RESUMO
OBJECTIVE: To provide real-world evidence on patient-individual tapering patterns of disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients in daily clinical practice. METHODS: Data obtained through a controlled prospective cohort study in Germany conducted from July 2018 to March 2021 were analyzed. Participants consist of RA patients in sustained remission who were eligible for DMARD tapering at enrolment. Data from RA patients who experienced tapering of DMARDs at least once during the observational period (nâ¯= 200) were used. Descriptive analyses of medical outcomes at baseline and at time of first tapering, time to first tapering, tapering patterns by substance group, and tapering intensity were documented. RESULTS: We did not observe meaningful differences in either disease activity or quality of life measures between substance groups at enrolment, time of first tapering, and at 6 or 12 months after tapering. Median time until first tapering varied between substance groups (csDMARDs: 108 days; bDMARDs: 189 days; combination: 119 days). Most patients received one iteration of tapering only (147/200 patients, 73.5%). Dose reduction was applied for patients treated with csDMARDs (79/86 patients, 91.8%), spacing of interval was the most frequent strategy for patients treated with bDMARDs only (43/48 patients, 89.5%). Necessity for increased DMARD dosage was observed in only 10% of patients (20/200). Tapering intensity by substance was overall heterogenous, indicating high individualization. CONCLUSION: We identify highly heterogeneous tapering patterns between substance groups and within substances. Identification and recognition of patient-individual approaches of tapering will help to further improve the management of RA for both patients and rheumatologists.
Assuntos
Antirreumáticos , Artrite Reumatoide , Humanos , Estudos Prospectivos , Qualidade de Vida , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Antirreumáticos/uso terapêutico , Indução de RemissãoRESUMO
OBJECTIVE: We aim to provide real-world evidence on the effectiveness of patient-individual tapering of DMARDs for patients with RA in daily clinical practice using medical records and claims data. METHODS: We utilize data obtained through a controlled prospective cohort study in Germany conducted from July 2018 to March 2021. Participants consist of RA patients in sustained remission (>6 months) who were eligible for tapering at enrolment. Patients treated with individual tapering based on shared decision making (n = 200) are compared with patients without any dose reduction (n = 237). The risk of loss of remission and the risk of flare is assessed with risk-adjusted Kaplan-Meier estimators and Cox regressions. We evaluate differences in costs 1 year before and after baseline based on claims data for the subgroup of patients insured at one major sickness fund in Germany (n = 76). RESULTS: The risk of flare (hazard ratio 0.88, 95% CI 0.59, 1.30) or loss of remission (hazard ratio 1.04, 95% CI 0.73, 1.49) was not statistically different between the individual tapering group and the continuation group. Minor increases of disease activity and decreases of quality of life were observed 12 months after baseline, again with no statistically significant difference. Drug costs decreased by 1017 in the individual tapering group while they increased by 1151 in the continuation group (P < 0.01). CONCLUSION: Individual tapering of DMARDs does not increase the average risk of experiencing flares or loss of remission. Encouraging rheumatologists and patients to apply tapering in shared decision making may be a feasible approach to allow individualization of treatment in RA.
Assuntos
Antirreumáticos , Artrite Reumatoide , Humanos , Estudos Prospectivos , Qualidade de Vida , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/induzido quimicamente , Indução de RemissãoRESUMO
In 2004, the Federal Joint Committee (G-BA) published a new directive for examination and treatment methods with respect to sleep-related breathing disorders for SHI-accredited physicians. The examination procedure is classified in four steps: anamnesis, clinical assessment, cardiorespiratory polygraphy (PG) and cardiorespiratory polysomnography (PSG). Starting with the date of the first PSG we analysed 1. whether this examination was preceded by a polygraphy, 2. whether there was a gain of diagnostic information through PSG, and 3. whether a PSG was used for the first adjustment examinations and controls after prescription of a positive airway pressure device. The analysis is based on claims data from the Techniker Krankenkasse (2009-2012). Diagnostic services were identified by fee schedule codes (EBM) for outpatient services and by procedure codes (OPS) for inpatient services. Sleep disorders were operationalised by ICD-10 codes and information was completed by prescriptions of a CPAP equipment.The study is based on data from 6.6 million persons who were permanently insured from 01.01.2009 to 30.06.2012 by TK. A preceding PG 90 (180) days before PSG was found for less than 56% (73%) of the analysed insured persons. By the latter procedure, only about 60% of the cases with no clear diagnostic information (G47.39) in the preceding quarter could be specified. Prescription of a positive airway pressure device within 90 days after PSG was found for about 45% of the insured. Concerning the stepwise diagnostic procedure for sleep disorders for SHI-accredited physicians, the directive was followed only partly. Against the background of an evidence-based, effective, and efficient diagnostic approach, the results show a clear need for action.
