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      Welche Potenziale und Mehrwerte bieten DiGA für die hausärztliche Versorgung? – Ergebnisse einer Befragung von Hausärzt*innen in Deutschland Translated title: What potential and added value do DiGA offer for primary care?—Results of a survey of general practitioners in Germany

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          Abstract

          Hintergrund

          Für Ärzt*innen besteht die Möglichkeit, Patient*innen digitale Gesundheitsanwendungen (DiGA) auf Rezept zu verordnen. Bislang fehlen Untersuchungen, die Anwendungsmöglichkeiten von DiGA im hausärztlichen Praxiskontext beleuchten und eine erste Bilanz zum Nutzen sowie Optimierungspotenzial ziehen.

          Ziel der Arbeit

          Die Studie exploriert hausärztliche Einstellungen, Erwartungen und Erfahrungswerte mit Blick auf die Anwendungspotenziale von DiGA.

          Methoden

          Im Frühjahr 2022 wurden sämtliche 13.913 als Behandler*innen aktive Hausärzt*innen in Baden-Württemberg, Hessen, Rheinland-Pfalz und im Saarland zu einer Online-Befragung eingeladen. 3829 vollständig ausgefüllte Fragebögen gingen in die Auswertung ein (Rücklauf: 28 %). Zur Ermittlung von signifikanten Unterschieden zwischen 2 Gruppen erfolgten ein t‑Test bei unabhängigen Stichproben sowie eine Faktorenanalyse.

          Ergebnisse

          Die meisten Befragten erachten DiGA als verlässliche (67 %) und sichere (61 %) Anwendungen. 22 % trauen sich zu, Patient*innen zu DiGA kompetent zu beraten. 14 % haben bereits DiGA verschrieben, 13 % haben dies vor. 83 % der Ärzt*innen mit DiGA-Erfahrung bewerten die verordneten Anwendungen als nützlich. Beobachtete Versorgungseffekte betreffen v. a. die Verbesserung von Therapietreue (95 %), Mobilität (94 %) und Aufklärung (93 %) sowie Gewichtsreduktion (82 %). Angeregt wird u. a. eine weitere Optimierung der Nutzerfreundlichkeit (59 %), die systematische Weiterbildung von Ärzt*innen (52 %) und die verstärkte Aufnahme spielerischer Elemente (49 %).

          Diskussion

          Hausärzt*innen sollten besser über die Grundlagen des Digitale-Versorgung-Gesetzes (DVG) informiert und Bedenken gezielt adressiert werden. Zentral erscheinen flächendeckende Schulungen, die über Rahmenbedingungen und Vorteile des DiGA-Einsatzes aufklären. Auch besteht Bedarf an fundierteren Informations- und Recherchequellen für Ärzt*innen.

          Zusatzmaterial online

          Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-022-03608-w) enthalten.

          Translated abstract

          Background

          For almost two years, physicians have been able to prescribe digital health applications (DiGA) to patients. So far, there has been a lack of studies that shed light on the possible use of DiGA in the context of primary care and take stock of the benefits and potential for optimization.

          Objectives

          This study explores general practitioners’ (GPs) attitudes, expectations, and experiences with regard to the application potential of DiGA.

          Methods

          In the spring of 2022, all 13,913 general practitioners in the federal states Baden-Württemberg, Hesse, Rhineland-Palatinate, and Saarland were invited to take part in an online survey. Included in the evaluation were 3829 completed questionnaires (response rate: 28%). A t-test on independent samples was used to determine significant differences between two groups. Moreover, a factor analysis was carried out.

          Results

          A majority of those surveyed consider DiGA to be reliable (67%) and secure (61%) applications. In addition, 22% trust themselves to competently advise patients on DiGA, 14% have already prescribed DiGA, and 13% plan to do so. Of the GPs with DiGA experience, 83% rate the prescribed applications as useful. Observed healthcare effects mainly relate to the improvement of compliance (95%), mobility (94%), and education (93%) as well as weight reduction (82%). The respondents suggest further optimization of DIGA, especially with regard to usability (59%), systematic further training of doctors (52%), and the expansion of gamification elements (49%).

