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Experiences with a patient-oriented navigation program in Germany from the navigators' perspectives

Authors:
  • Gemeinsamer Bundesausschuss (G-BA) (Federal Joint Committee)

Abstract

Background The German healthcare system has a distinct separation of outpatient and inpatient care, with no coordination along a patient's care trajectory between these sectors. Additionally, support offers are often unknown by patients and providers. To address these barriers, we developed a patient-oriented navigation program for people with chronic conditions in Germany, which mainly focus on the patients' individual needs. Methods In a mixed methods study our navigation program for people with lung cancer and stroke is being evaluated in the German healthcare context. Patient navigators support study participants in their individual healthcare organization and coordination for 13 months. Qualitative interviews are conducted regularly with the navigators to capture their experiences with the navigation program. Results In our study, three navigators support a total of 122 study participants. Their activities include emotional support, help with bureaucratic matters, organizing outpatient care and gathering specialized information. There is a high overlap in navigation tasks between the two groups of patients. Interviews show that the navigators perceive their work as meaningful and find the exchange within the team and the offer of supervision very important. Conclusions For navigation of chronic conditions that require complex care, such as lung cancer and stroke, it appears important to ensure that patients' emotional, social and coordination needs are met in a way that suits their individual wishes. The experiences of the navigators as providers of the navigation intervention can be used for a practice-oriented optimization of the navigation program. Key messages • Navigation tasks overlap to a large extent in both groups of patients despite the differences in disease trajectories. • We suggest that a patient-oriented navigation program focusing on social and coordination needs does not have to be disease-specific but can cover general needs of people with complex care situations.
carbohydrate and lipid metabolisms that precede T2D. The
correlation between IR and high-density lipoprotein choles-
terol (HDL-C) levels is known, but the underlying mechanisms
are not fully understood. The present study aimed to
investigate the association between HDL subfraction profile
and the development of IR.
Methods:
The progression of IR was assessed using the Homeostatic
Model Assessment for IR index (HOMA-IR), and IR was
defined as those with a HOMA-IR greater than 3.63. The HDL-
C was separated using the Lipoprint system, which identifies
ten subfractions (HDL-1-10) and three classes: large- (HDL-
L), intermediate- (HDL-I), and small-HDL (HDL-S). All
analyses were performed on samples of 240 control subjects
and 137 individuals with IR from the Hungarian general and
Roma populations.
Results:
The HDL-1 to -6 and the HDL-L and -I showed a significant
negative association with elevated HOMA-IR and the presence
of IR. Among them, HDL-2 (b= 42.2, p = 4.1 10-12) and
HDL-L (b= 15.5, p = 2.2 10-10) showed the strongest
correlation with the IR progression. The optimal cut-off
value was found to be 0.264 mmol/L for HDL-L and
0.102 mmol/L and above for HDL-2. The risk of IR is 5.1
times higher for HDL-L levels below the cut-off (p = 2.2 10-
7), and 4.2 times higher for HDL-2 (p = 3.0 10-6).
Furthermore, the risk of early manifestation of IR are
significantly higher in individuals with both HDL-L
(HR = 3.5, p = 3.2 10-7) and HDL-2 (HR = 3.19,
p = 2.0 10-6) levels below the cut-off.
Key messages:
HDL-2 and -L levels are strongly associated with the
development of insulin resistance.
Elevated risk of early onset of insulin resistance is
associated with HDL subfraction profile.
Abstract citation ID: ckad160.1138
Experiences with a patient-oriented navigation
program in Germany from the navigators’
perspectives
Hella Fuegemann
H Fuegemann
1
, K Goedde
2
, U Goerling
3
, N Rieckmann
2
, C Holmberg
1
1
Institute of Social Medicine and Epidemiology, Brandenburg Medical
School Theodor Fontane, Brandenburg a.d. Havel, Germany
2
Institute of Public Health, Charite
´- Universita
¨tsmedizin Berlin, Berlin,
Germany
3
Charite
´Comprehensive Cancer Center, Charite - Universita
¨tsmedizin
Berlin, Berlin, Germany
Contact: hella.fuegemann@mhb-fontane.de
Background:
The German healthcare system has a distinct separation of
