Original article
Economic aspects of health care have become significantly more important in the last 20 years and justify the introduction of health economics into the training of medical students. That is why the cross-sectional area Q3 “Health Economics / Health System / Public Health” was anchored in the medical licensing regulations in 2002. The design of the topics and the form of teaching was left to the institutes offering them, so that the theoretical content and the time scope of these lessons are not uniformly defined. The subject is not tied to any specific institute and is therefore shaped in Germany from the perspectives of different academic sub-fields. This results in major differences in the teaching offerings. The “Health System” and “Public Health Care” sub-areas of Q3 result from existing care structures, while the “Health Economics” sub-area has so far only existed as a discipline in economics. In addition to the 21 compulsory subjects, the medical course includes 14 cross-sectional subjects (e.g. Q1: epidemiology/medical biometry/medical informatics, Q7: medicine of aging and the elderly, Q14: palliative medicine) as well as block internships and elective subjects.
04.06.2018
Of all the discussions about “Big Data”, we are only interested in a small excerpt here: the ideas that have been made explicit on this topic in German health research or that have implicitly influenced the discussion. It is important to examine this section in more detail because biomedical research worldwide is in the process of significantly expanding its range of instruments. Unfortunately, the term “big data” does little to help us understand this process – on the contrary. It is about the historically unprecedented opportunity to observe large numbers of people with regard to the natural development of their health and to study the application and impact of interventions available on a mass scale. This approach has potential that has not yet been realized. The question of what access Germany will find to this development arises precisely from this perspective.
04.06.2018
The term delirium describes an etiologically unspecific organic brain syndrome that is characterized by simultaneous disorders of consciousness and attention, perception, thinking, memory, psychomotor skills, emotionality and the sleep-wake rhythm. The duration and severity can vary greatly [Dilling H et al., 2014]. Delirious syndromes are a common complication in the inpatient treatment of elderly patients. While delirious syndromes with a prevalence of 1-2 % were rarely found in outpatients over 65 years of age (Lange et al., 2013; Davies et al., 2013), there were sometimes very high prevalence rates of up to 70% in nursing homes (between 1.4% and 70.3%) and up to 82% in hospitals (between 7% and 82%) (Inouye et al., 2014, Lange et al., 2013). The wide range of these findings depends primarily on the diagnostic criteria used, the age of the patient and the dementia rate. In general, delirium is associated with increased length of stay, increased care needs, increased institutionalization, and ultimately increased mortality rates (Inouye et al., 2014; Pendleburry et al., 2015). It is known that delirium often goes undetected in both inpatient and outpatient settings (Lange de, et al. 2013, Jenkin et al., 2016). Therefore, identifying risk factors is particularly important in order to initiate preventative measures as early as possible (e.g., Kratz et al., 2015; Pendlebury et al., 2017). This applies in particular to preventive diagnostic instruments, such as those used, for example. B. were introduced for delirium in dementia (Richardson et al., 2017). However, there is little information on the prevalence and risk factors of delirium in the outpatient care sector (Lixouriotis et al., 2011; Lange et al., 2013). The aim of this study was therefore to determine the prevalence of documented delirium diagnoses in a large sample of patients in German general practices and to investigate whether risk factors that make the occurrence of delirium more likely can be identified.
04.06.2018
Early detection, the so-called skin cancer screening, has been a service since 2008 that legally insured people aged 35 and over can use every two years free of charge. Dermatologists and doctors from certain specialist groups with appropriate training examine the skin for suspicious changes that should be removed. The analyzes carried out here describe the status quo and development trends in utilization. The basis of the analyzes is the anonymized research database of AOK Nordost with its approximately 1.75 million insured persons. The results presented capture the development between 2008 - the year skin cancer screening was introduced as an insurance benefit - and the year 2015. All AOK Nordost insured persons aged 35 and over who were fully insured within the year under consideration and in the three federal states of Berlin , Brandenburg and Mecklenburg-Western Pomerania are part of the study population. In 2008, the study population comprised approximately 1.23 million insured people. By 2015, it had fallen to around 1.19 million insured people (see Table 1). For some analyses, nationalities were examined. Nationality can be viewed as an indicator of differences in individual risk factors – such as skin type.
04.06.2018
The development of new surgical procedures, advances in medical and anesthesia technology, and the establishment of integrative care structures make it possible to increasingly carry out surgical procedures on an outpatient basis. Compared to inpatient procedures, outpatient operations offer numerous advantages: savings in personnel and hospital costs, more patient-friendly treatment (e.g. due to lower psychological stress, especially in children and older patients), the possibility of more flexible scheduling and a lower risk of nosocomial infections (Castoro et al. 2007; Lemos et al. 2009; Shnaider & Chung 2006; Standl & Lussi 2012). The contract concluded between the National Association of Statutory Health Insurance Funds, the German Hospital Association and the National Association of Statutory Health Insurance Physicians in accordance with Section 115b Paragraph 1 SGB V “Outpatient surgery and ward-replacing procedures in the hospital” (AOP contract) enables insured persons to carry out selected operations on an outpatient basis. Despite this collective agreement option, the proportion of outpatient operations in Germany is around 37%, well behind countries such as the USA, Canada or Scandinavia, in which around 50-90% of all surgical procedures are already carried out on an outpatient basis (Toftgaard 2003). The reasons for the low proportion of outpatient operations could be that the remuneration is perceived as too low by the established service providers (clinically trained specialists) or a lack of billing options for these standard care operations.
