Eva Drewelow

Improvement of primary health care of patients with poorly regulated diabetes mellitus type 2 using shared decision-making – the DEBATE trial

BackgroundSince 2004, a national Disease Management Program (DMP) has been implemented in Germany, which includes educational measures aimed at patients with type-2 diabetes (T2D). However, about 15-20% of T2D patients remain in poor metabolic control. Qualitative research shows that one reason for this might be an increasing frustration of general practitioners (GPs) with the management of their poorly regulated T2D patients over time. We aim at approaching this problem by improving the GP-patient-communication and fostering shared decision-making.Methods/DesignAn educative intervention will be tested within a multi-centred cluster-randomized controlled trial (RCT) in Germany. We include 20 GPs in three regions. Each of the 60 GPs will recruit about 13 patients meeting the inclusion criteria (total of 780 patients). GPs allocated to the intervention group will receive a peer-visit from a specifically trained GP-colleague who will motivate them to apply patient-centred communication techniques including patient-centred decision aids. GPs allocated to the control group will not take part in any intervention program, but will provide care as usual to their patients. The primary inclusion criterion for patients at the time of the recruitment is an HbA1c-level of over 8.0. Primary outcome is the change of HbA1c at 6, 12, 18, and 24 months compared to HbA1c at baseline. Secondary outcomes include patient’s participation in the process of shared decision-making and quality of life.DiscussionIf this intervention proves to be effective it may be integrated into the existing Disease Management Program for T2D in Germany.

Optimizing polypharmacy among elderly hospital patients with chronic diseases--study protocol of the cluster randomized controlled POLITE-RCT trial.

BackgroundTreatment of patients with multimorbidity is challenging. A rational reduction of long-term drugs can lead to decreased mortality, less acute hospital treatment, and a reduction of costs. Simplification of drug treatment schemes is also related to higher levels of patient satisfaction and adherence. The POLITE-RCT trial will test the effectiveness of an intervention aiming at reducing the number of prescribed long-term drugs among multimorbid and chronically ill patients. The intervention focuses on the interface between primary and secondary health care and includes a pharmacist-based, patient-centered medication review prior to the patients discharge from hospital.MethodsThe POLITE-RCT trial is a cluster randomized controlled trial. Two major secondary health care providers of Mecklenburg-Western Pomerania, Germany, take part in the study. Clusters are wards of both medical centers. All wards where patients with chronic diseases and multimorbidity are regularly treated will be included. Patients aged 65+ years who take five or more prescribed long-term drugs and who are likely to spend at least 5 days in the participating hospitals will be recruited and included consecutively. Cluster-randomization takes place after a six-month baseline data collection period. Patients of the control group receive care as usual. The independent two main primary outcomes are (1) health-related quality of life (EQ-5D) and (2) the difference in the number of prescribed long-term pharmaceutical agents between intervention and control group. The secondary outcomes are appropriateness of prescribed medication (PRISCUS list, Beers Criteria, MAI), patient satisfaction (TSQM), patient empowerment (PEF-FB-9), patient autonomy (IADL), falls, re-hospitalization, and death. The points of measurement are at admission to (T0) and discharge from hospital (T1) as well as 6 and 12 months after discharge from the hospital (T2 and T3). In 42 wards, 1,626 patients will be recruited.DiscussionIn case of positive evaluation, the proposed study will provide evidence for a sustainable reduction of polypharmacy by enhancing patient-centeredness and patient autonomy.Trial registrationCurrent Controlled Trials ISRCTN42003273

Perceptions of interprofessional collaboration of general practitioners and community pharmacists - a qualitative study

BackgroundDespite numerous evidences for the positive effect of community pharmacists on health care, interprofessional collaboration of pharmacists and general practitioners is very often limited. Though highly trained, pharmacists remain an underutilised resource in primary health care in most western countries. This qualitative study aims at investigating pharmacists’ and general practitioners’ views on barriers to interprofessional collaboration in the German health care system.MethodsA total of 13 narrative in-depth interviews, and two focus group discussions with 12 pharmacists and general practitioners in Mecklenburg-Western Pomerania, a predominantly rural region of North-Eastern Germany, were conducted. The interviews aimed at exploring general practitioners’ and pharmacists’ attitudes, views and experiences of interprofessional collaboration. At a second stage, two focus group discussions were performed. Fieldwork was carried out by a multi-professional team. All interviews and focus group discussions were audio taped and transcribed verbatim. The constant comparative method of analysis from grounded theory was applied to the data.ResultsThere are three main findings: First, mutual trust and appreciation appear to be important factors influencing the quality of interprofessional collaboration. Second, in light of negative personal experiences, pharmacists call for a predefined, clear and straightforward way to communicate with physicians. Third, given the increasing challenge to treat a rising number of elderly patients with chronic conditions, general practitioners desire competent support of experienced pharmacists.ConclusionsOn the ground of methodological triangulation the findings of this study go beyond previous investigations and are able to provide specific recommendations for future interprofessional collaboration. First, interventions and initiatives should focus on increasing trust, e.g. by implementing multi-professional local quality circles. Second, governments and health authorities in most countries have been and still are reluctant in advancing political initiatives that bring together physicians and pharmacists. Proactive lobbying and empowerment of pharmacists are extremely important in this context. In addition, future physician and pharmaceutical training curricula should focus on comprehensive pharmacist-physician interaction at early stages within both professional educations and careers. Developing and fostering a culture of continued professional exchange and appreciation is one major challenge of future policy and research.

