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Univ.-Prof. Dr. med. Heinz-Harald Abholz 

Universitätsklinikum Düsseldorf

Abteilung für Allgemeinmedizin

Moorenstr. 5

40225 Düsseldorf

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Review dialogues as a means to foster patient orientation and to improve GP treatment quality in persons with chronic illness (BILANZ)

Applicants

Univ.‐Prof. Dr. med. Heinz‐Harald Abholz, Abt. für Allgemeinmedizin, Universitätsklinikum Düsseldorf (Leadership of general project); Prof. Dr. med. Stefan Wilm, Institut für Allgemeinmedizin und Familienmedizin im Interdisziplinären Zentrum für Versorgungsforschung, Universität Witten/Herdecke (Project coordination); Dr. Ottomar Bahrs, Abt. Medizinische Psycho‐logie und Medizinische Soziologie, Universität Göttingen (Leitung der qualitativen Teilstudie).

 

Biostatistics: Univ.‐Prof. K. Wegscheider, UKE, Hamburg

 

Experimental aim

Improvement in the achievement of goals agreed upon by patient and physician regarding

a) the prevention of lifestyle-determined progression of chronic illness and its complications and/or

b) better use of coping abilities and salutogenic resources of the patient

 

Hypothesis

Every six months, review dialogues conducted together between the patient and physician can foster the successes of medical advice regarding lifestyle and modes of attitude and action of chronically ill persons if the following conditions are in place:

a) Working out salutogenic possibilities and self-management abilities of the patients;

b) Sufficient time and continuity in the patient-centred physician-patient dialogue;

c) Physicians trained in the area of review dialogue and shared decision-making.

 

Study type

Linking of cluster-randomised, controlled, non-blinded intervention study and qualitative study (mixed-method design); health economic evaluation

 

Intervention

Training of the physician comprising 24 teaching hours (cluster level) on review dialogue, identification of salutogenic resources and self-management abilities, shared problem definition and decision making as well as patient-centred communication

 

Analysis

Evaluation of the two primary partial endpoints (sustainable achievement of jointly set goals from the patient's and physician's perspective) after 12 months with a random effect binary model with the intervention as fixed influencing factor and the practice affiliation as a random effect under consideration of imbalances.

 

Intention-to-treat evaluation on the patient level. Embedded qualitative study with analysis of a subsample of video-recorded consultations using the semi-standardised RIAS procedure as well as patient and physician interviews for the interpretation of the measured intervention effects. Health-economic evaluation through modelling with cost-effectiveness analysis and cost-benefit analysis from the perspective of the social insurance system.

 

Database

Documentation by physician, evaluation forms by patient and physician, video recording of dialogues, survey of patients and physicians; detailed data and process monitoring.

 

Sample / sample size

Consecutive patients (presence of at least one chronic illness; age 18 to 70 years) from n=104 GP practices (cluster) from two recruitment centres. Patients who can be included: n>5200; patients approached: n=2600; initially participating patients: n=1690 from 104 practices; patients who can be evaluated: n=1410 from 94 practices.

 

Subsample (n=40 practices) with video dialogue recordings; theoretical sampling, n=40 qualitative interviews.

 

Recruitment GP practices: 3 months; Recruitment patients: 5 months. First patient in to last patient out: 17 months.

 

Benefit and potential use of the research results

Better achievement of objectives in the care of persons with chronic illness through individualised, gender-sensitive offers and fostering patients' own resources; change in physician care culture with content-structural arrangement of the "physician dialogue"; module for physician further education and training that can be implemented in routine care, is theoretically founded and empirically tested, which can be used analogously for medical training. General content-based improvement of the care of chronically ill persons with the use of their self-management.




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