04.06.2018
Since the beginning of 2018, Germany has also had a “National Action Plan to Strengthen Health Literacy” following the example of other countries. Created by an independent group of experts, the plan contains fifteen recommendations that relate to four major areas of action: everyday living environments, the healthcare system, life with chronic illness and research (Schaeffer et al. 2018). The following article first provides a brief overview of the current state of discussion on the topic of “health literacy” and then explains why an action plan makes sense and is necessary, what empirical foundations it is based on and what its content focuses. The recommendation for promoting research on health literacy is then presented and explained. It is shown that the National Action Plan can also be read as an agenda for new approaches and topics in health services research.
04.06.2018
Pollen-related allergic rhinitis (hay fever) is one of the most common allergic diseases in children and adolescents (Schmitz et al. 2017). In Germany, the 12-month prevalence of medically diagnosed hay fever among 3 to 17 year olds is 9.9% (Poethko-Müller et al. 2018). This results in an allergic reaction of the nasal mucosa and the conjunctiva to certain pollen, for example that of birch, which leads, among other things, to increased secretion, sneezing, restrictions in nasal breathing and itching. Although the symptoms of a pollen allergy can be very stressful and severely limit the quality of life and academic success, they are often trivialized (Greiner et al. 2011). In addition, high direct and indirect economic costs are attributed to allergic rhinitis and its secondary diseases, for example bronchial asthma and later COPD (Pfaar et al. 2014).
04.06.2018
Orthopedic operations are among the most common operations in German hospitals and, according to initial forecasts, will continue to gain in importance as society ages [1, 2]. In order to avoid immobilization damage and to specifically support the healing process, mobilization measures should be started as early as possible during operations on knee joints, which must be carried out (almost) exclusively passively in the early postoperative phase. This is particularly true if the patient cannot or is not allowed to carry out any active self-exercises [3-7]. In addition to physiotherapeutic treatments, the use of motor-driven movement splints (Continuous Passive Motion - CPM splints) has become established in practice for passive movement of the joints. In the knee area, CPM movement splints are often used after endoprosthetic joint replacements, cartilage, tendon and ligament reconstructions as well as for exercise-stable osteosynthesis [8-13]. Numerous studies deal with the rehabilitative aftercare of patients after joint operations, but only rarely in the context of outpatient follow-up treatment in Germany. This work focuses on the actual care situation of patients in Germany in the sense of real world evidence. The starting point is a process cost analysis that documents the postoperative follow-up treatment of patients after knee joint surgery. The focus is on evaluating the cost-effectiveness of different treatment alternatives. Postoperative mobilization can be accomplished through the use of CPM motion splints, physical therapy, or a combination of both. The use of physiotherapy is regulated via the Therapeutic Products Directive; CPM movement splints are listed in the list of aids according to Section 139 SGB V as externally powered movement splints for the knee joint, among other things [14].
04.06.2018
One of the main reasons why many doctors turn away from medical care in Germany is proven to be poor working conditions with an unsatisfactory work-life balance, systematically excessive workloads and long and inflexible working hours (Via medici 2006). On the one hand, these result from the shortage per se (unfilled positions lead to overloading of compensating positions) but on the other hand, they can also be seen as a lasting consequence of the 80s and 90s. During that time of the “doctor glut”, a high workload for doctors was accepted because the job offer was very limited and the demand for jobs was high. Related violations of labor law or the Working Hours Act were and are often not reported or punished today (dpa 2017; Via medici 2014; Peters 2013). However, the high workload is not only caused by medical activities per se, but also increasingly by the increasing bureaucratization of the profession. In a doctor's survey from 2010, more than 50 % of the doctors surveyed said that they use more than a quarter of their daily planned working time for administrative activities (IQME 2011). Since there were sufficient financial and human resources available during the “doctor glut,” in the past only limited emphasis was placed on efficiency or optimizing structures and processes. While the structural and process deficits partially remained, personnel and economic resources continuously decreased, so that this constellation can be viewed as the cause of the current workload. However, this also means that there is still immense potential for increasing efficiency in these structures and processes. There are wards and hospitals in which activities that can be delegated to non-medical staff, such as taking blood samples or organizing documents, continue to be carried out by medical staff.
04.06.2018
There are already numerous studies and reviews on the subject of CPM splint therapy in the literature. In addition to controlled and randomized clinical studies on the use of CPM for various indications [4-12], there are also isolated meta-analyses [13, 14] and reviews [15, 16]. Overall, the study situation turns out to be very heterogeneous with regard to the indication, the comparative therapy, the duration of the study, the start of treatment and the endpoint consideration. In addition to this heterogeneity in the study situation, the fact that the studies come from different countries whose care structure cannot easily be transferred to the German health system [9, 17] makes it even more difficult. Methodologically, the studies are limited, among other things, by the fact that complete blinding of everyone involved is not practical. The treatment results are also influenced by many factors (e.g. type of joint injury, surgical technique, comorbidities). One objective of the present study was to describe this heterogeneity, with a focus on the real care situation. A central component of this care situation is the decision of the health insurance companies as to whether the CPM splint treatment will actually be approved after the prescription has been issued. In the sense of “real-world evidence”, this not only corresponds to the actual reality of care, but also does justice to the variety of possible scenarios in which patients can find themselves after knee or shoulder surgery.