10/2013}, pages = {121}, publisher = {Medizinische Universit{\"a}t Wien}, type = {Diplomarbeit}, address = {Wien}, abstract = {

Hintergrund

Diese Diplomarbeit behandelt die Priorit{\"a}ten von Patientinnen und Patienten im {\"a}rztlichen Gespr{\"a}ch in der {\"o}sterreichischen Allgemeinmedizin und wie sich diese nach Geschlecht, Bildungsgrad und Alter unterscheiden. Um gute Versorgung bieten zu k{\"o}nnen, m{\"u}ssen diese Pr{\"a}ferenzen erfasst und bedacht werden. Bisher gibt es in der {\"o}sterreichischen Allgemeinmedizin keine Untersuchung zu dieser Fragestellung. Diese Arbeit soll erste Ans{\"a}tze f{\"u}r die weitere Erforschung hinsichtlich Priorit{\"a}ten allgemein, wie auch hinsichtlich m{\"o}glicher Unterschiede zwischen den untersuchten Untergruppen bilden.

Methodik

Patientinnen und Patienten wurden im Rahmen der QUALICOPC-Studie (Quality and Costs of Primary Care in Europe) mittels anonymer Frageb{\"o}gen zu unterschiedlichen Bereichen der Allgemeinmedizin befragt, wobei in dieser Arbeit zehn Fragen zum {\"a}rztlichen Gespr{\"a}ch ausgewertet wurden. Mittels SPSS 21.0 wurden H{\"a}ufigkeiten der Antworten insgesamt sowie Unterschiede zwischen den Subgruppen untersucht.

Ergebnisse

Von 3.050 kontaktieren Haus{\"a}rztinnen und Haus{\"a}rzten nahmen 184 an der Studie teil (R{\"u}cklaufrate ca. 6\%). Von 2.662 angesprochenen Patientinnen und Patienten f{\"u}llten schlie{\ss}lich 1.791 einen Fragebogen aus (R{\"u}cklaufrate ca. 67\%). Generell bewerteten die Probandinnen und Probanden die untersuchten Aspekte als wichtig. Vor allem von {\"A}rztinnen/{\"A}rzten ernst genommen ({\quotedblbase}sehr wichtig{\textquotedblleft} 70,4\%) und verstanden zu\  werden (65,2\%), sowie aufmerksames Zuh{\"o}ren (59\%) und klare Anweisungen durch Medizinerinnen und Mediziner (69,5\%) sind Patientinnen und Patienten unabh{\"a}ngig vonden untersuchten\  Merkmalen wichtig. Zwischen M{\"a}nnern und Frauen zeigen sich am h{\"a}ufigsten Unterschiede, am seltensten zwischen den unterschiedlichen Bildungsgraden. Der Vergleich nach dem Alter l{\"a}sst keine klaren Schl{\"u}sse zu. Patientinnen und Patienten des prim{\"a}ren Bildungsgrades bevorzugen gegen{\"u}ber denjenigen des dritten Grades eine abschlie{\ss}ende Frage, ob sie die {\"A}rztin beziehungsweise den Arzt richtig verstanden h{\"a}tten (63,6\% vs. 29,2\%; p \< 0,05). Der Augenkontakt war Frauen anders als erwartet nicht wichtiger als M{\"a}nnern ({\quotedblbase}wichtig{\textquotedblleft} M: 46,2\% vs. F: 55\%, p \< 0,05; {\quotedblbase}sehr wichtig{\textquotedblleft} M: 17,9\% vs. F: 29,4\%, p \< 0,05). Die Wichtigkeit nonverbalen Verhaltens, das gr{\"o}{\ss}tenteils unbewusst abl{\"a}uft, ist aber m{\"o}glicherweise durch einen Fragebogen nicht fassbar.

Diskussion

Unterschiede in der Wichtigkeit von Kommunikation zeigen sich am h{\"a}ufigsten zwischen Frauen und M{\"a}nnern. Insgesamt d{\"u}rften Patientinnen und Patienten kommunikative Aspekte wichtig sein. Um dies zu {\"u}berpr{\"u}fen sollte eine genauere Untersuchung mit gr{\"o}{\ss}erer Stichprobe und ohne Selektionsbias erfolgen. Weiters sollte die Beachtung des Geschlechts der {\"A}rztin beziehungsweise des Arztes (Dyaden) sowie eine genauere Untersuchung des Alterseffektes Ziel zuk{\"u}nftiger Forschung sein.

}, keywords = {Gender, Kommunikation, Patientenzentriertheit, Prim{\"a}rversorgung}, url = {http://media.obvsg.at/AC10775689}, author = {Johannes Singer}, editor = {Kathryn Hoffmann and Manfred Maier} } @article {454, title = {Quality improvement in preoperative assessment by implementation of an electronic decision support tool.}, journal = {J Am Med Inform Assoc}, volume = {20}, year = {2013}, month = {2013 Jun}, pages = {e91-6}, abstract = {

OBJECTIVES: To evaluate the impact of the electronic decision support (eDS) tool {\textquoteright}PReOPerative evaluation{\textquoteright} (PROP) on guideline adherence in preoperative assessment in statutory health care in Salzburg, Austria.

MATERIALS AND METHODS: The evaluation was designed as a non-randomized controlled trial with a historical control group (CG). In 2007, we consecutively recruited 1363 patients admitted for elective surgery, and evaluated the preoperative assessment. In 2008, PROP was implemented and available online. In 2009 we recruited 1148 patients preoperatively assessed using PROP (294 outpatients, 854 hospital sector). Our analysis includes full blood count, liver function tests, coagulation parameters, electrolytes, ECG, and chest x-ray.

