Abstract ESCAPE Evaluation of a patient‐centred biopsychosocial blended collaborative care pathway for the treatment of multimorbid elderly patients. Therapeutic Area Healthcare interventions for the management of older patients with multiple morbidities. Aims Multi‐morbidity treatment is an increasing challenge for healthcare systems in ageing societies. This comprehensive cohort study with embedded randomized controlled trial tests an integrated biopsychosocial care model for multimorbid elderly patients. Hypothesis A holistic, patient‐centred pro‐active 9‐month intervention based on the blended collaborative care (BCC) approach and enhanced by information and communication technologies can improve health‐related quality of life (HRQoL) and disease outcomes as compared with usual care at 9 months. Methods Across six European countries, ESCAPE is recruiting patients with heart failure, mental distress/disorder plus ≥2 medical co‐morbidities into an observational cohort study. Within the cohort study, 300 patients will be included in a randomized controlled assessor‐blinded two‐arm parallel group interventional clinical trial (RCT). In the intervention, trained care managers (CMs) regularly support patients and informal carers in managing their multiple health problems. Supervised by a clinical specialist team, CMs remotely support patients in implementing the treatment plan—customized to the patients' individual needs and preferences—into their daily lives and liaise with patients' healthcare providers. An eHealth platform with an integrated patient registry guides the intervention and helps to empower patients and informal carers. HRQoL measured with the EQ‐5D‐5L as primary endpoint, and secondary outcomes, that is, medical and patient‐reported outcomes, healthcare costs, cost‐effectiveness, and informal carer burden, will be assessed at 9 and ≥18 months. Conclusions If proven effective, the ESCAPE BCC intervention can be implemented in routine care for older patients with multiple morbidities across the participating countries and beyond.
Aim. To evaluate the psychometric properties and validity of the updated version of the Dutch multidimensional European Society of Cardiology (ESC) psychosocial screening instrument in patients with heart disease and the general population. Method. 678 participants (Mage = 48.2, SD = 16.8; 46% male) of the Dutch general population and 312 cardiac patients (Mage = 65.9, SD = 9.9; 77% male) who recently received percutaneous coronary intervention completed the ESC Psychosocial screening instrument and validated questionnaires for depression (PHQ-9), anxiety (GAD-7), Type D personality (DS14), hostility (CMHS), anger (STAS-T), trauma (SRIP), and chronic work and family stress (ERI, MMQ-6). Results. Confirmatory factor analysis (CFA) confirmed that the eight screened risk factors were best measured as separate entities, rather than as broader indications of distress. Inter-instrument agreement, assessed with the intraclass coefficient (ICC) and the screening accuracy indicators (receiving operator characteristic [ROC] curves, sensitivity, specificity, and the positive and negative predictive values [PPV;NPV]) were good for most screened risk factors. PPV was low in low prevalence risk factors like anxiety and trauma. Conclusion. Overall, the current version of the ESC Psychosocial screening instrument has an acceptable performance in both populations, with a fair to excellent level of agreement with established full questionnaires. Besides a few suggestions for further refinement, the screener may be implemented in primary care and cardiological practice.
The COVID-19 outbreak has taken a heavy toll on the mental well-being of healthcare workers, even those who have not been directly involved in the care of acutely ill patients. The aims of this study were to identify the overall burden and mental health status of healthcare workers in pediatric developmental services under the influence of the COVID-19 pandemic, and to identify the risk and protective factors associated with mental health.
Objective: Outcome predictors and determinants for treatment outcome of inpatient psychotherapy will be assessed in a follow-up-study. Sociodemographic factors and the level of depressiveness at admission, the perceived psychotherapist's empathy rated by patients and the therapy motivation as possible moderators of treatment outcome (reduction of depressive symptoms) are analyzed. Methods: In a cohort study, the outcome of inpatient multimodal psychotherapy was examined with Beck-Depression-Inventory (BDI) at admission (T1), discharge (T2) and at follow-up (1-3 years after treatment) (T3). Inclusion criteria were: Inpatient psychotherapy between 2007 and 2010 with a duration of at least 1 week and complete data set. The influence on therapy success of (1) sociodemographic factors, (2) the perceived psychotherapist's empathy rated by patients using the Consultation and Relational Empathy Measure (CARE), and (3) the therapy motivation of the patients rated by therapists are examined by means of correlation analysis, distribution comparisons and subsequently logistic regression. Results: Ninety-two (64 females, average age 39 yrs.) of 182 eligible patients participated in the follow-up survey. Duration of inpatient psychotherapy lasted 8.7 weeks ± 3.6 [min. 1, max. 33 weeks]. The perceived psychotherapist's empathy, therapy motivation, education level and depression at baseline had a significant impact on therapy success. Gender, age, and partnership were not significant. The length between discharge and follow-up had no influence on the results. Based on these variables a multiple logistic regression explained 42% of the variation (goodness-of-fit). Conclusion: Due to the shown relevance of the psychotherapist's empathy perceived by patients and the therapy motivation of patients for therapy success, both factors should be considered already at the beginning of the therapy. Consequently, they should be recognized in the context of postgraduate training and education.
