Practice In Germany Research Articles

MS brain health quality standards: a survey on the reality in clinical practice in Germany

Abstract Background The quality of treatment is especially critical in the context of complex and chronic diseases such as multiple sclerosis (MS). The Brain Health Initiative, an independent international consortium of neurologists, reached a consensus on time-based quality standards prioritizing brain health-focused care for people with MS. Objectives To gain deeper insights into the transferability of these quality standards to a specific area, we conducted a survey among MS experts across various MS centers in Germany. Methods Participants were asked about time frames considered high standards and those currently being implemented in daily routine based on their experience. Results The results reveal a large gap between ideal conceptions and their adaptation in the real world, mostly due to a lack of resources. Conclusions Nevertheless, these guidelines and recommendations can be aspired to as ideals. Consensual and inclusive clinical pathways complemented by measurable quality indicators are needed to improve care and approach these ideals. Neither exists in the current management of MS.

EOLP-02. END-OF-LIFE CHALLENGES IN NEURO-ONCOLOGICAL PATIENT CARE: A YOUNGNOA SURVEY

Abstract BACKGROUND Malignant brain tumors inevitably relapse, almost always causing significant functional and neurological impairments. Thus, palliative care is crucial in managing individuals with malignant brain tumors. It is essential for neuro-oncologists to be well-prepared to openly communicate about and meet the palliative needs of these patients. With this survey, we sought to evaluate palliative care practices in Germany and their impact on the treatment of neuro-oncological patients. METHODS We conducted an anonymous, interdisciplinary survey targeting palliative care practices among neuro-oncologists in Germany, all members of the Neuro-oncology Working Group of the German Cancer Society. The questionnaire, designed in close coordination with board-certified palliative care specialists, was distributed to 450 physicians. It collected personal information and assessed respondents’ knowledge of and access to palliative care structures. The survey was conducted online from March 31 to April 30, 2023. RESULTS Ninety-two physicians completed the survey. Of these, 81 (88%) reported feeling comfortable with end-of-life conversations, while 11 (12%) did not. No significant differences were observed between the two subgroups regarding their level of medical education (p=0.7140), workplace (p=0.4966), sex (p=0.9999), medical specialty (p=0.5478), or region of practice (p=0.9999). However, those comfortable with end-of-life discussions had significantly more palliative care training either during specialty training (p=0.0475) or through active participation in palliative care courses (p=0.0254). Further detailed analysis is in progress. CONCLUSIONS The survey indicates that while the majority of participants are comfortable with end-of-life discussions, a clear correlation exists between their comfort level and the extent of palliative care training received. This highlights the critical need for enhanced and targeted palliative care education within neuro-oncology training programs to prepare physicians for the complex communication and care challenges in neuro-oncological palliation. Further analysis will continue to explore additional educational and systemic factors that could increase the quality of palliative care in neuro-oncology.

Maintenance OCS Were Used More Frequently Than Biologics in Patients with Uncontrolled GINA 4/5 Asthma in Germany in 2019.

Asthma is affecting 4-5% of all adults (10% of children) in Germany, ≥ half are inadequately controlled. In 2019 up to 54 thousand patients suffered from severe uncontrolled asthma, 52% were treated/co-treated by pneumonologists. 45% of them had continuous oral corticosteroid (OCS)- and short-acting β2-agonist (SABA) overuse for ≥2 years. The aim of the current study was to analyze the main treatments, escalation schemes and the adherence to the GINA recommendations. Retrospective analysis in 2021 based on data from January to December 2019 in Germany, using the IQVIA™ LRx prescription database and the IQVIA™ Disease Analyzer database containing anonymized electronic medical records as the main data sources. In 2019 25,200 patients with severe, uncontrolled asthma treated in a pneumonologist´s practice in Germany received GINA 3 (0,4%), GINA 4 (76%) or GINA 5 therapy (24%) during the study year compared to 59% GINA 5 therapy in the 5-10% (1,500-3,000) co-treated in a specialized outpatient department. In Pneumonologists` practices the most frequent choice in GINA 5 was OCS in 69% of patients (biologicals 37%, long-acting muscarinic antagonist (LAMA) 20%) compared to 66% biologicals, 55% OCS, and 25% LAMA in the outpatient department. 54,958 of 613,000 GINA 4/5 patients were treated with OCS, 9,725 even with doses above the so called "Cushing threshold" for prednisolone of 2700 mg/year. After introduction of a biological treatment, patients reduced their SABA prescriptions by 28%, OCS by 55%, and OCS overall exposure by 40%, one-third did not need OCS anymore. In 75% of patients with uncontrolled asthma for ≥2 years therapy was not escalated beyond GINA 4 or low dose OCS was used as the most frequent add-on treatment in GINA 5 contradictory to treatment recommendations. Use of biologics reduced on demand rescue medication and OCS use.

