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1.
Gesundheitswesen ; 81(11): 933-944, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31614386

RESUMO

OBJECTIVES: "Medical necessity" (MedN) is a fuzzy term. Our project aims at concretising the concept between medical ethics, social law, and social medicine to support health care regulation, primarily within Germany's statutory health insurance system. In a previous publication we identified MedN as a tripartite predicate: A specific clinical condition requires a specific medical intervention to reach a specific medical goal. Our two-part text searches for and discusses criteria to classify medical methods as generally medically necessary (medn), provided a non-trivial clinical condition and a relevant, legitimate, and reachable goal actually exist. In this paper we present the first part of our results. METHODS: Based on an extensive ethical, sociolegal and sociomedical body of literature, and starting with an non-controversial case vignette (thrombolysis in acute stroke), we generally followed a critical reconstructive approach. First we defined the term "medical method". In several interdisciplinary rounds, we then collected and discussed criteria from three sources: methods to develop clinical practice guidelines as compendia of indication rules, the National Model of Prioritisation in Swedish Health Care, and the HTA Core Model of the European Network for Health Technology Assessment as an instrument of political counselling. RESULTS: We identified general clinical efficacy and benefit as the 2 main "medical" criteria of MedN. As a third - epistemic - criterion, the corresponding bodies of evidence are always to be considered. Since clinical and prioritising guidelines grade their recommendations, the question arises whether MedN should be conceptualised as a dichotomous or finer graded predicate. In accord with German social law we advocate for the binary form. Further discussions focused on multifactorial MedN-configurations, the range of the term, and the variability of evidence requirements. CONCLUSIONS: No matter how the content of MedN is conceptualised, it seems impossible to include its criteria in an algorithm. So deliberative effort is indispensable at any stage of developing a programme to classify medical methods as medically necessary.


Assuntos
Ética Médica , Avaliação da Tecnologia Biomédica , Algoritmos , Alemanha , Humanos
2.
Gesundheitswesen ; 81(11): 945-954, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31597188

RESUMO

OBJECTIVES: "Medical necessity" (MedN) is a fuzzy term. Our project aims at concretising the concept between medical ethics, social law, and social medicine to support health care regulation, primarily within Germany's statutory health insurance system. In Part I, we identified efficacy, (net)benefit, and the corresponding bodies of evidence as obligatory criteria of MedN. This is the second part suggesting and discussing further criteria. METHODS: See Part I RESULTS: (Part II): As further MedN-criteria we critically assessed a method's effectiveness and acceptance in routine care, its potential beneficiaries, theoretical fundament, cost, and being without alternative as well as patients' self-responsibility, cooperation, and preferences. Since MedN has both lower and upper bounds, we had to consider certain cases of mis- and overuse, due for instance to "indication creep" or "disease mongering". CONCLUSIONS: The additional criteria neither establish MedN (when met singly or together) nor exclude it (when not met). If MedN is rejected in view of the 3 obligatory criteria then further information does not overturn the verdict. If a method is already assessed as being medn then further criteria do not make it "more or less necessary". Though we advocated for a binary MedN-concept (Part I) we are nonetheless convinced that not all medical methods deemed medn are equally medically relevant. Respective differences within the range of MedN could be assessed by techniques to prioritise medical conditions, methods, and aims.


Assuntos
Assistência à Saúde , Ética Médica , Alemanha , Humanos , Legislação Médica , Programas Nacionais de Saúde
3.
BMC Musculoskelet Disord ; 20(1): 94, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819162

