Archive:
Nach dem Eingangsreferat von Ministerialdirektor Dr. Ulrich Orlowski (BMG), der das Thema „Regionalität – Das neue Paradigma der Versorgung“ erläuterte, wurde auf dem MVF-Kongress „Regionale Versorgung“ klar, dass Regionalität schon bei dem Thema beginnt, wie es definiert wird und jenseits jedweder Qualitätsdimension der Erfolg aller Projekte vor allem davon abhängig sein wird, wie schnell die Finanzierungsfrage geklärt ist (s. MVF 02/17). Zu diesen Themenfeldern führte ein vielschichtiges Vortragsprogramm durch die Themenfelder Analyse, Modellprojekte und Translation.
03.04.2017
„Wenn belastbare Evidenz für Nutzen und Schaden medizinischer Verfahren benötigt wird, und relevante Entscheidungen mit Auswirkungen auf Patientensicherheit und Ökonomie zu treffen sind, können medizinische Register aus prinzipiellen methodischen Gründen und mangels Verfügbarkeit und Qualität auch praktisch keine ausreichend sichere und verlässliche Informationsgrundlage bieten“, schreibt ein Autorenteam rund um IQWiG-Leiter Prof. Dr. Jürgen Windeler im „Deutschen Ärzteblatt“ (16/2017). Dem widersprach das Deutsche Netzwerk Versorgungsforschung (DNVF) auf seiner 22. Mitgliederversammlung in Berlin.
03.04.2017
The oncologist and internist Prof. Dr. Franz Porzsolt is seen by some as a polluter and by others as a critical spirit because he doesn't mince his words when, in his opinion, the evidence-based medicine that he values so highly is inadmissibly reduced to randomization. You don't always have to agree with him, but he is certainly right when he says that "every discipline needs internal criticism in order to be taken seriously." This is all the more true when representatives of institutions try to criticize registers in general without mentioning some of the shortcomings of the RCT (see p. 16). Porzsolt, on the other hand, does this in this interview in order to open an open, certainly controversial, specialist discussion in “Monitor Health Services Research”, with the declared aim of achieving a better understanding and handling of the actually “quite extensive toolbox of EBM”.
03.04.2017
Eine bedarfsgerechte Arzneimittelversorgung stellt mit zunehmendem Alter eine Herausforderung dar. Alte und teilweise multimorbide Patienten mit einer optimalen Pharmakotherapie zu versorgen, bedingt nicht selten eine Multimedikation, auch oder besonders wenn leitliniengerecht therapiert wird. Denn allein die adäquate Therapie altersbedingter Stoffwechselveränderungen kann zu einer Einnahme von fünf oder mehr verschiedenen Wirkstoffen führen. Für den verordnenden Arzt ergibt sich dabei eine wesentliche Einflussmöglichkeit auf die Multimedikation und damit auch eine große Chance zur Prävention. In welchem Ausmaß insbesondere ältere Patienten von Multimedikation betroffen sind und welche Ansätze zur Bewältigung für Ärzte, Patienten und andere Beteiligte des Gesundheitswesens bestehen, wird exemplarisch erläutert.
03.04.2017
Health services research has gained in importance over the last decade because it is becoming increasingly clear that the majority of scientifically based decisions in health care are based on data that have been carried out under the ideal conditions of an experimental study. These ideal conditions make it possible to demonstrate 'efficacy', which means that an expected effect was very likely brought about by the intervention suspected of causing this effect. Under these ideal conditions, however, it is not possible to test whether the effect proven as efficacy can also be induced under everyday conditions (effectiveness) if the naturally occurring confounding factors (confounders) such as comorbidity or therapies for concomitant diseases cannot be ruled out. The differences in the methods for proving efficacy and effectiveness have been described (Porzsolt et al. 2015). In order to be able to make reliable care decisions, however, information on effects that occur under everyday conditions is required. The Lancet addressed the significant problem of overuse that will be with us in the next decade (Berwick 2017; Brownlee et al. 2017). This problem can neither be quantified nor solved without depicting the reality of care (under everyday conditions).
