Physicians In Germany Research Articles

Depression in primary care and the role of evidence-based guidelines: cross-sectional data from primary care physicians in Germany

BackgroundDepression is the most common mental health burden worldwide. Primary care physicians (PCPs) play a key role in the care provision for people with depression. The first objective of the present study was to examine the health care situation of depression in primary care, focusing on the cooperation between PCPs and mental health specialists. Secondly, we aimed at examining the role of the German S3 Guideline for Unipolar Depression in the primary care provision.MethodsData of N = 75 PCPs were analysed from a cross-sectional online survey. Analysis of descriptive information on the current status of primary health care and depression was conducted. Further, to examine factors that are related to the usage of guidelines, multiple regression was performed.ResultsOnly 22.1% of PCPs described the quality of cooperation with ambulatory mental health specialist as good. The most frequent problems in the cooperation were of structural nature (49.3%, long waiting list, few therapy units, as well as barriers in the communication and the information exchange). With regard to the role of the guideline, 65% of PCPs reported never or seldom using the guideline and 31.7% of PCPs perceived the guideline as not useful at all. In addition, perceived usefulness of the S3 guideline was positively associated with the usage of the guideline. Results of the logistic regression revealed a significant association between the usage of the German S3 Guideline for Unipolar Depression and rating of perceived usefulness of the guideline (OR: 4.771; 95% CI: 2.15–10.59; p < 0.001).ConclusionThis study highlights the central role of PCPs and demonstrates major barriers in the outpatient health care provision of depression. Present findings suggest a strong need for collaborative health care models to resolve obstacles resulting from fragmented mental health care systems. Finally, reported perceived barriers in the implementation of the German S3 Guideline for Unipolar Depression indicate the urge to involve PCPs in the development of evidence-based guidelines, in order to ensure a successful implementation and usage of guidelines in clinical practice.

Racism in German medical education – Perspectives of racialized physicians and medical students

Abstract Background The impact of racism on health and the quality of health care services for racialized patients have been the object of prior research. The experiences of racialized medical students and physicians, who operate in a field of tension between natural sciences and practical application and between a ‘medical habitus’ and exclusionary discrimination, have hardly been examined to date. The education of (future) physicians is an especially fruitful research area in the context of the study of institutional racism in the health care system, as informal everyday experiences come together with formal knowledge and normative learning. Methods Based on expert consultations and preliminary interviews with civic stakeholders, teaching and learning materials in German medical studies were randomly sampled and used as a starting point for qualitative guided interviews with physicians and medical students in Germany who are themselves affected by racism. The first steps of the thematic analysis of these interviews are reflected upon and further developed in focus group discussions with the interviewees. Results The study is particularly concerned with the question of how certain dimensions of racism in the health care sector are related, and how racist normativity appears in this context. This is concretized in the relationship between formal and informal medical curricula as well as in the interweaving of everyday experiences and teaching materials. Conclusions There are different dimensions of relation between a hegemonic normativity in the medical curriculum and the everyday experiences of racialized medical students and physicians in Germany. Politics, faculties, publishers, and civic society may be the target of several recommendations for action regarding those diverse dimensions, e.g. the line between omission and stereotyping of several patient groups. Key messages • Hegemonic normativity in German medical education is an important and challenging issue. There are several institutional levels of medical knowledge reproducing racism in the health care sector. • Both racialized physicians and racialized patients are affected by symbolic and material forms of racism in the German health care system, which are interweaving and crucial on diverse levels.

Empowerment for the Digital Transformation: Results of a Structured Blended-Learning On-the-Job Training for Practicing Physicians in Germany.