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Formulário de Reclamação de Seguro/estatística & dados numéricos , Polissonografia/estatística & dados numéricos , Respiração com Pressão Positiva/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Síndromes da Apneia do Sono/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/terapia , Resultado do Tratamento , Revisão da Utilização de Recursos de SaúdeRESUMO
BACKGROUND: Continuity of care is important for outcomes and patient satisfaction and includes additional considerations in the context of cross-border health care. Although this has been discussed in research and was picked up in the recently transposed Directive on patients' rights (2011/24/EU), there is limited evidence about related issues actually encountered by patients crossing borders. METHODS: An anonymous postal survey was carried out by the Techniker Krankenkasse, one of the largest sickness funds in Germany. The questionnaire was sent to 45 189 individuals who had received treatment in EU/EEA countries and included items on relational, management and informational continuity. RESULTS: The survey had a response rate of 41% (n = 17 543). Of those respondents who had travelled for care (n = 3307), â¼19% (n = 570) did so due to a relationship of trust with a given provider. Only 8% of all respondents required emergency follow-up services due to complications, the majority of which was obtained back in Germany. Twelve percentage of those who were prescribed medication abroad (n = 4208) reported problems, spanning unknown products, dispensation and reimbursement. Information exchange between providers across borders was rare and largely carried out by the patients themselves. CONCLUSIONS: Although relational continuity may be important to specific groups of patients travelling for care, it is primarily informational continuity and its interrelation with management continuity that need to be addressed in the cross-border context. Information exchange should be endorsed at European level. Additional focus is required on informing patients about documentation rights and requirements and providing health records that are comprehensive and comprehensible.
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Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Turismo Médico/estatística & dados numéricos , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Europa (Continente) , Feminino , Alemanha , Humanos , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Medicamentos sob Prescrição , Relações Profissional-PacienteRESUMO
AIMS: Based on an analysis of claims-based data of 8.298 million members of two German statutory health insurance funds, the aim of this contribution is to quantify age-/gender-specific prevalence/incidence of atrial fibrillation (AF) in a German setting. METHODS AND RESULTS: Patients were classified as AF prevalent, if they had received at least two outpatient diagnoses of AF (ICD10-Code I48.1-) in two different quarters of the year and/or had received at least one main AF diagnosis during inpatient treatment between 1 January 2007 and 12 December 2008. They were considered to have had new onset AF in 2008 under the following conditions; first, there was no AF diagnosis in 2007; secondly, patients had not received oral anticoagulant medication in 2007; and thirdly, patients had received either one inpatient/two outpatient diagnoses of AF in 2008. In our sample, a total of 176 891 patients had AF. AF prevalence was 2.132%. The average age of these AF patients was 73.1 years, and 55.5% (98 190 patients) were male. The incidence of AF in our sample was 4.358 cases/1000 person-years in men and 3.868 cases/1000 person-years in women. CONCLUSION: A comparison of the distribution of AF prevalence/incidence in our population with that in already published studies showed that our figures were higher, especially in the age groups above 70 years. Our data show that in a large industrial nation such as Germany care provision structures are going to be challenged by a requirement to treat more AF patients in the future.
