Patientenzentrierung

  • 文章类型: English Abstract
    背景:自2000年《世界卫生报告》以来,建立了卫生系统绩效评估(HSPA),作为对卫生系统进行评估和循证治理的工具。到目前为止,人口观点尚未系统地纳入HSPA,尽管人们的经验和期望对于改善卫生系统,特别是加强以患者为中心的护理非常重要。因此,这项研究旨在从人口的角度对德国卫生系统进行HSPA,涵盖世卫组织卫生系统框架的所有八个目标,并确定改进的优势和需求。
    方法:2018年,通过邮件邀请了32,000名获得德国疾病基金“AOKNordost”保险的人参加调查。问卷共包含43个项目,涵盖世卫组织卫生系统框架的八个目标(例如,access,质量,安全)加上被保险人的社会经济学和其他特征。对卫生系统目标的数据进行了描述性和亚组分析(年龄,性别,收入,慢性疾病,健康素养)。
    结果:样本(n=1,481;反应率4.6%)为54.8%的女性,平均年龄为59.1岁(±18.5)。总之,参与者看到了德国卫生系统内部的一些改进需求。例如,60.0%的人发现医院之间的质量差异很大,3.9%至8.5%的人报告了前两年与治疗或处方药有关的错误。特别是在自付费用(51.5%)以及门诊医生彼此之间(44.2%)和与医院(41.9%)的协调方面,需要进行改革。此外,观察到大的亚组差异,特别是收入和健康素养。在低收入群体的参与者中,37.2%的人报告说,由于自付付款,(非常)沉重的财务负担(与20.7%)。健康素养有限的人(52.1%)通常认为获得护理的机会不好,他们意识到更大的质量差异和改革需求,与他们的同行相比。例如,36.6%的人在前一年经历过歧视(与19.9%)。
    结论:调查结果从人口角度全面了解了德国的卫生系统。在某些地区,先前的发现得到了证实(例如,提供商之间缺乏协调)。其他结果扩展了现有知识(例如,健康素养在医疗保健提供中的作用)或提出新的问题(例如,来自自付费用的主观评估负担与目前使用的客观措施之间的差异)。小组之间的巨大差异是在政治和实践层面上采取行动的呼吁,以更好地考虑个人的需求,从而使每个人的健康更好。进一步的研究可以在这方面提供更深入的见解。
    结论:加强HSPA中的人口观点可以更好地理解和评估卫生系统,特别是,有助于确定以患者为中心的护理需要改进的地方。
    BACKGROUND: Since the World Health Report in 2000, Health System Performance Assessment (HSPA) has been established as a tool for the evaluation and evidence-informed governance of health systems. So far, the population perspective has not been integrated into HSPA in a systematic manner, although people\'s experiences and expectations are of great importance to improve health systems and especially to strengthen patient-centered care. Therefore, this study aims to conduct an HSPA of Germany\'s health system from the population\'s perspective covering all eight goals of WHO\'s Health Systems Framework, and to identify strengths and needs for improvement.
    METHODS: In 2018, 32,000 people insured with the German sickness fund \'AOK Nordost\' were invited by mail to participate in the survey. The questionnaire contained a total of 43 items covering the eight goals of WHO\'s Health Systems Framework (e.g., access, quality, safety) plus socioeconomics and other characteristics of the insured persons. The data on the health system goals were analyzed descriptively and by subgroups (age, sex, income, chronic conditions, health literacy).
    RESULTS: The sample (n=1,481; response rate 4.6%) was 54.8% female and had a mean age of 59.1 years (±18.5). Altogether, the participants saw several needs for improvement within the German health system. For instance, 60.0% found quality differences between hospitals to be big, and between 3.9% and 8.5% reported mistakes related to their treatment or prescription medication in the previous two years. A big need for reform was especially seen regarding out-of-pocket payments (51.5%) and the coordination of ambulatory care physicians among each other (44.2%) and with hospitals (41.9%). In addition, big subgroup differences were seen, especially for income and health literacy. Of the participants in the lower income group, 37.2% reported a (very) strong financial burden due to out-of-pocket payments (vs. 20.7%). People with limited health literacy (52.1%) assessed the access to care generally as not being good, and they perceived greater quality differences and needs for reform, compared to their counterparts. For instance, 36.6% had experienced discrimination in the previous year (vs. 19.9%).
    CONCLUSIONS: The survey results provide a comprehensive picture of Germany\'s health system from the population perspective. In some areas, previous findings were confirmed (e.g., a lack of coordination between providers). Other results expand existing knowledge (e.g., the role of health literacy in health care provision) or raise new questions (e.g., the difference between the subjectively assessed burden from out-of-pocket payments and the objective measures currently used). The great differences between subgroups are a call to action on the level of both politics and practice to better consider the individual\'s needs in order to make health better for everyone. Further research could provide deeper insights in this regard.
