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J Szecsenyi

Publications and source records attributed to J Szecsenyi.

At least 19 recordsLinked to original sources
PubMed2006

The frequency of inappropriate tablet splitting in primary care.

INTRODUCTION: We assessed the frequency and determinants of tablet splitting in primary care in Germany and evaluated the quality of information on divisibility in the Summary of Product Characteristics (SPCs) and in the Package Leaflet (PL) as legal sources of information for health care providers and patients. METHODS: We performed a cross-sectional questionnaire survey among patients of 59 general practitioners in the German Federal State Saxony-Anhalt in 2005 in order to collect detailed information on all drugs of patients maintained on more than three drugs. RESULTS: The response rate was 82.1% (n=905) and 3,158 drugs (tablets and dragées) were included in the analyses. Of all drugs, 24.1% were split (762 of 3,158): 8.7% of all split tablets were unscored (66 of 762) and 3.8% of all split tablets were not allowed to be split (29 of 762). Tablets of the higher price categories and higher strengths were twice as likely to be split. Only 22.5% of the SPCs (9 of 40) of the split unscored tablet brands contained explicit information on divisibility and only 36.4% of the PLs (8 of 22) of the split brands that were not allowed to be split stated that splitting was not appropriate. CONCLUSION: The splitting of tablets in primary care is a frequent habit likely driven by medical and economic considerations. Almost 1% of all tablets are split that must not be fragmented. However, the SPC and PL provide only limited information on divisibility stressing the need to improve this information promptly to avoid medication errors.

Aged↗
PubMed2006

Standardized documentation of drug recommendations in discharge letters--a contribution to quality management in cooperative care.

OBJECTIVES: To analyze the necessity and potential usefulness of a computerized physician order entry (CPOE) system in supporting the writing of pharmacotherapeutic recommendations in discharge letters. METHODS: Systematic analysis of drug recommendations in discharge letters of a hospital providing tertiary care, structured interviews with in-hospital prescribers, and focus groups with general practitioners who admit patients to this hospital. RESULTS: We analyzed 1800 randomly selected discharge letters, 1205 of which contained pharmacotherapeutic recommendations. The frequencies, structure, and quality of these recommendations varied considerably between departments. Nearly 16% of the recommendations contained both proprietary (brand) and non-proprietary names (active ingredient). Interviewed clinicians expressed interest in CPOE systems that check for contraindications and interactions between drugs, suggest cheaper products, and automatically insert active ingredients when omitted. The focus group sessions confirmed that the pharmacotherapeutic recommendations in current discharge letters do not effectively support daily clinical practice. CONCLUSIONS: Documenting active ingredients as well as brand names in drug therapy recommendations is currently not part of clinical practice. Computerized decision support can help to optimise the structure and communication of therapeutic information across interfaces and can be a quality factor with considerable influence on process quality, outcome quality, and costs of cooperative patient care.

Continuity of Patient Care↗
PubMed2005

Evaluation and cultural adaptation of a German version of the AIMS2-SF questionnaire (German AIMS2-SF).

OBJECTIVES: The aim of the study was to examine the validity of a translated and culturally adapted version of the Arthritis Impact Measurement Scales 2, Short Form (AIMS2-SF) in patients suffering from osteoarthritis (OA) in primary care. METHODS: A structured procedure was used for the translation and cultural adaptation of the AIMS2-SF into German. The questionnaire was administered to 220 primary care patients with OA of the knee or hip. Test-retest reliability was tested in 35 randomly selected patients, who received the questionnaire a second time after 1 week. The physical scale of the original AIMS2-SF was divided into an 'upper body limitations' scale and a 'lower body limitations' scale. RESULTS: With values ranging from 0.52 to 0.97 for Pearson's r, item-scale correlations were reasonably good. The discriminative power of separate scales was also good, reflected in low values for correlation between different scales, indicating little redundancy. Only two items (13 and 15) referring to the symptom scale showed item-scale correlation of r = 0.72 and r = 0.67, respectively with the lower body limitation scale. The assessment of internal consistency reliability also revealed satisfactory values: Cronbach's alpha was > or =0.83 for all scales, except for the social interaction scale (0.66). The test-retest reliability, estimated as the intraclass correlation coefficient (ICC), exceeded 0.85 except for the affect scale (0.72). Substantial floor effects occurred in the upper limb scale (33.8%). Principal factor analysis confirmed the postulated three-factor structure with physical, physiological and social dimensions, explaining 49.8, 14.1 and 6.4% of the variation, respectively. The assessment of external validity revealed satisfactory correlations with the corresponding WOMAC (Western Ontario and McMaster Universities Arthrosis Index) scales. As expected, correlations with radiological grading were moderate to low. The correlation with the physician's assessment was high in the scales that were dominated by physical factors, but rather low in the areas of health, which were found to be dominated by psychological or social factors. CONCLUSION: The German AIMS2-SF is a reliable and valid instrument to assess the quality of life in primary care patients suffering from OA. When addressing the different impacts of OA, the physical scale should be divided into an upper body scale and a lower body scale. The floor and ceiling effects revealed are in accordance with the disease characteristics of the study sample and do not limit the significance of the questionnaire.

