Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Jan 2007
Patient and citizen participation in German health care--current state and future perspectives.
Patient participation within the German healthcare system is described at three different levels: the macro level as active patient influence on the regulation of medical care, the meso level in terms of institutions enhancing patient information and counselling, and the micro level focusing on the actual treatment decision-making process in the medical encounter. The main focus of the present publication is on the health care system-specific influences on patient participation in medical decision-making and on the current state of research and implementation of shared decision-making in Germany. ⋯ The present state of the intervention projects' results is outlined as well as subsequently funded transfer projects and future perspectives of research grants. Supported by health politics and the utilisation of scientific evidence shared decision-making's transfer into practice is considered to be relevant to the German health care system.
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Z Arztl Fortbild Qualitatssich · Jan 2007
Shared decision-making in Canada: update, challenges and where next!
There is considerable interest for shared decision-making (SDM) within the Canadian healthcare system. The current state of SDM in Canada and challenges with implementation are addressed in the paper at three levels of patient involvement: (1) healthcare system (macro-level); (2) institutions (meso-level) and (3) clinical/medical encounter (micro-level). ⋯ The virtue of SDM has gained recognition through increased research funding, medical training and some initiatives embedding patient decision aids within the process of care. Future perspectives of SDM in Canada are highlighted such as evaluation of the long-term impact of and costs associated with patient participation in decisions as well as interprofessional approaches to SDM.
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Z Arztl Fortbild Qualitatssich · Jan 2007
[Participation of patients in the program for national disease management guidelines--current state and implications].
Patient involvement has been implemented in the Program for National Disease Management Guidelines since 2005. Currently patient/consumer participation is being incorporated in terms of patients' comments of consultation papers on National Disease Management Guidelines (NDMG) and in the development of NDMG-based patient guidelines (PG). The editorial activities in patient guideline development from the beginnings to its publication are conducted in close cooperation with the patient representatives appointed by the Patient Forum. ⋯ It describes the current state of patient involvement and joint work and indicates the implications that can be derived from patient participation in the NDMG Program. Accompanying the involvement procedures, experiences resulting from previous NDMG and PG development activities are continuously investigated for the possibility of further methodological development of consumer participation by a work group of the Patient Forum in coordination with the patient organizations involved. In particular, the procedures resulting from more intensive patient participation in patient guideline development are to be examined as to their relevance for the expansion of patient involvement in NDMG development.
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Z Arztl Fortbild Qualitatssich · Jan 2007
[Can rationing be fair? Ethical considerations regarding justice in the healthcare system].
While economy tries to solve the problem of scarcity by rationing, i.e. increasing efficiency, ethics reflect the path of the just distribution of scarce goods, necessarily including the means of transparent and fair rationing. But how can such rationing be realised in a healthcare system? Non-medical criteria such as the patient's social function or age, though vividly discussed, are inappropriate. ⋯ The QALY and DALY models are such an attempt. Careful reflection of these measures of quality of life and, in some aspects, accompanying rules to avoid extreme unfairness will be critical to their success.
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Z Arztl Fortbild Qualitatssich · Jan 2007
Shared decision-making in the Netherlands--current state and future perspectives.
Dutch government policy is aimed at introducing regulated competition among health care providers and among health care insurers and at empowering patients for being involved in decision-making in health care. Along with this, many Dutch organisations have been created to foster patient orientation within health care and increase patients' power for medical decision-making. The challenge is to deliver reliable and well-balanced information for patients and the public, eg. in patient-tailored web-based formats. ⋯ The theme of patient participation in medical decision making is a fairly widespread research topic theme in the Netherlands, including mutual exchange among the researchers in a vivid network. The real bottleneck is perhaps the implementation of patient participation into professional practice. Some recommendations for facilitating a change are made.