@article{WetzelKochPreiseretal.2022,
  author    = {Wetzel, Anna-Jasmin and Koch, Roland and Preiser, Christine and M{\"u}ller, Regina and Klemmt, Malte and Ranisch, Robert and Ehni, Hans-J{\"o}rg and Wiesing, Urban and Rieger, Monika A. and Henking, Tanja and Joos, Stefanie},
  title     = {Ethical, legal, and social implications of symptom checker Apps in primary Health Care (CHECK.APP)},
  series = {JMIR Research Protocols},
  volume    = {11},
  journal   = {JMIR Research Protocols},
  number    = {5},
  publisher = {JMIR Research Protocols},
  address   = {Toronto},
  issn      = {1929-0748},
  doi       = {10.2196/34026},
  pages     = {11},
  year      = {2022},
  abstract  = {Background: Symptom checker apps (SCAs) are accessible tools that provide early symptom assessment for users. The ethical, legal, and social implications of SCAs and their impact on the patient-physician relationship, the health care providers, and the health care system have sparsely been examined. This study protocol describes an approach to investigate the possible impacts and implications of SCAs on different levels of health care provision. It considers the perspectives of the users, nonusers, general practitioners (GPs), and health care experts. Objective: We aim to assess a comprehensive overview of the use of SCAs and address problematic issues, if any. The primary outcomes of this study are empirically informed multi-perspective recommendations for different stakeholders on the ethical, legal, and social implications of SCAs. Methods: Quantitative and qualitative methods will be used in several overlapping and interconnected study phases. In study phase 1, a comprehensive literature review will be conducted to assess the ethical, legal, social, and systemic impacts of SCAs. Study phase 2 comprises a survey that will be analyzed with a logistic regression. It aims to assess the user degree of SCAs in Germany as well as the predictors for SCA usage. Study phase 3 will investigate self-observational diaries and user interviews, which will be analyzed as integrated cases to assess user perspectives, usage pattern, and arising problems. Study phase 4 will comprise GP interviews to assess their experiences, perspectives, self-image, and concepts and will be analyzed with the basic procedure by Kruse. Moreover, interviews with health care experts will be conducted in study phase 3 and will be analyzed by using the reflexive thematical analysis approach of Braun and Clark. Results: Study phase 1 will be completed in November 2021. We expect the results of study phase 2 in December 2021 and February 2022. In study phase 3, interviews are currently being conducted. The final study endpoint will be in February 2023. Conclusions: The possible ethical, legal, social, and systemic impacts of a widespread use of SCAs that affect stakeholders and stakeholder groups on different levels of health care will be identified. The proposed methodological approach provides a multifaceted and diverse empirical basis for a broad discussion on these implications.},
  language  = {en}
}
@article{KonradBohlkenRappetal.2016,
  author    = {Konrad, Marcel and Bohlken, Jens and Rapp, Michael A. and Kostev, Karel},
  title     = {Depression risk in patients with heart failure in primary care practices in Germany},
  series = {International psychogeriatrics},
  volume    = {28},
  journal   = {International psychogeriatrics},
  publisher = {Cambridge Univ. Press},
  address   = {New York},
  issn      = {1041-6102},
  doi       = {10.1017/S1041610216000867},
  pages     = {1889 -- 1894},
  year      = {2016},
  abstract  = {Background: The goal of this study was to estimate the prevalence of and risk factors for diagnosed depression in heart failure (HF) patients in German primary care practices. Methods: This study was a retrospective database analysis in Germany utilizing the Disease Analyzer (R) Database (IMS Health, Germany). The study population included 132,994 patients between 40 and 90 years of age from 1,072 primary care practices. The observation period was between 2004 and 2013. Follow-up lasted up to five years and ended in April 2015. A total of 66,497 HF patients were selected after applying exclusion criteria. The same number of 66,497 controls were chosen and were matched (1:1) to HF patients on the basis of age, sex, health insurance, depression diagnosis in the past, and follow-up duration after index date. Results: HF was a strong risk factor for diagnosed depression (p < 0.0001). A total of 10.5\% of HF patients and 6.3\% of matched controls developed depression after one year of follow-up (p < 0.001). Depression was documented in 28.9\% of the HF group and 18.2\% of the control group after the five-year follow-up (p < 0.001). Cancer, dementia, osteoporosis, stroke, and osteoarthritis were associated with a higher risk of developing depression. Male gender and private health insurance were associated with lower risk of depression. Conclusions: The risk of diagnosed depression is significantly increased in patients with HF compared to patients without HF in primary care practices in Germany.},
  language  = {en}
}