Adult↗
PubMed2003

[What students and teaching doctors in Heidelberg think about early patient contact and tasks in general practice].

BACKGROUND: In Heidelberg, the clinical curriculum of medical education was fundamentally changed in 2001 due to co-operation with the Harvard Medical School. The pre-clinical curriculum has also already been undergoing reform since 1995: the benefits of two new lectures with early patient contact and special tasks in the subject of family medicine were to be assessed. METHODS: In the first year, the students therefore had to assess the seminars, tutorials, and the internships in GP by means of a standardised questionnaire. In addition, reports had to be produced on teaching practice. The teachers were also questioned following agreement with and introduction of quality assurance measures. RESULTS: 66-89% of students assigned good marks to the internships in GP, 40-58% for the accompanying seminars, and 70% for the tutors. The results of a general external evaluation which was carried out slightly differently were not quite so good. 87-89% of teachers agreed upon the elaborated criteria for the quality of teaching practice. CONCLUSIONS: The results show that GP-based education is already well accepted in the first year of training, and that early patient contact in primary care is highly appreciated by the students. On their part, the teaching GPs assess the quality promotion sessions as instruments towards continuous quality support in pre-clinical training as meaningful and necessary, especially with regard to licensing for teaching in General practice.

Adult↗
PubMed2003

The development of quality circles/peer review groups as a method of quality improvement in Europe. Results of a survey in 26 European countries.

BACKGROUND: Peer review groups (PRGs) and quality circles (QCs) commenced in The Netherlands and have grown to become an important method of quality improvement in primary care in several other European countries. OBJECTIVE: Our aim was to provide an overview of QC/PRG activities and exemplary programmes in European countries. METHODS: A survey was performed in three consecutive steps by EQuiP (European Working Party on Quality in Family Practice), which is a representative association of experts from 26 European countries. The national representatives initially completed a structured questionnaire documenting the number and objectives of QCs/PRGs, sources of support and special programmes in their countries (step 1). In step 2, these sources were used to extend and validate the expert statements. Step 3 studied paradigmatic initiatives in depth. RESULTS: Step 1 took place in 2000; the response rate was 100% (26 countries). QCs/PRGs were very active in 10 countries; 16 countries showed little or no activity. Participation ranged from <2 to 86% of all GPs. Step 2 concentrated upon the countries with a high level of activity. Development appeared to be associated with establishment in private practice and the portion of GPs with vocational training. Eight programmes from six countries describing the establishment and the targeting of QC/PRG work are presented as case reports (step 3). CONCLUSION: In the last 10 years, substantial development of QCs/PRGs has taken place in The Netherlands, the UK, Denmark, Belgium, Ireland, Sweden, Norway, Germany, Switzerland and Austria. Further evaluation is needed to clarify the impact on quality of care.

Europe↗
PubMed2001

[Evaluation of a patient-held medical record by patients--results from the Ried Medical Quality Network].

