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BACKGROUND: In order to preserve health and thus social participation, it is important for older people to make health-related decisions, such as those regarding the use of a secondary prevention service like cancer screening. National and international studies show that various predictors determine cancer screening participation. The aim of this study is to determine the cancer screening utilization of older people in a structurally weak region. METHODS: In 2021, a cross-sectional study in each of two urban and rural communities in Saxony-Anhalt surveyed individuals aged 55 years and older about determinants, reasons, and barriers to preventive service use (nâ¯= 954). Binary logistic regression analysis is used to analyze determinants of cancer screening use. RESULTS: Three quarters of the study population (76.6%) self-reported participating in a cancer screening service at least once. The multivariable analyses demonstrate factors that influence the utilization of cancer screening. Age, partial knowledge on cancer screening, cancer screening as a benefit offered by a statutory health insurances' bonus program, experience with cancer in the immediate environment, thoughts about one's own health, and the feeling of security that participation gives are factors that significantly influence the use of cancer screening. Descriptively, the physician's recommendation is the strongest factor for participation. CONCLUSION: The analyses show that cancer screenings are generally well received by older people in Saxony-Anhalt, but participation in them is not related to health literacy. In keeping with the National Cancer Plan, older people should generally be supported in making an informed decision, for example, through target-group-specific physician education.
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Letramento em Saúde , Neoplasias , Humanos , Idoso , Detecção Precoce de Câncer , Estudos Transversais , Alemanha/epidemiologia , Neoplasias/diagnóstico , Neoplasias/prevenção & controleRESUMO
The German research data center for health will provide claims data of statutory health insurances. The data center was set up at the medical regulatory body BfArM pursuant to the German data transparency regulation (DaTraV). The data provided by the center will cover about 90% of the German population, supporting research on healthcare issues, including questions of care supply, demand and the (mis-)match of both. These data support the development of recommendations for evidence-based healthcare. The legal framework for the center (including §§ 303a-f of Book V of the Social Security Code and two subsequent ordinances) leaves a considerable degree of freedom when it comes to organisational and procedural aspects of the center's operation. The present paper addresses these degrees of freedom. From the point of view of researchers, ten statements show the potential of the data center and provide ideas for its further and sustainable development.
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Emprego , Programas Nacionais de Saúde , AlemanhaRESUMO
In the federal state of Germany, Saxony-Anhalt, colorectal cancer is the second most frequent cause of death among cancer patients. In order to identify cancer precursors early, colorectal cancer screenings are essential. In this context, health information contributes to informing individuals and imparting them with necessary knowledge to make a decision about (non-)utilization of preventive services. Numerous public health stakeholders (e.g., statutory health insurances) provide health information. This study aimed to evaluate the quality of web-based health information offered by public health stakeholders in Saxony-Anhalt, Germany. A systematic evaluation was used. A search was performed using pre-defined eligibility criteria and search terms. Two independent reviewers assessed the search results based on seven main categories (60 items) developed by the study team in line with the "Guideline Evidence-based Health Information". In total, 37 materials from 16 different stakeholders were included and yielded a "mediocre quality" (median = 69%). The materials had only partially fulfilled the requirements of national recommendations for evidence-based health information. Access to digital health information regarding colon cancer screening was unsatisfactory, especially for individuals with auditory or visual impairments, due to use of inappropriate communication technologies. Further efforts are required to improve digital health information about colorectal cancer screening.
