[Dialysis care in Germany - demand, outpatient care and challenges]. / Dialyseversorgung in Deutschland : Bedarf, Angebot und Herausforderungen.

BACKGROUND: Dialysis is the mostly used renal replacement therapy in patients with end-stage renal disease. The aim of the study was to analyze the present dialysis care system and to scrutinize future changes regarding the need of dialysis as well as the system of care. METHODS: The study is based on a structured literature search in Pubmed; selecting relevant studies by predefined criteria. Prevalence of ESRD and the share of nephrologists in outpatient care were modeled until 2020. Guideline-based interviews with experts including a two-round Delphi survey were conducted to identify options for action. RESULTS: The number of dialysis-dependent patients will increase by one fifth from 83,000 in 2013 to 100,000 in 2020 while the share of nephrologists in outpatient care will decrease by 8% simultaneously. Therefore, young nephrologists and team-building in dialysis care need to be promoted. Home therapy should be used more often to cover the increasing need of dialysis in the future. Besides changes in the structures of care, shared-decision-making needs to be strengthened. CONCLUSIONS: The study offers concrete options to strengthen outpatient care by nephrologists (a) and to use home therapy more often (b) in order to provide adequate and appropriate dialysis care until 2020.

Healthcare Utilization of Patients With Acute Coronary Syndrome in Germany.

BACKGROUND: The aim of this study was to determine the health care utilization of patients with acute coronary syndrome (ACS) of one German statutory health insurance. The utilization of ambulatory services as well as of inpatient rehabilitation should be regarded. Moreover, the study should reveal the prescription of drugs for secondary prevention. Here, patients showing guideline corresponding prescriptions should be compared with patients without such prescriptions. METHODS: A retrospective claims data analysis of one German statutory health insurance was conducted. Health care utilization was considered in the first year after an index hospitalization due to ACS. Beneficiaries for whom an ICD-10 discharge diagnosis of ACS was reported between January 1st 2007 and December 31st 2009 were included. In order to reveal differences in health care utilization depending on the type of ACS (STEMI versus NSTEMI/UA) stratified analyses were performed. Another stratification was done for patients with and without defined drug prescriptions. RESULTS: From 45,188 patients with ACS almost three quarters were assigned to the group of NSTEMI/UA. For 8.9% of all ACS patients (18.74% STEMI, 8.89% NSTEMI/UA), inpatient post-hospital rehabilitation related to ACS was recorded. Ambulatory care related to CHD diagnosis was utilized by 77.6% of patients, more often by STEMI than by NSTEMI/UA patients. For 36.7% and 45.7% of ACS patients, a prescription of aspirin or clopidogrel was recorded, respectively, 79.4% of STEMI patients received at least one prescription for antiplatelet drugs, the corresponding proportion of NSTEMI/UA was 59.8%. A considerable part of patients without prescription dropped out within the first 90 days after the index event. CONCLUSIONS: A claims data analysis of one German statutory health insurance fund showed that health care utilization of ACS patients varied depending on the ACS type. It is necessary to distinguish between STEMI and NSTEMI/UA patients when discussing the ambulatory drug utilization.

Association between gout and all-cause as well as cardiovascular mortality: a systematic review.

Gout affects 1% to 2% of the population, and the prevalence is increasing due to changes in diet and the ageing of the population. Its development and risk factors have been explored frequently, and recommendations for the diagnosis and management of gout implemented. Nevertheless, there is a lack of knowledge regarding the long-term impact on gouty patients. This systematic review therefore evaluates the association between gout and all-cause as well as cardiovascular mortality. A systematic literature search was performed, and seven long-term studies were ultimately analyzed. Six of them used multivariate regressions to assess the adjusted mortality ratio in gouty patients with reference to patients without the disorder. Despite differences in study designs, study populations, and definitions of gout, the results were consistent: There was an independent association between gout and all-cause as well as cardiovascular mortality. Knowing that patients with gout are at risk emphasizes the need for adequate care.