Journal of health monitoring最新文献

Background: Surveillance systems for diseases serve as an early warning system and orientation for decision-makers. As part of the National Diabetes Surveillance at the Robert Koch Institute (RKI), existing formats of information transfer were evaluated and an analysis of users' requirements regarding the dissemination of results of surveillance for non-communicable diseases (NCD) was carried out.

Methods: 13 semi-structured guided interviews were conducted with persons from health politics, healthcare, media and science and analysed in a qualitative content analysis (interview survey period: 10/2022 - 01/2023).

Results: For all respondents, the frequency of diseases and their determinants, care and consequences were the focus of NCD surveillance. Wider determinants of health and illness situation were also considered relevant. Requirements regarding the presentation of these contents differed between the user groups. Factors that facilitate and inhibit the use of NCD surveillance information were consistent across the user groups.

Conclusions: There is a need for the presentation of options for action, especially for users involved in health politics and healthcare. Diabetes surveillance showed that many requirements are already met by the existing formats. Many of the users also wanted the content to be expanded to include other NCD.

Background: The European Core Health Indicators (ECHI) are a set of 88 indicators that provide a compact overview of the extensive field of European public health and healthcare. The ECHI set adds value to European Union health information systems (HIS) for both Member States and EU-associated countries and the European Commission by providing a solid, comparable information base on national public health and healthcare trends and developments. The indicators allow for learning by comparison and the list supports the organisation of national health information systems. As the ECHI set was defined more than ten years ago, it is time to review its current needs and readiness for the future.

Methods: In this article, we reflect on the sustainability of the ECHI set and explore directions for improving future use, based on the activities in the Joint Action on Health Information (2018 - 2021). There, we looked into ECHI governance and reviewed the set's metadata, content and link with other indicator sets in the wider European health information landscape.

Conclusions: We conclude that in order to remain relevant and keep up with technical and policy developments, the ECHI set needs maintenance and updates. This cannot be achieved in a non-systematic project-based manner; it requires sustainable funding, governance and formalised activities in a permanent structure. We call on the European Commission, Member States, research networks and individual users of the ECHI to take action in this.

Background: National health systems in Europe are facing similar challenges - demographic change, a rising burden of disease due to chronic non-communicable diseases, and health inequalities. Comparable health data and knowledge sharing between countries are therefore an important basis for policy decision-making. However, health information in the European Union (EU) is fragmented and approaches to establishing a comprehensive system are largely project-based.

Methods: This contribution describes the European projects BRIDGE Health (2015 - 2017), InfAct (Information for Action, 2018 - 2021) and PHIRI (Population Health Information Research Infrastructure, 2020 - 2023), which aimed at developing a sustainable health information infrastructure.

Results: The projects, which build on one another, laid the groundwork for an EU-wide health information system. For example, a health information portal was established, a federated research infrastructure was implemented, handouts were created and training on capacity building was provided.

Conclusions: An integrated EU-wide health information system is an important basis for policy decision-making and a prerequisite for a rapid and coordinated response to health crises. A sustainable structure or institution with a mandate for non-communicable diseases (NCD) and their determinants at the EU level would be desirable.

Background: In Europe, the health situation is primarily influenced by non-communicable diseases. Comparable information on key indicators for the European region can highlight potential areas for improvement in prevention and care.

Method: Based on EHIS 3, age-standardised prevalences of three disease groups and two indicators of self-assessed health among those affected were presented for Germany (n = 22,708) and the average of 29 European countries (n = 301,960).

Results: The disease prevalence estimates in Germany were higher compared to the European average: diabetes 8.4 % vs. 7.4 %, cardiovascular diseases 6.8 % vs. 5.7 %, chronic respiratory diseases 11.4 % vs. 7.9 %. Likewise, the proportion with self-assessed very good or good general health among those affected was also higher in Germany (diabetes 35.8 % vs. 30.7 %, cardiovascular diseases 25.3 % vs. 18.9 %, chronic respiratory diseases 44.7 % vs. 41.9 %). For limitations in everyday activities, higher proportions were found in Germany for diabetes (65.6 % vs. 60.6 %) and chronic respiratory diseases (64.5 % vs. 57.6 %). Germany showed similar gender-, age- and education-specific differences for disease prevalence, but in part less pronounced differences for the indicators of self-assessed health than the European average.

Conclusions: Further analysis of the differences for the indicators considered between Germany and the European average and the possible underlying factors, such as differences in prevention, diagnosis, disease severity and care, is required. The educational inequalities observed across Europe suggest considerable potential for promoting health equity.

Background: Needs-based care is a central concern of healthcare policy. A European comparison of the utilisation of medical services can help to assess national data and identify the need for action.

Methods: This article describes indicators on the utilisation of outpatient and inpatient services, medical examinations and the use of medicines from the third wave of the European Health Interview Survey (EHIS 3) and compares the results from Germany with the European averages.

Results: Age-standardised, the utilisation of medical services in Germany was above the European average without exception, whereby demographic and social differences were similar. Almost all services were utilised more frequently by women and in older age groups. Exceptions are inpatient services and colonoscopy, where there was no difference between the sexes, and more frequent use of psychiatric and psychotherapeutic services and non-prescription medication among younger adults. Specialist medical and dental services were used more frequently in the high education group, psychiatric and psychotherapeutic services as well as inpatient services and prescription medication in the low education group.