03.04.2017
Against the background of current social changes such as demographic change and the phenomenon of new morbidity (Thyen 2009: 14), the healthcare system in Germany is faced with new tasks. The term new morbidity describes a development from a focus on simple somatic diseases in the German population to an increase in complex chronic health disorders in the last decades. The development is always multifactorial. Due to the complex and long-term course of the disease, which usually includes somatic and psychological components, the therapy is demanding and can only be managed by cooperating care structures (Schlack 2009: 450). Both institutional framework conditions and therapeutic treatment programs must be tailored to the current care needs and needs of the population. Faced with this challenge, not only service providers (Schlack 2009: 450, German Medical Association 2010: 27, Ungewitter 2010: 112 ff.), but also science (Expert Council 2009: 430) and politics (BMG 2012:66) are calling for a more closely integrated care structure. Services should be provided at a low threshold and, if necessary, in an interdisciplinary manner (BMG 2011:10, 22, 32, 35).
03.04.2017
In statutory health insurance (GKV), service billing is carried out almost exclusively electronically, with service providers (e.g. doctors) extensively documenting the treatment of their patients according to precisely defined rules and then making this data available to the health insurance companies for billing purposes. Based on this routine data, a volume of more than 200 billion euros is billed annually for the entire statutory health insurance [1]. The purpose of GKV routine data is to bill GKV services [2]. However, this data can also be used as secondary data for many other purposes, such as in the context of health services research. Since billing data is usually available without any time or financial effort, there is increasing interest in the use of GKV routine data due to the latest health care reforms [3-6] and the reports of the Expert Council in the Health Care System [7-10]. In order to be able to use GKV routine data for scientific analyses, it must be clarified how valid such a secondary database is. This study therefore examined the question of the extent to which the billing data available to the health insurance companies on the use of medication by their insured persons corresponds to the actual medication taken, which was known from primary data from a clinical study that had already been carried out.
03.04.2017
The aging of our population is now accepted as an important issue at a political level - especially at a health policy level. The great burden on social systems is due, among other things, to the fact that older patients are known to be sicker than younger ones [an 80-year-old has on average just over three relevant diagnoses (van den Akker et al. 1998)], each of which is treated according to the applicable guidelines become. This results in so-called polypharmacy (at least five drugs): In the USA, men over 65 years old take five or more drugs in 44% cases, women in 57% cases, and even ten or more drugs in 12% cases (Kaufman et al. 2001). In Germany, a third of patients over 62 receive more than five medications daily (Barmer GEK Drug Regulation Report 2013). Drug side effects – particularly, of course, in these polypharmacy patients – are now the fourth most common cause of death in the United States (Light 2010).
03.04.2017
Osteoporosis is a common disease in the elderly population worldwide. According to the WHO, osteoporosis (bone loss) is classified as one of the ten most important and therefore most expensive diseases of all [1]. Osteoporosis is a systematic musculoskeletal disorder in which reduced bone strength increases the risk of fractures. Such fractures most commonly occur in the wrist, spine and hip [2]. Osteoporosis and associated fractures are an important public health problem due to the associated morbidity and disability of patients, reduced quality of life and mortality [3]. An estimated 22 million women and 5.5 million men in the EU suffer from osteoporosis [4]. The risk of osteoporosis is particularly high for women after menopause, a time when estrogen levels in a woman's body drop significantly [5]. In the German population, the annual incidence rate of osteoporosis was estimated at 6.3 million [6]. There is a significantly higher incidence rate in women (13.1 %) than in men (3.2 %) [7]. Due to demographic change in Germany, the number of osteoporosis patients will continue to rise in the future [8]. Previous research has shown a link between chronic somatic and mental illnesses such as depression [9, 10]. It can be assumed that fractures and pain as symptoms or complications of osteoporosis could lead to a reduced quality of life and depression.
03.04.2017
The German Pension Insurance (DRV) carries out a good one million medical and around 150,000 vocational rehabilitation services per year. In medical rehabilitation, there are inpatient and outpatient services in all relevant indications as well as rehabilitation services for children and adolescents (see Figure 1). Of the large number of vocational rehabilitation services (services for participation in working life), further training services and retraining are quality assured, as these are used over a longer period of time and cause a large part of the costs. According to Section 9 SGB VI, the aim of the rehabilitation of the pension insurance is to maintain or restore the professional integration of the insured and thus to avoid or eliminate a reduction in earning capacity due to illness or disability.