Archive:
Since 2020, digital health applications (DiGA or “apps on prescription”) have been offering new perspectives for the German healthcare system. In August 2021, 20 DiGAs had already been successfully tested by the Federal Institute for Drugs and Medical Devices (BfArM) and listed in the directory of prescribable DiGAs. These can now be prescribed and therefore reimbursed by statutory health insurance companies. Ten apps are used to prevent and treat mental illnesses (especially panic disorders and depression). However, there is no app for suicide prevention (Federal Institute for Drugs and Medical Devices).
17.05.2022
The malignant tumor disease of diffuse large-cell B-cell lymphoma (DLBCL), which originates from immune cells, is considered the most common non-Hodgkin's lymphoma in adults, with around 30 to 58% (Tilly et. al 2015: p. 116). With a two-year incidence of 3.8 cases per 100,000 inhabitants, it is the most common malignant disease of the lymphatic system in Europe (Sant et al. 2010: 3728). The incidence increases with age, with a median of 70 years (Morton et al. 2006: 265). In addition to an enlargement of the lymph nodes, the spleen can also be affected. Lymphomas often have an aggressive course. If left untreated, DLBCL can be fatal. Due to a high histological, clinical and molecular variability, the mean survival time varies greatly. The 5-year survival rates are given as 60-90% (Ärztezeitung 2021), although survival is worse, especially if there is no response to 1L therapy (AWMF online 2022). In the therapy, among other things, autologous or allogeneic stem cell transplants (STZ) are carried out; the expenses amount to between 107,457 euros and 230,399 euros per patient (Mayerhoff et al. 2019: 126). There are now newly approved treatment options in Germany that are intended to enable patients to survive longer. In August 2018, the treatment method of CAR-T cell therapy (chimeric antigen receptor on T cells) was approved in the European Union after 2L or more lines of therapy. This is a cancer immunotherapy based on genetically modified T cells with synthetic antigen-specific receptors (Srivastava/Riddell 2015: 494). Furthermore, especially in 1L and 2L, immunochemotherapies or classic chemotherapy are used, often in the form of complex treatment regimens and sometimes in combination with rituximab (RTX). Due to these complex treatment options, there is a need for scientific evidence on care.
17.05.2022
Since forms of reimbursed medical treatment have become known, there have also been fears that healthcare professionals will recommend care options to their patients that are not or not yet necessary. This fear becomes explosive in terms of health policy with regard to statutory health insurance, in which the costs and consequential costs for treatments that are not reported or not yet reported are financed in solidarity by all of the insured (Breyer/Zweifel/Kifmann, 2013; Breyer/Buchholz, 2021). As early as 2000/2001, the Advisory Council stated in its report that care with non-indicated services or with services without a sufficiently secured net benefit is tantamount to "medical oversupply". On the other hand, services with only a minor benefit that no longer justifies the costs or are provided in an inefficient (i.e. uneconomical) form are classified as “economic oversupply” (Sachverständigenrat 2000/2001). This form of incorrect care is also associated with incorrectly set incentives, which manifest themselves in low-threshold access conditions and can thus lead to the use of inappropriate levels of care (John/Stillfried 2021).
17.05.2022
In April last year, the IGES Institute for the Association of Replacement Funds eV (vdek) presented the results report “Quality improvement through service concentration in inpatient care - inventory, success factors and obstacles” - prepared by Dr. Martin Albrecht, Dr. Stefan Loos and Sebastian Irps – in front. The Federal Cartel Office's “Hospital Sector Investigation” published in September 2021 also dealt with this topic at one point, but came to sometimes contradictory conclusions. A few weeks ago, Albrecht took this as an opportunity to contrast the two positions at the Spreestadt Forum. “Monitor Health Services Research” asked him for a classification in the second cover interview on the quality issue in the hospital sector in this issue.
23.03.2022
The Covid-19 pandemic has had a dramatic impact on social life and economic development worldwide (1-5). The use of recently developed vaccines has proven effective in combating the spread of severe acute respiratory syndrome SARS-CoV-2 and preventing severe Covid-19 (6). However, vaccine hesitancy is reported in many countries for various reasons (7). Although vaccine distribution and administration has increased over time, some vaccine hesitancy remains a problem (7, 8). In addition to the obvious differences in vaccination rates between developed and developing countries, a similar trend in vaccine hesitancy emerged, with factors such as higher levels of education, higher income, residence outside of rural areas or the provision of free vaccinations as key factors in acceptance of vaccinations have been identified (7, 8). Some research has found that general trust in authorities and the government is strongly correlated with willingness to be vaccinated (7). However, possible side effects of the vaccine were identified as the most common reason for hesitation about the Covid-19 vaccination and were mentioned by more than 90% of the vaccine opponents surveyed (8, 9). Acute illnesses such as stroke and myocardial infarction were documented less frequently. The behavioral change that resulted from the implementation of strict hygiene rules may also have led to a “real” decrease in the rates of non-Covid-19 infectious diseases (5,6). In other words, the measures taken to combat the Covid-19 pandemic may also have influenced the spread of other germs that cause respiratory tract infections (AI) and gastrointestinal infections (GI). For this reason, in the present study the authors wanted to investigate the frequency of these AI and GI during the Covid-19 pandemic using data from a large database that includes anonymized treatment information from general practitioners and pediatricians in Germany.
