University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Center for Healthcare Research, Hamburg, Germany.
Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany.
Z Evid Fortbild Qual Gesundhwes. 2022 Jun;171:49-57. doi: 10.1016/j.zefq.2022.04.001. Epub 2022 May 18.
The main focus of this paper is to describe the development and current state of policy, research and implementation of patient-centered care (PCC) and shared decision-making (SDM) in Germany. What is the current state in health policy? Since 2013, the Law on Patients' Rights has standardized all rights and responsibilities regarding medical care for patients in Germany. This comprises the right to informed decisions, comprehensive and comprehensible information, and decisions based on a clinician-patient partnership. In addition, reports and action plans such as the German Ethics Council's report on patient well-being, the National Health Literacy Action Plan, or the National Cancer Plan emphasize and foster PCC and SDM on a policy level. There are a number of public organizations in Germany that support PCC and SDM. How are patients and the public involved in health policy and research? Publishers and funding agencies increasingly demand patient and public involvement. Numerous initiatives and organizations are involved in publicizing ways to engage patients and the public. Also, an increasing number of public and research institutions have established patient advisory boards. How is PCC and SDM taught? Great progress has been made in introducing SDM into the curricula of medical schools and other health care providers' (HCPs) schools (e.g., nursing, physical therapy). What is the German research agenda? The German government and other public institutions have constantly funded research programs in which PCC and SDM are important topics. This yielded several large-scale funding initiatives and helped to develop SDM training programs for HCPs in different fields of health care and information materials. Recently, two implementation studies on SDM have been conducted. What is the current uptake of PCC and SDM in routine care, and what implementation efforts are underway? Compared to the last country report from 2017, PCC and SDM efforts in policy, research and education have been intensified. However, many steps are still needed to reliably implement SDM in routine care in Germany. Specifically, the further development and uptake of decision tools and countrywide SDM trainings for HCPs require further efforts. Nevertheless, an increasing number of decision support tools - primarily with support from health insurance funds and other public agencies - are to be implemented in routine care. Also, recent implementation efforts are promising. For example, reimbursement by health insurance companies of hospital-wide SDM implementation is being piloted. A necessary next step is to nationally coordinate the gathering and provision of the many PCC and SDM resources available.
本文的主要重点是描述德国以患者为中心的护理（PCC）和共享决策（SDM）的政策、研究和实施的发展和现状。 健康政策的现状如何？ 自 2013 年以来，《患者权利法》规范了德国医疗保健中所有与患者相关的权利和责任。 这包括知情决策、全面和易懂的信息以及基于医患伙伴关系的决策的权利。 此外，报告和行动计划，如德国伦理委员会关于患者福祉的报告、国家健康素养行动计划或国家癌症计划，在政策层面强调并促进 PCC 和 SDM。 德国有许多公共组织支持 PCC 和 SDM。 患者和公众如何参与卫生政策和研究？ 出版商和资助机构越来越要求患者和公众的参与。 许多倡议和组织都参与宣传让患者和公众参与的方式。 此外，越来越多的公共和研究机构已经成立了患者咨询委员会。 如何教授 PCC 和 SDM？ 将 SDM 引入医学院和其他卫生保健提供者（HCP）学校（例如护理、物理治疗）的课程方面已经取得了很大进展。 德国的研究议程是什么？ 德国政府和其他公共机构不断为研究计划提供资金，其中 PCC 和 SDM 是重要的主题。 这促成了几个大规模的资助计划，并帮助为不同领域的 HCP 开发了 SDM 培训计划和信息材料。 最近，进行了两项关于 SDM 的实施研究。 在常规护理中，目前 PCC 和 SDM 的采用情况如何，正在进行哪些实施工作？ 与 2017 年的上一份国家报告相比，政策、研究和教育方面的 PCC 和 SDM 工作已经得到加强。 然而，要在德国常规护理中可靠地实施 SDM，还需要采取许多步骤。 具体来说，需要进一步发展和采用决策工具以及针对 HCP 的全国范围的 SDM 培训。 尽管如此，越来越多的决策支持工具 - 主要是在健康保险公司和其他公共机构的支持下 - 将在常规护理中实施。 最近的实施工作也很有希望。 例如，保险公司正在试点报销医院范围内的 SDM 实施。 下一步必要的是在全国范围内协调收集和提供可用的许多 PCC 和 SDM 资源。
