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BARMER has a long history in health services research. It has been organizing its own care and research congress since 2016 and has been publishing its highly regarded drug reports as well as several others since 2010 - on topics such as medicines and aids, outpatient care (doctor), health, hospital, care and dental health. This means that the fund has made a name for itself in health services research even before the merger as GEK and Barmer. The BARMER Institute for Health Systems Research, or bifg for short, was recently founded. “Monitor Health Care Research” spoke about this with the CEO of BARMER, Prof. Dr. med. Christopher Straub.
28.07.2020
Relatives such as children, spouses, parents, siblings or friends often play central roles in outpatient and inpatient care. Although most of the discourse is about relatives providing care, relatives also act, for example, as referrers, mediators, information seekers, translators or decision-makers (Bischofberger, 2011). They are thus (regardless of the patient's care needs) essential support in the treatment and management of numerous diseases (Reifegerste, 2019). At the same time, however, they can also disrupt care processes or at least be perceived accordingly by healthcare professionals because, for example, they impede the patient's recovery by providing too much support, their absence makes discharge more difficult, or they confront the doctors with too high expectations (Wilz & Meichsner, 2012 ). However, the majority of them show a high level of motivation to support the patient in coping with illnesses, so that the question arises as to how their motivation can be integrated well into care processes. Although the relatives are omnipresent in health care - be it with positive as well as negative consequences - they are often not considered as a stakeholder of the care. They are “hidden in plain sight” (Wolff & Roter, 2008). In nursing facilities, in paediatrics, oncology or palliative care, they are usually considered to be key participants. In many other areas of care, on the other hand, they are sometimes regarded as an annoying appendage of the patient, ignored or even actively avoided, even if there are hardly any diseases or patients in which they play no role at all (Reifebarste, in press).
28.07.2020
The digitalization of medicine makes it possible to detect diseases more quickly, monitor them better and take new findings into account promptly when making individual therapy decisions. The chemical and pharmaceutical industries are also facing this change, even though they are in the middle of the commercial economy in terms of digitalization in Germany. The current focus is primarily on the activities of Big Tech companies or digital healthcare start-ups and their approaches to drug development using big data or AI. However, little attention is paid to how the pharmaceutical industry, with its products that often require explanation, positions itself to communicate relevant information about its products and services to patients and medical professionals using digital tools and service innovations. The perspective of the patient without previous medical training must be taken into account, as well as the need for scientifically based information from medical professionals. The following comments are therefore dedicated to these new approaches to medical information.
28.07.2020
Thesis paper 3.0 builds on the previous papers (see MVF 03/20), updates the epidemiological analysis and focuses on the “third way” of specific prevention, the legal analysis and the problem of the corona tracing app. A strategy for stable control of the infection process and preventative measures to identify risk situations are described. Likewise, the path to returning civil rights that were restricted during the pandemic to a return to normality. The article published here is a short version of the full version, which was published by MVF in an online-first version.
28.07.2020
In Germany, around 7.5 million people live with diabetes (IDF2017) [1]. A total of 95% of them have type 2 diabetes (T2D) and 5% have diabetes type 1 (T1D) or another type according to the diabetes classification [2]. In many cases, oral antidiabetic drugs for T2D or insulin for T1D and T2D can be used very successfully [3-4]. The goal of diabetes management is always to achieve and maintain good blood sugar control. As recommended by the American Diabetes Association, a glucose level of 70-180 mg/dl (3.8-10 mmol/l) should be achieved. This value can of course be adjusted individually as required. The second goal is to avoid hypoglycemia (<70 mg/dl or <3.8 mmol/l) and hyperglycemia (>180 mg/dl or 10 mmol/l) as much as possible. The long-term goal of diabetes treatment is the prevention of diabetes complications such as retinopathy, nephropathy and neuropathy [5-10]. The biggest burden in the daily life of a patient with diabetes is monitoring blood sugar. Many fingertip blood samples are necessary every day in order to be able to adjust the individual insulin regimen and achieve good blood sugar control. In order to achieve optimal blood sugar control with intensive therapy, frequent blood sugar measurements are necessary (self-monitoring of blood sugar levels (SMBG)). Unfortunately, capillary blood sampling is not able to adequately prevent hypoglycemia and hyperglycemia. Hypoglycemia and hyperglycemia affect quality of life, and hypoglycemia in particular is a major burden in living with diabetes [11]. Blood glucose testing is very time-consuming and painful and many factors must be taken into account. In addition, capillary blood glucose measurements only represent a snapshot of the current glucose level. Flash Glucose Monitoring (FGM) has been available in Germany since 2014 and is reimbursed by health insurance companies for adults and children aged 4 and over with T1D and T2D.
