Gesundheitswesen最新文献

Background: Children and adolescents are significantly tied to their family's socioeconomic position and living environment. Neighbourhood and the living environment have been identified as potential risk factors for mental disorders in this age group.

Aim of the study: The aim of the study was to investigate the distribution of mental and behavioural disorders (prevalence) and the provision of mental health services for children and adolescents aged 0-19 years in the city of Cologne. In particular, the study aimed to examine the association of these factors with area deprivation and the availability of mental health services covered by statutory health insurance. Finally, possible spatial variations in these aspects were analysed.

Method: Claims data of children and adolescents aged 0 to 19 years included in four statutory health insurance of the year 2021 were analysed. A deprivation index using data on the level of the ZIP code area was calculated. Analyses were carried out descriptively, using ordinary least squares (OLS) and geographically weighted regression (GWR).

Results: The prevalence of mental and behavioural disorders in children and adolescents varied across ZIP code areas, with higher rates in the northern, southern, and eastern parts of the city. The results indicated that the use of services by male children and adolescents with a prevalent diagnosis of mental and behavioural disorders was higher in areas with a higher density of healthcare providers. However, prevalence was on the whole lower in areas with a higher density of healthcare providers. In addition, the density of health care providers was higher in the city centre with comparatively lower deprivation.

Conclusion: These results indicate inadequate access to care for children and young people outside the city centre. However, due to the heterogeneity of the population in these areas, this study provides only preliminary insights. Data with a finer geographic resolution are needed for further research in order to analyse the association further.

Background: Recent analyses have shown that in health services research in Germany, healthcare organisations are often considered primarily as a study setting, without fully taking their complex organisational nature into account, neither theoretically nor methodologically. Therefore, an initiative was launched to analyse the state of Organisational Health Services Research (OHSR) in Germany and to develop a strategic framework and road map to guide future efforts in the field. This paper summarizes positions that have been jointly developed by consulting experts from the interdisciplinary and international scientific community.

Methods: In July 2023, a scoping workshop over the course of three days was held with 32 (inter)national experts from different research fields centred around OHSR topics using interactive workshop methods. Participants discussed their perspectives on OHSR, analysed current challenges in OHSR in Germany and developed key positions for the field's development.

Results: The seven agreed-upon key positions addressed conceptual and strategic aspects. There was consensus that the field required the development of a research agenda that can guide future efforts. On a conceptual level, the need to address challenges in terms of interdisciplinarity, terminology, organisation(s) as research subjects, international comparative research and utilisation of organisational theory was recognized. On a strategic level, requirements with regard to teaching, promotion of interdisciplinary and international collaboration, suitable funding opportunities and participatory research were identified.

Conclusions: This position paper seeks to serve as a framework to support further development of OHSR in Germany and as a guide for researchers and funding organisations on how to move OHSR forward. Some of the challenges discussed for German OHSR are equally present in other countries. Thus, this position paper can be used to initiate fruitful discussions in other countries.

There is disparity in the healthcare sector between the extent of innovation in medical products (e. g., drugs) and healthcare structures. The reason is not a lack of ideas, concepts, or (quasi-) experimental studies on structural innovations. Instead, we argue that the slow implementation of structural innovations has created this disparity partly because evidence-based medicine (EBM) instruments are well suited to evaluate product innovations but less suited to evaluate structural innovations. This article argues that the unintentional interplay between EBM, which has changed significantly over time to become primarily theoretical, on the one hand, and caution and inertia in health policy, on the other, has resulted in structural conservatism. Structural conservatism is present when healthcare structures persistently and essentially resist innovation. We interpret this phenomenon as an unintended consequence of deliberate EBM action. Therefore, we propose a new assessment framework to respond to structural innovations in healthcare, centered on the differentiation between the theoretical best (possible) evidence, the practical best (possible) evidence, and the best available evidence.

Aim: To date, there are only a few studies analyzing health professionals' health literacy (HL). Mostly, the focus has been on personal rather than professional HL. To bridge this gap, a new concept and an associated survey instrument have been developed in a three-country consortium. The aim of this article was to examine the professional HL of general practitioners (GPs) in Germany.

