Multimodal Approaches in the Treatment of Chronic Peripheral Neuropathy-Evidence from Germany.

Patients with chronic peripheral neuropathy suffer greatly and their quality of life is often restricted. Drug therapy can be accompanied by undesirable side effects and intolerances, or the hoped-for effect does not materialize. Therefore, in addition to drug therapy, attempts are also made to treat the physical symptoms with complementary procedures. In the case of severe forms, the search for a suitable form of therapy is difficult. Complex treatments can be an innovative way to treat peripheral neuropathy. At the same time, several different therapy methods are carried out at high frequency by a specialized treatment team. This study aimed to provide an overview of possible complementary forms of therapy. The focus was on a comparison of two interdisciplinary complex therapies that are used in severe cases in an acute inpatient care setting in Germany. The six dimensions (energy, sleep, pain, physicality, emotional response and social isolation) of the Nottingham Health Profile (NHP) were used to assess quality of life. Both complex treatments (naturopathic complex therapy/multimodal pain therapy) showed a significant reduction in impairment in all dimensions of the NHP. In addition, a multivariate analysis was carried out to take into account several influencing variables at the same time. At the time of admission to the hospital, the degree of chronicity was recorded for each patient. This allowed statements to be made about the effect of the respective therapy depending on the chronification stage of the patient. It has been shown that patients with acutely exacerbated pain with the highest degree of chronicity also benefit from both complex treatments. The naturopathic complex treatment gives the treatment team more options. Aspects such as nutrition, methods from phytotherapy and traditional Chinese medicine can be integrated into inpatient care. Thus, a patient-centered, holistic therapy can take place. However, an interdisciplinary holistic therapy requires more time for both the practitioner and the patient. This should be taken into account in the health systems in the context of the diagnosis related groups.

Patient-Reported Outcomes Following Inpatient Multimodal Treatment Approach in Chronic Pain-Related Rheumatic Diseases.

INTRODUCTION: Musculoskeletal disorders may cause chronic pain, which is associated with deterioration in physical well-being, functions, and quality of life. There are worldwide shortfalls in the care that is provided to the affected patients. Holistic, interdisciplinary care is rare. Monomodal therapeutic approaches dominate when health-care resources are scarce. In this study, we test the patient-relevant outcomes of multimodal treatment for rheumatic diseases that are associated with pain and check for remuneration. METHODS: We performed a retrospective data analysis of an inpatient multimodal treatment. The target parameter was the patient perspective, which we assessed by means of Patient-Reported Outcomes (PRO). We applied the Visual Analogue Scale (mental and physical condition), the Heidelberg Short Early Risk Assessment Questionnaire, the Pain Disability Index, and the pain grading according to Kohlmann/Raspe (N = 375 patients). We also investigated compensation for inpatient treatments with and without multimodal treatments. Moreover, we compared Diagnosis-Related Group remuneration with and without complex treatment. RESULTS: After implementing a multimodal treatment, improved mental (mood) status was significantly better (Wilcoxon signed-rank test, P < . 001), despite high levels of pain (Kohlmann/Raspe) reported on admission. Apart from the underlying rheumatic disease, 111 patients also reported chronic back pain, which was improved following the treatment (t test, P < . 001). Subjective impairments associated with pain were significantly lower at the end of the hospital stay (Wilcoxon signed-rank test, P < . 001). Compensation for inpatient treatments with multimodal treatments increased noticeably in German hospitals in 2016 to 2019, while remunerations for monomodal treatments show mixed results. CONCLUSION: PROs regarding mood, pain, and perceived impairments improved following the multimodal complex treatment. Compensation of hospitals should take into account additional performance requirements of holistic treatments, whereby the promotion and further studies of PROs are recommended.

Long-Term Impact of Disasters on the Public Health System: A Multi-Case Analysis.

