Original article
The General Medicine Institute at the University Hospital Erlangen and the Chair of General Medicine at the FAU Erlangen-Nuremberg are probably one of the younger ones in the history of German health care research. The chair was only established in October 2013, but was the first regular general medical chair in Bavaria. Since then, the institute has been led by Professor Dr. med. Thomas Kühlein - who worked as a doctor in hospitals and general practitioners' practices for a long time - who, in addition to his role as chair, is also the medical director of the Eckental Medical Care Center (MVZ), part of the Erlangen University Hospital. Dr. phil. Susann Hueber has been research coordinator at the General Medicine Institute at Erlangen University Hospital since 2014.
28.11.2022
Breast cancer (BC) is the most common cancer among women in Germany, with around 69,000 new cases every year; 18,591 women died of BK in 2015 (Barnes et al., 2016). Approximately 70% of all newly diagnosed women with BK have a hormone receptor-positive tumor (HR+) who are eligible for primary adjuvant endocrine therapy (ET) with either tamoxifen (TAM) or an aromatase inhibitor (AI) (Franzoi et al., 2021) . Depending on the menopausal status, this standard therapy is taken daily for at least 5 years, significantly reduces the risk of BK recurrence and improves the overall survival of the patients (Waks & Winer, 2019, Font et al., 2022). Despite the proven effectiveness in preventing BK recurrence by 40%, approximately 50% of women take less than 80% of the prescribed dose. In addition, up to 50% of patients with BK discontinue their ET (Hadji et al., 2013; Moon et al., 2019; Peddie et al., 2021). It should be noted that both TAM and AI therapy can cause short- and long-term side effects in patients. These include hot flashes, myalgias and osteoporosis (Franzoi et al., 2021; Group et al., 2009). The occurrence of TAM- and AI-related side effects may therefore negatively impact a patient's persistence to ET. Persistence is defined as the continuation of drug use for the prescribed length of time (from initiation to discontinuation) while a patient adheres to the prescribed interval and dose of a dosing regimen (Cramer et al., 2008; Hadji et al., 2013). Recently, adherence to therapy and the persistence of ET in women with HR+ BK have been the subject of intense debate in the literature, since "non-adherence" to ET has been shown to be associated with an increased risk of disease recurrence (Font et al., 2019; Seneviratne et al ., 2015), for distant metastases (Blanchette et al., 2020; Lee et al., 2019) and for mortality (Inotai et al., 2021; Lao et al., 2019; Murphy et al., 2015). However, no study has yet investigated whether there is a connection between the health insurance company a woman has and her persistence in ET. The aim of this study was therefore to analyze persistence with TAM and AI and to show possible differences specific to health insurance companies.
28.11.2022
Diabetic polyneuropathy (DPN) is associated with significantly increased healthcare costs and thus an economic burden on society and the healthcare system (Happich et al. 2008; Khdour 2020; Shillo et al. 2019). A high number of hospital stays, need for care, incapacity to work as well as follow-up costs of DPN (e.g. amputations) and an overall greater use of healthcare resources are responsible for the higher medical costs (Sadosky et al. 2015; Schroeter/Hartung 2005; Ziegler 2020) and illustrate this Burden on patients suffering from DPN. The costs tend to increase as the burden of illness increases (Happich et al. 2008).
28.11.2022
Diabetic polyneuropathy (DPN) is associated with significantly increased healthcare costs and thus an economic burden on society and the healthcare system (Happich et al. 2008; Khdour 2020; Shillo et al. 2019). A high number of hospital stays, need for care, incapacity to work as well as follow-up costs of DPN (e.g. amputations) and an overall greater use of healthcare resources are responsible for the higher medical costs (Sadosky et al. 2015; Schroeter/Hartung 2005; Ziegler 2020) and illustrate this Burden on patients suffering from DPN. The costs tend to increase as the burden of illness increases (Happich et al. 2008).
