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Early detection, the so-called skin cancer screening, has been a service since 2008 that legally insured people aged 35 and over can use every two years free of charge. Dermatologists and doctors from certain specialist groups with appropriate training examine the skin for suspicious changes that should be removed. The analyzes carried out here describe the status quo and development trends in utilization. The basis of the analyzes is the anonymized research database of AOK Nordost with its approximately 1.75 million insured persons. The results presented capture the development between 2008 - the year skin cancer screening was introduced as an insurance benefit - and the year 2015. All AOK Nordost insured persons aged 35 and over who were fully insured within the year under consideration and in the three federal states of Berlin , Brandenburg and Mecklenburg-Western Pomerania are part of the study population. In 2008, the study population comprised approximately 1.23 million insured people. By 2015, it had fallen to around 1.19 million insured people (see Table 1). For some analyses, nationalities were examined. Nationality can be viewed as an indicator of differences in individual risk factors – such as skin type.
04.06.2018
The development of new surgical procedures, advances in medical and anesthesia technology, and the establishment of integrative care structures make it possible to increasingly carry out surgical procedures on an outpatient basis. Compared to inpatient procedures, outpatient operations offer numerous advantages: savings in personnel and hospital costs, more patient-friendly treatment (e.g. due to lower psychological stress, especially in children and older patients), the possibility of more flexible scheduling and a lower risk of nosocomial infections (Castoro et al. 2007; Lemos et al. 2009; Shnaider & Chung 2006; Standl & Lussi 2012). The contract concluded between the National Association of Statutory Health Insurance Funds, the German Hospital Association and the National Association of Statutory Health Insurance Physicians in accordance with Section 115b Paragraph 1 SGB V “Outpatient surgery and ward-replacing procedures in the hospital” (AOP contract) enables insured persons to carry out selected operations on an outpatient basis. Despite this collective agreement option, the proportion of outpatient operations in Germany is around 37%, well behind countries such as the USA, Canada or Scandinavia, in which around 50-90% of all surgical procedures are already carried out on an outpatient basis (Toftgaard 2003). The reasons for the low proportion of outpatient operations could be that the remuneration is perceived as too low by the established service providers (clinically trained specialists) or a lack of billing options for these standard care operations.
04.06.2018
Since the beginning of 2018, Germany has also had a “National Action Plan to Strengthen Health Literacy” following the example of other countries. Created by an independent group of experts, the plan contains fifteen recommendations that relate to four major areas of action: everyday living environments, the healthcare system, life with chronic illness and research (Schaeffer et al. 2018). The following article first provides a brief overview of the current state of discussion on the topic of “health literacy” and then explains why an action plan makes sense and is necessary, what empirical foundations it is based on and what its content focuses. The recommendation for promoting research on health literacy is then presented and explained. It is shown that the National Action Plan can also be read as an agenda for new approaches and topics in health services research.
04.06.2018
Pollen-related allergic rhinitis (hay fever) is one of the most common allergic diseases in children and adolescents (Schmitz et al. 2017). In Germany, the 12-month prevalence of medically diagnosed hay fever among 3 to 17 year olds is 9.9% (Poethko-Müller et al. 2018). This results in an allergic reaction of the nasal mucosa and the conjunctiva to certain pollen, for example that of birch, which leads, among other things, to increased secretion, sneezing, restrictions in nasal breathing and itching. Although the symptoms of a pollen allergy can be very stressful and severely limit the quality of life and academic success, they are often trivialized (Greiner et al. 2011). In addition, high direct and indirect economic costs are attributed to allergic rhinitis and its secondary diseases, for example bronchial asthma and later COPD (Pfaar et al. 2014).
04.06.2018
Orthopedic operations are among the most common operations in German hospitals and, according to initial forecasts, will continue to gain in importance as society ages [1, 2]. In order to avoid immobilization damage and to specifically support the healing process, mobilization measures should be started as early as possible during operations on knee joints, which must be carried out (almost) exclusively passively in the early postoperative phase. This is particularly true if the patient cannot or is not allowed to carry out any active self-exercises [3-7]. In addition to physiotherapeutic treatments, the use of motor-driven movement splints (Continuous Passive Motion - CPM splints) has become established in practice for passive movement of the joints. In the knee area, CPM movement splints are often used after endoprosthetic joint replacements, cartilage, tendon and ligament reconstructions as well as for exercise-stable osteosynthesis [8-13]. Numerous studies deal with the rehabilitative aftercare of patients after joint operations, but only rarely in the context of outpatient follow-up treatment in Germany. This work focuses on the actual care situation of patients in Germany in the sense of real world evidence. The starting point is a process cost analysis that documents the postoperative follow-up treatment of patients after knee joint surgery. The focus is on evaluating the cost-effectiveness of different treatment alternatives. Postoperative mobilization can be accomplished through the use of CPM motion splints, physical therapy, or a combination of both. The use of physiotherapy is regulated via the Therapeutic Products Directive; CPM movement splints are listed in the list of aids according to Section 139 SGB V as externally powered movement splints for the knee joint, among other things [14].