RESUMO

BACKGROUND: Stratified care is an up-to-date treatment approach suggested for patients with back pain in several guidelines. A comprehensively studied stratification instrument is the STarT Back Tool (SBT). It was developed to stratify patients with back pain into three subgroups, according to their risk of persistent disabling symptoms. The primary aim was to analyse the disability differences in patients with back pain 12 months after inclusion according to the subgroups determined at baseline using the German version of the SBT (STarT-G). Moreover, the potential to improve prognosis for disability by adding further predictor variables, an analysis for differences in pain intensity according to the STarT-Classification, and discriminative ability were investigated. METHODS: Data from the control group of a randomized controlled trial were analysed. Trial participants were members of a private medical insurance with a minimum age of 18 and indicated as having persistent back pain. Measurements were made for the risk of back pain chronification using the STarT-G, disability (as primary outcome) and back pain intensity with the Chronic Pain Grade Scale (CPGS), health-related quality of life with the SF-12, psychological distress with the Patient Health Questionnaire-4 (PHQ-4) and physical activity. Analysis of variance (ANOVA), multiple linear regression, and area under the curve (AUC) analysis were conducted. RESULTS: The mean age of the 294 participants was 53.5 (SD 8.7) years, and 38% were female. The ANOVA for disability and pain showed significant differences (p < 0.01) among the risk groups at 12 months. Post hoc Tukey tests revealed significant differences among all three risk groups for every comparison for both outcomes. AUC for STarT-G's ability to discriminate reference standard 'cases' for chronic pain status at 12 months was 0.79. A prognostic model including the STarT-Classification, the variables global health, and disability at baseline explained 45% of the variance in disability at 12 months. CONCLUSIONS: Disability differences in patients with back pain after a period of 12 months are in accordance with the subgroups determined using the STarT-G at baseline. Results should be confirmed in a study developed with the primary aim to investigate those differences.


Assuntos
Dor nas Costas/diagnóstico , Dor nas Costas/epidemiologia , Avaliação da Deficiência , Medição da Dor/normas , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Prognóstico , Fatores de Risco , Fatores de Tempo
4.
Gesundheitswesen ; 81(10): 831-838, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-29253915

RESUMO

BACKGROUND: To facilitate access to evidence-based care for persisting back pain, a private medical insurance developed a health programme and offered it proactively to their members. The aim of this study was to evaluate the feasibility and efficacy of this procedure. METHODS: The design of the study was a Zelen randomized controlled trial. Adult insured persons with persistent back pain were randomized to the control (CG) or intervention group (IG) prior to giving consent. The IG was invited to participate in the health programme, the CG in a survey. Primary outcomes were back pain intensity and disability (according to von Korff) and health-related quality of life (SF-12). At baseline, 12- and 24-month follow-up, outcomes were documented by identical online questionnaires. RESULTS: 552 of 3462 randomized insured persons agreed to participate in the study; 132 of 258 (51.2%) from the IG and 243 of 294 (82.7%) from the CG completed the questionnaires at the 12-month follow-up. Small beneficial effects were seen for 3 of 4 primary outcomes. Compared to the CG, the IG reported less severe pain intensity (38.6 vs 44.5; p=0.001; d=0.36) and less disability (1.6 vs 2.2; p=0.002; d=0.41). The IG scored better at the SF-12 physical health scale (43.6 vs 39.0; p<0.001; d=0.54); no beneficial effect was seen in the SF-12 mental health scale. CONCLUSIONS: The pro-active health programme seems to be feasible and effective as determined by patient-reported outcomes. Final evaluation awaits cost analysis and the results of the 24-month follow-up.


Assuntos
Dor nas Costas , Qualidade de Vida , Adulto , Dor nas Costas/reabilitação , Feminino , Seguimentos , Alemanha , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e Questionários
5.
Rehabil Psychol ; 63(2): 170-181, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29878825

RESUMO

OBJECTIVE: In this randomized controlled trial, we evaluated the effectiveness of a telephone-delivered intervention based on the Health Action Process Approach (HAPA) after discharge from inpatient rehabilitation to address behavior change, emotional status, and glycemic control in patients with Type 2 diabetes. DESIGN: In a German rehabilitation center, 249 patients with Type 2 diabetes were separated into randomized groups, either a 12-month telephone follow-up support group or the usual care group. The counselor identified personal target areas and intervention modules and developed with the patient an individualized action plan for the telephone support. To enhance motivational processes, they used motivational interviewing techniques. Counselors called patients monthly to support the implementation of the personal plans into the patients' daily routines and to screen for emotional problems. Assessments measured exercise, diet, medication adherence, psychological variables, body mass index, HbA1c, and cardiovascular risk. RESULTS: Twelve months after inpatient rehabilitation, the telephone group's rate of physical activity rose by 26% compared with the usual care group's 10%. Patients in the intervention group exhibited greater improvements in terms of their illness burden, psychological well-being, and depression. HbA1c fell in the telephone group but increased in the usual care group (-0.68% vs. 0.12%). The intervention group's cardiovascular risk fell, whereas the usual care group's rose (-0.57 vs. 0.23). CONCLUSION: A theory-based telephone-delivered follow-up intervention utilizing motivational interviewing techniques and focusing on personalized action planning demonstrated improvements in patients' level of activity and health status 12-months postrehabilitation discharge and may be a beneficial supplement to rehabilitation programs. (PsycINFO Database Record


