BackgroundIn recent years, implementation research has gained a renewed attention in the Netherlands. However, limited national funding for implementation research has mainly resulted in case- and context-specific descriptive data. To help prioritize research that holds high scientific value and practical relevance, this study aimed to identify gaps in both implementation science and implementation practice.MethodsA two-stage study was conducted combining multiple methods to collect data from implementation researchers working in the healthcare sector in the Netherlands. A two-round e-Delphi study was employed to identify research priorities amongst implementation researchers. In addition, a survey was conducted with practitioners to identify implementation knowledge gaps and needs in implementation practice.ResultsTwenty-six (55%) of the 47 invited researchers participated in Round 1 of the e-Delphi, leading to the identification of 31 research topics categorized into 7 themes. In Round 2, 22 of the 26 researchers (85%) completed the process, reaching consensus on 12 topics. These topics were grouped into six themes and linked to four areas of research: implementation, sustainability, scale-up, and de-implementation. The themes include: (1) understanding determinants, (2) matching strategies to determinants, (3) implementation strategies, (4) measuring implementation outcomes, (5) theories, models and frameworks, and (6) research designs. The survey of 74 practitioners revealed 230 implementation knowledge gaps, which were then triangulated with the e-Delphi results, highlighting specific research topics that emphasize implementation capacity and the need for pragmatic tools to enhance evidence-based implementation in practice.ConclusionsBy integrating insights from both implementation researchers and practitioners, the research agenda addresses topics that are relevant to both fields. Recommendations were made to advance the scientific field and improve implementation practice. This research agenda can guide research coordination and policymaking, aiming to consolidate research efforts in the Netherlands.

Process evaluation of implementation strategies is increasingly common, but a review by Bracci et al. showed that room for improvement exists. In this contribution, we complement their recommendations by ideas on the design of process evaluations. Process evaluations are meant to provide explanations for why implementation strategies were effective, or not effective. Therefore, they are best guided by theory or frameworks, but the frequent focus on intervention acceptability reflects a lack of imagination on moderators and mediators that influence outcomes. Intervention fidelity is relevant in all process evaluations. Meaningful synthesis of process evaluation studies requires a homogeneous outcome, such as uptake of practices.

BACKGROUND:The increasing demand for geriatric health services, particularly in rehabilitation, has led to significant delays in the delivery of care across many regions of Germany. In response, Germany has introduced several initiatives, including innovative care models such as the telemedicine integrating multimodal, home-based geriatric aftercare programs GeRas that aimed at improving service efficiency and accessibility in geriatric rehabilitation. While such programs may increase geriatric health services capacity further exploration is needed to assess the scalability of such programs. Thus, the objective of this study was to obtain the perspective of key stakeholders (e.g., health services provider) on the requirements for scaling up of geriatric aftercare programs including a telemedicine component. METHODS:In a qualitative interview study, 12 key stakeholders were interviewed to obtain their perspectives on the requirement for such geriatric aftercare programs, as well as their scalability, including the integration of telemedicine, taking the GeRas program as an example. The interview data were analysed using Qualitative Content Analysis according to Kuckartz. RESULTS:A total of four main themes emerged from the qualitative content analysis. Theme two, including six subthemes, addressed the requirements for scalability of geriatric aftercare programs. Stakeholders emphasized the need to address financial requirements and establish transparent remuneration models for healthcare providers (1). Personnel requirements (2), and structural needs, including cross-sectional collaboration, were also highlighted (3). Additionally, the development and implementation of educational concepts for both providers and participants were discussed (4). Key requirements for a geriatric aftercare program (5) and the role of telemedicine (6) were also considered. CONCLUSION:Clear definitions of structural, personnel, and financial requirements, along with interprofessional collaboration, were essential for the scalability and success of geriatric aftercare programs. However, findings show that the scalability of these programs remains complex, yet essential. TRIAL REGISTRATION:German Clinical Trials Register (DRKS00029559). Registered 5/10/2022.

