RESUMEN
BACKGROUND: In Germany, 85% of all antibiotics are prescribed in the outpatient care sector, and dentists account for 11% of the total outpatient antibiotic prescriptions. OBJECTIVE AND METHOD: Summarise published literature on antibiotic use, pathogens and antibiotic resistance in odontogenic infections and German clinical guidelines and interventions for antibiotic use in dental care. RESULTS: In contrast to other outpatient physicians, the volume of antibiotics prescribed by dentists in Germany did not decrease over the last decade. Penicillins and aminopenicillins are the most frequently prescribed antibiotics (70% of all prescriptions), followed by clindamycin (26%). Streptococcus spp. and Staphylococcus spp. are frequent pathogens isolated from odontogenic infections. However, the infections are often polybacterial with a mixed growth of anaerobic and aerobic bacteria. While the widespread use of penicillin class antibiotics is compatible with German recommendations on empiric antibiotic therapy, there is evidence that pathogens from odontogenic infections frequently exhibit resistance against them. Moreover, the high prescription volume of clindamycin (⟩25%) appears to be inadequate, since relatively high resistance rates are observed and clindamycin is not recommended as first-line choice in empiric antibiotic therapy. National and international studies show that continuous education of patients and dentists, individual prescription feedback as well as evidence-based guidelines are important measures to improve antibiotic prescription patterns among dentists. CONCLUSION: To promote rational antibiotic use in outpatient dental care, antibiotic stewardship measures are necessary that include prescription guidelines based on AMR surveillance data as well as continuous education of dentists.
Asunto(s)
Programas de Optimización del Uso de los Antimicrobianos , Humanos , Antibacterianos/uso terapéutico , Clindamicina/uso terapéutico , Farmacorresistencia Bacteriana , Penicilinas , Alemania , Prescripciones , Odontólogos , Pautas de la Práctica en OdontologíaRESUMEN
BACKGROUND: Most patients in the last phase of life can be treated in the context of generalist palliative care, especially by general practitioners. In contrast to specialized palliative care, non-cancer patients predominate in this setting. OBJECTIVE: The aim of this article is to review the literature and elaborate current topics for non-cancer patients at the end-of-life in primary palliative care. MATERIALS AND METHODS: A literature search was carried out in the databases PubMed and Scopus from 2008 to 2013 followed by a qualitative content analysis according to the PRISMA statement. RESULTS: A total of 127 articles could be included in the qualitative content analysis and the final review whereby four core topics were identified: (1) specific target groups (e. g. elderly patients, patients with advanced heart failure and pain), (2) collaboration of general practitioners with other physicians and health professionals, (3) qualifications in palliative care and (4) provision of primary palliative care. Most articles found were related to the fourth topic and the subtopic of barriers and facilitators of palliative care. Insufficient coordination of the persons involved was a barrier often discussed. Advanced care planning including concrete palliative care aspects at an early stage can be beneficial for both patients and professionals. CONCLUSION: The current literature search highlights the importance of optimizing the processes and structures in providing palliative care and the discussion of end-of-life issues at an early stage in general practice. Therefore, a structured identification of palliative care needs identified by appropriate assessment instruments is crucial.
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Medicina General , Cuidado Terminal , Anciano , Humanos , Dolor , Cuidados Paliativos , Investigación CualitativaRESUMEN
BACKGROUND: General Practitioners (GPs) are the main providers of primary palliative care (PPC). At the same time they are the main initiators of specialised palliative homecare (SPHC). In Germany, little is known about factors which influence GPs in their involvement of SPHC. Aim of our study is to identify factors that drive GPs to give value to and involve SPHC. METHODS: A cross-sectional survey was performed. In 2018, questionnaires were mailed to 6000 randomly selected GPs from eight German federal states, focusing on the extent of GPs' palliative care activities and their involvement of SPHC. RESULTS: With a response rate of 19.4% and exclusion of GPs working in SPHC-teams, n = 1026 questionnaires were appropriate for analysis. GPs valued SPHC support as the most "important/very important" for both "technical/invasive treatment measures" (95%) and availability outside practice opening hours (92%). The most relevant factor influencing perceived SPHC-importance was GPs' self-reported extent of engagement in palliative care (ß = - 0.283; CI 95% = - 0.384;-0.182), followed by the perceived quality of utilised SPHC (ß = 0.119; CI 95% = 0.048;0.190), involvement in treatment of palliative patients after SPHC initiation (ß = 0.088; CI 95% = 0.042;0.134), and conviction that palliative care should be a central part of GPs' work (ß = - 0.062; CI 95% = - 0.116;-0.008). Perceived SPHC-importance is also associated with SPHC-referrals (ß =0.138; p < 0.001). The lower the engagement of GPs in palliative care, the more they involve SPHC and vice versa. CONCLUSIONS: GPs with low reported activity in palliative care are more likely to initialise SPHC for palliative care activities they do not deliver themselves for various reasons, which might mean that the involvement of SPHC is substitutive instead of complementary to primary palliative care. This finding and its interpretation should be given more attention in the future policy framework for (specialised) palliative homecare. TRIAL REGISTRATION: German Clinical Trials Register DRKS00014726 , 14.05.2018.
