Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
-
Z Arztl Fortbild Qualitatssich · Jun 2000
[Guidelines Clearing House Statement "Hypertension". Summary and recommendations for a rational hypertension guideline in Germany].
In order to promote quality of hypertension management in Germany, a national hypertension guidelines clearing project was initiated in 1999 by the German Guidelines Clearinghouse. ⋯ To improve the quality of hypertension management in Germany, the expert panel suggested to develop a national evidence-based guideline. This should follow internationally agreed criteria and procedures. The experts identified and reviewed 11 out of 132 hypertension, which might make useful contributions for a future German Hypertension guideline. The expert group identified 16 key topics for a national hypertension guideline.
-
Z Arztl Fortbild Qualitatssich · Jun 2000
[Methodological standards of the evidence-based approach of clinical guidelines development in Germany. Consensus between the scientific community, self-governed bodies and practice].
The most appropriate method of clinical guidelines development has been the subject of controversial debates in Germany during the last few years. The German Guidelines Clearinghouse at the Society for Quality in Medicine (Cologne) provided a discussion forum where clinicians, methodologists, the Association of the Scientific Medical Societies, and the corporate self-governed bodies (the health insurances, physicians' associations, and the hospital associations) agreed on the most important methods of an evidence-based approach for guidelines development. ⋯ The quality of consensus is ensured through (1) the participation of all relevant stakeholders in the guideline panel and (2) the application of formal consensus development methods. This type of an "evidence-based consensus guideline" is assumed to possess the highest level of scientific and political legitimacy.
-
Z Arztl Fortbild Qualitatssich · Jun 2000
[Surveys on patient satisfaction in ambulatory care. Practicability, acceptance and relevance from the physician's perspective].
Surveys on patient satisfaction have become an integral part in quality management. Adequate survey conduction and appropriate feed back of survey results are essential prerequisites for a successful transfer of survey results into practice. During the validation of a new instrument to assess patient satisfaction in ambulatory care, we assessed the practicability, acceptance and relevance of the procedure used in this study (distribution and return of questionnaires, preparation of results and comparative feed back) from the perspective of the participating physicians (N = 60). ⋯ Two thirds of the participating physicians (65%) obtained ideas and suggestions for quality management and improvement. Most of the ideas were realised at the time the physician survey took place. Recommendations for conducting patient surveys in ambulatory care and feed back of survey results for participating physicians are presented.
-
Z Arztl Fortbild Qualitatssich · Apr 2000
[Instrumentation of full medical care for non-medical purposes].
A survey of European standards and recommendations is given defining the status of prison physicians in the 40 member states of the Council of Europe. Taking into account these standards, the two main tasks of prison physicians in Germany are the following: 1.) Prison physicians have to treat and, if possible, cure patients--just as physicians outside the prisons do. 2.) By expressing their opinion and by taking initiatives, prison physicians have to contribute, to the observance of health standards in connection with the determination of confinement conditions (hygiene, cleanliness, physical exercise, ventilation, nutrition) and to develop them further. They also have to raise the prisoners' awareness of the fact that they should care about their health. ⋯ Prison physicians are not court experts and the duties which they have to perform as physicians in charge of the treatment of prisoners do not include the rendering of opinions on questions relating to a person's fitness to undergo detention or to stand trial. This task is incumbent on experts, whom the courts have to find and appoint elsewhere than among prison physicians. Decisions regarding the determination of specific confinement conditions in a particular case or the granting of privileges to prisoners have to be taken by the prisons' managerial staff or the administration and not by the prison physicians, who, however, are frequently called in either by prisoners for the purpose of asserting alleged claims or by the prisons' managerial staff for the purpose of rejecting claims which the staff regard as unjustified.
-
Z Arztl Fortbild Qualitatssich · Dec 1999
[Medical confidentiality towards employers,health insurance medical services and health insurance companies from the point of view of a medical society].
In the Federal Republic of Germany, the medical discretion is protected by criminal law section 203, by section 9 of the medical professional law, and by the state law regarding data protection. Patient's secret may only be revealed if the patient agrees, if a law demands or allows the revelation, or if a legal good of higher value facilitates the revelation. The employer may be informed about the fact of sickness of an employed and about the results of an occupational medical screening but not about diagnosis and therapy. ⋯ If it is suspected that there is a mismanagement about the numbers of beds occupied by patients in a hospital, the medical service of a health insurance may examine all patient's records related to the health insurance of interest. There exists no legal rights or duties to reveal information to private health insurance companies. The revelation of patient's data to such companies is most commonly not allowed.