Original article
Patients who take at least three medications (AM) long-term have the legal right to have their family doctor draw up a national medication plan (BMP) (1-3). The introduction of the BMP, initially limited to the private sector, the lack of an interdisciplinary approach, the lack of suitable information technology and integration techniques led to criticism of the BMP and even rejection (4,5). With the establishment of hospital discharge management in mid-2017, the issuance of a medication plan (MP) was also established in the inpatient sector (6) and intersectoral use was initiated. But hospitals also lack suitable IT equipment and human resources. A current, completely and understandably completed BMP can serve as a source of information and as valuable training material for patients (5,7). Poor drug therapy safety and medication errors are caused by incomplete medication plans, incomplete information to the patient and inadequate exchange of information between the treating health care providers (8,9). The planned use of the standardized BMP on the electronic health card also requires interoperability of the information systems in the healthcare system [hospital information system (KIS), practice (PVS), pharmacy management systems (AVS)] as well as the willingness to participate and improve quality.
04.04.2019
Painkillers are one of the most commonly prescribed drug classes [1] and are used for a variety of diseases (e.g. headaches [2], arthritis [3], traumatic injuries [4], postoperative pain [5] and cancer) [6 ]. In 2016, between 22% and 57% of patients in general practices in Europe received painkiller prescriptions [7]. Paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs; e.g. ibuprofen or ketoprofen) and opioids (e.g. morphine or fentanyl) are the most commonly used painkillers today. These medicines are available with a prescription or without a prescription, depending on the medication and country. Pain is a very common symptom in women, making its effective treatment extremely important in this population [8–10]. One of the most common types of pain in women is chronic pelvic pain, which can be related to endometriosis [11], premenstrual syndrome [12] or urinary tract infections [13]. In recent years, there has been increasing interest in painkiller prescribing patterns among women [7,14–23]. For example, a 2017 study showed that between 25% and 60% of women in France, Germany and the UK were prescribed such drugs [7]. Other researchers estimated in an Australian study of over 20,400 participants that 13% of women complaining of chronic pain had recently taken opioids and 19% had received non-opioids [20]. Although these studies are of great interest, they were not conducted in gynecological practices in Germany and it is difficult to generalize their results to this setting. The aim of the present study was therefore to analyze the prescription prevalence and patterns of painkillers in gynecological practices in Germany.
04.04.2019
The following concept is intended to contribute to the methodological discussion about the use of application-related data in benefit assessment. Based on an overview of the current handling of non-randomized data by relevant health technology assessment (HTA) organizations as well as an overview of possible methodological evaluation procedures, recommendations are formulated on evidence generation, evidence assessment and necessary G-BA specifications that must be taken into account of the data for the quantifiability of an additional benefit.
04.04.2019
The statutory health insurance companies are responsible for statutory health insurance (GKV) in Germany. The GKV market is subject to an ongoing, albeit slowing, concentration process with a steadily declining number of providers in the market - the number of health insurance companies has fallen from 950 in 1995 to 110 currently (Federal Health Reporting 2018). The individual health insurance companies are in competition with each other, whereby the majority of their range of services is uniformly designed across all funds via the mandatory GKV service catalogue. The opportunities to stand out from other health insurance companies are very limited. On the service side, this is only possible in the area of the so-called statutory services, via selective contracts with service providers or via additional services. In addition, there is competition over the price in the form of the individual health insurance fund's additional contribution. However, functioning competition in health insurance systems only makes sense if either the conditions for a perfect market are met or balancing mechanisms are implemented that enable functioning competition (cf. also fundamentally Dahl, Lux and Matusiewicz 2012; Matusiewicz 2016).
04.04.2019
Spastic movement disorder (short: SB; synonymous use: spasticity, spasticity) is the name given to the increased health-dependent muscle tension resulting from damage to the central sensorimotor system as well as uncontrolled cloni, spasms and spastic dystonias [1]. The most common cause of SB is a stroke, but multiple sclerosis, traumatic brain injury, a spinal cord lesion or cerebral palsy can also cause so-called spastic paralysis [2]. It is assumed that around 250,000 patients in Germany are affected [3]. Depending on the underlying disease, SB can manifest itself at very different times in the course of the disease [4, 5]. Between 20 and 40% of patients develop SB within the first year after the stroke [3, 6-8]. In patients with multiple sclerosis, approximately half of the patients are affected by SB during the course of their disease [9-11]. It is not uncommon for SB to cause nursing restrictions or dependencies in carrying out activities of daily living and pain, which is accompanied by a significant reduction in the patient's quality of life [12, 13]. If adequate therapy is provided too late or insufficiently, complications such as pain, contractures, skin lesions up to pressure ulcers and significant impairment of activities of daily living can result. To avoid this, it is therefore advisable to initiate management of SB as early as possible, when the first relevant symptoms appear [14].
