Workplace Health Promotion and COVID-19 Support Measures in Outpatient Care Services in Germany: A Quantitative Study.
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ABSTRACT:
SUBMITTER: Neumann FA
PROVIDER: S-EPMC8620567 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has challenged health care systems worldwide. In Germany, patients in a palliative care setting have the opportunity to receive treatment by a specialised mobile outpatient palliative care team (OPC). The given retrospective single centre analysis describes the use of OPC structures for terminally ill COVID-19 patients during the height of the pandemic in Germany and aims to characterise this exceptional OPC patient collective.MethodsFirst, death certificates were analysed in order to collect data about the place of death of all deceased COVID-19 patients (n = 471) within our local governance district. Second, we investigated whether advance care planning structures were established in local nursing homes (n = 30) during the height of the COVID-19 pandemic in 2020. Third, we examined patient characteristics of COVID-19 negative (n = 1579) and COVID-19 positive (n = 28) patients treated by our tertiary care centre guided OPC service.ResultsThe analysis of death certificates in our local district revealed that only 2.1% of all deceased COVID-19 patients had succumbed at their home address (n = 10/471). In contrast, 34.0% of COVID-19 patients died in nursing homes (n = 160/471), whereas 63.5% died in an inpatient hospital setting (n = 299/471). A large proportion of these hospitalised patients died on non-intensive care unit wards (38.8%). Approximately 33.0% of surveyed nursing homes had a palliative care council service and 40.0% of them offered advance care planning (ACP) structures for their nursing home residents. In our two OPC collectives we observed significant differences concerning clinical characteristics such as the Index of Eastern Cooperative Oncology Group [ECOG] (p = 0.014), oncologic comorbidity (p = 0.004), as well as referrer and primary patient location (p = 0.001, p = 0.033).ConclusionsMost COVID-19 patients in our governance district died in an inpatient setting. However, the highest number of COVID-19 patients in our governance district who died in an outpatient setting passed away in nursing homes where palliative care structures should be further expanded. COVID-19 patients who died under the care of our OPC service had considerably fewer oncologic comorbidities. Finally, to relieve conventional health care structures, we propose the expansion of established OPC structures for treating terminally ill COVID-19 patients.
| S-EPMC9371950 | biostudies-literature
Project description:BackgroundInadequate assessment of the severity and urgency of health problems is one of the factors contributing to unnecessary emergency department visits. A software-based instrument for standardized initial assessment (SmED) aims to support healthcare professionals and steer patients to the appropriate source of care. The aim of this study was to evaluate the implementation process of SmED based on the point of view of users in order to facilitate sustainable implementation.MethodsA quantitative process evaluation on the basis of a paper-based questionnaire was carried out alongside the implementation of SmED in 26 outpatient emergency care services within 11 federal states in Germany. Healthcare professionals who worked with SmED either at the joint contact points of the outpatient emergency care service and the emergency departments of hospitals ("Joint Counter", German "Gemeinsamer Tresen") or at the initial telephone contact points of the outpatient emergency care service (116117) were invited to participate in the survey.Results200 users of SmED completed the questionnaire comprising the five scales: Intervention effectiveness/efficacy, Interprofessional context/occupational Interest, Individual Context, Organisational Framework Conditions, and Medical Context. Several individual characteristics were related to the implementation process of SmED. Female and younger healthcare professionals and participants with less than five years of professional experience tended to evaluate the implementation process as more positive. Factors related to the Individual Context and to the Medical Context were associated with the reported use of SmED (p = 0.004 and 0.041, respectively).ConclusionThe involvement of healthcare professionals, particularly more experienced professionals, in the implementation of SmED may help to facilitate sustainable implementation. In addition, training of potential user prior and during the implementation process and the adaption of Organisational Context factors are crucial. Trial registration The study was registered at the German Clinical Trials Register prior to the start of the study (DRKS00017014).
| S-EPMC8592824 | biostudies-literature
Project description:During the COVID-19 pandemic in Germany, non-pharmaceutical interventions were imposed to contain the spread of the virus. Based on cross-sectional waves in March, July and December 2020 of the COVID-19 Snapshot Monitoring (COSMO), the present study investigated the impact of the introduced measures on the perceived access to health care. Additionally, for the wave in December, treatment occasion as well as utilization and satisfaction regarding telemedicine were analysed. For 18-74-year-old participants requiring medical care, descriptive and logistic regression analyses were performed. During the less strict second lockdown in December, participants reported more frequently ensured access to health care (91.2%) compared to the first lockdown in March (86.8%), but less frequently compared to July (94.2%) during a period with only mild restrictions. In December, main treatment occasions of required medical appointments were check-up visits at the general practitioner (55.2%) and dentist (36.2%), followed by acute treatments at the general practitioner (25.6%) and dentist (19.0%), treatments at the physio-, ergo- or speech therapist (13.1%), psychotherapist (11.9%), and scheduled hospital admissions or surgeries (10.0%). Of the participants, 20.0% indicated utilization of telemedical (15.4% telephone, 7.6% video) consultations. Of them, 43.7% were satisfied with the service. In conclusion, for the majority of participants, access to medical care was ensured during the COVID-19 pandemic; however, access slightly decreased during phases of lockdown. Telemedicine complemented the access to medical appointments.
