Cornelia Wäscher’s research while affiliated with Charité Universitätsmedizin Berlin and other places

Zusammenfassung Hintergrund Multimorbide und hochaltrige Patient*innen wenden sich mit sozialen Beratungsanlässen meistens an ihre Hausärzt*innen (HÄ). Mit den Pflegestützpunkten (PSP) gibt es etablierte Institutionen, die entsprechende Beratungen anbieten. Methoden In einer Machbarkeitsstudie wurde eine Kooperation zwischen HÄ und PSP in 2 Berliner Stadtbezirken initiiert und untersucht. Während einer 15-monatigen Interventionsphase sollten HÄ multimorbide Patient*innen mit sozialen Beratungsanlässe zu lokal etablierten PSP schicken. Die sozialen Beratungen anhand der auf einem zuvor entwickelten „Überweisungsschein“ erhobenen Anlässe und Ergebnisse wurden kategorisiert. Patient*innenbezogene Outcomes wurden auf der Basis eines Assessments im Vergleich vor und nach der PSP-Beratung erhoben und deskriptiv analysiert. Ergebnisse Jede/r von den HÄ ( n = 10) in einen PSP „überwiesene/r“ Patient*in ( n = 63) erhielt dort ein Assessment des tatsächlichen Beratungsbedarfs unabhängig von zuvor benannten Beratungsanlässen. Die teilnehmenden Patient*innen waren mehrheitlich hochbetagt, chronisch krank und in ihren Alltagsaktivitäten eingeschränkt. Die Mehrheit erfüllte die Kriterien einer Depression, viele waren einsam. Nach der Beratung im PSP wissen mehr Patient*innen, an wen sie sich in Bezug auf soziale Fragen wenden können. Diskussion Die Teilnahmezahlen von HÄ und Patient*innen blieb deutlich hinter den Erwartungen, da das Projekt in die erste Phase der COVID-19-Pandemie fiel. Die Ergebnisse sind entsprechend nur eingeschränkt aussagefähig. Eine Kooperation von HÄ und PSP ist angesichts angrenzender Versorgungsaufträge naheliegend und machbar. Multimorbide Patient*innen leiden häufig unter Depressionen und Einsamkeit. Diese Patient*innen sollten durch ihre HÄ frühzeitig auf das Angebot der PSP hingewiesen werden.

Background Symptom checker apps (SCAs) are layperson-facing tools that advise on whether and where to seek care, or possible diagnoses. Previous research has primarily focused on evaluating the accuracy, safety, and usability of their recommendations. However, studies examining SCAs’ impact on clinical care, including the patient-physician interaction and satisfaction with care, remain scarce. Objective This study aims to evaluate the effects of an SCA on satisfaction with the patient-physician interaction in acute care settings. Additionally, we examined its influence on patients’ anxiety and trust in the treating physician. Methods This parallel-group, randomized controlled trial was conducted at 2 emergency departments of an academic medical center and an emergency practice in Berlin, Germany. Low-acuity patients seeking care at these sites were randomly assigned to either self-assess their health complaints using a widely available commercial SCA (Ada Health) before their first encounter with the treating physician or receive usual care. The primary endpoint was patients’ satisfaction with the patient-physician interaction, measured by the Patient Satisfaction Questionnaire (PSQ). The secondary outcomes were patients’ satisfaction with care, their anxiety levels, and physicians’ satisfaction with the patient-physician interaction. We used linear mixed models to assess the statistical significance of primary and secondary outcomes. Exploratory descriptive analyses examined patients’ and physicians’ perceptions of the SCA’s utility and the frequency of patients questioning their physician’s authority. Results Between April 11, 2022, and January 25, 2023, we approached 665 patients. A total of 363 patients were included in the intention-to-treat analysis of the primary outcome (intervention: n=173, control: n=190). PSQ scores in the intervention group were similar to those in the control group (mean 78.5, SD 20.0 vs mean 80.8, SD 19.6; estimated difference –2.4, 95% CI –6.3 to 1.1, P=.24). Secondary outcomes, including patients’ and physicians’ satisfaction with care and patient anxiety, showed no significant group differences (all P>.05). Patients in the intervention group were more likely to report that the SCA had a beneficial (66/164, 40.2%) rather than a detrimental (3/164, 1.8%) impact on the patient-physician interaction, with most reporting no effect (95/164, 57.9%). Similar patterns were observed regarding the SCA’s perceived effect on care. In both groups, physicians rarely reported that their authority had been questioned by a patient (intervention: 2/188, 1.1%; control: 4/184, 2.2%). While physicians more often found the SCA helpful rather than unhelpful, the majority indicated it was neither helpful nor unhelpful for the encounter. Conclusions We found no evidence that the SCA improved satisfaction with the patient-physician interaction or care in an acute care setting. By contrast, both patients and their treating physicians predominantly described the SCA’s impact as beneficial. Our study did not identify negative effects of SCA use commonly reported in the literature, such as increased anxiety or diminished trust in health care professionals. Trial Registration German Clinical Trial Register DRKS00028598; https://drks.de/search/en/trial/DRKS00028598/entails International Registered Report Identifier (IRRID) RR2-10.1186/s13063-022-06688-w

