Original article
Bundeswehr missions abroad have become a piece of normality (Frank Bötel 2016). But these missions are accompanied by stressful experiences for the soldiers and consequences for their mental health. For example, 2.9 % of the soldiers deployed in 2009 as part of the ISAF mission in Afghanistan met the DSM-IV-TR criteria for post-traumatic stress disorder 12 months after the deployment (Wittchen et al. 2012). This 12-month prevalence is not only significantly higher compared to the control soldiers who are not deployed, but also compared to the rates of the age- and gender-adjusted German general population (Jacobi et al. 2014). In addition, it must be feared that the prevalence rates of mental illness after foreign assignments in general (Kang and Hyams 2005), and that of post-traumatic stress disorder (PTSD) in particular (Brewin et al. 2012) will even increase over the years. A key task that not only the Bundeswehr but all those involved in the care of mentally ill people have to face is how to deal with soldiers of the Bundeswehr who have become mentally ill as a result of the deployment (Holtherm 2014). From the point of view of care, the situation is made more difficult by the fact that soldiers, after leaving the Bundeswehr, switch to the civilian German care system, in which the vast majority of service providers no longer have any personal experience with the military system. So far, however, there are no meaningful scientific findings for Germany either on the subjective need for care or on the objective need for care of former soldiers who are now in the civilian health system.
06.12.2017
With the Cost Containment Act of 1977 and the reform laws that followed in the years that followed, the legislature attempted to ensure high-quality, needs-based and economically efficient provision of medical services to the population. In order to achieve this goal, various instruments have been developed and used; Above all, it was about making the principle of economic efficiency more valid. However, the aforementioned goal was only partially achieved. The approximately 19 million patients who are admitted to inpatient treatment each year are largely well cared for. On the other hand, it is questionable whether the goal of meeting needs is realized in care practice. The increase in the number of inpatients, the number of procedures and the case mix (CM) in hospitals in Germany that has been observed for years was the reason for the development of several studies with the aim of examining the performance development and its causes to evaluate whether the number of medical services provided corresponds to their actual needs1. The studies were published between 2011 and 2014; They explain the volume developments with, among other things, the demographic development of the population, medical and medical-technical progress as well as the resulting new examination and treatment methods (NUB), the insufficient investment financing by the federal states, and various (false) incentives flat-rate G-DRG fee system and the economic interests of hospitals.
06.12.2017
First of all, it helps to repeat something that goes without saying: the healthcare system is there for the citizens, especially if they are patients, and not the other way around. Patient-centeredness is therefore the consistent alignment of all actors and their services/contributions as well as processes to the needs of patients1. It cannot be ignored that the term patient-centeredness has been devalued through inflationary use. The authors of this article therefore prefer the term patient orientation. This is the path to a healthcare system that actually aligns its services, including drug supply, with the needs of patients and enables targeted and easy access to these services for patients. The term is also interpreted heterogeneously in the literature.
06.12.2017
As part of the 1st Northeast Children's Report of the Northeast Health Sciences Institute of the AOK Nordost, the development of antibiotic use in the pediatric setting was also examined (Witte et al. 2017). In general usage and also in the clinical context, antibiotics refer to active ingredients that inhibit the growth of bacteria or kill them. Due to decades of excessive and untargeted use of antibiotics, the increase in insensitivity of bacterial pathogens has developed into a significant public health problem worldwide. Patients and doctors are increasingly confronted with bacterial strains that are resistant to many common antibiotic agents (WHO 2011). As a result of the increase in so-called multi-resistant pathogens, the duration of treatment, the severity of the disease and the risk of death from serious infections are increasing. The same applies to the resulting costs of appropriate medical care (Aloush et al. 2006; Maragakis et al. 2008; Song et al. 2003; Qavi et al. 2005).
06.12.2017
Germany has a care problem. What has long remained in the silence of the daily struggle of nurses to somehow provide adequate care for their patients is now reaching the public and is being taken up prominently in the political process. For example, the EU-funded RN4CAST study, which was carried out from 2009 to 2011, provided objective evidence of the “nursing crisis”1: while in the USA a nurse cared for an average of 5.3 patients in a hospital and in Norway for 3.4 to While 8.2 patients were responsible, the care ratio in Germany was between 7.5 and 19.2. This means that the best facilities in Germany were only slightly better than the worst in Norway. Germany is therefore at the bottom of all countries considered.
06.12.2017
There has been a clear volume dynamic on the German pharmaceutical market for several years [1]. In addition, factors such as demographic change, medical-technical progress and the increase in outpatient therapy options lead to increasing pharmaceutical expenditure [2]. The legislature took up this progressive development by introducing the Medicines Market Reorganization Act (AMNOG) in 2011. Since then, new medications have been evaluated for their additional benefits. It turns out that a large number of new pharmaceutical products continue to come onto the German market, the additional benefit of which often cannot be proven or for which only a small additional benefit has been identified [3]. In addition, in the period from 2013 to the beginning of 2014, drugs that had already been approved were assessed as part of the AMNOG with regard to their additional benefit (so-called existing market call).1 The only group of active ingredients whose process was completed include the DPP-4 inhibitors (also gliptins).