RESULTS: The number of tests/patient without indication was 3.39 in the CG vs 0.60 in the intervention group (IG) (p<0.001). 97.8\% (CG) vs 31.5\% (IG) received at least one unnecessary test. However, we also observed an increase in recommended tests not performed/patient (0.05{\textpm}0.27 (CG) vs 0.55{\textpm}1.00 (IG), p<0.001). 4.2\% (CG) vs 30.1\% (IG) missed at least one necessary test. The guideline adherence (correctly tested/not tested) improved distinctively for all tests (1.6\% (CG) vs 49.3\% (IG), p<0.001).

DISCUSSION: PROP reduced the number of unnecessary tests/patient by 2.79 which implied a reduction of patients{\textquoteright} burden, and a relevant cut in unnecessary costs. However, the advantage in specificity caused an increase in the number of patients incorrectly not tested. Further research is required regarding the impact of PROP on perioperative outcomes.

}, keywords = {Adult, Aged, Austria, Decision Support Systems, Clinical, Diagnostic Tests, Routine, Elective Surgical Procedures, Female, Guideline Adherence, Humans, Male, Middle Aged, Practice Guidelines as Topic, Preoperative Care, Quality Improvement}, issn = {1527-974X}, doi = {10.1136/amiajnl-2012-001178}, author = {Flamm, Maria and Fritsch, Gerhard and Hysek, Martin and Klausner, Sabine and Entacher, Karl and Panisch, Sigrid and Soennichsen, Andreas C} } @article {551, title = {The treatment experience questionnaire: development and validation of a questionnaire assessing the individual{\textquoteright}s emotional, perceptual, and cognitive reactions to alternative, physical, and dental treatments.}, journal = {Forsch Komplementmed}, volume = {20}, year = {2013}, month = {2013}, pages = {205-12}, abstract = {

BACKGROUND: The aim of this study was to develop and validate a questionnaire designed to assess the patient{\textquoteright}s affective, cognitive, and perceptual state during treatment administration.

METHODS: 362 individuals (214 females, 148 males, mean age 54.6 years) with predominantly musculoskeletal or dental problems participated in the study. Patients responded to the questionnaire immediately following a treatment. The questionnaire included items of 9 proposed scales devised to assess mood, psychological tension, sleepiness, mental absorption, treatment appraisal, perceived cooperation during treatment administration, perceived somatosensory intensity of treatment as well as negative and positive bodily sensations during treatment. Treatments were administered in 2 spa centers, a clinic for physical medicine and rehabilitation and a clinic for dentistry. Treatments investigated were among others dental treatment, massage, packs, baths, relaxation training, exercise, and acupuncture.

RESULTS: The proposed scales were confirmed. Scales had adequate to good reliability and validity. All scales significantly distinguished between treatments.

CONCLUSION: The devised questionnaire has adequate properties to assess patients{\textquoteright} experiences during treatment administration.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Austria, Cognition, Complementary Therapies, Dental Care, Emotions, Female, Humans, Male, Middle Aged, Musculoskeletal Pain, Patient Satisfaction, Perception, Physical and Rehabilitation Medicine, Psychometrics, Rehabilitation, Reproducibility of Results, Surveys and Questionnaires, Young Adult}, issn = {1661-4127}, doi = {10.1159/000351456}, url = {http://www.karger.com?doi=10.1159/000351456}, author = {Blasche, Gerhard and Marktl, Wolfgang and Eisenwort, Brigitte and Skolka, Astrid and Pichlh{\"o}fer, Otto} } @article {18, title = {Diabetes care among older adults in primary care in Austria--a cross-sectional study.}, journal = {Swiss Med Wkly}, volume = {142}, year = {2012}, month = {2012}, pages = {w13646}, abstract = {

QUESTIONS UNDER STUDY: The prevalence of diabetes mellitus in the older population is high, but hardly any data are available on current diabetes care in the primary care setting. We aimed at investigating the diabetes management of older patients with type 2 diabetes (T2DM) in the primary care setting, including adherence to current guidelines, comparing patients aged 70-79 years to those aged 80 years and above.

METHODS: From November 2008 through March 2009 a total of 23 primary care physicians and one consultant in internal medicine consecutively enrolled 203 unselected patients with T2DM aged >=70 years.

RESULTS: From the 203 study participants 66\% were 70-79 years of age, and 34\% were 80 years or older. Mean HbA1c and LDL-cholesterol were not significantly different between the older and the younger age group (7.6 {\textpm} 1.6 vs. 7.1 {\textpm} 0.9\%; p = 0.080; and 122 {\textpm} 40 vs. 114 {\textpm} 34 mg/dl; p = 0.273), whereas BMI was lower (27.5 {\textpm} 5.0 vs. 29.6 {\textpm} 5.0 kg/m2, p = 0.010), and the prevalent rates of coronary heart disease (55.1 vs. 37.1\%, p = 0.011) and of dementia (29\% vs. 6.1\%, p = 0.001) were higher in the older age group. LDL-cholesterol (77.6\% vs. 66.7\%, p = 0.012), creatinine clearance (34.6\% vs. 30.9\%, p = 0.049) but not HbA1c (74.6\% vs.73.9; p = 0.520) were monitored significantly less often in the older than in the younger age group.