In the "medical-quality network Ried", an independent practice network in the south of Hessia, an A 4 format patient held record for multi-morbid chronically ill patients is used since 1997. 655 patients (response-rate 71.0%) from sixteen general practitioner (GP) practices were surveyed by written questionnaire. Respondents were in average 68.1 years of age, and for 16.3 years with their GP. 52.2% were male. Patients had their own records for 24.2 months and had in average 1.9 (women) or 2.3 (men) serious health problems. Women had in average 5.0, men had 4.8 different drugs prescribed. 96.7% of the respondents thought that the patient-held record is a good idea, 85.5% felt more secure and 98.7% have it always at hand at home. The patient-held record provides better information about ones own health (92.1%) and 96.6% want to be able to look at their own record. The patient-held record makes it easier for patients to talk to doctors (86.6%) and provides a better overview for the GP (90.8%). The more drugs patients have to take, the more important it becomes for them to have their own record. 68.6% take the record on holyday, 57% take it to other doctors than the GP. 76.4% reported that the patient-held record was used at least once by a specialist, 61.3% by a hospital. 21.8% remembered emergency situations where it was helpful. Only 4.8% thought that it is tiresome. Few proposals for improvement were made, mainly focussing on a smaller format. On the basis of these results patient-held records should be a core activity of practice networks, especially for this type of patients.

Adult↗
PubMed2000

Patients in Europe evaluate general practice care: an international comparison.

BACKGROUND: Patients' evaluations can be used to improve health care and compare general practice in different health systems. AIM: To identify aspects of general practice that are generally evaluated positively by patients and to compare opinions of patients in different European countries on actual care provision. METHOD: An internationally-validated questionnaire was distributed to and completed by patients in 10 European countries. A stratified sample of 36 practices per country, with at least 1080 patients per country, was included. A set of 23 validated questions on evaluations of different aspects of care was used, as well as questions on age, sex, overall health status, and frequency of visiting the GP. RESULTS: The patient sample included 17,391 patients in 10 different countries; the average response rate was 79% (range = 67% to 89%). In general, patients visiting their general practitioner (GP) were very positive about the care provided. For most of the 23 selected aspects of care more than 80% viewed care as good or excellent; in particular, keeping records confidential, GP listening to patients, time during consultations, and quick services in case of urgent problems were evaluated positively. Patients were relatively negative about organisational aspects of care. The evaluations in different countries were largely similar, with some interesting differences; for instance, service and organisational aspects were evaluated more positively in fee-for-service health systems. CONCLUSIONS: Patients in Europe are positive about general practice but improvements in practice management in some countries are requested. More research is needed to study the complex field of differences in expectations and evaluations between countries with different health systems.

Culture↗
PubMed1999

[The DEGAM-concept--development, dissemination, implementation and evaluation of guidelines for general practice].

The German Society for General Practice/Family Medicine (DEGAM) has launched a project to develop and implement national guidelines for general practice accordingly to international models. Guidelines are seen as statements to assist practitioners and patients in deciding about appropriate, effective and efficient health care. They should be evidence-based, feasible for primary care practices, and purposefully addressing to physicians as well as practice staff and patients. The development follows a comprehensive and well-structured programme (10 stages) which requires the appraisal of medical evidence, the involvement of experienced general practitioners on various stages (primary review, feasibility testing), and comments of concerned specialists, before a guideline is promulgated. Implementation of each guideline is promoted by at least five tools (full text, quick reference guide, telephone card for practice staff; patient leaflet, and information-prescription--"infozept"). Methodological quality is checked for the first time in Germany according to the standards of the German Agency for Quality Assurance. Different targets and criteria for evaluation of guidelines in primary care are mandatory part of the DEGAM-concept.

Evaluation Studies as Topic↗
PubMed1999

[How do patients evaluate general practice? German results from the European Project on Patient Evaluation of General Practice Care (EUROPEP)].

