Suchergebnisse

Zusammenfassung
Einleitung Die kleinräumige Gesundheitsversorgung Sachsen-Anhalts
wird als disparat beschrieben, da sich Regionen mit guter Versorgungsstruktur
und zunehmend unterversorgte Regionen gegenüberstehen. Defizite beim
sektorenübergreifenden Therapiemanagement gefährden die
poststationäre Versorgung in ländlichen Gebieten. Ziel der
Arbeit war es, anhand von GKV-Routinedaten beispielhaft für
Patient*innen mit kolorektalem Karzinom sektorenübergreifend die
Versorgungssituation in Sachsen-Anhalt über den Zeitraum von
Diagnosestellung bis zu einem Jahr poststationär zu analysieren und zu
prüfen, ob Versorgungsunterschiede zwischen Versicherten aus
städtischen und ländlichen Regionen auszumachen sind.
Methoden Die Studienpopulation umfasst 13.218 Versicherte der AOK
Sachsen-Anhalt mit kolorektalem Karzinom der Jahre 2010–2014. Die
abgerechneten Versorgungsleistungen von Krankenhäusern und ambulanten
Ärzt*innen wurden in Bezug auf den Wohnort (Stadt oder Land) der
betroffenen Patient*innen betrachtet. Die Ermittlung der
Überlebenszeiten erfolgte nach Kaplan & Meier und die Analyse
erklärender Variablen auf das Überleben mittels
Regressionsanalyse nach dem Cox-Proportional-Hazards-Model.
Ergebnisse Unterschiede zwischen städtischen und
ländlichen Regionen wurden bei den involvierten Facharztgruppen im
ambulanten Bereich sowie bei der Versorgung in Darmkrebszentren deutlich. Der
Anteil der Versicherten mit onkologischen Zusatztherapien war sehr gering,
sodass nur in Ansätzen von leitliniengerechter Therapie ausgegangen
wird. Die Analyse offenbarte einen signifikanten Überlebensvorteil
für Versicherte aus der Großstadt im Vergleich zu Versicherten
aus ländlichen Regionen, wofür v. a. eine frühere
Diagnosestellung, ein jüngeres Alter, weniger Komorbiditäten und
eine adäquatere Krebstherapie ursächlich sind.
Schlussfolgerung Es bedarf einer Optimierung der Versorgungsstrukturen und
-prozesse, die eine frühe Diagnosestellung und barrierefreie
Inanspruchnahme adäquater Therapien ermöglicht.

Hintergrund: Um Herausforderungen in der Pflege und Betreuung von Personen mit Demenz zu bewäl-tigen, kommt technologischen Konzepten ein Potenzial zu. Jedoch ist unklar, wie eine Nutzung vontechnischen Assistenzsystemen in der Schweiz aussehen könnte und welche konkreten Potenziale sichdaraus ergeben. Das Ziel der vorliegenden Studie besteht darin, anhand der Meinungen, Erfahrungen undWissens bestände von Expertinnen und Experten die Nutzungsoptionen technischer Assistenzsysteme inder Pflege und Betreuung von Personen mit Demenz in der Schweiz zu erarbeiten.Methode: Wir wählten ein qualitatives Studiendesign. Die Experteninterviews werteten wir mit der the-matischen Analyse aus. Bei der Berichterstattung folgten wir den Standards qualitativer Studien (SRQR).Ergebnisse: Zwischen November 2018 und Mai 2019 fanden Interviews mit 15 Expertinnen und Expertenstatt. Die Analyse resultierte in drei Themen mit jeweils drei Subthemen: (i) Nutzung und Poten-ziale von technischen Assistenzsystemen (Unterstützung im häuslichen Betreuungsnetzwerk, Förderungvon Sicherheitsempfinden, Interaktionsermöglichung und -erhalt), (ii) Anforderungen an die Nutzungtechnischer Assistenzsysteme (strukturelle Rahmenbedingungen, Steigerung der Lebens- und Betreu-ungsqualität, Berücksichtigung der individuellen Bedürfnisse und der gesundheitlichen Situation) sowie(ii) ethische Überlegungen und technisches Vermögen (Sicherheit und Freiheit, Begleiterscheinungen vontelepräsenter Betreuung, Vorbehalte und Technikoptimismus).Schlussfolgerungen: Um die benannten Potenziale technischer Assistenzsysteme für Personen mitDemenz auszuschöpfen, sind Anforderungen auf struktureller Ebene in der Pflegepolitik, -bildung und-praxis zu erfüllen. Zudem sollten technische Assistenzsysteme zur Anwendung kommen, deren Wirk-samkeit in Abwesenheit von unerwünschten Wirkungen nachgewiesen ist. Eine Nutzung sollte nachindividuell zu bestimmenden Maßgaben erfolgen. Demnach sollte die Nutzung technischer Assistenzsy-steme die Bedürfnisse der involvierten Personen ...

Selecting relevant indicators is an important step in the development of public health monitoring for older people. Indicators can be used to combine information comprehensively from various data sources and enable recurring, comparable findings to be made about the health of older people. Indicators were systematically compiled from existing international monitoring systems. An indicator set on health in old age was developed using a multistage, structured consensus-based process together with an interdisciplinary panel of experts. The resulting 18 indicators were assigned to three health areas: (1) environmental factors, (2) activities and participation, and (3) personal factors. Data sources that can be used for the indicators are the health surveys within the framework of the Robert Koch Institute's (RKI) health monitoring system, as well as surveys from other research institutes and official statistics. In the future, the indicator set is to be developed further and integrated into an overall approach that is geared towards health reporting and the monitoring of chronic diseases in all phases of life.