RATIONALE:Tailored implementation strategies are frequently recommended to improve healthcare professional practice. Tailoring involves the selection and design of strategies to address context-specific barriers (referred to as determinants of practice) to best practice recommended in clinical guidelines. Improvements in practice are thought to be more likely if implementation strategies are selected to address identified practice determinants. This is an update of a review published in 2015. OBJECTIVES:To assess the effect of tailored implementation strategies, compared with a non-tailored strategy or no strategy, in improving healthcare professional practice. Secondary objectives were to assess whether the effects of tailored implementation strategies differ according to whether theory, evidence of the effectiveness of strategies, and input from stakeholders were involved in the tailoring process, and to assess whether the effects of tailored implementation strategies differ according to setting (high- or low-income country). SEARCH METHODS:We searched CENTRAL, MEDLINE, Embase, two other databases and two trials registers from 2014 to 5 March 2024. We performed a forward citation search for papers citing the previous update. We did not apply any restrictions on date of publication, publication status or language. ELIGIBILITY CRITERIA:We included randomised controlled trials (RCTs), including cluster-RCTs, that compared tailored implementation strategies with strategies not tailored to address determinants of health professional practice, or no strategy. We excluded studies of tailored strategies targeting behaviour change among patients only. OUTCOMES:The primary outcome was healthcare professional practice assessed using measures of adherence to recommended practices or guidelines in a healthcare setting. RISK OF BIAS:We used the Cochrane risk of bias tool version 2 (RoB 2) to assess risk of bias in the studies. SYNTHESIS METHODS:Review authors (working in pairs) screened all citations, extracted data, and assessed risk of bias independently and in duplicate. A third review author resolved disagreements. We performed meta-analyses using random-effects models for the primary outcome using the most conservative estimate of effect where multiple outcomes were reported. We also performed meta-analyses using the least conservative estimate in sensitivity analysis. Where data were unsuitable for pooling in meta-analyses, we conducted a narrative synthesis using a vote-counting approach. We assessed heterogeneity using the I² statistic and the certainty of the evidence for the main comparison using GRADE. INCLUDED STUDIES:The previous version of this review included 32 studies. In this update, we excluded five of those studies as they no longer met the review's eligibility criteria; they did not meet the definition of tailoring or focused on patient outcomes only. We added 52 new studies (including two from trials registers), bringing the total number of included studies to 79. Participant numbers were available for 41 of these studies (n = 25,630); participant counts were not reported or were unclear in the other 38 studies. SYNTHESIS OF RESULTS:Overall, 35 studies with a total of 5015 healthcare professionals examined the effect of a tailored implementation strategy on professional practice compared to a non-tailored strategy. In total, 44 studies with a total of 20,615 healthcare professionals examined the effect of a tailored strategy on professional practice compared to no strategy. We judged 41 of the 45 studies included in the meta-analysis as free from high risks of bias across all domains. Bias in the measurement of the outcome was the most common domain judged at high risk of bias among the remaining studies. Overall, the certainty of the evidence in the main comparison (tailored vs non-tailored) was moderate, reflecting visual inconsistency and high heterogeneity between study results. We found that tailored implementation strategies probably lead to a slight improvement in professional practice compared with non-tailored strategies (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.26 to 1.75; 23 studies, 2600 participants, moderate-certainty evidence). An OR greater than 1 indicates a small improvement in professional practice compared with no strategy. Some studies included effect measures for more than one outcome. Sensitivity analysis pooling the least conservative effect measures that were reported showed an OR of 1.74 (95% CI 1.3 to 2.24. For tailored implementation strategies compared with no strategy, we report a pooled OR of 1.34 (95% CI 1.17 to 1.53; 24 studies, 8250 participants). Some studies included effect measures for more than one outcome. Sensitivity analysis pooling the least conservative effect measures that were reported showed an OR of 1.51 (95% CI 1.28 to 1.79; P < 0.0001). AUTHORS' CONCLUSIONS:Despite the increase in the number of new studies identified, our overall finding is like that of the previous review. Tailored implementation strategies probably result in a slight improvement in professional practice. FUNDING:Dr Sheena McHugh received funding from the Irish Health Research Board (HRB-RL-2020-004) that helped to support the conduct of this review. REGISTRATION:Registration: Zenodo, 7104299, via DOI: 10.5281/zenodo.7104299 Protocol available via DOI: https://doi.org/10.5281/zenodo.7104299 Previous versions available via: DOI: 10.1002/14651858.CD005470.pub3, DOI: 10.1002/14651858.CD005470.pub2, and DOI: 10.1002/14651858.CD005470.