CONCLUSIONS: While glycaemic control on average appears strict, there may be ample room for improvement in reaching lipid targets and in the monitoring of lipid and renal function among older adults in primary care, in particular among individuals aged >=80 years.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Austria, Body Mass Index, Chi-Square Distribution, Cholesterol, HDL, Cholesterol, LDL, Creatinine, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Glomerular Filtration Rate, Glycated Hemoglobin, Humans, Male, Practice Patterns, Physicians{\textquoteright}, Statistics, Nonparametric, Triglycerides}, issn = {1424-3997}, doi = {10.4414/smw.2012.13646}, author = {Mann, Eva and Vonbank, Alexander and Drexel, Heinz and Saely, Christoph H} } @article {19, title = {Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list.}, journal = {Wien Klin Wochenschr}, volume = {124}, year = {2012}, month = {2012 Mar}, pages = {160-9}, abstract = {

BACKGROUND: The practice of inappropriate medication and drug prescription is a major risk factor for adverse drug reactions in geriatric patients and increases the individual, as well as overall, rates of hospital admissions, resulting in increased health care expenditures. A consensus-based list of drugs, generally to be avoided in geriatric patients, is a practical tool to possibly improve the quality of prescribing.

OBJECTIVE: The aim was to develop a consensus-based list of potentially inappropriate medications (PIM) for geriatric patients in Austria. Local market characteristics and documented prescribing regimens were considered in detail.

METHODS: A two-round Delphi process involving eight experts in the field of geriatric medicine was undertaken to create a list of potentially inappropriate medications. Using a 5-point Likert scale (from strong agreement to strong disagreement), mean ratings from the experts were evaluated for each drug selected in the first round. The participants were first asked to comment on the potential inappropriateness of a preliminary list of drugs, and to propose alternate substances missing in the previous questionnaire for a second rating process. All drugs whose upper limit of the 95\% CI was less than 3.0 were classified as potentially inappropriate. Drugs with a 95\% CI enclosing 3.0 entered a second rating by the experts, in addition to other substances suggested during the first questionnaire. Drugs in the second rating were evaluated in comparable fashion to the first one. The final list was synthesized from the results in both rounds.

RESULTS: Out of a preliminary list of 102 drugs, 61 drugs (59.2\%) were classified as potentially inappropriate for geriatric persons in the first Delphi- round. In the second rating, six drugs that were reevaluated, and six drugs proposed additionally, were rated as potentially inappropriate. The final list contains 73 drugs to be avoided in older patients because of an unfavorable benefit/risk profile and/or unproven effectiveness. The list also contains suggestions for therapeutic alternatives and information about pharmacological and pharmacokinetic characteristics of all drugs judged as potentially inappropriate.

CONCLUSION: The current Austrian list of potentially inappropriate medications may be a helpful tool for clinicians to increase the quality of prescribing in older patients. Like all explicit lists previously published, its validity needs to be proven in validation studies.

}, keywords = {Aged, Aged, 80 and over, Austria, Female, Humans, Inappropriate Prescribing, Male}, issn = {1613-7671}, doi = {10.1007/s00508-011-0061-5}, author = {Mann, Eva and B{\"o}hmdorfer, Birgit and Fr{\"u}hwald, Thomas and Roller-Wirnsberger, Regina E and Dovjak, Peter and D{\"u}ckelmann-Hofer, Christine and Fischer, Peter and Rabady, Susanne and Iglseder, Bernhard} } @article {20, title = {Prevalence of psychotropic medication use among German and Austrian nursing home residents: a comparison of 3 cohorts.}, journal = {J Am Med Dir Assoc}, volume = {13}, year = {2012}, month = {2012 Feb}, pages = {187.e7-187.e13}, abstract = {

BACKGROUND: Despite increasing knowledge about the limited effectiveness and severe adverse effects, the prescription rate of psychotropic medications in frail elderly persons remains high. Prescriptions are mainly made to control behavioral and psychological symptoms of dementia, although factors associated with prescriptions are rarely reported. However, such information is a prerequisite to develop intervention programs aiming to safely reduce psychotropic medication in nursing home residents.

METHODS: We report the comparison of cross-sectional data of psychotropic medication prescription rates from 3 large studies including nursing home residents in Germany and Austria. We aimed to compare the prevalence of (1) psychotropic medication, (2) different classes of psychotropic medication, (3) psychotropic medication administered for bedtime use, and (4) associations between prescription of psychotropics and institutional and residents{\textquoteright} characteristics. Confidence intervals of prevalences and multiple logistic regression analyses were adjusted for cluster correlation.

RESULTS: Data from 5336 residents in 136 long term care facilities were included. In Austria, 74.6\% (95\% CI 72.0-77.2\%) of all residents had a prescription of at least one psychotropic medication compared to Germany with about 51.8\% (95\% CI 48.3-55.2\%) and 52.4\% (95\% CI 48.7-56.1\%). Of all antipsychotics, 66\% (Austria) and 47\% (Germany) were prescribed for bedtime use. Most prescriptions were conventional, low-potency antipsychotics. In all 3 studies, there was no statistically significant association between psychotropic medication prescription and nursing home characteristics. On the level of residents, consistent positive associations were found for higher level of care dependency and permanent restlessness. Consistent negative associations were found for older age and male gender.

