@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 {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 {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 {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 {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} } @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 {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 {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 {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} } @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 {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} } @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 {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} } @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 {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} }