@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 {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 {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 {359, title = {10 Minuten pro Patient?!}, year = {2016}, publisher = {{\"A}rzte Krone}, author = {Maria Wendler}, editor = {Bernhard Panhofer and Matthias K{\"o}lbl} } @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 {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 {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} } @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 {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 {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 {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 {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} } @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} }