Häufigkeit von sexuell übertragbaren Infektio-nen in deutschen Facharztpraxen

The aim of this study is to analyze the incidence of sexually transmitted infections (STI) in dermatological, urological, and gynecological practices in Germany. Data from the nationwide IQVIA Disease Analyzer database was used for this study. This cross-sectional study included 6,535 patients in 2014 and 6,491 patients in 2023 with an insured diagnosis of a sexually transmitted disease in 69 dermatology, 148 gynecology and 55 urology practices. The number of patients treated for sexually transmitted diseases in these practices changed only minimally between 2014 and 2023. On average, each dermatology practice treated 31 patients with STIs in 2023, each gynecology practice treated 21 patients and each urology practice treated 23 patients. Anogenital warts were the most commonly diagnosed STI in all specialties, with prevalence varying by specialty. Interestingly, the number of patients per practice with anogenital warts increased slightly in dermatology and urology practices between 2014 and 2023, while it decreased in gynecology practices. The average age of patients treated for STDs increased between 2014 and 2023 In summary, this study highlights that despite vaccination efforts and awareness campaigns in various medical specialties, STI patient numbers remain almost the same and thus STI continues to be a persistent and increasing challenge in the ageing patient population. The findings call for further initiatives in the public health sector and an adjustment of everyday practice to the special needs of these patient groups.

Measures to increase the retention of migrant healthcare professionals in Germany

Abstract Background The shortage of skilled workers in the healthcare sector is a pressing issue in Germany that has been worsening in recent years. It is often compensated by the deployment of specialists from abroad. However, this is accompanied by various challenges. This article synthesizes challenges from nine years of research and proposes approaches to solutions that have proven successful in practice in Germany as well as in international settings. Methods The insights presented here condense the results from a total of six research projects (four on physicians and two on nursing). The research projects are based on exploratory qualitative interviews, quantitative questionnaires, mixed-methods designs, and the generation and testing of measures that can help with the integration of foreign skilled workers. Results The main challenges for migrated skilled workers are inadequate language and communication skills, lack of knowledge about the national healthcare system, disease and therapy concepts, unfamiliar forms of inter-hierarchical and inter-professional collaboration, a lack of understanding of administrative and bureaucratic processes and social integration. The following measures have proven successful in Germany and abroad: increasing social integration of physicians (e.g. through partner or peer programs), streamlining systems, establishing professional structures for the integration of foreign skilled workers, and creating a positive work environment. Conclusions Compared to findings from international studies, in Germany the hurdles of administrative processes, the peculiarities of the healthcare system (e.g. social medicine), and learning the language are considered to be the highest. It is important to counteract these challenges with appropriate measures in order to prevent a migration of healthcare professionals already in Germany to (mostly English-speaking) foreign countries. Key messages • In Germany the hurdles of administrative processes, the peculiarities of the German healthcare system (e.g. social medicine), and learning the German language are considered to be the highest. • It should be considered to no longer leave the migration of healthcare staff to individual integration efforts, but to create appropriate government structures that focus on their social integration.

Development of bacterial resistance in Germany from 2008 to 2022 - major culprit pathogens, antibacterial drugs, and prescribing practices.