| S-EPMC8303178 | biostudies-literature
Project description:To ensure continuing HIV care services during the COVID-19 pandemic, telehealth has been recommended and implemented in numerous HIV-related facilities. This study aims to understand telehealth utilization for HIV care services in South Carolina (SC), identify barriers to telehealth during COVID-19, and investigate strategies to facilitate remote HIV care delivery. In-depth interviews with 11 management personnel from 8 HIV-related facilities in SC were analyzed using thematic analysis. Utilizations of telehealth were diverse in delivering medical and non-medical HIV care services. Barriers included technological challenges, digital literacy, client/provider experiences, low socio-economic status of client population, and reimbursement issues. Various strategies were mentioned for promoting telehealth utilization, from client empowerment, provider training to improved organizational readiness. For successful telehealth use during and after COVID-19, it is necessary to continue efforts to promote telehealth and remove barriers to telehealth by implementing inclusive multi-level strategies for non-technologically savvy or disadvantaged populations living with HIV.
| S-EPMC8231748 | biostudies-literature
Project description:BACKGROUND:Socially disadvantaged people have an increased need for medical care due to a higher burden of health problems and chronic diseases. In Germany, outpatient care is chiefly provided by office-based general practitioners and specialists in private practice. People are free to choose the physician they prefer. In this study, national data were used to examine differences in the use of outpatient medical care by socioeconomic status (SES). METHODS:The analyses were based on data from 6,754 participants in the Robert Koch Institute's German Health Interview and Examination Survey for Adults (DEGS1) aged between 18 and 69 years. The number of outpatient physician visits during the past twelve months was assessed for several medical specializations. SES was determined based on education, occupation, and income. Associations between SES and physician visits were analysed using logistic regression and zero-truncated negative binomial regression for count data. RESULTS:After adjusting for sociodemographic factors and health indicators, outpatients with low SES had more contacts with general practitioners than outpatients with high SES (men: incidence rate ratio [IRR] = 1.25; 95% confidence interval [CI] = 1.08-1.46; women: IRR = 1.20; 95% CI = 1.07-1.34). The use of specialists was lower in people with low SES than in those with high SES when sociodemographic factors and health indicators were adjusted for (men: odds ratio [OR] = 0.68; 95% CI = 0.51-0.91; women: OR = 0.56; 95% CI = 0.41-0.77). This applied particularly to specialists in internal medicine, dermatology, and gynaecology. The associations remained after additional adjustment for the type of health insurance and the regional density of office-based physicians. CONCLUSION:The findings suggest that socially disadvantaged people are seen by general practitioners more often than the socially better-off, who are more likely to visit a medical specialist. These differences may be due to differences in patient preferences, physician factors, physician-patient interaction, and potential barriers to accessing specialist care.
| S-EPMC4883792 | biostudies-literature
Project description:Child care workers earn among the lowest wages in the United States and they struggle with many health issues. The purpose of this study was to describe workplace supports for nutrition, physical activity, other health behaviors (e.g., smoking cessation, stress management), and occupational health and safety available to child care workers, and thereby inform the development of future workplace-based interventions to improve worker well-being. Between 2015 and 2016, 74 North Carolina child care centers (and directors), participating in a larger randomized controlled trial, completed a Workplace Health and Safety Assessment (interview and observation) measuring four domains: Infrastructure, Organizational Policies and Procedures, Programs and Promotions, and Internal Physical Environment. This study used baseline data to report means and standard deviations. Participating child care centers employed, on average, 12.7 ± 8.4 employees. Total scores from the Workplace Health and Safety Assessment averaged 41.3 ± 12.6 out of a possible 154, demonstrating many missed opportunities for supporting health/safety. More specifically, centers scored on average 9.5 ± 3.9 on Infrastructure (35% of potential points), 11.1 ± 3.9 on Organizational Policies and Procedures (32% of potential), 7.6 ± 5.4 on Programs and Promotions (12% of potential), and 13.1 ± 2.2 on Internal Physical Environment (49% of potential). The most frequent supports available were for occupational health and safety issues, while fewer supports were available for physical activity and other health behaviors. Child care workers could benefit greatly from more comprehensive workplace health and safety interventions; however, strategies must overcome centers' limited capacity and resources.