BACKGROUND:We conducted a health economic evaluation alongside the PROVIDE-C randomised controlled trial which analysed the effectiveness of a model of integrated mental health video consultations for people with depression and anxiety in primary care in Germany in comparison to treatment as usual (TAU). METHODS:A cost-effectiveness (CEA) and cost-utility analysis (CUA) were performed six and twelve months after baseline from a societal perspective. Bootstrap procedure was applied and for each bootstrap replication, multiple imputation was conducted, and incremental costs and effects were estimated using generalised linear models. RESULTS:In total 376 participants (18 to 81 years) with depression and/or anxiety were included in the analysis. We found that €3662 would be required for an additional person who experienced a clinically minimum important reduction of 5 points at the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) and €1622 would be required for an additional person with a PHQ-ADS score below 10 points (persons with not more than mild symptom severity) six months after baseline. At twelve months after baseline, PROVIDE-C was dominant compared to TAU. While 6 months after baseline the probability of cost-effectiveness was approximately 36%, 40% and 56% in terms of quality adjusted life years (QALYs) for the respective willingness-to-pay threshold of €0, €20,000, and €100,000, at 12 months after baseline the respective probabilities of cost-effectiveness increased to approximately 71%, 78%, and 86%. CONCLUSIONS:While the PROVIDE-C intervention is less likely cost-effective 6 months after baseline, it was likely cost-effective 12 months after baseline.

The RECOVER-E project supported the shift away from mental health care provided in institutional settings (treatment as usual, TAU) towards community-based mental healthcare by introducing multidisciplinary community mental health teams (CMHT) for people with schizophrenia, bipolar disorder, and severe depression across five sites in Bulgaria, Croatia, Montenegro, North Macedonia, and Romania. This paper presents the cost-effectiveness of CMHT compared to TAU. Data from all five RECOVER-E trials (N = 931) was used to compute healthcare costs and societal costs which included additional patient and family costs, and costs stemming from productivity losses. Outcomes were incremental cost-effectiveness ratio’s (ICER) for gaining a QALY and gaining a treatment responder (based on WHODAS 2.0). Compared to TAU, CMHT had small incremental effects favouring CMHT (QALY: M = 0·023, SD = 0·013; Response: M = 0·093, SD = 0·034). The incremental costs were higher in CMHT than in TAU as seen from both the societal and healthcare perspective (societal costs: M=€1,892, SD=€950; healthcare costs: M = 1,125, SD=€720). The ICER for gaining a QALY was €82,261 and €48,913 as seen from the societal and healthcare perspective, respectively. These ICERs were well above the willingness to pay threshold of €20,000 for gaining a QALY. A similar picture arose with treatment response as outcome. Overall CMHT appeared to be more effective but also more costly, with the additional cost outweighing the benefits across countries, except in Bulgaria, which may highlight that cost-effectiveness is likely to be context dependent. Therefore, a recommendation for scaling up or sustaining CMHT must also depend on arguments other than health-economic alone, such as medical ethical, equity and human rights considerations. Bulgaria: NCT03922425, Croatia: NCT03862209, Macedonia: NCT03892473, Montenegro: NCT03837340, Romania NCT03884933.