CONCLUSION: Frequency of psychotropic and especially antipsychotic medication is substantial in nursing home residents in Germany and Austria. The high number of prescriptions is likely to be an indicator for a perceived or actual lack of strategies to handle behavioral and psychological symptoms of dementia.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Austria, Cluster Analysis, Cross-Sectional Studies, Dementia, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Utilization, Female, Geriatric Assessment, Germany, Homes for the Aged, Humans, Logistic Models, Long-Term Care, Male, Nursing Homes, Prevalence, Psychotropic Drugs, Risk Assessment, Sex Distribution}, issn = {1538-9375}, doi = {10.1016/j.jamda.2011.03.007}, author = {Richter, Tanja and Mann, Eva and Meyer, Gabriele and Haastert, Burkhard and K{\"o}pke, Sascha} } @conference {555, title = {The Ecology of Medical Care in Austria}, booktitle = {WONCA Europe 2011 Warsaw}, year = {2011}, author = {Pichlh{\"o}fer, Otto and Kutalek, Ruth and Zehetmayer, Sonja and Spiegel, Wolfgang and Shibamori, Yuka and Maier, Manfred} } @article {21, title = {Reporting quality of conference abstracts on randomised controlled trials in gerontology and geriatrics: a cross-sectional investigation.}, journal = {Z Evid Fortbild Qual Gesundhwes}, volume = {105}, year = {2011}, month = {2011}, pages = {459-62}, abstract = {

Without transparent reporting of how a randomised controlled trial was designed and conducted and of the methods used, its internal validity cannot be assessed by the reader. A congress abstract is often the only source providing information about a trial. In January 2008, an extended CONSORT statement on abstract reporting was published. Its impact has yet to be evaluated. Using a slightly modified CONSORT checklist comprising 17 items, we thus investigated the reporting quality of randomised controlled trials published in the book of abstracts presented at the World Congress of Geriatrics and Gerontology in Paris in July 2009. A total of n=4,416 abstracts was screened for inclusion; n=129 met the inclusion criteria. The overall quality of the abstracts was remarkably poor. The primary outcome was mentioned in 34/129 abstracts (26\%), none of the abstracts reported on the procedure of random allocation of participants or clusters, 21/129 abstracts (16\%) reported some kind of blinding, and the attrition rate was mentioned in only 12/129 abstracts (9\%). The majority of abstracts fulfilled two items: description of intended intervention for each group (102/129; 79\%) and general interpretation of results (107/129; 83\%). Trial status was reported in all abstracts. Both journal editors and committees organising congresses are requested to define the use of the CONSORT statement as a prerequisite in their guidelines for authors and to instruct reviewers to conduct compliance checks. Medical associations should finally endorse the indispensability of the CONSORT statement and publish it in their journals. Otherwise the intended benefits cannot be fully generated.

}, keywords = {Abstracting and Indexing, Checklist, Congresses as Topic, Cross-Sectional Studies, Geriatrics, Germany, Guidelines as Topic, Humans, Quality Assurance, Health Care, Randomized Controlled Trials as Topic, Research Design, Writing}, issn = {1865-9217}, doi = {10.1016/j.zefq.2010.07.011}, author = {Mann, Eva and Meyer, Gabriele} } @article {552, title = {Assessment of publication output in the field of general practice and family medicine and by general practitioners and general practice institutions.}, journal = {Fam Pract}, volume = {27}, year = {2010}, month = {2010 Oct}, pages = {582-9}, abstract = {

PURPOSE: The discipline of family medicine (FM) lacks a comprehensive methodology, which can be applied as a standard for assessing overall research output in both the field of FM and by general practitioners (GPs)/general practice institutions. It was the aim of this study to develop a sensitive search strategy for assessing publication output in the field of FM independent of the author{\textquoteright}s profession or affiliation and by GPs/general practice institutions independent of their field of scientific interest.

METHODS: Literature searches limited to the year 2005 were conducted in PubMed and ISI Web of Sciences (ISI WoS). In PubMed, all relevant MeSH terms were used. Search terms possibly contained in the author{\textquoteright}s affiliations have been collected. In ISI WoS, the same entry terms including their abbreviations and plural forms were applied. The final queries were validated by manual review and matching results with selected FM journals.

RESULTS: A comprehensive list of combined search terms could be defined. For the field of general practice/FM more publications could be retrieved in PubMed. Almost twice as many publications by GPs/general practice institutions could be retrieved in ISI WoS, where--in contrast to PubMed--the affiliation is documented for all authors.

CONCLUSIONS: To quantitatively assess publication output in the field of FM, PubMed was identified as the preferable database. To assess publication output by GPs/general practice institutions, the ISI WoS is recommended as the preferable database. Apparently, the ISI WoS is more suitable to compare the research productivity of different countries, authors or institutions.

}, keywords = {Bibliometrics, Biomedical Research, Databases, Bibliographic, Family Practice, General Practice, General Practitioners, Periodicals as Topic, PubMed}, issn = {1460-2229}, doi = {10.1093/fampra/cmq032}, url = {http://dx.doi.org/10.1093/fampra/cmq032}, author = {Jelercic, Stasa and Lingard, Heide and Spiegel, Wolfgang and Pichlh{\"o}fer, Otto and Maier, Manfred} } @article {24, title = {Comparison of hip fracture incidence and trends between Germany and Austria 1995-2004: an epidemiological study.}, journal = {BMC Public Health}, volume = {10}, year = {2010}, month = {2010 Jan 29}, pages = {46}, abstract = {

BACKGROUND: Several studies evaluated variations in hip fracture incidences, as well as trends of the hip fracture incidences. Comparisons of trends are lacking so far. We compared the incidence rates and, in particular, its trends between Austria and Germany 1995 to 2004 analysing national hospital discharge diagnosis register data.

METHODS: Annual frequencies of hip fractures and corresponding incidences per 100,000 person years were estimated, overall and stratified for sex and age, assuming Poisson distribution. Multiple Poisson regression models including country and calendar year, age and sex were used to analyse differences in incidence and trend. The difference of annual changes between the two countries was explored using an interaction term (calender year * country).

