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Biomedical subjects

H Pfaff

Publications and source records attributed to H Pfaff.

At least 19 recordsLinked to original sources
PubMed2007

[Determinants of severely injured patients' trust in their hospital physicians].

BACKGROUND: Several studies have shown negative effects of insufficient physician-patient interaction leading to a lack of compliance, worse subjective and objective evaluation of treatment outcome, increased consumption of pain medication, and decreased patient satisfaction. The aim of the present study was to identify patient-, physician-, and/or hospital-specific determinants which have a significant influence on the trust of severely injured patients in their physicians. METHODS: A written questionnaire was sent to 121 severely injured patients hurt predominantly in traffic accidents and treated between July 1996 and July 2001 in two departments of surgery in the German state of Northrhine-Westfalia. Applying the Total Design Method, a response rate of 74.4% (n=90) could be achieved. RESULTS: Using univariate analysis as a preselection tool, we developed a logistic regression model which identified four significant predictors of patients' trust in their physicians: (1) patient evaluation of information, (2) patient evaluation of their physician's decision policy, (3) patient evaluation of treatment success, and (4) patient age. CONCLUSIONS: Besides age of patient and subjective evaluation of treatment success, it is psychosocial aspects of interaction which influence trust in a physician. The results of this analysis confirm the importance of physician-patient communication for medical education, also for surgeons.

Accidents, Traffic↗
PubMed2006

[Tasks and development of health services research. A comparison between the USA, UK, Australia and Germany].

Given the fact that health services research has become increasingly popular in Germany during the last 5 years this article focuses on the status quo of this research field in a multinational comparison. An overview of the health services research situation in the USA, UK, Australia and Germany is given by considering development status, definition and future challenges. This overview shows that health services research is by now regarded as an essential field in these countries. Despite clear distinctions in research tradition and research infrastructure there are cross-national themes and challenges regarding research questions and organisation of research. The common challenges of the future are probably the enhancement of research capacities, the further development of adequate research methods and the question of translating research results into practice. All countries concur that the cooperation between stakeholders of the health services research field needs to be strengthened.

Australia↗
PubMed2006

[Patient- and hospital-related determinants of satisfaction with hospital stay of severely injured patients].

BACKGROUND: General political and legal changes in the German health care system will increase the importance of patient surveys. Patient satisfaction with medical and organizational care during their stay in a hospital is a relevant outcome of quality assurance. Satisfied patients also show a higher compliance with treatment and therefore increase the probability of a successful outcome. The objective of this analysis was to identify determinants of satisfaction with hospital stay of severely injured patients. METHODS: A written questionnaire was sent to 121 severely injured patients, who were predominantly hurt by traffic or work-related accidents and were treated between 1996 and 2001 in two hospitals in Cologne (response rate=74.4%, n=90). The questionnaire used in this study contained questions about psychosocial care of physicians and nurses in and organizational and structural characteristics of the hospital. RESULTS: Logistic regressions identified two significant predictors for satisfaction with hospital stay: (1) subjective evaluation of psychosocial quality of care by physicians and (2) patients' perception of active integration in treatment decisions. CONCLUSION: The results of this analysis confirm the importance of soft science in medical education also for surgeons. Medical education should integrate knowledge about psychosocial aspects of medicine. The quality of psychosocial care of physicians seems to be a predictor of patient satisfaction. The probability of dissatisfaction increases with deficits in communication, information, and time as well as no active integration in treatment. The results of this analysis confirm the vital importance of psychosocial aspects in physician-patient interactions with severely injured patients for satisfaction with stay in hospital.

Accidents, Occupational↗
PubMed2006

[Patient satisfaction and geriatric care - an empirical study].

Patients' satisfaction has become a central concept in quality assurance. Despite progress in research in this area is still a lack of data for geriatric patients. Referring to the consumer model, satisfaction can be described as a difference between expectations and assessed performance. The aim of this study is to analyze satisfaction among geriatric patients in an in-patient setting. A personal interview was performed 1-2 days before discharge. Patients suffering for dementia or with problems to communicate were excluded. 124 of 268 geriatric patients who were discharged in 2003 were included (inclusion rate 46.3%). 119 were willing to participate (response rate 96.0%). Respondents were between 61 and 96 years old, 39% were male and 42% had serious functional limitations at time of admission. Multiple linear regression analysis revealed three significant predictors of a combined index of satisfaction and expectations: a) quality of hotel services; b) experience of neglect; c) provision of medical information and skills. In summary, standardized personal questionnaires can provide valid and reliable data of geriatric patients. Satisfaction of elderly patients is negatively affected by neglect and positively influenced by provision of medical information and a good hotel services.

