Tobias Freund

• MD
• Researcher at Heidelberg University

„Allgemeinmedizin: Der Mentor für die Facharztprüfung und für die allgemeinmedizinische ambulante Versorgung“ der Herausgeber Hans-Dieter Klimm und Frank Peters-Klimm erschien im Jahr 2023 in der bereits siebten und überarbeiteten Auflage im Georg Thieme Verlag. Das in fünf Teile gegliederte Buch ist logisch aufgebaut. So informieren die Autor*inne...

Background Growing prevalence of chronic diseases is a rising challenge for healthcare systems. The Primary Care Practice-Based Care Management (PraCMan) programme is a comprehensive disease management intervention in primary care in Germany aiming to improve medical care and to reduce potentially avoidable hospitalisations for chronically ill pati...

Background: Previously we developed a structured case management for multimorbid chronically ill patients in primary care (called ‘PraCMan’), delivered by Health Care Assistants in General Practice (VERAHs). The ‘TelePraCMan’ project aims to develop a supplementary web-based application to ‘PraCMan’, including a digital symptom diary in which patie...

Background: Previously we developed a structured case management for patients with multiple chronic conditions in primary care (called ‘PraCMan’), delivered by Health Care Assistants in General Practice (VERAHs). The ‘TelePraCMan’ project aims to develop a supplementary web-based application to ‘PraCMan’, including a digital symptom diary in which...

Zielgruppe von QISA sind in der Praxis tätige Ärztinnen und Ärzte. Unter ihnen spricht das Indikatorensystem insgesamt eher die hausärztlich Tätigen an. Die Einzelbände richten sich aber auch an die fachärztlich Tätigen. QISA ist speziell für ärztliche Kooperationen wie Qualitätszirkel, Arztnetze, Medizinische Versorgungszentren oder Hausarztverträ...

[This corrects the article DOI: 10.1371/journal.pone.0214056.].

Purpose This study aimed to assess the effectiveness of a care management intervention in improving self-management behavior in multimorbid patients with type 2 diabetes; care was delivered by medical assistants in the context of a primary care network (PCN) in Germany. Methods This study is an 18-month, multi-center, two-armed, open-label, patien...

Background Hospitalisations are a critical event in the care process. Insufficient communication and uncoordinated follow-up care often impede the recovery process of the patient resulting in a high number of rehospitalisations and increased health care costs. The overall aim of this study is the development, implementation and evaluation of a stru...

Objective: On the basis of current treatment guidelines, we developed and validated a medication-based chronic disease score (medCDS) and tested its association with all-cause mortality of older outpatients. Study design and setting: Considering the most prevalent chronic diseases in the elderly German population, we compiled a list of evidence-...

Attachment theory helps us to understand patients´ health behavior. Attachment styles might explain patient differences in coping behavior, self-treatment, or patient-provider relationships. In primary care time constrains are relevant. A short instrument may facilitate screening and assessment in daily medical practice. The aim of this study was t...

Background: Key recommendations for the management of patients with polypharmacy are structured medication counselling (SMC), medication lists and systematic medication reviews. Objective: The aim of this study was to identify determinants (hindering and facilitating factors) for the implementation of the recommendations in general practice. Me...

Background We developed and evaluated a tailored programme to implement three evidence-based recommendations for multimorbid patients with polypharmacy into primary care practices: structured medication counselling including brown bag reviews, the use of medication lists and medication reviews. No effect on the primary outcome was found. This proce...

Background: Multimorbid patients receiving polypharmacy represent a growing population at high risk for negative health outcomes. Tailoring is an approach of systematic intervention development taking account of previously identified determinants of practice. The aim of this study was to assess the effect of a tailored program to improve the imple...

Background Although there is evidence that tailored implementation strategies can be effective, there is little evidence on which methods of tailoring improve the effect. We designed and evaluated five tailored programs (TPs) each consisting of various strategies. The aim of this study was to examine (a) how determinants of practice prioritized in...

Background: Patients with multiple chronic conditions are at high risk for potentially avoidable hospitalizations, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective: To determine whether protocol-based care managem...

Background: Patient Reactions Assessment (PRA) is an established instrument in the English language to measure patient perceived quality of the physician-patient relationship. The aim of the study was to transfer the 15 item questionnaire with three subscales( information, communication and affectivity) to German and to evaluate it in a primary car...