(1) Background: Practicing physicians have not been in the focus of structured qualifications in basic digital competences so far. However, they are the current gatekeepers to implement digital technologies and need empowerment to proactively take part in the ongoing digital transformation process. The present study investigates if a structured blended-learning training for practicing physicians in Germany enhances both physicians’ knowledge about central aspects of the digital transformation (including awareness of personal possibilities to act) and their attitudes towards a more digitally empowered mindset. (2) Methods: Participants (n = 32) self-assessed their knowledge (19 items, 10-point Likert-scale) and attitudes (6 items, 5-point Likert-scale) towards the digital transformation at the beginning and at the end of the training. MANCOVAs were conducted. (3) Results: Participants reported an increase in every knowledge domain, representing large effects (Hedges’ g 1.06 to 2.82). Attitudes were partly shifted towards a more empowered mindset with decreased insecurity towards technological, legal, and ethical aspects of the digital transformation (Hedges’ g −0.82 to −1.40). However, preparedness for the digital transformation remained low. (4) Conclusions: Generally, the hypotheses were confirmed. The presented on-the-job training had the desired effects on practicing physicians’ knowledge and attitudes. Nevertheless, additional empowerment and support are essential.

Use of Instant Messaging Software in a German Hospital-An Exploratory Investigation among Physicians.

Internationally, evidence exists that physicians use instant messaging services for communication tasks in everyday clinical practice However, there are only few data on physicians in Germany in this regard. Therefore, at the initiation of our project “DocTalk-Dialog meets Chatbot: Collaborative Learning and Teaching in the Process of Work”, we conducted a stakeholder survey with an exploratory research approach. The aim was to gain initial insights into use of instant messaging software and attitudes towards data security and advantages and disadvantages before implementing a data-secure in-house messaging platform. N = 70 physicians at Charité-Universitätsmedizin Berlin completed an exploratory questionnaire with closed and open-ended questions. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. The use of messenger software was not widespread in the sample studied. Physicians most frequently used face-to-face contact for communication. On average, up to ten instant messages were exchanged per day, mainly among colleagues, to answer mutual questions, and to send pictures. With a high awareness of privacy-related restrictions among participating physicians, advantages such as fast and uncomplicated communication were also highlighted. An instant messenger solution that complies with the German data protection guidelines is needed and should be investigated in more detail.

History of Pilot Physicians in Germany.

History of Pilot Physicians in Germany.

Analysis of the impact of increasing feminization in the healthcare system on urology

Hintergrund und FragestellungZiel dieser wissenschaftlichen Arbeit war es, Genderaspekte und Trends in Klinik, Forschung und Niederlassung in der Urologie zu analysieren. Dabei lag der Fokus auf der Objektivierung des genderspezifischen Wandels im Fachgebiet „Urologie“ zum aktuellen Zeitpunkt und in der Zukunft.Material und MethodenEs erfolgte eine digitale Umfrage bei urologischen Ärzt:innen in Deutschland über das Portal SurveyMonkey©, welche über den E‑Mail-Verteiler der Deutschen Gesellschaft für Urologie e. V. (DGU) und des Berufsverbands der Deutschen Urologen e. V. (BvDU) an alle eingetragenen Mitglieder verschickt wurde. Es wurden Basisdaten im ambulanten und stationären Sektor erhoben, sowie geschlechtsspezifische Daten in Bezug auf Arbeitsplatzverteilung, Ziele, Zufriedenheit und Gründe für berufliche Entscheidungen.ErgebnisseDie Auswertung von 398 Antworten ergab, dass urologische Kolleg:innen in der Niederlassung seltener weiblich (23,6 %) und deutlich älter (mittleres Alter 53 Jahre) waren als im stationären Sektor (Frauenanteil 47,2 %, mittleres Alter 43 Jahre). Niedergelassene Vertragsärzt:innen waren mehr Männer (49,4 %) als Frauen (29,9 %) und die Niederlassung wurde von mehr Männern als Berufswunsch angegeben (28,1 % vs. 22,8 %). Die Gründe für die Niederlassung lagen bei Frauen häufiger im familiären Bereich als bei den Männern (Hauptgründe gute Gelegenheit oder Berufswunsch). Frauen arbeiteten häufiger Teilzeit (27,0 % vs. 11,5 %) und strebten häufiger eine Karriere als Oberärztin an (29,1 % der Frauen, 9,4 % der Männer). Entsprechend war der Wunsch nach einer Habilitation oder Professur bei den Frauen häufiger als bei den Männern (20,5 % vs. 15 %). Signifikant mehr Urologinnen sahen eine Ungleichheit bei den beruflichen Aufstiegschancen (59,7 % vs. 17,5 %, p < 0,001) und 73,3 % (vs. 18,5 % der Männer, p < 0,001) empfanden ihr Geschlecht als Ursache einer Benachteiligung. Dies führte zu einer signifikant geringeren Zufriedenheit von Frauen mit ihrem beruflichen Status (p = 0,008), sowie einem geringeren Gefühl der Wertschätzung (p < 0,001).SchlussfolgerungUm die Urologie zukunftsfähig zu machen ist es essenziell, Genderaspekte noch stärker zu berücksichtigen. Der eingeschlagene Weg, der nächsten Generation von Urolog:innen ein modernes Fachgebiet zu bieten, in dem alle Ärzt:innen unabhängig von ihrem Geschlecht gerne arbeiten, wertgeschätzt werden und Chancengleichheit herrscht, sollte unbedingt weiter verfolgt und intensiviert werden, um die Urologie für die Zukunft gut aufzustellen.Zusatzmaterial onlineDie Online-Version dieses Beitrags (10.1007/s00120-022-01931-3) enthält eine Tabellarische Darstellung der vollständigen Umfrageergebnisse „Genderaspekte in Klinik und Niederlassung“.