23.03.2022
In the simplest case, so-called SIR models are used for the mathematical modeling of epidemics. The three capital letters describe the states of the individuals or the population that are relevant to the infection process: S means being susceptible to the infection, I means being infected and infectious, and R stands for resistance (immunity). As elsewhere, SIR models are mainly used at the Robert Koch Institute (an der Heiden 2020; Maier 2022). Without further modifications, SIR models are used for modeling infectious diseases that leave lifelong immunity after recovery, as is the case with many “childhood diseases”. But this does not seem to apply to an infection with SARS-CoV-2. There is evidence that both infection with the coronavirus and vaccination against the coronavirus produce only temporary immunity (Baraniuk 2021). In addition, the virus can circumvent an existing immunity with new virus variants (so-called escape variants), against which cross-immunity from previous infections is not available or insufficient (Starr 2021; Weisblum 2020). This article neither describes the incidence of the disease in society nor the burden on the healthcare system. Instead, modeling will be used to examine how various factors could influence the transmission of the infection. In this case, infections must not be equated with diseases that are influenced by many other factors (age, previous illnesses, etc.); infections that occur after previous vaccinations or after previous infections are also associated with a different probability of illness, which is very likely lower. The article presented here focuses on the parameters relevant to infection epidemiology, in particular concerning prevalence and immunity.
23.03.2022
The increasing aging of society has led to an increase in age-related diseases in recent years. This particularly includes dementia. The term comes from Latin and describes the absence (prefix: de-) of the ability to think (suffix: -mens). “Dementia” literally means “without reason”. Dementia is not only accompanied by cognitive and mnestic losses, but also by the loss of basic orientation and everyday skills that were previously taken for granted (Stoffers 2016: 7). The term dementia does not include a specific disease, but rather an acquired condition caused by organic brain damage (Stoffers 2016: 8). In Germany, there are currently around 1.7 million people living with a diagnosis of dementia (Thyrian et al. 2020: n.p.), with Alzheimer's dementia making up the majority of the diseases with around 60% (Stoffers 2016: 9). So far there is little knowledge regarding the triggering risk factors, but different expert assessments and study notes show (at different levels of evidence) that different prevention approaches could be useful for avoiding dementia. These include, among other things, increasing exercise behavior, quitting smoking, or reducing alcohol consumption (WHO 2019: xii-xiii). Social contacts as well as intensive cultural and sporting activity also appear to be protective factors against the development of dementia (Förstl, Förstl 2020: n.p.).
23.03.2022
In order to successfully introduce innovations into complex adaptive systems, such as doctors' offices or hospitals, we need to understand how implementation processes and their contexts depend on each other. In particular, detailed knowledge of what actions actors take to give an innovation meaning and to integrate it into their work processes, as well as knowledge of contextual elements that influence actions, are an essential prerequisite for the transition of an innovation from model project status to model project status Everyday supply. The Normalization Process Theory (NPT), which is currently one of the most prominent theories in implementation research, can provide guidance in this context. It characterizes the introduction and embedding of innovations as a social process of collective action and less as an effort by individuals. As a medium-range theory, it describes a series of generative mechanisms of different types that motivate and structure the actions of those involved in integrating innovations into care.
23.03.2022
Although the system theory of Luhmann's style is considered “extremely complex, counterintuitive, difficult to understand, if not perverse” (Hörisch, 2010, p. 343), it also has properties that make it particularly relevant to scientific problem solving in general particularly attractive in relation to issues relating to health services research. On the one hand, it can be used universally as a so-called “super theory” (Berghaus, 2011, p. 24), which means that it can basically be applied to all social situations in which concrete questions or problems are considered. The reason for their diverse possible uses lies in the basic assumption that so-called functional systems have developed (and are still developing) in the modern world. These systems can differentiate themselves at the macro level (e.g. science, politics, economics), at the meso level (e.g. institutions or organizations) or at the micro level (e.g. family or school classes). The (social) environment of humans is characterized above all by increasing complexity.
23.03.2022
At the specialist conference “Theory Dare”, which “Monitor Health Services Research” held at the end of last year in cooperation with the Federal Association of Managed Care e. V. (BMC) conducted online, it quickly became clear: health services research needs not just one theory, but many that exist in different scientific areas. You just have to know them and use them. After the first day of the congress, which dealt with the basics of the theories and the results of which were presented in the first part of the report in MVF 01/22, the second day of the congress attempted to answer the question of how theories can be applied in practice and whether that – discussed using the example of pilotage projects – would make sense.