@article{ParisiLehnerSchraderetal.2023, author = {Parisi, Sandra and Lehner, Nina and Schrader, Hanna and Kierer, Leonard and Fleischer, Anna and Miljukov, Olga and Borgulya, Gabor and R{\"u}ter, Gernot and Viniol, Annika and G{\´a}gyor, Ildik{\´o}}, title = {Experiencing COVID-19, home isolation and primary health care: A mixed-methods study}, series = {Frontiers in Public Health}, volume = {10}, journal = {Frontiers in Public Health}, issn = {2296-2565}, doi = {10.3389/fpubh.2022.1023431}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-301498}, year = {2023}, abstract = {Objectives Although the vast majority of COVID-19 cases are treated in primary care, patients' experiences during home isolation have been little studied. This study aimed to explore the experiences of patients with acute COVID-19 and to identify challenges after the initial adaptation of the German health system to the pandemic (after first infection wave from February to June 2020). Methods A mixed-method convergent design was used to gain a holistic insight into patients experience. The study consisted of a cross-sectional survey, open survey answers and semi-structured telephone interviews. Descriptive analysis was performed on quantitative survey answers. Between group differences were calculated to explore changes after the first infection wave. Qualitative thematic analysis was conducted on open survey answers and interviews. The results were then compared within a triangulation protocol. Results A total of 1100 participants from all German states were recruited by 145 general practitioners from August 2020 to April 2021, 42 additionally took part in qualitative interviews. Disease onset varied from February 2020 to April 2021. After the first infection wave, more participants were tested positive during the acute disease (88.8\%; 95.2\%; P < 0.001). Waiting times for tests (mean 4.5 days, SD 4.1; 2.7days, SD 2.6, P < 0.001) and test results (mean 2.4 days, SD 1.9; 1.8 days, SD 1.3, P < 0.001) decreased. Qualitative results indicated that the availability of repeated testing and antigen tests reduced insecurities, transmission and related guilt. Although personal consultations at general practices increased (6.8\%; 15.5\%, P < 0.001), telephone consultation remained the main mode of consultation (78.5\%) and video remained insignificant (1.9\%). The course of disease, the living situation and social surroundings during isolation, access to health care, personal resilience, spirituality and feelings of guilt and worries emerged as themes influencing the illness experience. Challenges were contact management and adequate provision of care during home isolation. A constant contact person within the health system helped against feelings of care deprivation, uncertainty and fear. Conclusions Our study highlights that home isolation of individuals with COVID-19 requires a holistic approach that considers all aspects of patient care and effective coordination between different care providers.}, language = {en} } @article{SchraderRuckBorgulyaetal.2023, author = {Schrader, Hanna and Ruck, Jessica and Borgulya, G{\´a}bor and Parisi, Sandra and Ehlers-Mondorf, Jana and Kaduszkiewicz, Hanna and Joos, Stefanie and Grau, Anna and Linde, Klaus and G{\´a}gyor, Ildik{\´o}}, title = {Stress experiences of healthcare assistants in family practice at the onset of the COVID-19 pandemic}, series = {Frontiers in Public Health}, volume = {11}, journal = {Frontiers in Public Health}, issn = {2296-2565}, doi = {10.3389/fpubh.2023.1238144}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-327427}, year = {2023}, abstract = {Background: At the beginning of the pandemic in 2020, healthcare assistants in general practices were confronted with numerous new challenges. The aim of the study was to investigate the stress factors of healthcare assistants in March/April 2020 as well as in the further course of the pandemic in 2020. Methods: From August to December 2020, 6,300 randomly selected healthcare assistants in four German states were invited to participate in the study. We performed a mixed methods design using semi-structured telephone interviews and a cross-sectional survey with quantitative and open questions. The feeling of psychological burden was assessed on a 6-point likert-scale. We defined stress factors and categorized them in patient, non-patient and organizational stress factors. The results of the three data sets were compared within a triangulation protocol. Results: One thousand two hundred seventy-four surveys were analyzed and 28 interviews with 34 healthcare assistants were conducted. Of the participants, 29.5\% reported experiences of a very high or high feeling of psychological burden in March/April 2020. Worries about the patients' health and an uncertainty around the new disease were among the patient-related stress factors. Non-patient-related stress factors were problems with the compatibility of work and family, and the fear of infecting relatives with COVID-19. Organizational efforts and dissatisfaction with governmental pandemic management were reported as organizational stress factors. Support from the employer and team cohesion were considered as important resources. Discussion: It is necessary to reduce stress among healthcare assistants by improving their working conditions and to strengthen their resilience to ensure primary healthcare delivery in future health crises.