Doctors on the move 2: a qualitative study on the social integration of middle eastern physicians following their migration to Germany

BackgroundThe integration of immigrating physicians has become a challenge for many societies and health care systems worldwide. Facilitating the integration process may benefit both the uptaking country and the immigrating physicians. Previous studies have approached this problem from a system integration perspective. The present study explores the degree of social integration of an exemplary group of Middle Eastern physicians following their migration to Germany from an individual perspective.MethodsBased on social constructivist epistemology, a series of fifteen interviews and two focus groups with immigrated Middle Eastern physicians (n = 23, purposively sampled) were conducted between 2017 and 2020 in Germany. The audio recordings were transcribed, translated into English and analysed deductively based on Esser’s model of social integration, consisting of four dimensions: acculturation, positioning, interaction and identification.ResultsThe social integration of the participants showed a multifaceted picture. The early phase was characterized by disorientation and trial and error. Cultural differences were of major importance. Acculturation was facilitated by German language acquisition and increased over time, although some cultural difficulties remained. Professional positioning was facilitated by the need for physicians and a relatively low-hurdle relicensing procedure. Interaction and identification depended on the efforts of the individual physicians.ConclusionsThis study provides a comprehensive picture of the individual social integration of Middle Eastern physicians in Germany. Language and cultural adaptation are identified as being of primary importance. Social integration can be facilitated through orientation programmes or cross-cultural training that benefits the uptaking countries as well as the immigrating physicians.

Usability of Electronic Health Records in Germany - An Overview of Satisfaction of University Hospital Physicians.

EHR are a part of daily task of physicians in Germany. This study surveyed the satisfaction of a small group of physicians in German university hospitals using EHR with focus on usability. The questioning was carried out by an online survey. Addressed were all physicians working at university hospitals in Germany. The study showed that users are not satisfied with EHR (Grade 3.62). They pointed out some problems in general but reflected many advantages of those systems. EHR systems have to develop and adopt to users' tasks. They have to get faster and low error rates must be realized. Existing infrastructure must be improved and rolled out to users especially in times where digital healthcare services gain importance.

