>> “Perception through provision”
could be a key point with which one can best describe the Institute for Health Services Research in Dermatology and Nursing Professions, IVDP for short. Everyone who works in the IVDP, as a theoretical care researcher, also wears the glasses of a providing healthcare professional: This applies to study nurses as well as to doctors who regularly put on their white coats simply because they work every day See patients. "We live in a permanent doctor-patient interaction and take our patients seriously in all their facets," explains Augustin, who is of the opinion that in his institute - more than in many others - patient-related topics are researched , because, according to the experienced dermatologist, “if you have a consultation for a whole day, then many ideas come to you of your own accord as to what needs to be researched in order to provide effective care”.
Except that on Martinistrasse at the UKE in Hamburg-Eppendorf, the “should”, “would have”, “could” or “would” so often used in healthcare quickly and often turns into “do”. Hundreds of publications, many of them in respected international journals, go back to the founding year of the Competence Centers for Dermatological Research (CeDeF) in 2005, when at least 15 scientific articles were published. The number rose steadily, but then made a big leap from 2009 - still with 26 papers - to 76 papers in 2010, the year in which the Institute for Health Services Research in Dermatology and Nursing Professions (IVDP) was founded. Since then, 599 scientific publications have been written, an average of 100 per year, i.e. one every 3rd to 4th day.
Now one could assume that this is due to the sheer number of employees (currently 124) at the IVDP - of which 30 are scientists, 13 nurses and 9 doctors. There is also 1 German specialist who, with the help of 2 employees, is responsible for publication management in his own department; something that most other institutes can only dream of.
This department is exclusively there to relieve unnecessary and stressful work from scientists and practitioners who are researching and willing to publish by taking care of the submissions to predominantly international specialist journals, adapting the texts to the respective requirements of the journals, and also obtaining the image rights Literature is processed and everything is delivered at the appropriate time. “As a result of this alone, we have 30 to 40 percent more publications than before,” says Augustin and can be proud of the fact that his institute also has scientific publications.
obeys the highest standards of effectiveness.
Although the IVDP is the smallest institute at the UKE in terms of budgetary positions, it is much larger than all UKE clinics together due to the scientific expertise combined here, but also the type of publication in the media's external perception. And since the IVDP and the dermatology clinic to which it is attached are essentially one big whole, both have something to gain; Which, according to Augustin, shows one thing very clearly: “You can actually be economically successful with health services research!”
Because in addition to the external perception and
Thanks to the scientific reputation gained in this way, the patients cared for here have the great advantage that the results of health services research are fed back into practice relatively strongly via the institute. Augustin: “Everything we find out in health services research will be fed back into care as quickly as possible.” Initially, primarily only in the microcosm of the main clinic at the UKE, but also with the IVDP and the dermatology clinic acting as a kind of care laboratory act in that new concepts are created and tested - as a kind of development platform for everyone who wants better care in dermatology.
A positive example of this type is the discharge management of patients with chronic
niche wounds. These are well adjusted and cared for in the dermatology clinic, but - having hardly returned to their home environment and basic care - a good third of them return to the clinic within three months: often in a worse condition than before the initial admission.
What is the reason for this strong revolving door effect in chronic wounds? Augustin's answer: "Due to a lack of discharge management and insufficient translation across sector boundaries." However, to place the problem exclusively on the outpatient sector would be too short-sighted. In contrast to the clinical setting with its daily visits, a normal family doctor sees his patient perhaps once a week, a specialist
approximately every two months, which means that “the intensity and quality of our comprehensive supply and also of the trained eye” collapses due to the system alone. That is why Augustin is fighting for a systematic sector transition, not only for the care of chronic wounds, but in principle for all complex entities, including all chronic diseases. “Ultimately, we need a new, different disease management for such patients,” demands Augustin, who thinks very little of the current, almost rudimentary and inadequately equipped DMP. Because: “You have to place the management of a complex patient with the specialists.” In the case of skin diseases, for example, at a specialized facility like the one at the UKE, which is viewed as a kind of reference center far beyond Hamburg’s borders.
Outside such facilities would
Patients, if they are lucky, "treated benevolently or with good intentions, but actually only cared for chronically, but not cured". With innovative medication - such as in the case of psoriasis - a near cure, i.e. "extensive freedom from symptoms" (see MVF 06/17) would be possible today. The problem is: “No matter how good the care is, if you don’t provide strict causal therapy, chronicity begins.”
For this reason, the IVDP, together with the PsoNetz, has created six branch offices in Hamburg under the title “Comprehensive Wound Center”, where UKE nurses and doctors - of course also Augustin himself - are regularly present in order to be able to offer on-site support . “There are people without socks in rubber boots, sometimes walking for miles because they can’t afford a taxi or bus ticket,” says Augustin, adding: “And yet some of them have to pay for the necessary antiseptics themselves because most of them don’t is more reimbursable.” And what happens to these patients? “Essentially, due to their social need, they soon end up stationary somewhere.” Which adds high cost dynamics to the already unnecessary and therefore undesirable revolving door effect.
The patients who present to the field offices are not even admitted as inpatients, but are treated on an outpatient basis. In addition, all the necessary disciplines are available here and can therefore be carried out on the patient on the same day: “This means that we get a complete clarification within a few hours, and half of that on an outpatient basis “It can take up to a whole year,” says Augustin, looking at the busy schedules of the resident specialists. In the “Comprehensive Wound Centers,” however, patients receive a complete therapy plan drawn up in just one day, which is also supported via telemedicine on a voluntary basis. Those insured with DAK will even receive a smartphone from the health insurance fund if they do not have one, so that they themselves - or the family doctor, a caring relative and the outpatient nursing staff - can control whether the digital findings made with this smartphone are transmitted should.
This alone makes patients the gatekeepers of their data, along with the positive effect of self-efficacy through which the patient becomes an actor, which in turn leads to greater adherence. The side effect: With this telemedical system
The specialists at the UKE see photos of the wounds every week - but in order to take these, the bandage must first be removed and then reapplied, which otherwise might not necessarily happen. The images are then emailed to the UKE in a protected manner and automatically saved in the patient file. In addition, the findings are read and feedback is given by a control center that is staffed twice a week. The effect: No matter who is treating the wound, they are under observation and everyone is very anxious to do their things correctly because they know full well that the findings will not only be published once a week, but will also be evaluated. Augustin's opinion: "This effect is actually the strongest because it creates a stringency in the quality of care that we often cannot generate otherwise."
Incidentally, the doctors in private practice have no objection at all to this offer because the patients in question are very time-consuming for them to look after and the time investment is not rewarded enough by the health insurance companies. Augustin: "In this respect, we even relieve the resident doctors with this offer." Which is also good, because you have to work with the general practitioners as partners, because this patient group is often polymorbid. <<
by: MVF editor-in-chief Peter Stegmaier