Rising bacterial resistance is a global threat, causing rising financial burdens on healthcare systems and endangering effective treatment of bacterial infections. To ensure the efficacy of antibacterial drugs, it is essential to identify the most dangerous pathogens and vulnerable antibacterial drugs. Previous research by our group suggested irrational outpatient prescribing practices in Germany, supporting a growing bacterial resistance. This study analyses developments and characteristics for the ten most prescribed antibacterial drugs in Germany from 2008 to 2022. Conclusions are based on the development of bacterial resistance levels and an analysis of correlations between pathogens. We identified cefuroxime axetil, sulfamethoxazole-trimethoprim and nitrofurantoin as the most problematic drugs. Particularly problematic pathogens include E. faecalis, E. faecium, K. pneumoniae, and P. mirabilis. Besides increasing bacterial resistance, they are characterised by a high proportion of significant positive correlations, indicating a high potential for mutually reinforcing resistance development. Alarmingly, most of the antibacterial drugs analysed showed a growing resistance to at least one of the analysed pathogens. In most cases, the best treatment option is threatened by increasing bacterial resistance. We also identified several differences between current bacterial resistance data and therapeutic guidelines. In aggregate, our findings support irrational prescribing behaviour and underscore the urgent need for improved prescribing practices to counter rising bacterial resistance in Germany. Moreover, therapeutic guidelines for bacterial infections, the "holy grail" of pharmacotherapy, must be updated more frequently.

Investigation into the Effectiveness of an Herbal Combination (Angocin®Anti-Infekt N) in the Therapy of Acute Bronchitis: A Retrospective Real-World Cohort Study.

The goal of this study was to evaluate whether the medical recommendation of Angocin®Anti-Infekt N (heretofore referenced as Angocin®) on the day of diagnosis of acute bronchitis is negatively associated with the recurrence of acute bronchitis diagnosis, antibiotic prescriptions, incidence of chronic bronchitis, and duration of sick leave. This study included patients in general practices in Germany with a first documented diagnosis of acute bronchitis between 2005 and 2022 (index date) and a prescription of Angocin®, thyme products, essential oils, mucolytics or antibiotics on the index date. The association between Angocin® prescription and the risks of a relapse of acute bronchitis, development of chronic bronchitis, or subsequent antibiotic prescription were evaluated using Cox regression models. Univariable conditional logistic regression models were used to investigate the association between Angocin® prescription and duration of sick leave. After a 1:5 propensity score matching, 598 Angocin® patients and 2990 patients in each of the four comparison cohorts were available for analysis. Angocin® prescription was associated with significantly lower incidence of a renewed confirmed diagnosis of acute bronchitis as compared to essential oils (Hazard ratio (HR): 0.61; 95% Confidence Interval (CI): 0.46-0.80), thyme products (HR: 0.70; 95% CI: 0.53-0.91), mucolytics (HR: 0.65; 95% CI: 0.49-0.85) or antibiotics (HR: 0.64; 95% CI: 0.49-0.84). Also, there were significantly lower incidences of subsequent re-prescriptions of antibiotics when compared to mucolytics (HR: 0.73; 95% CI: 0.53-0.99) or antibiotics (HR: 0.53; 95% CI: 0.39-0.72) and a significantly lower risk of chronic bronchitis as compared to essential oils (HR: 0.60; 95% CI: 0.46-0.78), thyme products (HR: 0.53; 95% CI: 0.41-0.69), mucolytics (HR: 0.49; 95% CI: 0.38-0.63) or antibiotics (HR: 0.59; 95% CI: 0.45-0.76). Considering the limitations of the study, the results shed light on the sustaining effectiveness of Angocin® prescription in the management of acute bronchitis and the associated outcomes when compared to several other treatments commonly used for this condition.

Seasonal variation and demographic characteristics of acute tonsillitis and peritonsillar abscess in ENT practices in Germany (2019-2023).

Peritonsillar abscess (PTA) is a common soft tissue infection of the head and neck. It remains unclear to what extent inflammatory diseases of the palatine tonsils or other infections contribute to the development of PTA. This study examines the demographic characteristics and seasonal variations of acute tonsillitis (aT) and PTA in ENT practices in Germany using a practice database. Retrospective analysis based on data from the German-wide IQVIA™ Disease Analyzer database for the period 2019 to 2023. Data include diagnoses of aT (ICD-10: J03) and PTA (ICD-10: J36) as well as patient demographics (age, sex). Seasonal variations were identified by analysing the monthly diagnosis rates. The Pearson correlation between the monthly case numbers of aT and PTA was determined. 59,934 cases of aT and 5,024 cases of PTA were recorded. The mean age was 30.3 years (aT) and 39.4 years (PTA). The proportion of female patients was 60% (aT) and 49% (PTA). Both diagnoses showed seasonal variations with peaks in winter and spring and a decline in summer, although the decline was less pronounced for PTA. The monthly case numbers of aT and PTA showed high correlations between r = 0.75 (2019) and r = 0.94 (2020). The average correlation for the period 2019-2023 was r = 0.81. During the coronavirus pandemic, a significant decrease in the case numbers of both diseases was observed, while the typical seasonal variations disappeared. After the pandemic, the case numbers increased to higher levels than before the pandemic. aT and PTA both show seasonal variations with peaks in winter and spring and a decline in summer. The correlation between the variations of aT and PTA could be related to a partly common aetiology or to the specific sample of the practice database. The attenuation of seasonal variation during the coronavirus pandemic illustrates the impact of COVID-19 on the incidence of other diseases and on the use of healthcare pathways by patients.