Multimorbidität aus Hausarzt- und Patientensicht

BACKGROUND For general practioners (GP) the treatment of patients suffering from multimorbidity is an everyday challenge. For these patients guidelines which each focus on a specific chronic disease cannot be applied comprehensively and equally; therefore, it is necessary to prioritize. OBJECTIVE Given this situation the study aimed at analyzing how GPs and patients deal with this challenge and what their priorities are. MATERIAL AND METHODS Narrative interviews were conducted with 9 GPs and 19 of their multimorbid patients. The data were analyzed by means of content analysis. RESULTS The majority of interviewed patients felt well or very well cared for by their GPs; however, GPs and multimorbid patients often had relatively different priorities. Whereas GPs mostly focused on the management of diseases that could lead to life-threatening situations, patients put an emphasis on maintaining autonomy and a social life. CONCLUSION The results of this study suggest that there is room for development in the way GPs and multimorbid patients communicate with each other, particularly as far as shared priority setting is concerned.ZusammenfassungHintergrundFür Hausärzte ist die Betreuung von Patienten mit Multimorbidität eine alltägliche Herausforderung. Leitlinien, die jeweils nur einzelne Erkrankungen im Fokus haben, können hier nicht umfassend und „gleichberechtigt“ Anwendung finden. Stattdessen müssen Prioritäten gesetzt werden.FragestellungVor diesem Hintergrund wird herausgearbeitet, wie Hausärzte und ihre Patienten diesen Herausforderungen begegnen und welche Prioritäten sie jeweils setzen.Material und MethodenNeun Hausärzte und 19 ihrer Patienten mit Multimorbidität wurden narrativ interviewt. Die Analyse erfolgte inhaltsanalytisch.ErgebnisseDie Mehrzahl der interviewten Patienten fühlte sich durch ihren Hausarzt gut oder sehr gut betreut. Dennoch stellten sich die Prioritäten der Hausärzte und die ihrer Patienten häufig unterschiedlich dar. Während die Ärzte die meiste Energie auf das Management von Erkrankungen verwendeten, die zu potenziell lebensbedrohlichen Situationen führen können, stand bei den Patienten der unmittelbare Erhalt von Autonomie und sozialem Miteinander im Vordergrund.DiskussionDie Ergebnisse der Studie legen den Schluss nahe, dass die Kommunikation zwischen Hausärzten und ihren Patienten gerade in Bezug auf einen gemeinsamen Prozess der Prioritätensetzung bei Multimorbidität weiterentwickelt werden kann.AbstractBackgroundFor general practioners (GP) the treatment of patients suffering from multimorbidity is an everyday challenge. For these patients guidelines which each focus on a specific chronic disease cannot be applied comprehensively and equally; therefore, it is necessary to prioritize.ObjectiveGiven this situation the study aimed at analyzing how GPs and patients deal with this challenge and what their priorities are.Material and methodsNarrative interviews were conducted with 9 GPs and 19 of their multimorbid patients. The data were analyzed by means of content analysis.ResultsThe majority of interviewed patients felt well or very well cared for by their GPs; however, GPs and multimorbid patients often had relatively different priorities. Whereas GPs mostly focused on the management of diseases that could lead to life-threatening situations, patients put an emphasis on maintaining autonomy and a social life.ConclusionThe results of this study suggest that there is room for development in the way GPs and multimorbid patients communicate with each other, particularly as far as shared priority setting is concerned.

