1,721,248 research outputs found
Strong primary care and patients' survival
Full text linkPrimary healthcare is the cornerstone of any healthcare system. A major health system reform to strengthen primary care has been implemented in Germany since 2008. Key components include: voluntary participation, intensive management of patients with chronic diseases, coordination of access to medical specialists, continuous quality improvement, and capitation-based reimbursement. The objective of this study was to assess the effect of this reform on survival of enrolled patients. We conducted a comparative cohorts study with 5-year follow-up, starting in the year 2012 in Baden-Wuerttemberg, Germany. Participants were 1,003,336 enrolled patients and 725,310 control patients. A Cox proportional hazards regression model was applied to compare survival of enrolled patients with a composed control cohort of non-enrolled patients, adjusted for a range of patient and physician characteristics. Average age of enrolled patients was 57.3 years and 56.1% were women. Compared to control patients, they had lower mortality (Hazard Ratio: 0.978; 95% CI: 0.968; 0.989). Participation in chronic disease management programs had independent impact on survival rate (Hazard Ratio 0.744, 95% CI: 0.734; 0.753). We concluded that strong primary care is safe and potentially beneficial in terms of patients' survival
Local networks of community and healthcare organisations: a mixed methods study
No full textBackground- Local collaboration of community organisations and healthcare organisations is seen as relevant for the efficiency and efficacy of health and social care because of their potential role in providing social involvement which may reduce the need for the utilisation of formal services. Care organisations connect to each other in different ways, thus comprising an organisational network. This study aimed to describe and explore organisational networks with respect to their activities for people with diabetes mellitus type 2 and potential mechanisms of effective collaboration. Collaboration could include, for example, referring to each other and organising activities together. Potential mechanisms are navigation, negotiation and contagion.Method - A mixed methods study was conducted in an urban and a rural area in the Netherlands. The participating organisations were mentioned by a sample of diabetes patients in these regions and by organisations’ representatives in a snowballing procedure. Next a quantitative survey and a semi-structured interview were conducted, including 35 representatives of these local organisations. The social network analysis methods was used to map and characterise the organisational networks based on results from the survey. A thematic analysis of interviews was undertaken to identify how three mechanisms (navigation, negotiation and contagion) were used in the collaboration.Results - Both interviews and network structures showed evidence of navigation-related mechanisms. Organisations referred patients with diabetes to services within their organisation or to relevant services provided by other organisations. Hardly any negotiation or contagion-related mechanisms were identified. If negotiation between organisations was found, it seemed externally enforced. The density, centrality, and reciprocity in the networks seemed low to facilitate contagion of practices. Some organisations reported actions that could have impacted on contagion. Representatives emphasized the need of network collaboration with local or regional community and healthcare organisations.Conclusion - The study suggests that navigation to resources is a relevant theme in organisational networks, which could be targeted by interventions. More research is needed to explore the relevance of other network-related mechanisms.<br/
Implementation fidelity in a multifaceted program to foster rational antibiotics use in primary care: an observational study
No full textBACKGROUND: The ARena study (Sustainable Reduction of Antimicrobial Resistance in German Ambulatory Care) is a three-arm, cluster randomized trial to evaluate a multifaceted implementation program in a German primary care setting. In the context of a prospective process evaluation conducted alongside ARena, this study aimed to document and explore fidelity of the implementation program. METHODS: This observational study is based on data generated in a three-wave survey of 312 participating physicians in the ARena program and attendance documentation. Measures concerned persistence of participation in the ARena program and adherence to intervention components (thematic quality circles, e-learning, basic expenditure reimbursements, additional bonus payments and a computerized decision support system). Participants’ views on five domains of the implementation were also measured. Binary logistic and multiple linear regression analyses were used to explore which views on the implementation were associated with participants’ adherence to quality circles and use of additional bonus compensation. RESULTS: The analysis of fidelity showed overall high persistence of participation in the intervention components across the three intervention arms (90,1%; 97,9%; 92,9%). 96.4% of planned quality circles were delivered to study participants and, across waves, 30.4% to 93% of practices participated; 56.1% of physicians attended the maximum of four quality circles. 84% of the practices (n = 158) with a minimum of one index patient received a performance-based additional bonus payment at least once. In total, bonus compensation was triggered for 51.8% of affected patients. Participation rate for e-learning (a prerequisite for reimbursement of project-related expenditure) covered 90.8% of practices across all intervention arms, with the highest rate in arm II (96.5%). Uptake of expenditure reimbursement was heterogeneous across study arms, with a mean rate of 86.5% (89.1% in arm I, 96.4% in arm II and 74.1% in arm III). Participants’ views regarding participant responsiveness (OR = 2.298) 95% CI [1.598, 3.305] and Context (OR = 2.146) 95% CI [1.135, 4.055] affected additional bonus payment. Participants’ views on participant responsiveness (Beta = 0.718) 95% CI [0.479, 0.957], Context (Beta = 0.323) 95% CI [0.055, 0.590] and Culture of shared decision-making (Beta = -0.334) 95% CI [-0.614, -0.053] affected quality circle attendance. CONCLUSION: This study showed an overall high fidelity to the implementation program. Participants’ views on the implementation were associated with degree of intervention fidelity. TRIAL REGISTRATION: ISRCTN, ISRCTN58150046. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12874-022-01725-3
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Evaluation of patient perspective on quality of oral health care in Germany - An exploratory study
No full textBackground: Patients' evaluation of care presents an essential dimension of the quality of care. The aim of this exploratory study was to determine which factors of EUROPEP-Dental were associated with overall patients' evaluation of oral health care. Methods: Data were collected from 8,160 patients from 106 dental practices (response rate 77%) who completed the 30-item EUROPEP-Dental questionnaire. The possible answers ranged from 1 (poor) to 5 (excellent). The EUROPEP-Dental questionnaire covers four domains: dentist-patient relationship' (11 items), accessibility and waiting time' (10 items), quality of care' (six items), costs of care' (three items). Each domain was aggregated by mean scores of the associated items. Regression analyses were performed in addition to descriptive analyses. Results: Over 66% of the patients were overall positive with their dental care. Linear regression analyses were performed with patient satisfaction as the dependent outcome variable. The item medical-technical quality of care' showed the highest score (R-2=0.378) of explained variance, while the EUROPEP-Dental domain quality of care' showed the highest score (R-2=0.467) for explained variance regarding overall patient satisfaction. Conclusions: The results are important for understanding patients' priorities with regard to oral health care and for identifying possible areas for improvement of quality. The evaluation of patient perspective on quality of oral health care is likely to continue to be an important aspect of oral health-care evaluatio
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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