Completed

Master student (Medical Process Management): Carolin Nürnberger

The topic of oversupply is becoming increasingly important in health science and medical research. The term oversupply refers to care that goes beyond the needs of a patient and is more harmful than beneficial. This has various causes and consequences, both for patients personally and for the entire healthcare system. To counteract oversupply, various concepts such as "Choosing Wisely" have already been introduced, which focus directly on patients. However, according to several studies, these are still rather unknown among patients.

This study was conducted to find out what patients and healthy citizens understand by oversupply and how they perceive it. For this purpose, citizens were interviewed as part of an online survey.

Master student: Laura Dlugosch

In order to contain the rapid spread of the novel "SARS-CoV-2" virus and maintain patient care during the pandemic, dynamic action and a flexible adaptation of the previous practice structures in general practice are necessary. This poses new challenges for practice staff. This raises the question of how these organisational changes in everyday practice are subjectively perceived by the medical staff in the general practitioner's practice due to health policy. The following main research question needs to be answered: How do organizational restructurings influence the mental well-being of general practitioner practice teams using the example of the Corona pandemic?

While previous studies that dealt with the effects of the Corona pandemic on the mental health of employees in patient care tended to focus on medical staff in the inpatient sector, this thesis will look at the outpatient, general practitioner care sector. In particular, the perspective of medical professionals in private practices has so far received insufficient attention.

To answer the research question, a qualitative interview study will be conducted in which family doctors and medical assistants of general practitioners' practices will be interviewed on the described topic.

Doctoral student: Eva Maria Loesch

With the implementation of §75a of SGB V on the establishment of competence centers for further training, the legal mandate was given for the first time to improve the quality and efficiency of further training to become a specialist in general practice. In addition to content qualification, the “Seminar Days for Advanced Training in General Practice” (SemiWAM) offered by the General Practice Coordination Office are intended to strengthen identification as a general practitioner and thus the motivation to complete specialist training.

A quantitative questionnaire will be used to record and analyze the social integration of the seminar participants and its potential correlations and influencing factors. The expected results are to be discussed in the overall context of further training, in which the basic psychological needs, with a particular focus on social integration, are to be taken into account and strengthened in the best possible way.

Doctoral student: Zawa Othmann

In a survey conducted by the Health Monitor, 90% stated that they had a family doctor. Another 60% of these respondents also stated that they would go straight to a specialist without consulting their family doctor if they had a health problem. So what significance do family doctors actually have for people? The aim of this study is to find out what role GPs play in healthcare, what role they play in a system of free choice of doctor and what competencies are ascribed to them by their patients. In order to approach this topic in an open and explorative manner, a qualitative study design was chosen.

Doctoral student: Louisa Hecht

Due to the increasing shortage of junior doctors in general practice, the practical year (PJ) is becoming increasingly important in this subject. In order to ensure the quality of the practical year, there have recently been increasing efforts to prepare the relevant teaching physicians for their tasks with the help of training courses. The aim of this work in the field of teaching and didactics research is to collect the experiences of PJ teaching physicians with these training courses and their transfer to everyday practice. The results are to be used to optimize the design of didactic training courses.

Doctoral student: Frederik Woll

Too many antibiotics are often prescribed for respiratory tract infections. Studies show that prescribing behavior is influenced by a complex interplay of physician and patient factors. Using billing data from the Association of Statutory Health Insurance Physicians in Bavaria, we will investigate which physician and patient factors are associated with antibiotic prescribing. Special focus is placed on the analysis of the factor “comorbidity”. Scores have been developed to predict the course of the disease and mortality, which are intended to assess the comorbidity of patients. A large number of different comorbidity scores exist. It is unclear which score is suitable for use with routine data from outpatient care.

Doctoral student: Lena Kukulenz

The link between outpatient and inpatient care is of great importance in order to ensure optimal patient care. However, the interface between these sectors presents a number of hurdles.

Using the example of oral anticoagulation, the challenge of drug prescriptions will be examined in more detail by means of a qualitative interview study.