Assuntos
Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/reabilitação , Estilo de Vida , Entrevista Motivacional/métodos , Grupos de Autoajuda , Telemedicina/métodos , Feminino , Seguimentos , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Telefone , Resultado do Tratamento
6.
Z Gastroenterol ; 56(10): 1267-1275, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29742780

RESUMO

INTRODUCTION: Assessment of disease activity in Crohn's disease (CD) and ulcerative colitis (UC) is usually based on the physician's evaluation of clinical symptoms, endoscopic findings, and biomarker analysis. The German Inflammatory Bowel Disease Activity Index for CD (GIBDICD) and UC (GIBDIUC) uses data from patient-reported questionnaires. It is unclear to what extent the GIBDI agrees with the physicians' documented activity indices. METHODS: Data from 2 studies were reanalyzed. In both, gastroenterologists had documented disease activity in UC with the partial Mayo Score (pMS) and in CD with the Harvey Bradshaw Index (HBI). Patient-completed GIBDI questionnaires had also been assessed. The analysis sample consisted of 151 UC and 150 CD patients. Kappa coefficients were determined as agreement measurements. RESULTS: Rank correlations were 0.56 (pMS, GIBDIUC) and 0.57 (HBI, GIBDICD), with p < 0.001. The absolute agreement for 2 categories of disease activity (remission yes/no) was 74.2 % (UC) and 76.6 % (CD), and for 4 categories (none/mild/moderate/severe) 60.3 % (UC) and 61.9 % (CD). The kappa values ranged between 0.47 for UC (2 categories) and 0.58 for CD (4 categories). DISCUSSION: There is satisfactory agreement of GIBDI with the physician-documented disease activity indices. GIBDI can be used in health care research without access to assessments of medical practitioners. In clinical practice, the index offers a supplementary source of information.


Assuntos
Colite Ulcerativa , Doença de Crohn , Doenças Inflamatórias Intestinais , Índice de Gravidade de Doença , Colite Ulcerativa/classificação , Doença de Crohn/classificação , Humanos , Doenças Inflamatórias Intestinais/classificação , Inquéritos e Questionários
7.
Z Evid Fortbild Qual Gesundhwes ; 130: 8-12, 2018 02.
Artigo em Alemão | MEDLINE | ID: mdl-28935458

RESUMO

Since about 2005 VbHC has become a prominent movement on the border between population medicine and health economics. The "value" it is aiming at is defined as health care "outcomes per dollar spent". The text focuses on the work of two prominent proponents: M.E. Porter and J.A.M. Gray. It considers background and central elements of VbHC and discusses similarities and differences between the two authors. Especially the differences raise questions that will hopefully play a role in the German discussion that is still in its infancy. Three complex topics seem to be particularly relevant: the relationship between VbHC and evidence-based health care, the question of who is to benefit from VbHC (total, diseased, patient population?), and the role of moral values especially the value of solidarity with the severely ill and socially deprived.


Assuntos
Assistência à Saúde , Prática Clínica Baseada em Evidências , Ética Médica , Medicina Baseada em Evidências , Alemanha , Humanos , Populações Vulneráveis
8.
Gesundheitswesen ; 79(12): 983-986, 2017 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-29287299

RESUMO

The German Society for Social Medicine and Prevention (DGSMP) confers the Salomon Neumann Medal for outstanding merit in the field of Preventive and Social Medicine. The Salomon Neumann Medal 2017 was awarded to Bernt-Peter Robra, Institute for Social Medicine and Health Economics (ISMG) of the Otto von Guericke University Magdeburg. It honours an outstanding representative of social medicine, in whose person and Institute the essential problem areas of social medicine as well as the competencies of the 3 scientific bodies that gathered in Lübeck - epidemiology, medical sociology and social medicine - and the sociopolitical engagement of Salomon Neumann come together.