As past events have shown, disasters can have a tremendous impact on the affected population's health. However, research regarding the long-term impact on a systems level perspective is still scarce. In this multi-case study, we analyzed and compared the long-term impacts on the public health system of five disasters which took place in Europe: avalanche (Austria), terror attack (Spain), airplane crash (Luxembourg), cable-car tunnel fire (Austria), and a flood in Central Europe. We used a mixed-methods approach consisting of a document analysis and interviews with key stakeholders, to examine the various long-term impacts each of the disasters had on health-system performance, as well as on security and health protection. The results show manifold changes undertaken in the fields of psychosocial support, infrastructure, and contingency and preparedness planning. The holistic approach of this study shows the importance of analyzing long-term impacts from the perspective of the type (e.g., disasters associated with natural hazards) and characteristic (e.g., duration and extent) of a disaster, as well as the regional context where a disaster took place. However, the identified recurring themes demonstrate the opportunity of learning from case studies in order to customize the lessons and apply them to the own-disaster-management setting.

Nature Relatedness of Recreational Horseback Riders and Its Association with Mood and Wellbeing.

Connectedness to nature and nature contact can provide many benefits to humans, like stress reduction, recovery from illness, and increased positive emotions. Likewise, recreational horseback riding is a widespread sports activity with the potential to enhance physical and psychological health. Yet, the influence of connectedness to nature on the wellbeing of older aged recreational horseback riders has not been investigated so far. The aim of the present study therefore was to explore the relationship between nature relatedness and physical, psychological and social wellbeing and happiness. The study sample was composed of Austrian recreational horseback riders aged 45 years and older, who were compared with dog owners and people without pets (n = 178). We found significantly higher nature relatedness, significantly higher overall wellbeing and a significantly better mood rating in recreational horseback riders compared to people without pets and similar scores compared to dog owners. Physical wellbeing is correlated with overall nature relatedness in horseback riders and dog owners, but no correlation was found in people without pets. A structural equation model shows a direct relationship between nature relatedness and mood in horseback riders and an indirect relationship through pet attachment in dog owners. The results suggest the activity with horses and dogs in nature environments is a source of wellbeing, enjoyment, self-confidence and social contacts.

Interdisciplinary assessment-oriented treatment of fibromyalgia: a case report.

Patients with fibromyalgia (FM) have often tried many outpatient treatments, and breakthrough pain frequently stops them from performing everyday tasks and participating in society. FM-pain that has become chronic, therefore, affects quality of life. This case study describes the administration of interdisciplinary inpatient pain therapy due to a primary diagnosis of fibromyalgia with integrated complementary medicine. The female patient, who had several concomitant disorders and had been suffering from pain for many years, benefited from the holistic treatment approach in terms of a reduction in pain and an improvement in physical functions and mental health. The ability to have a positive effect on pain symptoms in the longer term is essential. Compliance with the treatments used should also be improved, so that a healthier lifestyle and better pain management can continue after discharge from hospital. These results are supported by other study results and should provide the impetus for major studies to evaluate holistic pain therapies in FM.

Levels of Patient Satisfaction on Integrative Medicine Before and After Implementation of Diagnosis-related Groups.

OBJECTIVES: The aim of this article is to study patient satisfaction with complementary and alternative medicine (CAM) in an in-hospital setting before and after the introduction of diagnosis-related groups (DRGs). METHODS: Patients were interviewed regarding a general evaluation of their hospital stay, the psychological talking therapy, the nutrition therapy, and the overall success of the treatment. RESULTS: The medical treatment was evaluated by 1158 patients. A very good success was reported by 347, a good by 609, a moderate by 181, and none by 21 patients. DRG implementation showed no significant effects. Psychological talking therapy was evaluated as "very good" (P ≤ .05). With regard to the success of the medical talking and nutrition therapy, there were no significant differences (P ≥ .05) between the time before and after DRG implementation. CONCLUSION: Broadening conventional medical treatment with CAM practices can lead to a parallel treatment of DRGs in hospitals working with complementary medicine. This results in very patient-centered therapies, which may impact patient satisfaction.

Integration of naturopathic medicine into acute inpatient care: An approach for patient-centred medicine under diagnosis-related groups.

