Instruments

Many people associate attention deficit hyperactivity disorder (ADHD) with the image of the little fidget spinner. Studies show that there is more to it than that. It is estimated that around 3.1-4.7% of adults in Germany are affected by ADHD. The symptoms have far-reaching consequences for those affected. How can we recognize these patients in order to provide them with adequate treatment? Together with the developer Ronald Kessler, we are validating a German version of the Adult ADHD Self-Report Screening Scale for DSM-5 (ASRS-5). The short screening instrument consists of only 6 questions. Is it suitable for use in a GP practice? If you would like to find out together with us, please contact Cora.Ballmann@med.uni-muenchen.de

Source: Ballmann C, Kölle MA, Bekavac-Günther I, Wolf F, Pargent F, Barzel A, Philipsen A, Gensichen J. Evaluation of the German Version of the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5 as a Screening Tool for Adult Attention-Deficit/Hyperactivity Disorder in Primary Care. Front. Psychol. 2022;13:858147. doi: 10.3389/fpsyg.2022.858147.

Up to 13% of patients who present as outpatients may also have suicidal thoughts. Many find it difficult to talk about this. When talking to the patient, four questions about the past, plans, the likelihood of this happening and possible protective factors may help. We are currently validating a German version with Prof. Kurt Kroenke. If you would like to contribute to this important work, please contact Karoline.Lukaschek@med.uni-muenchen.de

Source: Schluessel S, Halfter K, Haas C, Kroenke K, Lukaschek K, Gensichen J on behalf of the POKAL-Group. Validation of the German Version of the P4 Suicidality Tool. J. Clin. Med. 2023; 12(15):5047. https://doi.org/10.3390/jcm12155047

Among other things, attachment theory can be used as an explanatory perspective for the development and maintenance of illnesses and the doctor-patient relationship. The Experience of Close Relationships-Revised (ECR-R) is an internationally established instrument for recording partnership-related attachment (Fraley 2000). The German-language version ECR-RD (Ehrenthal 2009) comprises 36 items and has already been evaluated on a clinical and non-clinical sample, whereby the good psychometric properties of the original version were confirmed. A practicable short version comprising 12 items was developed for primary care.

Source: Brenk-Franz K, Ehrenthal J, Freund T, Schneider N, Strauß B, Tiesler F, Schauenburg H, Gensichen J. Evaluation of the short form of "Experience in Close Relationships" (Revised, German Version "ECR-RD12") - A tool to measure adult attachment in primary care. PLoS One. 2018 Jan 23;13(1):e0191254. DOI: 10.1371/journal.pone.0191254. eCollection 2018.

The Health Care Climate Questionaire (HCCQ) is an instrument for assessing the atmosphere of health care and patient autonomy in medical consultations (Williams, Grow 1996). A valid German translation and cultural adaptation of the HCCQ for primary care was provided.

Source: Schmidt K, Gensichen J, Petersen JJ, Szecsenyi J, Walther M, Williams G, Freund T. Autonomy support in primary care-validation of the German version of the Health Care Climate Questionnaire. J Clin Epidemiol. 2012;65(2):206-11.

Active patient participation is both necessary and effective in health promotion and prevention as well as in the treatment of chronic and acute illnesses in particular. Active patient participation and self-management of health and illness play a decisive role in primary medical care in particular. The promotion and facilitation of this active participation is one of the tasks of the family doctor (Hollnagel 1995). A German-language version for primary care was developed and evaluated.

Source: Brenk-Franz K, Hibbard JH, Herrmann WJ, Freund T, Szecsenyi J, Djalali S, Steurer-Stey C, Sönnichsen A, Tiesler F, Storch M, Schneider N, Gensichen J. Validation of the German Version of the Patient Activation Measure 13 (PAM13-D) in an International Multicentre Study of Primary Care Patients. PLoS One. 2013;8(9):e74786.

