Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Jan 2007
Patient and citizen participation in German health care--current state and future perspectives.
Patient participation within the German healthcare system is described at three different levels: the macro level as active patient influence on the regulation of medical care, the meso level in terms of institutions enhancing patient information and counselling, and the micro level focusing on the actual treatment decision-making process in the medical encounter. The main focus of the present publication is on the health care system-specific influences on patient participation in medical decision-making and on the current state of research and implementation of shared decision-making in Germany. ⋯ The present state of the intervention projects' results is outlined as well as subsequently funded transfer projects and future perspectives of research grants. Supported by health politics and the utilisation of scientific evidence shared decision-making's transfer into practice is considered to be relevant to the German health care system.
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Z Arztl Fortbild Qualitatssich · Jan 2007
[Interdisciplinarity and chronic pain therapy--implementation of a new Interdisciplinary Center at the University Hospital Dresden on the basis of an integrated health care contract].
Due to the bio-psycho-social complexity and presence of various health departments, chronic pain requires interdisciplinary cooperation which enables the accurate evaluation of the clinical findings and is a prerequisite for an individual and resource-oriented therapeutic concept focusing on both physical and mental activation. This concept forms the basis of medical care at the University Pain Center, which was founded in April 2004 at the Carl Gustav Carus University Hospital in Dresden. ⋯ Following a draft version of a coherent multimodal, interdisciplinary healthcare concept along with full cost accounting after 1 1/2 years, an integrative healthcare contract got signed by two health insurances (AOK-Sachsen and VdAK) in June 2004. After two years of existence, the first experiences, results and especially the Pain Center's treatment spectrum ought to be demonstrated.
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Z Arztl Fortbild Qualitatssich · Jan 2007
[Participation of patients in the program for national disease management guidelines--current state and implications].
Patient involvement has been implemented in the Program for National Disease Management Guidelines since 2005. Currently patient/consumer participation is being incorporated in terms of patients' comments of consultation papers on National Disease Management Guidelines (NDMG) and in the development of NDMG-based patient guidelines (PG). The editorial activities in patient guideline development from the beginnings to its publication are conducted in close cooperation with the patient representatives appointed by the Patient Forum. ⋯ It describes the current state of patient involvement and joint work and indicates the implications that can be derived from patient participation in the NDMG Program. Accompanying the involvement procedures, experiences resulting from previous NDMG and PG development activities are continuously investigated for the possibility of further methodological development of consumer participation by a work group of the Patient Forum in coordination with the patient organizations involved. In particular, the procedures resulting from more intensive patient participation in patient guideline development are to be examined as to their relevance for the expansion of patient involvement in NDMG development.
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The value of consensus recommendations for improving clinical practice may be restricted by the limitations of the evidence on which they are based. When few high quality studies are identified for evaluation from the specific field of interest, selected 'transferable' evidence from comparable clinical situations may add important information. ⋯ In particular, systems for grading of recommendations must take into account the different types of evidence used, so as not to give equivalent weight to transferable and specific evidence without justification. In this article, we discuss the use of transferable evidence by the PROSPECT Working Group, which has developed a clinical decision support programme (www.postoppain.org) to provide evidence and recommendations for procedure-specific postoperative pain management.
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Z Arztl Fortbild Qualitatssich · Jan 2007
Shared decision-making in Canada: update, challenges and where next!
There is considerable interest for shared decision-making (SDM) within the Canadian healthcare system. The current state of SDM in Canada and challenges with implementation are addressed in the paper at three levels of patient involvement: (1) healthcare system (macro-level); (2) institutions (meso-level) and (3) clinical/medical encounter (micro-level). ⋯ The virtue of SDM has gained recognition through increased research funding, medical training and some initiatives embedding patient decision aids within the process of care. Future perspectives of SDM in Canada are highlighted such as evaluation of the long-term impact of and costs associated with patient participation in decisions as well as interprofessional approaches to SDM.