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Biomedical subjects

F M Gerlach

Publications and source records attributed to F M Gerlach.

14 recordsLinked to original sources
PubMed2006

Case management to improve major depression in primary health care: a systematic review.

BACKGROUND: Deficits in the care of depression lead to poor medication adherence, which increases the risk of an unfavourable outcome for this care. This review evaluates effects on symptoms and medication adherence of case management in primary health care. METHOD: A systematic literature search was performed. The quality of the studies was rated according to the Cochrane Effective Practice and Organization of Care Group (EPOC) criteria. To conduct a subgroup analysis interventions were classified as either 'standard' or 'complex' case management. RESULTS: Thirteen studies met the inclusion criteria. In a meta-analysis we calculated a standard mean difference/effect size on symptom severity after 6-12 months of -0.40 (95% CI -0.60 to -0.20). Patients in the intervention groups were more likely to achieve remission after 6-12 months [relative risk (RR) 1.39, 95% CI 1.30-1.48]. The relative risk for clinical response was 1.82 (95% CI 1.68-2.05). Patients in intervention groups had better medication adherence than the control group (RR 1.5, 95% CI 1.28-1.86). We found heterogeneous results when assessing effects of different types of intervention. CONCLUSIONS: We conclude that case management improves management of major depression in primary health-care settings.

Case Management↗
PubMed2003

The development of quality circles/peer review groups as a method of quality improvement in Europe. Results of a survey in 26 European countries.

BACKGROUND: Peer review groups (PRGs) and quality circles (QCs) commenced in The Netherlands and have grown to become an important method of quality improvement in primary care in several other European countries. OBJECTIVE: Our aim was to provide an overview of QC/PRG activities and exemplary programmes in European countries. METHODS: A survey was performed in three consecutive steps by EQuiP (European Working Party on Quality in Family Practice), which is a representative association of experts from 26 European countries. The national representatives initially completed a structured questionnaire documenting the number and objectives of QCs/PRGs, sources of support and special programmes in their countries (step 1). In step 2, these sources were used to extend and validate the expert statements. Step 3 studied paradigmatic initiatives in depth. RESULTS: Step 1 took place in 2000; the response rate was 100% (26 countries). QCs/PRGs were very active in 10 countries; 16 countries showed little or no activity. Participation ranged from <2 to 86% of all GPs. Step 2 concentrated upon the countries with a high level of activity. Development appeared to be associated with establishment in private practice and the portion of GPs with vocational training. Eight programmes from six countries describing the establishment and the targeting of QC/PRG work are presented as case reports (step 3). CONCLUSION: In the last 10 years, substantial development of QCs/PRGs has taken place in The Netherlands, the UK, Denmark, Belgium, Ireland, Sweden, Norway, Germany, Switzerland and Austria. Further evaluation is needed to clarify the impact on quality of care.

Europe↗
PubMed2001

[Importance and possibilities of general guidelines in family practice strategies--do we need 'basic guidelines' in general practice?].

General practice is distinguished particularly by complex patient problems and generic competencies to act and counsel as a family practitioner. Guidelines which are only centered on clinical topics like diagnoses, treatments etc. are not sufficient to support action and decision in general practice. The article proposes the concept of generic guidelines (basic guidelines) for family medicine. A need for basic guidelines in general practice is established in three areas: 1) cross sectional patient problems (e.g. care for immigrants, common strain and distress, counselling of screening procedures), 2) basic skills and strategies in family practice (e.g. problem-oriented consultation, home visits, patient information and informed consent), and 3) practice management and documentation. The development of generic guidelines seems to be difficult as the efforts to evidence-based professional practice are only recently started, but this is matched by the high importance of guidance for general practice, and certain concepts of family medicine support it. It is concluded that the development of basic guidelines in general practice will have a considerable impact on structuring the framework and fostering the quality improvement of general practice.

Counseling↗
PubMed1999

[The DEGAM-concept--development, dissemination, implementation and evaluation of guidelines for general practice].

The German Society for General Practice/Family Medicine (DEGAM) has launched a project to develop and implement national guidelines for general practice accordingly to international models. Guidelines are seen as statements to assist practitioners and patients in deciding about appropriate, effective and efficient health care. They should be evidence-based, feasible for primary care practices, and purposefully addressing to physicians as well as practice staff and patients. The development follows a comprehensive and well-structured programme (10 stages) which requires the appraisal of medical evidence, the involvement of experienced general practitioners on various stages (primary review, feasibility testing), and comments of concerned specialists, before a guideline is promulgated. Implementation of each guideline is promoted by at least five tools (full text, quick reference guide, telephone card for practice staff; patient leaflet, and information-prescription--"infozept"). Methodological quality is checked for the first time in Germany according to the standards of the German Agency for Quality Assurance. Different targets and criteria for evaluation of guidelines in primary care are mandatory part of the DEGAM-concept.

Evaluation Studies as Topic↗
PubMed1999

[Continuing medical education from the view of ambulatory care physicians--representative outcomes and needs in Bremen and Saxony-Anhalt].

RESEARCH QUESTION: To study the habits of ambulatory care physicians in CME, and to investigate the motivating and negative experiences with different types of CME in Germany. METHODS/SETTING: Survey with a five-page questionnaire posted to all ambulatory care physicians in the German states of Saxony-Anhalt (n = 3139) and Bremen (n = 1131). RESULTS: Response rates were 61.8% in Saxony-Anhalt and 41.7% in Bremen. 2412 questionnaires were available in this largest survey on that topic in Germany. Mean time devoted to CME was 4.6 hours per week, the respondents participated on the average at 14 CME-events per year. A content analysis was made to investigate positive and negative experiences. Practice orientation and personal exchange in small groups was appraised; criticism was mostly directed towards the efficiency and effectiveness of CME at large events (e.g. congresses). CONCLUSIONS AND SUGGESTIONS: Regionally performed surveys are able to guide the planning of CME about habits, wants and needs of the target group and may increase the attendance as well as the involvement. Motivating as well as critical experiences of the participants should be regarded more rigorously in the planning. Consideration can increase the quality and the impact of CME. This applies the more, when certification of the quality of CME and of individual CME-efforts are planned. This article will be followed in one of the next issues by a second from the same survey focusing on the attitudes of ambulatory care physicians towards quality improvement and their intentions to join quality circles (peer review groups).