Conclusions: The European comparison requires a differentiated categorisation of the findings. While the high utilisation in Germany for some evidence-based services (e.g. colonoscopy, dentistry) indicates good access to care, the high inpatient utilisation, for example, is also the subject of critical discussion.

Background: This article examines discrepancies in the frequency of diagnoses of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents in Germany using information on health care utilisation from both administrative and parent-reported survey data linked at person level.

Methods: 5,461 parents of 0- to 17-year-olds insured with DAK-Gesundheit in 2020 and being registered with a confirmed administrative ADHD diagnosis (ICD-10 F90.0-9) in at least one quarter in 2020 (M1Q criterion) were surveyed online on their child's ADHD diagnosis, utilisation of specialist care and therapeutic service providers. With regard to the presence of a parental report of the child's documented ADHD diagnosis, administrative data and survey data were bi- and multivariately analysed.

Results: The response rate was 21.5 %. ADHD diagnoses were given more frequently in the context of paediatric care, but in the multivariable model with the administrative data only the diagnosis made by mental health professionals (OR = 2.78), in the model with the survey data only utilisation of mental health professionals (OR = 2.99) positively predicted the parental diagnostic report. With regard to the utilisation of therapeutic service providers, only the utilisation of occupational therapy was associated with the parental report of the diagnosis in both data sources.

Conclusions: Parental non-reporting of a child's administrative ADHD diagnosis in survey studies can be in part be explained by utilisation characteristics.

Background: The consortium project INTEGRATE-ADHD compared administrative data on the presence of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents with the results of a parent survey and a comprehensive clinical assessment based on the S3 guideline of the Association of the Scientific Medical Societies in Germany (AWMF). Due to the COVID-19 pandemic, the clinical assessment was carried out online.

Methods: The article describes how a guideline-based clinical assessment of ADHD can be implemented in an online setting. A specially developed diagnostic matrix is presented to illustrate the assessment procedures and the diagnostic decision-making process. The matrix is intended to help the diagnostician to gain an overview of the numerous individual findings that have been collected using different assessment perspectives and methods (e.g. diagnostic interviews, rating scales, performance tests) in order to make a well-founded and transparent diagnostic decision.

Discussion: The consortium project INTEGRATE-ADHD has shown that an online assessment can be implemented in a guideline-compliant manner and allows a valid clinical decision. The diagnostic strategy is discussed with reference to international guidelines and recommendations for online diagnostics (e.g. aspects of feasibility, acceptability and safety of the assessment procedures). The challenges and opportunities of using online assessments in clinical practice are also described.

Background: The health-related quality of life (HRQoL) of individuals living with Attention-deficit/hyperactivity disorder (ADHD) is known to be impaired. Identifying factors that influence HRQoL can provide important information for the development of prevention and intervention programmes for affected children and adolescents. The aim of the present study was to investigate health care-related and psychosocial risk and protective factors for HRQoL in children and adolescents with an administrative ADHD diagnosis.

Methods: In the consortium project INTEGRATE-ADHD, n = 4,809 parents of children and adolescents aged 7 to 17 years participated in an online survey between October 2021 and August 2022 and answered questions regarding HRQoL (KIDSCREEN-27), health care utilisation, and psychosocial risk and protective factors. Multiple linear regression analyses were conducted to assess the association between these factors and the five HRQoL dimensions of the KIDSCREEN-27.

Results: Findings indicate that parental psychopathology and parental burden were risk factors for lower HRQoL in children and adolescents with ADHD. Further, a positive association was found between the five HRQoL dimensions and the psychosocial factors family climate and social support, indicating that these are protective factors.

Conclusions: The results highlight the importance of prevention and intervention programmes for individuals with ADHD that consider parental mental health and aim to strengthen resources such as the availability of good family climate and social support.

Background: In the project INTEGRATE-ADHD, administrative and parent-reported ADHD diagnosis data of children and adolescents were linked at person level for the first time in Germany. This contribution analyses discrepancies between the data sources, considering sociodemographic characteristics.

Methods: Parents of 5,461 0- to 17-year-olds insured with the German statutory health insurance company DAK-Gesundheit in 2020, who had a confirmed administrative diagnosis of ADHD (ICD-10 F90.0-9) in at least one quarter (M1Q criterion), were surveyed online about their child's ADHD diagnosis and other health and care-related topics. Using logistic regression, associations between the presence of a parental report of the child's administrative ADHD diagnosis and sociodemographic predictors were analysed.

Results: 71.6 % of parents reported their child's administrative diagnosis of ADHD in the survey. The diagnosis was significantly less likely to be reported by parents of girls, younger children, children with a migration background and children from nuclear families with both biological parents. There were no differences with regard to parental education, urbanisation (urban/rural) or density of care. Bivariate findings were confirmed in the multivariable model.

Conclusions: Approximately one third of parents do not report their child's administrative diagnosis of ADHD. The likelihood of parental reporting varies according to sociodemographic factors. This should be considered when contextualising the data sources in the future.