Method: The survey instrument used consists of 34 items and assesses subjective difficulties in four dimensions to be addressed in promoting patients' HL: "information and knowledge management", "conveying information and knowledge", "patient-centred communication", "professional digital HL". A total of 297 GPs and internists working in general practice were surveyed online over the summer of 2022. The professional HL (score from 0 to 100) was analyzed descriptively and examined in relation to gender, selected job-related, and organizational characteristics, using multiple linear regression.

Results: Depending on the four areas, GPs achieved approximately half to almost three-quarters of the highest possible score. The dimension "patient-centred communication" was perceived as the easiest, followed by "information and knowledge management", and "conveying information and knowledge". The most challenging dimension was "professional digital HL". According to the multivariate analysis, professional HL shows a relation to gender, organizational framework and training conditions, job duration, and coping with the diversity of digital information. The strength of correlation varies by area and is rather weak in some instances.

Conclusions: The results demonstrate the importance of promoting professional HL of GPs and provide numerous indications of where to start. They also indicate that the regression models should be extended by additional determinants, since the included variables can explain only a small amount of variance.

Background: Saxony-Anhalt has the highest old-age dependency ratio among the German federal states. The proportion of long-term care-dependent people can be expected to increase in the future, given the aging of the population. The SARS-CoV-2 pandemic has influenced nursing care, reduced the utilisation of services and led to changes in care arrangements. The aim of this study was to analyse the development of long-term care-dependency in Saxony-Anhalt, Germany, taking into account the legal changes, the pandemic and the development after the lifting of the contact ban.

Method: The analysis uses aggregated and anonymised health claims data from people insured with AOK Saxony-Anhalt from 2017 to 2022 in need of long-term care. Changes over time in the use of various care services were analysed.

Results: In 2017, 64,591 people insured in the statutory health insurance AOK Saxony-Anhalt (AOK ST) were in need of long-term care. The prevalence increased continuously throughout the observation years. For the lowest level of care (minor impairment of independence), the most significant and strongest increase was recorded in the first years after its introduction from 2017-2019. The majority of people in need of long-term care (41-44%) were in the category of care level 2 (considerable impairment of independence). Overall, the proportion of cash benefits has risen steadily since 2017, from 40.5% to 50.3% in 2022. At the same time, the proportion of long-term care in nursing homes decreased at all care levels. The trend toward less nursing home care has become stronger since 2017 and particularly since the onset of the SARS-CoV-2 pandemic in 2020.

Conclusion: Since the introduction of the new definition of the need for long-term care in Germany, the analysis shows an increase in the number of people in need of long-term care, with those with considerable impairment of independence making up the largest proportion. There has been a significant increase in the number of people receiving cash benefits and a decline in nursing home care. Compared to the nationwide data of health claims, data show a greater use of nursing services in home-based arrangements. The analysis during the COVID-19 pandemic shows a trend towards home care, but no fundamental change. Special situations such as contact restrictions may have influenced the use of care services. Future research should examine the design of home care arrangements and the needs of those affected in greater detail.

Background: Heatwaves might diminish the sense of well-being and are associated with increased mortality. Individual measures to protect against heat are often insufficient, with the perception of one's own risk playing a crucial role. Due to varying levels of vulnerability, it is expected that the perception differs among populations. Presumably, symptom awareness is higher when people are concerned with and inform themselves about the topic of heat. Our study examined subjective health impairment during the heatwave in 2022, its association with socio-demographic and economic factors, as well as perceived heat stress and individual engagement with the issue.

Method: An online survey of a population-based sample from five federal states of Germany was carried out. Multivariable regression analyses were conducted to explore the relationship between subjective health impairment due to heat and potential risk indicators.

Results: Out of 3,111 people contacted, 1,522 responded, with 649 (20.9%) included in the analysis as they were affected by heat in their region of residence during the summer of 2022. The average subjective health impairment was 9.29 (SD: 5.25) out of 29 possible points. Higher age was associated with lower impairment; -1.36 points (95%-CI: -4.10; 1.38) in the group of those aged 80 and compared with the reference group of 60 to 69-year-old people. Furthermore, higher impairment was reported more by women and individuals with lower educational levels. Low impairment was associated with a high perceived level of information.

Conclusion: Interventions aimed at reducing heat-related health problems should target a broader audience, particularly young people, women, individuals with lower education, and working people.

