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Search Results: 1 - 10 of 1360 matches for " Hanna Kaduszkiewicz "
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Self-reported competence, attitude and approach of physicians towards patients with dementia in ambulatory care: Results of a postal survey
Hanna Kaduszkiewicz, Birgitt Wiese, Hendrik van den Bussche
BMC Health Services Research , 2008, DOI: 10.1186/1472-6963-8-54
Abstract: A standardised postal survey was sent to 389 GPs and 239 neurologists and psychiatrists in six metropolitan areas in Germany. The 49-item questionnaire consisted of attitudinal statements to be rated on a Likert-type scale. Return rates were 54 percent for GPs and 40 percent for specialists. Statistical methods used to analyze data included correlation analysis, cluster analysis and ordinal regression analysis.No differences were found between GPs and specialists with regard to their general attitude towards caring for patients with dementia. Approximately 15 percent of both disciplines showed a clearly negative attitude. Self-reported competence was strongly associated with general attitude. In particular among GPs, and less so among specialists, a strong positive association was found between self-reported competence, general attitude and professional approach (e.g. early detection, active case finding and cooperation with caregivers). Differences between GPs and specialists were smaller than expected and appear to predominantly reflect task differences within the German health care system.Training opportunities which enable in particular GPs to enhance not only their competence but also their general attitude towards dementia care would appear to be beneficial and might carry positive consequences for patients and their caregivers.In most industrialized countries, GPs are responsible for providing care for the majority of patients suffering from dementia, whether in the community or in nursing homes. But do they feel competent enough to perform this task? Furthermore, does a lack of self-perceived competence influence professional attitude or approach in caring for patients with dementia? Several studies from the United Kingdom reveal that general practitioners (GPs) consider themselves to be insufficiently qualified in dealing with dementia and also see the need for improved training. In a study conducted on behalf of the Audit Commission in England and Wales, o
Ambulatory health services utilization in patients with dementia - Is there an urban-rural difference?
Daniela Koller, Marion Eisele, Hanna Kaduszkiewicz, Gerhard Sch?n, Susanne Steinmann, Birgitt Wiese, Gerd Glaeske, Hendrik van den Bussche
International Journal of Health Geographics , 2010, DOI: 10.1186/1476-072x-9-59
Abstract: Basis for the analysis were all insured persons of a German Health Insurance fund (the GEK) aged 65 years and older living in rural and urban areas. We focussed on physician contacts in the outpatient sector during the first year after an incidence diagnosis of dementia. Special attention was given to contacts with primary care physicians and neurologists/psychiatrists. The dementia cohort was analyzed together with a non-dementia control group drawn according to age, gender and amount of physician contacts. Uni- and bivariate as well as multivariate analysis were performed to estimate the influences on service utilization.Results show that the provision of primary care seems to be equally given in urban and rural areas. For specialists contacts however, rural patients are less likely to consult neurologists or psychiatrists. This trend can already be seen before the incident diagnosis of dementia. All consultations rise in the quarter of the incident dementia diagnosis compared to the control group. The results were also tested in a linear and a logistic regression, showing a higher chance for persons living in urban areas to visit a specialist and an overall higher rate in service utilization for dementia patients.Because of a probable increase in the number of dementia patients, service provision has to be accessible even in rural areas. Due to this and the fact that demographic change is happening at different paces in different regions, regional variations have to be considered to ensure the future service provision.Accessibility to health services, especially for persons with a disease with such an impact as dementia, is important in order to ensure guideline-orientated diagnosis and optimal therapy.Dementia is a disease with a major impact on patients, relatives and society; and its importance will grow in the future due to demographic changes. In Germany, the population aged 65 years and older consisted of over 15 million persons in the year 2005 (19% of the
Strategies for Improving Participation in Diabetes Education. A Qualitative Study
Ingmar Sch?fer, Marc Pawels, Claudia Küver, Nadine Janis Pohontsch, Martin Scherer, Hendrik van den Bussche, Hanna Kaduszkiewicz
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0095035
Abstract: Objective Diabetes mellitus is highly prevalent and can lead to serious complications and mortality. Patient education can help to avoid negative outcomes, but up to half of the patients do not participate. The aim of this study was to analyze patients' attitudes towards diabetes education in order to identify barriers to participation and develop strategies for better patient education. Methods We conducted a qualitative study. Seven GP practices were purposively selected based on socio-demographic data of city districts in Hamburg, Germany. Study participants were selected by their GPs in order to increase participation. Semi-structured face-to-face interviews were conducted with 14 patients. Interviews were audiotaped and transcribed verbatim. The sample size was determined by data saturation. Data were analysed by qualitative content analysis. Categories were determined deductively and inductively. Results The interviews yielded four types of barriers: 1) Statements and behaviour of the attending physician influence the patients' decisions about diabetes education. 2) Both, a good state of health related to diabetes and physical/psychosocial comorbidity can be reasons for non-participation. 3) Manifold motivational factors were discussed. They ranged from giving low priority to diabetes to avoidance of implications of diabetes education as being confronted with illness narratives of others. 4) Barriers also include aspects of the patients' knowledge and activity. Conclusions First, physicians should encourage patients to participate in diabetes education and argue that they can profit even if actual treatment and examination results are promising. Second, patients with other priorities, psychic comorbidity or functional limitations might profit more from continuous individualized education adapted to their specific situation instead of group education. Third, it might be justified that patients do not participate in diabetes education if they have slightly increased blood sugar values only and no risk for harmful consequences or if they already have sufficient knowledge on diabetes.