Concordance of data collected by an app for medical history taking and in-person interviews from patients in primary care.

This study investigates the concordance of patient information collected using a medical history app compared to in-person interviews. In this cross-sectional study we used an app to collect medical data from patients in family practice in Germany. Collected information included age, height, weight, perceived severity of complaints, and 38 current complaints. Subsequently, in-person interviews based on the query structure of the app were conducted with patients directly after the patient finished filling out the app. Concordance was assessed as exact matches between the data collected app-based and in-person interviews, with the in-person interview as a reference. Regression analysis examined which patient characteristics were associated with mismatching and underreporting of complaints. Three hundred ninety-nine patients were included in the study. Concordance of reported age, weight, and height, as well as perceived severity of complaints ranged from 76.2% to 96.7%. Across all 38 complaints, 64.4% of participants showed completely identical complaint selection in app-based and in-person interviews; 18.5% of all participants overreported; and 17.0% underreported at least 1 complaint when using the app. Male sex, higher age, and higher number of stated complaints were associated with higher odds of underreporting at least one complaint in the app. App-collected data regarding age, weight, height, and perceived severity of complaints showed high concordance. The discordance shown concerning various complaints should be examined regarding their potential for medical errors. The introduction of apps for gathering information on complaints can improve the efficiency and quality of care but must first be improved. The study was registered at the German Clinical Trials Register No. DRKS00026659 registered November 3, 2021. World Health Organization Trial Registration Data Set, https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00026659.

From Science to Therapy: The Shaping of German Psychology Through Student Preferences

In 2020, a new record was set: For the first time in history, more than 100.000 students of psychology were officially enrolled in Germany. This remarkable number is the outcome of a long-term transformation of the whole academic landscape in Europe as well as dynamics that are specific to the German context. As these recent changes have not yet been properly discussed outside the German-speaking world, this paper provides a contextual analysis of the factors that have contributed to the current state of discipline, including legal regulations and economic conditions, academic curricula, and students’ preferences. It is argued that the growth of the discipline was primarily an effect of psychology becoming the primary route to psychotherapeutic practice in Germany after World War II. Even though representatives of the discipline repeatedly voiced concern about the one-sided interest of their students, German academic psychology has benefited from the steady increase in demand for clinical training, especially among female students, on many levels. In late 2020, a new law came into force which redefined the requirements for the qualification of psychotherapists. Although this legal reform was introduced only very recently, it is already becoming apparent that this change will have a profound impact on the discipline. As the tensions between basic research and applied branches increase, cracks are appearing in the foundations of the whole discipline, forcing it to make tough choices about its future development.

Educational practice in Germany between racism and far-right ideologies

Researching educational responses to far-right youth mobilization and ideologies has so far focused mainly on informal education spaces. We thus know little about how and why teachers seek to respond to these issues in their classrooms in formal education. This is despite the fact that far-right mobilization and attitudes are rising in Germany and are having a political impact. In this article I present data from an 18-month ethnographic study in Berlin’s secondary schools, arguing that it is not only important to understand how teachers conceptualize the problem in their student body but also how teachers seek to address these issues. Through this knowledge, we will be able to better understand and systematically respond to far-right ideologies in classrooms.

Barriers and facilitators to the use of clinical practice guidelines in osteoarthritis care: a qualitative study among German physiotherapists

ObjectivesThe objective of this study was to explore barriers and facilitators to the use of clinical practice guidelines (CPGs) in osteoarthritis (OA) care among German physiotherapists.DesignQualitative semistructured interviews were conducted...

