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Objective: We investigated whether patients receiving Unemployment Benefit II (Hartz-IV) differ in their addiction-related prevalence rates from recipients of Unemployment Benefit I (ALG I) and employed patients subjected to social security contributions. Method: For this purpose, we analysed the data of all AOK-insurees who were continuously insured with the AOK in the years 2007-2012 and in outpatient or inpatient treatment. We analysed all addiction-related ICD-10-GM-diagnoses: F10-F19, F50 and F63.0, differentiating between men and women and 3 age groups: 18-29, 30-49 and 50-64 years. To ensure maximum coincidence between the social and employment status and addiction-related diagnosis, we chose quarterly periods as evaluation unit. The data are based on 28 million quarterly cases for the Hartz-IV group and 173 million cases for all 3 groups in the years 2007-2012. As rate of addiction-related diagnoses, the percentage of investigated quarters with medically coded ICD diagnoses was calculated separately for the 3 study groups. Results: For 10.2% of all Hartz-IV quarterly cases at least one addiction-related diagnosis was found. For unemployed ALG-I recipients, the diagnosis rate was 6.3% and 3.7% for employed patients. A similarly striking disparity in diagnosis rates was found for F10 (alcohol), F11 (opioids), F12 (cannabinoids), F13 (sedatives/hypnotics), F17 (tobacco), F19 (multiple substance use) and F50 (eating disorders), both for men and women as well as in all 3 age classes. For the diagnoses F14 (cocaine), F15 (other stimulants), F16 (hallucinogens), F18 (volatile solvent) and F63.0 (pathological gambling), generally little or no coding was found. Conclusions: Conclusions are drawn on the use of screening procedures in primary health care and in relation to the duty of job centers to refer Hartz-IV recipients affected by addiction to facilities of addiction aid.


METHODS: The administrative prevalence of HK (ICD-10 F90) was analysed for 3,6 million children, up to 18 years old and in the whole year 2009 insured by the AOK, using health insurance data. Additionally, administrative prevalence changes between 2006 and 2008 were investigated. The prevalence analyses were differenciated according to postal code areas and regions of the associations of statutory health insurance physicians (SHIP-regions).RESULTS: The analyses revealed a continous increase of the administrative HK-prevalence between 2006 (2,8 %) and 2009 (3,8 %). The administrative prevalence was notably lower in the city states Bremen, Hamburg and Berlin, but rather high in four of five SHIP-regions in the New Laender. 14 % of children with HK were diagnosed with HK and ICD-10 F98.8. In 47 % these different diagnoses had been coded by different physicians.CONCLUSIONS: Regional differences in administrative prevalence rates and discrepancies in diagnosis coding by different physicians may indicate uncertainties regarding HK-diagnosis in routine health care. Future studies should analyse these associations more detailed.OBJECTIVE: To analyse the administrative prevalence and regional differences in hyperkinetic disorder (HK) diagnoses in Germany. © Georg Thieme Verlag KG Stuttgart · New York.


Godman B.,Karolinska University Hospital | Godman B.,Mario Negri Institute for Pharmacological Research | Godman B.,University of Liverpool | Paterson K.,Scottish Medicines Consortium | And 4 more authors.
Expert Review of Pharmacoeconomics and Outcomes Research | Year: 2012

The Managed Introduction of New Medicines Ljubljana, Slovenia, 19-21 March 2012 The 3-day course on the managed entry of new medicines was run by the Piperska group, which is a pan-European group striving to enhance the health of the public as a whole and the individual patient through exchanging ideas and research around the rational use of drugs. Participants included health authority and health insurance personnel, academics and those from commercial organizations. The principal aim of the conference was to bring together people to discuss ways to improve the managed entry of new drugs. © 2012 Expert Reviews Ltd.


Wienhold R.,Universitats Medizin Leipzig | Scholz M.,University of Leipzig | Adler J.-B.,Wissenschaftliches Institute der AOK WIdO | Gunster C.,Universitats Medizin Leipzig | Paschke R.,Universitats Medizin Leipzig
Deutsches Arzteblatt International | Year: 2013

Background: In Germany, about 59 000 thyroid operations are performed each year for unior multinodular goiter, most of them for diagnostic purposes. The rate of detection of thyroid cancer in such operations is relatively low, at 1:15. Evidence suggests that the preoperative tests recommended in guidelines for estimating the risk of cancer are not being performed as often as they should. In the present study, we determined the measures that were actually taken to diagnose and treat thyroid nodules and compared the findings with the guideline recommendations. Method: We retrospectively analyzed data from a single, large statutory health-insurance carrier in Germany (AOK), determining the diagnostic and therapeutic measures that were reimbursed for 25 600 patients in whom a unior multi-nodular goiter was newly diagnosed in the second quarter of 2006 (none of these patients had carried such a diagnosis 1 year previously). We recorded the diagnostic measures performed in the preceding 9 months and all other tests and treatments, including surgery and radioactive iodine treatment, in the 2 years thereafter. Results: Among patients who underwent surgery for uninodular goiter, the preoperative diagnostic studies included ultrasonography (in 100% of patients), scintigraphy (94%), measurement of thyroid-stimulating hormone (95%), measurement of calcitonin (9%), and fine-needle aspiration cytology (FNAC) (21%). An ultrasonographic examination was billed for only 28% of patients with uninodular goiter in the two years after the diagnosis was made. 13% of patients with uninodular goiter who were not operated on were given L-thyroxine, even though this is against guideline recommendations. Conclusion: Inadequate preoperative risk stratification of thyroid nodules may explain the large number of thyroid operations that are performed for diagnostic purposes, resulting in a low percentage of malignancies detected. Preoperative FNAC and calcitonin measurement should be used in the diagnostic evaluation of thyroid nodules far more often than this is now done. As a rule, follow-up ultrasonography should be performed for all thyroid nodules that are not operated on. Patients with non-operated thyroid nodules should not be given thyroxine. A limitation of this study is that diagnostic measures were only recorded if they were performed in the 9 months before surgery, with earlier diagnostic measures (if any) being missed.


Objective: To analyse the administrative prevalence and regional differences in hyperkinetic disorder (HK) diagnoses in Germany. Methods: The administrative prevalence of HK (ICD-10 F90) was analysed for 3,6 million children, up to 18 years old and in the whole year 2009 insured by the AOK, using health insurance data. Additionally, administrative prevalence changes between 2006 and 2008 were investigated. The prevalence analyses were differenciated according to postal code areas and regions of the associations of statutory health insurance physicians (SHIP-regions). Results: The analyses revealed a continous increase of the administrative HK-prevalence between 2006 (2,8 %) and 2009 (3,8 %). The administrative prevalence was notably lower in the city states Bremen, Hamburg and Berlin, but rather high in four of five SHIP-regions in the New Laender. 14 % of children with HK were diagnosed with HK and ICD-10 F98.8. In 47 % these different diagnoses had been coded by different physicians. Conlusions: Regional differences in administrative prevalence rates and discrepancies in diagnosis coding by different physicians may indicate uncertainties regarding HK-diagnosis in routine health care. Future studies should analyse these associations more detailed. © Georg Thieme Verlag KG.

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