Ambulatory Care Facilities↗
PubMed1999

[Promoting quality and quality circles from the viewpoint of established physicians--representative Bremen and Saxony-Anhalt results].

RESEARCH QUESTION: To study the attitudes of ambulatory care physicians towards quality improvement, the intentions to join quality circles (QCs, peer review groups) and the expectations directed towards them. METHODS/SETTING: Survey with a five-page questionnaire posted to all ambulatory care physicians in the German states of Saxony-Anhalt (n = 3139) and Bremen (n = 1131). RESULTS: Response rates were 61.8% in Saxony-Anhalt and 41.7% in Bremen. 2412 questionnaires were available in this largest survey on that topic in Germany. Necessity of quality improvement (QI) in ambulatory care was approved by the majority of the respondents (1.7 on a 5-point Lickert scale). Concerns existed about a rise in control and the risk of abuse of QI measures. 56.4% in Saxony-Anhalt and 52.3% in Bremen had the intention to join a QC. Motives and impediments of participation in QCs were investigated by content analysis. A causal dominance analysis was performed to identify the key elements for the decision to participate. The main benefits of QC-participation were expected as assistance in daily practice and exchange of experiences. The major obstacles were professional and private duties, fear of control and inefficiency. CONCLUSIONS: Policies that could be adequate to rise motivations and tackle on widespread fears should be purposely adapted to the needs and expectations of the physicians.

Attitude of Health Personnel↗
PubMed1998

[Quality management in medicine--definitions and goals].

The meanings of the terms "quality", "quality of care", and "quality management" were clarified with common international definitions. Based on that, the basic ideas, concepts, and objectives of quality management in medicine were explained. Finally some future trends related to quality were viewed, which represent challenges for the medical profession and entire medicine.

Forecasting↗
PubMed1998

Quality circles in ambulatory care: state of development and future perspective in Germany.

OBJECTIVE: To survey the quantitative development of quality circles (peer review groups; QC) and their moderators in ambulatory care in Germany, to describe approaches to documentation and evaluation, to establish what types of facilities and support is available and to assess opinions on the future importance of QC. DESIGN: Cross-sectional survey using a standardized questionnaire and supplementary telephone interviews. SETTING: All 23 German regional Associations of Statutory Health Insurance Physicians (ASHIP) were surveyed. RESULTS: The total number of QC in ambulatory care in Germany increased rapidly from 16 in 1993 to 1633 in June 1996, with about 17% (range 1.0-52.1%) of all practicing physicians (112 158) currently involved. Throughout Germany, 2403 moderators were trained in 168 training courses by the qualifying date. Follow-up meetings were held or being planned in 20 ASHIP, with approximately 39% (23-95%) of the moderators participating. Systematic documentation of QC work was undertaken or planned in all 23 ASHIIP, and 10 ASHIP carried out comparative evaluation, with at least five others planning to start it. The ASHIP promoted the work of QC by providing organizational (22) or financial (20) support, materials (20) or mediation of resource persons (16). Eleven ASHIP received grants from drug companies. ASHIP rated the future importance of QC as increasing (18) or stable (four), but in no case as decreasing. CONCLUSIONS AND RECOMMENDATIONS: The quantitative growth of QC in Germany is encouraging, but the extent of support and evaluation appears insufficient. Increased methodological support and facilitation, follow-up meetings on a more regular basis, improved documentation and evaluation of individual QC, and problem oriented evaluation of their impact on health care are essential for further successful development. Principles, problems and solutions discussed may be relevant for similar QI activities in other countries.

Ambulatory Care↗
PubMed1995

[Case-oriented work in the quality circle].

Considering the discrepancy between scientific knowledge and definite behaviour during consultation ("performance gap"), acceptance, proceedings and case oriented work in quality circles/peer review groups are described. 79% of 138 general practitioners declared that working in quality circles should base on cases from daily practice. Exchange of experiences and the expectation to get help for solving specific problems in the daily practice are the most important motives for participating in quality circles. For one circle as an example, the process of topic and case oriented work on the basis of objective documents from the practices of the participants and the following case oriented development of guidelines are described. Finally, the implicit chances of case oriented work in quality circles are shown with respect to existing experiences.

Education, Medical, Continuing↗
PubMed1995

[Evaluation of a training program for moderators of panel doctor quality circles: a progress assessment].

We report about the first 7 seminars of a training programme for presenters of quality circles for panel doctors. The seminars aim to train techniques of moderating a group and to give a methodological background for the work with quality circles. 65 (44.2%) of the 147 participants were general practitioners, 34 (23.1%) were internists and 32 (21.8%) were specialists of other disciplines. 16 (10.9%) were not physicians or not working as a physician. An evaluation of the seminars by a structured questionnaire showed mean ratings of 2.1 for lectures [in terms of school-marks from 1 (very good) to 6 (very poor)] and 1.8 for the work in small groups. Working atmosphere and opportunities for active participation were rated most positively. 6 months after the course, 64.9% of the participants already had arranged dates for meetings or had started with own quality circles.

Education, Medical↗