          Conclusions

          It is important to better inform GPs about the basics of the Digital Healthcare Act (DVG) and to address concerns in a targeted manner. Comprehensive training courses that explain the framework conditions and advantages of using DiGA appear to be crucial. There is also a need for more well-founded sources of information and research for doctors.

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          Most cited references26

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          Theories Predicting End-User Acceptance of Telemedicine Use: Systematic Review

          Background Only a few telemedicine applications have made their way into regular care. One reason is the lack of acceptance of telemedicine by potential end users. Objective The aim of this systematic review was to identify theoretical predictors that influence the acceptance of telemedicine. Methods An electronic search was conducted in PubMed and PsycINFO in June 2018 and supplemented by a hand search. Articles were identified using predefined inclusion and exclusion criteria. In total, two reviewers independently assessed the title, abstract, and full-text screening and then individually performed a quality assessment of all included studies. Results Out of 5917 potentially relevant titles (duplicates excluded), 24 studies were included. The Axis Tool for quality assessment of cross-sectional studies revealed a high risk of bias for all studies except for one study. The most commonly used models were the Technology Acceptance Model (n=11) and the Unified Theory of Acceptance and Use of Technology (n=9). The main significant predictors of acceptance were perceived usefulness (n=11), social influences (n=6), and attitude (n=6). The results show a superiority of technology acceptance versus original behavioral models. Conclusions The main finding of this review is the applicability of technology acceptance models and theories on telemedicine adoption. Characteristics of the technology, such as its usefulness, as well as attributes of the individual, such as his or her need for social support, inform end-user acceptance. Therefore, in the future, requirements of the target group and the group’s social environment should already be taken into account when planning telemedicine applications. The results support the importance of theory-guided user-centered design approaches to telemedicine development.
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            Using Smartphones and Health Apps to Change and Manage Health Behaviors: A Population-Based Survey

            Background Chronic conditions are an increasing challenge for individuals and the health care system. Smartphones and health apps are potentially promising tools to change health-related behaviors and manage chronic conditions. Objective The aim of this study was to explore (1) the extent of smartphone and health app use, (2) sociodemographic, medical, and behavioral correlates of smartphone and health app use, and (3) associations of the use of apps and app characteristics with actual health behaviors. Methods A population-based survey (N=4144) among Germans, aged 35 years and older, was conducted. Sociodemographics, presence of chronic conditions, health behaviors, quality of life, and health literacy, as well as the use of the Internet, smartphone, and health apps were assessed by questionnaire at home visit. Binary logistic regression models were applied. Results It was found that 61.25% (2538/4144) of participants used a smartphone. Compared with nonusers, smartphone users were younger, did more research on the Internet, were more likely to work full-time and more likely to have a university degree, engaged more in physical activity, and less in low fat diet, and had a higher health-related quality of life and health literacy. Among smartphone users, 20.53% (521/2538) used health apps. App users were younger, less likely to be native German speakers, did more research on the Internet, were more likely to report chronic conditions, engaged more in physical activity, and low fat diet, and were more health literate compared with nonusers who had a smartphone. Health apps focused on smoking cessation (232/521, 44.5%), healthy diet (201/521, 38.6%), and weight loss (121/521, 23.2%). The most common app characteristics were planning (264/521, 50.7%), reminding (188/521, 36.1%), prompting motivation (179/521 34.4%), and the provision of information (175/521, 33.6%). Significant associations were found between planning and the health behavior physical activity, between feedback or monitoring and physical activity, and between feedback or monitoring and adherence to doctor’s advice. Conclusions Although there were many smartphone and health app users, a substantial proportion of the population was not engaged. Findings suggest age-related, socioeconomic-related, literacy-related, and health-related disparities in the use of mobile technologies. Health app use may reflect a user’s motivation to change or maintain health behaviors. App developers and researchers should take account of the needs of older people, people with low health literacy, and chronic conditions.
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              Current Knowledge and Adoption of Mobile Health Apps Among Australian General Practitioners: Survey Study