. Medication lists and structured medication counselling (SMC) including “brown bag reviews” (BBR) are important instruments for medication safety. The aim of this study was to explore whether patients’ use of a medication list is associated with their beliefs about their medicine and their memory of SMC. Methods. Baseline data of 344 patients enro...

Background On the basis of the assumption that a significant proportion of hospitalisations for so-called ambulatory care sensitive conditions (ACSCs) are potentially avoidable by ambulatory care measures, hospitalisation rates for ACSCs are used internationally as population based indicators for access to and quality of ambulatory care. The German...

World-wide, shortages of primary care physicians and an increased demand for services have provided the impetus for delivering team-based primary care. The diversity of the primary care workforce is increasing to include a wider range of health professionals such as nurse practitioners, registered nurses and other clinical staff members. Although t...

Background One of the most widely used self-reporting tools assessing diabetes self-management in English is the Summary of Diabetes Self-Care Activities (SDSCA) measure. To date there is no psychometric validated instrument in German to assess self-management in patients with diabetes mellitus. Therefore, this study aimed to translate the SDSCA in...

Case management allows us to respond to the complex needs of a vulnerable clientele through a structured approach that promotes enhanced interaction between partners. Syntheses on the subject converge towards a need for a better description of the relationships between programmes and their local context, as well as the characteristics of the client...

Background Care management interventions in the German health-care system have been evaluated with promising results, but further research is necessary to explore their full potential in the context of multi-morbidity. Our aim in this trial is to assess the efficacy of a primary care practice network–based care management intervention in improving...

In the 'Tailored Implementation for Chronic Diseases (TICD)' project, five tailored implementation programs to improve healthcare delivery in different chronic conditions have been developed. These programs will be evaluated in distinct cluster-randomized controlled trials. This protocol describes the process evaluation across these trials, which a...

BACKGROUND: On the basis of the assumption that a significant proportion of hospitalisations for so-called ambulatory care sensitive conditions (ACSCs) are potentially avoidable by ambulatory care measures, hospitalisation rates for ACSCs are used internationally as population based indicators for access to and quality of ambulatory care. The Germa...

Patients with chronic disease usually need to take multiple medications. Drug-related interactions, adverse events, suboptimal adherence, and self-medication are components that can affect medication safety and lead to serious consequences for the patient. At present, regular medication reviews to check what medicines have been prescribed and what...

Implementation research deals with the question of how to ensure that evidence-based knowledge is put into practice. One approach is the development of "tailored interventions (TI)". These are designed to address previously identified barriers and enablers. A common definition or methodological concept for TI has not yet been established. In this p...

Multimorbid patients frequently receive complex medication regimens and are at higher risk for adverse drug reactions and hospitalisations. Managing patients with polypharmacy is demanding, because it requires coordination of multiple prescribers and intensive monitoring. Three evidence-based recommendations addressing polypharmacy in primary care...

Primary care-based care management (CM) could reduce hospital admissions in high-risk patients. Identification of patients most likely to benefit is needed as resources for CM are limited. This study aimed to compare hospitalization and mortality rates of patients identified for CM either by treating primary care physicians (PCPs) or predictive mod...

The patients' active participation in their medical care is important for patients with chronic diseases. Measurements of patient activation are needed for studies and in clinical practice. This study aims to validate the Patient Activation Measure 13 (PAM13-D) in German-speaking primary care patients. This international cross-sectional multicentre...

This study aimed to describe and to analyse the importance of educational level for controlled risk factors and health-related quality of life (HRQoL). This observational study was conducted in nine European countries (5632 patients in 249 practices). We compared patients with a low level of education (up to 9 years) with patients with a high level...

Targeting patients for multimorbid care management interventions requires accurate and comprehensive assessment of patients' need in order to direct resources to those who need and can benefit from them the most. Multimorbid patient selection is complicated due to the lack of clear criteria - unlike disease management programs for which patients wi...

Purpose: Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are seen as potentially avoidable with optimal primary care. Little is known, however, about how primary care physicians rate these hospitalizations and whether and how they could be avoided. This study explores the complex causality of such hospitalizations from the perspe...

Background: Successful and clinically relevant research in family medicine requires interdisciplinary and interprofessional cooperation between family practices and academic departments of primary care. The aim of this paper is to report on the development of a reliable functional structure bridging the "gap" between practice and the university. Me...

Background: The academic development of family medicine plays an important role for its professionalisation in Germany. An important aspect of development is the promotion of young academic family practitioners (FPs). However, young FPs in clinical training who also perform research and teaching are confronted with many difficulties. The aim of thi...