Assuntos
Distinções e Prêmios , Medicina Social , Academias e Institutos , Alemanha , História do Século XX , História do Século XXI , Humanos , Sociedades Médicas
9.
Z Evid Fortbild Qual Gesundhwes ; 129: 12-17, 2017 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-29153355

RESUMO

The Choosing Wisely Initiative (CWI) started in 2012 follows a proposal by Howard Brody (2010). Using CWI, the US ABIM Foundation continued its work to strengthen medical professionalism. The text describes CWI's development, aims, mission, and dissemination. It discusses some of its limits and problems. An appendix tabulates similarities and differences between CWI and a (2016) subsequent initiative from the German Society of Internal Medicine (DGIM: Klug Entscheiden Empfehlungen/decide wisely recommendations).


Assuntos
Medicina Interna , Sociedades Médicas/normas , Alemanha , Humanos , Medicina Interna/normas , Sobremedicalização/prevenção & controle
10.
Clin Exp Gastroenterol ; 10: 215-227, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28919797

RESUMO

BACKGROUND/AIMS: Patients with inflammatory bowel disease (IBD) need comprehensive, interdisciplinary and cross-sectoral health care. In Germany, evidence-based care pathways have been developed to improve the quality of care of IBD patients. We aimed to evaluate the effects of the implementation of some of these recommendations on patient-related outcomes. METHODS: In a region of North Germany, outpatients with IBD were recruited by gastroenterologists (intervention group). Three activities based on the recommendations of the IBD pathways were implemented, namely, 1) patient participation in a questionnaire-based assessment of 22 somatic and psychosocial problems combined with individualized care recommendations (patient activation procedure); 2) patient invitation to participate in a 2-day patient education program and 3) invitation to their gastroenterologists to participate in periodic interdisciplinary case conferences. For the control group, IBD patients receiving standard care at gastroenterology practices outside the specified region were recruited by their doctors. At baseline, 6- and 12-month follow-up, study patients were invited to complete questionnaires. Generic health-related quality of life, social participation and self-management skills were the main outcomes. RESULTS: At baseline, 349 patients were included in the study (intervention group: 189; control group: 160); 142 patients from the former and 140 from the latter group returned completed questionnaires at the 12-month follow-up. Over time, improvement in health-related quality of life and social participation was similar in both groups. Participants of the intervention group demonstrated improved self-management skills and more often followed steroid-free medication regimens. CONCLUSION: In a real-world clinical context, patient activation procedure combined with patient education and case conferences was less effective than expected. The observed beneficial effects, however, encourage the evaluation of more intensive and addressee-centered activities.

12.
Z Evid Fortbild Qual Gesundhwes ; 108(10): 601-3, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25499114

RESUMO

The American Board of Internal Medicine (ABIM) Foundation launched the Choosing Wisely campaign in 2012 and until today convinced more than 50 US specialist societies to develop lists of interventions that may not improve people's health but are potentially harmful. We suggest combining these new efforts with the already existing efforts in clinical practice guideline development. Existing clinical practice guidelines facilitate a more participatory and evidence-based approach to the development of top 5 lists. In return, adding top 5 lists (for overuse and underuse) to existing clinical practice guidelines nicely addresses a neglected dimension to clinical practice guideline development, namely explicit information on which Do or Don't do recommendations are frequently disregarded in practice.


Assuntos
Técnicas de Apoio para a Decisão , Medicina Baseada em Evidências , Fidelidade a Diretrizes , Mau Uso de Serviços de Saúde , Medicina , Sociedades Médicas , Alemanha , Pesquisa sobre Serviços de Saúde , Humanos , Estados Unidos
13.
Inflamm Bowel Dis ; 20(6): 1057-69, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24788217

RESUMO

BACKGROUND: Inflammatory bowel diseases impose on patients a broad spectrum of somatic and psychosocial burden. We hypothesized that patients' self-responsibility in planning and initiating adequate usually multimodal health care can be supported by self-assessment and proactive information, thus improving health-related quality of life and social participation. METHODS: We conducted a randomized controlled trial among a random sample of adult members of a German statutory health insurance with Crohn's disease or ulcerative colitis with at least 1 inflammatory bowel diseases-related hospital stay or sick leave in 2009 or 2010. Five hundred fourteen patients completed a postal screening questionnaire inquiring about 22 problems. The intervention group (IG) received an automated data analysis with individualized written advice on appropriate health services, and the control group received usual care. Main outcomes were health-related quality of life and social participation. Secondary outcomes included health care utilization, number of screened problems, and self-management skills. RESULTS: After 12 months, small beneficial effects were seen for all primary outcomes in the IG: EuroQol visual analog scale score (difference between IG and control group: 4.4; 95% confidence interval, 7.7-1.0; P = 0.011), index for measuring participation restriction (IMET) score (difference between IG and control group: 0.4; 95% confidence interval, 0.07-0.62; P = 0.013). The number of disability days improved only in the IG. The IG reported significantly fewer outpatient visits, fewer disease-related problems, and improved self-management skills (health education impact questionnaire scores) with no increase in disease activity, hospital stays, or consultations with allied health professionals. CONCLUSIONS: Our activation and information procedure is effective and beneficial. Further studies might show its usefulness in comprehensive management of patients with inflammatory bowel diseases.


