Judith Stumm’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.

Introduction The proportion of children and young people in Germany who have problematic media use has increased, particularly as a result of the coronavirus pandemic. The presence of comorbidities such as anxiety disorders, depression, sleep disorders, impulsivity and lack of social skills are interdependent with media addiction. Medical rehabilitation is suitable for the long-term care of children and adolescents with media addiction. As part of the MeKi study, a rehabilitation program for children and adolescents with media addiction is being developed and piloted in a cooperating rehabilitation clinic. The trial is registered under DRKS-ID: DRKS00034461, Medienabhängigkeit bei Kindern und Jugendlichen—Entwicklung, Pilotierung und Evaluation eines nachhaltigen, integrativen Rehabilitationskonzepts. Methodes and analysis As part of a mixed methods design a multimodal rehabilitation concept for children and adolescents with media addiction will be developed in a preparation phase based on the results of a scoping review as well as interviews and focus groups with affected children and adolescents, their parents and experts. In a trial phase the concept will be implemented with a planned sample of 80 Children and adolescents over a period of 1.5 years and evaluated by means of a results evaluation using a questionnaire survey and a process evaluation using interviews and focus groups. Discussion The lack of a standardized definition for problematic media use in children and adolescents complicates both the scientific discourse and the practical care of those affected. Furthermore, there are currently only a few therapeutic offers and these are only available in the acute sector. The development and piloting of a rehabilitation program for children and adolescents with media addiction is intended to provide sustainable rehabilitative care, which is to be transferred to other clinics after the end of the project. Trial registration The trial is registered under DRKS-ID: DRKS00034461, Medienabhängigkeit bei Kindern und Jugendlichen—Entwicklung, Pilotierung und Evaluation eines nachhaltigen, integrativen Rehabilitationskonzepts.

Background Medical rehabilitation for children and adolescents in Germany has been strengthened in recent years, including facilitated admission of parents/caregivers, leading to an increase in the number of ‘accompanying persons’ in the rehabilitation setting. The aim of this study was to explore the roles of accompanying persons in rehabilitation, taking into account the perspectives of different stakeholders. Methods Semi-structured interviews were conducted with 12 accompanying persons at the beginning and the end of rehabilitation, as well as 18 healthcare providers with different areas of expertise. Data were analysed deductively and inductively using framework analysis. Results In addition to the topics of pre-rehabilitation-information and the general conflicting character of accompanying persons, three role categories could be identified within the rehab setting: Accompanying persons as child-caregiver , self-caregiver and clients of care . These roles are associated with different demands, needs and tasks. Conclusions Our findings suggest that the concept of ‚accompanying person' should be further developed. Both clinical staff and accompanying persons themselves should become more aware of the different role-requirements. Greater consideration of the different needs and resources of accompanying persons is essential to provide sustainable support for both children and caregivers.