Introduction Implementation research deals with the question of how to ensure that evidence-based knowledge is put into practice. One approach is the development of “tailored interventions (TI)”. These are designed to address previously identified barriers and enablers. A common definition or methodological concept for TI has not yet been establish...

Patients with chronic disease usually need to take multiple medications. Drug-related interactions, adverse events, suboptimal adherence, and self-medication are components that can affect medication safety and lead to serious consequences for the patient. At present, regular medication reviews to check what medicines have been the prescribed and w...

BACKGROUND: For patients with coronary heart diseases a substantial part of secondary prevention is delivered in primary care. Along with the growing importance of prevention, health-related quality of life (HRQoL) is an indicator of patient-centered care that has gained increased attention. Different approaches for reorganization in primary care h...

Fixed part results of the random intercept models fitted to subsample of single- handed practices. (DOCX)

Fixed part results of the random intercept models fitted to the total sample. (DOCX)

Fixed part results of the random intercept models fitted to subsample of group practices. (DOCX)

Wie behandeln Sie Husten und Halsschmerzen? Erfüllen Sie die Erwartungen der Patienten oder schicken Sie diese ohne Rezept wieder nach Hause? Unser Autor nimmt zu diesen für die Praxis wichtigen Fragen Stellung.

Medication adherence can be essential for improving health outcomes. Patients with multiple chronic conditions, often receiving multiple medications, are at higher risk for medication nonadherence. Previous research has focused on concordance between patients and providers about which medication should be taken. However, the question of whether pat...

Introduction: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the...

Hintergrund: Das BMBF-Vorhaben Metropolregion Rhein-Neckar – Raum für Gesundheit. ist eine von fünf BMBF-geförderten „Gesundheitsregionen der Zukunft“. Das Vorhaben integriert in enger Kooperation von Industrie und Wissenschaft neue Technologien in Gesundheitsdienstleistungen, mit dem Ziel, die sektorenübergreifende Versorgung zu verbessern. Das Te...

Hintergrund: Das BMBF-Vorhaben Metropolregion Rhein-Neckar „Raum für Gesundheit“ ist eine von fünf BMBF-geförderten „Gesundheitsregionen der Zukunft“. Das übergeordnete Ziel der Gesundheitsregion ist es, Strukturen und Prozesse zu etablieren, welche eine integrierte und sektorenübergreifende Versorgung von chronisch kranken Menschen ermöglichen. Au...

Background Primary care for chronic illness varies across European healthcare systems. In patients suffering from coronary heart disease (CHD), factors associated with patients’ experiences of receiving structured chronic care and counselling at the patient and practice level were investigated. Methods In an observational study comprising 140 gene...

This study explores the impact of perceived social support and sense of coherence as positive resources for health-related quality of life in multimorbid primary care patients. We analysed cross-sectional survey data on health-related quality of life (EQ-5D), perceived social support (FSozU-K22), sense of coherence (SOC-L9), social demographics and...

BACKGROUND: Self-care behaviour in patients with heart failure (HF) represents a series of specific actions that patients should take, as an important treatment component. AIMS: The aim of this study was to identify potential determinants of HF self-care in ambulatory patients with stable systolic HF. METHODS: In a cross-sectional study of 318 pati...

The identification of patients most likely to benefit from care management programs-case finding-is a crucial determinant of their effectiveness regarding improved health outcomes and reduced costs. Until now, research has mainly focused on claims data-based case finding. This study aimed to explore how primary care physicians (PCPs) select patient...

Care management is seen as a promising approach to address the complex care needs of patients with multimorbidity. Predictive modeling based on insurance claims data is an emerging concept to identify patients likely to benefit from care management interventions. We aimed to identify and explore patterns of multimorbidity in primary care patients w...

The Patient Assessment of Chronic Illness Care (PACIC) is a widely used instrument to evaluate the quality and patient-centeredness of chronic illness care based on the Chronic Care Model (CCM). It is a validated and reliable instrument which consists of 20 items. Additionally, a short form with 11 items was developed. The aim of this study was to...

Aims Previous evaluations of the German disease management program (DMP) for type 2 diabetes show that this approach curbs drug and hospital costs, may reduce mortality and improve quality of diabetes care. Otherwise until now there have been no evaluations which analyse the impact of comorbidity (COMORB) on the effectiveness of German DMP to stren...