BACKGROUND: Chronic non-cancer pain (CNCP) is a frequent reason for consulting a general practitioner. German guidelines underline its biopsychosocial etiology, relevance of self-care and nonpharmacological therapy options, and comprehensive assessment for individualized treatment and monitoring of pain medication use. A case management program was developed in project RELIEF (Resource-oriented case management to implement recommendations for patients with chronic pain and frequent use of analgesics in general practices) to support implementation of pain management guideline recommendations in general practice regarding assessment and monitoring, patient and practice team education, promotion of self-care strategies, and rational pharmacotherapy. OBJECTIVE: The aim is to effectively reduce pain-related disability in patients with chronic non-cancer pain and improve associated outcomes. METHODS: Following the assessment of its feasibility, the program will now be tested in a cluster randomized controlled trial with general practices and adult patients with CNCP, pain-related disability, and analgesics use located in Baden-Württemberg, Germany. The intervention comprises software-supported medical pain history, structured appointments, e-learning for practice teams, educational material for patients, and a toolbox with additional resources. Participating practices will recruit eligible patients via a screening questionnaire. The primary outcome will be measured by the Pain Disability Index German version. Outcome evaluation data will be collected by digitalized questionnaires to be completed by participants. Descriptive statistics will summarize demographics and baseline characteristics. A mixed-methods process evaluation will use digitally provided surveys and telephone interviews to assess intervention mechanisms regarding pain-related self-efficacy, patient activation, medication use, non-pharmacological treatment options, and intervention fidelity. RESULTS: Recruitment takes place between January and April 2026. Targeted maximum sample size is 28 practices and 252 patients. The intervention period will start with completed recruitment. It is expected that eligible patients will benefit from improved medication management, intensified use of nonpharmacological treatment strategies and reduction of pain-related disabilities. CONCLUSIONS: This study will provide valuable information regarding potential effects of the intervention.

OBJECTIVES:Maternal alcohol consumption during pregnancy is a major, yet preventable, risk factor for fetal alcohol spectrum disorders (FASD), which can lead to lifelong neurodevelopmental, educational, and social challenges. The economic burden of FASD in Germany remains poorly quantified. In this study, we aimed to estimate the direct and indirect lifetime costs associated with FASD in Germany. STUDY DESIGN:Static cohort-based cost-of-illness study. METHODS:We conducted a cost-of-illness analysis from the perspectives of the German healthcare (e.g., psychiatric care) and social (e.g., alternative housing, special education) systems. Data from German and international studies were used to derive age-specific annual costs, which were applied to a modeled cohort of 12,600 and 13,500 individuals with FASD in Baden-Württemberg. Lifetime costs were calculated from birth to the German retirement age (67 years), adjusted to inflation in 2024, and discounted at 0%, 3%, and 5% per annum. RESULTS:The estimated undiscounted lifetime cost per affected individual was EUR 3.9 million, corresponding to EUR 49.6-53.1 billion for a single birth cohort, depending on the assumed prevalence. Applying a 3% discount rate reduced the present value to EUR 1.5 million per individual and EUR 18.4-19.8 billion for the birth cohort, while a 5% discount rate further decreased these estimates to EUR 0.9 million per individual and EUR 11.1-11.9 billion. CONCLUSIONS:FASD represents a significant lifetime economic burden in Germany. Both undiscounted and discounted estimates underscore the importance of early preventive interventions, improved screening, and targeted support to reduce long-term costs for healthcare, social services, and society.

Venous leg ulcers (VLU) account for the majority of chronic wounds, with an estimated rise in prevalence due to demographic change. Care often does not comply with evidence, and patients remain passive and uninformed. To support general practice VLU care, the 'UlcusCrurisCare' (UCC) project developed a multimodal intervention comprising provider training, software-supported case management and standardised patient education. Experts from the medical community (physicians, nurses, association of medical assistants), health insurance and patient representatives provided their assessment of barriers in VLU care, requirements for intervention components and their expected effects. Semi-structured interviews and questionnaires were used at two measuring points. Qualitative data analysis was based on the Theoretical Domains Framework. Quantitative data were analysed descriptively. Ten experts named a lack of knowledge and application regarding compression therapy, reluctance to assume role as primary care provider, and inadequate remuneration as barriers for evidence-based VLU care. To effectively address these barriers, interventions are required to foster the use of compression therapy and patient education. A multimodal approach such as pursued in UCC is expected to effectively address deficits in VLU care at general practitioner level by promoting provider knowledge about evidence-based treatment and supporting patient adherence.