Assuntos
Fibrilação Atrial/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Fatores de Tempo , Adulto JovemRESUMO
OBJECTIVE: Data on fracture frequency and medical care of patients with osteoporosis are still insufficient. We aimed to analyze frequency of osteoporosis-related fractures and multiple fractures, re-fracture rates, treatment prevalence, and persistence to osteoporosis-related medication in Germany. METHODS AND MATERIALS: Using claims data of a state health insurer (2006 - 2009), we performed a retrospective "real world" analysis. Inclusion criteria were age of 50 years or older and an osteoporosis diagnosis or a prescription for defined osteoporosis-related medication. We assessed fractures, frequencies, and the number of multiple fractures per patient as well as time to follow-up fracture and drug persistence using Kaplan-Meier analysis. RESULTS: Within the observation period, 27% of the osteoporosis patients sustained fractures; of those with fractures, 69% had multiple fractures. For patients with multiple fractures, re-fracture rate after 360 days was between 69% for patients who received parathyroid hormone and 85% for patients who received no anti-osteoporotic medication 360 days before follow-up fracture. In the patient population, persistence rates after 1 year were between 58% for parathyroid hormone and 2% for other osteoporosis-specific drugs (alfacalcidol, fluorides, nandrolone, calcitonin). CONCLUSIONS: In Germany, the number of patients with osteoporosis-attributable fractures is high. There are still deficits in proper treatment as well as in drug persistence. Low persistence lead to a relatively high proportion of patients with follow-up fractures.
Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/epidemiologia , Idoso , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Assistência ao Paciente , Estudos RetrospectivosRESUMO
BACKGROUND: Society benefits on a large scale from improved medical care and pharmaceuticals. The prescription of pharmaceuticals, however, also carries risks such as the possibility of an increased hazard of falls, which may lead to severe injuries and increased health expenditures associated with these injuries. This study investigates the relationship of several fall risk increasing drugs (FRIDs) and injuries of elderly persons using multivariate regression models. METHOD: Routine data from the Techniker Krankenkasse of frail elderly persons aged ≥ 65 years is analysed for the year 2009 by estimating count data models, in order to take the data generating process of the number of injuries into account. The results of this model are compared to those from logistic regressions, which is the default regression model in this field of research. RESULTS: The empirical results suggest that the incidence of injuries strongly increases with doses of antidepressants, anxiolytics, hypnotics and sedatives, antiarrhythmics and drugs from the Priscus-list. However, antihypertensives and antiparkinsonian agents show no significant association and neuroleptics indicate a significant negative association. CONCLUSION: As recurrent injuries are common, the analysis of the number of injuries rather than just the probability of having an injury provides a more informative analysis of FRIDs. According to the empirical results, antidepressants, anxiolytics, hypnotics and sedatives, antiarrhythmics as well as drugs from the Priscus-list should be prescribed carefully, because these drugs are positively correlated with the incidence of injuries.
Assuntos
Acidentes por Quedas , Idoso Fragilizado , Ferimentos e Lesões/epidemiologia , Idoso , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , RiscoRESUMO
BACKGROUND: The statutory health insurance system embodies a large amount of data on the treatments of their members. Depending on joint, prosthesis type, patient activity and comorbidity, knee and hip replacements can last up to 20 years. Based on statutory health insurance data the main object of this analysis was to investigate how high the early revision rate of replacements actually is. METHODS: The number of replacements in the years 2005 and 2006 has been extracted from the TK database for hip (OPS-Code 5-820, n = 20,875), knee (OPS 5-822, n = 13,466), upper limbs (OPS 5-824, n = 901), and lower limbs (OPS 5-826) replacements. This data has then been related to each consecutive operation (i. e. change or excision of joint endoprosthesis) over a joint-specific observation period of two years. RESULTS: In 3.7% of the cases joint replacements stood for less than 2 years (hip 3.5%, knee 3.8%, upper limbs 6.5%, and lower limbs 5.5%). There is a significantly positive correlation between the treatment data of the hospitals and the outcome as to low rates of reoperations at early stages. The main reason for short lifetime (76 - 81%) is mechanical failure. CONCLUSION: The percentage of joint endoprostheses with significantly short lifetimes has been unexpectedly high. The de facto lifetimes of joint endoprostheses thus often do not match the manufacturers' information. The authors strongly support the idea of a national endoprosthesis register as such a register could give detailed information on firstly whether these deficits are due to material defects, osteolysis or dislocation and secondly which products are mainly affected.
