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Hannover, Germany

Krauth C.,Institute For Epidemiologie
Gesundheitsokonomie und Qualitatsmanagement | Year: 2010

The article gives an overview of cost estimation methods in health economic evaluation. The process of cost estimation identification, quantification, and valuation of resource consumption is described from the perspectives of society and statutory health insurance (SHI). The following aspects are discussed: 1. Should productivity costs (due to morbidity and/or mortality) be considered on the cost side or the effect side of a health economic evaluation, 2. which costs in life years gained (related or all) should be considered, 3. when should a precise micro-costing approach be applied and when is a macro-costing approach sufficient, 4. when (and how) should administered prices be adapted to opportunity costs, 5. how should productivity and time costs be valuated, 6. why should costs be discounted and what is the right discount rate, 7. which differences do exist between cost analyses from societal and SHI perspectives, 8. are there any proposals for standardisation of cost valuation. © Georg Thieme Verlag KG Stuttgart.

Backround: The goal orientation of rehabilitation has increasingly found its way in research and practice. Though, shortcomings were ascertained for the implementation into the clinical routine furthermore. An empirical analysis of goal setting in clinical practice should complement the available evidence. Methods: The study is based on a cross-sectional survey of all endometriosis patients, who had been treated at a rehabilitation center in 2008 or 2009. Data stemmed from the uniform medical rehabilitation discharge reports, and a patient questionnaire, which was sent to the registered women by the clinic routinely before the beginning of the rehabilitation. Data about rehabilitaÂtion goals were available as free text information for both the discharge reports as well as the paÂtient questionnaires. A category system oriented at the ICF system (International Classification of Functioning, Disability and Health), was developed to structure the goals. Results: 293 patients had provided information concerning their rehabilitation goals, while 69 patients didn't reply to the question of their rehabilitation goals. The latter were excluded to the analysis. In the discharge reports, altogether, more goals were documented than in the patient questionnaires (5.98 compared to 4.97 goals per patient). In 35% of the numbers of rehabilitation goals clear congruence was found between the data in the discharge reports and the patient questionnaires. Conclusion: The results support the assumpÂtion that the included patients had difficulties in goal-setting. In addition it is obvious that the goals in the discharge reports had little relation to the goals framed by the patients, in language and content. A goal-setting process less oriented towards the medical and clinical needs but more towards the patients needs and expectation would be desirable particularly with regard to a more intensive patient orientation. The implementation of a prepared list of possible rehabilitation goals could serve for the shared goal-setting process in the context of anamnesis. © Georg Thieme Verlag KG Stuttgart. New York.

The three-stage cross-sectional study used a mixed methods design of quantitative and qualitative methods. Phase I: Full survey of preschool education concepts (N = 4114 preschools) in Lower Saxony. Phase II: Survey of children and parents to analyse the effects of structured physical activity measures in preschools and parental influences on children's physical activity. Phase III: Focused ethnographic study to assess the everyday practice of preschools with and without a physical activity concept.

Hussein R.J.,Institute For Epidemiologie
Gesundheitswesen (Bundesverband der Ärzte des Öffentlichen Gesundheitsdienstes (Germany)) | Year: 2013

Dentists' suggestions for the establishment of preventive care were investigated on 3 levels; dentist, dental associations and unions (DAU), and health care system (HCS). Associations between categories of suggestions and dentists' characteristics were explored. A postal survey was sent to 2,075 dentists practicing in Bremen and Lower Saxony. The answers on 3 open-ended questions were analysed in a qualitative manner based on the quality control protocol (QCP) of the Federal Joint Committee. Quantitative methods were used for exploring associations between categories of suggestions and gender as well as age. Response rate was 33% (n=685). Dentists made 2,120 suggestions (dentist=752, DAU= 574, HCS= 794). The majority of dentists (90%) suggested educating and motivating patients. Dentists stated that support from DAU is needed in educating the public (50%), offering preventive-oriented training (35%), and in advertising for prophylaxis (18%). On the HCS level, about 60% of the suggestions concerned remunerating prophylaxis and expanding the existing bonus system. Significantly more female (p=0.010) and younger dentists (p=0.031) contributed to educating patients than male and older dentists. Education is the key message of this work. Essential topics such as prevention for elderly and risk groups were not a focal point. Education on the DAU and HCS levels can be realised through organising nation-wide health campaigns. Funding options for prevention and regulating multidisciplinary work between dentists and other health-care providers should be examined. These changes can contribute enormously to further establish prevention. © Georg Thieme Verlag KG Stuttgart · New York.

Objective: Models of integrated care (IC) have a high potential to improve psychiatric care in a sectored health care system. The present study aims to delineate differences in the perception of psychiatric care after introduction of a regional IC-model in schizophrenic patients and family caregivers. Methods: Six focus group interviews with n=32 schizophrenic patients and three with n=17 family caregivers either from the region with IC-model or a nearby control region were conducted. Categories of the contents of transcribed interviews were developed and subsequently compared between persons with and without experience of IC. Results: Most participants of the IC-group were not aware to participate in an IC-model. Differences between IC- vs. non-IC groups were primarily related to feelings of security and experiences of flexibility of care which was ensured by the outpatient nursing service in the IC-model. This was noticeable both in daily living and in coping with crisis. No substantial differences were found with regard to the experience of cooperation of professionals, information and psychoeducation of patients as well as support for family caregivers, amongst others. Conclusions: IC will play an important part in the psychiatric care of schizophrenic patients. It has the potential to integrate sustainable relations, general availability and needs-related care provision. © Georg Thieme Verlag KG Stuttgart New York ISSN 0303-4259.

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