Cascade screening and registry for patients with familial hypercholesterolemia in Germany – A follow-up survey

Background and Aims : The aim of the registry is to record as many German patients with FH as possible and to raise awareness for FH among patients and physicians in Germany. Will the lipid-lowering therapy (LLT) intensify over the course of 2.5 years? Can the target values according to the EAS guidelines be achieved? Does the patients ‘quality of life improve?Methods: FH-patients are included into the registry after their informed consent. The data is recorded and analyzed using questionnaires for physicians and patients. After 2.5 years and five years follow up questionnaires are collected.Results: By the end of November, 2.400 FH patients had been entered into the registry. Follow up of 370 patients show that LLT intensified during the previous 2.5 years and average baseline LDL-C values of 132±67 mg/dl decreased to an average of 110±51 mg/dl. The target of the EAS dyslipidemia guideline of an LDL cholesterol below 70 mg/dl in FH is not achieved. FH patients are aware of their condition, which is reflected by a surprisingly healthy lifestyle. The majority (53%) never smoked; 36% have given up smoking and 94% of FH patients are active in sports. They had informed at least two relatives about their FH diagnosis and thus help to raise awareness in the population. One third of FH patients stated that their quality of life had improved, deteriorated, or remained the same, respectively.Conclusions: The registry can increase awareness of the disease. Despite this, achieving the target values of the EAS guidelines remains difficult. Background and Aims : The aim of the registry is to record as many German patients with FH as possible and to raise awareness for FH among patients and physicians in Germany. Will the lipid-lowering therapy (LLT) intensify over the course of 2.5 years? Can the target values according to the EAS guidelines be achieved? Does the patients ‘quality of life improve? Methods: FH-patients are included into the registry after their informed consent. The data is recorded and analyzed using questionnaires for physicians and patients. After 2.5 years and five years follow up questionnaires are collected. Results: By the end of November, 2.400 FH patients had been entered into the registry. Follow up of 370 patients show that LLT intensified during the previous 2.5 years and average baseline LDL-C values of 132±67 mg/dl decreased to an average of 110±51 mg/dl. The target of the EAS dyslipidemia guideline of an LDL cholesterol below 70 mg/dl in FH is not achieved. FH patients are aware of their condition, which is reflected by a surprisingly healthy lifestyle. The majority (53%) never smoked; 36% have given up smoking and 94% of FH patients are active in sports. They had informed at least two relatives about their FH diagnosis and thus help to raise awareness in the population. One third of FH patients stated that their quality of life had improved, deteriorated, or remained the same, respectively. Conclusions: The registry can increase awareness of the disease. Despite this, achieving the target values of the EAS guidelines remains difficult.

Does It Pay Off? Understanding Subjective Employment Mobility of European Physicians in Germany

This article investigates the subjective employment mobility, defined as migrants’ evaluation of their employment situation before and after migration, of European physicians in Germany. Analyzing different dimensions of occupation (e.g., income, working conditions, use of skills, career opportunities) of physicians who migrated to Germany from within the European Union (i.e., EU physicians), it examines which factors influence physicians’ perception of whether migration worsened or improved their employment situation. I argue that the original reasons to migrate (e.g., economic, career-related, or family reasons) and other migration-related factors (e.g., language skills), as well as characteristics of the occupation (e.g., the hierarchical structure), must be considered to understand subjective employment mobility. The analyses are based on original survey data collected among EU physicians in Germany ( N = 1,058). Results from OLS regressions show that physicians’ original reasons for migration largely matched their subjective employment mobility, suggesting that migration for career reasons and a perceived improvement of use of skills and career opportunities are positively linked while migration for economic reasons positively affected physicians’ perception of income and working conditions. Physicians aiming for the highest position perceived their overall employment situation as worse compared to before migration, and the origin region mattered, particularly for physicians from EU Eastern member-states, who were more likely to perceive an improvement in their employment situation. Results further inform understandings of labor-related migration of high-skilled professionals by identifying obstacles and conducive conditions at migration for a group that is often assumed not to face barriers in using migration for professional advancement.

