Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Jan 2005
[Introduction of quality management with the EFQM Self-Assessment method. Implementation and experience in a university department of dermatology].
In the near future, the German legislative and health insurance agencies will increasingly demand proof of quality in hospital health care. The role of quality management in hospitals is emphasized by the introduction of per-case payment (DRG) in Germany. The implementation of internal quality management at an early stage sets the course of a systematic and continuous quality improvement process, with the goal to increase performance and results by efficient utilization of resources. ⋯ A high degree of motivation of the personnel is fostered by the creation of a local guidance circle, a coordinating group, and several Self-Assessment teams. However, formulation and deployment of improvement actions are necessary for the long-term implementation of quality management. The application of Self-Assessment in quality management appears a suitable tool to promote excellence.
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Z Arztl Fortbild Qualitatssich · Jan 2005
[Suspicion of COPD--development of an algorithm for stepwise diagnosis in primary care].
The implementation of the disease management programme (DMP) for asthma and COPD in the German health system in 2005 requires an optimal and evidence-based work-up of patients by general practitioners in routine daily practice. The German and international guidelines for COPD do not provide recommendations for a stepwise diagnostic work-up in primary care. Therefore, an evidence-based algorithm was developed for a stepwise diagnosis of COPD and its different stages in general practice, based on national and foreign guidelines that provide specific advice on diagnostic procedures.
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Z Arztl Fortbild Qualitatssich · Jan 2005
[Cognition-based medicine from the viewpoint of evidence-based medicine].
The anthroposophic medicine plays a prominent role among the special forms of therapy. The concept of a cognition-based medicine (CBM)--in critical analogy to the evidence-based medicine (EBM)--has emerged from the circle of promoters of this type of therapy. The present paper attempts to identify common and different features of EBM and CBM. ⋯ The EBM can certainly accept the critical relevance and justification of this concept, particularly with regard to the constantly educational (self)evaluation of the clinical decision. Individual causal recognition, on the other hand, is unable to replace the summatory evaluation of controlled studies. In certain single cases, the CBM makes "evident" the effect of a given therapy, on the other hand it is unable to establish a generally valid efficacy, which is so critical for the orientation of patients, physicians, and the socially-based healthcare system.
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Z Arztl Fortbild Qualitatssich · Nov 2004
Review[Methadone substitution--a scientific review in the context of out-patient therapy in Germany].
The German Betäubungsmittelverschreibungsverordnung BtmVV (prescription regulation of narcotics), 5 part 2, 01 July 2001 commissioned the German Medical Association to establish guidelines on methadone maintenance therapy according to the medical-scientific state of the art. A joint commission of the German Medical Association and the National Association of Statutory Health Insurance Physicians developed guidelines for substitution therapy of opiate dependence which were adopted by the board of the German Medical Association in March 2002 and were published in the Deutsche Arzteblatt in May 24, 2002. The present study is a systematic review of the scientific literature on successful treatment in general, as well as on particular aspects of methadone substitution therapy considered by the German Medical Association's guidelines. ⋯ Older randomised controlled trials and more recent quasi-experimental studies provide evidence that methadone maintenance therapy is an effective strategy to reduce illicit drug use, to improve the health situation of drug users, to diminish criminal behaviour, and to promote rehabilitation of opiate-dependent individuals. The evaluation of international studies clearly shows that access criteria to substitution therapy beyond the diagnosis of opiate dependence, e.g. the presence of a life-threatening co-morbidity, is not a prerequisite for substitution in other countries, and therefore is not discussed in the international literature. Study evidence shows that the German Medical Association's guidelines for substitution therapy of opiate dependence reflect the best evidence available from scientific studies and apply it to the conditions of the German healthcare system.
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Z Arztl Fortbild Qualitatssich · Oct 2004
[Patient safety and training in human factor--challenge for anaesthesia training].
Patient safety is a central issue for every hospital. Prerequisites are reliable routine processes, avoidance of accidents, and flexible management of incidents. In anaesthesia, ca. 80% of all incidents can be assigned to human factors (e.g. communication, management of workload, decision-making). ⋯ The individual modules and their methodological implementation are briefly presented here. Besides the communication of knowledge about human factors, we discuss the employment of computer-simulated low-fidelity scenarios and full-scale patient simulators. In principle, this integrative training strategy can be easily adapted to other related medical branches.