BACKGROUND: The integration of naturopathic methods into acute inpatient care has been the subject of very few scientific studies. Patient expectations of the service received in hospital are increasing, and the integration of naturopathy into clinical practice can serve as Unique Selling Proposition. MATERIALS AND METHODS: The present study was conducted over a period of two years. In total, over 1700 patients were included in the study. The setting is an acute hospital specialising in a multimodal, patient-centred approach to treatment. Patient satisfaction with the use of holistic care, patient perception of adherence to treatment and the amount of time care staff spend with patients were all investigated. The patients' principal diagnoses were also recorded using the DRG classification system, as were the number of concomitant diseases and the length of their stay in hospital. RESULTS: The majority of patients rate the integration of complementary care in the acute hospital very positively. The effects on patient perception of adherence to treatment and the amount of time care staff spend with patients are also assessed positively. At the same time, we can see that patients who receive patient-centred care in this study predominantly suffer from diseases and disorders of the musculoskeletal system and connective tissue, diseases of the nervous system and mental diseases and disorders. They also have numerous concomitant diseases. CONCLUSIONS: It could be shown that patients are very satisfied with the combination of naturopathy and academic medicine and with approaches that take patient preferences into account. Integrating naturopathy can be considered for multimorbid patients, in particular. Moreover, patient-centred care can improve staff satisfaction levels.

Fibromyalgia with severe forms of progression in a multidisciplinary therapy setting with emphasis on hyperthermia therapy--a prospective controlled study.

INTRODUCTION: Fibromyalgia syndrome (FMS) is a multi-factorial disease involving physiological as well as psychological factors. The aim of the study was to investigate a multidisciplinary inpatient treatment with emphasis on hyperthermia therapy by patients with widespread pain. MATERIALS AND METHODS: The study involved 104 patients suffering from severely progressive FMS. A convenience sample and a prospective cohort design were used. The patients were treated in an acute hospital focusing on rheumatologic pain therapy and multidisciplinary complementary medicine. One patient group was treated with inclusion of hyperthermia therapy and the other group without. The therapy density (number of performed therapies per patient) was determined for every patient. Functional capacity measured by the Hannover functional status questionnaire (Funktionsfragebogen Hannover) and symptoms (von Zerssen complaint list) were analyzed for both groups on admission and on discharge. RESULTS: On admission, no significant difference could be established between control group (CG; multimodal without hyperthermia) and hyperthermia group (HG; multimodal with hyperthermia) (functional capacity, P=0.936). Functional capacity improved for the CG and the HG. On discharge, there was a significant difference between the two groups (functional capacity, P=0.039). There were no significant differences in fibromyalgia symptoms between CG (mean 41.8) and HG (mean 41.8) on their admission to hospital (P=0.988). On discharge, there was a significant difference (P=0.024) between the two groups (HG, mean 30.6; CG, mean 36.6). The inpatient therapy of patients with severely progressive fibromyalgia is characterized by a high frequency of therapy input. CONCLUSION: FMS, especially with severe progression and a high degree of chronification, demands a multidisciplinary approach. In addition to the use of complementary medical procedures, integration of hyperthermia in the treatment process is a useful option.

Evidence-based complementary and alternative medicine in inpatient care: take a look at Europe.

The aim of this report is to provide the reader an overview of the complex therapy currently used within the German health system. Complex therapies in inpatient care in Germany establish the basis for an integrative and interdisciplinary provision of services. They define minimal criteria for the organization of a hospital, enable the integration of different therapeutic approaches, and therefore, lead to an intensive and holistic treatment by a specially trained team. The German model can be viewed as a pilot program for the introduction of integrative patient-centered care in other hospitals around the world.

Inpatient hospital costs and length of stay for the treatment of affective and somatoform disorders - evidence from Germany.