Model of integrated mental health video consultations for people with depression or anxiety in primary care (PROVIDE-C): assessor masked, multicentre, randomised controlled trial

ObjectiveTo evaluate whether an integrated mental health video consultation approach (PROVIDE model) can improve symptoms compared with usual care in adults with depression and anxiety disorders attending primary care.DesignAssessor masked,...

Implementation of a Virtual Reality Intervention in Outpatient Physiotherapy for Chronic Pain: Protocol for a Pilot Implementation Study.

Chronic pain is a global health issue that causes physical, psychological, and social disabilities for patients, as well as high costs for societies. Virtual reality (VR) is a new treatment that provides an opportunity to narrow the gap between clinical practice and recommended care in the use of patient education and behavioral interventions in the outpatient physiotherapy setting. However, there is currently no implementation strategy to integrate VR treatments into this setting. This protocol outlines a pilot implementation study that aims to (1) identify barriers and facilitators for implementing a VR intervention in outpatient physiotherapy care for people with chronic pain and (2) develop and pilot test an implementation strategy in 5 practices in Germany. The study consists of 4 phases. The first phase involves adapting the treatment protocol of the VR intervention to the local context of outpatient physiotherapy practices in Germany. The second phase includes the collection of barriers and facilitators through semistructured interviews from physiotherapists and the development of a theory-driven implementation strategy based on the Theoretical Domains framework and the Behavior Change Wheel. This strategy will be applied in the third phase, which will also include a 6-month span of using VR interventions in practices, along with a process evaluation. The fourth phase consists of semistructured interviews to evaluate the developed implementation strategy. The recruitment process and phase 1, including the adaptation of the treatment protocol, have already been completed. We recruited 5 physiotherapy practices in Lower Saxony, Germany, where the VR intervention will be implemented. The collection of barriers and facilitators through semistructured interviews is scheduled to begin in February 2024. This pilot implementation study aims to develop a theory-driven implementation strategy for integrating a VR intervention into outpatient physiotherapy care for people with chronic pain. The identified barriers and facilitators, along with the implementation strategy, will serve as a starting point for future randomized controlled implementation studies in different settings to refine the implementation process and integrate VR interventions into the outpatient care of people with chronic pain. German Clinical Trials Register DRKS00030862; https://tinyurl.com/3zf7uujx. DERR1-10.2196/58089.

Using a combination of cognitive behavioral therapy, case management and eHealth components for patients with depression or panic disorders in primary care practices in Hesse, Germany: an exploration of healthcare professionals’ lived experiences

BackgroundDepression and panic disorders have high prevalence rates in primary care. Given the crucial role of general practitioners in diagnosing and treating mental disorders, the two-arm cluster-randomized, controlled PREMA trial was designed. PREMA was aimed at investigating a new intervention combining cognitive behavioral therapy, case management and eHealth components for patients with depression and/or panic disorder with or without agoraphobia in primary care practices in Germany. This qualitative study, embedded in the PREMA trial, explores primary healthcare professionals’ lived experiences in using the new treatment program. Using a qualitative design, we conducted eleven interviews with general practitioners and medical assistants from Hesse, Germany, between July 2021 and March 2022. For both groups we relied on a semi-structured interview guide covering the following subjects: study procedures, implementation, practicality, and individual components of the treatment program. Interviews were audio-recorded, transcribed verbatim and analyzed by two researchers using content analysis. A deductive-inductive approach was used for the analysis according to Kuckartz.ResultsWe narratively summarized the facilitators and barriers from two different stakeholders across five key themes regarding experiences of feasibility and practicability of the new treatment program: study instruction materials, individual components of the treatment program, practicality, target population, and benefits of the treatment program. Facilitators to become familiar with the study include study instruction materials that are easy to understand and not too complex, considering the limited time resources available; barriers included text-heavy instruction materials, lack of collegial exchange, and issues especially with digital materials also involved access and log-in difficulties on the online platform. Facilitators for using the treatment program include the combination of face-to-face consultations and the use of an online platform, enabling a structured approach and regularity; barriers included patients feeling unsupported in performing anxiety exercises independently at home. For practicality, the professional skills of medical assistants and their central role as points of contact for patients facilitated the implementation; barriers included time-intensive organization and planning of monitoring phone calls and consultations. Regarding the target population, general practitioners and medical assistants state that the treatment program would be most appropriate for patients with mild to moderate depression and for those waiting for psychotherapeutic treatment; it would be less suitable for older patients, and those with negative attitudes towards technological tools. For benefits of the program, facilitating factors included free and low-threshold access to the online platform and strengthening the relationship between medical assistants and patients; barriers included a preference for in-person conversations and the inability of some people to use online applications.ConclusionsThe complexity of the new treatment program and the associated high workload underline the need for further adjustments to the treatment approach. Team-based care and the expanded responsibilities of medical assistants demonstrated promising results.Trial registrationThe study was registered in the German Clinical Trials Register (DRKS00016622) on February 22, 2019.

