Gesundheitswesen最新文献

{"title":"[Waiting times for a second opinion appointment for tonsillectomy/tonsillotomy - a study of simulated patients].","authors":"Barbara Prediger, Louis Traxel, Nadja Könsgen, Niklas Schäfer, Dawid Pieper","doi":"10.1055/a-2495-8494","DOIUrl":"10.1055/a-2495-8494","url":null,"abstract":"<p><p>  Since December 2018, statutory health insured people with indication for tonsillectomy/tonsillotomy have the right to obtain a second opinion (SO) according to the SO directive. It is a legal requirement that the physician providing the indication has to inform the patient about his/her right to obtain an SO. This has to be done usually at least 10 days before the procedure, but in any case in time for the patient to make a well-considered decision about seeking an SO. The aim was to assess waiting times for appointments with physicians to obtain an SO.  In our study of simulated patients, all practices with physicians of the Associations of Statutory Health Insurance Physicians of North Rhine and Westphalia-Lippe providing SO (n=53 medical practices) were contacted via phone up to three times between January and February 2022. Using a standardized and piloted protocol, it was stated that there was an indication for a tonsillectomy/tonsillotomy and that the patient wanted to make an appointment for an SO. It was assessed how long the waiting time for an appointment would be, as well as whether it would be possible to obtain the appointment via video consultation and whether any further questions or details were provided during this telephone call (e. g. reference to documents to be brought along).  Overall, 94.4% (50/53) of the medical practices could be reached. A great majority of them (92% (46/50)) offered an appointment in contrast to three medical practices that offered open consultation hours. The remaining practice offered both ways to obtain an SO. On average, a waiting time of 8.1 (Standard deviation 5.4) working days was needed for an appointment in the morning and 10.1 (standard deviation 5.9) for an appointment in the afternoon. The availability of the medical practices was high. In 31% of cases, it took longer than 10 days to obtain the SO. Nevertheless, the overall waiting times were short.  In principle, patients should be provided with a timely appointment for an SO, which is possible within the Associations of Statutory Health Insurance Physicians of North Rhine and Westphalia-Lippe. The SO is very rarely offered via video consultation. However, this could possibly increase rural care.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Health Economic Benefit Analysis of ENT Centers: Simulation-based analysis of centralization in laryngeal surgery using population data from Schleswig-Holstein, exemplified by laryngeal carcinoma].","authors":"Simon Bettin, Marco Müller, Ines Weinhold, Leonie Zetzsch, Karl-Ludwig Bruchhage, Christian Elsner","doi":"10.1055/a-2522-5745","DOIUrl":"10.1055/a-2522-5745","url":null,"abstract":"<p><p>The health economic impacts of centralization in the German healthcare system, particularly in the field of ENT, are insufficiently researched. Therefore, this study investigates the potential benefits of a head and neck tumor center using the example of surgical care for laryngeal carcinoma in Schleswig-Holstein.A systematic literature review was conducted using the PRISMA search schema to examine the correlation between a hospital's treatment volume and mortality rates for laryngeal carcinomas. Subsequently, an 8-year Markov model simulation was employed to demonstrate the effects of establishing centers. This was supplemented by a cost analysis based on data from the PROGNOS study.The simulation shows the hypothetical impact on patient care for the existing head and neck tumor center in Schleswig-Holstein over an 8-year period. Maintaining the center in Schleswig-Holstein over eight years would save 113 lives and gain 1,333 life years (equivalent to 933.1 QALYs), corresponding to costs of 12,866 euros per QALY.The results suggest that centralizing care has medical and economic effectiveness in the ENT sector. They provide important insights for current political discussions and decision-making processes in healthcare. Future research should expand the focus to include other ENT cancers to gain a more comprehensive understanding of the impacts of centralization.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Intercultural competence in healthcare - a narrative review of definitions, quality criteria and the effectiveness of training measures].","authors":"Maximilian Hinse, Stephanie Roll, Matthias David, Jalid Sehouli, Stefan N Willich","doi":"10.1055/a-2527-5573","DOIUrl":"https://doi.org/10.1055/a-2527-5573","url":null,"abstract":"<p><p>Around a quarter of the German population has a migrant background. There are some differences in the healthcare provided to migrants and their successor generations compared to people without a migrant background. The aim of this review was to show the different definitions of intercultural competence (ICC), the different target groups of doctors and nursing staff given ICC training courses, and the extent to which the effectiveness of these courses can be assessed with the help of existing quality criteria.Relevant publications were found by searching PUBMED, reviewing the references and literature databases of the participating authors and additionally using Google and Researchgate web searches. Both German- and English-language publications were included in the search.There are several definitions and explanations of ICC, some of which differ, but most of of them include the aspects of cultural awareness, cultural knowledge, cultural sensitivity, cultural interaction and cultural understanding. Previous studies show different target groups for ICC training and a methodologically heterogeneous assessment of the effectiveness of these measures.There is a great need for methodologically sound studies using standardised and objectifiable criteria for the evaluation of intercultural training. Further development of measures, guidelines and political framework conditions would be important for patients, professionals, organisations and associations.