BACKGROUND: The topic of patient safety has been a subject of much discussion since the end of the last millennium. Ensuring patient safety is a central challenge in health care. An important tool to raise awareness for and learn from adverse events and thus promote patient safety are error-reporting and learning systems (Critical Incident Reporting System = CIRS).
METHODS: More than 17 years after its establishment, the CIRS \"jeder-fehler-zaehlt.de\" (JFZ) for German primary care has undergone a revision in terms of content and technology. The revised web-based system can be used for reporting as well as for classifying and analyzing incident reports. During this process, a descriptive analysis of the current report inventory was carried out, with a focus on serious medication errors. This included all 781 valid incident reports received between September 2004 and December 2021.
RESULTS: In 576 of the 781 reports (73.8%), the GP practice was directly involved in the critical incident. Among error types, process errors predominated (79.8% of the classifications, 99.1% of the reports) compared with knowledge and skills errors (20.2% of the classifications, 39.7% of the reports). Communication errors (63.0%) were the most common contributing factor to critical incidents, followed by flaws in tasks and measures (39.7%). Serious and permanent patient harm was rarely reported (8.3% of the reports), whereas temporary patient harm was more common (40.3% of the reports). Incident reports about medication errors with at least serious patient harm included, in particular, substances that affected blood clotting, corticosteroids, and opiates.
CONCLUSIONS: Our results complement the rates that are reported internationally for error types, patient harm, and contributing factors. Serious but preventable adverse events, so-called never events, are frequently associated with the medication process in both JFZ reports and the literature.
CONCLUSIONS: Critical incident reporting systems cannot provide accurate information about the frequency of errors in health care, but they can offer important insights into, for example, serious medication errors. Therefore, they offer both employees and healthcare institutions an opportunity for individual and institutional learning.

BACKGROUND: General practitioners (GP) face major challenges in everyday practice when it comes to identifying dementia cases as early as possible under the condition of time and resource constraints. The involvement of the practice staff promises decisive advantages in detection and diagnosis. So far, there has been a lack of studies exploring the extent to which non-medical practice employees in general practices are integrated into dementia detection, what experiences they have had and how they assess their own potential to contribute to more efficient dementia detection.
METHODS: Between August 2020 and August 2021, a total of 64 semi-structured, audio-technically recorded individual / expert interviews were conducted with non-medical practice employees (medical assistants) in general practices in all German federal states (four interviewees per federal state). The interview transcripts were evaluated using a qualitative, structuring content analysis according to Mayring (Software MAXQDA 2020).
RESULTS: The GP team members show a high degree of willingness and motivation to support the doctor in identifying and diagnosing dementia; situations have been reported where their assistance has led to an earlier identification of people with dementia. Observation and detection of dementia patients are rarely based on systematic criteria. On the whole, only some GPs entrust their staff with tasks like this. A large portion of the interviewees expressed considerable uncertainty regarding the assessment of possible signs of incipient dementia, which corresponds to the fact that only a minority of the interviewees have ever completed further training with a focus on dementia.
CONCLUSIONS: Practice staff can provide invaluable support when it comes to the timely and consistent detection of incipient dementia in general practice. In addition to sensitizing GPs and optimizing practice management, targeted training with regard to geriatric issues will be instrumental in achieving this. Accordingly, more advanced training formats should be developed that are tailored to the perspective of practice employees and convey important dementia-specific diagnostics, action and communication skills.

BACKGROUND: Family doctor care in rural areas is facing upheaval. On the one hand, demographic change is increasing patient demand, but on the other hand, it is also reducing physician density. In this context, telemedicine opens up new potentials for care. This study explores the possibilities of digitalization in family care with diverse stakeholders. The most important element of this work is to explore the attitudes towards telemedical supplementary options in primary care. In doing so, the chances and concerns of both general practitioners and citizens will be analyzed. The aim is to find out possibilities which can relieve GPs and support the health care provision in rural regions in the long term.
UNASSIGNED: A mixed-methods design combines findings from qualitative semi-structured guided interviews with general practitioners (N=8) with a quantitative citizen survey (N=1,276) in a rural region.
RESULTS: Concern about future health care provision is high among physicians and citizens. Although physicians see a need for action and opportunities through telemedicine measures, they also raise clear concerns about the doctor-patient relationship. The citizens are principally open to various telemedical options and can imagine using simple services such as e-prescription and e-appointment booking.
CONCLUSIONS: These results can serve as a basis for the further development of digital offerings of family doctors\' offices as well as other model projects in rural regions, if they guarantee low-threshold access, are implemented in cooperation with doctors and patients and do not endanger the established doctor-patient relationship.
CONCLUSIONS: There are major concerns about the future of family physician care, especially in rural areas. The COVID-19 pandemic opens up opportunities for digitization across age boundaries. Initially, however, telemedicine care can only have a supplementary role. Low-threshold offerings in close cooperation with the family doctor are particularly promising here.

BACKGROUND: Pragmatic randomized controlled trials are able to make an essential contribution to the further development of evidence-based treatment recommendations for primary care patients. However, drug trials are regulated by specific guidelines and have not yet become a routine task in GP practices. Within the scope of a multi-center, double-blind, randomized controlled trial on treating urinary tract infections in women with and without antibiotics (REGATTA), the feasibility of pharmaceutical studies in GP practices was evaluated by means of a questionnaire sent out to participating physicians and practice nurses.
METHODS: Using a self-designed, non-validated questionnaire, the perspectives, attitudes and experiences of participating physicians and practice nurses were assessed anonymously. In this way, we identified both hindering and beneficial factors affecting the conduct of drug trials in German GP practices.
RESULTS: 39 physicians and 48 practice nurses participated in the survey. 95 % of the physicians and 88 % of the practice nurses indicated that the implementation of drug trials with all their regulatory requirements is, in principle, possible in GP practices. In particular, the high amount of time and documentation necessary were identified as barriers. The implementation can be facilitated by formulating a research question that is relevant to practice and patients and by support from the study center.
CONCLUSIONS: Although participation in a drug trial is an additional burden in everyday practice, it is considered feasible and worthwhile by the GPs and practice nurses involved. Due to an assumed selection bias, the predominantly positive experiences of the respondents may be overestimated and transferable only to a limited extent.