Die Auswahl relevanter Indikatoren ist ein wichtiger Schritt in der Entwicklung eines Public-Health-Monitorings zur Gesundheit im höheren Lebensalter. In diesem können Informationen aus verschiedenen Datenquellen gezielt und systematisch zusammengeführt werden, um wiederkehrende und vergleichbare Aussagen zur gesundheitlichen Lage älterer Menschen zu ermöglichen. Basierend auf einer systematischen Zusammenstellung bestehender Indikatoren aus internationalen Monitoringsystemen wurde in einem mehrstufigen strukturierten Konsentierungsprozess gemeinsam mit einem interdisziplinär besetzten Gremium aus Expertinnen und Experten ein Indikatorensatz zur Gesundheit im Alter entwickelt. Die 18 Indikatoren lassen sich den drei Handlungsfeldern (1) Lebensweltfaktoren, (2) Teilhabe und Aktivität sowie (3) personenbezogene Faktoren zuordnen. Datenquellen, die zur Erhebung der Indikatoren genutzt werden können, sind die Surveys des Gesundheitsmonitorings am Robert Koch-Institut, Erhebungen anderer Forschungseinrichtungen sowie Daten der amtlichen Statistik. Perspektivisch soll der Indikatorensatz weiterentwickelt und in ein Gesamtkonzept zur Gesundheitsberichterstattung und zum Monitoring chronischer Krankheiten in allen Lebensphasen integriert werden.

The project is supported through the following funding organizations under the aegis of JPND - www.jpnd.eu. Germany, Ministry of Education and Research, Ireland, Health research board, Italy, Ministry of Health, the Netherlands, The Netherlands organization for Health Research and Development, Sweden, The Swedish Research Council for Health, Working Life and Welfare, Norway, The Research Council of Norway, Portugal, Foundation for Science and Technology, (Fundação para a Ciência e Tecnologia (FCT - JPND-HC/0001/2012), United Kingdom, Economic and Social Research Council. JPND has read and approved of the protocol of the Actifcare study. ; Background: Previous findings indicate that people with dementia and their informal carers experience difficulties accessing and using formal care services due to a mismatch between needs and service use. This mismatch causes overall dissatisfaction and is a waste of the scarce financial care resources. This article presents the background and methods of the Actifcare (ACcess to Timely Formal Care) project. This is a European study aiming at best-practice development in finding timely access to formal care for community-dwelling people with dementia and their informal carers. There are five main objectives: 1) Explore predisposing and enabling factors associated with the use of formal care, 2) Explore the association between the use of formal care, needs and quality of life and 3) Compare these across European countries, 4) Understand the costs and consequences of formal care services utilization in people with unmet needs, 5) Determine the major costs and quality of life drivers and their relationship with formal care services across European countries. Methods: In a longitudinal cohort study conducted in eight European countries approximately 450 people with dementia and informal carers will be assessed three times in 1 year (baseline, 6 and 12 months). In this year we will closely monitor the process of finding access to formal care. Data on service use, quality of life and needs will be collected. Discussion: The results of Actifcare are expected to reveal best-practices in organizing formal care. Knowledge about enabling and predisposing factors regarding access to care services, as well as its costs and consequences, can advance the state of the art in health systems research into pathways to dementia care, in order to benefit people with dementia and their informal carers. ; publishersversion ; published

Background:With 10.5 million people with dementia in Europe and $301 billion associated costs, governments face challenges organizing access to care. Objective:To examine the costs related to formal and informal care use and quality of life for people with dementia in eight European countries, and explore the association with unmet needs. Methods:Cross-sectional data from 451 persons with dementia and their informal caregivers of the Actifcare cohort study were obtained. Formal and informal care use was multiplied by country specific unit prices of services. Needs were measured using the CANE and health-related quality of life (HRQOL) of the person with dementia (both self- and proxy-rated) and informal caregiver's quality of life using EQ-5D-5L, ICECAP-O, DEMQOL-U, and CarerQol utility scores. The association between costs and country, European region, and unmet needs was assessed using multi-level linear regression. Results:Self-rated EQ-5D-5L utility score was higher than proxy-rated (0.84 and 0.71, respectively). Informal caregivers' utility score was 0.84. Across eight countries annual mean costs of formal and informal care were approximately € 17,000. Unmet needs were not associated with annual costs of care, nor with proxy-rated HRQOL, but were associated with self-rated HRQOL. Conclusion:We found varying relationships between unmet needs and quality of life, and no association between unmet needs and care costs, although the results were sensitive to various factors. Future research should further investigate the relation between unmet needs, quality of life and costs to generate a better understanding of the effects of (un)timely access to care.

Background As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Methods Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4–7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. Results The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness. Conclusions Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations.

Background: As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Methods: Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. Results: The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness. Conclusions: Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations.

Background: As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Methods: Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. Results: The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness. Conclusions: Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations. ; publishersversion ; published