Assuntos
Artroplastia de Quadril/instrumentação , Artroplastia do Joelho/instrumentação , Remoção de Dispositivo , Prótese de Quadril , Prótese do Joelho , Programas Nacionais de Saúde , Falha de Prótese , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Sistema de Registros , Reoperação , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Evidence-based patient information (EBPI) has been recognised as important tool for informed choice in particular in the matter of preventive options. An objective, on the best scientific evidence-based consumer information about subthreshold elevated blood glucose levels (impaired fasting glucose and impaired glucose tolerance) and primary prevention of diabetes, is not available yet. Thus we developed a web-based EBPI and aim to evaluate its effects on informed decision making in people 50 years or older. METHODS/DESIGN: We conduct a web-based randomised-controlled trial to evaluate the effect of information about elevated blood glucose levels and diabetes primary prevention on five specific outcomes: (i) knowledge of elevated blood glucose level-related issues (primary outcome); (ii) attitudes to a metabolic testing; (iii) intention to undergo a metabolic testing; (iv) decision conflict; (v) satisfaction with the information. The intervention group receives a specially developed EBPI about subthreshold elevated blood glucose levels and diabetes primary prevention, the control group information about this topic, available in the internet.The study population consists of people between 50 and 69 years of age without known diabetes. Participants will be recruited via the internet page of the cooperating health insurance company, Techniker Krankenkasse (TK), and the internet page of the German Diabetes Centre. Outcomes will be measured through online questionnaires. We expect better informed participants in the intervention group. DISCUSSION: The design of this study may be a prototype for other web-based prevention information and their evaluation. TRIAL REGISTRATION: Current Controlled Trial: ISRCTN22060616.
Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto , Prevenção Primária/métodos , Idoso , Automonitorização da Glicemia , Interpretação Estatística de Dados , Diabetes Mellitus Tipo 2/diagnóstico , Medicina Baseada em Evidências , Feminino , Alemanha , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Avaliação de Programas e Projetos de SaúdeRESUMO
BACKGROUND: Innovative technologies challenge healthcare systems, as evidence on costs and benefits frequently usually are slow to reflect new technology. We investigated these dynamics for Germany, using the emergence of transcatheter aortic valve implementation (TAVI) as an alternative to conventional aortic valve replacements (CAVR). OBJECTIVE: We focused on the role of patient co-morbidity-which would be a medical explanation for adopting TAVI-and hospital ownership status, hypothesizing that for-profit facilities are more likely to capitalize on the favorable reimbursement conditions of TAVI. METHODS: The analysis uses claims data from the Techniker Krankenkasse, the largest health insurance fund in Germany, for the years 2009-2015, covering 2892 patients with TAVI and 9523 with CAVR. The decision on TAVI versus CAVR was estimated for patient-level data, that is, socioeconomic data as well as co-morbidity. At the hospital level, we included the ownership type. We also controlled for effects of the respective owner (rather than the type of ownership), including a random intercept. RESULTS: While the co-morbidity score of TAVI patients was much higher in the early years, over time, the score almost converged with that of CAVR patients. This is in agreement with emerging evidence that suggests the use of TAVI also leads to better patient outcomes. Our results indicate that the type of ownership does not drive the switch to TAVI. We found little, if any, effect from the respective owner, regardless of ownership type. CONCLUSION: Overall, the effects of co-morbidity suggest that providers acted responsibly when adopting TAVI while evidence was still emerging.
Assuntos
Estenose da Valva Aórtica/cirurgia , Hospitais com Fins Lucrativos/estatística & dados numéricos , Hospitais Filantrópicos/provisão & distribuição , Substituição da Valva Aórtica Transcateter , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/epidemiologia , Comorbidade , Feminino , Alemanha , Implante de Prótese de Valva Cardíaca/economia , Implante de Prótese de Valva Cardíaca/métodos , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Mecanismo de Reembolso/economia , Mecanismo de Reembolso/estatística & dados numéricos , Substituição da Valva Aórtica Transcateter/economia , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Resultado do TratamentoRESUMO
Hazardous alcohol consumption in Germany is a main threat to health. By using insurance claim data from the German Statutory Health Insurance and a classification strategy based on ICD10 diagnoses-codes we analyzed a sample of 146,000 subjects with more than 19,000 hazardous alcohol consumers. Employing different regression models with a control function approach, we calculate life years lost due to alcohol consumption, annual direct and indirect health costs, and the burden of pain and suffering measured by the Charlson-Index and assessed pain diagnoses. Additionally, we simulate the net accumulated premium payments over expenses in the German Statutory Health Insurance and the Statutory Pension Fund for hazardous alcohol consumers from a lifecycle perspective. In total, 39.3 billion each year result from hazardous alcohol consumption with an average loss of 7 years in life expectancy. Hazardous alcohol consumers clearly do not "pay their way" in the two main German social security systems and also display a higher intangible burden according to our definitions of pain and suffering.