RESULTS: Overall, the increase of hip fracture risk was 1.31 fold higher (95\% CI 1.29-1.34) in Austria compared to Germany, adjusted for age, sex, and calendar year. The risk increase was comparable for both sexes (males: RR 1.35 (1.32-1.37), females: RR 1.31 (1.29-1.33)). Hip fracture trend from 1995 to 2004 indicates an increase in both countries without a statistically significant difference between Austria and Germany (interaction term: p = 0.67).

CONCLUSION: In this study comparing hip fracture incidences and its trend using pooled data, the incidence in Austria was 30\% higher compared to its neighbouring country Germany. For both countries a similar increasing trend of hip fracture incidence over the 10-year study period was calculated. The results need confirmation by other studies.

}, keywords = {Adult, Aged, Aged, 80 and over, Austria, Female, Germany, Hip Fractures, Humans, Incidence, Male, Middle Aged, Poisson Distribution, Young Adult}, issn = {1471-2458}, doi = {10.1186/1471-2458-10-46}, author = {Mann, Eva and Meyer, Gabriele and Haastert, Burkhart and Icks, Andrea} } @article {23, title = {Discrepancies in national incidence trends for hip fracture: why does Austria have such a high incidence?}, journal = {Wien Klin Wochenschr}, volume = {122}, year = {2010}, month = {2010 Mar}, pages = {126-8}, keywords = {Accidental Falls, Age Factors, Aged, Austria, Causality, Cross-Cultural Comparison, Cross-Sectional Studies, Female, Germany, Hip Fractures, Humans, Incidence, Male, Middle Aged, Risk Factors, Sex Factors, Switzerland}, issn = {1613-7671}, doi = {10.1007/s00508-010-1321-5}, author = {Mann, Eva and Icks, Andrea and Meyer, Gabriele} } @article {22, title = {Is it really a true reversal?}, journal = {Wien Klin Wochenschr}, volume = {122}, year = {2010}, month = {2010 Sep}, pages = {545}, keywords = {Age Factors, Aged, Aged, 80 and over, Austria, Cross-Cultural Comparison, Cross-Sectional Studies, Female, Hip Fractures, Humans, Incidence, Male, Middle Aged, Sex Factors}, issn = {1613-7671}, doi = {10.1007/s00508-010-1454-6}, author = {Mann, Eva and Icks, Andrea and Haastert, Bernhard and Meyer, Gabriele} } @article {556, title = {[Current diagnosis of acute pharyngitis].}, journal = {Wien Med Wochenschr}, volume = {159}, year = {2009}, month = {2009}, pages = {202-6}, abstract = {

BACKGROUND: Throat infections with Group A Streptococci have a high incidence and are, therefore, a considerable health problem. It is, therefore, desirable to distinguish this bacterial infections from viral infections of the upper respiratory tract. We report about the application of an immunologic rapid antigen detection test for Group A Streptococci and its medical and economic implications.

METHODS: In a cross-sectional cohort study, 30 family physicians documented the application of the test in 519 patients. Follow-up costs were compared with 109 family physicians who did not have access to the test.

RESULTS: 40.27\% of tests performed were positive for Streptococci. 99\% of those patients received antibiotic treatment - predominantly with Penicillin. From those patients who had shown a negative test result, only 18.4\% received antibiotic treatment. Both patients and physicians welcomed the availability of the test. We did not find any significant difference regarding the economic effect of the test.

CONCLUSIONS: The employment of a rapid antigen detection test for Group A Streptococci in patients with acute pharyngitis increases therapeutic certitude and guideline-conform prescription of antibiotics among family physicians. We, therefore, assume that potential side effects of unnecessary antibiotic treatments could be minimized.

}, keywords = {Antigens, Bacterial, Austria, Cephalosporins, Child, Cohort Studies, Cross-Sectional Studies, Early Diagnosis, Family Practice, Humans, Penicillins, Pharyngitis, Predictive Value of Tests, Reagent Kits, Diagnostic, Streptococcal Infections, Streptococcus pyogenes}, issn = {1563-258X}, doi = {10.1007/s10354-009-0672-x}, author = {Reichardt, Berthold and Pichlh{\"o}fer, Otto and Zehetmayer, Sonja and Maier, Manfred} } @article {26, title = {Frailty: an emerging concept for general practice.}, journal = {Br J Gen Pract}, volume = {59}, year = {2009}, month = {2009 May}, pages = {e177-82}, abstract = {

Ageing of the population in western societies and the rising costs of health and social care are refocusing health policy on health promotion and disability prevention among older people. However, efforts to identify at-risk groups of older people and to alter the trajectory of avoidable problems associated with ageing by early intervention or multidisciplinary case management have been largely unsuccessful. This paper argues that this failure arises from the dominance in primary care of a managerial perspective on health care for older people, and proposes instead the adoption of a clinical paradigm based on the concept of frailty. Frailty, in its simplest definition, is vulnerability to adverse outcomes. It is a dynamic concept that is different from disability and easy to overlook, but also easy to identify using heuristics (rules of thumb) and to measure using simple scales. Conceptually, frailty fits well with the biopsychosocial model of general practice, offers practitioners useful tools for patient care, and provides commissioners of health care with a clinical focus for targeting resources at an ageing population.