Hintergrund Schriftliche Patienteninformationen haben im Verlauf der Krankenhausbehandlung eine große Bedeutung. Allerdings werden damit verbundene Anforderungen oftmals aus der Perspektive der Patienten betrachtet. Übersehen wird dabei, dass vor dem Hintergrund struktureller Veränderungen im Gesundheitssystem auch aus Sicht der Krankenhäuser mit d...

Patients with chronic heart failure have complex care needs which can be addressed by case management interventions. Monitoring lists for heart failure were developed and tested as part of a trial evaluating primary care-based case management of patients with heart failure (HICMan). Design and characteristics of the monitoring lists used during the...

Practice quality indicators. (DOC)

BACKGROUND: Cardiovascular risk management plays an important role in primary care. In patients at high risk for cardiovascular diseases (CVD) lifestyle and, where appropriate, medical interventions are recommended in guidelines. Health-related quality of life (HRQoL) is an important outcome in clinical practice. This study aimed to assess the HRQo...

The greatest proportion of basic health care for patients with a migrational background living in Germany is provided by general practitioners. There is evidence that patients with a migrational background see a general practitioner as a gate keeper in case of physical or mental complaints even more frequently than the native German population. In...

The greatest proportion of basic health care for patients with a migrational background living in Germany is provided by general practitioners. There is evidence that patients with a migrational background see a general practitioner as a gate keeper in case of physical or mental complaints even more frequently than the native German population. In...

Objective: Self-efficacy - the confidence to carry out certain behaviour in order to achieve a specific goal - has increasingly been recognized as an essential prerequisite of effective self-management of chronic diseases. Therefore, valid and reliable measures are needed to evaluate self-efficacy in both research and clinical practice. This study...

There is a growing need for studies to measure how patients feel supported in their autonomy. The Health Care Climate Questionnaire (HCCQ) is an instrument to assess the physician's support to motivate the patient to take personal responsibility for his/her health. The aim of this study was to translate the HCCQ into German and validate the transla...

The co-occurance of multiple medical conditions has a negative impact on health related quality of life (HRQoL) for patients with type 2 diabetes. These patients demand for intensified care programs. Participation in a disease management program (DMP) for type 2 diabetes has shown to counterbalance this effect. However, it remains unclear which dim...

Introduction: In light of limited human and restricted financial resources there is a call for innovative multi-professional care strategies that take up the challenge of primary care for the chronically ill. Case management is an increasingly discussed approach. This raises the question how family practice teams conceptualize and experience case m...

Care management programmes are an effective approach to care for high risk patients with complex care needs resulting from multiple co-occurring medical and non-medical conditions. These patients are likely to be hospitalized for a potentially "avoidable" cause. Nurse-led care management programmes for high risk elderly patients showed promising re...

To compare predictive modeling (PM), selection by primary care physician (PCP), and a combination of both as approaches to prospective patient identification for care management programs. Observational study. A total of 6026 beneficiaries of a statutory health insurance program in Germany served as a sample for patient identification by PM and sele...

The Chronic Care Model (CCM) is a framework for the structured care of patients with chronic conditions. It requires access of both physicians and patients to scientific evidence in order to facilitate shared treatment decision-making on the basis of the patient's individual needs and the best available external evidence. The aim of this study was...

Models for the structured delivery of care rely on organizational attributes of practice teams. The Survey of Organizational Attributes for Primary Care (SOAPC) is known to be a valid instrument to measure this aspect in the primary care setting. The aim of this study was to determine the validity of a translated and culturally adapted German versi...

Beim Impfstatus Erwachsener in Deutschland zeigen sich seit Jahren deutliche Lücken. Auch die Teilnahmerate an der Gesundheitsuntersuchung nach § 25 SGB V (Check up 35) ist gering. Insgesamt nimmt der Impfschutz mit dem Alter ab, die Teilnahmerate am Check up 35 aber zu. Im Rahmen einer Studie zum Präventionsverhalten hausärztlicher Patienten unter...

Background and purpose: Since 2004, primary care in Germany has increasingly been provided in special general practitioner (GP)-centred health care contracts (HZV). To date there is limited evidence about the characteristics of their beneficiaries regarding morbidity burden and health care utilization. Methods: We analysed insurance claims data...

The vaccination status of German adults needs improvement. Low participation is also known in health screening programmes like the "Check up 35" which is offered every two years for adults aged 35 or above. However, the number of participants in health screening increases with age whereas vaccination status decreases. Within a study about patients'...

