[Patient pathways in thrombosis prophylaxis after hip and knee replacement surgery : results of a survey]. / Patientenpfade in der Thromboseprophylaxe nach Hüft- und Kniegelenkersatz : Ergebnisse eines Surveys.

A key element of patient care after hip and knee replacement is medication-based thrombosis prophylaxis. Due to decreasing lengths of acute hospital stays the question arises to what extent outpatients are taking responsibility thrombosis prophylaxis (patient pathway analysis).To analyze patient pathways a telephone survey of 668 patients was conducted. On average patients were interviewed 38 days following surgery with a focus on low molecular weight heparins. The analysis showed that nearly 90% of patients need to carry out thrombosis prophylaxis in an outpatient or home environment for at least 1 day and for 47.2% of patients a linking period between acute and rehabilitation stay is relevant. The obviously existing quantitative importance of outpatient thrombosis prophylaxis is also reflected by its duration and 45.7% of interviewed patients needed at least 5 days of outpatient prophylaxis.Outpatient thrombosis prophylaxis clearly makes high demands on the patients, in particular when combined with the task of administering complex forms of injections. Those involved in inpatient and outpatient provision of care should not assume that all patients carry out the necessary prophylaxis at the required level of reliability. On the contrary initial evidence shows that the non-adherence of patients during ambulatory thrombosis prophylaxis presents a genuine challenge to care providers.

[Comparative evaluation of methods to determine efficiency potentials in drug utilisation]. / Vergleichende Bewertung von Methoden zur Ermittlung von Effizienzreserven in der Arzneimittelversorgung.

BACKGROUND: Discussions in health-care policy frequently pursue a raising efficiency in drug utilisation. Therefore saving potentials are quantified based on health insurance company claims data. This article is a contribution to methodical discussions about the determination of saving potentials in drug utilisation. METHODS: Based on claims data from the health insurance company Gmuender ErsatzKasse (GEK) of 2005, four different methods to calculate efficiency potentials in the generic drug market are presented. The different effects are illustrated for the example of Omeprazol. RESULTS: Depending on the used methods, different estimates, abstractions and varied information are required. In the given example the identified increase in efficiency varies between 741,000 Euro and 165,000 Euro (80%). According to the used method, saving potentials range between 2.9% and 13.1% as measured by the total expenditure for Omeprazol. CONCLUSION: The amount and the pertinence of saving potentials in theory are highly dependent on underlying assumptions and used methods. Calculations on the level of several drugs should, in the best case, occur at the time of prescription under consideration of drug prices. A detailed methods description is required for an appropriate outcome evaluation.

[High usage of zolpidem and zopiclone. Cross-sectional study using claims data]. / Hochverbrauch von Zolpidem und Zopiclon. Querschnittsstudie auf Basis von Krankenkassendaten.

BACKGROUND: Case reports indicate dose increase, abuse, and dependence concerning zolpidem and zopiclone (so-called Z-drugs). METHODS: We conducted a cross-sectional study between 1 July and 31 December 2004 using claims data of the German health insurer Gmuender ErsatzKasse to examine high usage of these drugs. RESULTS: A total of 6959 subjects bought at least one packet of zolpidem or zopiclone, including 20.9% containing 90 daily doses (DDD) or more. High usage, defined as at least 180 DDD, was identified in 501 subjects (7.2%). Compared to other use, high usage was associated with GP visits only for the prescription of Z-drugs (odds ratio 2.01, 95% confidence interval 1.52-2.67), neuroleptics (odds ratio 2.53, 95% confidence interval 2.02-3.18), and polypharmacy (odds ratio 2.40, 95% confidence interval 1.84-3.15). CONCLUSION: Zolpidem and zopiclone are often prescribed in higher doses or for long-term use. Such therapy regimens should be viewed critically.

[Validity of information relevant to research in routine medication claims data from 2000 to 2006]. / Validität forschungsrelevanter Informationen in Arzneimittelroutinedaten von 2000 bis 2006.

BACKGROUND: Claims data of German statutory health insurance companies have been used increasingly over the last years for various research purposes. However, little is known about the validity of these data. Aim of this study was to analyse whether information relevant for research purposes is accurately recorded in computerized out-patient medication claims data. METHODS: We used data of the Gmünder ErsatzKasse (GEK) over the years 2000 - 2006. A random sample of 300 prescriptions annually was drawn from a total of 6.3 to 7.5 million prescriptions. Data on the scanned original prescriptions ("gold standard") were validated against that information in claims data. RESULTS: Over the years 2000 - 2006 an increasing proportion of dates of writing was recorded accurately (77.3 % to 93.0 %; p for trend < 0.0001). Concomitantly the proportion of handwritten prescriptions declined and that of printed ones increased. Dates of dispensing were barely correct until 2003. Thereafter, the agreement ranged from 65.3 % in 2004 to 86.1 % in 2006 (p for trend < 0.0001). There were significant differences between pharmacy data processing centres (Apothekenrechenzentren). The accuracy of physician and pharmacy identifiers (97,7%, 99,75% and 100.0 %, respectively) was nearly constant over these 7 years. CONCLUSION: The accuracy of variables analysed in this study is very good for those which are immediately related to the flow of money in German out-patient medication claims data. Recording of dates of prescription and dispensing are fairly good quality.

[How often are dates of prescription and dispensing of drugs correct in claims data?]. / Wie häufig sind Verordnungs- und Abgabedatum von Arzneimitteln in Routinedaten korrekt erfasst?

Up to now, little research has been done to analyse how often the date of the prescription and the dispensing of the drugs are correct in German statutory health insurance claims data. We used data of the Gmünder ErsatzKasse (GEK). Out of 6.99 million prescriptions in 2005 we drew a simple random sample of 1,000. Dates of filling and dispensing on the scanned original prescription (SOP) were validated against that information in computerized claims data. Factors associated with nonagreement were also evaluated. In 90.4 % (95 % CI: 88.5-92.1) the SOP date of prescribing was identical to the information in the claims data. Compared to printed dates, handwritten or stamped dates were less frequently recorded correctly (95.4 % vs. 40.4 %; p<0.0001). In 76.6 % (95 % CI: 73.8-79.1) of the SOPs the dispensing date was consistent with the information in the claims data. Compared to good legible prints, moderately legible dispensing dates were less frequently recorded correctly (80.4 % vs. 68.2 %; p<0.0001). Because of weak printing about one third of the dispensing dates were moderately legible. In cases where drug exposure has to be measured accurately, original prescriptions should be viewed. There is further need for clarification on the correctness of variables in claims data.