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Atypische Antipsychotika haben die medikamentöse Behandlung psychischer Erkrankungen revolutioniert. Gegenüber den konventionellen Therapieansätzen zeichnen sie sich durch eine nebenwirkungsärmere Beseitigung der Negativsymptome aus. Führt dieser Vorteil zu einer Verordnungspräferenz der atypischen Präparate, oder stellen sie vielmehr eine Behandlungsalternative zu den konventionellen Wirkstoffen dar?
19.09.2016
Seit April 2016 ist Dr. Andreas Meusch Direktor des Wissenschaftlichen Instituts für Nutzen und Effizienz im Gesundheitswesen (WINEG) sowie Beauftragter des Vorstands der Techniker Krankenkasse (TK) für strategische Fragen des Gesundheitswesens, und damit Nachfolger von Dr. Frank Verheyen, der das WINEG seit 2009 geleitet hat und nun bei der TK strategische Aufgaben der Arzneimittelversorgung im Bereich Versorgungsinnovation übernimmt. Meusch, der mit einer Arbeit über „Moral Hazard in der gesetzlichen Krankenversicherung“ promovierte, nimmt kein Blatt vor den Mund, wenn er das System Krankenkasse/Versorgungsforschung beleuchtet.
19.09.2016
Around 1.4 million people with dementia live in Germany today (around 35 million worldwide). According to forecasts, this number will double to around 3 million people by 2050 (115 million worldwide). On this basis, an increase of 40,000 new cases per year is predicted. One reason for this development is demographic change, which describes an increasingly aging population [1, see Fig. 1]. Age is the greatest risk factor for dementia because the likelihood of the disease increases sharply with age. This is z. For example, for 65-74 year olds it is only 1.7%, for 75-84 year olds it is 11% and increases exponentially to 30% for 84 year olds [2]. Overall, it can be said that the economic relevance of dementia will increase. One consequence of dementia is the patient's early need for care and the depression that is often associated with this disease. Depending on the severity of the disease and the resulting care effort, the costs are around 15,000-42,000 euros per patient per year [3]. Most patients today are still cared for at home with the help of relatives. The resulting costs are not yet factored into the above. As a result, the actual costs of caring for dementia patients are even higher. Furthermore, in the future there will be fewer and fewer younger people who can take on this care. One way to limit the predicted amount of care would be to provide appropriate, high-quality therapy. The aim of the present study was to analyze the care of dementia patients with galantamine based on our insurance data. <<
31.03.2016
Numerous medications are available to treat patients with type 2 diabetes mellitus (T2DM). Metformin and sulfonylureas have been in use for decades and can be used either as monotherapy or as part of combination therapies [12–14]. Since the mid-2000s, numerous new drugs have appeared on the market for the treatment of T2DM that cause fewer side effects than metformin and sulfonylureas: inhibitors of dipeptidyl peptidase 4 (DPP4), glucagon-like peptide 1 (GLP-1) receptor agonists and inhibitors the sodium/glucose cotransporter 2 (SGLT2). Their use in Europe was approved by the European Medicines Agency (EMA) in 2007, 2009 and 2013, respectively [15–17]. While DPP-4 inhibitors and GLP-1 stimulate the release of insulin and inhibit that of glucagon, the SGLT2 inhibitors influence the renal reabsorption of glucose [18–20]. Although these three drug classes have different mechanisms of action, they all prevent hyperglycemia and regulate HbA1c in patients with T2DM [18,19,21]. Although such drugs have already proven their effectiveness, the success of these therapies depends not only on the drugs themselves, but also on compliance [22], nutrition [23], management and treatment strategies [24,25]. The aim of this study was therefore to analyze the changes in a German T2DM population before (2006) and after (2010, 2014) the introduction of these new drugs in order to gain a better understanding of their effects.
31.03.2016
Immigration to Germany, which has increased significantly since 2014 and increased sharply since 2015, also poses new challenges for the health care system in particular when it comes to ensuring health care. The previously insufficiently researched problem of overcoming language barriers, cultural differences and logistical challenges to ensure optimal access to healthcare, but also to ensure that migrants receive healthcare that meets their needs, should be examined in this study – the first “Berlin Migrant Study” – by GeWINO be discussed and presented. The North East Health Sciences Institute (GeWINO) of the AOK Nordost has been monitoring the development of health care for people with a migrant background for some time now, also within the framework of the “International Health Insurance” focus, and, together with regional partners, is looking for quick and unbureaucratic solutions to improve the health care of migrants in Berlin, Brandenburg and Mecklenburg-Western Pomerania. The aim of the first “Berlin Migrant Study” was to provide data and facts on the current development of health care for migrants in Berlin in order to support the planning and development of regional structures to overcome the challenges posed by migration in the German health care system and to address these through innovative measures AOK Nordost to be added. The first “Berlin Migrant Study” was carried out by the North East Health Sciences Institute (GeWINO) of the AOK Nordost in cooperation with the bbw Bildungswerk der Wirtschaft in Berlin und Brandenburg eV and the bbw Hochschule Berlin in 2015. The second “Berlin Migrant Study”, which is being carried out in the same constellation, has already been started and GeWINO will continue to devote itself to the topic in the future.
