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Final report PrefCheck (German)

 

Contact

Medizinische Hochschule Hannover
Dr. Ulrike Junius-Walker
Institut für Allgemeinmedizin in Kooperation mit dem Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung
Carl-Neuberg-Straße 1, 30625 Hannover 
www.mh-hannover.de



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Project “PrefCheck”: Patient-centred treatment planning with older patients

The aim is to develop and test a structured GP preference dialogue module. In view of the multitude of health problems in old age, this should bring about an improved agreement and focus on treatment goals between physician and patient.

 

In the first part of the study, health problems of 40 older patients are surveyed. Building on this, influencing factors and motives for the decision regarding relevance and treatment preferences among the patients and their GPs are qualitatively explored and from this, the preference dialogue module is developed. In a controlled comparison study, this dialogue module is tested according to survey of the health problems in 20 GP practices with 160 patients and compared to a same-sized control group without a dialogue module. A further part serves to provide feedback evaluation of physicians and patients on the preference dialogue module.

 

Insights into health and treatment priorities of older patients and GPs as well as the concrete implementation of a patient-oriented treatment plan serve to develop an innovative GP care model.

 

U. Junius-Walker1 und M. L. Dierks2

  1. Institut für Allgemeinmedizin, Schwerpunkt: Gesundheit im Alter; Medizinische Hochschule Hannover
  2. 2.    Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Schwerpunkt: Patienten und Konsumenten; Medizinische Hochschule Hannover

 

Background

The increasing cost pressure in the health system is principally attributed to the ageing society. This results in rationalisation efforts which increasingly affect older people. Thus, calls are increasingly made for the available resources to be efficient, transparent and fairly implemented.

On the micro level of GP care, a systematic treatment model in old age is also required. At the core, the concern is with capturing multimorbidity in a clear-cut manner and to create patient-oriented and effective treatments through a partnership-based planning of priority treatment goals.

 

Aims

A GP dialogue module is developed and tested. This is based on a stock-taking of individual health problems of older people (STEP assessment), i.e. on the provision of a systematic basis of information. The dialogue module to be developed should strengthen patient orientation by measuring patients’ health preferences in a structured manner. The dialogue model should serve narrative-based medicine through the fact that patient priorities and physician treatment priorities lead to a consented treatment planning.

 

Methods / Study design 

Qualitative part A:

Aim: Exploration of the motives for relevance and treatment preferences of present health problems and development of a dialogue module (PrefCheck).

Methods: STEP assessment and subsequent interview with 40 older patients and their GPs.

 

Quantitative part B

Aim: Testing of the PrefCheck in a cluster-randomised controlled intervention study.

Method: All patients receive the STEP assessment in order to ascertain individual health problems. Physician and patient in both groups evaluate independently from one another whether each individual problem is relevant. In the intervention group, this is followed by the joint dialogue module with consented treatment planning; in the control group, the usual care is provided. After two weeks, all physicians and patients are surveyed regarding primary and secondary outcomes. The primary outcome is the degree of agreement between physician and patient regarding the relevance of individual health problems. It is expected that in the intervention group, the dialogue module will lead to significantly improved agreement regarding the relevance evaluations pertaining to the individual health problems. Secondary outcomes refer on the part of the patient to being informed, evaluation of shared decision making, satisfaction, and improved dealing with one’s own problems.

 

Qualitative part C:

Aim: Quality assurance of the PrefCheck.

Method: 15 patients of the control group from five GP practices receive the PrefCheck in order to evaluate the dialogue module in terms of content validity, practicability and acceptance.

 

Benefits

The intention is to provide essential insights into health and treatment priorities of older multimorbid patients and their GPs.

The project should make a care-based contribution to strengthening the position of older persons in terms of information and involvement in complex treatment processes




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