Leistungstrends der rehabilitativen rheumatologischen Versorgung in Deutschland

Recent Deutsche Gesellschaft für Rheumatologie (DGRh, German Society of Rheumatology) guidelines emphasized the significance of coordinated multidisciplinary care and rehabilitation of patients with inflammatory rheumatic diseases. Nationwide data from the German pension insurance funds showed that inpatient rehabilitation due to rheumatoid arthritis (RA) varied by a factor of 2.6 between the different German states. From 2000 to 2012 rehabilitation measures were reduced by one third, most significantly in men with ankylosing spondylitis (AS). Rehabilitation measures because of RA or AS were provided up to 14 times more frequently by the German statutory pension insurance scheme compared with a large compulsory health insurance which is responsible for rehabilitation measures after retirement. In rehabilitation centers with high numbers of patients with inflammatory rheumatic diseases, higher structural and process quality were demonstrated. In 2011 a total of 40 % of RA patients in the national database of the collaborative arthritis centers showed medium or severe functional limitations. Among these disabled RA patients inpatient rehabilitation was reduced by about 50 % between 1995 and 2011. Out of all RA patients from outpatient rheumatology care with severe functional limitations 38 % had no functional restoration therapy within the previous 12 months with a high variation between rheumatologists. Experiences from other European countries may inspire German rheumatologists and other involved health professionals to initiate a wider range of rehabilitative interventions in the future.     

Bestandsaufnahme der ambulanten rheumatologischen Versorgung in Deutschland

Aim

To gather information on current organizational structures in rheumatologic ambulatory health care in Germany. Based on the results recommendations on future structures will be discussed.

Methods

This study involved data collection and statistical analysis via a structured 10-page questionnaire among the members of the German Association of Rheumatologists. The questions concerned a variety of topics including information on office structures, patient structure, structure of services offered, co-operation with colleagues and hospitals, quality assurance measures, economic factors, and a subjective assessment of the health care structures in rheumatology by the participants.

Results

Data obtained from 197 rheumatologists who participate in health care were analyzed. In this paper results concerning the organizational as well as the medical ambulatory health care structure will be presented. Data on economic factors will be presented in part 2 of this study.

Conclusions

The organization of ambulatory treatment regarding processes and treatment differences between office-based physicians and rheumatologic outpatient departments in hospitals was very homogeneous. However, physicians in the eastern regions treated significantly more patients compared with the western parts of Germany. This difference was also observed between the north and south. Differences in patient groups (e.g. underlying diseases) were reported between different sub-groups of rheumatologists (e.g. internal specialists vs. GP vs. orthopedic rheumatologists). Integrated health care, as promoted by German social law, did not play a major role. Overall there was a high level of self-initiated training of physicians and participation in education of patients and other physicians.     

Rolle der Pneumologen in der intensivmedizinischen Versorgung in Deutschland

Zusammenfassung Im Rahmen einer Fragebogenaktion wurde der Stand der Intensiv-Versorgung an Kliniken mit in der Deutschen Gesellschaft für Pneumologie (DGP) organisierten Pneumologen untersucht. Dazu wurden s?mtliche eingetragenen Mitglieder der DGP zur Situation an der Klinik, an der sie arbeiten, befragt. Von mehr als 1600 angeschriebenen ?rzten antworteten 240, die 145 verschiedene Kliniken repr?sentieren (Rücklaufquote: 14,4%). Analysiert wurden die Anzahl und Art der Einrichtungen, die pneumologische Gesamt- und Intensivbettenzahl und das pneumologisch-intensivmedizinische Leistungsspektrum. Auch wenn der Anteil pneumologischer Intensivbetten an der Gesamtzahl pneumologischer Betten an Universit?tskliniken genau so hoch liegt wie an Lungenkliniken, finden sich weder an Universit?tskliniken (8%) noch an Versorgungskrankenh?usern (2%) eine akzeptable Anzahl pneumologisch verantworteter Intensivbetten, und selbst an Lungenkliniken (50%) wird nur ein Teil der Intensivstationen durch Pneumologen geleitet. Pneumologen haben in Deutschland bezogen auf die Gesamtzahl der internistischen Intensivbetten so gut wie nichts mit der Intensiv-Versorgung zu tun. Das in Deutschland bestehende Defizit in der Pr?senz von Pneumologie an Universit?tsklinika und an den anderen Krankenh?usern spiegelt sich – im Gegensatz zu anderen L?ndern – in besonderer Weise in der internistischen Intensivmedizin wider. Eingegangen: 4. Februar 1999 Akzeptiert: 12. Februar 1999     

Rolle der Pneumologen in der intensivmedizinischen Versorgung in Deutschland

Im Rahmen einer Fragebogenaktion wurde der Stand der Intensiv-Versorgung an Kliniken mit in der Deutschen Gesellschaft für Pneumologie (DGP) organisierten Pneumologen untersucht. Dazu wurden s?mtliche eingetragenen Mitglieder der DGP zur Situation an der Klinik, an der sie arbeiten, befragt. Von mehr als 1600 angeschriebenen ?rzten antworteten 240, die 145 verschiedene Kliniken repr?sentieren (Rücklaufquote: 14,4%). Analysiert wurden die Anzahl und Art der Einrichtungen, die pneumologische Gesamt- und Intensivbettenzahl und das pneumologisch-intensivmedizinische Leistungsspektrum. Auch wenn der Anteil pneumologischer Intensivbetten an der Gesamtzahl pneumologischer Betten an Universit?tskliniken genau so hoch liegt wie an Lungenkliniken, finden sich weder an Universit?tskliniken (8%) noch an Versorgungskrankenh?usern (2%) eine akzeptable Anzahl pneumologisch verantworteter Intensivbetten, und selbst an Lungenkliniken (50%) wird nur ein Teil der Intensivstationen durch Pneumologen geleitet. Pneumologen haben in Deutschland bezogen auf die Gesamtzahl der internistischen Intensivbetten so gut wie nichts mit der Intensiv-Versorgung zu tun. Das in Deutschland bestehende Defizit in der Pr?senz von Pneumologie an Universit?tsklinika und an den anderen Krankenh?usern spiegelt sich – im Gegensatz zu anderen L?ndern – in besonderer Weise in der internistischen Intensivmedizin wider.     

