Declared dead?: Recommendations regarding integrated care from the perspective of German statutory health insurance [Totgesagte leben länger: Empfehlungen zur Integrierten Versorgung aus Sicht der gesetzlichen Krankenkassen]
Amelung V.,Bundesverband Managed Care e. V. |
Wolf S.,Pforzheim University |
Ozegowski S.,Bundesverband Managed Care e. V. |
Eble S.,Berlin Chemie AG |
And 5 more authors.
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2015
The traditional separation of health care into sectors in Germany causes communication problems that hinder continuous, patient-oriented care. This is most evident in the transition from inpatient to outpatient care. That said, there are also breaks in the flow of information, a lack of supply, or even incorrect information flowing within same-sector care. The transition from a division of functions into sectors to a patient-oriented process represents a change in the paradigm of health care that can only be successfully completed with considerable effort. Germany's statutory health insurance (SHI) funds play a key role here, as they are the contracting parties as well as the financiers of integrated care, and are strategically located at the center of the development process. The objective of this article is to explore how Germany’s SHI funds view integrated care, what they regard as being the drivers of and barriers to transitioning to such a system, and what recommendations they can provide with regard to the further development of integrated care. For this purpose semi-structured interviews with board members and those responsible for implementing integrated care into the operations of ten SHI funds representing more than half of Germany's SHI-insured population were conducted. According to the interviewees, a better framework for integrated care urgently needs to be developed and rendered more receptive to innovation. Only in this way will the widespread stagnation of the past several years be overcome. The deregulation of § 140a–d SGB V and the establishment of a uniform basis for new forms of care in terms of a new innovation clause are among the central recommendations of this article. The German federal government's innovation fund was met with great hope, but also implied risks. Nonetheless, the new law designed to strengthen health care overall generated high expectations. © 2015, Springer-Verlag Berlin Heidelberg.
Scholze J.,Charité - Medical University of Berlin |
Weinstock A.,SIMW GmbH |
Kirchner F.,Berlin Chemie AG |
Limberg R.,Berlin Chemie AG |
Kreutz R.,Charité - Medical University of Berlin
Current Medical Research and Opinion | Year: 2014
Objective: To investigate the role of socio-economic factors on the therapeutic effectiveness of and therapeutic adherence to the angiotensin II receptor blocker (ARB) olmesartan (OM) alone or in combination with hydrochlorothiazide in the treatment of arterial hypertension. Research design and methods: In a multi-center, open-label, prospective and long-term observational study, data from hypertensive patients treated with OM were analyzed at baseline, month 3 and month 12 within the context of patients' socio-economic status (SES), determined using pre-defined criteria by physicians in outpatient practices and including multivariate analysis. Results: Overall, 7724 patients were assigned to three subgroups representing low, medium and high socio-economic status. Baseline conditions differed significantly between the subgroups. Patients of low SES had worse nutritional habits, less physical activity and more concomitant medication compared to patients of high SES. Cardiovascular risk factors were more common in the low SES group as were concomitant diseases such as heart failure, coronary heart disease, atherosclerosis and renal failure. OM therapy led to a significant decrease in blood pressure (23.0/11.6 mmHg) in all patients. The blood pressure target of <140/90 mmHg was achieved in about 70% of the documented population. Effectiveness was comparable between patients with low, medium or high SES. Treatment adherence was high in the overall population with only minor differences between the subgroups. In total the incidence of adverse events (AEs) was 1.6% documented in 98 patents (1.3%) during the course of the study. Of this total number only 1.0% was related to the drug, matching the percentage expressed in the Summary of Product Characteristics (SmPC). Conclusions: The ARB OM is effective and well tolerated in all patients, irrespective of their socio-economic status. The risk status and the established cardiovascular disease of hypertensive patients are strongly influenced by the SES. To validate these interesting data a randomized controlled trial is needed. © 2014 Informa UK Ltd.
Berndt-Zipfel C.,Diabeteszentrum Bad Lauterberg |
Kothe L.,Diabeteszentrum Bad Lauterberg |
Nawrodt B.,Diabeteszentrum Bad Lauterberg |
Mraz B.,A. Menarini Diagnostics |
And 2 more authors.
Experimental and Clinical Endocrinology and Diabetes | Year: 2011
Aims: Waking up in response to an alarm-clock may evoke a stress reaction that leads to rising glucose concentrations. Method: 30 type 1-diabetic patients participated in 3 overnight conditions: (a) with an alarm-clock set at 2 h intervals for glucose self monitoring, (b) with a nurse performing blood glucose determinations, and (c) with the patients left undisturbed. Continuous glucose monitoring (CGM) was performed with a GlucoDay® S device. Results: After waking up in response to an alarm-clock, CGM-determined glucose concentrations rose by 18±6 mg/dl at 4 a.m. (p=0.0003), whereas negligible increments were seen with nurse assistance (e. g., 0±4 mg/dl at 4 a.m.). Conclusions: Waking up in response to an alarm-clock leads to an arousal reaction that causes significant elevations in glucose concentrations. Continuous glucose monitoring is a suitable method to detect such short-lived increments in glucose concentrations. But at the moment the CGMS is not able to substitute for inpatient glucose profiles. Registered with ClinicalTrials.gov, Identification number NCT00740012. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart New York.
