To evaluate the sensitivity, specificity and predictive values of fractional exhaled nitric oxide (FENO) for the diagnosis of asthma in general practice.
Although the impact of asthma education on important outcomes (e.g. emergency visits) has been well established, only an estimated quarter of asthma patients in Germany have received patient education yet. The aim of the study was to identify patient factors that could increase participation in asthma education programs.This cross-sectional study investigated participation factors and differences between trained (n = 64) and untrained (n = 65) asthma patients from a large outpatient center in Germany. The survey included answers to asthma-related questions and open questions on patient education as well as such about knowledge of health literacy and eHealth.Mean age of participants was 55 ± 19 years and 61% were female. Trained patients were more likely to participate in disease management programs (odds ratio (OR) 6.85; 95%CI 2.17-21.59), were more frequently non-smokers (OR 0.07; 95%CI 0.01-0.85) and more often had an asthma action plan (OR 20.2; 1.55-263.41). Open questions' analysis of untrained asthma patients revealed that patients felt they were not adequately informed about asthma education (37%). About one-third of all patients (27%) showed openness to online asthma education. Analysis of HL and eHealth showed no difference between the groups.Untrained asthma patients should be informed even more intensively by their physicians about the importance and value of asthma education. Asthma education does not seem to benefit patients' health literacy. Online asthma education is of interest to approximately one-third of asthma patients. This should be motivation to develop and implement online asthma education concepts.
Patients with difficult personalities or personality disorders are a special challenge for primary care physicians. Their style of interpersonal interaction is often difficult. As the ICD-11 classification comes into use, a new systematic approach to diagnosis is being introduced that focuses on the patient's functional impairments in everyday life. We describe the implications for the diagnosis and treatment of patients of this type.This review is based on pertinent publications retrieved by a selective search, with particular attention to primary care and to somatic morbidity and mortality.10-12% of the population suffers from personality disorders. A high degree of psychiatric comorbidity is typical; somatic diseases are also more than twice as common as in the general population. In emergency medicine, persons with personality disorders are more likely than others to present with a suicide attempt. Their lifetime risk of suicide is between 1.4% and 4.5% (the latter for persons with borderline personality disorder).Primary care physicians have an important role in the initial diagnosis of patients with personality disorders and in the planning of their treatment. Such patients require special care and attention from their physicians in view of their elevated somatic morbidity and mortality. In everyday clinical practice, physicians who encounter patients with complex and persistent mental problems, or just with a difficult style of interpersonal interaction, should consider the possibility of a personality disorder and motivate such patients to undergo psychotherapy, if indicated.
Introduction: Worldwide, incidence and prevalence of multiple sclerosis (MS) have increased over the last decades. We present a systematic epidemiological study with recent prevalence and incidence rates of MS in Bavaria. Methods: Incidence and prevalence of MS stratified by gender, age groups and region were analyzed by data records from 2006 to 2015 of more than 10 million people insured by the Bavarian Association of Statutory Health Insurance Physicians. Official statistics of the German Federal Ministry of Health provided the size of the general population. Future prevalence was estimated with a predictive model. Results: From 2006 to 2015 prevalence of MS in Bavaria increased from 171 per 100,000 to 277 per 100,000, while incidence rates remained relatively stable (range 16 to 18 per 100,000 inhabitants with a female to male ratio between 2.4:1 and 2:1). Incidence and prevalence were higher in urban than urbanized and rural areas. The prevalence is expected to increase to 374 per 100,000 in 2040 with the highest prevalence rates between 50 and 65 years. Conclusion: The prevalence of MS in Bavaria is among the highest worldwide and will further rise over the next two decades. This demonstrates a need to strengthen healthcare provision systems due to the increasing numbers of particularly older patients with MS in the future.
