Original article
The aging of society with a significant increase in the number of elderly and very old patients is known to be a socio-political and therefore also a medical challenge (World Population Aging 2017). Older patients usually suffer from several chronic illnesses and therefore have to take numerous medications at the same time: multimorbidity and multimedication, also known as polypharmacy, have therefore long been the focus of medical interest in this context (van den Akker et al. 1998, Kaufman et al. 2002). Therefore, it can be difficult for treating physicians to find the right balance between over- and under-care; It is important to avoid harmful drugs and not to forget cheaper drugs, i.e. to minimize risks (e.g. side effects) but also not to miss opportunities (e.g. fewer strokes) (Maher et al. 2014, Barnett et al. 2012). Older patients continue to be underrepresented in clinical research, so there is little evidence on the appropriateness and safety of many medications in old age (Wehling 2011). To support doctors, the FORTA classification (Fit for The Aged) and from it the FORTA list were developed in a Delphi consensus process (Wehling 2008, Kuhn-Thiel et al. 2014), in which active ingredients are combined with age-relevant indications are rated hierarchically from A (positive) to D (negative) by over 20 medical and pharmacological experts (A-bsolutely, B-eneficial, C-areful, D-on't). The use of the FORTA list was clinically successful in a randomized endpoint study (VALFORTA) and was relatively easy and efficient to teach as a learning tool (Wehling et al. 2016). This evaluation approach is now to be tested and used IT-based as an automated algorithm for medication optimization.
04.10.2019
In the area of incapacity for work (AU), according to Meyer and colleagues, various health insurance companies have noticed a significant increase in the importance of depression in recent years [7]. According to data from the current health report from the Techniker Krankenkasse (TK), there was a significant increase in absences due to psychiatric disorders by more than four fifths between 2006 and 2014. This absenteeism only stagnated at a high level in the years 2014 to 2017. An increase in 90% is reported between 2000 and 2017 [8]. Similar information can be found in the current health report of the German Employee Health Insurance Fund (DAK). DAK data shows that the duration of AU in mental disorders has continuously increased threefold over the last 20 years. In 2017, the number of days absent due to mental disorders increased, albeit only slightly, by 1.5% more than in the previous year [9]. With 16.7% of lost days, mental disorders rank second in terms of the volume of sick days. In the results of the report by the umbrella organization of company health insurance companies (BKK), mental disorders also rank second among the causes of AU with 16.6% of all AU days [10]. By far the most absent days were caused by depression [9, 10].
04.10.2019
As part of the Bertelsmann Foundation's “Reorganization of Hospital Care” project, a target image was developed for the German hospital landscape in 2030, which is primarily based on higher quality requirements without resulting in poorer accessibility. The starting point of the Bertelsmann Foundation's “Reorganization of the Hospital Landscape” project is the assessment, shared by numerous healthcare experts, that the hospital sector in Germany is still characterized by overcapacity, a particularly large number of small hospitals, as well as insufficient concentration and specialization, which lead to deficits in the quality of treatment , an above-average frequency of acquisition of patients via the emergency room as well as the treatment of patients without the need for inpatient treatment (so-called “outpatient-sensitive conditions”), loss of efficiency and sometimes ruinous competition.
04.10.2019
Although the trends in the German healthcare system point to greater importance of health for insured persons and patients, healthcare is still not sufficiently oriented towards the needs of the individual patient. In particular, the patient perspective is not sufficiently taken into account when choosing diagnostic and therapeutic procedures. The health care researchers presented the current situation at the opening of the 17th German Congress for Health Care Research (DKVF) in Berlin1. Studies have also shown that expectations of concepts such as participatory decision-making (PEF), which are intended to promote the integration of patients, are changing have so far only been inadequately fulfilled and that the medical profession is still a long way from confidently adopting the basic principles of professional conversation and communication for the participation and integration of the patient.2 This means that there is significant potential for increasing the outcome, i.e. the level of impact Health services cannot be increased, and the legal requirements of the Patient Rights Act are not yet met.