Multimorbidity Patterns in the Elderly: A New Approach of Disease Clustering Identifies Complex Interrelations between Chronic Conditions
Ingmar Sch?fer,Eike-Christin von Leitner,Gerhard Sch?n,Daniela Koller,Heike Hansen,Tina Kolonko,Hanna Kaduszkiewicz,Karl Wegscheider,Gerd Glaeske,Hendrik van den Bussche
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0015941
Abstract: Multimorbidity is a common problem in the elderly that is significantly associated with higher mortality, increased disability and functional decline. Information about interactions of chronic diseases can help to facilitate diagnosis, amend prevention and enhance the patients' quality of life. The aim of this study was to increase the knowledge of specific processes of multimorbidity in an unselected elderly population by identifying patterns of statistically significantly associated comorbidity.
Impact of geriatric comorbidity and polypharmacy on cholinesterase inhibitors prescribing in dementia
Falk Hoffmann, Hendrik van den Bussche, Birgitt Wiese, Gerhard Sch?n, Daniela Koller, Marion Eisele, Gerd Glaeske, Martin Scherer, Hanna Kaduszkiewicz
BMC Psychiatry , 2011, DOI: 10.1186/1471-244x-11-190
Abstract: We used claims data of 1,848 incident patients with dementia aged 65 years and older. Inclusion criteria were first outpatient diagnoses for dementia in at least three of four consecutive quarters (incidence year). Our dependent variable was the prescription of at least one ChEI in the incidence year. Main independent variables were polypharmacy (defined as the number of prescribed medications categorized into quartiles) and measures of geriatric comorbidity (levels of care dependency and 14 symptom complexes characterizing geriatric patients). Data were analyzed by multivariate logistic regression.On average, patients were 78.7 years old (47.6% female) and received 9.7 different medications (interquartile range: 6-13). 44.4% were assigned to one of three care levels and virtually all patients (92.0%) had at least one symptom complex characterizing geriatric patients. 13.0% received at least one ChEI within the incidence year. Patients not assigned to the highest care level were more likely to receive a prescription (e.g., no level of care dependency vs. level 3: adjusted Odds Ratio [OR]: 5.35; 95% CI: 1.61-17.81). The chance decreased with increasing numbers of symptoms characterizing geriatric patients (e.g., 0 vs. 5+ geriatric complexes: OR: 4.23; 95% CI: 2.06-8.69). The overall number of prescribed medications had no influence on ChEI prescription and a significant effect of age could only be found in the univariate analysis. Living in a rural compared to an urban environment and contacts to neurologists or psychiatrists were associated with a significant increase in the likelihood of receiving ChEIs in the multivariate analysis.It seems that not age as such but the overall clinical condition of a patient including care dependency and geriatric comorbidities influences the process of decision making on prescription of ChEIs.International and national guidelines recommend the use of cholinesterase inhibitors (ChEIs) for mild to moderate Alzheimer's disease [1-3].