28.11.2022
In a current representative survey by the Federal Center for Health Education (BZgA) on infection protection, 81% of those surveyed said they were supporters of vaccination. The proportion of those who have a positive attitude towards vaccinations has increased by 22 percentage points since 2012. In comparison, 15% are at least partially more critical of vaccinations and 4% are (more) negative (Seefeld et al. 2022). Despite the high proportion of vaccination supporters, the political requirements according to §132e SGB V to increase the vaccination rates for the vaccinations recommended by the Standing Vaccination Commission (STIKO) have not been achieved in recent years. For example, the nationwide average vaccination rate for the first measles vaccination in children aged 15 months is currently 85.8%. This means that almost all districts are missing the target of 95% for this age group set in the National Measles Action Plan. The potential of the HPV vaccination (vaccination against human papilloma viruses) for girls and boys is still far from exhausted, despite slightly increasing vaccination rates. According to the KV vaccination surveillance, 47.2% of 15-year-old girls were fully vaccinated in 2019. The vaccination rates varied greatly regionally between 37.7% in Bremen and 66.9% in Saxony-Anhalt.
28.11.2022
Die digitale Transformation in der Medizin versetzt uns in die Lage, immer größere und komplexere Datenmengen in verwertbares Wissen zu verwandeln. Die klassische medizinische Evidenzgenerierung wird dadurch zunehmend ergänzt oder sogar teilweise ersetzt durch versorgungsnahe Daten bzw. Real-World-Data (RWD). Damit einher geht die Chance, Arzneimittelforschung besser, effizienter, sicherer und schneller zu gestalten. Erkenntnisse können schneller in die Versorgung und klinische Entscheidungsprozesse einfließen. Um diese Chance zu nutzen, gilt es, Althergebrachtes allmählich loszulassen.
28.11.2022
On the past, present and future of the use of GKV routine data for health care research: Access and availability are of course particularly important for health care research, but also for many other parties who work in and for the health care system. The “Data Usage Act” (DNG) passed by the previous government (Federal Ministry of Justice 2021) got the ball rolling in this regard, including introducing the term “research data”1, but ultimately raised more questions than it resulted in any useful regulations.
28.11.2022
Organizational tensions refer to conflicts that arise from opposing, sometimes contradictory views and requirements in an organization (Smith/Lewis 2011, 2022; Putnam et al. 2016; Farjoun 2017). In situations in which different development directions and perspectives come together, these tensions become noticeable. The contradictions underlying the tensions in an organization can vary in strength and range from simple discrepancies and differing views, to dilemmas, i.e. opposing options for action, to irresolvable contradictions or paradoxes.
28.11.2022
On July 27, 2022, the Federal Cabinet passed the draft of a law for the financial stabilization of statutory health insurance (GKV Financial Stabilization Act), which - after being submitted to the parliamentary procedure - was passed by the Bundestag on October 20, 2022 and finalized by the Bundesrat on October 28, 2022 was approved. Dierk Neugebauer, Vice President Market Access at Bristol-Myers Squibb GmbH & Co. KGaA, explained at the online press conference “Oncology: Rethinking the fight against cancer” what effects the law could have on Germany as a research location.
28.11.2022
Prof. Dr. Franz Porzsolt, der seit dem Jahr 1994 in vielen wissenschaftlichen Publikationen seinen Begriff von klinischer Ökonomik zu prägen versucht und zudem als einer der Erfinder der „Pragmatic Controlled Trials“ gelten kann, gilt ebenso als ein eher unbequemer Zwischenrufer, der sich immer wieder an Glaubenssätzen und Grundfesten von Forschung und Medizin abarbeitet. So auch an der Versorgungsforschung, der er sich – als klinischer Forscher und versorgender Onkologe – seit vielen Jahren verbunden fühlt. Er begreift diese Wissenschaftsrichtung „als Königsdisziplin aller Forschungsmethoden im Gesundheitssystem“, die es immer mit hoch komplexen Systemem zu tun habe und sich nicht nur mit einem Priorisierungskatalog, sondern auch einem grundlegenden Fragebogenkonzept auseinandersetzen muss.