Patient- vs Physician-Reported Implementation of and Compliance to Anti-Osteoporotic Medication One Year after Sustained Fragility Fracture Abstract. We were interested why therapy recommendations made by specialists are often not followed by general practitioners (GPs) and patients. We evaluated systematic questionnaires comparing both, patient and GP statements (n = 151 each) with regard to the implementation of and compliance to specific therapy recommended by an osteologic specialist one year after an osteoporotic fracture. In 53 % GPs prescribed antiosteoporotic drugs, more often if the indication for treatment was less aggressive (p <0.001). Once prescribed, in 94 % of cases the GPs\' medication followed the specialists\' recommendations. 74 % of patients followed their GP\'s prescription. Patients most often stated a missing prescription as the reason for not taking drugs (39 %), whereas GPs cited a missing interest of their patients (44 %). The observed discrepancies call for a melioration in the communication between all parties involved.
Zusammenfassung. Im Rahmen eines Qualitätsprojekts zur Behandlung von Osteoporosefrakturen fiel auf, dass fachärztliche Therapie-Empfehlungen oftmals nicht umgesetzt wurden, was genauer untersucht werden sollte. Durchgeführt wurde eine systematisch vergleichende Fragebogen-Evaluation bei Patienten wie Hausärzten (n = 151) ein Jahr nach empfohlener Osteoporosetherapie. In 53 % der Fälle folgten die Hausärzte der vom Spezialisten empfohlenen Osteoporosetherapie-Indikation, häufiger, wenn diese medizinisch enger gestellt wurde (p <0,001). Sofern der Patient eine hausärztliche Verordnung erhalten hatte, entsprach diese meist der Spezialisten-Empfehlung (94 %). 74 % der Patienten folgten der hausärztlichen Verschreibung. Patienten gaben am häufigsten eine fehlende Verordnung als Grund für die Nichteinnahme der vom Spezialisten empfohlenen Medikamente an (39 %), hingegen nannten Hausärzte am häufigsten ein Patienten-Desinteresse (44 %). Die beobachteten Diskrepanzen sprechen für einen Bedarf an verbesserter Information, insbesondere im Fall einer eher aggressiv gestellten Therapieindikation.

暂无摘要。

暂无摘要。

暂无摘要。

BACKGROUND: The German Society of General Practice and Family Medicine (DEGAM) has defined educational seminars during post-graduate training as a core element to improve trainees\' specific knowledge and competencies. Furthermore, these seminars facilitate networking among trainees and support the process of identity formation in family medicine. Since its implementation in 2009, the Verbundweiterbildung(plus) Baden-Württemberg (VWB(plus) Ba-Wü) has offered educational seminars. Aim of this article is to analyse the content of these educational seminars and to derive implications for other family medicine training programmes in Germany.
METHODS: From 2009 to 2015, the data from all educational seminars was descriptively analysed. Furthermore, two researchers categorised the seminar contents independently of each other and assigned them to the competence-based curriculum for family medicine training (Kompetenzbasiertes Curriculum Allgemeinmedizin, KCA).
RESULTS: Until 2015, 600 trainees participated in a starter seminar of the VWB(plus) Ba-Wü. In total, 1,116 teaching units and 160 different seminars covered all relevant topics of the KCA. A restructuring of organisational processes and seminars was necessary to handle the increase in the number of participants, including the development of specific software for electronic support. Of all these seminars, 56% were held by specialists or trainees in family medicine. The participating trainees rated the educational seminars in general and the possibility for networking as (very) good.
CONCLUSIONS: The contents of the educational seminars included in family medicine training programs will have to be specifically based on family medicine and cover all relevant aspects of the KCA - medical expertise, competencies and procedures. In order to ensure a common standard concerning didactic methods and qualifications of teachers, a didactic guideline is to be developed. The increasing demand of family medicine training programmes requires (further) development of the software eSchoolab, including integration of the KCA.

BACKGROUND: General practitioners (GPs) are among the first to be contacted by persons with dementia and their relatives. Fitness to drive in dementia is a subject of uncertainty and conflict for GPs.
OBJECTIVE: Development of recommendations for German general practice on managing fitness to drive in dementia.
METHODS: Specification of problem areas by using relevant parts of a metasynthesis of international qualitative dementia research with GPs; literature review on evidence regarding the pre-defined problem areas; deduction of a preliminary design for a recommendation in a multi-professional team.
RESULTS: The difficulties include the assessment of fitness to drive in the office setting, concerns about damaging the patient-physician relationship by raising the issue of driving fitness, and uncertainties about the GP\'s own legal role. A diagnosis of dementia does not per se preclude driving. The majority of elderly people would accept discussing fitness to drive with their GP. In Germany, GPs are not obliged to assess fitness to drive, or to report unsafe drivers to the Licensing Agency, but under certain conditions they do have the right to report. Addressing the issue of driving and dementia early with the patient seems to be a prerequisite for a resource-oriented and patient-centred management.
CONCLUSIONS: The distinction between medical, ethical-communicative, and legal aspects enabled us to break down this complex problem and thus provide the informative basis to draft tailored recommendations. In an ongoing project, this framework will be further developed and informed by the expertise of patients, family caregivers, and professionals from various fields.