Coping with multimorbidity in old age – a qualitative study
Christin L?ffler, Hanna Kaduszkiewicz, Carl-Otto Stolzenbach, Waldemar Streich, Angela Fuchs, Hendrik van den Bussche, Friederike Stolper, Attila Altiner
BMC Family Practice , 2012, DOI: 10.1186/1471-2296-13-45
Abstract: 19 narrative in-depth interviews with multimorbid patients were conducted. The data was analysed using grounded theory. Of the 19 interviewed patients 13 were female and 6 male. Mean age was 75?years. Participating patients showed a relatively homogeneous socio-economic status. Patients were recruited from the German city of Hamburg and the state of North Rhine-Westphalia.Despite suffering from multimorbidity, interviewees held positive attitudes towards life: At the social level, patients tried to preserve their autonomy to the most possible extent. At the emotional level, interviewees oscillated between anxiety and strength - having, however, a positive approach to life. At the practical level, patients aimed at keeping their diseases under control. The patients tended to be critical in regards to medication.These findings might have implications for the treatment of multimorbid patients in primary care and further research: The generally presumed passivity of older individuals towards medical treatment, which can be found in literature, is not evident among our sample of older patients. In future, treatment of these patients might take their potential for pro-active cooperation more strongly into account than it is currently the case.Today, multimorbidity is a common problem among the elderly and its occurrence rises with age [1-3]. Research has shown that in Europe, for instance, more than 60% of people aged 65+ can be classified as multimorbid [4,5]. Figures for the US show a similar pattern [6,7]. Whereas numerous studies focus on chronic conditions – both from the physicians’ as well as the patients’ point of view – few studies address multimorbidity. This is rather surprising, since multimorbidity is a particular challenge – not only for General Practitioners (GPs), but also for patients. In 2005, Boyd and colleagues, for instance, reviewed clinical practice guidelines for the 15 most common chronic diseases in the US. They conclude that strict adherence to
The disease management program for type 2 diabetes in Germany enhances process quality of diabetes care - a follow-up survey of patient's experiences
Ingmar Sch?fer, Claudia Küver, Benjamin Gedrose, Falk Hoffmann, Barbara Ru?-Thiel, Hans-Peter Brose, Hendrik van den Bussche, Hanna Kaduszkiewicz
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-55
Abstract: Cohort study with a baseline interview and a follow-up after 10.4 ± 0.64 months. Data on process and outcome measures were collected by telephone interviews with 444 patients enrolled and 494 patients not enrolled in the German DMP for type 2 diabetes. Data were analyzed by multivariate logistic regression analyses.DMP enrolment was significantly associated with a higher process quality of care. At baseline enrolled patients more often reported that they had attended a diabetes education course (OR = 3.4), have ≥ 4 contacts/year with the attending physician (OR = 3.3), have at least one annual foot examination (OR = 3.1) and one referral to an ophthalmologist (OR = 3.4) and possess a diabetes passport (OR = 2.4). Except for the annual referral to an ophthalmologist these parameters were also statistically significant at follow-up. In contrast, no differences between enrolled and not enrolled patients were found concerning outcome quality indicators, e.g. self-rated health, Glycated hemoglobin (GHb) and blood pressure. However, 16-36% of the DMP participants reported improvements of body weight and/or GHb and/or blood pressure values due to enrolment - unchanged within one year of follow-up.In the light of patient's experiences the DMP enhances the process quality of medical care for type 2 diabetes in Germany. The lack of significant differences in outcome quality between enrolled and not enrolled patients might be due to the short program duration. Our data suggest that the DMP for type 2 diabetes should not be withdrawn unless an evidently more promising approach is found.Health care improvement for patients with type 2 diabetes is an important target of health care policy in Germany. In summer 2003 a disease management program (DMP) for type 2 diabetes was introduced on a nationwide basis within the statutory health insurance, which covers 86% of the German population. Participation in the DMP is voluntary for physicians and patients and connected with financial
Specialist involvement and referral patterns in ambulatory medical care for patients with dementia in Germany: results of a claims data based case-control study
Hendrik van den Bussche, Birgitt Wiese, Daniela Koller, Marion Eisele, Hanna Kaduszkiewicz, Wolfgang Maier, Gerd Glaeske, Susanne Steinmann, Karl Wegscheider, Gerhard Sch?n
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-148