04.06.2018
One of the main reasons why many doctors turn away from medical care in Germany is proven to be poor working conditions with an unsatisfactory work-life balance, systematically excessive workloads and long and inflexible working hours (Via medici 2006). On the one hand, these result from the shortage per se (unfilled positions lead to overloading of compensating positions) but on the other hand, they can also be seen as a lasting consequence of the 80s and 90s. During that time of the “doctor glut”, a high workload for doctors was accepted because the job offer was very limited and the demand for jobs was high. Related violations of labor law or the Working Hours Act were and are often not reported or punished today (dpa 2017; Via medici 2014; Peters 2013). However, the high workload is not only caused by medical activities per se, but also increasingly by the increasing bureaucratization of the profession. In a doctor's survey from 2010, more than 50 % of the doctors surveyed said that they use more than a quarter of their daily planned working time for administrative activities (IQME 2011). Since there were sufficient financial and human resources available during the “doctor glut,” in the past only limited emphasis was placed on efficiency or optimizing structures and processes. While the structural and process deficits partially remained, personnel and economic resources continuously decreased, so that this constellation can be viewed as the cause of the current workload. However, this also means that there is still immense potential for increasing efficiency in these structures and processes. There are wards and hospitals in which activities that can be delegated to non-medical staff, such as taking blood samples or organizing documents, continue to be carried out by medical staff.
04.06.2018
There are already numerous studies and reviews on the subject of CPM splint therapy in the literature. In addition to controlled and randomized clinical studies on the use of CPM for various indications [4-12], there are also isolated meta-analyses [13, 14] and reviews [15, 16]. Overall, the study situation turns out to be very heterogeneous with regard to the indication, the comparative therapy, the duration of the study, the start of treatment and the endpoint consideration. In addition to this heterogeneity in the study situation, the fact that the studies come from different countries whose care structure cannot easily be transferred to the German health system [9, 17] makes it even more difficult. Methodologically, the studies are limited, among other things, by the fact that complete blinding of everyone involved is not practical. The treatment results are also influenced by many factors (e.g. type of joint injury, surgical technique, comorbidities). One objective of the present study was to describe this heterogeneity, with a focus on the real care situation. A central component of this care situation is the decision of the health insurance companies as to whether the CPM splint treatment will actually be approved after the prescription has been issued. In the sense of “real-world evidence”, this not only corresponds to the actual reality of care, but also does justice to the variety of possible scenarios in which patients can find themselves after knee or shoulder surgery.
04.06.2018
Every year around 5 million people die from injuries worldwide. This number accounts for 9% of all deaths [1]. It has been proven that men and young people die from injuries more often than women and the elderly, respectively [1–3]. In addition, injuries cause one million permanent disabilities in the European Union every year, and thus have a significant impact on public health in this region of the world [4]. The prevalence of injuries in Germany has only been examined by a few authors in recent years. In 2010, there were an estimated 8 million injuries and more than 20,000 injury deaths in this country [5,6]. In the same year, Rickels et al. found that the incidence of traumatic brain injuries in two separate regions of Germany was 332 per 100,000 people [7]. A cross-sectional telephone survey published in 2013 also estimated that more than 10% of the participants had been diagnosed with accidental injuries requiring medical treatment in the 12 months prior to the survey [8]. More recently, in 2016, Rommel and colleagues showed that at least 2.8% out of more than 14,000 adults were affected by an accident at work [9].
04.06.2018
On February 19, 2018, the “National Health Literacy Action Plan” (NAP) was presented to the public (Schaeffer et al., 2018). Following the example of other countries, it lists the most important challenges for improving the population's health education and promoting health communication among professional staff in educational and care facilities (see Figures 1 and 2) and then makes targeted recommendations. The project was financially supported by the Robert Bosch Foundation, the AOK Federal Association, Bielefeld University and the Hertie School of Governance in Berlin. It is headed by Prof. Dr. Doris Schaeffer, Prof. Dr. Klaus Hurrelmann, Prof. Dr. Ullrich Bauer and Dr. Kai Kolpatzik. The following article addresses the first of the NAP's 15 recommendations, which focuses on strengthening health literacy in the education sector.
04.06.2018
The diagnosis of dementia is an enormous emotional and financial burden for many of those affected and their relatives. At the same time, it represents a major cultural and political challenge for society. There are no treatment options. It is therefore important for everyone involved to learn to live with dementia and to find ways that enable them to live a good life despite the illness (cf. Klie 2017). Dementia is the most common “mental” illness in older people and one of the most common reasons for the need for care. The most common forms of dementia are Alzheimer's disease (ICD codes F00. & G30.) and vascular dementia (ICD F01.), which is caused by damage to the blood vessels in the brain. There are also secondary forms of dementia (F02.), e.g. B. in connection with Parkinson's or HIV, and unspecified forms of dementia (F04.). These five ICD codes were used in the analysis to identify patients with dementia and a level of care.