Aged↗
PubMed2004

[Demands on and benefit from insurance-orientated hospital management - findings from qualitative interviews with executive members of statutory health insurance].

PURPOSE: Starting from the fact that statutory health insurance bodies are increasingly important hospital stakeholders, the article focuses on the question of demands on and benefit from an insurance-orientated hospital management. METHOD: A methodological approach is chosen which takes the views of the stakeholder health insurance as a starting point: Semi-structured interviews were conducted with 14 executives of different statutory health insurance. Data analysis was based on the "zusammenfassende Inhaltsanalyse" (literal translation: summarizing content analysis), developed by Mayring. RESULTS: From the participants' points of view the highly regulated relationship between hospitals and insurances offers opportunities for active development. The analysis of expectance distinguishes between five areas of demand: "Hospital services", "service development", "case management", "management of conflicts/reviews" and "budget negotiations". Within these areas dimensions of demand are differentiated. Most participants feel that an insurance-oriented hospital management is beneficial to the hospital. CONCLUSION: A number of specific demands is identified on which management activities can be based. Hospitals need to consider carefully the benefit of insurance-orientation and suitable measures in the light of hospital-specific aims and strategies.

Budgets↗
PubMed2004

[Care required by disabled persons: are official severe disability statistics good enough for requirement analyses?].

The appropriateness of the German Official Severe Disability Statistics for determining the amount of care needed by disabled persons is a controversial issue and therefore in the focus of this article. The criteria for determining the care required by disabled persons are pointed out. Data on prevalence and incidence exemplify that Official Severe Disability Statistics is only partially appropriate for assessing future care requirements. The problems become particularly obvious in topics of data collection, data processing and data storage. The deletion of the statistical data at regular intervals of five years makes long term prognosis almost impossible. While the problems concerning data processing and data storage could be solved by few modifications, the improvement of data collection could only be achieved by including and applying the International Classification of Functioning (ICF) of the WHO.

Activities of Daily Living↗
PubMed2001

Hypertension guidelines and their limitations--the impact of physicians' compliance as evaluated by guideline awareness.

OBJECTIVE: The initial step of an optimal therapeutic strategy for patients with arterial hypertension is the recognition and acceptance of new recommendations by the physicians themselves. This guideline awareness of the physicians has never been evaluated in detail. DESIGN: The awareness of content of current recommendations in hypertension diagnosis, treatment and treatment control was therefore assessed in primary care physicians using a questionnaire. The guidelines of the German Hypertension Society were used as the reference standard. PARTICIPANTS: A total of 24 899 German physicians, including all internists, all cardiologists and 22% of general practitioners were contacted in a nationwide survey. MAIN OUTCOME MEASURES: The number of answers in agreement with the guideline was used as a measure of guideline awareness. Adequate awareness of content of guideline recommendations was defined as the correct answer to five out of eight questions; the correct answers had to include the appropriate definition of hypertension. RESULTS: The analysis was based on 11 547 returned questionnaires (47.1%). An adequate guideline awareness was found in 23.7% of the total study population, especially in 37.1% of cardiologists, in 25.6% of internists and in 18.8% of general practitioners. While the guideline awareness was significantly influenced by the duration of private practice, regional and municipal factors had only minor influence on the results. CONCLUSION: The impact of hypertension guidelines on actual medical knowledge is modest. Thus, the information strategies about current treatment guidelines must be improved and tailored to the needs of physicians in clinical practice to ultimately improve patient care.

Awareness↗
PubMed2001

[Guideline-adequate knowledge in internists and general practitioners about the diagnosis and treatment of arterial hypertension].

Only a small proportion of patients with arterial hypertension are adequately treated. Although a possible cause for this fact may be the deficient knowledge of physicians about diagnosis and treatment of arterial hypertension, to date no studies have addressed this important problem in Germany. Therefore, we have reviewed the knowledge of internists and general practitioners about diagnosis and treatment of arterial hypertension using a questionnaire. The guidelines of the German Hypertension Society were used as the reference standard. The questionnaire was sent out in December 1999 to all internists (n = 15,952) and to a random sample of general practitioners (n = 8947) who work as statutory health insurance physicians. A total of 11,547 questionnaires were sent back and could be analysed. Adequate guideline knowledge was assumed if five out of eight questions were correctly answered; the correct answers had to include the correct definition of arterial hypertension (> 140/90 mmHg). The correct definition of arterial hypertension was known by 4103/11,547 participants (36%). An adequate guideline knowledge was found in 18.8% of the general practitioners and in 26.6% of the internists. There were no relevant regional differences. The level of awareness about diagnosis and treatment of arterial hypertension is insufficient among internists and general practitioners. This insufficient knowledge may in part explain the inadequate care for patients with arterial hypertension. Thus, the implementation and evaluation of new information and training strategies are mandatory to improve the care for patients with arterial hypertension.