Zusammenfassung Hintergrund und Zielstellung Für einen langfristigen und nachhaltigen Rehaerfolg bei chronisch erkrankten Kindern und Jugendlichen wurde mit Inkrafttreten des Flexirentengesetzes unter anderem die Durchführung der Rehanachsorge für Kinder und Jugendliche ermöglicht. Für die Umsetzung und Nutzung von Rehanachsorgeprogrammen gilt es, verschiedene Barrieren und Herausforderungen zu überwinden und involvierte Akteur*innen rollenspezifisch mit einzubeziehen. Ziel der qualitativen Studie war es, die Perspektiven von Kinderärzt*innen und Rehaklinikmitarbeiter*innen hinsichtlich des Wissensstandes, des Bedarfs sowie der Barrieren in Bezug auf Nachsorgeangebote für Kinder und Jugendliche zu untersuchen. Methodik Es wurden 20 semistrukturierte Telefoninterviews mit niedergelassenen Kinder- und Jugendärzt*innen (N=10) sowie Rehaklinikmitarbeiter*innen (N=10) geführt. Die Daten wurden audiodigital aufgenommen, anonymisiert transkribiert und inhaltsanalytisch ausgewertet. Ergebnisse Sowohl die niedergelassenen Ärzt*innen als auch die Klinikmitarbeiter*innen sind positiv gegenüber dem Konzept der Rehanachsorge eingestellt. Mangelnde Informationen, fehlende Kommunikationswege, knappe zeitliche Ressourcen und unklare Verantwortungsbereiche sind Gründe für die zurückhaltende Nutzung von Rehanachsorgeangeboten. Schlussfolgerung Rehanachsorgeangebote für Kinder und Jugendliche stellen eine essentielle Ergänzung zur medizinischen Rehabilitation dar. Barrieren und Herausforderungen im Zugang und der Nutzung sollten zunächst aus der Perspektive von Versorger*innen beleuchtet und berücksichtigt werden. Eine gezielte Informationspolitik zu bestehenden Nachsorgeangeboten sowie eine standardisierte Regelung der Zuständigkeiten können eine Umsetzung und Nutzung von Rehanachsorgeangeboten fördern und die jeweiligen Akteur*innen entlasten.

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.

Zusammenfassung In der hausärztlichen Versorgung multimorbider Patient*innen haben neben den medizinischen- auch soziale Beratungsanlässe eine große Bedeutung. Pflegestützpunkte stellen in Berlin ein etabliertes Angebot zur Beratung bei sozialen Anliegen auf Stadtbezirksebene dar. Im Rahmen einer berlinweiten Fragebogenerhebung wurde das Wissen von Hausärzt*innen über und die Erfahrungen mit Pflegestützpunkten exploriert. 700 Fragebögen wurden explorativ deskriptiv analysiert. Hausärzt*innen sind nur bedingt mit dem Angebot der Pflegestützpunkte vertraut (60% kaum oder gar nicht). 57% der Hausärzt*innen gaben an, dass sie bereits Kontakt mit einem Pflegestützpunkt hatten. Hausärzt*innen ohne bisherigen Pflegestützpunkt-Kontakt empfehlen ihren Patient*innen andere Beratungsstellen bei sozialen (76%) und bei pflegerischen Beratungsanlässen (79%). Eine große Mehrheit aller befragten Hausärzt*innen benennt weiteren Informationsbedarf zu Pflegestützpunkten.

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.

Background The concept of patient navigation was first established in the USA to support vulnerable patient groups in receiving timely and comprehensive access to cancer care. It has recently gained increasing interest in Germany to support patients with chronic diseases in a fragmented healthcare system. The aim of this paper is to present the development of such a model adapted to the German context based on the results of mixed-methods studies investigating the need for and barriers to patient-oriented care. Methods In a process adapted from Delphi rounds, we conducted regular structured workshops with investigators of the project to discuss results of their studies and identify content and structure of the model based on the data. Workshop discussions were structured along seven core components of a navigation model including target patient groups, navigator tasks, occupational background and education of navigators, and patient-navigator interaction mode. Results Using an approach based on empirical data of current care practices with special focus on patients’ perspectives, we developed a patient-oriented navigation model for patients who have experienced stroke and lung cancer in the German healthcare context. Patients without personal social support were viewed as struggling most with the healthcare system, as well as multimorbid and elderly patients. Navigators should serve as a longer-term contact person with a flexible contact mode and timing based on the individual situation and preferences of patients. Navigator tasks include the provision of administrative and organizational support as well as referral and guidance to available resources and beneficial health programs with special forms of knowledge. Implementation of the navigator should be flexibly located to ensure a reliable outreach to vulnerable patients for first contact in settings like specialized in-patient and out-patient settings, while navigation itself focuses on care coordination in the out-patient setting. Conclusion Flexibility of navigator tasks needed to be a core characteristic of a navigation model to be perceived as supportive from patients’ perspectives. In a subsequent feasibility study, an intervention based on the model will be evaluated according to its acceptance, demand, and practicality.