28.07.2020
With the Act for More Safety in the Supply of Medicines (GSAV), the legislature has, among other things, provided for the automatic substitution of biologics in pharmacies from 2022. In fact, the new regulation on automatic substitution in the GSAV paves the way for the introduction of exclusive discount agreements in the biologicals market. The current contractual practice in the biologics market is determined by health insurance companies' tenders for non-exclusive open-house contracts in accordance with Section 130a Paragraph 8 SGB V. Both manufacturers of the biological reference products and the respective biosimilars, including any imports, can agree to these contracts at the rates specified by the respective health insurance company join the specified conditions. Although interchangeability can also come into play in the context of other types of competition models, it seems obvious that the GKV side in particular is aiming for such exclusive tenders based on the model of the generics market. Against this background, published calculations by the AOK Scientific Institute (WIdO) show that a savings volume of 141 million euros was achieved through the use of biosimilars in the period from July 2017 to June 2018.
28.07.2020
Hypertension is responsible for more than seven million deaths worldwide each year, accounting for approximately 13% of all deaths [1]. In Germany, hypertension is diagnosed in more than 60% of people aged 65 and over [2]. Diabetes mellitus (DM) is one of the most common chronic metabolic diseases, affecting around 7% of people in Germany [3]. DM is one of the main risk factors for hypertension [4]. Most hypertension and DM patients require drug therapy, often polypharmacotherapy, to achieve optimal blood pressure and blood glucose control [4,5]. Several classes of drugs are recommended for the treatment of hypertension [4] and DM [5]. However, adherence to these therapies is still a common problem [6, 7]. The current coronavirus pandemic is having a major impact on healthcare systems around the world. Maintaining adherence in patients with chronic diseases during a pandemic can become a major challenge for physicians and pharmacies [8]. There is a risk that good care for Covid-19 patients could negatively impact the care of around 19 million patients with hypertension [9] and over 7 million patients with type 2 diabetes mellitus [10]. To date, no studies have been published on prescriptions of antihypertensive and antidiabetic medications or patient adherence to these therapies during the pandemic. It is to be expected that people are less likely to be adherent to therapy during this time. The aim of this study was to examine the development of the number of patients who received cardiovascular or diabetic medications from pharmacies in the first quarter of 2020.
28.07.2020
Over the past 25 years, the quality of care for birthing women has continually improved, as measured by infant and maternal mortality. Hospitals are the main contributors to this. Between 1999 and 2017, an average of 98.4 % children were delivered in hospitals2. During the same period, the number of clinics with specialist departments for gynecology and obstetrics (hereinafter referred to as maternity clinics) has declined significantly throughout Germany1. The observed improvement in quality is causally related to this increasing concentration of births in fewer and fewer clinics and manifested itself in 2006 at the latest with the division of these clinics into 4 levels of care (perinatal center level 1, perinatal center level 2, clinic with perinatal center and maternity clinic). Depending on the level of care, the clinics differ in their personnel and structural requirements in order to ensure a high quality of care for women giving birth3. There are 163 level 1 perinatal centers and 49 level 24 perinatal centers across Germany. The focus is particularly on the risks associated with premature births. After birth, the premature baby is usually examined and treated in the incubator in the intensive care unit, particularly with regard to the possible incomplete development of various organs, for which the perinatal centers are prepared. After all, in 2016, 8.6% of children were born before the 37th week of pregnancy5.
28.07.2020
The more differentiated the services in a health system, the more important it is to have higher-level coordination. Care and case management concepts have existed for over 20 years to provide high-quality, needs-based health care. However, they have not yet been widely adopted into standard care. The form of care is tested and systematically evaluated in a variety of model projects. Is the time ripe for a standard benefit claim?
28.07.2020
Two telemedicine programs from Bavaria are leaders in home monitoring services for chronically ill patients. Both “Cordiva” (Curaplan Heart Plus) and the more recent program “mecor” (Care4Cardio) were developed by Dr. Josef Leiter and his colleagues developed it. “Monitor Health Services Research” spoke to Dr. Head, founding partner of Health Care Systems GmbH (HCSG), about the background and options resulting from the PDSG.