Since 2004, primary care in Germany has increasingly been provided in special general practitioner (GP)-centred health care contracts (HZV). To date there is limited evidence about the characteristics of their beneficiaries regarding morbidity burden and health care utilization. We analysed insurance claims data from all beneficiaries of the "Allge...

Complex care management is seen as an approach to face the challenges of an ageing society with increasing numbers of patients with complex care needs. The Medical Research Council in the United Kingdom has proposed a framework for the development and evaluation of complex interventions that will be used to develop and evaluate a primary care-based...

To cater to the needs of informed and proactive patients in family medicine, health care providers could offer access to care and health information via practice Web sites. To determine the content and quality of family medicine Web sites, we performed a cross-sectional study on a large sample of family practices' Web sites in Berlin, Germany. Afte...

Background Case management is an important component of structured and evidence-based primary care for chronically ill patients. Its effectiveness and efficiency has been evaluated in numerous clinical trials. This protocol describes aims and methods of a systematic review of research on the effectiveness and efficiency of case management in primar...

Risk of bias assessment checklist. This file contains a detailed checklist for the assessment of risk which will be used in this review. It is an adapted version of the tool provided by the Cochrane EPOC Group.

Hintergrund und Ziel: Die Versorgung chronischer Krankheiten und Multimorbidität stellen eine zunehmende Herausforderung dar. Die speziellen Anforderungen multipel und chronisch erkrankter Patienten lassen die hausärztliche Versorgung stetig komplexer werden. Als Teil umfassender Konzepte zur strukturierten Versorgung wie etwa des Chronic-Care-Mode...

Care for patients with multiple and chronic diseases is an increasing challenge. The particular demands of chronically ill patients increase the complexity of primary care. Involvement of doctors' assistants is discussed as part of comprehensive frameworks for structured care like the Chronic Care Model (CCM). The aim of this qualitative study was...

Tobias Freund and Carsten Lekutat argue that out of hour locums from abroad must face stronger checks

The inverse correlation of mycobacterial infection with asthma prevalence and the inhibitory effects of vaccination with Bacille Calmette-Guérin (BCG) on airway hyperreactivity in asthma models suggest modulation of dendritic cell (DC) and T cell functions by mycobacterial compounds. To delineate these immunological effects, the immunogenicity of B...

Dendritic cells (DCs) play an important role in directing naive T cells towards a Th1/Th2 or regulatory T cells (Treg) cell phenotype. In this context, interleukin (IL)-10 has been shown to exhibit immune regulatory capacities. The aim of this study was to delineate the influence of high-IL-10-producing DCs on DC-T-cell interactions in inhibiting a...

This comparative study of tumour patients and volunteers aimed at differentiating liver parenchyma from neoplastic lesions by using localised (1)H MRS at 3.0 T as an adjunct to MRI. In total 186 single-voxel proton spectra of the liver were acquired at 3.0 T using the body transmit receive coil. Consecutive stacks of breath-hold spectra were acquir...

Hintergrund: Der von der neuen Approbationsordnung für Ärzte geforderte „Unterricht am Krankenbett” findet im Fach Allgemeinmedizin in der Hausarztpraxis statt. Die Anwesenheit von Studierenden während der Konsultation kann das Arzt-Patient-Verhältnis beeinflussen. Methoden: Eine anonyme Befragung von Patienten in Lehrpraxen sollte klären, wie sie...

Evaluation of MR-guided interstitial laser thermotherapy (ILT) of colorectal liver metastases under consideration of efficacy, safety and patient survival. Sixty-six inoperable patients with a total of 117 colorectal liver metastases were treated with MR-guided laser therapy in 96 sessions. 40.9% of patients presented metastases from rectum carcino...

Retrospectively, magnetic resonance (MR) colonography images obtained from a colon model and in routine examinations of patients screened for polyps were compared in terms of whether, and to what degree, image quality improved at a higher field strength of 3.0 T compared to 1.5 T. One hundred twenty-eight MR colonography images from 40 patients, of...

To improve the sensitivity of computed tomography (CT) colonography in the detection of polyps by comparing the 3D reconstruction tool "colon dissection" and endoluminal view (virtual colonoscopy) with axial 2D reconstructions. Forty-eight patients (22 M, 26 F, mean age 57 +/- 21) were studied after intra-anal air insufflation in the supine and pro...