To this end, clinicians will be asked which factors influence the prescription of medicines from their perspective and which solutions could be considered in order to achieve better cooperation between the sectors. The subsequent evaluation follows the qualitative content analysis according to Mayring.

Master student: Stefanie Stark

The global spread and the very high infection rate make the coronavirus relevant in both medical and social discourse and not comparable to other previous pandemics. This is made clear by the declaration of a state of emergency and the establishment of crisis teams in individual countries, but also by the WHO's declaration of an international state of emergency. Primarily, the rapid global spread, the dynamic development and the unknown nature of the virus and its course pose major challenges for countries' healthcare systems. It is precisely this system that must be protected from being overloaded or even collapsing. At the center of the healthcare system is the family doctor, as the “primary care provider with a coordinating function”, who plays a key role, especially during such a pandemic. Political measures have been taken that not only influence the actions of all citizens, but also those involved in general practice, especially GPs, in that health policy guidelines have a significant influence on professional medical action in GP care.

Based on these adjustments and changes in the approach to GP care in the pandemic situation, the following research interest arises: The focus is on the professional and health policy adjustments caused by the crisis and the centralization on GP care. Thus, the role and relevance of the Bavarian family doctor in the Corona crisis will be examined in a discourse-analytical consideration, which will be based on the presentation of the Bavarian Family Doctors' Association as an organizational form and information medium of the medical profession and the examination of the official “Corona circulars” of the BHÄV to the family doctors. By applying the sociological discourse analysis (WDA) according to Reiner Keller (2008), the following question will be investigated: “What role(s), task(s) and relevance is/are attributed to or denied to the GP in the corona pandemic?”

Doctoral student: Anna Schlenz

The expectations of doctors and patients regarding drug therapies often differ. In an online questionnaire study, medical laypersons and doctors from different specialties are to be surveyed once. The aim is to find out what these groups of people expect from medication for osteoporosis.

The participants in the study are to put themselves in the position of a patient with a defined risk and decide at what therapeutic effect they would be prepared to take a drug with the side effects described above. In general, it is also a question of the personal risk of bone fracture at which the test subjects would consider drug therapy. The doctors are also asked how they assess the actual benefit of a particular group of drugs (bisphosphonates) in the case study.

Doctoral student: Josephine Reymann

Campaigns such as “Choosing Wisely” address the issue of overuse and target citizens and patients in popular scientific articles. But what does overuse actually mean for people? In this study, patients and citizens are asked whether and how they perceive overuse, whether it plays a role for them and how they deal with this discussion.

Doctoral student: Korbinian Saggau

It is not possible for the average doctor to find out exactly what a GP is doing right in the treatment of their patients and where there is room for improvement with the help of practice software or the health insurance companies' Disease Management Program (DMP). Using the example of asthma and COPD, we try to provide German GPs with these tools. This work is intended to show what is important for the individual patient and to show a way in which doctors can determine these parameters and then influence them positively.

Master student (Medical Process Management): Andrea Riedel

Due to the constant development in medicine, there is a wide range of diagnostic and therapeutic options for various diseases. How can technical progress in digitalization help to incorporate various individual patient information into treatment decisions? Can an interplay between clinical decision aids and evidence-based guidelines for patient stratification be technically implemented?

The Master's thesis in Medical Process Management was carried out in cooperation with Siemens Healthineers. The main focus of the thesis is on the generation of a probabilistic network in order to be able to generate artificial prostate cancer patient data. This network, which is based on current study data, is intended to enable the classification of realistic patients. The classification is based on their characteristics, adherence to or deviation from treatment guidelines and the resulting outcome indicators. The finally developed probabilistic network will be part of the virtual clinic for the development and testing of various digital products.

Doctoral students: Kathrin Alber and Maximilian Pausch

The topic of overuse is increasingly finding its way into the health science debate. The aim is to recognize and prevent overuse. Against this background, the concept of quaternary prevention has become established. Quaternary prevention is the “prevention of unnecessary, potentially harmful medicine, the prevention of overdiagnosis and overtreatment”. Patients who are at risk of overuse should be identified, as should elements of care that are of no benefit. Quaternary prevention is seen as the central task of GPs, who are the first point of contact in the healthcare system at the beginning of a potential process of overuse.