Structural barriers limit timely access to specialised mental health services. Technology-based integrated care models, such as mental health specialist video consultations, connect primary care physicians, patients, and mental health specialists regardless of geographic constraints. Primary care physicians are pivotal for delivering mental health care and critical for understanding facilitators and barriers to implementing mental health specialist video consultations. This study aimed to (1) prospectively investigate the implementation of mental health specialist video consultations in primary care and (2) derive actionable recommendations for scalable implementation by exploring primary care physicians’ experiences through Normalization Process Theory. Mixed-methods evaluation (qualitative-primary embedded design) using semi-structured interviews, complemented by quantitative NoMAD (Normalisation MeAsure Development) questionnaire data. Eighteen rural primary care physicians in Germany. Thematic analysis guided by Normalization Process Theory (Coherence, Cognitive Participation, Collective Action, Reflexive Monitoring). NoMAD data were analysed using descriptive statistics. Narratives and high NoMAD scores indicated clear understanding of mental health specialist video consultations as delivering low-threshold, immediate support regardless of regional barriers (Coherence), and confidence in the suitability of on-site delivery within primary care, particularly for patient safety (Cognitive Participation). However, participants emphasised the need for adequate resources—space, staff, and streamlined workflows—to minimise burden on practice routines (Collective Action). Physicians highlighted the benefits of mental health specialist video consultations, including reduced workload, improved patient outcomes, and overall relief for the health system (Reflexive Monitoring). Mental health specialist video consultations are a promising practical tool for integrating mental health services into primary care, with primary care physicians central to its success. However, addressing structural barriers at the practice and system levels is crucial for embedding mental health specialist video consultations into routine workflows. ClinicalTrials.gov (NCT04316572). Prospectively registered on 20 March 2020.

Recruitment of participants for preventive health intervention studies remains a significant challenge: Approximately 19

BACKGROUND:Prescribing high-potency opioids for chronic non-cancer pain has increased in Germany, despite limited evidence of long-term efficacy. General practitioners write approximately 87% of all opioid prescriptions. The guideline "Long-term use of opioids for chronic non-cancer pain" (LONTS) provides recommendations for responsible opioid management, but its uptake in primary care remains unclear. OBJECTIVE:This study investigates how general practitioners apply LONTS guideline recommendations and identifies barriers to implementation. METHODS:A mixed-methods study was conducted, including an online questionnaire to detect deviations from LONTS recommendations, followed by semi-structured telephone interviews to explore barriers for guideline adherence. RESULTS:A total of 131 questionnaires and 21 interviews with general practitioners were analyzed. 45% of questionnaire participants were unfamiliar with the LONTS guideline. Four key gaps were identified: (i) Nearly 40% of general practitioners rarely or never set individualized treatment goals for chronic pain patients; (ii) 49% preferred combining long-acting opioids at fixed intervals with short-acting opioids on demand; (iii) 17% used short-acting opioid monotherapy, considered a treatment error; (iv) 44% did not discuss opioid reduction or discontinuation after 6 months of effective pain relief. Qualitative analysis identified key barriers: lack of integration into daily routines, anticipating patients' fear of pain recurrence, and preference for personal experience over evidence. CONCLUSION:General practitioners in Germany may struggle to implement LONTS recommendations for opioid use in chronic non-cancer pain. Targeted strategies are needed to promote and improve the adoption of these guidelines in primary care.