Abstract: In this case-control study claims data from 1,848 insurants with incident dementia aged 65 years and more and 7,392 matched controls were compared over a two-year period covering the pre-incidence, incidence and post-incidence time periods.We found an increase in referrals of 30% in the incidence quarter, mainly from general practice to neuropsychiatry and from there to radiology. Referrals to clinical chemistry and other disciplines for dementia-specific reasons were negligible in amount. 34% of incident cases had at least one contact with a neuropsychiatrist during the year of incidence, and the majority of them visited this specialist repeatedly during that year. Only a minority (13.5%) of patients was referred to radiology for imaging. Referrals to other specialists declined whereas self-referrals did not increase.The referral rates to relevant specialists (neuropsychiatry, radiology and clinical chemistry) are far less frequent than proposed in German guidelines. More research is needed to explain the gape between guidelines and daily care and to find ways for a better implementation of guidelines in ambulatory care. Guidelines should not only deal with diagnostic procedures and therapeutic options but also consider questions of applicability in daily clinical practice and propose effective organizational models of care provision.Referrals between primary care physicians (PCPs) and specialists are an important instrument in assuring the quality of ambulatory medical care, in Germany and elsewhere. In spite of the importance of referrals, the division of labour and the communication pathways between PCPs and specialists as well as between specialists of different disciplines have not been investigated thoroughly in health services research. Also, the quality of studies on medical referrals is generally low, as shown by Faulkner et al. [1] and by Akbari et al. in a recent Cochrane Review [2]. In Germany, only the Department of General Practice and Health Services
Selection effects may account for better outcomes of the German Disease Management Program for type 2 diabetes
Ingmar Sch?fer, Claudia Küver, Benjamin Gedrose, Eike-Christin von Leitner, András Treszl, Karl Wegscheider, Hendrik van den Bussche, Hanna Kaduszkiewicz
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-351
Abstract: Case control study comparing DMP patients with usual-care patients at baseline and follow up; mean follow-up period of 36 ± 14 months. We used chart review data from 51 GP surgeries. Participants were 586 DMP and 250 usual-care patients with type 2 diabetes randomly selected by chart registry. Data were analysed by multivariate logistic and linear regression analyses. Significance levels were p ≤ 0.05.There was a better chance for enrolment if patients a) had a lower risk status for diabetes complications, i.e. non-smoking (odds ratio of 1.97, 95% confidence interval of 1.11 to 3.48) and lower systolic blood pressure (1.79 for 120 mmHg vs. 160 mmHg, 1.15 to 2.81); b) had higher activity rates, i.e. were practicing blood glucose self-monitoring (1.67, 1.03 to 2.76) and had been prescribed a diabetes patient education before enrolment (2.32, 1.29 to 4.19) c) were treated with oral medication (2.17, 1.35 to 3.49) and d) had a higher GP-rated motivation for diabetes education (4.55 for high motivation vs. low motivation, 2.21 to 9.36).At baseline, future DMP patients had a lower risk for diabetes complications, were treated more intensively and were more active and motivated in managing their disease than usual-care patients. This finding a) points to the problem that the German DMP may not reach the higher risk patients and b) selection bias may impair the assessment of differences in outcome quality between enrolled and usual-care patients. Suggestions for dealing with this bias in evaluation studies are being made.Sufficient evaluation is a precondition for deciding whether the implementation of any new health care policy was successful. Policy makers depend on this scientific evidence, but their decisions sometimes restrain researchers from generating evidence in a valid way. This is the case with the nationwide disease management program (DMP) for type 2 diabetes, which was introduced in Germany in 2003.The DMP was started in a rush with no preceding randomized con
Prediction of Dementia in Primary Care Patients
Frank Jessen,Birgitt Wiese,Horst Bickel,Sandra Eiffl?nder-Gorfer,Angela Fuchs,Hanna Kaduszkiewicz,Mirjam K?hler,Tobias Luck,Edelgard M?sch,Michael Pentzek,Steffi G. Riedel-Heller,Michael Wagner,Siegfried Weyerer,Wolfgang Maier,Hendrik van den Bussche
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0016852
Abstract: Current approaches for AD prediction are based on biomarkers, which are however of restricted availability in primary care. AD prediction tools for primary care are therefore needed. We present a prediction score based on information that can be obtained in the primary care setting.
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