1. Qualitative Interviewstudie (Kathrin Alber). In Einzelinterviews mit Hausärztinnen und Hausärzten aus der Region soll untersucht werden, welche Meinungen, Einstellungen, Begründungen und Handlungsstrategien auf Seiten der Hausärztinnen und Hausärzte im Hinblick auf Überversorgung und Quartäre Prävention vorliegen. (Publikation)

2. Quantitative Befragung (Maximilian Pausch). In der qualitativen Studie wurde bereits ein erstes Bild zu Meinungen und Handlungsstrategien auf Seiten der Hausärztinnen und Hausärzte erfasst. Dieses Bild soll nun anhand einer größeren Stichprobe quantifiziert werden. (Publikation)

Doctoral student: Luca Frank

There are controversial public discussions about the benefits and risks of screening tests. People are uncertain and rely on the advice of trusted medical experts. But even for doctors, it can be difficult to come to a final judgment. It is not only statistical parameters that are decisive, but also the clinical expertise of the doctors and the experiences and preferences of the patients seeking advice. With our approach, we first want to find out what influence epidemiological parameters have on GPs' decision-making.

Doctoral student: Astrid Theurer (born Ganz)

In Germany, every child is entitled to ten free preventive medical check-ups (U1 to U9, including U7a). Despite this, the number of visits decreases from U1 to U9. The KiGGS study found that parents with a migration background and/or a lower social status in particular are less likely to take their children to the U9. The aim of the study is to investigate whether social status and migration background have an influence on the health and developmental status of children at the U9.

Doctoral student: Kathrin Ludwig

The shortage of GPs is increasingly threatening medical care, especially in rural areas. Various measures are already being taken to increase the attractiveness of rural general practice. One motivating factor is the successful completion of the elective tertial in general practice during the final year. The Chair of General Practice has developed the concept of accompanying mentoring for PJ students. Regular university mentoring accompanies the students throughout the entire 12 months, i.e. also outside the general medical tertial. The aim is to enable students to view the teaching content taught in the hospitals from the perspective of general practice as early as the clinical PJ stages. The aim is to investigate whether these intensified structures contribute more to motivating students to choose general practice than a routine implementation of the PJ in general practice. A further aim is to explore individual barriers to a possible settlement in rural regions. The project is funded by the Bavarian State Ministry of Nursing and Health.

Doctoral student: Anne Lutz

The common is common, the rare is rare. From the point of view of GPs, however, rare diseases are not so rare after all. As there are over 5000 different rare diseases in total, this results in a considerable patient population. Statistically speaking, every GP has to look after at least one of these patients. The question now arises as to how good the quality of care is for these patients in general practice. To this end, carers of people with Prader-Willi syndrome were asked in an open interview, which was evaluated qualitatively. The aim is to identify positive and improvable conditions in the care of these patients.

Doctoral student: Moritz Männer

The impending shortage of GPs in rural areas worries doctors and society alike. A number of measures have already been launched to reduce barriers by providing financial and non-material support. This study aims to explore the reasons for working in rural areas. As part of two seminars organized by the Coordination Office for General Practice in Bavaria, 43 prospective GPs were asked to design a fictitious advertising campaign that would motivate them to work as a GP in rural areas. The positive aspects identified concerned professional issues in terms of better framework conditions and more comprehensive work content. The private environment was also addressed, with the more favorable lifestyle, a family-friendly environment, life in nature and life satisfaction being important topics. Barriers were also discussed. There are fears of a restriction of privacy, a feeling of constant availability or a higher workload, as well as overstretching one's own skills. Almost 70 % (n = 29) of participants could imagine working as a doctor in the countryside.