Education Competencies for Integrative Oncology in Germany: Results of a Stakeholder Engagement Survey Study

Background: Integrative Medicine (IM) training programs in oncology lacked standardized education core competencies to ensure the practical relevance of its learning content and objectives. In a previous international and interprofessional consensus procedure, core competencies were developed for health professionals working in Integrative Oncology (IO). However, the transferability of the developed core competencies to IO physicians working in Germany has not yet been verified. The overall aim of this survey study as part of the KOKON Project (Kompetenznetzwerk Komplementärmedizin in der Onkologie; Competence Network Complementary Medicine in Oncology) was to investigate if the international core competencies developed for IO for a broader group of health professionals are suitable for physicians in Germany. Material and Methods: Paper-pencil and digital questionnaires were distributed amongst various stakeholder groups (cancer patients and representatives; IO physicians; members of IM organization and IM researchers; multipliers of cancer support groups). The stakeholders were asked to rate the 37 core competencies developed according to their importance for the respective stakeholder group (not important, moderately, very important). Analyses were conducted using a 60% agreement threshold for medium to highly important competencies and 50% agreement threshold for highly important competencies. Results: We contacted different persons from various stakeholder groups (n > 370) with a survey response rate of 55.5–68.4% (n = 271) depending on the respective stakeholder group. Using the 50% agreement threshold, all competencies were accepted by the stakeholder groups. 27 competencies were considered very important by 60% of the survey participants. In particular, cancer patients and cancer support groups showed similar results. Conclusion: The list of developed international core competencies for IM health professionals seems to be suitable for physicians providing IO in Germany according to different stakeholder groups. The implementation of competencies can support the development of evidence-based, patient-centered training programs for physicians.

Impact of off-label use regulations on patient care in dermatology - a prospective study of cost-coverage applications filed by tertiary dermatology clinics throughout Germany.

In dermatology, a medical speciality with a relatively high number of rare diseases, physicians often have to resort to off-label treatment options. To avoid claims, physicians in Germany can file a cost-coverage request (off-label application, OL-A). Our aim was to investigate the extent to which the current regulations affect patient care. Prospective cohort study among tertiary dermatology clinics throughout Germany, consecutively including OL-As (05/2019-09/2020) and assessing the follow-up correspondence. We modelled regressions to assess factors associated with cost-coverage decisions and the time needed by health insurers to process the OL-As. Thirteen clinics provided data on 121 OL-As, two of which applied for on-label treatments. Of the remaining 119 OL-As, 70 (58.8%) were immediately approved and 44 (37.0%) rejected. Including cases with one or more appeals, 87 of 119 OL-As (73.1%) were finally approved and 26 (21.9%) rejected. There was an association of the final approval rate with (1) the class of medication/treatment, with approval rates being significantly lower for JAK inhibitors than for biologics (OR 0.16, 95%-CI: 0.03-0.82); (2) German state, with approval rates being lower in eastern than in western states (OR 0.30, 95%-CI 0.12-0.76); and (3) cost of the intervention (no linear trend). However, none of these predictors was significant in our multiple logistic regression models. The median health insurer's processing time (first response) was 29 days (IQR 22-38). Our analyses showed no evidence of an association with the predictors we assessed. In cases approved, the median time from the decision to file an OL-A to the actual initiation of the treatment was 65.5 days (IQR 51-92). Our study points to substantial delays and inequalities in the provision of timely health care for dermatological patients with rare diseases, often involving treatments for which there is no adequate approved therapy.

Identifying desired qualifications, tasks, and organizational characteristics of practice managers—a cross-sectional survey among group practice physicians in Germany