}, keywords = {Aged, Aged, 80 and over, Aging, Family Practice, Frail Elderly, Geriatric Assessment, Health Services for the Aged, Humans}, issn = {1478-5242}, doi = {10.3399/bjgp09X420653}, author = {De Lepeleire, Jan and Iliffe, Steve and Mann, Eva and Degryse, Jean Marie} } @article {558, title = {{A}ntibiotikaeinsatz verbessern {\textendash} {S}chnelldiagnosetest erleichtert bei {R}acheninfekten die {D}ifferenzierung in bakteriell oder viral.}, journal = {{\"A}rztewoche}, year = {2009}, abstract = {

Racheninfekte mit Gruppe-A- Streptokokken sind ein h{\"a}ufiges Krankheitsbild und damit auch ein betr{\"a}chtliches Gesundheits- problem. Eine klare Differenzie- rung zu viralen Infekten ist nicht zuletzt deshalb w{\"u}nschenswert, weil sich dadurch potentielle Ne- benwirkungen durch unn{\"o}tigen Antibiotikagebrauch reduzieren lassen. Eine zeitgem{\"a}{\ss}e Diag- nostik der akuten Pharyngitis hilft dem niedergelassenen Arzt bei der Entscheidungsfindung.

}, keywords = {orp-publications}, author = {Berthold Reichardt and Otto Pichlh{\"o}fer and Sonja Zehetmayer and Manfred Maier} } @article {25, title = {Psychotropic medication use among nursing home residents in Austria: a cross-sectional study.}, journal = {BMC Geriatr}, volume = {9}, year = {2009}, month = {2009 May 21}, pages = {18}, abstract = {

BACKGROUND: The use of psychotropic medications and their adverse effects in frail elderly has been debated extensively. However, recent data from European studies show that these drugs are still frequently prescribed in nursing home residents. In Austria, prevalence data are lacking. We aimed to determine the prevalence of psychotropic medication prescription in Austrian nursing homes and to explore characteristics associated with their prescription.

METHODS: Cross-sectional study and association analysis in forty-eight out of 50 nursing homes with 1844 out of a total of 2005 residents in a defined urban-rural region in Austria. Prescribed medication was retrieved from residents{\textquoteright} charts. Psychotropic medications were coded according to the Anatomical Therapeutic Chemical Classification 2005. Cluster-adjusted multiple logistic regression analysis was performed to investigate institutional and residents{\textquoteright} characteristics associated with prescription.

RESULTS: Residents{\textquoteright} mean age was 81; 73\% of residents were female. Mean cluster-adjusted prevalence of residents with at least one psychotropic medication was 74.6\% (95\% confidence interval, CI, 72.0-77.2). A total of 45.9\% (95\% CI 42.7-49.1) had at least one prescription of an antipsychotic medication. Two third of all antipsychotic medications were prescribed for bedtime use only. Anxiolytics were prescribed in 22.2\% (95\% CI 20.0-24.5), hypnotics in 13.3\% (95\% CI 11.3-15.4), and antidepressants in 36.8\% (95\% CI 34.1-39.6) of residents. None of the institutional characteristics and only few residents{\textquoteright} characteristics were significantly associated with psychotropic medication prescription. Permanent restlessness was positively associated with psychotropic medication prescription (AOR 1.54, 95\% CI 1.32-1.79) whereas cognitive impairment was inversely associated (AOR 0.70, 95\% CI 0.56-0.88).

CONCLUSION: Frequency of psychotropic medication prescription is high in Austrian nursing homes compared to recent published data from other countries. Interventions should aim at reduction and optimisation of prescriptions.

}, keywords = {Adult, Aged, Aged, 80 and over, Austria, Cross-Sectional Studies, Female, Homes for the Aged, Humans, Male, Middle Aged, Nursing Homes, Psychotropic Drugs}, issn = {1471-2318}, doi = {10.1186/1471-2318-9-18}, author = {Mann, Eva and K{\"o}pke, Sascha and Haastert, Burkhard and Pitk{\"a}l{\"a}, Kaisu and Meyer, Gabriele} } @conference {557, title = {{A B}ias of {S}pecialty {C}hoice {\textendash} {W}hy did you become a {F}amily {P}hysician in {A}ustria?}, booktitle = {Proceedings of the 14\textsuperscript{th} Regional Conference of Family Doctors (WONCA Europe) in Istanbul.}, year = {2008}, abstract = {

Aims: At some point in her career a physician makes a specialty choice hoping that eventually practicing her chosen medical specialty (CMS) will result in her optimal job satisfaction. On the other hand anecdotal evidence suggests that the medical job selection process in Austria is at best arbitrary and therefore many physicians do not attain their CMS. The aims of this study were to assess the extent to which physicians fail to attain their CMS and how that affects actual job satisfaction. Methods: All board-certified physicians practicing in Vienna were polled with a 12-item questionnaire sent out in two mailings. Their actual job satisfaction was correlated to their expected job satisfaction had they attained their CMS. Results: Of the 8,127 physicians included in the study 2,736 (34\%) completed the questionnaire. 50.3\% of all physicians and 65.1\% of family physicians (FPs) did not attain their CMS. There was a significant difference in RJS between specialists who reached their CMS (RJS=0.95) and those who didn{\textquoteright}t (RJS=0.62) (Chi-square p\<0.000). No significant difference in RJS could be found between FPs who originally aspired to become specialists (RJS=0.89) and specialists who originally wanted to become FPs (RJS=0.81). Conclusion: There is a high percentage of FPs in Austria who had originally aspired to becoming specialized in a different discipline. Nevertheless they obtained a high level of job satisfaction in Family Medicine. The contrary can be observed in specialists who do not fare well when not having attained their CMS.