Assuntos
Colite Ulcerativa/terapia , Doença de Crohn/terapia , Participação do Paciente/psicologia , Autocuidado/métodos , Autocuidado/psicologia , Adulto , Colite Ulcerativa/psicologia , Procedimentos Clínicos , Doença de Crohn/psicologia , Feminino , Seguimentos , Serviços de Saúde/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Relações Médico-Paciente , Qualidade de Vida/psicologia , Resultado do Tratamento
15.
BMC Med Res Methodol ; 13: 52, 2013 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-23537286

RESUMO

BACKGROUND: Different approaches have been developed for measuring change. Direct measurement of change (transition ratings) requires asking a patient directly about his judgment about the change he has experienced (reported change). With indirect measures of change, the patients' status is assessed at different time points and differences between them are calculated (measured change). When using the quasi-indirect approach ('then-test'), patients are asked after an intervention to rate their statuses both before the intervention as well as at the time of the enquiry. Associations previous studies have found between the different approaches might be biased because transition ratings are generally assessed using a single, general item, while indirect measures of change are generally based on multi-item scales. We aimed to quantify the agreement between indirect and direct as well as indirect and quasi-indirect measures of change while using multi-item scales exclusively. We explored possible reasons for non-agreement (present-state bias, recall bias). METHODS: We re-analysed a data set originally collected to investigate the prognostic validity of different approaches of change measurements. Patients from a 3-week inpatient rehabilitation programme for either cardiac or musculoskeletal disorders filled in health-status questionnaires (which included scales for sleep function, physical function, and somatisation) both at admission and at discharge. The patients were then randomised to receive either an additional transition-rating or then-test questionnaire at discharge. RESULTS: Out of 426 patients, 395 (92.7%) completed all questionnaires. Correlation coefficients between indirect and quasi-indirect measures of change ranged from r = .60 to r = .71, compared to r = .37 to r = .48 between indirect and direct measures of change. Correlation coefficients between pre-test and retrospective pre-test (then-test) results ranged from r = .69 to r = .82, indicating a low level of recall bias. Pre-test variation accounted for a substantial amount of variance in transition ratings in addition to the post-test scores, indicating a low level of present-state bias. CONCLUSIONS: Indirect and quasi-indirect measurements of change yielded comparable results indicating that recall bias does not necessarily affect quasi-indirect measurement of change. Quasi-indirect measurement might serve as a substitute for pre-post measurement under conditions still to be specified. Transition ratings reflect different aspects of change than indirect and quasi-indirect methods do, but are not necessarily biased by patients' present states.


Assuntos
Indicadores Básicos de Saúde , Cardiopatias/diagnóstico , Doenças Musculoesqueléticas/diagnóstico , Cardiopatias/fisiopatologia , Humanos , Doenças Musculoesqueléticas/fisiopatologia , Inquéritos e Questionários
16.
Int J Epidemiol ; 42(1): 128-128k, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23257687

RESUMO

Parkinson's disease is increasingly viewed as a complex disorder including a range of typical non-motor symptoms in addition to the cardinal motor signs. This cohort was set up in 2010 to investigate the specificity of non-motor symptoms for Parkinson's disease. For this, we included several control groups with decreasing contrast from Parkinson's disease patients. Group definitions ranged from healthy control subjects to those with suspected early motor signs of parkinsonism. Using a mailed questionnaire, we screened 5838 inhabitants of Lübeck, Germany, out of a target population of 10 000 citizens, enquiring about motor impairment, pain, quality of life, comorbidities, somatization and demographics. Based on this information, participants were assigned to screening groups, and selected participants were invited for in-person examination (n = 623). The examination included cognitive examinations, transcranial ultrasound, a brief psychiatric interview and a standardized motor examination that was used to assign examination groups. In addition, all participants answered questionnaires addressing depression, anxiety, sleep and quality of life. The first-year follow-up examination was performed either in person using the same protocol or via mailed questionnaires. This study is ongoing and publications are in preparation, but you may contact the first author (meike.kasten@neuro.uni-luebeck.de) with suggestions for collaboration or data requests.