Assuntos
Alcoolismo/economia , Efeitos Psicossociais da Doença , Gastos em Saúde/estatística & dados numéricos , Acidentes/economia , Alcoolismo/complicações , Alcoolismo/reabilitação , Custos e Análise de Custo , Feminino , Alemanha , Humanos , Expectativa de Vida , Masculino , Pensões/estatística & dados numéricos , Prevalência , Aposentadoria/economia , Licença Médica/economia , Desemprego/estatística & dados numéricosRESUMO
The implementation of a graded return-to-work (RTW) program to reintegrate the long-term sick started in Germany in 1971 and has been manifested in the Social Code Book V since 1989. Based on a return plan by the physician and the insured, participants increase their working hours slowly over a specified period of time. As participants are still classified as incapable of working they still receive sick leave benefits. Using claims data from the Techniker Krankenkasse, the largest German sickness fund, the study aims at identifying participants and analyzing the full return-to-work and the impact of the RTW program. Thereby, we account for socio-economic factors, insurance-based characteristics, and medical and health-related information. We consider a possible selection bias by using individual weights to analyze determinants of length of the sickness absence by applying models for survival analysis (Cox proportional hazard model). As a main result - depending on the central assumption of unconfoundedness - sickness absence is positively related to participation in the RTW program for those with sickness absence longer than 120 days. For mental disorders, our results indicate an even stronger effect. The study results emphasize the need further promotion of this instrument among those insured, physicians and employers, as occupational health management is one key for a successful return-to-work.
Assuntos
Nível de Saúde , Modelos Econométricos , Retorno ao Trabalho/economia , Licença Médica/economia , Adulto , Feminino , Alemanha , Hospitalização/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores SocioeconômicosRESUMO
The implementation of a graded return-to-work (RTW) program to reintegrate those in long-term sickness started in Germany in 1971. Based on a return plan by the physician and insured, participants increase their working hours slowly over a specified period of time. Using data on sick leaves from claims data of the Techniker Krankenkasse, we consider sick-leave spells starting from October 2010 to January 2011 with a successful return to work within 517 days. We applied a propensity score matching between participants and non-participants to further analyze differences in sickness spells, medical demand and treatment costs in a follow-up period of 540 days and hence estimate the average treatment effect on the treated (ATT) for the RTW participation with respect to sickness time, sickness benefits and medical expenditures. We found significant but rather small differences in medical costs between treatment and control group. In detail, RTW participants showed slightly lower expenditures on hospitals but higher for ambulatory services and pharmaceuticals. Moreover, differences in expenditure were related to the condition of the initial sickness spell. Reasons behind this findings may be a different perception of the own health care status and a higher need for medical services. Overall, our findings differ between diagnosis groups of the initial sickness period.
Assuntos
Gastos em Saúde/estatística & dados numéricos , Retorno ao Trabalho/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Adulto , Seguimentos , Alemanha , Humanos , Pessoa de Meia-IdadeRESUMO
With the steadily growing health burden of obesity in Germany, the measuring and quantification of its costs and relevant economic consequences have become increasingly important. The usual quantifications via previous cost-of-illness approaches mostly have several weaknesses, e.g., applying "indirect methods" by using "population-attributable fractions" to identify parts of costs that can be accrued to obesity, second using highly aggregated data and third often only displaying part of the costs. This article presents a new approach and a new estimation of the cost and consequences of obesity in Germany using claims data from a German health insurance company. A sample of 146,000 individuals was analyzed with both a prevalence and a life-cycle focus on the cost and consequences of obesity. With additional data sets, we calculate the deaths per year due to obesity, the excess costs per year and several intangible consequences usually referred to as "pain and suffering". Our results show that the cost estimations of obesity in Germany so far have been largely underestimated. The annual direct costs of obesity in Germany amount to approximately 29.39 billion and the indirect costs to an additional 33.65 billion. A total of 102,000 subjects die prematurely each year because of obesity, and there is a significant excess of unemployment, long-term nursing care, and pain and suffering due to obesity. From a lifetime perspective, every obese man is equal to an additional burden of 166,911 and each woman of 206,526 for the social security system in Germany. Obesity due to unhealthy eating is thus about to replace tobacco consumption in terms of costs and consequences as the main hazardous lifestyle factor and thus should be more intensively focussed by public health policy.
Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Obesidade/economia , Adulto , Índice de Massa Corporal , Comorbidade , Feminino , Alemanha/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde , Humanos , Seguro Saúde , Masculino , Obesidade/epidemiologia , Pensões , Prevalência , Análise de Regressão , Licença Médica/economia , Análise de Sobrevida , DesempregoRESUMO
AIMS: The aim was to assess whether the use of additional data from the Disease Management Program (DMP) diabetes mellitus type 2 to minimize the potential for residual confounding will alter the estimated risk of either myocardial infarction, ischemic stroke or heart failure in patients with type 2 diabetes using sulfonylureas compared to dipeptidyl peptidase-4 (DPP-4) inhibitors in addition to metformin based on routine health care data. METHODS: We conducted a nested two-phase case-control study using claims data of one German health insurance from 2004 to 2013 (phase 1) and data of the DMP from 2010 to 2013 (phase 2). Adjusted odds ratios (ORs) for the combined cardiovascular event myocardial infarction, ischemic stroke or heart failure were calculated using a two-phase logistic regression. RESULTS: Phase 1 comprised 3179 patients (289 cases; 2890 controls) and phase 2 comprised 1968 patients (168 cases; 1800 controls). We observed an adjusted OR of 0.83 for the combined cardiovascular event (95% CI: 0.61-1.13). CONCLUSIONS: We observed a non-significantly reduced risk for cardiovascular diseases in patients using DPP-4 inhibitors compared to sulfonylureas in addition to metformin. This finding was not altered by the inclusion of additional information of the DMP in the analysis. However, due to the low power of this study, further studies are needed to reproduce our findings.
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Doenças Cardiovasculares/epidemiologia , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Compostos de Sulfonilureia/uso terapêutico , Idoso , Isquemia Encefálica/epidemiologia , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/tratamento farmacológico , Dipeptidil Peptidases e Tripeptidil Peptidases , Quimioterapia Combinada/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/epidemiologiaRESUMO
OBJECTIVE: While Directive 2011/24/EU on cross-border patient mobility makes specific provisions in relation to information availability and accessibility, little empirical evidence exists to guide best practice. This paper explores the information-seeking behaviour of German patients who received planned care abroad. METHODS: A postal survey among German patients treated in other European countries was carried out by Techniker Krankenkasse, a major German sickness fund. The influence of certain predictors on whether patients informed themselves before travelling for care was investigated using multiple logistic regression. Types and sources of information were analysed using descriptive statistics. RESULTS: Information activity was contingent on patients' level of education, type of service, regularity of treatment abroad and awareness of entitlement to cross-border services. Respondents most frequently enquired about elements of reimbursement, entitlement to services and cost-saving, and consulted their sickness fund for information. Differences in both content and medium of choice were observed between patient groups. CONCLUSION: A structured and inclusive approach to information provision should be adopted. National Contact Points should collaborate with a range of stakeholders, who will vary depending on the health care system; however, patient organizations, health professionals and third-party payers should always be represented. Dynamically monitoring cross-border movements can help determine the range, medium and language of relevant information.
Assuntos
Comportamento de Busca de Informação , Conhecimento , Turismo Médico/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Conscientização , Escolaridade , Europa (Continente) , Feminino , Alemanha , Humanos , Reembolso de Seguro de Saúde , Masculino , Pessoa de Meia-Idade , Satisfação do PacienteRESUMO
BACKGROUND AND OBJECTIVES: The costs and treatment patterns of attention deficit hyperactivity disorder (ADHD) are subjects of health services research in Germany and worldwide. Previous publications focused mainly on prevalent patients and thus research gaps were identified regarding costs and treatment patterns of incident patients before and after the first diagnosis. METHODS: Analyses were conducted using claims data obtained from a large German sickness fund (Techniker Krankenkasse). Inclusion criteria consisted of patients with at least two secured outpatient or one inpatient ADHD diagnosis in 2007. Incidence was ensured by defining a baseline period without ADHD-diagnosis in 2006. In addition to diseaserelated cost analyses compared to a control group including age group comparisons, comorbidities, the proportion of multimodal treatment and medication treatment patterns were described. RESULTS: In total, 9083 newly diagnosed ADHD patients were identified (73 % male; mean age: 12.9 years (SD: 10.3)). The mean total cost of ADHD patients during the year after the first diagnosis exceeded the mean total cost of the year before by 976 (Differencein-Difference-estimator: 1006 ). Our analyses have shown that 10 % of ADHD patients have been treated with multimodal therapy. In addition, 11 % of the investigated ADHD population have received methylphenidate or atomoxetine preceeding the date of diagnosis in the relevant observation period. DISCUSSION: This study provides important insights into the costs as well as the treatment patterns of incident ADHD patients. ADHD-related costs and medications can be identified prior to the date of the first ADHD diagnosis. Although, multimodal therapy is presented as an optimal treatment option by many international guidelines and experts, its proportion for treatment is low (10 %). Further research is necessary to identify reasons for the low proportion of multimodal therapy and (cost-)effectiveness has to be evaluated in comparison to other treatment options. In addition, ADHD-related costs could be identified before the first diagnosis is documented. The reasons for medication prior to diagnosis have to be further investigated.