31.03.2016
In Germany, an estimated 250,000 people with diabetes currently have a foot lesion and around 1 million diabetics are at increased risk of suffering a foot injury. This makes diabetic foot syndrome (DFS) one of the main complications of patients with diabetes mellitus, with the most significant consequences of diabetic foot problems being ulcers (deep substance defects, commonly ulcers - often in the form of chronic wounds) as well as small (minor) and high (major) Amputations are [1]. Although the DMP diabetes mellitus type 2 has been in existence since 2003 and the DMP diabetes mellitus type 1 since 2005, in which over four million diabetics now take part [2] and thus outpatient care for diabetics has improved overall, they appear to have increased complication rates microangiopathy, especially that of diabetic foot syndrome, does not have a positive effect. When checking the level of target achievement of the fund's own DMP Diabetes, the AOK Nordost noticed that the once-a-year foot examination specified here was not carried out without interruption for all diabetics, and that if an abnormal foot status was detected, there was not always a referral or a late referral to a specialist The treatment and further treatment of the abnormal foot was only initiated with a long delay and amputations occurred, although only low levels of severity were consistently stated in the DMP documentation. In 2011, the “Gesundheitskasse” took this as an opportunity to conclude a contract with doctors who are particularly qualified to care for DFS patients in accordance with Section 73c SGB V, which is intended to improve diabetologically qualified outpatient care for insured persons with DFS. This article presents the first evaluations of the DFS contract, with which AOK Nordost was able to meet its self-imposed goal of reducing amputations among its insured persons with diabetic foot syndrome.
31.03.2016
The German healthcare system performs well in international comparisons in terms of quality and efficiency, but comparative studies point to existing potential for optimization (Lauerer et al. 2013: 483–491; Manouguian et al. 2010). Trends such as demographic change, which poses new challenges for regional supply security, require a continuous improvement in the supply structure and quality (Stüve 2009: 51–60; Amelung/Wolf 2011: 1566–1572). In order to do justice to this, politicians are calling for stronger networking and cooperation between service providers in the form of integrated care models (Amelung et al. 2009; Mühlbacher 2002). Various studies view interconnected structural, product and process innovations as necessary in order to significantly increase efficiency and effectiveness (Omachonu/Objection 2010: 1-20; Varkey et al. 2008: 382-388; Ilinca et al. 2012: 193 –202). Innovations, which are defined as the successful implementation of a new idea in a way that increases value for some or all participants, are no longer initiated only by individual actors, but are increasingly developed and disseminated in cooperative networks (Akrich et al. 2002: 187-206 ; Varkey et al. 2008: 382–388). With the aim of improving medical care, EU, federal and state policies promote health innovations at all levels, but 40% of these only exist until the start-up funding runs out (Savaya et al. 2008: 478–493). This volatility of improvement initiatives negatively impacts society's support and trust in future projects (Shediac-Rizkallah/Bone 1998: 87-108). The high use of resources during the new introduction creates a legitimate demand for goal achievement and long-term success and increases the interest of stakeholders in the sustainability factor (Edwards et al. 2007: 37–47).
31.03.2016
Dementia is a psychiatric disease caused by neurodegeneration, characterized by a progressive loss of cognitive functions, leading to changes in patients' daily lives (WHO, 2015). 47.5 million people worldwide suffer from dementia, and this number is expected to rise to 75.6 million by 2030 and exceed 140 million by 2050 (WHO, 2015). In Germany, dementia affects around 1.2 million people, mainly women and seniors. Approximately 200,000 new cases are diagnosed every year (Tunstall, 2015). The average cost associated with these mental illnesses is more than 43,000 euros per patient per year, with almost 68% of this amount borne by carers and families (Tunstall, 2015). Dementia therefore has a significant impact on patients and their relatives, which underlines the need for specially adapted treatments and appropriate management of the disease in Germany.
31.03.2016
From a patient's perspective, beneficial innovations—product innovations, but especially process innovations—should benefit all those affected as quickly as possible, meaning they should be covered by the collective agreement. The fact that the Federal Joint Committee (G-BA) largely fails in this regard in the age of out-of-pocket expenses and selective contracts is inherent in the prevailing incentives. The legislator intended the Innovation Fund to at least mitigate this problem. The question is: Can it actually fulfill this function? There is growing evidence that it will not, or hardly, do so.