TY - THES T1 - Community-oriented Primary Care in Austria: Status Quo and Prospects for the Future T2 - Public Health School Graz Y1 - 2020 A1 - Sebastian Huter A1 - Jan DeMaeseneer A1 - Florian Stigler KW - Community KW - COPC KW - Primärversorgung KW - Primary Health Care AB -

Hintergrund: Die stärkere Integration des Public Health-Ansatzes in die
Primärversorgung erlebt derzeit wieder mehr internationale Aufmerksamkeit.
Gemeinde-orientiere Primärversorgung (COPC) ist ein bekannter Ansatz, um
dies zu erreichen. Diese Arbeit soll analysieren, inwieweit COPC bereits in der
Primärversorgung in Österreich etabliert ist und welche wesentlichen Barrieren
und Ressourcen für eine Stärkung dieses Ansatzes bestehen.

Methoden: Es wurde ein Scoping Review von wissenschaftlicher Literatur zu
COPC in Österreich durchgeführt und primärversorgungsrelevante
Grundsatzpapiere und Gesetze auf Gemeinde-Orientierung hin durchsucht.
Zudem wurden 13 semi-strukturierte Interviews mit Primärversorger*innen,
Projektmanager*innen und Wissenschaftler*innen geführt und mittels
thematischer Inhaltsanalyse untersucht, um gemeinde-orientierte Aspekte in
existierenden Projekten sowie relevante Barrieren und Ressourcen für COPC zu
identifizieren.

Ergebnisse: Es findet sich kaum österreich-spezifische, peer-reviewte Literatur
zu COPC und kaum gezielte Erwähnungen von Gemeinde-orientierung in den
untersuchten Dokumenten. Zwar existieren gemeinde-orientierte Projekte in
Österreich, diese vermissen jedoch meist wesentliche Elemente von COPC.
Hausärzt*innen können 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 Primärversorgung ist in
Österreich nicht systematisch implementiert. Um diesen Ansatz zu stärken
braucht es daher systemische Anstrengungen, zum Beispiel durch die
Einbindung von Gemeinde-orientierung in den Versorgungsauftrag und die
Erleichterung der Bildung von lokalen Primärversorgungsteams. Eine
strukturierte Anbindung an das bereits gut etablierte Netzwerk der “Gesunden
Gemeinden” wäre ein rasch umsetzbarer erster Schritt.

JF - Public Health School Graz PB - Medizinische Universität Graz CY - Graz VL - Master in Public Health (MPH) ER - TY - Generic T1 - Allseits Zufriedenheit Y1 - 2017 A1 - Barbara Degn A1 - Silke Eichner PB - Ärzte Krone IS - 05 ER - TY - Generic T1 - Das war der WONCA-Europe-Kongress 2016 in Kopenhagen Y1 - 2016 A1 - Christoph Dachs KW - Editorial KW - Erfahrungsbericht KW - WONCA PB - Ärzte Krone IS - 14-16 ER - TY - Generic T1 - Opportunistisches- vs. Recall-System beim Zervixkarzinom-Screening Y1 - 2016 A1 - Theresa Drexel ED - Christoph Fischer KW - Cervixkarzinom JF - Tiroler Gesellschaft für Allgemeinmedizin PB - Medizinische Universität Innsbruck CY - Innsbruck VL - Doktorin der gesamten Heilkunde (Dr. med. univ.) ER - TY - Generic T1 - Was hat die Welt mit uns zu tun? Y1 - 2016 A1 - Christoph Dachs PB - Ärzte Krone IS - 20 ER - TY - Generic T1 - Was ist Familienmedizin (nicht) - Definition, Modelle und Grenzen der Familienmedizin Y1 - 2016 A1 - Amanda Howe A1 - Maria Wendler A1 - Barbara Degn PB - Ärzte Krone IS - 20 ER - TY - JOUR T1 - Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): study protocol for a cluster-randomised controlled trial. JF - Implement Sci Y1 - 2015 A1 - Richter, Christin A1 - Berg, Almuth A1 - Fleischer, Steffen A1 - Köpke, Sascha A1 - Balzer, Katrin A1 - Fick, Eva-Maria A1 - Sönnichsen, Andreas A1 - Löscher, Susanne A1 - Vollmar, Horst Christian A1 - Haastert, Burkhard A1 - Icks, Andrea A1 - Dintsios, Charalabos-Markos A1 - Mann, Eva A1 - Wolf, Ursula A1 - Meyer, Gabriele KW - Accidental Falls KW - Antipsychotic Agents KW - Costs and Cost Analysis KW - Dementia KW - Drug Utilization KW - Germany KW - Homes for the Aged KW - Humans KW - Inservice Training KW - Mental Disorders KW - Nursing Homes KW - Patient-Centered Care KW - Psychomotor Agitation KW - Quality of Life KW - Research Design AB -