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enrichment of health insurance claims data with official death certificate information from three German cancer registries: Proportions of successful linkages and differences by region, year, and age.","authors":"Franziska Heinze, Ingo Langner, Sebastian Bartholomäus, Martin Meyer, Joachim Kieschke, Kerstin Maaser, Jonas Czwikla","doi":"10.1055/a-2531-6220","DOIUrl":"10.1055/a-2531-6220","url":null,"abstract":"<p><p>Evaluating breast cancer mortality in the German mammography screening program with health insurance claims data requires the availability of claims data with information on causes of death. This work aimed to determine the proportions of successful cause-of-death linkages between the second-largest German statutory health insurance fund and three federal cancer registries and to investigate whether linked proportions differed by region, year, and age. Women aged 40-90 years whose insurance was terminated between 2006 and 2018 were included. Proportions successfully linked to the official death certificate databases of all individuals (available in one registry) and of registered cancer cases (available in three registries) were calculated. Of 150,369 women whose insurance was terminated due to death, 90.0% were linked to the database including all deceased women. Regarding the databases including only registered cancer cases, 35.9% of 150,369, 38.6% of 47,472, and 20.1% of 65,893 deceased women were linked. Linked proportions increased from 2006 to 2018 and peaked in age group 60-69 years. The data will be used for the evaluation of the German Mammography screening program. Since causes of death were not linked for all deceased women and the proportions of linkages differed by region, year, and age, claims-based algorithms will also be considered to complement claims data with causes of death.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Physicians' documentation behaviour and (non-)fulfillment of quality indicators in outpatient care of children and adolescents - A qualitative analysis].","authors":"Teresa Müller, Claudia Mehl, Werner de Cruppé, Christian Bachmann, Max Geraedts","doi":"10.1055/a-2515-9417","DOIUrl":"https://doi.org/10.1055/a-2515-9417","url":null,"abstract":"<p><p>The research project \"Evaluation of quality of care in routine outpatient care for common childhood and adolescent diseases\" (QualiPäd) measures the quality of care for seven common somatic and psychiatric diseases in children and adolescents based on a set of consensual and evidence-based quality indicators developed specifically for this purpose. Analyses of patient files of pediatricians, general practitioners and child and adolescent psychiatrists showed that in some cases, due to lack of information in the patient records, fullfillment of some of the quality indicators could not be measured or the degree of fulfillment of the quality indicators was found to be low. Therefore, the aim of the present study was to identify system-, physician- and patient-related factors that influence documentation in patient records as well as (non)fulfillment of quality indicators.Three specialist-specific focus group interviews were conducted with physicians (8 pediatricians, 5 general practitioners, 2 child and adolescent psychiatrists) already involved in the study. Interview guides were developed to pick up the previous results of the study and to enable discussions on the interpretation of results as well as possible influencing factors at different levels. The interviews were transcribed and content-analyzed using MAXQDA software.The following factors were identified that appeared to influence treatment, documentation, and therefore (non)fulfillment of quality indicators: Patient characteristics (e. g., age, disease burden), demands of everyday practice (e. g., time pressure), treatment continuity (e. g., cared for by several providers), preference for experiential knowledge instead of quality indicators/guidelines, and an individual approach to documentation behavior (e.g, short reports as a personal thought support). In addition, participants criticized the approach to quality measurement via indicators and patient records.The physicians we interviewed decide individually how to proceed and what to document when treating common medical conditions in children and adolescents. In some cases, this is in clear contrast to the documentation requirements for calculating quality indicators, which means that quality measurement based on patient records is only possible to a limited extent.