RESUMO
OBJECTIVE: To evaluate the effectiveness of a web-based, individually tailored decision aid (Patient Dialogue) on depression or acute low back pain for insurees of a German sickness fund. METHODS: Patient Dialogue (PD) was compared to the non-tailored Static Patient Information (SPI) in an online randomized controlled trial (RCT). The primary outcome was decisional conflict; secondary outcomes included knowledge, preparation for decision-making, preference for participation, involvement in decision-making, decision regret, and adherence. RESULTS: Out of 2480 randomized participants, 657 (26.5%) provided analyzable data immediately after using the system. Three months later, data from 131 (5.3%) participants could be included in the analysis. The PD group reported a significantly lower overall decisional conflict than the SPI group (38.7 vs. 45.1; p=0.028 via multiple imputation estimator). The largest standardized effect (Cohen's d 0.56) resulted from the preparation for decision-making (PD 59.4 vs. SPI 46.8; p<0.001). CONCLUSION: PD may be an effective tool to reduce decisional conflict and prepare participants for treatment decision-making. However, the large dropout rate needs to be taken into account. PRACTICE IMPLICATIONS: This study shows how a health insurance fund can support shared decision-making and how a decision aid can be evaluated in a RCT under routine care conditions.
Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Depressão/psicologia , Internet , Dor Lombar/psicologia , Educação de Pacientes como Assunto/métodos , Doença Aguda , Adulto , Idoso , Conflito Psicológico , Depressão/terapia , Feminino , Alemanha , Humanos , Seguro Saúde , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Participação do Paciente/métodos , Preferência do Paciente , Assistência Centrada no Paciente , Análise de RegressãoRESUMO
The German healthcare system modernization act enables healthcare providers to fund interdisciplinary healthcare centres. The Techniker Krankenkasse (TK) is a statutory health sickness fund that has contracted with some of the interdisciplinary healthcare centres named ATRIO-MED to achieve high-quality medical care and healthcare management. A range of patient-centred services is described in the cooperation agreement; in addition to central medical patient records one of the core competencies includes integrated pathways for defined diagnosis. The concept of the interdisciplinary healthcare centre is highly accepted among patients. It will serve as a platform for future TK healthcare policies.
Assuntos
Atenção à Saúde/normas , Coalizão em Cuidados de Saúde/organização & administração , Seguro Saúde/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Atenção à Saúde/economia , Alemanha , HumanosAssuntos
Transtornos Mentais/terapia , Programas Nacionais de Saúde/legislação & jurisprudência , Pessoas com Deficiência Mental/legislação & jurisprudência , Previdência Social/legislação & jurisprudência , Comportamento Cooperativo , Análise Custo-Benefício/tendências , Estudos Transversais , Transtorno Depressivo/economia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/terapia , Avaliação da Deficiência , Previsões , Alemanha , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Programas Nacionais de Saúde/economia , Equipe de Assistência ao Paciente/economia , Equipe de Assistência ao Paciente/estatística & dados numéricos , Pessoas com Deficiência Mental/estatística & dados numéricos , Qualidade da Assistência à Saúde/economia , Previdência Social/economiaRESUMO
To support insured patients, especially those with chronic illnesses or disabilities, the German statutory health insurance Techniker Krankenkasse (TK) offers continuous case management (CCM) under a rehabilitation advisory program serving more than 150,000 insurees each year Rehabilitation advisors provide individual counseling, generally by telephone. They inform patients about treatment and rehabilitation options, about health care providers, and about other TK services. In a key feature, the model coordinates care across different health care sectors. Through the CCM approach, TK not only assures the best possible care for its insurees, but also safeguards its long-term financial sustainability.