Multimorbidität aus Hausarzt- und Patientensicht: Qualitative Studie

BACKGROUND For general practioners (GP) the treatment of patients suffering from multimorbidity is an everyday challenge. For these patients guidelines which each focus on a specific chronic disease cannot be applied comprehensively and equally; therefore, it is necessary to prioritize. OBJECTIVE Given this situation the study aimed at analyzing how GPs and patients deal with this challenge and what their priorities are. MATERIAL AND METHODS Narrative interviews were conducted with 9 GPs and 19 of their multimorbid patients. The data were analyzed by means of content analysis. RESULTS The majority of interviewed patients felt well or very well cared for by their GPs; however, GPs and multimorbid patients often had relatively different priorities. Whereas GPs mostly focused on the management of diseases that could lead to life-threatening situations, patients put an emphasis on maintaining autonomy and a social life. CONCLUSION The results of this study suggest that there is room for development in the way GPs and multimorbid patients communicate with each other, particularly as far as shared priority setting is concerned.ZusammenfassungHintergrundFür Hausärzte ist die Betreuung von Patienten mit Multimorbidität eine alltägliche Herausforderung. Leitlinien, die jeweils nur einzelne Erkrankungen im Fokus haben, können hier nicht umfassend und „gleichberechtigt“ Anwendung finden. Stattdessen müssen Prioritäten gesetzt werden.FragestellungVor diesem Hintergrund wird herausgearbeitet, wie Hausärzte und ihre Patienten diesen Herausforderungen begegnen und welche Prioritäten sie jeweils setzen.Material und MethodenNeun Hausärzte und 19 ihrer Patienten mit Multimorbidität wurden narrativ interviewt. Die Analyse erfolgte inhaltsanalytisch.ErgebnisseDie Mehrzahl der interviewten Patienten fühlte sich durch ihren Hausarzt gut oder sehr gut betreut. Dennoch stellten sich die Prioritäten der Hausärzte und die ihrer Patienten häufig unterschiedlich dar. Während die Ärzte die meiste Energie auf das Management von Erkrankungen verwendeten, die zu potenziell lebensbedrohlichen Situationen führen können, stand bei den Patienten der unmittelbare Erhalt von Autonomie und sozialem Miteinander im Vordergrund.DiskussionDie Ergebnisse der Studie legen den Schluss nahe, dass die Kommunikation zwischen Hausärzten und ihren Patienten gerade in Bezug auf einen gemeinsamen Prozess der Prioritätensetzung bei Multimorbidität weiterentwickelt werden kann.AbstractBackgroundFor general practioners (GP) the treatment of patients suffering from multimorbidity is an everyday challenge. For these patients guidelines which each focus on a specific chronic disease cannot be applied comprehensively and equally; therefore, it is necessary to prioritize.ObjectiveGiven this situation the study aimed at analyzing how GPs and patients deal with this challenge and what their priorities are.Material and methodsNarrative interviews were conducted with 9 GPs and 19 of their multimorbid patients. The data were analyzed by means of content analysis.ResultsThe majority of interviewed patients felt well or very well cared for by their GPs; however, GPs and multimorbid patients often had relatively different priorities. Whereas GPs mostly focused on the management of diseases that could lead to life-threatening situations, patients put an emphasis on maintaining autonomy and a social life.ConclusionThe results of this study suggest that there is room for development in the way GPs and multimorbid patients communicate with each other, particularly as far as shared priority setting is concerned.

Multimorbidität aus Hausarzt- und Patientensicht@@@Approaches of general practitioners and patients to multimorbidity: Qualitative Studie@@@Qualitative study

BACKGROUND For general practioners (GP) the treatment of patients suffering from multimorbidity is an everyday challenge. For these patients guidelines which each focus on a specific chronic disease cannot be applied comprehensively and equally; therefore, it is necessary to prioritize. OBJECTIVE Given this situation the study aimed at analyzing how GPs and patients deal with this challenge and what their priorities are. MATERIAL AND METHODS Narrative interviews were conducted with 9 GPs and 19 of their multimorbid patients. The data were analyzed by means of content analysis. RESULTS The majority of interviewed patients felt well or very well cared for by their GPs; however, GPs and multimorbid patients often had relatively different priorities. Whereas GPs mostly focused on the management of diseases that could lead to life-threatening situations, patients put an emphasis on maintaining autonomy and a social life. CONCLUSION The results of this study suggest that there is room for development in the way GPs and multimorbid patients communicate with each other, particularly as far as shared priority setting is concerned.ZusammenfassungHintergrundFür Hausärzte ist die Betreuung von Patienten mit Multimorbidität eine alltägliche Herausforderung. Leitlinien, die jeweils nur einzelne Erkrankungen im Fokus haben, können hier nicht umfassend und „gleichberechtigt“ Anwendung finden. Stattdessen müssen Prioritäten gesetzt werden.FragestellungVor diesem Hintergrund wird herausgearbeitet, wie Hausärzte und ihre Patienten diesen Herausforderungen begegnen und welche Prioritäten sie jeweils setzen.Material und MethodenNeun Hausärzte und 19 ihrer Patienten mit Multimorbidität wurden narrativ interviewt. Die Analyse erfolgte inhaltsanalytisch.ErgebnisseDie Mehrzahl der interviewten Patienten fühlte sich durch ihren Hausarzt gut oder sehr gut betreut. Dennoch stellten sich die Prioritäten der Hausärzte und die ihrer Patienten häufig unterschiedlich dar. Während die Ärzte die meiste Energie auf das Management von Erkrankungen verwendeten, die zu potenziell lebensbedrohlichen Situationen führen können, stand bei den Patienten der unmittelbare Erhalt von Autonomie und sozialem Miteinander im Vordergrund.DiskussionDie Ergebnisse der Studie legen den Schluss nahe, dass die Kommunikation zwischen Hausärzten und ihren Patienten gerade in Bezug auf einen gemeinsamen Prozess der Prioritätensetzung bei Multimorbidität weiterentwickelt werden kann.AbstractBackgroundFor general practioners (GP) the treatment of patients suffering from multimorbidity is an everyday challenge. For these patients guidelines which each focus on a specific chronic disease cannot be applied comprehensively and equally; therefore, it is necessary to prioritize.ObjectiveGiven this situation the study aimed at analyzing how GPs and patients deal with this challenge and what their priorities are.Material and methodsNarrative interviews were conducted with 9 GPs and 19 of their multimorbid patients. The data were analyzed by means of content analysis.ResultsThe majority of interviewed patients felt well or very well cared for by their GPs; however, GPs and multimorbid patients often had relatively different priorities. Whereas GPs mostly focused on the management of diseases that could lead to life-threatening situations, patients put an emphasis on maintaining autonomy and a social life.ConclusionThe results of this study suggest that there is room for development in the way GPs and multimorbid patients communicate with each other, particularly as far as shared priority setting is concerned.

