Original article
Berichte über seltene schwere Komplikationen im Zusammenhang mit der Verwendung des „Vaxzevria“-Impfstoffes von AstraZeneca haben zu einer erheblichen Verunsicherung der Impflinge geführt. Dazu schreibt das renommierte „Winton Centre for Risk and Evidence Communication“ der Universität Cambridge (Prof. David Spiegelhalter): „Alle medizinischen Behandlungen haben sowohl potenzielle Schäden als auch potenziellen Nutzen, und es ist wichtig, diese gegeneinander abwägen zu können“. In dem Artikel „Communicating the potential benefits and harms of the Astra-Zeneca Covid-19-vaccine“ (1) berichtet das Winton Centre über den potenziellen Nutzen und Schaden des Covid-19-Impfstoffs von AstraZeneca in Abhängigkeit von Alter und Expositionsrisiko. Demnach überwiegt der potenzielle Nutzen (vermiedene Aufnahme in die Intensivstation) die potenziellen Schäden (Blutgerinnsel) bei weitem. Nur bei Menschen unter 30, die ein geringes Expositionsrisiko haben, bringt das Impfen keinen Vorteil. Dazu meint Prof. Woods, ehemaliger Chef der Britischen Zulassungsbehörde, nach einem Bericht der „Financial Times“ (2), dass es „auf dem Kontinent keine solche evidenzbasierte Analyse“ gäbe und er den Eindruck habe, dass man dort „die Zahlen aus der Luft gegriffen“ habe.
07.06.2021
Results of a Delphi survey and retrospective data analysis
07.06.2021
Health, its maintenance and promotion are central tasks in health care. However, curative medicine alone is increasingly reaching its limits in order to counteract the consequences of chronic diseases in view of the demographic development in our “society of longer life” (Special report 2009 p. 18 ff, Expert Council “Coordination and Integration – Health care in a society of longer life” )1. These findings contributed to the evidence-based development of the general medical and specialist medical full care contracts on the part of the AOK Baden-Württemberg, among other things, to promote the biopsychosocial perspective, including non-drug care, and to agree on this as a common basis with the medical outpatient contractual partners, for example Back pain and many other growing problems caused by civilization.
07.06.2021
With digitalization in the healthcare system, great expectations are tied to increasing the quality of healthcare (Mathews et al., 2019), this particularly applies to diagnostics, prevention and the management of chronic diseases (Gordon, Landman, Zhang & Bates, 2020). Health and medicine apps (GuMA) are given a special role due to the ubiquitous availability of smartphones among the population. However, there has been a broad discussion for some time regarding the still limited evidence of GuMA, which is assessed as heterogeneous in various systematic reviews (Agarwal, Lefevre & Labrique, 2017; Felix et al., 2018; Mathews et al., 2019). In a systematic review by Bayambasuren et al. the authors searched for systematic reviews of randomized controlled trials (RCTs) with prescribable GuMAs that were freely available for download (Byambasuren, Sanders, Beller & Glasziou, 2018). The authors define prescriptive apps as apps that are currently available, that are effective and that are used on their own (stand-alone) without the involvement of healthcare professionals. The authors included a total of six systematic reviews in their analysis, from which they in turn extracted 23 RCTs on 22 different GuMAs. Only 11 of these 23 RCTs demonstrated a meaningful effect on health or on selected surrogate endpoints that could possibly be attributed to GuMA. Overall, however, the evidence of effectiveness was of limited quality, which makes it much more difficult for doctors to prescribe these apps (Mathews et al., 2019). The authors also criticized a high risk of bias in both the six included systematic reviews and the 23 extracted RCTs, which also contributes to a limitation of the results. Likewise, positive results in terms of effectiveness can be found in various areas of application. This can be stated, for example, for the self-management of hypertension (Li, Liang, Bu & Hesketh, 2020) or the self-management of mental illnesses (Linardon, Cuijpers, Carlbring, Messer & Fuller-Tyszkiewicz, 2019).
