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Biomedical subjects

M Butzlaff

Publications and source records attributed to M Butzlaff.

13 recordsLinked to original sources
PubMed2004

[Shared decision making].

BACKGROUND AND OBJECTIVE: The demand for integration of patients in medical decisions becomes more and more obvious. Little is known about whether patients are willing and ready to share therapeutic decisions. So far information is lacking, whether existing communication skills of both -- patients and physicians -- are sufficient for shared decision making (SDM). This paper presents new data on patients perspectives regarding SDM. METHODS: Standardized survey of 3058 German speaking people (1565 females, 1493 males), aged 18-79 years, a population based random sample of an access panel (pool of german households available for specific surveys) regarding the following topics: medical decision making in practice, communication skills and behaviour of physicians. RESULTS: A majority of patients approved the model of SDM. However, some subgroups of patients, especially older patients, were less interested in the concept of SDM. Necessary communication skills which may help patients to participate in decision making were used rather scarcely. Patients who approved the model of SDM more often experienced a common and trustful exchange of information. CONCLUSION: Most patients favour the concept of SDM. The communication skills necessary for this process are to be promoted and extended. Research on patients' preferences and their participation in health care reform should be intensified. Academic and continuous medical education should focus on knowledge transfer to patients.

Adolescent↗
PubMed2004

Learning with computerized guidelines in general practice?: A randomized controlled trial.

BACKGROUND: Evidence-based guidelines are seen as an important instrument to transfer scientifically generated knowledge into daily clinical practice and to ensure high standards of clinical care. Despite wide promulgation, clinical guidelines so far have a limited impact on individual professional learning and on changing daily medical practice. OBJECTIVES: Our aims were (i) to study a potential knowledge increase among German GPs after implementation of web- and evidence-based guidelines and (ii) to identify and analyse potential barriers to individual professional learning with computerized guidelines. METHODS: A prospective, randomized controlled trial was conducted including 72 GPs (21% female, 79% male). The intervention group (n = 38) had access to clinical guidelines via the Internet or CD-ROM, the control group had not (n = 34). Both groups received a standardized two-part questionnaire. An increase of knowledge was measured with 25 multiple choice questions related to four different medical topics. In addition, reasons for using or not using computerized guidelines were analysed after access to guidelines was open to all participating physicians. RESULTS: There was no significant knowledge increase in the intervention group (P = 0.69). Twenty-two (58%) GPs of the intervention group had used the guidelines. Unspecified curiosity (76%) and a specific medical question (38%) were predominant motives for usage among physicians who had used the guidelines. Among 'non-users', 78% stated 'lack of time' as the main reason for not using guidelines. CONCLUSION: An efficient knowledge transfer through computerized guidelines was not achieved. Usage, individual learning and potential implementation depend on adequate incentives and pragmatic aspects of clinical practice: easy and quick access.

Adult↗
PubMed2002

[Evidence-based guidelines as tools for medical knowledge transfer. The work mode of the Medical Knowledge Network evidence.de].

The amount of medical knowledge is growing with increasing speed. Physicians are confronted with more and more--and often useless--information. However, the time lag between the creation of new knowledge and its implementation into daily medical practice is often exceeding a decade. In view of these challenges the knowledge network of the medical faculty of the University Witten/Herdecke is focusing on two different tasks: It provides evidence based medical guidelines in a format that is meant for easy access and use in daily practice. It scientifically explores different ways of presenting and transferring evidence based guidelines in order to develop better and easier ways of implementation. National and international guidelines and studies are screened, evaluated, updated and adapted for its use in the academic network by a team of five university based physicians. In addition, clinical specialists as well as primary care physicians provide expertise for detailed scientific adaptations and for adequate implementation strategies. The implementation process of the guidelines among the faculty based primary care physicians is continuously monitored and evaluated. The main goal of this concept is to create a learning environment for the complex process of medical knowledge transfer.

Decision Making↗
PubMed2002

[Free choice of doctors in Germany in retrospect].

Due to discussions on the cost and quality of health care and a new legislation on the German statutory sickness insurance system in 1999, the free choice of doctors has recently become topical. To assess its legitimation for the German health care system, its history and the groups of interest involved should be taken into consideration. Before the period of industrialization no homogeneous pattern of the medical profession existed. In case of illness individuals who lived within reach and were known for their competence in disease matters were approached. However, industrialization destroyed existing social networks, and establishment of new structures of health care in rural as well as metropolitan areas became necessary. The government approached this challenge by structuring medical education, passing regulations on the settlement of doctors and promoting the foundation of statutory sickness funds. The Health Insurance Law of 1883 established a mandatory insurance system for a broad array of industries. As it was the sickness funds' responsibility to provide sufficient resources for medical care, a sick member was tied to the physician under contract with his insurance. After a rapid increase in practising physicians at the end of the 19(th) century, doctors' organisations were eager to gain access to the new market segment of insurance members by calling for the free choice of physicians. The Leipzig association (Hartmannbund) was founded in 1900 to organize strikes of doctors in order to get their goals accepted. After 30 years of conflicts an appeasement was achieved by a presidential emergency law in 1931. It transferred the responsibility for the provision of sufficient health care resources from the sickness funds to the newly created body of the Association of Sickness Fund Physicians (Kassenärztliche Vereinigung) and determined the patients' free choice among licensed sickness fund physicians.