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' 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.

VL - 10 U1 - https://www.ncbi.nlm.nih.gov/pubmed/26037324?dopt=Abstract ER - TY - JOUR T1 - Diabetes care among older adults in primary care in Austria--a cross-sectional study. JF - Swiss Med Wkly Y1 - 2012 A1 - Mann, Eva A1 - Vonbank, Alexander A1 - Drexel, Heinz A1 - Saely, Christoph H KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Austria KW - Body Mass Index KW - Chi-Square Distribution KW - Cholesterol, HDL KW - Cholesterol, LDL KW - Creatinine KW - Cross-Sectional Studies KW - Diabetes Mellitus, Type 2 KW - Female KW - Glomerular Filtration Rate KW - Glycated Hemoglobin KW - Humans KW - Male KW - Practice Patterns, Physicians' KW - Statistics, Nonparametric KW - Triglycerides AB -

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 ± 1.6 vs. 7.1 ± 0.9%; p = 0.080; and 122 ± 40 vs. 114 ± 34 mg/dl; p = 0.273), whereas BMI was lower (27.5 ± 5.0 vs. 29.6 ± 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.

VL - 142 U1 - https://www.ncbi.nlm.nih.gov/pubmed/22918615?dopt=Abstract ER - TY - JOUR T1 - Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list. JF - Wien Klin Wochenschr Y1 - 2012 A1 - Mann, Eva A1 - Böhmdorfer, Birgit A1 - Frühwald, Thomas A1 - Roller-Wirnsberger, Regina E A1 - Dovjak, Peter A1 - Dückelmann-Hofer, Christine A1 - Fischer, Peter A1 - Rabady, Susanne A1 - Iglseder, Bernhard KW - Aged KW - Aged, 80 and over KW - Austria KW - Female KW - Humans KW - Inappropriate Prescribing KW - Male AB -

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

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

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

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

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

VL - 124 IS - 5-6 U1 - https://www.ncbi.nlm.nih.gov/pubmed/22134410?dopt=Abstract ER - TY - JOUR T1 - Frailty: an emerging concept for general practice. JF - Br J Gen Pract Y1 - 2009 A1 - De Lepeleire, Jan A1 - Iliffe, Steve A1 - Mann, Eva A1 - Degryse, Jean Marie KW - Aged KW - Aged, 80 and over KW - Aging KW - Family Practice KW - Frail Elderly KW - Geriatric Assessment KW - Health Services for the Aged KW - Humans AB -

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

VL - 59 IS - 562 U1 - https://www.ncbi.nlm.nih.gov/pubmed/19401013?dopt=Abstract ER - TY - JOUR T1 - Family physicians need easy instruments for frailty. JF - Age Ageing Y1 - 2008 A1 - De Lepeleire, Jan A1 - Degryse, Jan A1 - Illiffe, Steve A1 - Mann, Eva A1 - Buntinx, Frank KW - Activities of Daily Living KW - Aged KW - Family Practice KW - Frail Elderly KW - Geriatric Assessment KW - Humans VL - 37 IS - 4 U1 - https://www.ncbi.nlm.nih.gov/pubmed/18515292?dopt=Abstract ER -