04.04.2019
The gross value added in the core area of the healthcare industry was around 350 billion euros in 2017. This corresponds to around 12 percent of the gross domestic product. The health sector is not only seen as an important economic sector per se, but also has great economic benefits, as health is seen as the basis for creativity and economic success (BMG 2019a, WHO). In the current discussion, in addition to medical progress and technological achievements, holistic considerations play a role, which lead to better care and can be achieved through the digital networking of the actors. Compared to other European countries, Germany lags behind when it comes to digital offerings, and the welcome initiative to establish a “Global Health Hub” cannot hide this.
04.04.2019
On the occasion of the 2019 SpringSchool of the German Network for Health Services Research in April 2019, Christian Klose (Department "Digitization and Innovation" of the BMG) presented the BMG's roadmap for the development of the Digitization Act (1). This presentation is valuable for several reasons, although the reason for the connection between "digitization and innovation" is not immediately obvious. The value becomes apparent in the description of the determinants to be taken into account*. The Institute of Clinical Economics (ICE) eV is therefore establishing a new working group that deals with the practical application of technical advances in telecommunications in health services research. In this first part of our report, the preliminary work of politics is briefly mentioned and the preliminary work of science is described: The differences between clinical research (KF) and health services research (SR).
04.04.2019
In order to determine the so-called EU reference price, the pharmaceutical company must “report the amount of the actual selling price in other European countries (see Appendix 2, RV) (…) to the extent that the drug in question is offered there” (framework agreement according to Section 130b Paragraph 9 SGB, §3 paragraph (2) SGB V). According to Annex 4 to the RV, in order to “determine the actual sales price weighted according to purchasing power and sales, the company’s actual country-specific sales price must be corrected according to purchasing power and weighted with the sales share of this country in the total sales of the countries to be taken into account. The prices weighted in this way are added together for the comparison countries (framework agreement according to §130b SBG V, Annex 4) and result in the European reference price. However, the arbitration award on the RV of June 21, 2016 (§6 (3) RV) expressly included a regulation in the RV according to which, in justified cases, the turnover weighting can be deviated from and the turnover weighting can instead be carried out approximately using the number of inhabitants. Furthermore, a regulation was included in the RV according to which the contractual partners can deviate from the requirements of Annex 4 No. 2 and No. 3 of the RV, provided that both contractual partners agree or the special features of the specific reimbursement amount agreement or special problems in obtaining data give rise to this. Which methodology appears suitable in which cases and what limitations there are, particularly when it comes to sales weighting, will be discussed below.
04.04.2019
Digital media consumption in western industrialized countries is becoming increasingly widespread. These include the use of computers, online services, smartphones, game consoles and television (Colombani & Videlaine, 2013). All of these digital media make up a large proportion of children and young people's leisure activities (Feierabend, Plankenhorn, Rathgeb & Behrens, 2017a, 2017b). Current study results by Feierabend et al. (2017b) show that 98% of German households are equipped with media devices, usually with a large number of them. At the same time, industrialized countries are increasingly confronted with diseases of affluence such as obesity and overweight, which, in addition to the health impairment, also represent a corresponding financial burden on the health systems (Branca, Nikogosian & Lobstein, 2007; Bader, 2012). Data from the Robert Koch Institute's Child and Adolescent Health Survey (KiGGS) show that in 2008, 15% of 3 to 17-year-old German children and adolescents were overweight. Of these, 6.3% are affected by obesity (Kurth & Schaffrath Rosario, 2010). It is questionable which intervention programs can successfully reduce screen time and whether they actually have an influence on BMI. It is possible that digital media can even be used as an opportunity to exercise and thus have a positive influence on BMI.
04.04.2019
The fact that it is still not known how many people die at home in Germany is chosen as the starting point for the argument in favor of establishing a place of death register. For this purpose, the fundamental importance - with quite heterogeneous objectives and functional purpose - of medical registers is made recognizable. It becomes clear that a register of places of death can be expected to be of great benefit in the short term, particularly for health care planning and health policy, but also in the medium term for the development of the quality of care and for findings for health care research and epidemiological studies in the medium to long term. This applies to all places (milieus, settings) of care. In order to design such a place of death register effectively in terms of content and function, an interdisciplinary working group with transsectoral experience extending beyond palliative care should be brought together. However, the precise - and annually reported - determination of the place of death would be a clear and practically easy to achieve progress.