Doctoral student: Marc Morgott

In the context of evidence-based medicine, associations of all kinds strive to summarize the unmanageable flood of new and old findings in guidelines in order to keep the medical profession as up to date as possible with the latest scientific findings and to give them a certain degree of certainty in their actions. Due to their nature, these guidelines are constantly evolving and - not infrequently - in the crossfire of debate. Against this background, a contribution is to be made to clarify one of the current questions: “Are guidelines currently suitable for providing (general) practitioners with sufficient information so that they can a) form their own well-founded opinion when treating individual patients and b) provide the patient with comprehensive and optimal advice in the sense of informed consent?” As an introduction to this topic, the frequency of reports of effect measures relative to the number of recommendations given in the guidelines was chosen as the outcome for the current study, as reports of effect measures regarding effects and side effects are considered essential for the targeted selection of interventions in individual cases. German and English-language guidelines on chronic CHD and type 2 diabetes mellitus, which are common topics in general practice, with national and international influence are researched for this purpose and quantitatively analyzed with regard to the outcome mentioned. The results are then presented and discussed accordingly. This should provide a basis for justifying and promoting further research in this area if necessary.

Doctoral student: Christiane Nittritz

Consultations are of great importance in the GP setting. It is a central element in establishing and maintaining a sustainable doctor-patient relationship. In the course of the modernization of further training regulations, the acquisition of consultation and communication skills is moving more into focus. The study examines the question of how the content of further training is currently perceived in relation to consultation behavior. The aim is to obtain an impression of the importance of consultation in everyday medical practice and in further training. To this end, young doctors in further training and those in further training are surveyed.

Doctoral student: Lisa Brühl (born Schwarz)

In patients with respiratory tract infections, doctors must differentiate between an often viral infection and a bacterial infection, which may need to be treated with antibiotics. The decision is not always clear based on the clinical symptoms. Conjoint analysis is used to examine which symptoms or symptom constellations are decisive for prescribing antibiotics.

Student (Medical Process Management): Friederike Eichhorn

Quality management serves to improve processes and structures and to increase the quality of medical work. In order to measure the quality of practice work and patient care, the assessment of the practice by patients is often also recorded. The aim of the work was to develop a questionnaire to measure patient satisfaction in GP care and to transfer this instrument to standard care. The survey was conducted in summer 2014 at MVZ Eckental.

Student (Medical Process Management): Franziska Madlo-Thiess

10 years ago, quality management (QM) was made mandatory for the outpatient sector. We wanted to know how GPs experienced the introduction of QM, how important it is to them today and how they see the future of QM. In a qualitative study design, doctors from a network of doctors were questioned in expert interviews using a semi-structured interview guide. The results show that there is agreement on the standardization of some basic processes such as hygiene. However, QM could hardly be transferred to an area that is essentially characterized by interpersonal relationships and communication. The doctors stated that they had reduced QM to a tolerable level that made sense for them. Certification was largely rejected. Expectations for the next ten years were rather pessimistic in terms of ever more bureaucratic requirements. The statutory introduction of QM was an intrusion by society into the professional sphere of doctors. Instead of passive resistance and limiting QM to a tolerable minimum, committed independent quality work could help to regain social trust in order to maintain the necessary professional autonomy.

Master student: Dominik Edel

Since the “Discharge management rehab” framework agreement came into force on February 1, 2019, inpatient rehabilitation facilities have been obliged to carry out discharge management for their patients. After a transitional period until 01.08.2019, the necessary changes were implemented.

Well-organized discharge management plays a decisive role for the time after rehabilitation. It has the potential to close gaps in care, optimize medical and nursing care and increase the chances of long-term success of rehabilitation measures. With the introduction of discharge management, the clinic is responsible for organizing the medical and nursing measures required after the rehabilitation stay together with the patients. This also includes support in applying for benefits from the health insurance fund and/or care insurance fund. In addition, the rehabilitation facility can now determine an inability to work after rehabilitation. In addition, services such as medication, remedies, aids or home nursing care can be prescribed for up to 7 days after rehabilitation.

These new responsibilities require interdisciplinary cooperation between the stakeholders within and outside the rehabilitation clinic. Successful implementation of discharge management is only possible if these new and complex processes are implemented in a standardized manner.