Background: General practitioners (GPs) are important providers and coordinators of palliative home care (PHC). Through this double role, their perspectives and their treatment decisions influence PHC fundamentally. This study aims to gain deeper insights into GPs’ perspectives regarding PHC in North Rhine, Germany. Methods: An explorative, semistructured focus group was conducted with 7 doctors. The researchers performed content analysis. Main topics were GPs’ role definition in PHC and GPs’ medical activities in PHC. Results: Participating GPs describe their role in PHC, based on high motivation and positive attitudes toward PHC as a hybrid role: coordinator, provider (mostly in general PHC), and referrer (gateway to palliative care [PC] specialists). According to GPs’ medical activity, participants describe moderate expertise, demanding tasks, and elaborate PHC provision for GPs. Participants stressed the importance of PC in GPs’ work. But also PC is a small field in general practice. GPs’ PHC benefits from the deep trust resulting from the often close and long-term GP–patient relationship. Complexity and bureaucracy of PHC structures as well as the lack of resources and multidisciplinary cooperation are named as barriers for providing PHC. The highest level of care is reached in specialized PHC, which only very few, severely impaired patients need. Conclusions: Participating GPs see themselves as important PHC providers as well as referrers and coordinators. Complexity and discontinuity in PC arrangements create challenges for their provision. Therefore, they long for reduced bureaucratic burdens.

Purpose: Outpatient parenteral antimicrobial therapy (OPAT) offers several key advantages, including enhanced patient quality of life, reduced healthcare costs, and a potential reduction of nosocomial infections. It is acknowledged for its safety and effectiveness. This study provides the first systematic clinical data for Germany, where OPAT has not yet been widely adopted. The aim is to establish a foundational reference point for further research and integration of OPAT into the German healthcare system. Methods: This prospective observational study descriptively analyses data obtained from a cohort of patients receiving OPAT. Both in- and outpatients from all medical specialties could be recruited. Patients administered the anti-infective medications themselves at home using elastomeric pumps. Results: 77 patients received OPAT, with a median duration of 15 days and saving 1782 inpatient days. The most frequently treated entities were orthopaedic infections (n = 20, 26%), S. aureus bloodstream infection (n = 16, 21%) and infectious endocarditis (n = 11, 14%). The most frequently applied drugs were flucloxacillin (n = 18, 23%), penicillin G (n = 13, 17%) and ceftriaxone (n = 10; 13%). Only 5% of patients (n = 4) reported to have missed more than one outpatient dose (max. 3 per patient). Only one catheter-related adverse event required medical intervention, and there were no catheter-related infections. Conclusion: The study demonstrates that OPAT can be safely conducted in Germany. In preparation for its broader implementation, crucial next steps include creating medical guidelines, fostering interdisciplinary and inter-sectoral communication, as well as creating financial and structural regulations that facilitate and encourage the adoption of OPAT. Trial registration number: NCT04002453.

General practitioners (GPs) are important providers of palliative home care (PHC). To deliver adequate palliative care, cooperation with specialised PHC teams is necessary. Specialised PHC is a typ...

Background: There is a high, co-dependent strain on health care professionals (HCPs), patients, and their relatives in intensive care units (ICUs), leading to long-term mental, physical, and occupational consequences. To date, there is no systematic intervention to address this growing problem. Objective: The aim of the IPS-Pilot (German: Integrierte Psychosoziale Versorgung; English: “Integrated Psychosocial Care”) project is the development (phase A) and pilot testing (phase B) of an integrated and complex psychosocial care intervention for HCPs, patients, and their relatives in ICUs. This study protocol focuses on phase A. A separate protocol for phase B will be published later. Methods: A structured, multimethod approach was used to gather evidence from the target groups mentioned above on the needs, expected benefits, and necessary conditions for implementation. These methods included (1) a scoping umbrella review conducted by 2 researchers, who independently screened and selected reviews and meta-analyses in the field of needs and demands in the ICU setting, following the Levac framework; (2) web-based and face-to-face interviews and focus group discussions, which were coded independently by 2 researchers and analyzed using qualitative content analysis; the identified categories and codes were then quantified by (3) an online survey conducted with former ICU patients, their relatives, HCPs working in ICUs, and members of the general population. Synthesized results—complemented by the theories of Psychosocial Safety Climate and Conservation of Resources, as well as online and face-to-face stakeholder workshops—were used for intervention development, which was guided by the Intervention Mapping framework. Results: Through the 4 substudies, we aim to gain insights into the psychosocial needs of the aforementioned target groups. Intermediate analyses were conducted to develop both a model of the problem and a model illustrating how these needs can be effectively addressed through a psychosocial intervention that involves integrating a clinically trained psychologist into the HCP team. Data collection and analysis for the intervention development were completed by June 2024, including substudy 1 (n=104 included articles), substudy 2 (n=22 interviews and n=18 participants in focus groups), substudy 3 (n=237 survey participants), and substudy 4 (n=11, n=15, and n=20 participants in 3 consecutive workshops), with further analyses still ongoing beyond the scope of intervention development. The results of the substudies, as well as the final needs-based intervention design, will be published separately. These findings form the basis for the feasibility study (phase B), conducted from July 2024 to July 2025, during which the intervention will be implemented in randomly selected ICU wards and evaluated in terms of feasibility. Conclusions: Phase B will assess the feasibility of the IPS intervention. The findings will be incorporated into the intervention design and serve as the basis for a future randomized controlled trial to evaluate its efficacy. Trial Registration: OSF Registries 10.17605/OSF.IO/VFXJK; https://osf.io/vfxjk International Registered Report Identifier (IRRID): RR1-10.2196/65682

Due to demographic change, the number of patients in palliative care (PC) is increasing. General Practitioners (GPs) are important PC providers who often have known their patients for a long time. PC can be demanding for GPs. However, there are few studies on the job stress factors of GPs performing PC and the potential influence of their PC training. To get more insights, a postal survey was performed with GPs in North Rhine, Germany. The questionnaire was based on a literature search, qualitative pre-studies, and the Hospital Consultants’ Job Stress & Satisfaction Questionnaire (HCJSSQ). Participants state that a high level of responsibility, conflicting demands, and bureaucracy are the most important stressors they experienced in PC. The influence of PC qualification level on their perceived job stress factors is low. Only advanced but not specialist qualification shows a correlation with renumeration-related stress. Gender and work experience are more dominant influences. In our study, female GPs and physicians with more work experience tend to be more stressed. In conclusion, organisational barriers, such as administration, should be reduced and renumeration should be increased to facilitate the daily work of GPs.