04.10.2019
With its high density of care facilities, free access to medical services, free choice of doctor and a high degree of differentiation, the German health system offers its insured persons a wide range of services and a variety of options. Responsible and enlightened patients use this freedom and are increasingly taking matters into their own hands: They are better informed than ever before, question, demand, know their rights and work proactively to regain or maintain their health. Such self-determined and competent use of the care system requires that patients can deal with health-relevant information and actively participate in decision-making processes. However, the current study situation indicates that this is often not the case. According to this, over half of the German population faces significant problems when it comes to finding, understanding, assessing and applying health-relevant information (Schaeffer et al. 2016). The skills and abilities required for this are defined as “health literacy”. Competent handling of health-relevant information forms the basis for taking an active role in the treatment process, finding your way around the diversity of instances in the system and being able to participate in decisions in the treatment process. The term “health literacy”, which is derived from the English “health literacy”, has been growing in popularity in German specialist literature for several years and is increasingly being described as a significant factor in the public health debate worldwide (Sørensen et al. 2012).
04.10.2019
>> The BMC has developed seven proposals for a healthcare master plan (1). A central point is the development of business models for manufacturers of digital health applications. The proposal is likely to be widely accepted because every service provider strives for profit and every service user strives for security, and both goals correspond to basic human needs. Since health is one of the most important assets, it can be predicted that profit and security will be easily linked, although what one means by security will depend greatly.
04.04.2019
Around 70 scientists discussed a previously unsolved problem at the 7th Healthcare Research Forum of the German Network for Healthcare Research (see page III of the DNVF pages in this issue): that of the structured and efficient transfer of study results into real healthcare. This question arises in particular with the Innovation Fund, which, according to the draft bill for the “Law for Better Care through Digitalization and Innovation” – Digital Supply Act or TVG for short – is initially to be extended until 2024. The present interim report on the Innovation Fund (see p. 28), prepared by Prognos, recommends, for example, that in the future not only “the systematic evaluation of the project results with regard to the transfer process will be ensured”, but also that the “organization of a transfer process” should be evaluated more positively Project results should be incorporated into standard care by a “transfer committee”. The “how” was hotly debated.
04.04.2019
According to the most widely used definition in Europe, developed by a scientific consortium in preparation for the first European health literacy survey, health literacy (HC) means that “people have the knowledge, motivation and skills to understand information relating to health care, “To find, understand, evaluate and apply disease prevention and health promotion in order to be able to make decisions and actions to improve or maintain one’s own health over the course of life” (Sørensen et al. 2012).
04.04.2019
“RheinMain University of Applied Sciences wants to be one of the leading universities for applied sciences in Germany, recognized for its scientifically sound and professionally qualified teaching and for its application-related research, which is closely linked to teaching.” This is what Dean Prof. Dr. Stefan Jugel in the mission statement of the Wiesbaden Business School, a department of the RheinMain University of Applied Sciences with a total of 13,700 students. The Wiesbaden Business School offers its over 3,000 students an attractive range of courses in six degree programs with the aim of providing training that is practical and problem-solving oriented. In the “Health Economics” course, Prof. Dr. rer. pole. Hans R. Hartweg the subject combination “care planning, controlling and accounting in the healthcare system”.
04.04.2019
“If health services research does not take action in health and social policy based on its results, then the patient-oriented power and impact of health services research is lost.” With these words, Prof. Dr. Gerd Glaeske, co-head of the Health, Care & Old Age Security department and head of the “Live better for longer” institute in Bremen, presented his lecture “Transfer needs evaluation” with the subtitle “Interaction between care models and health care research as a basis for change”. he gave at the DNVF SpringSchool 2019 in Bonn. However, Glaeske, co-initiator, companion and honorary member of the German Network for Health Services Research, has a caveat: “However, this requires that health care researchers know and follow the current health and social policy discussions and legal framework in order to be able to place the results of their research in the appropriate context .” His demand: “Health care research must get involved and strive to bring evidence into the system based on diverse Windows of Opportunity.”