Multimorbidität aus Hausarzt- und PatientensichtApproaches of general practitioners and patients to multimorbidity

BACKGROUND For general practioners (GP) the treatment of patients suffering from multimorbidity is an everyday challenge. For these patients guidelines which each focus on a specific chronic disease cannot be applied comprehensively and equally; therefore, it is necessary to prioritize. OBJECTIVE Given this situation the study aimed at analyzing how GPs and patients deal with this challenge and what their priorities are. MATERIAL AND METHODS Narrative interviews were conducted with 9 GPs and 19 of their multimorbid patients. The data were analyzed by means of content analysis. RESULTS The majority of interviewed patients felt well or very well cared for by their GPs; however, GPs and multimorbid patients often had relatively different priorities. Whereas GPs mostly focused on the management of diseases that could lead to life-threatening situations, patients put an emphasis on maintaining autonomy and a social life. CONCLUSION The results of this study suggest that there is room for development in the way GPs and multimorbid patients communicate with each other, particularly as far as shared priority setting is concerned.ZusammenfassungHintergrundFür Hausärzte ist die Betreuung von Patienten mit Multimorbidität eine alltägliche Herausforderung. Leitlinien, die jeweils nur einzelne Erkrankungen im Fokus haben, können hier nicht umfassend und „gleichberechtigt“ Anwendung finden. Stattdessen müssen Prioritäten gesetzt werden.FragestellungVor diesem Hintergrund wird herausgearbeitet, wie Hausärzte und ihre Patienten diesen Herausforderungen begegnen und welche Prioritäten sie jeweils setzen.Material und MethodenNeun Hausärzte und 19 ihrer Patienten mit Multimorbidität wurden narrativ interviewt. Die Analyse erfolgte inhaltsanalytisch.ErgebnisseDie Mehrzahl der interviewten Patienten fühlte sich durch ihren Hausarzt gut oder sehr gut betreut. Dennoch stellten sich die Prioritäten der Hausärzte und die ihrer Patienten häufig unterschiedlich dar. Während die Ärzte die meiste Energie auf das Management von Erkrankungen verwendeten, die zu potenziell lebensbedrohlichen Situationen führen können, stand bei den Patienten der unmittelbare Erhalt von Autonomie und sozialem Miteinander im Vordergrund.DiskussionDie Ergebnisse der Studie legen den Schluss nahe, dass die Kommunikation zwischen Hausärzten und ihren Patienten gerade in Bezug auf einen gemeinsamen Prozess der Prioritätensetzung bei Multimorbidität weiterentwickelt werden kann.AbstractBackgroundFor general practioners (GP) the treatment of patients suffering from multimorbidity is an everyday challenge. For these patients guidelines which each focus on a specific chronic disease cannot be applied comprehensively and equally; therefore, it is necessary to prioritize.ObjectiveGiven this situation the study aimed at analyzing how GPs and patients deal with this challenge and what their priorities are.Material and methodsNarrative interviews were conducted with 9 GPs and 19 of their multimorbid patients. The data were analyzed by means of content analysis.ResultsThe majority of interviewed patients felt well or very well cared for by their GPs; however, GPs and multimorbid patients often had relatively different priorities. Whereas GPs mostly focused on the management of diseases that could lead to life-threatening situations, patients put an emphasis on maintaining autonomy and a social life.ConclusionThe results of this study suggest that there is room for development in the way GPs and multimorbid patients communicate with each other, particularly as far as shared priority setting is concerned.