outpatient and inpatient care, with no coordination along a
patient’s care trajectory between these sectors. Additionally,
support offers are often unknown by patients and providers.
To address these barriers, we developed a patient-oriented
navigation program for people with chronic conditions in
Germany, which mainly focus on the patients’ individual
needs.
Methods:
In a mixed methods study our navigation program for people
with lung cancer and stroke is being evaluated in the German
healthcare context. Patient navigators support study partici-
pants in their individual healthcare organization and coordi-
nation for 13 months. Qualitative interviews are conducted
regularly with the navigators to capture their experiences with
the navigation program.
Results:
In our study, three navigators support a total of 122 study
participants. Their activities include emotional support, help
with bureaucratic matters, organizing outpatient care and
gathering specialized information. There is a high overlap in
navigation tasks between the two groups of patients. Interviews
show that the navigators perceive their work as meaningful and
find the exchange within the team and the offer of supervision
very important.
Conclusions:
For navigation of chronic conditions that require complex
care, such as lung cancer and stroke, it appears important to
ensure that patients’ emotional, social and coordination needs
are met in a way that suits their individual wishes. The
experiences of the navigators as providers of the navigation
intervention can be used for a practice-oriented optimization
of the navigation program.
Key messages:
Navigation tasks overlap to a large extent in both groups of
patients despite the differences in disease trajectories.
We suggest that a patient-oriented navigation program
focusing on social and coordination needs does not have to
be disease-specific but can cover general needs of people
with complex care situations.
Abstract citation ID: ckad160.1139
Exercise as medicine: Physicians’ perceptions of
physical activity and exercise for chronic diseases
Niki Syrou
N Syrou
1,2
, IG Fatouros
1
, G Metsios
3
, AZ Jamurtas
1
, D Draganidis
1
,,
TJ Angelopoulos
4
, G Loules
1
, G Mastorakos
2
1
Physical Education and Sport Science, University of Thessaly, Trikala,
Greece
2
School of Medicine, National and Kapodistrian University of Athens,
Athens, Greece
3
Dietetics and Nutrition, University of Thessaly, Trikala, Greece
4
Rehabilitation and Movement Science, University of Vermont, Vermont,
USA
Contact: nikisyrou@uth.gr
Background:
Although physical activity and exercise (PAE) offer several
health advantages in the management of non-communicable
diseases (NCDs), its systematic implementation in medical
practice remains questionable. The aim of the study was to
investigate Greek physicians’ knowledge, attitudes, intentions,
abilities, and behavior (KAIAB) towards PAE in the manage-
ment of NCDs.
Methods:
A nationwide, cross-sectional, online study was conducted
(October 2022 - March 2023) in Greece via a new
questionnaire, which was developed and pilot-tested at an
earlier stage of the study. The questionnaire’s link was
distributed to participants by email through their Medical
Association. We computed physicians’ KAIAB total scale score
as the sum of their responses. The three levels of Bloom’s cut-
off points were modified and were used to classify physicians’
KAIAB levels towards PAE.
Results:
The physicians’ KAIAB levels in PAE were expressed as mean
values (MV) and standard deviations (SD) respectively (MV/
SD), as follows: 11.5/3.32 (low knowledge), 134.8/17.20
(moderate attitudes), 33.8/5.63 (high intentions), 19.48/5.76
(low abilities), and 30.81/7.23 (moderate behavior).
Cronbach’s alpha varied from 0.796 to 0.930 to achieve a
high internal consistency to the scales of the new
questionnaire.
Conclusions:
Greek physicians definitely are willing to advise and prescribe
PAE and demonstrate moderate attitudes and behavior on these
issues that need further improvement. However, their knowl-
edge and self-reported abilities are apparently low, particularly
on PAE prescription. These results suggest that, in order to
include PAE in medical practice, are needed future policies to
develop strategies to promote physicians’ education and training
to improve their knowledge and skills on PAE, the adoption of
exercise prescription strategies, and the integration of PAE into
ii454 European Journal of Public Health, Volume 33 Supplement 2, 2023
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