}, keywords = {orp-publications}, author = {Otto Pichlh{\"o}fer and Wolfgang Spiegel} } @article {29, title = {[Chemical restraints in nursing homes in the federal state Vorarlberg, Austria--an analysis of nursing home documentation according to legal obligation and suggestions for future improvement].}, journal = {Wien Med Wochenschr}, volume = {158}, year = {2008}, month = {2008}, pages = {489-92}, abstract = {

High prevalence of chemical restraints in nursing homes is being criticised as suboptimal care. According to a new legal act, the Austrian "Heimaufenthaltsgesetz" 2005, nursing homes are obliged to report not only physical restraints but also chemical restraints. Using the Beers criteria we analysed all 78 notifications of chemical restraints registered during 18 months. Pronounced deficits concerning the selection of reporting criteria and the quality of doctors{\textquoteright} documentation of prescription were observed. National guidelines defining chemical restraints and providing valid assessment instruments are urgently warranted.

}, keywords = {Austria, Behavior Control, Diazepam, Documentation, Drug Prescriptions, Forecasting, Humans, Hypnotics and Sedatives, Nursing Homes, Tranquilizing Agents}, issn = {0043-5341}, doi = {10.1007/s10354-008-0549-4}, author = {Mann, Eva and Meyer, Gabriele} } @conference {561, title = {{E}pidemiologie der {CED}}, booktitle = {4. Kongress f{\"u}r Allgemeinmedizin und Integrierte Gesundheitsversorgung {\textendash} Wien}, year = {2008}, month = {Mai}, address = {MuseumsQuartier, Arena21, Wien}, keywords = {orp-publications}, author = {Otto Pichlh{\"o}fer} } @article {28, title = {Family physicians need easy instruments for frailty.}, journal = {Age Ageing}, volume = {37}, year = {2008}, month = {2008 Jul}, pages = {484; author reply 484-5}, keywords = {Activities of Daily Living, Aged, Family Practice, Frail Elderly, Geriatric Assessment, Humans}, issn = {1468-2834}, doi = {10.1093/ageing/afn116}, author = {De Lepeleire, Jan and Degryse, Jan and Illiffe, Steve and Mann, Eva and Buntinx, Frank} } @article {27, title = {Hip fracture incidence in the elderly in Austria: an epidemiological study covering the years 1994 to 2006.}, journal = {BMC Geriatr}, volume = {8}, year = {2008}, month = {2008 Dec 23}, pages = {35}, abstract = {

BACKGROUND: Hip fractures in the elderly are a major public health burden. Data concerning secular trends of hip fracture incidence show divergent results for age, sex and regions. In Austria, the hip fracture incidence in the elderly population and trends have not been analysed yet.

METHODS: Hip fractures in the population of 50 years and above were identified from 1994 to 2006 using the national hospital discharge register. Crude incidences (IR) per 100,000 person years and standardised incidences related to the European population 2006 were analysed. Estimate of age-sex-adjusted changes was determined using Poisson regression (incidence rate ratios, IRRs).

RESULTS: The number of hospital admissions due to hip fracture increased from a total number of 11,694 in 1994 to 15,987 in 2006. Crude incidences rates (IR) per 100.000 for men increased from 244.3 (95\% confidence interval (CI) 234.8 to 253.7) in 1994 to IR 330.8 (95\% CI 320.8 to 340.9) in 2006 and for women from 637.3 (95\% CI 624.2 to 650.4) in 1994 to IR 758.7 (95\% CI 745.0 to 772.4) in 2006. After adjustment for age and sex the annual hip fracture incidence increase was only small but statistically significant (IRR per year 1.01, 95\% CI 1.01 to 1.01, p < 0.01). Change of IRR over the 12 years study period was 13\%. It was significantly higher for men (IRR over 12 years 1.21, 95\% CI 1.16 to 1.27) than for women (IRR over 12 years 1.10, 95\% CI 1.06 to 1.14) (interaction: p = 0.03).

CONCLUSION: In contrast to findings in other countries there is no levelling-off or downward trend of hip fracture incidence from 1994 to 2006 in the Austrian elderly population. Further investigations should aim to evaluate the underlying causes in order to plan effective hip fracture reduction programmes.

}, keywords = {Aged, Aged, 80 and over, Austria, Female, Hip Fractures, Humans, Incidence, Male, Middle Aged}, issn = {1471-2318}, doi = {10.1186/1471-2318-8-35}, author = {Mann, Eva and Icks, Andrea and Haastert, Burkhard and Meyer, Gabriele} } @article {563, title = {Specialty selection and relative job satisfaction of family physicians and medical specialists in Austria.}, journal = {Croat Med J}, volume = {49}, year = {2008}, month = {2008 Jun}, pages = {375-83}, abstract = {

AIM: To estimate the relative job satisfaction of Austrian family physicians and other specialists with respect to whether or not they obtained training in the desired specialty.

METHODS: In this cross-sectional study, we re-examined the previous data on allocation of medical training posts in Austria. All board-certified physicians practicing in Vienna were surveyed with a 12-item questionnaire. We analyzed the association between respondents{\textquoteright} desired and practiced medical specialty and their answer to the question of whether they thought they would have had greater job satisfaction in a different medical specialty. We also calculated their relative job satisfaction.

RESULTS: Of 8127 licensed physicians, 2736 (34\%) completed the questionnaire in two mailings. Of physicians who completed the questionnaire, 50.3\% (43.2\% of men) did not obtain the training in their desired specialty and 65.1\% stated that they had originally desired a different specialty. There was a significant difference in relative job satisfaction between specialists who got their desired medical specialty (n=1005) and those who did not (n=697) (0.95 vs 0.62 of maximum 1, P<0.001). No significant difference in relative job satisfaction was found between family physicians who had originally wanted to become specialists (n=679) and specialists who had originally wanted to become family physicians (n=533; 0.89 vs 0.81; P=0.01; chi(2) test).