RESUMO
OBJECTIVES: A common characteristic of sending countries in cross-border dental care is that of high costs and/or high copayments for dental services. This study aims to provide an insight into the characteristics of German patients receiving planned and emergency (unplanned) dental care abroad and their satisfaction with received services. METHODS: The Europabefragung is a postal survey carried out by Techniker Krankenkasse for patients who are treated in EU/EEA countries. This study uses data from the Europabefragung 2012. The survey was sent to 45 189 individuals; descriptive statistics for the subset of respondents who received emergency (unplanned) or planned dental treatment are presented. RESULTS: There were 18 339 responses to the questionnaire, out of which 17 543 were deemed valid; 1416 respondents had received emergency (unplanned) (78%) or planned (22%) dental care and were included in the analysis. There were clear differences between unplanned and planned treatments regarding country and type of treatment as well as satisfaction with different aspects of treatment and the need for follow-up care. Overall, satisfaction with treatment was high for both groups; individuals who had received planned treatment were more satisfied on all aspects of care and reported a need for follow-up care less frequently. CONCLUSIONS: While German patients who received both emergency (unplanned) and planned services abroad are mostly satisfied with their experience, some concerns arise with regard to continuity of care. Types of information provided to patients seeking care abroad and dissemination modalities should be carefully planned.
Assuntos
Assistência Odontológica/estatística & dados numéricos , Viagem , Idoso , Continuidade da Assistência ao Paciente , Assistência Odontológica/economia , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Alemanha/etnologia , Custos de Cuidados de Saúde , Humanos , Masculino , Turismo Médico/economia , Turismo Médico/estatística & dados numéricos , Pessoa de Meia-Idade , Satisfação do Paciente , Fatores Socioeconômicos , Inquéritos e Questionários , Viagem/estatística & dados numéricosRESUMO
BACKGROUND: The responsiveness of a health system is considered to be an intrinsic goal of health systems and an essential aspect in performance assessment. Numerous studies have analysed health system responsiveness and related concepts, especially across different countries and health systems. However, fewer studies have applied the concept for the evaluation of specific healthcare delivery structures and thoroughly analysed its determinants within one country. The aims of this study are to assess the level of perceived health system responsiveness to patients with chronic diseases in ambulatory care in Germany and to analyse the determinants of health system responsiveness as well as its distribution across different population groups. METHODS AND ANALYSIS: The target population consists of chronically ill people in Germany, with a focus on patients suffering from type 2 diabetes and/or from coronary heart disease (CHD). Data comes from two different sources: (i) cross-sectional survey data from a postal survey and (ii) claims data from a German sickness fund. Data from both sources will be linked at an individual-level. The postal survey has the purpose of measuring perceived health system responsiveness, health related quality of life, experiences with disease management programmes (DMPs) and (subjective) socioeconomic background. The claims data consists of information on (co)morbidities, service utilization, enrolment within a DMP and sociodemographic characteristics, including the type of residential area. DISCUSSION: RAC is one of the first projects linking survey data on health system responsiveness at individual level with claims data. With this unique database, it will be possible to comprehensively analyse determinants of health system responsiveness and its relation to other aspects of health system performance assessment. The results of the project will allow German health system decision-makers to assess the performance of nonclinical aspects of healthcare delivery and their determinants in two important areas of health policy: in ambulatory and chronic disease care.