German results from the European Project on Patient Evaluation of General Practice Care (EUROPEP). As part of the European collaborative study, "EUROPEP" 2224 patients in Germany (response rate 77.2%) filled in a questionnaire to evaluate their general practitioners (GP's) and the care they were delivering over the last 12 month. Overall satisfaction was high: 95.4% reported that they had no reasons to change to another GP. On a five-point scale ranging from 'excellent' to 'poor' the possibility to reach the practice on the phone was evaluated best (73.8% 'excellent') and waiting times were rated worst (31.0% 'excellent'). Also less often rated 'excellent' than other items were 'preparing the patient for what to expect from specialist or hospital care' (53.3%), 'the GP's knowledge on what s/he had done or told the patient during previous contacts' (54.3%) and 'helping the patient to deal with emotional problems related to her/his health status' (54.6%). Relevant differences between practices concerning evaluation of care and sociodemografic background of their patients were detected. Patient evaluation of care can contribute to make practices an their teams more responsive to patients needs.

Adult↗
PubMed1997

[Quality circles with emphasis on pharmacotherapy in North Hessia: evaluation from the viewpoint of participants].

Evaluation by Participants: For a project aimed at improving the prescribing performance of general practitioners (GPs) in Northern Hessia, 53 GPs who exceeded average prescribing costs by more than 20% were approached. 32 agreed to participate in 10 peer-review group meetings and to discuss an analysis of their own prescriptions issued during a three-months period. These 32 GPs in three quality circles as an intervention group were compared with a group of 15 GPs as a "gold standard" who had been working for two years already on other items than rational prescribing and who had not had any problems with prescribing costs. Apart from positive effects in changing actual prescribing behaviour, discussed elsewhere, an evaluation of the group work by participants in structured questionnaires and open discussions revealed differences between the intervention and the "gold standard" groups. Members of the intervention group had to overcome feelings of being controlled by the authorities in the first session, and felt less satisfied with the effect of the group work on their daily work in practice. This article discusses matters of working in groups, and points out the importance of volunteer participation.

Attitude of Health Personnel↗
PubMed1997

[Patient initiative and referral decision of the primary care physician].

Using the German data of the European referral study from primary to secondary care this paper attempts to answer the following questions: which are the specialties GPs refer to, and which referrals were initiated by the patients. According to the study's methodology the gatekeeper function of the GPs or the patient initiative should be described by distinguishing between direct and indirect referrals. A direct referral is defined by a face to face encounter between patient and GP, while an indirect referral requires no such contact. For direct referral the GPs recorded the influence of the patient on their referral decision. In 71 practices (only the western part of the Federal Republic of Germany) 2077 direct and 1665 indirect referrals were documented. Every second direct referral was influenced by the patients. Women had a greater influence than men. An analysis by specialty showed that most of the direct referrals were directed to orthopaedics (14%), surgery (12%) and internal medicine (10%) and most of the indirect referrals to ophthalmology (25%), gynaecology (20%) and dermatology (8%) (64% of all indirect referrals were given to women). These results could be taken as an example how patients take over the responsibility of managing their complaints and illnesses by themselves in a health system with free access to specialist care. The role of the German GP as a gatekeeper and co-ordinator in the health care system turned out to be very limited. In consequence this might result in future problems such as a lack of co-operation, deficiencies in the continuity of medical treatment, over-medication unnecessary parallel investigations and additional costs.

Adolescent↗
PubMed1995

Influenza surveillance: experiences from establishing a sentinel surveillance system in Germany.

OBJECTIVES: Before and during peak influenza periods there is increased morbidity from other respiratory tract disorders. Sentinel networks of primary care physicians can be very effective in the early detection of influenza epidemics and the German network, the Arbeitsgemeinschaft Influenza (AGI), began its work in this area in 1992. METHODS: Data are transmitted weekly from the doctor's computer via Btx to a central computer. The numerator is the weekly number of acute respiratory infections (ARI) in five age groups and the denominator is the weekly number of patient consultations. Data on hospitalisation, mortality, and days of sick leave from work or school are also collected. Swabs for influenza specimens are collected in 30 physicians' offices each Monday and sent to three reference centres. FINDINGS: During the last recording period, from week 46 1993 to week 15 1994, 411 physicians' offices participated in the network. For 16 to 22 weeks, more than 60% of the participants transmitted data. During both the 1992-93 and 1993-94 influenza seasons, peaks were observed in the rate of ARI. There was a corresponding increase in sick leave from work and school. Rates for hospitalisation and deaths due to influenza showed no peaks during either season. CONCLUSIONS: Although the German sentinel network for influenza experienced some technical problems in the first year, it was possible to solve these. Reporting rates were very satisfactory in the second year. The network will now be expanded to include 750 physicians in order to receive 600 weekly reports and obtain a solid baseline for an early warning system.