30.03.2021
The coronavirus SARS-CoV-2 has been spreading worldwide since it was first discovered at the end of 2019. In Germany, too, the virus and the associated respiratory disease Covid-19 pose major challenges for society as a whole and for individual citizens. In dealing with the crisis, politicians have taken far-reaching measures, which are primarily aimed at containing the epidemic, protecting vulnerable population groups and targetedly increasing or maintaining capacities in health care. These measures include in particular those that serve to limit contacts and thus the possibility of the virus spreading and lead to a lockdown of varying degrees of severity. During the lockdown, numerous public and private facilities, such as schools or care facilities, are temporarily or partially closed. In addition, employers and employees are encouraged to work from home. The measures mentioned reduce the possibility of spread and lead to falling incidence rates. However, they also have potential side effects on people's health and health behaviors. As a result, for example, both adults (Munk et al., 2020; Salari et al., 2020) and children and adolescents (Schlack et al., 2020) appear to have increased anxiety, depression and post-traumatic stress symptoms. Data from the GEDA 2019/2020 EHIS study (collection period between April 2019 and September 2020) in Germany indicate an increase for body weight and body mass index, while there is an overall decrease in tobacco consumption (Damerow et al., 2020), suggesting multidirectional developments in health behavior. In general, there are signs of an increase in social inequalities with regard to the development of health behavior (Jordan et al., 2020).
30.03.2021
Poisoning or intoxication is defined as contact with a substance or noxious agent that leads to a harmful effect on a living being (O'Malley & O'Malley, 2018). According to the current classification (ICD-10), a distinction is made between, among other things, • intoxications with medicines and drugs (excluding alcohol intoxication, drunkenness and suicides due to poisoning), T36.* to T50.* and • intoxications with non-drug substances (e.g. solvents, hydrocarbons , gases, metals, cosmetics, insect bites, food, e.g. mushrooms), ICD-10 codes T51.* to T65.*• as well as mental and behavioral disorders caused by psychotropic substances (e.g. alcohol intoxication, alcohol dependence, opioid intoxication), F10.* to F19 .*• and intentional self-poisoning with drugs (X60–X64) Poisoning often occurs unintentionally, for example in children, with medication or with everyday products. In addition to the risk group of children, poisoning in cognitively impaired people is also gaining in importance (Hahn & Feistkorn, 2019). There is isolated data on the frequency of the various types of intoxication in Germany and, for example, in addition to the statistics from the poison information centers, federal hospital or death statistics can also serve as data sources (GIZ, 2020; GBEa,b,c,d). However, there are hardly any comparable analyzes of these different sources and relatively few statistical analyzes on the frequency of poisonings and correlations with socio-economic factors from Germany. In comparison to other health impairments, poisoning accidents in Germany are not comprehensively documented and evaluated, which hinders the development of preventive measures (Hahn et al. 2014).
30.03.2021
Digital health applications (DiGA), both in the sense of the Digital Care Act of 2019 as patient-centric applications and in the sense of the use of telemedical solutions on the part of providers (e.g. teleconsultations, electronic files), are increasingly recognized as real clinical interventions (Kowatsch et al 2019). They have the potential to supplement and improve care and to make processes more effective (Eysenbach 2001; World Health Organization (WHO) 2015). Nevertheless, innovative digital applications in Germany, as in many other Western healthcare systems, are often not established in standard care (Huang et al. 2017). The dissemination of an innovation within an existing system is described in science with the term diffusion and the associated theory of diffusion of innovations (Rogers 2003). In practice, people tend to talk about the phenomenon of inability to scale up. Above all, this phenomenon underlines that it is a central problem for digital innovation projects to leave the test phase in the project context and to expand the sphere of action to include standard care (Häckl 2010; Gersch and Rüsike 2011).
30.03.2021
The current pandemic triggered a discussion early on about how to deal with the feared situation of insufficient ventilation options (or no longer) in intensive care units. In order to avoid the need for triage decisions, an attempt must first be made to make as much intensive care capacity available as possible through organizational measures. Postponing planned elective operations and other interventional measures frees up intensive care capacity and also frees up qualified personnel. It has not yet been sufficiently clarified what exactly “elective procedures” are and what criteria should be used to prioritize and the resulting postponement of operations. This working paper aims to provide a basis for discussion in this regard.
30.03.2021
The online conference “Structural migration using complex intervention” by IGiB StimMT was divided into three workshops: “Economic dimensions of outpatient care” (part 1, MVF 06/20), “Bright and dark sides of managing large-scale innovation fund projects” (part 2, MVF 01/21) and the following series part, which deals with the “evaluation of complex interventions”. This is anything but trivial, as inav scientists reported in consecutive lectures. This article focuses primarily on the part of the inav health economist Dr. Linda Kerkemeyer and partly that of research assistant Michelle Kutscher. The contribution by co-speaker Manuel Recker – also a research associate at inav – who focused on selected interim results of the innovation fund project IGiB StimMT, which will soon be overtaken by the upcoming publication of the final results, is hidden.
30.03.2021
Comment from Prof. Dr. rer. oec. Axel C. Mühlbacher, Professorship of Health Economics and Medical Management, Neubrandenburg University of Applied Sciences, and Prof. Dr. oec. publ. Peter Doubt, full professor at the University of Zurich.