06.12.2017
Psychogenic eating disorders include various types of eating disorders that differ in their symptoms. Psychogenic eating disorders include anorexia nervosa (AN), also known as “anorexia”. In addition to bulimia nervosa (BN), also known as “bulimia” or “eating addiction”, and binge eating disorder (BES, also “eating addiction”), AN is one of the most researched forms of eating disorders. Depending on the type of eating disorder, different symptoms are characteristic of psychogenic eating disorders (DGPM/DKPM 2010). The risk of chronicity in eating disorders is high. Those affected usually have to struggle with the disease for several years, require several treatment attempts and the symptoms sometimes persist even after successful therapy. In addition, it is assumed that most of those affected do not attract attention in the healthcare system and that only a fraction of those who do seek treatment (Hoek 2006; DGPM/DKPM 2010; Smink 2016). In addition, eating disorders are accompanied by numerous physical sequelae. The earlier the disease breaks out, the higher the risk of chronic damage (Holtkamp/Herpertz-Dahlmann 2005). In addition, deaths due to an eating disorder are often due to the physical consequences. Overall, mortality in eating disorders is significantly higher: in bulimia by a factor of 1.9 and in anorexia by a factor of 5.9 (Smink 2016).
06.12.2017
The Hospital Structure Act, which came into force on January 1, 2016, provides for the inclusion of quality data in inpatient health care that is relevant to remuneration and planning. In order to be able to categorize quality, the legislator uses Donabedian's model for structural, process and result quality (e.g.: §136 Social Security Code V). This model implies that improving the quality of structure and processes can improve the quality of results (Donabedian 1966; Donabedian et al. 1987). In this context, good evidence about the strength of the controllable influence of structure- and/or process-related interventions on the treatment outcome was called for early on (Donabedian 1980; Institute of Medicine 1990). Following the implementation of the KHSG, the G-BA published both planning-relevant structural indicators and a cross-sectoral guideline for the design of internal quality management (Joint Federal Committee 2015, 2016). From the perspective of evidence-based medicine, however, it can be said that previous reviews indicated that there was often weak evidence for influencing the quality of results through complex interventions at the structural or process level (Conry et al. 2012; Khan/Ollenschläger 2014). However, a current critical analysis of the published studies on the effect of complex quality interventions in the setting of the German healthcare system is currently missing. We therefore analyzed the literature on the influence of planned complex interventions at the structural and/or process level on the quality of results in inpatient settings in the German healthcare system using a systematic review.
06.12.2017
The regional disparities in the provision of health services have come to the fore, particularly against the background of the discussion about demographic change. The focus here is primarily on existing and expected supply bottlenecks in rural areas (Greß/Stegmüller 2011, Lessing/Herr 2015, Ried 2016). The system of statutory health needs planning has been criticized in the past, particularly with regard to its spatial control function, with the planning areas considered too large for both analysis and planning purposes and the failure to take into account the actual accessibility of health facilities (Greß/Stegmüller 2011: 22ff.). In the course of the reform of demand planning in 2013, this problem was already addressed through smaller-scale planning levels and the possibility of regional adjustments to demand (KBV 2013, Schulz et al. 2015).
06.12.2017
It has been known since the Middle Ages that sufficient exercise and sleep, a balanced diet, little alcohol and appropriate handling of stress protect health. This traditional prevention quintet, supplemented by nicotine abstinence to form a sextet and better implemented through the development of a “preventive self” in the 20th century, needs to be expanded to include a dimension: stratified prevention. In particular, the findings based on large biomedical data sets and physiological measurements in everyday life will in the near future make it possible to assess individual health risks more precisely than before and to develop more precise prevention strategies. The immense opportunities of this development, which enables a more targeted, effective and less risky prevention of diseases, are offset by legitimate concerns and considerable dangers when faced with a “transparent person”, with problems of equal opportunities or with what is medically sensible for most people, but in individual cases endangering health Measures should be warned. This article summarizes the discussions at an interdisciplinary conference in Augsburg with the participation of cardiologists, epidemiologists, lawyers, techno-economists, ethicists and health managers. The participants tried together to identify the goals of stratified prevention. This prevention requires that clinical pictures be defined more narrowly. The starting point and guiding principle is the self-responsible patient, who is to be informed in a lifelong health educational mission that goes beyond school and is also individualized using digital technology. The social security law and the new prevention law rightly underline the considerable need for research that is necessary to develop ethical, effective and evidence-based stratified prevention and make it generally accessible. The necessary interdisciplinary research in the area of this precise prevention, which is only just beginning, should be scientifically strengthened and better anchored in society through better regulation of biodatabases and research consent that enables donations “for science”.