Adolescent↗
PubMed1995

[Evaluation of a training program for moderators of panel doctor quality circles: a progress assessment].

We report about the first 7 seminars of a training programme for presenters of quality circles for panel doctors. The seminars aim to train techniques of moderating a group and to give a methodological background for the work with quality circles. 65 (44.2%) of the 147 participants were general practitioners, 34 (23.1%) were internists and 32 (21.8%) were specialists of other disciplines. 16 (10.9%) were not physicians or not working as a physician. An evaluation of the seminars by a structured questionnaire showed mean ratings of 2.1 for lectures [in terms of school-marks from 1 (very good) to 6 (very poor)] and 1.8 for the work in small groups. Working atmosphere and opportunities for active participation were rated most positively. 6 months after the course, 64.9% of the participants already had arranged dates for meetings or had started with own quality circles.

Education, Medical↗
PubMed1995

COOP-WONCA charts: a suitable functional status screening instrument in acute low back pain?

BACKGROUND: Functional status is considered an important measure of health status in primary care. The COOP-WONCA charts, which comprise six single-item scales, have mainly been used to determine functional ability in chronically ill patients. AIM: A study was carried out to determine whether the charts are able to measure the degree of functional impairment associated with acute illness and the improvement in functional ability accompanying the process of recovery. METHOD: A total of 95 patients presenting with acute low back pain were recruited from 15 single-handed general practices in northern Germany. At presentation and at two-week follow up, these patients completed self-administered questionnaires which included the COOP-WONCA charts. The charts ask patients to use the timescale of the past two weeks when rating their condition. Baseline and follow-up measurements of the charts were compared and correlations of chart scores with patients' measurements of pain intensity on a visual analogue scale, general practitioners' ratings of impairment and patients' measurements of recovery were analysed. RESULTS: Only the chart measuring change in health revealed a deterioration in functional ability associated with the onset of pain and an improvement in functional status at follow up. Two of the other charts indicated a deterioration at follow up. Only the chart measuring change in health was correlated with ratings of pain and impairment at baseline. At follow up, strong correlations were found between general practitioners' assessments of impairment, patients' ratings of pain and patients' ratings of recovery for all scales except for those measuring social activities and daily activities. The patients interpreted the instructions for using the COOP-WONCA charts differently; some included the period of acute back pain while others did not. CONCLUSION: Of the six charts only the change in health chart proved to be a suitable scale for measuring short-term changes in functional ability among general practice patients with acute low back pain. This may partly be a result of patients misunderstanding the instructions. If the COOP-WONCA charts are used with acutely ill patients, the fixed two-weeks timescale is not appropriate. It is suggested that patients consider their present complaints when rating their condition.

Activities of Daily Living↗
PubMed1994

[Sore throat patients as the topic of a general practice quality circle. Determination and development of a practice guideline. Quality Assurance Study group for General Medicine].

UNLABELLED: The present paper describes the institutionalization of a general practitioners' quality circle and the development of management guidelines for the treatment of patients with sore throat. Doctors participating: An invitation to attend an "information meeting" on the subject quality control and a quality circle sent to 200 general practitioners and internists, evoked a response by 18 physicians, ten of whom participated in the first meeting of the quality circle. Practical procedure: Stocktaking of the procedure in the doctor's office on the basis of a documentation questionnaire, the discussion of a video of the counselling of a patient with a sore throat, interviews with patients and the personal experience of the participating physicians was compared with a current analysis of the literature. The results of the comparison were taken as a basis for the development of management guidelines following the Dutch NHG Standard (Nederlands-Huisartsen-Genootschap-Standarden). RESULTS AND CONCLUSIONS: A wide variation was found in the treatment offered to patients with sore throats in the doctor's office. Deviation from text book information does not indicate a priori any quality deficit in the GP's practice. With respect to the management guideline worked out, it was agreed that in the individual case, a wellfounded deviation can be justified.

Family Practice↗