BackgroundThe increase of centralization developments in primary and secondary care practices may cause the organizational needs to increase as well, as the practices grow in size. This continuous change is observed in different stages in various countries since, from the perspective of a physician, it is reinforced by the benefits it adds to flexible work configuration, professional exchange and specialization. However, in order to benefit from the joint practice system, the proper managerial skills of practice managers are required, as doctors are not naturally prepared to fulfill such tasks. This study thus aims to gain insight into physicians' views in group practices and acquire a greater understanding of expectations towards practice management and the emerging role of practice managers (PM).MethodsA cross-sectional study design was employed which utilized an anonymous online questionnaire. In total, 3,456 physicians were invited to participate in the study between February 8th and March 17th 2021 by the Association of Statutory Health Insurance Physicians of Baden-Württemberg, Germany. Bivariate and multivariate analyses were applied to characterize the expectations of physicians towards practice management.ResultsThe survey yielded 329 replies (9,5%). 50% of the participating practices already had a PM employed. In general, these practices were larger than practices without a PM. Most physicians (85%) considered a medical background to be essential for the task of a PM. While practices without a PM considered it important for PMs to have medical qualifications, practices with a PM favored qualifications in business administration. 77.2% of physicians preferred to educate and recruit PMs out of their current practice staff. Competence in organizational tasks, such as coordination of tasks and quality management, was considered to be an essential skill of a PM and had the highest agreement levels among those surveyed, followed by staff management of non-physicians, billing, bookkeeping, staff management of physicians and recruiting. Based on multivariate regression analysis, larger practices valued the role of a PM more and were more likely to employ a PM. Notably, the effect that size had on these items was more substantial for generalists than specialists.ConclusionsThe benefits and importance of PMs as well as the potential for delegation are recognized, in particular, by larger practices. The positive feelings that physicians who already employ PMs have towards their contribution to ambulatory care are even more significant. Pre-existing medical support staff has been identified to be the most desirable candidates for taking on the role of PM.

Perioperative management of antithrombotic drugs in skin surgery - A survey of dermatologists in Germany.

We identified substantial heterogeneity in the perioperative management of antithrombotic drugs in skin surgery in Germany in 2012 and 2017 in two cross-sectional surveys. The first national guideline on this subject was published in 2014 and updated in 2021. We sought to identify whether the management of these drugs had changed. We sent a paper-based survey to 1115 dermatologists throughout Germany asking them about their perioperative management of antithrombotic drugs in skin surgery, as well as their familiarity with the guideline. We received responses from 65 hospital- and 202 office-based dermatologists. Most dermatologists reported continuing antithrombotic drugs in their patients when performing minor surgeries. A notable proportion of dermatologists reported discontinuing phenprocoumon treatment perioperatively and bridging patients with heparin when performing more invasive surgeries. Continuation was less common during combination therapies. The proportion of physicians in Germany who reported managing antithrombotic drugs during skin surgery in ways that are in concordance with the national guideline has increased since 2012. However, continuing antithrombotic drugs during large excisions and sentinel lymph node biopsies, abstaining from bridging patients on phenprocoumon with heparin, and continuing antithrombotic combination therapies perioperatively need to be further encouraged, especially among office-based dermatologists.

Preferences for and use of oral anticoagulants for stroke prevention in atrial fibrillation under real-world conditions in Germany: A survey among physicians

In Germany, there is little real-world evidence on physicians’ choice of oral anticoagulants (OACs). Our study aimed at assessing preferences for and prescribing patterns of treatment options for stroke prevention in atrial fibrillation in clinical practice in Germany.We conducted a nationwide quantitative online survey among office-based physicians in Germany. Physicians were asked about their preference for and use of treatment options as well as factors influencing their choice of a specific OAC.A total of n = 953 physicians was surveyed in September and October 2020 (general physicians: 36.0%; internists: 37.3%; cardiologists: 23.7%; neurologists: 10.5%; multiple specialties possible). Preference and use were highest for non-vitamin K oral anticoagulants (NOACs); followed by vitamin K antagonists (VKAs). Most preferred OACs were apixaban (39.3%), rivaroxaban (28.5%) and edoxaban (14.7%). Most used OACs were apixaban (24.3%), rivaroxaban (21.2%) and phenprocoumon (21.4%). NOACs were preferred more often than used (85.6% > 68.6%). VKAs were preferred less often than used (9.6% < 23.5%). OAC attributes and patient characteristics related to efficacy and safety, as well as patients’ kidney function were most important when selecting a specific OAC. Federal and regional governance instruments likely influenced treatment decision-making.We found a high divergence between preferences for and use of available treatment options in clinical practice. Further exploration of the importance of OAC attributes, patient characteristics as well as federal and regional governance instruments for physicians’ choice of a specific OAC may help to further optimize the healthcare of patients with atrial fibrillation in the long-term.