}, language = {en} } @article{SchmiemannGreserMaunetal.2023, author = {Schmiemann, Guido and Greser, Alexandra and Maun, Andy and Bleidorn, Jutta and Schuster, Angela and Miljukov, Olga and R{\"u}cker, Viktoria and Klingeberg, Anja and Mentzel, Anja and Minin, Vitalii and Eckmanns, Tim and Heintze, Christoph and Heuschmann, Peter and G{\´a}gyor, Ildik{\´o}}, title = {Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial}, series = {BMJ}, volume = {383}, journal = {BMJ}, issn = {1756-1833}, doi = {10.1136/bmj-2023-076305}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-349395}, year = {2023}, abstract = {Objectives To evaluate whether a multimodal intervention in general practice reduces the proportion of second line antibiotic prescriptions and the overall proportion of antibiotic prescriptions for uncomplicated urinary tract infections in women. Design Parallel, cluster randomised, controlled trial. Setting General practices in five regions in Germany. Data were collected between 1 April 2021 and 31 March 2022. Participants General practitioners from 128 randomly assigned practices. Interventions Multimodal intervention consisting of guideline recommendations for general practitioners and patients, provision of regional data for antibiotic resistance, and quarterly feedback, which included individual first line and second line proportions of antibiotic prescribing, benchmarking with regional or supra-regional practices, and telephone counselling. Participants in the control group received no information on the intervention. Main outcome measures Primary outcome was the proportion of second line antibiotics prescribed by general practices, in relation to all antibiotics prescribed, for uncomplicated urinary tract infections after one year between the intervention and control group. General practices were randomly assigned in blocks (1:1), with a block size of four, into the intervention or control group using SAS version 9.4; randomisation was stratified by region. The secondary outcome was the prescription proportion of all antibiotics, relative within all cases (instances of UTI diagnosis), for the treatment of urinary tract infections after one year between the groups. Adverse events were assessed as exploratory outcomes. Results 110 practices with full datasets identified 10 323 cases during five quarters (ie, 15 months). The mean proportion of second line antibiotics prescribed was 0.19 (standard deviation 0.20) in the intervention group and 0.35 (0.25) in the control group after 12 months. After adjustment for preintervention proportions, the mean difference was -0.13 (95\% confidence interval -0.21 to -0.06, P\<0.001). The overall proportion of all antibiotic prescriptions for urinary tract infections over 12 months was 0.74 (standard deviation 0.22) in the intervention and 0.80 (0.15) in the control group with a mean difference of -0.08 (95\% confidence interval -0.15 to -0.02, P\<0.029). No differences were noted in the number of complications (ie, pyelonephritis, admission to hospital, or fever) between the groups. Conclusions The multimodal intervention in general practice significantly reduced the proportion of second line antibiotics and all antibiotic prescriptions for uncomplicated urinary tract infections in women. Trial registration German Clinical Trials Register (DRKS), DRKS00020389}, language = {en} } @article{RohdeHimmelHofingeretal.2022, author = {Rohde, J{\"o}rn and Himmel, Wolfgang and Hofinger, Clemens and L{\^a}m, Thi{\^e}n-Tr{\´i} and Schrader, Hanna and Wallstabe, Julia and Kurzai, Oliver and G{\´a}gyor, Ildik{\´o}}, title = {Diagnostic accuracy and feasibility of a rapid SARS-CoV-2 antigen test in general practice - a prospective multicenter validation and implementation study}, series = {BMC Primary Care}, volume = {23}, journal = {BMC Primary Care}, number = {1}, doi = {10.1186/s12875-022-01756-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-299659}, year = {2022}, abstract = {Background PCR testing is considered the gold standard for SARS-CoV-2 diagnosis but its results are earliest available hours to days after testing. Rapid antigen tests represent a diagnostic tool enabling testing at the point of care. Rapid antigen tests have mostly been validated by the manufacturer or in controlled laboratory settings only. External validation at the point of care, particularly in general practice where the test is frequently used, is needed. Furthermore, it is unclear how well point of care tests are accepted by the practice staff. Methods In this prospective multicenter validation study in primary care, general practitioners included adult individuals presenting with symptoms suggesting COVID-19. Each patient was tested by the general practitioner, first with a nasopharyngeal swab for the point of care test (Roche SARS-CoV-2 Rapid Antigen Test) and then with a second swab for PCR testing. Using the RT-PCR result as a reference, we calculated specificity, sensitivity, positive predictive value and negative predictive value, with their 95\% confidence intervals. General practitioners and medical assistants completed a survey to assess feasibility and usefulness of the point of care tests. Results In 40 practices in W{\"u}rzburg, Germany, 1518 patients were recruited between 12/2020 and 06/2021. The point of care test achieved a sensitivity of 78.3\% and a specificity of 99.5\% compared to RT-PCR. With a prevalence of 9.5\%, the positive predictive value was 93.9\% and the negative predictive value was 97.8\%. General practitioners rated the point of care test as a helpful tool to support diagnostics in patients with signs and symptoms suggestive for infection, particularly in situations where decision on further care is needed at short notice. Conclusion The point of care test used in this study showed a sensitivity below the manufacturer's specification (Sensitivity 96.25\%) in the practice but high values for specificity and high positive predictive value and negative predictive value. Although widely accepted in the practice, measures for further patient management require a sensitive interpretation of the point of care test results.