Family Practice↗
PubMed1998

[Results of a prospective catamnestic study following rehabilitation according to section 64 StGB of alcoholic patients].

Delinquent alcohol addicts who went through compulsory treatment in a psychiatric hospital in Rheinland-Pfalz from 1989-1991 gave feedback regarding their subsequent development in conduct supervision via their probation officers. During the follow-up period, 25 months on average, 63% of the clients succeeded in living without any criminal offence, 37% remained abstinent from alcohol and illegal drugs. A lack of occupational training and previous unsuccessful treatments proved to be prognostically unfavorable. Maintenance of abstinence from drugs was very important for a successful trial course.

Adult↗
PubMed1993

[Detoxication therapy according to section 64 StGB. Socio-demographic data and therapeutic results of a random 3 year sample].

In the context of a prospective study of alcohol-dependent men, who were committed to compulsory treatment after violations of the law, all patients of a treatment unit in Rheinland/Pfalz during the years 1988-90 were studied. Sociodemographic data, results of psychological testing and records of therapeutic progress of 76 men are evaluated. Besides the evidence of severe social deficits, particular attention is paid to the negative effect of marked delinquency and the additional abuse of drugs and medicaments upon therapeutic outcome.

Adult↗
PubMed1988

[Long-term anxiety and depression following myocardial infarct].

Data from the 5-year Oldenburg Longitudinal Study were used for investigating the causes of differences in psychological well-being in a national sample of 1000 cardiac patients. In a subsample of 400 married patients, for whom data from the spouse were available, exogenous influences, cognitive mediators, and two measures of psychological distress were linked up in models explaining/predicting the level of anxiety and depression. A major hypothesis was the salience of the illness-related cognitions of the patient as a determinant of long-term behavior and mood state. Early patient subjective health perceptions, the 'primary appraisal' of threat/harm/loss, were found to be the most important predictors of subsequent psychological well-being at the fourth wave of the study several years later. As an instrument for patient screening and psychosocial intervention, Type A's and other groups of subjects seemed to constitute high-risk patient groups.

Adaptation, Psychological↗
PubMed1988

Marriage and the psychological consequences of a heart attack: a longitudinal study of adaptation to chronic illness after 3 years.

As part of a larger study on recovery from myocardial infarction in a national sample of male cardiac patients, data was collected on slightly under 400 men and their wives over a 5-year period. This longitudinal data set was used to investigate the role of patient health cognitions and marital factors on long-term psychological response to the illness. Negative appraisals of threat and loss due to cardiac impairment/disability were found to be the best predictor of anxiety and depression at 3-4 years after hospitalisation. Patient cognitions appeared to be a chief mediator of medically-defined illness. Supportive marital environments were defined by scales measuring intimate attachment and spouse conflict. The latter was found associated with negative health cognitions and elevated anxiety. High intimacy marriages appeared to provide adequate social support, and the level of intimacy between the spouses was inversely related to the level of depressed mood. These findings were suggestive of a buffering effect of the patient's social support system. Other predictors, including the type A pattern, 'vital exhaustion', and social class were investigated as components of a multifactorial model for clinical screening purposes.

Adaptation, Psychological↗
PubMed1983

Diagnosis of exocrine pancreatic insufficiency from stool fat and weight.

Diagnostic workup was performed in 118 patients with a chronic malassimilation syndrome. 45 patients had exocrine pancreatic insufficiency, 23 patients jejunal mucosal atrophy (mainly celiac disease), 36 patients increased enteral deconjugation of bile acids and as shown by the 14C-glycocholate breath test and in 14 patients with chronic diarrhea and steatorrhea the cause could not be determined. Eleven patients with irritable bowel syndrome served as controls. Stool fat and weight were determined in all patients. Classification function coefficient were calculated on the basis of a discriminant analysis, leading to a correct classification in 82.2% of the patients with pancreatic insufficiency, 67.8% in the patients with jejunal mucosal atrophy and 83.3% in the patients with increased enteral deconjugation of bile acids. Calculation of sensitivity, specificity and predictive value in the total group and in two randomized subgroups and the correct diagnosis of exocrine pancreatic insufficiency in 78.5% of the patients of an independent verification group suggest clinical usefulness of this approach mainly in the diagnosis of exocrine pancreatic insufficiency.

Atrophy↗