Background Continuity of care (COC) refers to the sustained quality of healthcare over time and is a central element of effective general practice. High levels of COC have been associated with improved health outcomes, including reduced risks of hospitalisation. Previous research demonstrated that participation in Germany’s “general practitioner-centred healthcare” (GPCHC) programme, designed to strengthen general practice care, led to higher COC. Furthermore, higher COC was independently linked to decreased risks of hospitalisations, including rehospitalisations and avoidable admissions. This study aimed to investigate whether the benefits of COC for GPCHC patients persisted in 2020, the first year of the COVID-19 pandemic, compared with 2019, the year preceding the pandemic.Methods An observational study was conducted in Germany using data from a health insurance database. The study included two patient cohorts: those enrolled in the GPCHC programme (n=1 049 910) and those not enrolled in GPCHC (n=537 759) for both 2019 and 2020. The analysis compared three measures of COC—Usual Provider Index, Herfindahl Index and Sequential Continuity Index—adjusted for patient characteristics. Longitudinal multivariable regression models were employed to evaluate differences between the cohorts and assess the impact of the COVID-19 pandemic on COC outcomes.Results For GPCHC patients, COC in general practice was relevantly and significantly higher with respect to the three COC measures in 2019. We could observe the same advantage for GPCHC patients in 2020. Interestingly, for the SCI index, indicating the fraction of sequential encounter pairs at which the same provider is seen, we could observe that COC was even more advantageous for GPCHC patients in 2020 in comparison to 2019. Finally, we could observe that higher COC in 2019 was independently associated with decreased healthcare utilisation of the inpatient care sector in 2020.Conclusions In a pandemic period in which healthcare is faced with new challenges, both for patients and healthcare providers, GPCHC was still associated with higher COC. The GPCHC programme and its contents are obviously better up to the requirements of the COC even in such a situation of pandemic-induced discontinuity.

Introduction: Considering the global increase in cancer, integrative medicine combines conventional and complementary methods, offering a holistic approach to treating cancer patients. To optimize care and support care continuity for oncological patients, the integrative healthcare structure CCC-Integrativ provided evidence-based, interprofessional counseling in four oncology centers in Southern Germany. A process evaluation explored the program’s perceived effects and factors relevant to the implementation process to identify opportunities and challenges for a sustainable implementation of the program. Methods: In a qualitative study, semi-structured guide-based interviews with medical and nursing staff directly and indirectly involved in the program were conducted to explore their perspectives. The generated data were analyzed in a content analysis. Participant perceptions regarding potential program effects and factors influencing its’ implementation were first identified through open inductive coding. The Consolidated Framework for Implementation Research (CFIR) was then used as a categorizing analytical framework to guide further coding and facilitate a deeper understanding of the implementation process. Results: N = 21 interviews were analyzed (n = 12 directly involved in counseling; n = 9 indirectly involved through leadership position). Participants perceived an added value of the integrative care approach and expressed a positive attitude towards a continuation of the program. Patient interest in complementary medicine and care, their positive response to the program, and a perceived supportive effect of the interprofessional collaboration were reported as promoting factors. Still, insufficient evidence and a perceived low acceptance of some complementary medicine methods by hospital staff, skepticism, lack of space, and recruitment problems, were identified as key challenges for successful long-term implementation. Conclusions: A variety of factors need to be addressed for sustained implementation. Promoting acceptance of supportive complementary methods is essential for evidence-based, patient-centered cancer care. Consideration of interprofessional care could be a key factor for the long-term implementation of consultations on complementary and integrative healthcare.

BACKGROUND:The number of long-term ventilated patients in out-of-hospital intensive care (OIC) in Germany has risen sharply in recent years. Due to financial disincentives, structural care deficits and resource bottlenecks, there is an increasing risk of inadequate care. In 2020, the Intensive Care and Rehabilitation Strengthening Act (IPReG) was therefore passed by legislators with the aim of improving OIC. This study examines the opportunities and challenges of the IPReG with regard to the care of long-term ventilated patients in OIC from the perspective of payers and healthcare policy. MATERIALS AND METHODS:A qualitative interview study was conducted as part of the process evaluation of the multicenter study PRiVENT (Prevention of invasive Ventilation). Using semi-structured, guideline-based individual interviews, health policy actors and representatives of statutory health insurers were asked about the IPReG. RESULTS:In all, 11 health policymakers and 12 representatives of statutory health insurance companies took part in the interviews. Both interview groups showed a positive attitude towards the IPReG and expressed the expectation of added value for the outpatient care of long-term ventilated patients. The current remuneration regulations for weaning and the assessment of weaning potential in the OIC were criticized, among other things. CONCLUSION:The IPReG provides a legal basis for improving OIC, but there is still room for improvement in its current version. The evaluation planned by legislators should be used to identify potential weaknesses and make appropriate adjustments.