To characterize the doctor-patient relationship, a cognitive approach (cognitive care) is often discussed in contrast to an emotional approach with a focus on empathy (emotional care) (DiBlasi 2001). Patient Reaction Assessment (PRA) is an established and valid instrument in the English-speaking world for assessing the perceived quality of the doctor-patient relationship. The 15-item questionnaire distinguishes between 3 subscales: Information, affective behavior and communication (Galassi 1992). A German-language version was developed and evaluated for primary care.

Source: Brenk-Franz K, Hunold G, Galassi JP, Tiesler F, Herrmann W, Freund T, Steurer-Stey C, Djalali S, Sönnichsen A, Schneider N, Gensichen J. [Quality of the physician-patient relationship - evaluation of the German version of the Patient Reactions Assessment (PRA-D)]. Quality of the physician-patient relationship - evaluation of the German version of the Patient Reactions Assessment Instrument (PRA-D). Z Allg Med. 2016;92(3):103-8.

Patients with chronic illnesses are supported by GPs and their practice teams in numerous areas in addition to diagnosis and treatment indication, such as managing the illness. The PACIC is a measurement tool derived from the Chronic Care Model (Wagner 1998, Glasgow 2005) that can map this practical support well. A German-language full version (a) and a short version (b) were created and evaluated for primary care.

Source a: Rosemann T, Laux G, Droesemeyer S, Gensichen J, Szecsenyi J. Evaluation of a culturally adapted German version of the Patient Assessment of Chronic Illness Care (PACIC 5A) questionnaire in a sample of osteoarthritis patients. J Eval Clin Pract. 2007 Oct;13(5):806-13.

Short version - support from the GP practice: Patient Assessment of Chronic Illness Care - PACIC short

Source b: Goetz K, Freund T, Gensichen J, Miksch A, Szecsenyi J, Steinhaeuser J. Adaptation and psychometric properties of the PACICshort form. Am J Manag Care. 2012 Feb 1;18(2):e55-60. PMID: 22435885.

Chronically ill patients in particular face the challenge of having to cope with their illness on a daily basis. It has been shown that a patient's confidence in actually being able to carry out specific aspects of self-care is an important measure of successful coping with chronic illness. The SES6G is a validated translation of the Self-efficacy for chronic illness scale by Kate Lorig et al. for the German-speaking world. The instrument contains 6 items with a 10-point Likert scale. The reliability is 0.93 (Cronbach's alpha).

Source: Freund T, Gensichen J, Goetz K, Szecsenyi J, Mahler C. Evaluating self-efficacy for managing chronic disease: psychometric properties of the 6-item Self-Efficacy Scale in Germany. J Eval Clin Pract. 2011 Aug 23. doi: 10.1111/j.1365-2753.2011.01764.x. [Epub ahead of print]

A medication-based chronic disease score (medCDS) was developed and validated on the basis of current treatment guidelines and its correlation with overall mortality in older outpatients was tested. In developing the score, both the most common chronic diseases in the older German population and evidence-based medications for their treatment were taken into account. The results of a cohort study showed that the new medCDS predicts the mortality of elderly outpatients significantly better than existing scores (e.g. RxRisk, CDS). It can serve as a tool for comparing the morbidity-related burden of disease and survival prospects of different populations and settings (e.g. primary care and public health).

Source: Quinzler R, Freitag MH, Wiese B, Beyer M, Brenner H, Dahlhaus A, Döring A, Freund T, Heier M, Knopf H, Luppa M, Prokein J, Riedel-Heller SG, Schäfer I, Scheidt-Nave C, Scherer M, Schöttker B, Szecsenyi, Thürmann P, van den Bussche H, Gensichen J, Haefeli WE. A novel superior medication-based chronic disease score predicted all-cause mortality in independent geriatric cohorts. J Clin Epidemiol. 2019 Jan; 105:112-124. DOI: 10.1016/j.jclinepi.2018.09.004. Epub 2018 Sep 22.