CONCLUSION: A high percentage of family physicians in Austria had originally wanted to become practitioners of a different specialty. Among physicians who did not receive training in their desired medical specialty, family physicians showed a significantly higher relative job satisfaction than specialists. Obtaining the desired medical specialty is a strong predictor of relative job satisfaction among specialists, but not among family physicians.

}, keywords = {Adult, Austria, Cross-Sectional Studies, Female, Humans, Job Satisfaction, Male, Middle Aged, Physicians, Family, Specialization}, issn = {1332-8166}, doi = {10.3325/cmj.2008.3.375}, url = {http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2443622/}, author = {Spiegel, Wolfgang and Pichlh{\"o}fer, Otto and Haoula, Diana and Schneider, Barbara and Maier, Manfred} } @article {30, title = {Preventive health risk appraisal for older people and impact on GPs{\textquoteright} patient management: a prospective study.}, journal = {Fam Pract}, volume = {24}, year = {2007}, month = {2007 Dec}, pages = {604-9}, abstract = {

BACKGROUND: Health risk appraisals (HRAs) are recommended for detection of potentially modifiable risk factors for health status decline of older people. Little is known how family physicians manage detected risk factors.

OBJECTIVE: We evaluated (i) if risk factors in one or more of five predefined domains were detected in a primary care-based HRA and (ii) how often these findings had an impact on the further management of patients.

METHODS: We performed a prospective observational study in a rural community in Austria and included persons (age >or= 70 years) living at home. We applied the standardized assessment for elderly people in primary care (STEP) instrument and evaluated risk factors for status decline assessing five domains (cognitive function, depression, urinary incontinence, hearing impairment and mobility/falls).

RESULTS: Two hundred and sixty-four persons participated and the HRA revealed a wide range of risk factors for health status decline [from 4.5\% (12/264) in the depression domain up to 31\% (81/264) for mobility/falls and 41\% (107/264) in the cognitive domain]. The findings had an impact on the further management in four domains: hearing impairment (100\% of findings with impact), mobility/falls (93\%), depression (83\%) and urinary incontinence (65\%). In contrast, abnormal cognitive findings lead to action only in every fifth participant (18\%; 19/107).

CONCLUSION: In contrast to other domains, family physicians are hesitant to act upon abnormal findings of cognitive testing. Additional knowledge is needed to clarify the value of abnormal cognitive findings for management of patients and support of their carers.

}, keywords = {Aged, Aged, 80 and over, Austria, Female, Health Status Indicators, Humans, Male, Observation, Patient Care Management, Physicians, Family, Prospective Studies, Risk Factors}, issn = {0263-2136}, doi = {10.1093/fampra/cmm063}, author = {Eichler, Klaus and Scrabal, Clemens and Steurer, Johann and Mann, Eva} } @article {31, title = {Comprehensive Geriatric Assessment (CGA) in general practice: results from a pilot study in Vorarlberg, Austria.}, journal = {BMC Geriatr}, volume = {4}, year = {2004}, month = {2004 May 19}, pages = {4}, abstract = {

BACKGROUND: Most comprehensive geriatric assessment (CGA) programs refer to hospital-based settings. However the body of geriatric healthcare is provided by general practitioners in their office. Structured geriatric problem detection by means of assessment instruments is crucial for efficient geriatric care giving in the community.

METHODS: We developed and pilot tested a German language geriatric assessment instrument adapted for general practice. Nine general practices in a rural region of Austria participated in this cross-sectional study and consecutively enrolled 115 persons aged over 75 years. The prevalence of specific geriatric problems was assessed, as well as the frequency of initiated procedures following positive and negative tests. Whether findings were new to the physician was studied exemplarily for the items visual and hearing impairment and depression. The acceptability was recorded by means of self-administered questionnaires.

RESULTS: On average, each patient reported 6.4 of 14 possible geriatric problems and further consequences resulted in 43.7\% (27.5\% to 59.8\%) of each problem. The items with either the highest prevalence and/or the highest number of initiated actions by the GPs were osteoporosis risk, urinary incontinence, decreased hearing acuity, missing pneumococcal vaccination and fall risk. Visual impairment was newly detected in only 18\% whereas hearing impairment and depression was new to the physician in 74.1\% and 76.5\%, respectively.A substantial number of interventions were initiated not only following positive tests (43.7\% per item; 95\% CI 27.5\% to 59.8\%), but also as a consequence of negative test results (11.3\% per item; 95\% CI 1.7\% to 20.9\%). The mean time expenditure to accomplish the assessment was 31 minutes (SD 10 min). Patients (89\%) and all physicians confirmed the CGA to provide new information in general on the patient{\textquoteright}s health status. All physicians judged the CGA to be feasible in everyday practice.

CONCLUSION: This adapted CGA was feasible and well accepted in the general practice sample. High frequencies of geriatric problems were detected prompting high numbers of problem-solving initiatives. But a substantial number of actions of the physicians following negative tests point to the risks of too aggressive treatment of elderly patients with possibly subsequent negative effects.

}, issn = {1471-2318}, doi = {10.1186/1471-2318-4-4}, author = {Mann, Eva and Koller, Michael and Mann, Christian and van der Cammen, Tischa and Steurer, Johann} } @conference {559, title = {{D}er postoperative {P}atient in der {P}raxis}, booktitle = {Van Swieten Tagung, Wien}, year = {1998}, keywords = {orp-publications}, author = {Mueller,Michael R and Pichlh{\"o}fer, Otto} } @conference {566, title = {Update Bronchuskarzinom}, booktitle = {Van Swieten Tagung, Wien}, year = {1998}, keywords = {orp-publications}, author = {Mueller,Michael R and Pichlh{\"o}fer, Otto} }