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[INVADE: a real-life primary care long-term intervention program for brain health - results from 2013 to 2020].","authors":"Horst Bickel, Bernhard Nimmrichter, Klaus Pürner, Dirk Sander, Hans Förstl","doi":"10.1055/a-2525-2794","DOIUrl":"https://doi.org/10.1055/a-2525-2794","url":null,"abstract":"<p><p>The primary care prevention program INVADE (INtervention project on VAscular brain diseases and Dementia in the district of Ebersberg) is intended to prevent stroke and dementia through systematic detection and evidence-based treatment of modifiable vascular risk factors. The study reports on the results of an eight-year evaluation phase.Longitudinal study with non-randomized control group. AOK-insured patients over the age of 50 from the Bavarian district of Ebersberg were invited to participate in the project. The control group consisted of AOK-insured individuals of the same age-group from the district of Dachau. Primary clinical endpoints (mortality and long-term care dependency) and secondary endpoints (inpatient treatment due to cerebrovascular diseases) were based on the administrative data from the AOK. Analyses were carried out according to the principle \"intention to treat\".The intervention group (n=10,663) included 39.7% of insured persons who had enrolled in the program. Significant advantages were observed in the intervention group compared to the control group (n=13,225). Mortality was reduced by 6%, the incidence of long-term care by 10% and the prevalence of long-term care by 18.6%. There were about 190 fewer deaths and 260 fewer new cases of long-term care dependency than expected over a period of eight years. The prevalence of care dependency decreased by 1,600 years. The frequency of hospital treatment for cerebrovascular diseases, however, did not differ between the groups.Our results suggest that a real-life practice-based prevention program aimed at better control of vascular risk factors can possibly contribute to a reduction of care dependency and an increase in life expectancy.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Unmet Needs in Stroke Aftercare - A Survey of Stroke Survivors in Germany].","authors":"Christina Franzisket, Christian Voigt, Michael Brinkmeier, Markus Wagner, Rebecca Pries","doi":"10.1055/a-2525-2857","DOIUrl":"https://doi.org/10.1055/a-2525-2857","url":null,"abstract":"<p><p>Surviving stroke has become more common since implementing stroke units in Germany. Little information is available regarding life after stroke and unmet stroke survivors' needs in Germany. This survey is an attempt to close some information gaps.The German Stroke Foundation developed an unmet needs questionnaire in German based on three validated stroke assessment tools covering different domains of life after stroke. The questionnaire was tested and finalized including stroke survivors' expertise. In May 2021, it was sent to more than 3,000 stroke survivors from the German Stroke Foundation database.A total of 979 completed responses could be included in the analysis (response rate 29%). The majority was male (56%) and the average age at the time of stroke was 56 years. Approximately 70% of the respondents reported at least one unmet need. Unmet needs were primary found in the following areas: further rehabilitation measures, remembering and concentrating, further therapeutic measures, and stiffness in arms, hands and/or legs (spasticity).This survey offers a better overview of stroke survivors' needs in Germany. Additional research is needed as unmet needs are not closely monitored in German stroke aftercare. Knowledge of these is important for individualized patient care and a good quality of life for those affected.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Change in the dental profession and the attitude of dental professionals towards dental care centers (ZMVZ)].","authors":"Patricia Gaillard, Rainer Haak, Heide Glaesmer","doi":"10.1055/a-2525-2919","DOIUrl":"https://doi.org/10.1055/a-2525-2919","url":null,"abstract":"<p><p>The number of dental care centers (ZMVZ) in Germany has been increasing rapidly since 2015. This new form of practice is being discussed critically, especially when run by investors. This study analyzes the opinions and attitudes towards ZMVZ of dentists practicing in Germany, focusing on age and gender differences in dentists' attitudes as well as different aspects of working for a ZMVZ.A total of 937 dentists throughout Germany (63% female, aged 23 to 77 years) were asked in an online survey via the LimeSurvey platform conducted in 2021/2022 about their attitudes towards ZMVZ, readiness to work in one of them and whether there was a basic willingness to change their workplace; 575 of these questionnaires were available for analysis.The critical view of ZMVZ, especially management by investors, was shared by most of the respondents. There were differences between the age groups. Younger respondents were more in favor of management by specialist colleagues, while older respondents had a more positive attitude towards investor-run ZMVZ. The oldest respondents also tended to agree with the statement that the ZMVZ would replace the traditional practice. In general, practitioners feared that they would not be able to practice freely. However, one-third of the surveyed dentists who were considering a job change could imagine working in a ZMVZ.This study provides an insight into the attitudes of practicing dentists towards ZMVZ as well as their willingness to work in one. Since the ZMVZ are becoming increasingly important, while at the same time are subject to debate, the present overview of the advantages and disadvantages from the perspective of those working in practice should help in clarifying the issues involved. They also demonstrate that, despite all the criticism, there are positive aspects, and a significant proportion of those surveyed could imagine working in a ZMVZ. Since the ZMVZ have become a relevant part of the dental care system, it is important to identify problems and potential areas for development in order to improve care of dental patients.