Transcending boundaries on unequal ground: A critical reimagination of global North-South cooperation on social work practice and the Sustainable Development Goals

Using collaborative autoethnography, this article encapsulates the rich discourse that unfolded during a symposium titled: "Human Rights, The Sustainable Development Goals and Social Work Practice in Germany and Africa". The symposium was a testament to the collaborative synergy between Fachhochschule Dortmund in Germany, Midlands State University (MSU) in Zimbabwe, the University of Johannesburg, and the University of KwaZulu-Natal (UKZN) in South Africa. This scientific event was an academic convergence where researchers and postgraduate social work students shared research, experiences and insights from the Global North and South, offering a mosaic of perspectives on critical issues. It illuminated shared challenges that transcended geographical boundaries. Poverty, climate change, and social injustice were common but contextually unique across the three countries. In this paper, we employ critical and world systems theories to reflect on the symposium. The discussions and reflections underscore social work's strategic position to inform context-specific anti-poverty, climate change discourse, anti-racism and collaborative efforts to combat economic disparities. This paper encourages the power of sustainable partnerships, dialogue, and shared learning across geographical and socio-economic boundaries. Collaborative efforts between Global North and South universities provide a platform for cross-cultural learning and mutual capacity building amongst postgraduate students.

Four-year Outcomes of Class III and IV Anterior Restorations Based on a Subset of German Health Insurance Data.

Numerous studies report on the outcome performance of posterior composite restorations. However, there are fewer studies providing data for anterior restorations. The aim of this study was to evaluate the clinical outcome performance of anterior permanent restorations by analyzing a large dataset from a German national health insurance company. Routine claims data from a major German national health insurance company were assessed. Fee codes were used for tracing restoration careers on a day-count basis. The treatment was defined as a placed restoration (Class III and IV) on a mesial or distal tooth surface, irrespective of the extension. The restorations were placed between January 1, 2010 and December 31, 2013. Statistical analyses were conducted using Kaplan-Meier survival analysis to determine cumulative 4-year survival rates. The primary outcome was re-intervention on the same surface. Secondary outcomes were crowning and extraction which were analyzed separately. A total of 2,417,791 restorations involving mesial surfaces and a number of 2,409,031 restorations involving distal surfaces were observed. At 4 years, the cumulative survival rates concerning the primary outcome 're-intervention' were 79.9% for mesial and 80.9% for distal restorations. The respective annual failure rates (AFR) were 5.5% and 5.2%. Four-year survival rates for the secondary outcome 'crown' were 93.8% for mesial and 94.1% for distal anterior restorations. The respective AFRs were 1.6% and 1.5%. For the secondary outcome 'extraction,' the respective rates were 94.6% for mesial and 93.9% for distal restorations. The respective AFRs were 1.4% and 1.6%. The performance of permanent anterior restorations which were placed in general dental practices in Germany can be rated as acceptable.

The Europeanization of Sports Associations Welcoming Migrants: International Recommendations, Local Contexts and Transnational Practices in Germany, France and England

ABSTRACT This article examines the impact of European recommendations, local contexts and transnational exchanges on sports programs for welcoming migrants. The “sport model” promoted by European institutions, which is not very restrictive, contrasts with the reality of highly differing national and local policies and contexts. Despite this, we discovered numerous transnational relationships among members of these sport programs in three European countries (England, France, and Germany). Analyzed from the concept of social figurations developed by Norbert Elias and allowing the interdependence of relationships, we show that these interactions help legitimize and disseminate “good ways of doing things” across borders. This horizontal sharing of norms and beliefs reveals finally the diffusion, from the bottom up, of an “informal Europeanization” of welcoming migrants through sport. In addition, migrants express an alternative, transnational and informal culture in sport, which also calls for the establishment of intercultural relations with the local population, which are often limited.