Background: The principle of "rehabilitation before care" is a principle of social law. The recommendation of the Medical Service (MD) as part of the assessment (§ 31 SGB XI) plays an important role in rehabilitation recommendations. In around 3% of its assessments, the MD recommends implementation of rehabilitation. Only every fourth to fifth recommendation is actually carried out. The aim of the study was to find out if rehabilitation recommendations are utilized and exploited.

Materials and methods: This study aimed to examine the perspective of insured persons whose recommended rehabilitation was actually carried out. After evaluating 586,228 routine data records with care assessments by the MD, 1,972 survey questionnaires were sent out in March 2023, and 1,116 analyzable questionnaires were included in the data analysis. In seven questions, the respondents were asked to retrospectively assess the overall success and satisfaction with rehabilitation procedures carried out.

Results: The evaluation of the results showed that 87% of the study participants would be ready to undergo repeat rehabilitation. The assessment of the success of rehabilitation in terms of remaining at home for a longer period of time also carried weight. On the other hand, only around 10% of rehabilitation was carried out on an outpatient basis.

Conclusions: One previously assumed reason for the low rate of patients taking advantage of recommended rehabilitation was that those in need of care had already received rehabilitation in the previous year. In this study focussing on whether recommended rehabilitation is taken advantage of, this assumption was found not to be correct. The question needs to be raised whether the strong focus in Germany on inpatient rehabilitation is up-to-date, both medically and with regard to the preferences of those entitled to rehabilitation. In contrast to inpatient rehabilitation, individual, outpatient and, if necessary, mobile rehabilitation offers might be more suitable, and these would also take into consideration issues of individual mobility and patient autonomy. The offer of different modes of rehabilitation also enables meeting the wish of those patients who prefer to have rehabilitation carried out in a home environment.

The effect of service concentration on outcome quality of inpatient services in the hospital sector is debated, and is particularly important in the field of obstetrics. The aim of this article was to investigate the influence of volume-outcome factors and competitive economic parameters on the quality of outcomes in obstetric departments of German hospitals. In this study, structural and performance data on 412 German hospitals in 2021 were analyzed with a quantitative research approach. To test the hypotheses, a polynomial multiple regression model with a total of eleven independent variables was estimated. Newborn mortality was used as an indicator of outcome quality in obstetrics departments. Contrary to expectations, the competitive economic parameters that are important for births play a rather subordinate role, while strong empirical evidence was found for volume-outcome relationships. The results of this study suggest that positive quality effects of service concentrations also predominate in the field of obstetrics and thus provide evidence in support of the forthcoming hospital reform in Germany.

Introduction: Informal caregiving is associated with mental disorders and reduced quality of life. The aim of this systematic review was to summarize the results of methodologically high-quality intervention studies on the effectiveness of non-pharmacological interventions on patient-relevant outcomes for family caregivers in Germany.

Method: We searched three large scientific literature databases for intervention studies with a control group and a low or moderate risk of bias on the effectiveness of non-pharmacological interventions for family caregivers in Germany.

Result: Among 4,376 publications reviewed, 10 intervention studies with good methodological quality were identified. These investigated multi-component interventions or cognitive behavioral therapy for family caregivers of people with dementia (8 studies), stroke (1 study) and with general care dependency (1 study). The control groups received information material as a minimal intervention or usual standard care. Meta-analyses showed a statistically significant slight reduction in depressive symptoms 3-6 months after the start of the study as a result of cognitive behavioral therapy (standardized mean difference -0.27; 95% confidence interval -0.44 - -0.10), but this no longer reached statistical significance after 9-12 months (-0.21; -0.51 - 0.09). Multi-component interventions showed no changes in depressive symptoms either after 3-6 or after 9-12 months (-0.18; -0.40 - 0.03 and -0.14; -0.47 - 0.14, respectively). In contrast, the mental component of quality of life of family caregivers improved statistically significantly in the multi-component intervention groups compared to the control groups: slightly after 3-6 months (0.28; 0.01 - 0.56) and moderately after 9-12 months (0.45; 0.09 - 0.82). The interventions had no effect on the physical component of quality of life.

Conclusion: The reduction of depressive symptoms by behavioral therapy interventions for family caregivers appears to be only slight and not sustainable. The mental component of quality of life of people affected may be improved in the longer term by multi-component interventions. Current scientifically examined interventions for informal caregivers do not appear to have a sufficient and sustainable effect. Greater effects could possibly be achieved through more elaborate behavioral approaches, but also structural preventive measures.