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Travel costs and ecologic imprint associated with different fractionation schedules in prostate cancer radiotherapy.","authors":"Georg W Wurschi, Maximilian Graf, Steffen Weimann, Matthias Mäurer, Christoph Straube, Daniel Medenwald, Justus Domschikowski, Marc Münter, Klaus Pietschmann","doi":"10.1055/a-2512-9269","DOIUrl":"10.1055/a-2512-9269","url":null,"abstract":"<p><p>Improving the sustainability and cost-effectiveness of healthcare systems has become increasingly relevant in times of climate change, energy transition, an aging population and skyrocketing social costs. The selection of an adequate fractionation schedule is of fundamental importance in the field of Radiation Oncology. We evaluated three internationally established fractionation schedules for definitive prostate cancer radiation therapy (RT) with respect to their ecological and health-economic impacts.We analyzed the data of 109 patients with prostate cancer, who underwent outpatient radiation therapy at Jena University Hospital in 2022. After determination of travel distances between their homes and the treatment facility, carbon dioxide (CO₂)-emissions and taxi costs were calculated for normofractionated RT (39 fractions, A), moderately hypofractionated RT (20 fractions, B) and ultrahypofractionated RT (5 fractions, C).Travel distances of 1616 km (A), 848 km (B) and 242 km (C) were calculated with corresponding costs ranging from 638 € (C) to 4255 € (A). According to the 2024 German physician's fee schedule, 9,604 € would be invoiced for medical treatment and transportation in (A), with transportation costs accounting for 44% of total treatment costs in normofractionated RT. The travel distance, CO₂-emissions and transportation costs could be reduced by up to 85% by hypofractionation.(Ultra-)hypofractionated radiation therapy for prostate cancer has great potential to lower healthcare costs and reduce environmental pollution. Given that and the non-inferiority of oncological outcome and toxicity, hypofractionation should appear beneficial from patient's and healthcare provider's point of view. Current reimbursement structures seem to be inappropriate regarding increased personnel and technical efforts required for highly precise dose application and might hinder comprehensive establishment of ultrahypofraktionated RT in Germany.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Primary care physicians' perspectives on the referral of patients with social problems to non-medical services - a cross-sectional survey].","authors":"Sinah Evers, Thomas Kloppe, Ansgar Gerhardus","doi":"10.1055/a-2518-8609","DOIUrl":"10.1055/a-2518-8609","url":null,"abstract":"<p><p>Physicians in primary care practices encounter social problems among their patients on a daily basis. Physicians can refer these patients to social services to improve their health and reduce pressure on the health care system. Open questions remain about how these referral practices are carried out and what areas have potential for improvement.An online survey with 21 closed or open-ended questions was conducted among primary care physicians (general practitioners and paediatricians) in Bremen, Germany. Data from closed questions were analysed for frequency distributions, while responses to open-ended questions were coded and interpreted using qualitative content analysis.Out of 580 primary care physicians in Bremen, 45 (8%) participated in the survey. Most of the respondents considered it important to be able to refer patients to support services outside the medical care system. Physicians referred a median of 10% of patients for whom they identified a need for social support. The most common reasons for not referring patients included a lack of knowledge about available services or the absence of such services, as well as time constraints. A total of 33 physicians (73%) reported feeling highly burdened when unable to refer patients. Furthermore, 34 respondents (76%) anticipated that a central contact point for social issues would greatly improve their job satisfaction. More general practitioners than paediatricians considered support services related to finances, unemployment, and housing to be important, while paediatricians were more open to providing external social support services in their own practices or using a \"Gesundheitskiosk\" (health kiosk).This is the first study to compare general practitioners and paediatricians regarding social issues in patient care. Given the low response rate, the results should be interpreted with caution. Notably, physicians reported that they did not refer most patients with identified social needs and experienced this as a burden. The majority indicated that, if available, they would use various forms of collaboration with social services.</p>","PeriodicalId":47653,"journal":{"name":"Gesundheitswesen","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}