}, language = {en} } @article{KurotschkaFulgenzioDaCasetal.2022, author = {Kurotschka, Peter Konstantin and Fulgenzio, Chiara and Da Cas, Roberto and Traversa, Giuseppe and Ferrante, Gianluigi and Massidda, Orietta and G{\´a}gyor, Ildik{\´o} and Aschbacher, Richard and Moser, Verena and Pagani, Elisabetta and Spila Alegiani, Stefania and Massari, Marco}, title = {Effect of fluoroquinolone use in primary care on the development and gradual decay of Escherichia coli resistance to fluoroquinolones: a matched case-control study}, series = {Antibiotics}, volume = {11}, journal = {Antibiotics}, number = {6}, issn = {2079-6382}, doi = {10.3390/antibiotics11060822}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-278771}, year = {2022}, abstract = {The reversibility of bacterial resistance to antibiotics is poorly understood. Therefore, the aim of this study was to determine, over a period of five years, the effect of fluoroquinolone (FQ) use in primary care on the development and gradual decay of Escherichia coli resistance to FQ. In this matched case-control study, we linked three sources of secondary data of the Health Service of the Autonomous Province of Bolzano, Italy. Cases were all those with an FQ-resistant E. coli (QREC)-positive culture from any site during a 2016 hospital stay. Data were analyzed using conditional logistic regression. A total of 409 cases were matched to 993 controls (FQ-sensitive E. coli) by the date of the first isolate. Patients taking one or more courses of FQ were at higher risk of QREC colonization/infection. The risk was highest during the first year after FQ was taken (OR 2.67, 95\%CI 1.92-3.70, p < 0.0001), decreased during the second year (OR 1.54, 95\%CI 1.09-2.17, p = 0.015) and became undetectable afterwards (OR 1.09, 95\%CI 0.80-1.48, p = 0.997). In the first year, the risk of resistance was highest after greater cumulative exposure to FQs. Moreover, older age, male sex, longer hospital stays, chronic obstructive pulmonary disease (COPD) and diabetes mellitus were independent risk factors for QREC colonization/infection. A single FQ course significantly increases the risk of QREC colonization/infection for no less than two years. This risk is higher in cases of multiple courses, longer hospital stays, COPD and diabetes; in males; and in older patients. These findings may inform public campaigns and courses directed to prescribers to promote rational antibiotic use.}, language = {en} } @article{GagyorGreserHeuschmannetal.2021, author = {G{\´a}gyor, Ildik{\´o} and Greser, Alexandra and Heuschmann, Peter and R{\"u}cker, Viktoria and Maun, Andy and Bleidorn, Jutta and Heintze, Christoph and Jede, Felix and Eckmanns, Tim and Klingeberg, Anja and Mentzel, Anja and Schiemann, Guido}, title = {REDuction of Antibiotic RESistance (REDARES) in urinary tract infections using treatments according to national clinical guidelines: study protocol for a pragmatic randomized controlled trial with a multimodal intervention in primary care}, series = {BMC Infectious Diseases}, volume = {21}, journal = {BMC Infectious Diseases}, doi = {10.1186/s12879-021-06660-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-264725}, year = {2021}, abstract = {Background: Urinary tract infections (UTIs) are a common cause of prescribing antibiotics in family medicine. In Germany, about 40\% of UTI-related prescriptions are second-line antibiotics, which contributes to emerging resistance rates. To achieve a change in the prescribing behaviour among family physicians (FPs), this trial aims to implement the guideline recommendations in German family medicine. Methods/design: In a randomized controlled trial, a multimodal intervention will be developed and tested in family practices in four regions across Germany. The intervention will consist of three elements: information on guideline recommendations, information on regional resistance and feedback of prescribing behaviour for FPs on a quarterly basis. The effect of the intervention will be compared to usual practice. The primary endpoint is the absolute difference in the mean of prescribing rates of second-line antibiotics among the intervention and the control group after 12 months. To detect a 10\% absolute difference in the prescribing rate after one year, with a significance level of 5\% and a power of 86\%, a sample size of 57 practices per group will be needed. Assuming a dropout rate of 10\%, an overall number of 128 practices will be required. The accompanying process evaluation will provide information on feasibility and acceptance of the intervention. Discussion: If proven effective and feasible, the components of the intervention can improve adherence to antibiotic prescribing guidelines and contribute to antimicrobial stewardship in ambulatory care.}, language = {en} }