Attitudes Toward Mandatory COVID-19 Vaccination in Germany.

Adequate immunity to COVID-19 apparently cannot be attained in Germany by voluntary vaccination alone, and therefore the introduction of mandatory COVID-19 vaccination is still under consideration. We present findings on the potential acceptance of such a requirement by the German population, and we report on the reasons given for accepting or rejecting it and how these reasons vary according to population subgroup. We used representative data from the Socio-Economic Panel for the period January to December 2021. We linked the respondents' answers concerning mandatory COVID-19 vaccination to information about their sociodemographic characteristics, state of health, political attitudes, and degree of confidence in the judicial and political systems. We analyzed these data using univariate, bivariate, and multivariate statistical methods. Just over half of the respondents (50.44% [49.08%; 51.79%]) favored mandatory COVID-19 vaccination. Among the supporters, the reason most frequently given (95.22% [94.45; 96.00]) was that, without such a requirement, not enough people would be vaccinated. Among the opponents of mandatory COVID-19 vaccination (49.56% [48.21%; 50.92%]), by far the most common reason given for opposing it was a desire to uphold individual freedom (91.36% [90.31%; 92.40%]). Persons supporting mandatory COVID-19 vaccination, on average, older than those who opposed it; they less commonly had an education beyond secondary school, were less healthy, tended to have no children, had centrist political views, and expressed more confidence in the political system. The largest difference between the two groups was that about 90% of supporters of mandatory COVID-19 vaccination were themselves vaccinated, compared to only about 62% of opponents. The lack of consensus on this issue among politicians and physicians in Germany is reflected in a similar lack of consensus in the German population as a whole. A discussion of the appropriate understanding of individual freedom would be the most promising way to widen the acceptance of mandatory COVID-19 vaccination. A commonly expressed conception of freedom that permits the deliberate endangerment of other people's health seems morally questionable.

The Effect of Biosimilar Prescription Targets for Erythropoiesis-Stimulating Agents on the Prescribing Behavior of Physicians in Germany

ObjectivesThis study aimed to aid decision makers by analyzing the impact of introducing biosimilar prescription targets on physician prescribing behavior in the prescription of biologic erythropoiesis-stimulating agents in Germany. MethodsWe combined secondary data of regional level biosimilar prescription targets and secondary data of routinely collected claims data of dispensed prescriptions by physicians operating within the statutory health insurance system in ambulatory care across 7 German regions from 2009 to 2015. Two-way fixed-effects regression analysis was used to identify the average treatment effect of introducing biosimilar prescription targets at the physician level. The main outcome of interest was the share of biosimilar prescriptions on all prescriptions within the substance group. We compared 6 regions that introduced biosimilar prescription targets with 1 region without any prescription target policy. ResultsIntroducing biosimilar prescription targets increased the average share of biosimilars between 6 percentage points (P < .05) in Hamburg and up to 20 percentage points (P < .001) in Saxony-Anhalt. Stratification of specialists by prescription volume and adoption status indicated heterogeneous effects. We identified similar but higher effects for high-volume prescribers. Disentangling of effects with regard to the composition of biosimilar share suggested that the increase in biosimilar share was driven by increased biosimilar use accompanied by a nonsignificant decrease in original biologics prescriptions. ConclusionsPrescription targets to alter physician prescribing behavior meet their intended goals by increasing biosimilar share. Physicians partly responded to the policy by decreasing overall prescriptions of the target substance. Prescription targets might be a useful tool, but decision makers need to consider all aspects of potential responses.

Differences in training among prehospital emergency physicians in Germany.