Over 60 percent of patients with depression are treated in GP practices. Regular and structured monitoring helps with the reliable and timely detection of possible complications and patient adherence. With the German-language DeMol developed for GPs, clinically important information can be quickly made available to the treating GP using a traffic light system. They can then act in good time.

Source: Gensichen J, Peitz M, Torge M, Mosig-Frey J, Wendt-Hermainski H, Rosemann T, Gerlach FM, Löwe B. The "Depression Monitoring list" (DeMoL) with integrated PHQ-D-Rationale and design of a tool for the case management for depression in primary care. Z Arztl Fortbild Qualitatssich. 2006;100(5):375-82.

Patients with anxiety or panic are often treated in GP practices. Regular and structured monitoring helps with the reliable and timely detection of possible complications and patient adherence. With the German-language JaMol developed for GPs, clinically important information can be quickly provided to the treating GP using a traffic light system. They can then act in good time.

Source: Hiller TS, Freytag A, Breitbart J, Teismann T, Schöne E, Blank W, Schelle M, Vollmar HC, Margraf J, Gensichen J; for the Jena-PARADISE Study Group. The Jena Anxiety Monitoring List (JAMoL) - a tool for the evidence-based treatment of panic disorder with or without agoraphobia in primary care. Z Evid Fortbild Qual Gesundhwes. 2018 Apr;131-132:28-37. DOI: 10.1016/j.zefq.2018.02.003. Epub 2018 Mar 13.

Patients with arthritis suffer from a complex chronic disease and are often treated in GP practices. Regular and structured monitoring helps to reliably record complications. With the German-language ArthMol developed for GPs, clinically important information can be quickly provided to the treating GP using a traffic light system. He can then adjust the therapy in good time.

Source: Rosemann T, Körner T, Wensing M, Gensichen J, Muth C, Joos S, Szecsenyi J. Rationale, design and conduct of a comprehensive evaluation of a primary care based intervention to improve the quality of life of osteoarthritis patients. The PraxArt-project: a cluster randomized controlled trial [ISRCTN87252339]. BMC Public Health. 2005 Jul 19;5:77.

Patients with heart failure need regular monitoring of their clinical symptoms. Structured monitoring with a reliable measurement tool can detect possible complications and patient adherence in good time. The German-language HiMol, developed for use by GPs, uses a traffic light system to provide important information to the GP treating the patient. He or she can then prevent the worst in good time.

Source: Freund T, Baldauf A, Muth C, Gensichen J, Szecsenyi J, Peters-Klimm F. Practice-based home visit and telephone monitoring of chronic heart failure patients: rationale, design and practical application of monitoring lists in the HICMan trial]. Z Evid Fortbild Qual Gesundhwes. 2011;105(6):434-45. DOI: 10.1016/j.zefq.2010.06.027. Epub 2010 Jul 21. PMID: 21843846.

In order to ensure efficient follow-up care for patients who have been treated in the intensive care unit, e.g. with sepsis, also in the GP practice, it is advisable to introduce regular monitoring of the consequences in the practice team. With the help of a traffic light scheme, the six main complications (pain, cachexia, depression, post-traumatic stress, critical illness myopathy and neuropathy) following sepsis are regularly assessed at symptom level using validated measuring instruments, and appropriate recommendations for action are offered depending on the severity. The instrument developed for primary care also helps with internal practice coordination.

Source: Schmidt K, Worrack S, Von Korff M, Davydow D, Brunkhorst F, Ehlert U, Pausch C, Mehlhorn J, Schneider N, Scherag A, Freytag A, Reinhart K, Wensing M, Gensichen J; SMOOTH Study Group. Effect of a Primary Care Management Intervention on Mental Health-Related Quality of Life Among Survivors of Sepsis: A Randomized Clinical Trial. JAMA. 2016 Jun 28;315(24):2703-11. DOI: 10.1001/jama.2016.7207.