How does the role of complementary and alternative medicine in general practice differ between countries? Interviews with doctors who have worked both in Germany and elsewhere in Europe

BackgroundAvailable data suggest that general practitioners (GPs) in Germany use complementary and alternative medicine (CAM) modalities more frequently than GPs in many other countries. We investigated the country differences perceived by general practitioners who have worked in Germany and in one of four other European countries with regard to the role of complementary and alternative treatments in primary care.MethodsIn this qualitative study we conducted semi-structured interviews with 12 GPs who had worked both in Germany and Italy, the Netherlands, Norway or the United Kingdom (UK; n = 3 for each of the four countries). Participants were asked how they perceived and experienced country differences regarding health system, relevance of CAM modalities, the role of evidence-based medicine (EBM) and science, and how they handle so-called indeterminate situations. For the analysis, we followed a thematic analysis approach according to Braun and Clarke with focus on themes that cover CAM.ResultsParticipants unanimously reported that they perceived CAM to be more relevant in general practice in Germany compared to the other countries. We identified four overarching themes in relation to the perceived reasons for these differences. Firstly, physicians with experiences in countries with a strong EBM and science orientation (Netherlands, Norway and the UK) considered the deeply ingrained view in national healthcare systems and GP communities that CAM modalities are not evidence-based as the main reason for the lower use of CAM by GPs. Secondly, extensive training of communication skills was cited as a reason that reduced the need for CAM in the Netherlands, Norway and the UK. Thirdly, differences in patient expectations and demands were perceived as a factor contributing to greater utilisation of CAM by German GPs compared to the other countries. Finally, country-specific reimbursement mechanisms were considered as a factor influencing the role of CAM in general practice.ConclusionsThe study results point to major differences between countries with regard to the role of CAM in GP care. Differences in basic attitudes in the discipline of general practice, patient expectations and system conditions appear to play an important role here.

63 General practitioners’ experience, attitudes and needs on providing advice on physical activity to people with chronic ischemic heart disease - A qualitative study (OptiCor study)

Abstract Purpose The German treatment guideline “chronic ischemic/coronary heart disease (IHD)” recommends that general practitioners (GPs) deliver advice on physical activity (PA) to IHD patients. However, the provision of PA advice is inadequately implemented in general practice in Germany. One reason is the lack of medical training in providing PA advice effectively and efficiently. International guidelines recommend such training for GPs. This study aims to explore needs, experiences, and attitudes including barriers and facilitators of GPs towards the routine delivery of PA advice to IHD patients, in order to adequately inform a customised development of such a training. Methods Over a period of four months (March – June 2023), 12 face-to-face problem centred interviews (n = 12; 5/12 females, age range: 35-73 years) and six focus group discussions (n = 37; 13/37 females, age range: 36-70 years) with GPs were conducted. Interview and discussion guides were developed and pilot tested by the multi-professional study team. Data were collected in an iterative process. Purposive sampling and techniques of maximal structural variation were applied (e.g., with regard to professional experience, interest in PA). Audio-recorded data were transcribed verbatim and analysed using a content structuring procedure (deductive and inductive approach). GPs were involved throughout the entire research process, e.g., in multi-professional analysis groups. Results Whereas GPs are mostly aware of the health benefits of PA for IHD patients, PA advice is not routinely provided. Conversations on PA tend to be unstructured and advice is often addressed more generally than customised to the patients’ needs and preferences. Priority is given to other lifestyle issues, such as smoking. The effectiveness of PA advice is perceived as less effective but time consuming. GPs mention frustration in this context. They express a need for communication strategies (structure and tools) to motivate patients to PA that can be integrated into everyday GP care. Conclusion The results provide relevant insights into the everyday practice of GPs, information on GPs’ needs and requirements and can thus contribute to a target group-specific development of a GP training on PA advice for patients with IHD in the OptiCor study. Funding German Ministry of Education and Research (01GY2103).