BackgroundGermany has an interdisciplinary physician-based emergency medical service. Differences in training likely lead to different levels of expertise.ObjectivesWe assessed the number of manual procedures performed at the completion of training to determine level of experience of prehospital emergency physicians of different primary specialties.Materials and methodsImmediately after passing the board examination each examinee was asked to estimate the number of performed procedures for 26 manual skills. We compared the results with recommendations and data on learning manual skills. Results are presented as mean (standard deviation).ResultsEndotracheal intubation via direct laryngoscopy was performed 1032 (739) times by anesthesiologists. Surgeons and internists performed 89 (89) and 77 (65) intubations, respectively. Intubation via video laryngoscopy was performed 79 (81) times by anesthesiologists, 11 (17) times by surgeons and 6 (11) times by internists. Surgeons had little experience in non-invasive ventilation, with 9 (19) performed procedures and had rarely used external pacemaker therapy or electrical cardioversion. In comparison, among all participants non-invasive ventilation was performed 152 (197) times, electrical cardioversion was performed 41 (103) times and an external pacemaker was used 6 (15) times. For other procedures the numbers did not markedly differ between the different specialties.ConclusionThe number of performed procedures markedly differed for some skills between different primary specialties. Recommendations regarding a procedural volume were not always met, suggesting missing expertise for some skills. A defined number of procedures should therefore be a formal requirement to be eligible for board certification in prehospital emergency medicine.

Intercountry and intracountry variations in opinions of palliative care specialist physicians in Germany, Italy, Japan and UK about continuous use of sedatives: an international cross-sectional survey

ObjectivesTo explore intercountry and intracountry differences in physician opinions about continuous use of sedatives (CUS), and factors associated with their approval of CUS.SettingsSecondary analysis of a questionnaire study.ParticipantsPalliative care physicians...

Utilization of point-of-care tests among general practitioners, a cross-sectional study

BackgroundPoint-of-care testing (POCT) has numerous potential benefits to improve health care service, especially in resource-limited settings. We aim to identify which POC-tests (POCTs) of laboratory parameters are known, employed, and rated as useful by general practitioners (GPs).MethodsA questionnaire with 27 POCTs was posted to a random selection of GPs (n = 451) in Saxony, Germany.ResultsA total of 208 GPs replied (response rate 46.1%). Out of 27 POCTs, each GP knew an average of 20.3 as laboratory parameters and 9.2 as POCTs. Urine test strips (99.0%), blood glucose test (98.1%), and Troponin I/T (86.4%) were the best-known, followed by INR/Quick (82.5%), Microalbumin (79.1%), and D-dimer (78.6%) POCTs. Yet, solely 0 to 13 POC tests were actually used (mean value 4.6). Urine test strips were employed most frequently (97.6%), followed by blood glucose test (94.7%), Troponin I/T (57.8%), Microalbumin (57.3%), and INR/Quick POCTs (41.7%). Heart fatty binding protein (H-FABP), Syphilis, Coeliac disease, and Malaria appeared as the least frequently used POCTs. The majority of the GPs declared 14 of the 27 POCTs to be useful.Discussion/conclusionThe most recurrently employed POCTs are those for diagnosing or monitoring diabetes mellitus, ensued by POCTs addressing acute cardiovascular diseases (Troponin I/T, D-dimer) or monitoring the therapy of infectious diseases or the anticoagulant therapy. POCTs most often rated as useful by GPs are also widely known and frequently used. Nonetheless, the majority of GPs rate only a very limited number of POCTs as useful. Frequent concerns might be low economic benefit, over-reliance, and test accuracy coming along with the complex implementation of the tests requiring technical skills, accurate storage, and the correct interpretation of test results.Trial registrationIn accordance with the (Model) Professional Code for Physicians in Germany, neither human body materials nor data that can be assigned to a specific human being are used in our study. A declaration of no objection from the Ethics Committee of the Martin-Luther University Halle-Wittenberg (Medical Faculty) confirms no professional or ethical concerns due to completely anonymized data collection and analysis. Our study was therefore not registered in a corresponding registry.