Zusammenfassung Hintergrund Die COVID-19-Pandemie stellt eine anhaltende Belastung für die Gesellschaft und das Gesundheitssystem dar. Die Bereitschaft des Gesundheitspersonals zur COVID-19-Impfung ist aufgrund seiner Schlüsselrolle in der Pandemiebewältigung besonders relevant. Ziel der Arbeit Die Studie untersuchte die Impfbereitschaft des Gesundheitspersonals in Deutschland in Abhängigkeit von soziodemografischen, berufsbezogenen und COVID-19-spezifischen Merkmalen sowie psychischer Gesundheit. Methoden Zwischen November 2020 und Januar 2021 wurden 6217 Beschäftigte im deutschen Gesundheitswesen mithilfe der Onlinebefragung VOICE im Rahmen des Netzwerks Universitätsmedizin (NUM) zu ihrer Impfbereitschaft, ihren soziodemografischen, berufsbezogenen, COVID-19-spezifischen und psychosozialen Daten befragt. Ergebnisse Die Impfbereitschaft der Stichprobe lag bei 65,3 %. Mit einer höheren Impfbereitschaft assoziiert waren: männliches Geschlecht, Alter > 40 Jahre, keine Kinder und keinen Migrationshintergrund zu haben, keine Tätigkeit in der direkten Patientenversorgung, Zugehörigkeit zu einer COVID-19-Risikogruppe, Zugehörigkeit zur Berufsgruppe der Ärztinnen und Ärzte und der Psychologinnen und Psychologen im Vergleich mit den Pflegekräften, ausreichende Informiertheit über COVID-19 und der wahrgenommene Schutz durch die Maßnahmen nationaler/lokaler Behörden und des Arbeitgebers, Angst vor Infektion sowie keine Anzeichen von Depression. Die höchste Impfbereitschaft zeigten Ärztinnen und Ärzte. Diskussion Die Bereitschaft zur COVID-19-Impfung im Gesundheitswesen war im beschriebenen Zeitraum insgesamt als mäßig einzuschätzen. Informationen über die Krankheit und Impfung, vor allem für jüngere, weibliche und nichtärztliche Beschäftigte, angemessene Schutzmaßnahmen und die Prävention depressiver Symptome könnten die Impfbereitschaft erhöhen.
Ziel: Das Ziel dieser Darstellung war es, einen aktuellen Überblick über psychosomatisch-psychotherapeutische Aspekte in der Herztransplantationsmedizin zu geben und die Qualität der Studien nach den Cochrane Kriterien zu beurteilen. Ergebnisse: Depressive Patienten haben eine niedrigere Lebenserwartung nach der HTx als nicht depressive Patienten. Patienten mit einer transplantationsbezogenen posttraumatischen Belastungsstörung (PTBS) haben eine signifikant niedrigere Lebenserwartung als Patienten ohne PTBS. Ein erhöhter Body Mass Index nach der HTx erhöht das Risiko, eine chronische Transplantatdysfunktion zu entwickeln. Eine Noncompliance bezüglich der Medikamente vor der HTx sagt ein schlechteres Überleben nach der HTx voraus. Eine Noncompliance bezüglich der Medikation nach der HTx erhöht das Risiko für spätakute Abstoßungsreaktionen und für eine chronische Transplantatdysfunktion. Ein Messintrument zur Abschätzung der Medikamentencompliance ist die Medikamenten-Erfahrungs-Skala für Immunsuppressiva (MESI). Eine internetbasierte psychosoziale Unterstützung kann wahrscheinlich das Outcome der HTx verbessern. Empfehlungen: Die genannten Faktoren müssen berücksichtigt werden. Bei Problemen in einem der Bereiche ist eine konsequente Behandlung zu erfolgen. Ausblick: Es besteht ein Mangel an kontrollierten und randomisierten Studien auf diesem Gebiet. Multizentrische Studiendesigns können helfen, genügend große Fallzahlen zu akquirieren.
To compare health care experiences of patients with cancer or non-cancer diseases in their last year of life.A cross-sectional post-bereavement survey was conducted using an adapted German version of the VOICES questionnaire (VOICES-LYOL-Cologne). Differences in the reported experiences were assessed using a two-sided Pearson's chi-square test and Mann-Whitney U test.We collected data from 351 bereaved relatives. More than half of non-cancer patients were not informed that their disease could lead to death (p < 0.001). When this was communicated, in 46.7% of non-cancer and 64.5% of cancer patients, it was reported by the hospital doctor (p = 0.050). In all, 66.9% of non-cancer and 41.6% of cancer patients were not informed about death being imminent (p < 0.001). On average, non-cancer patients had significantly fewer transitions and hospital stays in their last year of life (p = 0.014; p = 0.008, respectively). Non-cancer patients were treated more often by general practitioners, and cancer patients were treated more often by specialists (p = 0.002; p = 0.002, respectively). A substantially lower proportion of non-cancer patients were treated by at least one member of or in the setting of general or specialized palliative care (p < 0.001).Non-cancer patients experience disadvantages in communication regarding their care and in access to specialized palliative care in their last year of life compared to cancer patients. Regarding the assessment of palliative care needs and the lack of communication of an incurable disease, non-cancer patients are underserved. An early identification of patients requiring palliative care is a major public health concern and should be addressed irrespective of diagnosis.Prospectively registered by the German Clinical Trials Register (DRKS00011925, data of registration: 13.06.2017).
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