    CONCLUSIONS: Strengthening the population perspective in HSPA allows for a better understanding and evaluation of health systems and, in particular, helps to identify areas for improvement in patient-centered care.
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  • 文章类型: English Abstract
    Development and implementation of primary nursing in the intensive care unit: evaluation in mixed-methods design. Abstract:Background: In a university hospital, the development and implementation of Primary Nursing (Prozessverantwortliche Pflege, PP) in a pilot intensive care unit was initiated. To develop the roles of nurses with and without process responsibility a working group PP was founded while taking into account the skill-grade mix. Aim: The working group aimed to develop the roles of process-responsible nurses (PP) and nurses (P), as well as to plan and implement the implementation process. Methods: Development and piloting steps were taken based on the recommendations of the Medical Research Council. At three measurement points, the instrument for recording nursing systems (IzEP©) was used quantitatively and a focus group interview, as well as a ward process analysis, were used qualitatively in t0 (as-is analysis before development and piloting), t1 (6 months after implementation) and t2 (12 months after implementation). Results: PP mainly take over the care process\'s design and control. The IzEP© analysis showed that room care was practiced in t0 with 50.0%. The values increased towards PP from 74.0% in t1 to 83.5% in t2. Qualitatively obtained data supported these results and showed further optimization potential for practice. Conclusions: The results prove the successful implementation of PP in practice. For the development and implementation of new nursing roles, the involvement of the affected nurses is mandatory.
    Zusammenfassung:Hintergrund: In einem Universitätsklinikum wurde die Entwicklung und Implementierung von Primary Nursing (Prozessverantwortliche Pflege, PP) auf einer Pilot-Intensivstation initiiert. Zur Entwicklung der Rollen von Pflegenden mit und ohne Prozessverantwortung wurde unter Berücksichtigung des Skill-Grade-Mixes eine Arbeitsgruppe PP (AG PP) gegründet. Problemstellung und Zielsetzung: Ziel der AG PP war es, die Rollen von prozessverantwortlich Pflegenden (PP) und Pflegenden (P) zu entwickeln sowie den Implementierungsprozess zu planen und umzusetzen. Methodik: Gemäß den Empfehlungen des Medical Research Council wurden die Schritte Entwicklung und Pilotierung berücksichtigt. Zu drei Messzeitpunkten wurden quantitativ das Instrument zur Erfassung von Pflegesystemen (IzEP©) und qualitativ ein Fokusgruppeninterview sowie eine Stationsablaufanalyse in t0 (IST-Analyse vor Entwicklung und Pilotierung), t1 (6 Monate nach Umsetzung) und t2 (12 Monate nach Umsetzung) eingesetzt. Ergebnisse: PP übernehmen vor allem die Gestaltung und Steuerung des Pflegeprozesses. Die IzEP©-Analyse zeigte in t0 mit 50,0% eine Bereichspflege. Die Werte konnten von 74,0% in t1 auf 83,5% in t2 hin zu PP gesteigert werden. Qualitativ gewonnene Daten stützten diese Ergebnisse und zeigten weiteres Optimierungspotential für die Praxis auf. Schlussfolgerung: Die Ergebnisse belegen die Umsetzung von PP in der Praxis. Zur Entwicklung und Implementierung neuer pflegerischer Rollen ist die Einbindung der betroffenen Pflegenden obligat.
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  • 文章类型: Journal Article
    \"Putting patients first in health care\" seems to be a rhetorical statement. But is it really the case that patients always come first? And where exactly do we stand with patient involvement and patient orientation in Germany? What participation options are currently available? Is the patient involvement and patient orientation we have so far achieved sufficient? What needs to be done? These questions will be addressed in the following discussion. Patient self-help organizations, patient interest groups, patient representatives as well as the industrial and political decision-making bodies agree that the patient perspective should be more strongly integrated into health care and health care delivery decisions. The relevant information and sources of evidence, however, are yet insufficiently provided and used. Patients are experts for their own cause. There is consensus that patient participation is and must be an integral part of all levels of health care. Patient representation has made enormous progress in the last decade. This article outlines the current state of affairs of patient representation, patient involvement, their legal legitimacy and possible future scenarios. The transformation from of a paternalistically oriented health care system towards a patient-oriented system is far advanced, but much remains to be done. (As supplied by guesteditors).
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  • 文章类型: English Abstract
    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.
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