| S-EPMC7369321 | biostudies-literature
Project description:ObjectiveTo gain insight into epilepsy care during coronavirus disease (COVID-19) pandemic, we analyzed prescription data of a large cohort of persons with epilepsy (PWE) during lockdown in Germany.MethodsInformation was obtained from the Disease Analyzer database, which collects anonymous demographic and medical data from practice computer systems of general practitioners (GP) and neurologists (NL) throughout Germany. We retrospectively compared prescription data for anti-seizure medication (ASM) and physicians' notes of "known" and "new" PWE from January 2020 until May 2020 with the corresponding months in the three preceding years 2017-2019. Adherence was estimated by calculating the proportion of patients with follow-up prescriptions within 90 days after initial prescriptions in January or February. We additionally analyzed hospital referrals of PWE. The significance level was set to 0.01 to adjust for multiple comparisons.ResultsA total of 52,844 PWE were included. Anti-seizure medication prescriptions for known PWE increased in March 2020 (GP + 36%, NL + 29%; P < 0.01). By contrast, a decrease in prescriptions to known and new PWE was observed in April and significantly in May 2020 ranging from -16% to -29% (P < 0.01). The proportion of PWE receiving follow-up prescriptions was slightly higher in 2020 (73.5%) than in 2017-2019 (70.7%, P = 0.001). General practitioners and NL referred fewer PWE to hospitals in March 2020 (GP: -30%, P < 0.01; NL: -12%), April 2020 (GP: -29%, P < 0.01; NL: -37%), and May 2020 (GP: -24%, P < 0.01; NL: -16%).ConclusionAdherence of known PWE to ASM treatment appeared to remain stable during lockdown in Germany. However, this study revealed findings which point to reduced care for newly diagnosed PWE as well as fewer hospital admissions. These elements may warrant consideration during future lockdown situations.
| S-EPMC7895474 | biostudies-literature
Project description:ObjectivesThere is a growing acceptance of the need for routine implementation of patient-reported experience measures (PREMs) in health care. Rheumatology patients, as frequent and long-term users of care, stand to benefit from collection of experience-related data. The aim of this study was to perform a systematic review to identify and critically appraise the development and psychometric validation of PREMs in rheumatology.MethodsSix databases were searched systematically from inception to 14 December 2020: MEDLINE, EMBASE, PsycINFO, SCOPUS, Cochrane and Google Scholar. We included articles in English that described the use or development of PREMs, with results of psychometric testing, in an adult outpatient rheumatology context. This study is registered with PROSPERO (CRD42021233819). Articles were appraised using the COnsensus Based Standards for the selection of health status Measurement Instruments (COSMIN) (i) Risk of Bias checklist and (ii) criteria for good measurement properties.ResultsThe search yielded 3809 publications, and six studies met inclusion criteria. All the included studies on PREM development fulfilled COSMIN standards for 'doubtful' or 'inadequate' quality of instrument development. One study fulfilled a 'sufficient' rating for content validity, and the remainder fulfilled 'inconsistent' ratings. During validity testing, studies fulfilled between one and four of the eight COSMIN checklist criteria for good measurement properties.ConclusionMethodological concerns regarding instrument development and validation limit the generalizability of the existing six validated PREMs in use in rheumatology contexts. There is a need for further well-designed studies to validate existing and new PREMs in this area.
| S-EPMC8578687 | biostudies-literature
Project description:BackgroundAmong community-dwelling older adults who require long-term care and use outpatient rehabilitation services, we aimed to examine the characteristics of patients who discontinued using outpatient rehabilitation services to prevent exposure to COVID-19 and the effects of this discontinuation on patient frailty.MethodsParticipants were 119 older adults (69 males, 50 females; average age 77.3 ± 8.3 years) requiring long-term care who used outpatient rehabilitation services. Our outpatient rehabilitation service involved day care for older adults undergoing rehabilitation including pick-up and drop-off services under the long-term care insurance system. They were divided into two groups: participants who discontinued using outpatient rehabilitation services and participants who continued their use. To find the factors associated with this discontinuation, binomial logistic regression analysis was performed, in which the following independent variables were used: gender, age, height, weight, long-term care level, grip strength, and normal walking speed. Frailty status was investigated in April 2020 and again in September 2020 through interviews and telephone surveys utilizing the Frailty Screening Index.ResultsWomen and normal walking speed were independent factors associated with the discontinuation of outpatient rehabilitation due to COVID-19. According to the results of the Frailty Screening Index, similar tendencies were exhibited in both April and September. The discontinued group indicated that they were getting less exercise and having stronger feelings of fatigue than the continuing group.ConclusionsThe findings are in accordance with other studies indicating that women are more likely to employ prevention measures against COVID-19, as seen among the community-dwelling older adults requiring long-term care who used outpatient rehabilitation services. People with higher levels of physical function were also likely to refrain from using outpatient rehabilitation services. Results further suggested that the discontinued group had more frailty-related factors (i.e., low physical activity and strong exhaustion) than the continuing group.
| S-EPMC8029655 | biostudies-literature
Project description:Worksite-based programs to improve workforce health and well-being (Workplace Health Promotion (WHP)) have been advanced as conduits for improved worker productivity and decreased health care costs. There has been a countervailing health economics contention that return on investment (ROI) does not merit preventive health investment. METHODS/PROCEDURES: Pertinent studies were reviewed and results reconsidered. A simple economic model is presented based on conventional and alternate assumptions used in cost benefit analysis (CBA), such as discounting and negative value. The issues are presented in the format of 3 conceptual dilemmas.In some occupations such as nursing, the utility of patient survival and staff health is undervalued. WHP may miss important components of work related health risk. Altering assumptions on discounting and eliminating the drag of negative value radically change the CBA value.Simple monetization of a work life and calculation of return on workforce health investment as a simple alternate opportunity involve highly selective interpretations of productivity and utility.
| S-EPMC4562175 | biostudies-other