Schmidt T.H.,University of Bonn |
Raunest M.,MLL Munchner Leukamielabor GmbH |
Fischer N.,Berlin Chemie AG |
Reith D.,Bonn-Rhein-Sieg University of Applied Sciences |
Kandt C.,Bonn-Rhein-Sieg University of Applied Sciences
Biochimica et Biophysica Acta - Biomembranes | Year: 2016
One way by which bacteria achieve antibiotics resistance is preventing drug access to its target molecule for example through an overproduction of multi-drug efflux pumps of the resistance nodulation division (RND) protein super family of which AcrAB-TolC in Escherichia coli is a prominent example. Although representing one of the best studied efflux systems, the question of how AcrB and TolC interact is still unclear as the available experimental data suggest that either both proteins interact in a tip to tip manner or do not interact at all but are instead connected by a hexamer of AcrA molecules. Addressing the question of TolC-AcrB interaction, we performed a series of 100 ns - 1 μs- molecular dynamics simulations of membrane-embedded TolC in presence of the isolated AcrB docking domain (AcrBDD). In 5/6 simulations we observe direct TolC-AcrBDD interaction that is only stable on the simulated time scale when both proteins engage in a tip to tip manner. At the same time we find TolC opening and closing freely on extracellular side while remaining closed at the inner periplasmic bottleneck region, suggesting that either the simulated time is too short or additional components are required to unlock TolC. © 2016 Elsevier B.V. All rights reserved.
Jecht M.,Gemeinschaftskrankenhaus Havelhohe |
Hasche S.,Berlin Chemie AG |
Fehske C.,Berlin Chemie AG |
Silbermann S.,Berlin Chemie AG |
Limberg R.,Berlin Chemie AG
Diabetes, Stoffwechsel und Herz | Year: 2011
There is no alternative to insulin treatment in type 1 diabetes, or in long-standing type 2 diabetes with advanced beta-cell loss. However, insulin therapy is often left until very late in type 2 diabetes patients; possible deterrents include the necessary training along with loss of quality of life due to subcutaneous application and fear of weight gain or hypoglycaemia. We examined changes in metabolism and quality of life after first using BerliPen® areo in a non-interventional study on 2857 patients. Around eighty percent of the patients achieved individual metabolic targets according to medical assessment, while forty percent reported improved quality of life and eighty-five percent reported a general improvement in life after insulin injection. This demonstrates more than the absence of any justification for delaying insulin therapy - indeed, there are good reasons for initiating insulin therapy along with orally administered treatment in a timely fashion. The use of a modern insulin pen eased the integration of insulin therapy into the patients' daily life according to the survey.
Characteristics of integrated care programmes and their impact on patient benefit: A discrete-choice experiment for integrated care networks [Eigenschaften von integrierten Versorgungs programmen und deren Einfluss auf den Patientennutzen: Ein Discrete-Choice Experiment für Versorgungsnetzwerke]
Muhlbacher A.C.,University of Applied Sciences Neubrandenburg |
Bethge S.,University of Applied Sciences Neubrandenburg |
Eble S.,Berlin Chemie AG
Gesundheitswesen | Year: 2015
Purpose: Innovative care models shall reduce the frictional losses in health-care. The successful implementation of care networks requires the acceptance by the health care providers, by the patients and citizens as well as by the payers. The consideration of preferences is an essential factor for success. The aim of this study is to analyse patient preferences. Methods: With the help of Discrete-Choice experiment 21 patient-relevant attributes of innovative healthcare programmes were examined. On the basis of a balanced overlapping design (sawtooth) a total of 140 choice sets with the highest possible D efficiency was generated. The 21 attributes were divided into 4 thematic priorities for analysis. The cost attribute was integrated as a uniform comparator. The evaluation was done by a random effects logit estimation (STATA). Results: The representative samples (N=1 322) revealed that in all 4 DCE blocks the attribute additional costs had the strongest influence on the patients choice (1: coeff.; 1.047; 2: coeff.: 1.105; 3.: coeff.: 0.956; 4.: coeff.: 0.954). This was followed by medical apparatus and facilities, waiting time for an appointment, professional experience, travelling time to treatment site, and exchange of clinical information. Transfer management and consideration of individual circumstances for example, had a small influence on patient choice. Conclusion: In order to increase the acceptance of innovative health-care programmes preferences must be known and integrated into the design of the services. The present study has attempted to depict the patients' perspectives towards the new care systems. The individual selection decisions were not, as would be expected, influenced by the innovative approaches such as case management or shared decision making but rather by the quality of the infrastructure, the waiting times and professional experience.