Completed work areas including a short summary of results and reference to new publications:
The physician survey of Cologne GPs and those of the administrative district has been successfully completed with a response rate of 20%, which is in line with our expectations. The questionnaires received have been read in, the data set has been labelled and is now ready for analysis. The survey is intended to provide information, for example, about GPs’ assessments of the suitability of patient groups, about the risks and implementation requirements of APAT, as well as about the GP role in the context of APAT.
In the meantime, nine interviews with patients have been conducted. So the number of in-depth patient interviews conducted exceeds the target of the application. Further interviews are planned in order to gain comprehensive insights for the study. From the evaluations so far, it can be concluded that patient satisfaction is high. The master’s thesis for this work package is in full swing.
Current processes /preparations:
The data from the GP survey are currently being analysed and prepared for publication. In addition, more in-depth analyses are being carried out as part of a master’s thesis.
Patient inclusion via the University Hospital Cologne is still ongoing. At the end of the year, there were fewer patients than expected in the project plan. By conducting the GP survey, we hope for greater awareness of the project and thus more patients taking up the option of outpatient therapy. Especially in view of the current high utilisation of inpatient capacities, APAT can contribute both to relieving the hospitals and to the satisfaction of the patients by allowing them to remain in their familiar surroundings.
Outlook for next steps:
The planned focus groups had to be postponed again due to the regulations on contact restrictions in the context of the Covid-19 pandemic. The focus groups are now planned for the second quarter of 2021 and will be conducted on the basis of the results of the GP survey. The focus groups are composed of doctors from the outpatient and inpatient sector who examine the current care situation and thus the relevance of APAT.
Due to the current situation caused by the corona pandemic, the planned meeting in March to prepare the patient inclusion in the other clinics of the Network Infectiology Cologne could not take place. Therefore, patient inclusion in the other hospitals is still pending. We are therefore pleased that inclusion at the University Hospital of Cologne can continue and that the associated patient survey is also proceeding according to plan.
The already conducted individual interviews with patients have been transcribed and the evaluation has started. A master’s thesis is currently being planned.
The planned focus groups with hospital doctors and general practitioners cannot be carried out at present either. Since the preparations, such as the development of guidelines, have already been completed, we will make up for the focus groups at a later date.
We are currently preparing our large general practitioner survey, which we will start with after the summer holidays. For this purpose, we are currently developing a questionnaire based on literature and based on the patient survey and interviews. One of the aims of the survey is to find out what general practitioners think about outpatient parenteral antibiotic therapy. This is intended to identify possible implementation hurdles, e.g. in outpatient-inpatient cooperation.
With the ethics vote of the North Rhine Medical Association, we have fulfilled the prerequisite for the inclusion of patients in the network Infectiology Cologne in addition to the already included university hospital. In addition, doctors in private practice from the network should also be able to take over the visits and aftercare of patients. In preparation for this important step, a network meeting is planned to discuss the exact procedure and to bring the participating project partners up to the same state.
We are very satisfied with the patient inclusion in the University Hospital and are pleased that other departments besides infectiology are increasingly becoming aware of the project and the form of care. We are also delighted that the patient survey is proceeding well and that the response to the questionnaires is satisfactory. Here we are very curious about the first results.
We have already prepared a literature-based guideline for the upcoming focus groups in May with hospital doctors and doctors in private practice. The focus groups will discuss possible barriers and support factors at the organisational, financial and patient level from the doctors’ point of view. For further preparation, we have started recruiting possible participants. Two master theses are currently being planned for the focus groups.
In the autumn we will conduct a quantitative survey of all general practitioners in Cologne in order to find out the perspective of those involved who are important for this form of care. We are currently already preparing for this. We have prepared information flyers for the survey. The questionnaire will be developed on the basis of the results from the focus groups.
The project “Ambulatory parenteral antibiotic therapy in the Cologne Metropolitan Region” (K-APAT) started in April 2019. Since then, some small but also big steps have taken place.
The positive ethics vote (vote number: 19-1284) from the Ethics Commission of the University of Cologne represented a first milestone. The vote is a confirmation that both data protection and ethical-moral aspects are taken into account in the interviews with patients and care providers.
In the regular meetings of the project staff and network meetings with the project partners and study physicians, helpful findings were gained to continuously improve the study design.
In order to inform patients and doctors about the project and to make the form of ambulatory intravenous antibiotic therapy better known, target-group-specific flyers were designed.
We developed three questionnaires for the survey of patients at three points in time regarding their satisfaction and the course of treatment. For this purpose, both validated instruments and self-developed scales were used. The comprehensibility and logic of the questionnaires were checked within the framework of presets and reviewed accordingly.
In November, patient inclusion at the University Hospital started successfully with the aim of including at least 120 patients in the study. At the same time, the survey was started and we are pleased with the questionnaires that have already been received. The patients are interviewed before, during and after treatment. The aim is to document comprehensive experiences of the patients in the ambulatory environment with antibiotic therapy in order to be able to draw important findings from it.
In addition, the preparation of the qualitative evaluation was started. Within this framework, focus groups with clinic and general practitioners as well as interviews with patients will take place. We are currently still in the process of developing guidelines for both survey forms.
The ethics vote of the North Rhine-Westphalian Medical Association is still pending, but is expected soon. We are looking forward to presenting K-APAT at the CoRe-Net Symposium on January 15, 2020 and to exchanging ideas with people from health services research and practice.