Assuntos
Depressão/epidemiologia , Doença de Parkinson/complicações , Doença de Parkinson/epidemiologia , Vigilância da População/métodos , Transtornos das Sensações/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Depressão/etiologia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Atividade Motora , Testes Neuropsicológicos , Doença de Parkinson/diagnóstico , Doença de Parkinson/psicologia , Prevalência , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Transtornos das Sensações/etiologia , Transtornos do Sono-Vigília/etiologia , Fatores Socioeconômicos , Inquéritos e Questionários , Ultrassonografia Doppler Transcraniana
18.
Z Evid Fortbild Qual Gesundhwes ; 106(6): 389-96, 2012.
Artigo em Alemão | MEDLINE | ID: mdl-22857724

RESUMO

Germany's Central Ethics Committee of the Federal Chamber of Physicians (FCP) and other relevant national actors called for a public discourse on priority setting in health care. Politicians, members of a Federal Joint Committee and health insurance representatives, however, refused to promote or participate in the establishment of a public discussion. A change to that attitude only became apparent after former FCP President Hoppe's opening speech at the annual FCP assembly in Mainz in 2009. The present paper applies the Sociology of Knowledge Approach to Discourse, implemented through Qualitative Content Analysis and elements of Grounded Theory, to examine the development of the national public discourse in leading German print media. It creates a matrix that represents the discourse development between May 2009 and May 2010 and reflects central actors, their "communicative phenomena" and their interactions. Additionally, the matrix has been extended to cover the period until December 2011. Hoppe's arguments for priority setting in health care are faced with a wide opposition assuming opposing prerequisites and thus demanding alternative remedies. The lack of interaction between the different parties prevents any development of the speakers' positions. Incorrect accounts, reductions and left-outs in the media representation add to this effect. Consequently, the public discussion on priority setting is far from being an evolving rational discourse. Instead, it constitutes an exchange of preformed opposing positions.


Assuntos
Prioridades em Saúde/tendências , Programas Nacionais de Saúde/tendências , Opinião Pública , Participação da Comunidade , Redução de Custos/ética , Redução de Custos/tendências , Ética Médica , Medicina Baseada em Evidências/economia , Medicina Baseada em Evidências/tendências , Previsões , Alemanha , Alocação de Recursos para a Atenção à Saúde/economia , Alocação de Recursos para a Atenção à Saúde/ética , Alocação de Recursos para a Atenção à Saúde/tendências , Prioridades em Saúde/economia , Prioridades em Saúde/ética , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/ética , Acesso aos Serviços de Saúde/tendências , Humanos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/ética , Jornais como Assunto , Política
20.
Z Evid Fortbild Qual Gesundhwes ; 106(6): 418-25, 2012.
Artigo em Alemão | MEDLINE | ID: mdl-22857729

RESUMO

The German debate on prioritisation in medicine is getting well under way. This development has raised the question of which substantial and procedural criteria should be used to guide fair and legitimate prioritisation. It seems to be obvious that in a pluralist, democratic society citizens should be involved in such a discussion. But which is the adequate method, and what is the potential of citizen participation? In this paper we compare the results of a regional citizens' conference on prioritisation in medicine with various European reports on principles and criteria for prioritisation, and thereby aim to identify the conference members'contributions to the German debate on prioritisation criteria. The results of this exemplary deliberative event can provide hints towards the general potential of discursive participation. (As supplied by publisher).


Assuntos
Participação da Comunidade , Alocação de Recursos para a Atenção à Saúde/organização & administração , Prioridades em Saúde/organização & administração , Programas Nacionais de Saúde/organização & administração , Congressos como Assunto , Comparação Transcultural , Alemanha , Acesso aos Serviços de Saúde/organização & administração , Pesquisa sobre Serviços de Saúde , Humanos , Política , Seguridade Social
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