BACKGROUND Symptom checker apps (SCAs) are layperson-facing tools that advise on whether and where to seek care, or possible diagnoses. Previous research has primarily focused on evaluating the accuracy, safety, and usability of their recommendations. However, studies examining SCAs’ impact on clinical care, including the patient-physician interaction and satisfaction with care, remain scarce. OBJECTIVE This study aims to evaluate the effects of an SCA on satisfaction with the patient-physician interaction in acute care settings. Additionally, we examined its influence on patients’ anxiety and trust in the treating physician. METHODS This parallel-group, randomized controlled trial was conducted at 2 emergency departments of an academic medical center and an emergency practice in Berlin, Germany. Low-acuity patients seeking care at these sites were randomly assigned to either self-assess their health complaints using a widely available commercial SCA (Ada Health) before their first encounter with the treating physician or receive usual care. The primary endpoint was patients’ satisfaction with the patient-physician interaction, measured by the Patient Satisfaction Questionnaire (PSQ). The secondary outcomes were patients’ satisfaction with care, their anxiety levels, and physicians’ satisfaction with the patient-physician interaction. We used linear mixed models to assess the statistical significance of primary and secondary outcomes. Exploratory descriptive analyses examined patients’ and physicians’ perceptions of the SCA’s utility and the frequency of patients questioning their physician’s authority. RESULTS Between April 11, 2022, and January 25, 2023, we approached 665 patients. A total of 363 patients were included in the intention-to-treat analysis of the primary outcome (intervention: n=173, control: n=190). PSQ scores in the intervention group were similar to those in the control group (mean 78.5, SD 20.0 vs mean 80.8, SD 19.6; estimated difference –2.4, 95% CI –6.3 to 1.1, P =.24). Secondary outcomes, including patients’ and physicians’ satisfaction with care and patient anxiety, showed no significant group differences (all P >.05). Patients in the intervention group were more likely to report that the SCA had a beneficial (66/164, 40.2%) rather than a detrimental (3/164, 1.8%) impact on the patient-physician interaction, with most reporting no effect (95/164, 57.9%). Similar patterns were observed regarding the SCA’s perceived effect on care. In both groups, physicians rarely reported that their authority had been questioned by a patient (intervention: 2/188, 1.1%; control: 4/184, 2.2%). While physicians more often found the SCA helpful rather than unhelpful, the majority indicated it was neither helpful nor unhelpful for the encounter. CONCLUSIONS We found no evidence that the SCA improved satisfaction with the patient-physician interaction or care in an acute care setting. By contrast, both patients and their treating physicians predominantly described the SCA’s impact as beneficial. Our study did not identify negative effects of SCA use commonly reported in the literature, such as increased anxiety or diminished trust in health care professionals. CLINICALTRIAL German Clinical Trial Register DRKS00028598; https://drks.de/search/en/trial/DRKS00028598/entails INTERNATIONAL REGISTERED REPORT RR2-10.1186/s13063-022-06688-w