BackgroundChronic noncancer pain (CNCP) is a frequent reason for counseling in general practice. Current German guidelines emphasize its biopsychosocial etiology and the importance of self-care and nonpharmacological treatment strategies such as education, physical and social activity, and psychological approaches. Comprehensive assessments are necessary to individualize treatment maximally and monitor appropriate use of pain medication. General practitioners face many challenges in implementing holistic pain management, which considers biological, psychological, and social aspects. In project RELIEF (resource-oriented case management to implement recommendations for patients with chronic pain and frequent use of analgesics in general practices), a case management program was developed to facilitate implementation of guideline recommendations on pain management regarding medical assessment and monitoring, patient and practice team education, promotion of self-care strategies, and rational pharmacotherapy. ObjectiveWe evaluated the feasibility of the intervention and study procedures before applying them in a larger cluster randomized controlled trial. Our secondary objective is to estimate potential effects of the complex intervention. MethodsA single-arm trial with general practices and patients with CNCP and analgesics use will be conducted, accompanied by a mixed methods process evaluation. The intervention comprises 5 components, including software-supported medical pain history, 3 scheduled structured appointments, e-learning on CNCP for general practitioners and medical assistants, educational material for patients, toolbox with information on (regional) resources for patients and practice teams. Participating practices will be located in the federal state of Baden-Württemberg, Germany, and will recruit eligible patients (adults with CNCP for more than 3 months, with at least moderate pain-related disability, permanent or on-demand use of analgesics or co-analgesics in the previous 4 weeks, and practice team assessed ability to participate actively in the trial). A questionnaire given to the first 150 adult patients entering the practice in February 2025 will help screen eligible patients. The primary objective will be measured by a set of predefined indicators. The key secondary outcome is pain-related disability measured by the Pain Disability Index German version. All participants will be asked to participate in the process evaluation. Outcome evaluation data will be gathered by paper-based and digitally provided questionnaires to be completed by participants. Process evaluation data will be gathered in surveys and a qualitative study. Descriptive analyses will be performed. ResultsRecruitment occurred between October and December 2024. Targeted sample size was 6 practices and 50 patients. The intervention period will be February-June 2025. It is expected that eligible patients will benefit from the intervention and that improved medication management and intensified use of nonpharmacological treatment strategies will reduce pain-related disabilities and other patient-reported outcomes. ConclusionsThis study will provide valuable information regarding feasibility and potential effects before testing the intervention in a confirmatory cluster randomized controlled trial. Trial RegistrationGerman Clinical Trials Register DRKS00034831; https://www.drks.de/search/de/trial/DRKS00034831 International Registered Report Identifier (IRRID)PRR1-10.2196/66335

Introduction: The multicentre cluster-randomized PRiVENT study aims to improve weaning of long-term ventilated patients in German intensive care units via a complex interprofessional intervention. To assess perceptions on interprofessional collaboration and job satisfaction among different health professions, a survey was conducted in four clusters, each comprising one weaning centre and 7-12 cooperation hospitals. METHODS:Three validated questionnaires were used to measure (a) interprofessional socialization (7-level Likert scale), (b) interprofessional collaboration (5-level), and (c) job satisfaction (7-level). Alongside a descriptive analysis, a subgroup analysis was performed comparing mean scores between physicians and non-physicians and the four clusters. Correlation coefficients were calculated to check for correlations of age group and work experience with interprofessional collaboration and job satisfaction. RESULTS:Sixty-two questionnaires were returned by health workers of the intensive care units, corresponding to a response rate of 47%. Respondents rated interprofessional socialization (5.7 ± 0.6) and collaboration (3.8 ± 0.6) as good. Job satisfaction was high (5.1 ± 1.0), particularly regarding the collegial environment and variety of work tasks. Satisfaction with physical workload, income, and working hours was lower. Compared to physicians, overall ratings of non-physicians were lower, although the differences were not statistically significant, as were those between clusters. There was a statistically significant positive correlation of age group and work experience with overall job satisfaction. CONCLUSION:Health workers within PRiVENT are satisfied with their workplace conditions and rate interprofessional collaboration as good. Follow-up surveys will provide insights into the impact of PRiVENT on interprofessional cooperation and job satisfaction. .