Starting in 2013, a five-year, competence-based postgraduate programme, the "Seminartage Weiterbildung Allgemeinmedizin" (SemiWAM®) for continuing education in general practice, was developed and offered in Bavaria. This evaluation reports on the experiences of SemiWAM® after a first cycle.Process reflection based on the cycle of Kern: In addition to qualitative findings, results of the evaluation forms (mean values with standard deviation) are presented. The evaluation form contained questions on organisational issues, content of presentation, didactic preparation of the supervisor, transfer to real life practice as well as demographic variables. All questions were voted on a six-point Likert scale from "1=very satisfied" to "6=very dissatisfied".The reflection showed three crucial entry points: Choosing "reason for encounter" as a content precondition to ensure target audience needs, the close didactic supervision of supervisor, and the continuous growth of supervisor team with newly qualified GP. The evaluation results for the overall assessment (MW 1.11-1.60), the didactic concept (MW 1.30-1.87), as well as the transfer into daily life practice (MW 1.48-2.35) reflect the high quality of the SemiWAM®.The SemiWAM® curriculum presented can be easily transferred to comparable structures in Germany that accompany specialty training, such as the competence centres for residency training in general practice. The process evaluation based on the core cycle also provides important support for the agile implementation of these or similar programmes.Beginnend im Jahr 2013 wurde in Bayern ein fünfjähriges, kompetenzbasiertes, weiterbildungsbegleitendes Seminarcurriclum, die „Seminartage Weiterbildung Allgemeinmedizin“ (SemiWAM®) für die Weiterbildung in der Allgemeinmedizin entwickelt und angeboten. Mit diesem Evaluationsbericht werden die Erfahrungen der SemiWAM® nach einem ersten Durchlaufen berichtet.Prozessreflexion auf Basis des Kern-Zyklus: Neben qualitativen Befunden werden Ergebnisse der Evaluation der Teilnehmenden (Mittelwerte mit Standardabweichung) dargestellt. Der Evaluationsbogen enthielt Fragen, u.a. zur Bewertung der Organisation, Inhalten und Art der Präsentation der Referierenden, der didaktischen Aufbereitung, des Transfers in die Weiterbildungspraxis sowie demographische Variablen. Alle Fragen wurden auf einer sechststufigen Likertskala von „1=sehr zufrieden“ bis „6=sehr unzufrieden“ abgestimmt.In der Prozessreflexion zeigten sich drei Stellschrauben als zielführend: Die Ausrichtung der Inhalte an Beratungsanlässen nah am Bedarf der Zielgruppe, die enge didaktische Supervision von Referierendenteams und die stetige Erweiterung des Referierendenteams durch junge Fachärztinnen und Fachärzte für Allgemeinmedizin. Die Evaluationsergebnisse für die Gesamtbewertung (MW 1,11-1,60), die didaktische Konzeption und Aufbereitung (MW 1,30-1,87) sowie den Transfer in die Weiterbildungspraxis (MW 1,48-2,35) spiegeln die hohe Qualität der SemiWAM®.Das vorgestellte Curriculum der SemiWAM® lässt sich zwanglos auf vergleichbare weiterbildungsbegleitende Strukturen in Deutschland wie die Kompetenzzentren Weiterbildung Allgemeinmedizin übertragen. Die Prozessevaluation auf Basis des Kern-Zyklus gibt zudem wichtige Hilfestellung in der agilen Umsetzung dieser oder ähnlicher Programme.
Patient empowerment, in other words letting patients take charge of managing their own illnesses, is fortunately being taken ever more seriously. This is not just reflected in increased patient autonomy and individual maturity; it also improves treatment outcomes in a major way. The efficacy of patient education has already been demonstrated for a variety of indications, including asthma (1), diabetes (2), and other chronic diseases. The merit of the trial by Stefan Viktor Vormfelde and coauthors that appears in this issue of Deutsches Arzteblatt International is to have extended our knowledge that patient education does, in fact, work to the area of therapeutic anticoagulation with phenprocoumon—and to have done so with an innovative, interactive study design that was directly implemented in general practitioners‘ practices (3). Many patients are still being treated with phenprocoumon, and, in view of the current debate about the safety of the newer anticoagulant drugs (4), permanent anticoagulation with phenprocoumon will likely continue to play an important role in patient care (5). Thus, the method of patient education used in this trial will continue to be important.
Abstract Rationale, aims and objectives Diagnostic uncertainty plays an important role in primary care. Nevertheless, the practical way how general practitioners (GPs) deal with uncertainty remains unclear. The purpose was to develop a questionnaire which describes and measures the level of action and active reasoning in dealing with uncertainty. Methods Raw items for the ‘GP action scale’ and ‘GP diagnostic reasoning scale’ were derived by literature research. The questionnaire was modified by focus group discussion. The final version was administered to 325 GPs. The results of the ‘Dealing with uncertainty questionnaire’ (DUQ) were compared with the scales of the ‘Physician Reaction to Uncertainty’ (PRU) questionnaire. PRU measures affective reactions to uncertainty. Results Item‐scale correlation of the ‘GP action scale’ and ‘GP diagnostic reasoning scale’ ranged from 0.41 to 0.61 and from 0.31 to 0.53, respectively. Crohnbach's alpha for ‘GP action scale’ was 0.75 and for ‘GP diagnostic reasoning scale’ 0.62. The ‘GP diagnostic action scale’ was significantly positively associated with ‘Anxiety due to uncertainty’, ‘Concern about bad outcomes’ and ‘Reluctance to disclose mistakes to physicians’, scales of PRU. In female doctors, ‘Concern about bad outcomes’ correlated positively with the ‘GP diagnostic reasoning scale’ (0.213; P < 0.05). In male doctors, ‘Anxiety due to uncertainty’ correlated negatively with the ‘GP diagnostic reasoning scale’ (−0.163; P < 0.05). Conclusions Diagnostic reasoning in primary care appears as a complex process using typical primary care inherent ‘heuristics’. Affective intolerance against uncertainty correlates with self‐rated diagnostic activity. Affective reactions to uncertainty might influence gender‐specific reactions to uncertainty in different ways.