Zusammenfassung Hintergrund Intensivmedizinische Aufenthalte führen bei vorbelasteten Menschen häufig zu Symptomen einer posttraumatischen Belastungsstörung (Post-ICU-PTBS). In der Nachsorge spielen HausärztInnen eine wichtige Rolle. Falldarstellung Eine 58-jährige Patientin entwickelt nach erlebter Sepsis eine Post-ICU-PTBS. Sie erhält durch ihre Hausärztin eine Kurzform der Narrativen Expositionstherapie (NET) und erfährt eine deutliche Symptombesserung. Schlussfolgerung Die angewandte Kurzform der NET kann für die Behandlung von leicht- bis mittelgradigen Symptomen einer Post-ICU-PTBS geeignet sein.

Introduction: Primary care for multimorbid patients does not only include medical but also social counseling. In Germany, community care points represent an institutionalised support offer for counseling for social and care-related issues at district level. Methods: Within the framework of an intervention study on the cooperation between general practices and community care points in Berlin, 14 telephone interviews were conducted with multimorbid patients with social counseling needs who received advice by a community care point. The aim was to investigate satisfaction with the cooperation process as a whole and with the counseling provided by the community care points. The transcribed interviews were analysed using the framework analysis. Results: Overall, the patients were satisfied with the counseling they received from the community care points. In many cases, even after counseling, patients were not aware of the range of services offered by the community care points, and there was confusion about community care points and locally known mobile care services. Patients felt that it was particularly important to have a friendly, reliable contact person, to be close to their own place of residence and to have a long-term connection to the service. From the point of view of those affected, the general practitioner remains an important contact person who initiates the counseling, if necessary, and coordinates the interventions to be derived from the counseling result. Discussion: The confusion about community care points and mobile care services due to a lack of knowledge about the range of services offered by community care points are central topics in the interviews. This could be due to the heterogeneous supply of the community care points as well as the lack of networking with GP practices. A standardisation of the offer and increased information and networking activities of the community care points at district level could contribute to an increased level of awareness and improve transparency of their services. Conclusion: In the long term, cooperation between community care points and general practitioners could help relieve the burden on general practitioners and improve social care for multimorbid patients at district level.

Introduction General practitioners (GP) increasingly face the challenge of meeting the complex care needs of multi-morbid patients. Previous studies show that GP practices would like support from other institutions in advising on social aspects of care for multi-morbid patients. Already existing counselling services, like community care points, are not sufficiently known by both GPs and patients. The aim of COMPASS II is to investigate the feasibility of cooperation between GP practices and community care points. Methods and analysis During the intervention, GPs send eligible multi-morbid patients with social care needs to a community care point. The community care points report the consultation results back to the GPs. In preparation for the intervention, in a moderated process, GP practices meet with the community care points to agree on information exchange. The primary outcome is the feasibility of the cooperation: Questionnaires will be sent to GPs, medical practice assistances and community care point personnel (focus: practicality, acceptability). Data will be collected on frequency and reasons for GP-initiated consultations at community care points (focus: demand). Qualitative interviews will be conducted with all participating groups (focus: acceptability, satisfaction). The secondary outcome is the assessment of changes in health-related quality of life, social support and satisfaction with care: participating patients complete a questionnaire before and three to six months after their counselling. The results of the study will be incorporated into a manual in which the experiences of the cooperation will be made available to other GP practices and community care points. Discussion In COMPASS II, GP practices establish cooperation with community care points. The latter are already existing institutions that provide independent and free advice on social matters. By using an existing institution, the established cooperation and experiences from the study can be used beyond the end of the study. Trial registration The trial is registered with DRKS-ID: DRKS00023798, Coordination of Medical Professions Aiming at Sustainable Support II.