Abstract: Background The disease myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is unknown to many doctors in Germany. Within the health system, significant deficits in dealing with ME/CFS patients are repeatedly revealed. Here, the doctor-patient relationship (DP relationship) plays a central role. Hence, the aim of the present study is to analyse in more detail the appearance and behaviour of doctors as an important factor in the DP relationship in ME/CFS from the perspective of those affected. Methods As part of an exploratory qualitative survey, 549 adult ME/CFS patients (> 20 years; 456 women, 93 men) with a medical diagnosis of ME/CFS were asked about their subjective experiences with regard to the appearance and behaviour of the attending physicians. The sampling was done by self-activation and via the snowball principle. The questionnaire was structured analogously to a focused, standardized guideline interview. The questionnaires were evaluated as part of an extensive qualitative content analysis according to Mayring. Results The participants named the contemptuous, unpleasant appearance and behaviour of the treating physicians as a central factor in a problematic DP relationship in ME/CFS. They reported a lack of empathy, sensitivity and social skills and felt that the doctors did not take them seriously and classified them as "difficult patients". Their basic interactional needs were not taken into account, nor was there a relationship on an equal footing. In addition, a defensive attitude towards the patient was described. As a result, these factors affected the DP relationship. Conclusions From the point of view of ME/CFS sufferers, the appearance and behaviour of the attending physician is a central aspect of an DP relationship that they experience as problematic. Based on these findings, further factors characterizing the DP relationship in ME/CFS will now be analysed. In addition, the health effects of a problematic AP relationship are to be examined from the point of view of those affected

Abstract: Background In the aging population of Western societies, an increasing number of older adults have multiple chronic diseases. As multifaceted health problems imply the involvement of several healthcare professionals, multimorbid older people frequently face a fragmentation of health care. Addressing these challenges, we developed a local, collaborative, stepped, and personalized care management approach (LoChro-Care) and evaluated its effectiveness. Methods A two-group, parallel randomized controlled trial was conducted comparing LoChro-Care recipients (IG) to participants with usual care (CG). Patients aged 65 + with chronic conditions were recruited at inpatient and outpatient departments of the Medical Center, University of Freiburg. Participants were allocated using block randomization (nIG = 261, nCG = 263). LoChro-Care comprised individualized care provided by chronic care managers with 7 to 13 contacts over 12 months. Questionnaires were given at 3 time points (T0: baseline, T1: after 12 months, T2: after 18 months). The primary outcome was the physical, psychological, and social health status represented by a composite score of functional health and depressive symptoms. Secondary outcomes were the participants' evaluation of their health care situation, health-related quality of life (HRQL), and life-satisfaction (LS). The data were analyzed using linear mixed modelling. Results We analyzed N = 491 participants (nIG = 244, nCG = 247), aged M = 76.78 years (SD = 6.35). For the composite endpoint, neither a significant difference between IG and CG (p = .88) nor a group-time interaction (p = .52; p = .88) could be observed. Participants in both groups showed a significant decline on the primary outcome between T0 and T2 (p .001). Post hoc analyses revealed a decline in both functional health (p .001) and depressive symptoms (p = .02). Both groups did not differ in their evaluation of their health care situation (p = .93), HRQL (p = .44) or LS (p = .32). Relevant confounding variables were female gender and multimorbidity.brConclusionbrbrSupporting patients' self-management in coordinating their individual care network through LoChro-Care did not result in any significant effect on the primary and secondary outcomes. A decline of functional health and depressive symptoms was observed among all participants. Potential future intervention adaptations are discussed, such as a more active case management through direct referral to (in-)formal support, an earlier treatment initiation, and the consideration of specific sociodemographic factors in care management planning.brTrial registration