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Neoplasias Colorretais , Detecção Precoce de Câncer , Humanos , Saúde Pública , Neoplasias Colorretais/diagnóstico , AlemanhaRESUMO
BACKGROUND: In Germany, the proportion of people with chronic diseases and multimorbidity is increasing. To counteract the emergence and worsening of age-related conditions, there is a need for preventive care structures and measures. The preventive services that are financed by statutory health insurance (SHI; eg, vaccinations, cancer screening) are only used by part of the German population. There are no current findings about the utilization of these services by older adults in the eastern German federal state of Saxony-Anhalt, which is particularly strongly affected by demographic change. OBJECTIVE: The aim of this study is to investigate the actual utilization and determinants of, reasons for, and barriers to utilization of preventive services financed by the SHI in Saxony-Anhalt in the 55-plus age group. METHODS: In this study, a convergent mixed methods design is used. The actual use of preventive services will be shown by means of (1) a claims data analysis looking at data on statutory outpatient medical care from both the Central Research Institute of Ambulatory Health Care in Germany (Zi) and the Association of Statutory Health Insurance Dentists in Saxony-Anhalt (KZV LSA). The determinants, attitudes, and behaviors associated with use will be analyzed through (2) a cross-sectional survey as well as (3) qualitative data from semistructured interviews with residents of Saxony-Anhalt and from focus group discussions with physicians. (4) A stock take and systematic evaluation of digitally available informational material on colorectal cancer screening, by way of example, provides an insight into the information available as well as its quality. The conceptual framework of the study is the behavioral model of health services use by Andersen et al (last modified in 2014). RESULTS: (1) The Zi and KZV LSA are currently preparing the requested claims data. (2) The survey was carried out from April 2021 to June 2021 in 2 urban and 2 rural municipalities (encompassing a small town and surrounding area) in Saxony-Anhalt. In total, 3665 people were contacted, with a response rate of 25.84% (n=954). (3) For the semistructured interviews, 18 participants from the 4 different study regions were recruited in the same period. A total of 4 general practitioners and 3 medical specialists participated in 2 focus group discussions. (4) For the systematic evaluation of existing informational material on colorectal cancer screening, 37 different informational materials were identified on the websites of 16 health care actors. CONCLUSIONS: This study will provide current and reliable data on the use of preventive services in the 55-plus age group in Saxony-Anhalt. It will yield insights into the determinants, reasons, and barriers associated with their utilization. The results will reveal the potential for preventive measures and enable concrete recommendations for action for the target population of the study. TRIAL REGISTRATION: German Clinical Trials Register DRKS00024059; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024059. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/33512.
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BACKGROUND: Currently, there is a big need for data on emergency department (ED) utilization in Germany. One reason is the ongoing reorganisation of emergency care. Possible sources are routine data that are being collected based on legal regulations. Different payers and compensation systems have their own requirements for data collection. METHODOLOGICAL CHALLENGES: Due to the sectoral separation of health care services, there is no dataset or data holder to provide information on all ED treatments in Germany. From an administrative point of view, emergency care in Germany is considered ambulatory outpatient or inpatient care from the time point of admission to the ED. In contrast, clinical decision about inpatient admission can sometimes only be made towards the end of emergency care. EDs themselves cannot be identified in claims data; only the medical discipline (e. g. surgery) is classified. In the case of outpatient treatment, reimbursed by the Association of Statutory Health Insurance Physicians, at least one coded diagnosis (ICD) has to be recorded, accompanied by an additional code for the likelihood of this diagnosis. In case of multiple ICDs, a primary diagnosis cannot be specified. In the case of in-hospital treatment, an admission diagnosis must be recorded. After completion of hospital treatment, the main diagnosis and possibly secondary diagnoses are transferred to the respective health insurance fund. The statutory occupational accident insurance has its own requirements. SOLUTIONS: Depending on the research question and study design, different approaches are required. If data are queried directly in emergency departments or hospitals, additional information on the designated data holder and billing mode is crucial. When using health insurance data from inpatient care, the identification of emergency departments can be estimated on the basis of the reason for hospital admission and defined "unique" emergency ICDs. The case-related hospital statistics has its own limitations, but includes inpatients of all payers. DISCUSSION: Differing requirements for the administrative documentation cause a high workload in emergency departments. A standardised data collection system for all payers for inpatient and outpatient emergency care is recommended. This would contribute to the creation of valid and comparable datasets. The introduction of a particular identifier for EDs in claims data would enhance health services research.
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Documentação , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Confiabilidade dos Dados , Alemanha , Hospitalização , HumanosRESUMO
Cohort studies provide the best evidence of all epidemiological observational studies for the identification of causal relationships between risk factors and diseases. However, this design may lead to drawbacks that may affect the validity and reliability of the results. This follows in particular from systematic errors, such as selection bias or recall bias. One possibility to avoid or counteract some of these drawbacks is to link primary data from cohort studies with secondary and register data. The linkage of these data may also be used for mutual validations. Data that were previously linked with primary data within the context of cohort studies in Germany were obtained from statutory health insurances and pensions as well as data from the Federal Employment Agency and cancer registries. All these data have two features in common: First, they all cover detailed information about a large population and over a long period of time. Second, all sources are in principle able to provide data on an individual level such that an individual data linkage, e.g. with primary data, is possible. However, use and linkage of each of these data sources are restricted by several limitations. These have to be accounted for as well as numerous legal restrictions that exist in Germany to especially prevent the misuse of social data.