Asunto(s)
Médicos Generales/psicología , Cuidados Paliativos/normas , Percepción , Adulto , Anciano , Estudios Transversales , Femenino , Médicos Generales/normas , Médicos Generales/estadística & datos numéricos , Alemania , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/tendencias , Encuestas y CuestionariosRESUMEN
BACKGROUND: Most patients in the last phase of life can be treated in the context of generalist palliative care, especially by general practitioners. In contrast to specialized palliative care, non-cancer patients predominate in this setting. OBJECTIVE: The aim of this article is to review the literature and elaborate current topics for non-cancer patients at the end of life in primary palliative care. MATERIAL AND METHODS: A literature search was carried out in the databases PubMed and Scopus from 2008 to 2013 followed by a qualitative content analysis according to the PRISMA statement. RESULTS: A total of 127 articles could be included in the qualitative content analysis and the final review whereby four core topics were identified: (1) specific target groups (e.g. elderly patients, patients with advanced heart failure and pain), (2) collaboration of general practitioners with other physicians and health professions, (3) qualifications in palliative care and (4) provision of primary palliative care. Most articles found were related to the fourth topic and the subtopic of barriers and facilitators of palliative care. Insufficient coordination of the persons involved was a barrier often discussed. Advanced care planning including concrete aspects of palliative care at an early stage can be beneficial for both patients and professionals. CONCLUSION: The current literature search elucidates the importance of optimizing the processes and structures in providing palliative care and the discussion of end of life issues at an early stage in general practice. Therefore, a structured identification of palliative care needs identified by appropriate assessment instruments is crucial.
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Dolor Crónico/terapia , Medicina General , Cuidados Paliativos/métodos , Anciano , Anciano de 80 o más Años , Humanos , Comunicación Interdisciplinaria , Colaboración Intersectorial , Dimensión del Dolor , Cuidado Terminal/métodosRESUMEN
OBJECTIVE: Clinical trials are regarded as complex due to the high demands on quality and patient safety and are still exceptional in German primary care. To optimise future trial planning, this study aimed at investigating the barriers and enablers experienced by primary care physicians (PCPs) for trial participation. METHODS: PCPs were surveyed on 11 regional primary care medical education (CME) events using a standardised questionnaire. Regression analyses were used to identify predictors for future trial participation. RESULTS: Of 804 invited PCPs, 408 (50.7%) participated in the survey (51 ± 9 years, female 35%). 69% of participants could imagine their participation in a clinical trial. Of 12 potential factors assessed, the final model retained the 2 predictors (OR; CI; P-value) "research questions relevant to practice" (2.25; 1.61-3.14;<0.001) and "new challenges/change from everyday life" (2.24; 1.67-2.97;<0.001). While 58% of participants were principally willing to participate in investigator training courses according to Good Clinical Practice (GCP), only 6% had participated in such training at the time of answering. Short events were preferred. Only 7% were willing to take over at least half of the costs of these courses. CONCLUSION: To enhance German PCPs motivation to participate in clinical trials, both trials and training courses should be tailored to the needs in the primary care setting.
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Actitud del Personal de Salud , Médicos de Atención Primaria/estadística & datos numéricos , Ensayos Clínicos Pragmáticos como Asunto/estadística & datos numéricos , Actitud Frente a la Salud , Femenino , Alemania , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND AND AIM: Within end-of-life care concepts, relatives of patients suffering from incurable illness are an important target group. This study aims to explore the experiences of relatives of deceased patients regarding health care delivery within the last days and weeks of life, and to work out implications for patient and relatives oriented improvement strategies. PATIENTS AND METHODS: We conducted 19 qualitative interviews with bereaved relatives addressing the patient's use of health care services and satisfaction with the services, as well as communication and information. Interviews were transcribed verbatim and analyzed using qualitative content analysis. RESULTS: Three main categories were developed: (1) present health care delivery, e. g. positive and negative experiences concerning communication and information; (2) expectations and wishes, e. g. better support and coordination concerning discharge from hospital; (3) the relative and the dying patient, e. g. attitudes towards death and dying as well as individual limitations and resources. Overall, from the perspective of the bereaved relatives there are deficits concerning coordination of health care delivery and communication. CONCLUSION: Improving coordination of health care in particular with regard to the interfaces of outpatient and inpatient care, advanced care planning and strengthening "talking medicine" may contribute to optimize health care delivery for severely ill and dying patients and their relatives.