Germany↗
PubMed2002

[Free choice of doctors - an international comparison].

The focus of this international comparison concerning the issue of free choice among primary care physicians and specialists is to learn from experiences in other countries. Two different types of health care systems are analysed: state-administered health systems such as in Finland and Great Britain or competition-based systems such as in Switzerland and the USA. In the countries outlined mentioned and other OECD nations (Organisation for Economic Co-Operation and Development) not described in this study, several restrictions of free choice among physicians can be observed. Restrictions are to be found when changing the general practitioner as well as in first contact to specialists. Both limitations do not seem to have a significant effect on the level of satisfaction of the population with health care in general. From an international perspective free choice of doctors seems to be an exception in health systems.

Cross-Cultural Comparison↗
PubMed2002

[Risks, chances and perspectives of restricting the free choice of doctors by patients].

Population surveys regarding free access to primary care physicians and medical specialists focus on selected aspects of public opinion. They are helpful but not sufficient in answering the relevant question: 'What are appropriate and efficient ways of access to the health care system?'. More important than survey results would be options for practical decisions by the patients themselves, based on a system offering different possibilities of choice. Competent piloting by 'gatekeepers' would need a problem- oriented and patient-centred medical education for primary-care physicians, starting during medical education and training and continuing throughout the professional medical careers. It should focus on three additional issues: New, alternative and unbiased ways of access to medical care should be developed, tried and evaluated to ensure beneficial use of the full potential of our health care system.

Forecasting↗
PubMed2001

[Physicians, internet and new knowledge. Utilization and efficiency of new continuing education media in the hospital].

BACKGROUND AND OBJECTIVES: The application of new information technologies will have a lasting impact on the physicians' working environment. Not only will classic learning methods change, but also ways of communication and strategies to find relevant information. This survey is designed to demonstrate current methods of and demand for continuing medical education and communication. METHODS: 110 participating physicians (26% female, 74% male) in nine different regional hospitals were asked regarding "continuing medical education", "communication" and "use of computerized technology". RESULTS: Most physicians regard their colleagues, scientific journals, textbooks and scientific meetings as most useful. The internet, scientific staff at research institutions and pharmaceutical representatives were valued as less useful. Physicians regarded scientific basis, speed and user-friendliness as the most important features of potential data and knowledge sources. Case specificity, German language and interactivity were viewed as less important. Most physicians expressed a growing need for education regarding use of e-mail as a communication tool and internet research techniques. CONCLUSION: Continuing medical education is in strong demand. The successful introduction of modern information technologies into physicians' daily work may and should be enhanced by specifically tailored training courses.

Adult↗
PubMed1996

Advance directives and withdrawal of dialysis in the United States, Germany, and Japan.

OBJECTIVE: To determine the role of advance directives in decisions to withdraw chronic dialysis in the United States, Germany, and Japan. DESIGN: Survey by questionnaire. PARTICIPANTS: Seventy-two American, 87 German, and 73 Japanese nephrologists. MAIN OUTCOME MEASURES: Each nephrologist's total number of (1) dialysis patients, (2) cases of withdrawal of dialysis, (3) patients with advance directives, and (4) uses of such directives. Nephrologists also stated whether they would continue or stop dialysis in 8 hypothetical cases. RESULTS: American, German, and Japanese nephrologists reported withdrawing dialysis for 5.1%, 1.6%, and 0.7% of their patients in the last year, respectively. Thirty percent of American patients had advance directives, and such directives were used in decision making for 3.2% of all patients. Only 0.3% of German and Japanese patients had advance directives, and such directives were used in decision making for 0.09% of patients. When asked about a hypothetical mentally incompetent patient whose family requests withdrawal of dialysis, American nephrologists were much more likely to stop dialysis in the absence of an advance directive than German or Japanese nephrologists. However, almost all nephrologists from the 3 countries would stop dialysis when a family request to withdraw was supported by a patient advance directive. CONCLUSIONS: There is a high prevalence of advance directives among American dialysis patients, and such directives frequently play a role in decision making. German and Japanese nephrologists appear willing to follow advance directives, but the low prevalence of such directives limits the frequency of their use.

Advance Directive Adherence↗
PubMedDate not supplied

[Acute otitis media in children: an evidence-based practice guideline].

Acute Otitis media is one of the most common acute respiratory infections managed in primary care and the most common infection among in children. Diagnostic criteria, however, do not always correspond to scientific evidence. They often differ depending on individual preferences and competences. Treatment, also, is controversial. In Germany, most children attending their pediatrician or primary care physician will be prescribed antibiotics. Evidence from several randomized studies and systematic reviews suggests that routine usage of antibiotics provides only modest benefit. The benefit of prescribing antibiotics should not only be balanced against the increased likelihood of side effects such as diarrhoea but also against the potential to contribute to longterm antibiotic resistance.

Acute Disease↗