Hintergrund Mit dem ParkinsonNetzwerk Ostsachsen (PANOS) soll ein intersektorales, pfadbasiertes und plattformunterstütztes Versorgungskonzept etabliert werden, um trotz steigender Behandlungszahlen eine flächendeckende Parkinson-Versorgung mit adäquaten Therapien zu unterstützen. Fragestellung Welche Barrieren könnten die Akzeptanz und eine erfolgreiche Verstetigung des PANOS-Behandlungspfades gefährden? Methode Implementierungsbarrieren wurden über eine selektive Literaturrecherche identifiziert und in einer Onlinebefragung von 36 projektassoziierten Neurolog*innen und Hausärzt*innen priorisiert. Die Auswertung der Ergebnisse erfolgte anonymisiert und deskriptiv. Ergebnisse Dreizehn mögliche Implementierungsbarrieren wurden identifiziert. Es nahmen 11 Neurolog*innen und 7 Hausärzt*innen an der Onlineumfrage teil. Die befragten Neurolog*innen sahen in Doppeldokumentationen sowie in unzureichender Kommunikation und Kooperation zwischen den Leistungserbringenden die größten Hindernisse für eine Akzeptanz von PANOS. Hausärzt*innen beurteilten u. a. die restriktiven Verordnungs- und Budgetgrenzen und den möglicherweise zu hohen Zeitaufwand für Netzwerkprozesse als hinderlich. Diskussion Doppeldokumentationen von Patienten- und Behandlungsdaten sind zeitintensiv und fehleranfällig. Die Akzeptanz kann durch adäquate finanzielle Kompensation der Leistungserbringenden erhöht werden. Das hausärztliche Verordnungsverhalten könnte durch die Verwendung interventionsbezogener Abrechnungsziffern positiv beeinflusst werden. Die Ergebnisse zeigen u. a. einen Bedarf an integrativen technischen Systemlösungen und sektorenübergreifenden Dokumentationsstrukturen, um den Mehraufwand für Leistungserbringende zu reduzieren. Schlussfolgerung Eine Vorabanalyse der Einflussfaktoren von PANOS sowie die Sensibilisierung aller mitwirkenden Akteure für potenzielle Barrieren sind entscheidend für die Akzeptanz des Versorgungsnetzwerkes. Gezielte Maßnahmen zur Reduzierung und Vermeidung identifizierter Barrieren können die anwenderseitige Akzeptanz erhöhen und die Behandlungsergebnisse optimieren. / Introduction The ParkinsonNetwork Eastern Saxony (PANOS) aims to establish an intersectoral, path-based and platform-supported care concept in order to support comprehensive care with adequate therapies despite the increasing number of patients to be treated. Objective Which barriers may limit the acceptance and successful implementation of PANOS? Methods Implementation barriers were identified through a selective literature review and prioritized in an online survey of 36 project-associated neurologists and general practitioners. The results were analyzed anonymously and descriptively. Results Thirteen potential implementation barriers were identified. Eleven neurologists and seven general practitioners participated in the online survey. The surveyed neurologists assessed double documentation and inadequate communication and cooperation between the service providers as the biggest obstacles to the acceptance of PANOS. General practitioners rated the restrictions for prescription and budget and the potentially high time expenditure required for network activities as barriers. Discussion Double documentation of patient and treatment data is time consuming and prone to errors. Adequate financial compensation could increase service providers’ willingness to participate in such measures. In addition, the prescribing behavior of general practitioners may be influenced positively by the use of intervention-related accounting numbers. The results indicate a need for integrative technical system solutions and intersectoral documentation structures in order to reduce the additional effort for service providers. Conclusion Analyzing the influencing factors of the PANOS network, and raising the awareness of all participating service providers to potential barriers, are decisive measures for the acceptance of the care network. Targeted measures to reduce and avoid identified barriers can increase user acceptance and optimize treatment results.

Background: Antenatal Psychosocial Assessment (APA) has recently been introduced into routine antenatal care, but the ways in which maternity service providers assess and respond to maternal stress are subject of debate. There is a lack of consensus on the instrument(s) of choice and lack of evidence regarding appropriate interventions. Further, national guidelines have not kept apace with the conceptual shift from ‘postnatal depression’ to ‘perinatal anxiety and depression’. Adopting the Medical Research Council Complex Interventions Framework, the ARMS research aimed to inform the development of interventions that support women who are experiencing, or at risk of, mild-moderate mental health disorder in pregnancy. Methods: A mixed methods approach was adopted. In the quantitative element (Study Part 1) participants (n=191) completed a questionnaire when attending for their first formal antenatal appointment, using a procedure and materials that had been previously tested in a pilot study. Details including mental health assessment and referrals were obtained from their health records, following delivery. In the qualitative element (Study Part 2) a sub-sample of women (n=22) experiencing high levels of maternal stress took part in up to three serial in-depth interviews during pregnancy and the early postnatal period.Findings: Maternal stress was found to be common. Using the Edinburgh Postnatal Depression Scale (EPDS) threshold of ≥10, approximately 1 in 4 women were classed as high depression (halving to 1 in 8 at the more conservative threshold of ≥13). Almost 1 in 3 women were classed as high anxiety, using the state scale of the State-Trait Anxiety Inventory (STAI-S, threshold ≥41), compared with 1 in 5 using the two-item GAD (threshold ≥3). Fewer than half of the women identified as high anxiety were identified by both measures. Factor analyses of the symptom measures were consistent with wider literature suggesting a three-item anxiety component of the EPDS; however, concurrent validation using regression analyses did not indicate that the EPDS could be used as an anxiety case finding instrument. Women reported that maternal stress had significant impact on their lives that may not be captured with existing clinical approaches. Women commonly found it difficult to self-assess severity of maternal stress and the assessment process could itself act as an intervention. The research provided the first validation of the depression case finding questions in UK clinical practice. The Whooley items completed in clinical practice identified only half of the possible cases identified by the EPDS, at both commonly adopted EPDS thresholds. Inclusion of the Arroll 'help' question as a criterion improved specificity of the assessment completed in clinical practice but substantially compromised sensitivity, missing 9 in 10 possible cases. Women’s mental health history and treatment history were similarly under-reported, particularly concerning anxiety. APA was introduced into routine clinical practice without attention to topics of relevance to women, context of disclosure or to provision of adequate resources for consistently responding to identified need. Women experiencing, or at risk of, mild-moderate disorder were thus usually ineligible for further support. Implications: Care pathways are needed that encompass both assessing and responding to maternal stress, where communication with health professionals, subsequent referral and management are addressed. The development, implementation and evaluation of low-cost resources embedded in such pathways are a priority and the research presented in the thesis offers a foundation on which to build.