              Background Mobile health (mHealth) apps can be prescribed as an effective self-management tool for patients. However, it is challenging for doctors to navigate 350,000 mHealth apps to find the right ones to recommend. Although medical professionals from many countries are using mHealth apps to varying degrees, current mHealth app use by Australian general practitioners (GPs) and the barriers and facilitators they encounter when integrating mHealth apps in their clinical practice have not been reported comprehensively. Objective The objectives of this study were to (1) evaluate current knowledge and use of mHealth apps by GPs in Australia, (2) determine the barriers and facilitators to their use of mHealth apps in consultations, and (3) explore potential solutions to the barriers. Methods We helped the Royal Australian College of General Practitioners (RACGP) to expand the mHealth section of their annual technology survey for 2017 based on the findings of our semistructured interviews with GPs to further explore barriers to using mHealth apps in clinical practice. The survey was distributed to the RACGP members nationwide between October 26 and December 3, 2017 using Qualtrics Web-based survey tool. Results A total of 1014 RACGP members responded (response rate 4.6% [1014/21,884], completion rate 61.2% [621/1014]). The median years practiced was 20.7 years. Two-thirds of the GPs used apps professionally in the forms of medical calculators and point-of-care references. A little over half of the GPs recommended apps for patients either daily (12.9%, 80/621), weekly (25.9%, 161/621), or monthly (13.4%, 83/621). Mindfulness and mental health apps were recommended most often (32.5%, 337/1036), followed by diet and nutrition (13.9%, 144/1036), exercise and fitness (12.7%, 132/1036), and women’s health (10%, 104/1036) related apps. Knowledge and usage of evidence-based apps from the Handbook of Non-Drug Interventions were low. The prevailing barriers to app prescription were the lack of knowledge of effective apps (59.9%, 372/621) and the lack of trustworthy source to access them (15.5%, 96/621). GPs expressed their need for a list of safe and effective apps from a trustworthy source, such as the RACGP, to overcome these barriers. They reported a preference for online video training material or webinar to learn more about mHealth apps. Conclusions Most GPs are using apps professionally but recommending apps to patients sparingly. The main barriers to app prescription were the lack of knowledge of effective apps and the lack of trustworthy source to access them. A curated compilation of effective mHealth apps or an app library specifically aimed at GPs and health professionals would help solve both barriers.
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                Author and article information

                Contributors
                julian.wangler@unimedizin-mainz.de
                Journal
                Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz
                Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz
                Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1436-9990
                1437-1588
                21 October 2022
                21 October 2022
                2022
                : 65
                : 12
                : 1334-1343
                Affiliations
                GRID grid.410607.4, Zentrum für Allgemeinmedizin und Geriatrie, , Universitätsmedizin Mainz, ; Am Pulverturm 13, 55131 Mainz, Deutschland
                Article
                3608
                10.1007/s00103-022-03608-w
                9722862
                36269336
                a2c4212c-565f-4493-8175-e9625bf1352d
                © The Author(s) 2022

                Open Access Dieser Artikel wird unter der Creative Commons Namensnennung 4.0 International Lizenz veröffentlicht, welche die Nutzung, Vervielfältigung, Bearbeitung, Verbreitung und Wiedergabe in jeglichem Medium und Format erlaubt, sofern Sie den/die ursprünglichen Autor(en) und die Quelle ordnungsgemäß nennen, einen Link zur Creative Commons Lizenz beifügen und angeben, ob Änderungen vorgenommen wurden.

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                History
                : 15 July 2022
                : 30 September 2022
                Funding
                Funded by: Universitätsmedizin der Johannes Gutenberg-Universität Mainz (8974)
                Categories
                Originalien und Übersichten
                Custom metadata
                © Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature 2022

                digitale gesundheitsanwendung,diga,gesundheits-apps,m‑health,prävention,gesundheitsförderung,hausarzt,digital health applications,health apps,mhealth,prevention,health promotion,general practitioner

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