[Health care research: the last mile in sight].
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Germany↗
Biomedical subjects
Holger Pfaff
Publications and source records attributed to Holger Pfaff.
[Strengthening health services research: the development of the "German Network for Health Services Research" (DNVF)].
One of the main challenges in health services research is to overcome the structural and professional boundaries restricting the opportunities for cooperation between researchers, clinicians, and practitioners in designing and conducting applied research. In our view, two steps are necessary to strengthen linkage and exchange between organizations and bodies interested in health services research. First, reconnecting the different scientific disciplines and researchers working in the field of health services research is essential. Second, it is necessary to bring both researchers and the users and funders of research together in order to ensure that the research agenda is pursuing the right questions and to foster the translation of the data generated into valuable information for practical decisions. The "German Network for Health Services Research" was launched on May 2, 2006, by 26 representatives of different national medical and public health associations. The aim of this network is to help bridge the gap between the scientific communities on the one hand and between researchers and practitioners on the other hand.
Delivery of Health Care↗
[Shared decision-making as a new quality indicator in nephrology: a nationwide survey in Germany].
BACKGROUND AND PURPOSE: Shared decision-making (SDM) as a model in physician-patient interaction is gaining relevance in the German health system. By applying this model, mid- and long-term improvements are expected especially in the outcomes of chronic diseases. Up to now, there has hardly been any empirical data available in German health services research regarding the state and development of SDM. This study establishes a baseline and provides actual data on this subject based on a German-wide survey of end-stage renal disease (ESRD) patients. METHODS: Standardized German-wide survey of 6,614 patients with ESRD. The questionnaire included an instrument to measure the patients' perceived involvement in care (PICS) which had been translated and validated before. RESULTS: 82% of the questioned patients feel their physicians facilitated involvement in decision making. 81% of the patients actively inform themselves concerning their disease and treatment options. 69% state that SDM has taken place. Age, years on dialysis and gender correlate with perceived involvement. CONCLUSION: This paper provides a valid baseline for the prospective research of SDM in ESRD. The results indicate that dialysis patients are willing to participate in the process of medical decision-making. Characteristics and preferences of the patients should be taken into account not only in everyday clinical interactions. They could be monitored systematically within the framework of quality management and used as potential for quality improvement.
Communication↗
[Memorandum about preventive medicine research in Germany].
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Germany↗
[Shared decision making as a chance of implementing disease management programs].
Since June 2002 disease management programmes have been legally established in Germany. The law demands the patients' active involvement in decision making. First, the present paper will point out that the legal intentions are in accordance with the concept of shared decision making. Second, we will discuss how patients and physicians may be prepared to implement this model within the scope of disease management programmes. For example, knowledge and practical skills in the field of shared decision making should be taught within legally required courses for patients and physicians. In the administrative field shared decision making could be embodied into clinical practice guidelines.
Education, Medical, Continuing↗
[Shared decision making: an overview of international research literature].
Shared decision making (SDM) is a particular type of physician-patient-interaction to which the patient brings his/her individual preferences and the physician contributes the medical expertise. The aim of the SDM process is a treatment decision based on mutual agreement and active participation. This kind of decision-making is best effectuated in cases of diseases with medical uncertainty and/or differing patient outcome-treatment potentialities (e.g., breast- or prostate cancer). The concept of SDM is widely known in the English-speaking world. A database search with the keywords "shared decision" produced 301 relevant papers, of which 193 are theoretical and 108 empirical works. This paper gives an overview over the state of international research under special consideration in continental European literature. Different questions are explored with regard to potential methodological and contextual research fields. Present results indicate that the level of patient preference to participate in decisions is higher than their actual involvement. Results also prove that SDM leads to higher rates of satisfaction and better treatment results according to patients. Results regarding the efficacy of various intervention methods used to promote SDM, especially within different cultural contexts, are inconsistent. A great amount of research still needs to be done in this field.
Decision Making↗
[Physicians and the internet--a cross-sectional study against the background of guideline implementation].
The internet is an innovative medium for the implementation of current recommendations for diagnosis and therapy, e.g. by means of guidelines. In this context, evaluation of the internet is very important because traditional ways of implementation have been proved less effective. Therefore, we investigated the frequency of online access and individual utilisation of the internet among 13,547 family practitioners, internists and general practitioners using a questionnaire procedure. Furthermore, we asked for a personal grading of its current relevance in their daily practice. Out of 2,786 responders (20.6% response rate) 79% reported personal online access. 40% had online computer access in their office and 71% at home. 45% of the internists had online access in their office compared to 34% of general practitioners. Almost all physicians under the age of 40 years (94%) had personal online access in comparison to only 49% of those over 60 years. The average daily duration of internet usage was up to ten minutes in 61%, and 1.5% use the internet more than one hour per day. 46% of responders believe that the internet is an appropriate source for professional education, whereas it has little professional relevance for 38%. We conclude that the internet appears to be a useful medium for the implementation of guidelines. However, in subgroups with the most urgent need for current medical information the internet seems to be unsuitable as an implementation tool.
Cross-Sectional Studies↗
[Organization development of the public health system].
BACKGROUND: Changes in the German health care system require changes in health care institutions. Organizational development (OD) techniques can help them to cope successfully with their changing environment. CONCEPT: OD is defined as a collective process of learning aiming to induce intended organizational change. OD is based on social science methods and conducted by process-oriented consultants. In contrast to techniques of organizational design, OD is characterized by employee participation. One of the most important elements of OD is the so-called "survey-feedback-technique". EXAMPLES: Five examples illustrate how the survey-feedback-technique can be used to facilitate organisational learning. CONCLUSIONS: OD technique supports necessary change in health care organizations. It should be used more frequently.
Community Participation↗