INTRODUCTION: Diagnosis related costs analyses are the subject of science and research and are of great relevance and importance for decision makers in the hospital and for funding bodies, but also for international health policy. Up to now, standardized costs analyses with valid costs data have not been available for inpatient care of patients with affective and somatoform disorders. BACKGROUND: This clinical picture presents a major challenge for the provision of outpatient and inpatient care. An interdisciplinary approach in an inpatient setting can be beneficial for already "chronified" patients with severe forms of progression. Because of its structural and procedural demands, this type of care is associated with a greater expenditure of resources. METHODS: Costs data from the years 2008 to 2012 were analyzed for a total of 17,424 hospitalized patients in more than 200 different hospitals in Germany. The study compared the costs of treating patients with the main diagnosis affective and somatoform disorders using standardized interdisciplinary therapy, with the costs of conventional therapy. RESULTS: Interdisciplinary patient care is characterized by a high proportion of the costs derived from the structural and procedural implementation and the medical and nursing care. For interdisciplinary therapy with a mean period of hospitalization of 15.2 days, over 60% of the total costs were incurred by the personnel and material costs of the medical and non-medical infrastructure. The outlay is considerably greater than would be incurred by a conventional therapeutic approach without interdisciplinary therapy. DISCUSSION AND CONCLUSION: For the first time, detailed diagnosis-related costs data are published which were generated by consistent, standardized cost unit accounting. An interdisciplinary, holistic approach to the clinical picture results in a significant increase in costs for the hospitals.

Physiotherapy as one column of an integrative and interdisciplinary medical approach--impact of the introduction of diagnosis related groups in Germany.

OBJECTIVES: To investigate the introduction of case tariff fee remuneration - as required by the current system - and its influence on patient satisfaction with the provision of physiotherapeutic treatment in an acute hospital aligned on a holistic, interdisciplinary therapeutic approach. DESIGN AND SETTING: Randomised controlled study with a total of 4598 patients were interviewed. No case tariff fee system was used during the years 2004 to 2006. The data were compared with the results of interviews that took place during 2007 and 2008 (use of DRGs). The results of this study are based on the largest survey performed to date of patient satisfaction with physiotherapeutic treatment in acute care focusing on a holistic interdisciplinary approach. In-patients being treated under DRG conditions were compared with a control group for whom the DRG system had not been applied. OUTCOME MEASURES: The target parameter of the study, which took more than five years, was the determination of patient satisfaction with the physiotherapeutic interventions. RESULTS: There were no significant differences between the two groups in respect of satisfaction with the physiotherapeutic treatments received. Regarding the outcome parameter encouragement to take more exercise, a significant change could be demonstrated under DRG conditions. CONCLUSIONS: Physiotherapeutic interventions play an important role in the provision of interdisciplinary care. In particular, the holistic perception of the patient, the interdisciplinary approach to complex diseases, and the requirements of the DRG system on the care provider can exert a positive influence on outcome quality.

Economic aspects of nursing in inpatient naturopathy: vidence from Germany.

The costs of nursing in Germany are defined in terms of "nursing-relevant secondary diagnoses." However, the further development of the German-DRG system reveals nursing diagnoses play a constantly declining role with regard to increasing severity and revenue assurance. In particular, additional therapeutic nursing services performed, for example, by specially trained, certified nurses in acute hospitals focusing on naturopathy are not adequately defined. In this study, researchers analyzed naturopathic care, especially the nursing costs for inpatient care of multi-morbid cardiac patients, with a particular focus on a holistic, comprehensive treatment. Results indicated the nursing costs in an inpatient acute hospital with a naturopathic focus are significantly higher than nursing costs in hospitals operating exclusively according to conventional medicine. Questions about adequate determination of the costs of DRGs for professional groups such as the nursing service need to be addressed.

A study of costs and length of stay of inpatient naturopathy--evidence from Germany.

BACKGROUND: Classical naturopathy in an acute, inpatient, internal medicine setting is rare in Germany. Procedure 8-975 regulates the structures and processes for providing naturopathic complex therapy in German hospitals. An interdisciplinary team is required to provide therapy from at least five therapeutic areas of classical naturopathy, all applied within a narrow time-frame. The entry criteria for being entitled to receive naturopathy in an acute hospital depend upon the degree of chronicity, the intensity of the symptoms and the complexity of the disease. METHODS: In the present study, a total of 918 patients who received naturopathic complex therapy were investigated regarding their clinical picture and the length of their stay in hospital. RESULTS: The results showed that the duration of hospitalization was significantly greater than that of the comparison group of patients (cases from 263 German hospitals) receiving purely internal medical treatment in hospitals at national level.