Bestandsaufnahme und Perspektiven der ambulanten rheumatologischen Versorgung in Deutschland

AIM: To gather information about current structures in rheumatologic ambulatory health care in Germany. Based on the results recommendations on future structures will be evaluated. METHODS: Data collection and statistical analysis via a structured 10-page questionnaire answered by members of the German Association of Rheumatologists. Questions in this second part of the study related to two topics: economic factors and a subjective assessment of the health care structures by the participants. RESULTS: Data from 197 ambulatory rheumatologists who participated in health care could be included in the analyses. Extensive and detailed data on economic issues surrounding ambulatory patient treatment and practice management from the perspective of ambulatory rheumatologists are presented (e.g., revenue, income, income differences between regions or practice size). In addition, perceptions of participating rheumatologists on future perspectives of patient treatment, health policy, and their own economical survival are reported. CONCLUSIONS: As in other specialties there is a significant difference not only between the eastern and western regions in Germany but also between the north and the south looking at e.g., revenue, income, with rheumatologists in the east treating significantly more patients. Reasons for those differences are not only related to regional remuneration schemes or the number of patients with a private but statutory health insurance, but are also driven by the number of different services provided (e.g., own laboratory). Physicians perceptions towards their own future in rheumatology are generally positive. Scepticism was reported for the individual economic survival in ambulatory treatment and future changes in health policy.     

Dosisanpassung bei Patienten mit rheumatoider Arthritis unter Therapie mit Infliximab in der rheumatologischen Versorgung in Deutschland

OBJECTIVE: Data from international observational studies show that a considerable proportion of patients use higher dosages of infliximab (INF) than the usual 3 mg every 8 weeks used in Germany for treatment of rheumatoid arthritis. The Data are, however, inconsistent and vary between countries. Using data from the German Biologics Register RABBIT we investigated: (1) how dosage of INF develops during the first year of treatment in routine care, and (2) how dosage translates into clinical effectiveness. PATIENTS: We analysed data from 344 patients who started a treatment with INF at their inclusion into the register and who were observed for the subsequent 12 months. Mean dosage at 3 months (after the loading dose) was 3.2 mg/kg body weight/infusion and 3.3 mg/kg after 1 year. If we also consider shortening the infusion intervals, the mean dosages at the start and after 1 year were 4.0 mg/kg body weight every 8 weeks. RESULTS: Patients who were treated with low dosages of up to 3 mg/kg/8 weeks showed significantly less improvement (EULAR response) than those who were treated with higher dosages. CONCLUSIONS: The data show that German rheumatologists are aware of the high costs of treatment and try to use the lowest possible dosage. However, for a certain proportion of the patients this might be insufficient.     

Die systemische Sklerose – Eine rheumatologische Herausforderung

The connective tissue disease systemic sclerosis (SSc) is still a challenge to every rheumatologist. SSc is characterized by progressing fibrosis of the skin and internal organs, abnormal activation of the immune system and distinct changes in microcirculation. Although it is a rare disease with a prevalence of about 20:100,000, one may come across it in daily practice. SSc is classified into limited and diffuse forms. Both entities usually involve internal organs. Life expectancy is limited and depends predominantly on the extent of the organs involved. Therefore, it is essential to diagnose SSc early and to identify and closely monitor the organs involved.     

Ambulante pflegebegleitende Soziale Arbeit

Zusammenfassung Pflegebegleitende Soziale Arbeit mit ?lteren Menschen im ambulanten Bereich stellt fachlich ein unverzichtbares Angebot dar. Der angemessenen Berücksichtigung von Passung zwischen informellen und formellen Hilfen kommt eine Schlüsselstellung bei der gesellschaftlichen Erm?glichung von Pflege zu. Soziale Arbeit kann dies auf betrieblicher und tr?gerneutraler Ebene realisieren. Auf der Ebene der direkten Einzelfallhilfe werden einige Spezifika Sozialer Altenarbeit in Pflegehaushalten diskutiert. Dazu geh?ren sowohl bedrohliche, schwierige und besch?mende Dimensionen der Pflegebedürftigkeit im Alter als auch die Notwendigkeit eines von allen beteiligten Akteuren getragenen Hilfeplans und -prozesses. Als angemessenes wissenschaftliches Bezugssystem alltagsnaher Sozialer Arbeit in und mit Pflegehaushalten werden Dimensionen des sozialwissenschaftlichen Blicks und Aspekte der Praxisforschung diskutiert. Beispielhaft werden zentrale Dimensionen ambulanter Angeh?rigenorientierung vorgestellt.     

Ambulante Koronarangiographie und PTCA

Ohne Zusammenfassung     

Grundlagen und Grundsätze zur Weiterentwicklung der Rettungsdienste und der notfallmedizinischen Versorgung der Bevölkerung in der Bundesrepublik Deutschland

Ohne Zusammenfassung     

Integrierte Versorgung

Integrated care offers the opportunity to organise structured, sector-wide treatment of proven quality. The aim of the current article is to show, using the diabetic foot syndrome (DFS) as an example, that this innovative model of care makes sense and is efficient. The concrete example of the Cologne foot network gives an overview of the practical procedure and results gained so far.     

Integrierte Versorgung

Ohne Zusammenfassung