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Item-typ:Veröffentlichung, Nutzen und Risiken der zulassungsüberschreitenden Arzneimittelanwendung in der ambulant-ärztlichen Versorgung(2015-10-02); ; ; Off-label use (OLU) is defined as the prescription of pharmaceutical drugs for an indication or other application that has not been approved by the governing authorization body. Off-label uses are not only common practice but are often the standard and relate to the need for a patient-oriented and patient-specific therapy. The current thesis discusses off-label use from the perspective of health services research. The question is of particular interest because civil and criminal requirements on the one hand and the health insurance law on the other have a direct impact on the doctor as a health care provider and the patient as a beneficiary. The first part of this thesis (Chapters 1-6) briefly outlines the legal aspects, the second part (chapters 7-9) analyses the possible conditions that enable an off-label use in drug therapy of chronic diseases. The focus is primarily on possible structural and administrative gaps as the cause of an OLU. The present work integrates different areas of supply research. This thesis considers the strengths and limitations of different databases and indicates more trans-parency with regard to off-label use discussing the gap between the admission authorised usage and patient-specific care. Finally it outlines the implications for better health care provision.Dissertation387 258 - Some of the metrics are blocked by yourconsent settings
Item-typ:Veröffentlichung, Behandlungsmöglichkeiten chronischer Viruserkrankungen und ihre Auswirkungen auf das öffentliche Gesundheitssystem(2019-08-06); ; ; Chronic diseases caused by various types of viruses are becoming an ever greater challenge for health care systems because of the associated costs they induce. In the context of this dissertation, the effects of new and innovative drugs on the German health care system are analyzed. The focus is on infections with HIV and the hepatitis c - virus. Medication is relatively new and extraordinary expensive for these diseases. A large number of pharmaceuticals have been approved in recent years. After a brief introduction to the status quo of the pharmaceutical market, chapter 2 descibes the infection with HIV, followed by the infection with HCV in chapter 3. Both chapters also deal with pharmaceutical methods, information about new drugs and their importance of treating the infection. The results of a data analysis based on the Arzneiverordnungs-Report show the influence of pharmaceutical companies on the choice of antiretroviral drugs by the treatment providers. Finally the thesis critically scrutinises methods providing a better health care situation for both the patientsa health and economically for the social insurance system.Dissertation481 442 - Some of the metrics are blocked by yourconsent settings
Item-typ:Veröffentlichung, Inanspruchnahme von Leistungen der Hebammenhilfe durch GEK-versicherte Schwangere 2008-2009. Eine explorative Analyse von Routinedaten einer gesetzlichen Krankenkasse.(2012-06-30); In dieser Arbeit wird die Inanspruchnahme von Leistungen der gesetzlichen Hebammenhilfe mithilfe von Abrechnungsdaten der Gmünder Ersatzkasse (GEK) analysiert. Die Ergebnisse sollen dazu beitragen, die Versorgungssituation von Frauen rund um die Geburt umfassend zu beschreiben. Die Analyse zielt darauf ab, Inanspruchnahmeraten der Hebammenhilfe zu ermitteln sowie die Leistungen der Hebammenhilfe und deren Kosten zu beziffern. @!In die Analyse gingen Daten von 18.104 GEK-versicherten Frauen aus den Jahren 2008 und 2009 ein. Es zeigt sich, dass 81,3% der Leistungsberechtigten Hebammenhilfe nutzen, mit einer durchschnittlichen Betreuungsfrequenz von 22,5 Kontakten. Der überwiegende Teil der Frauen nutzt Hebammenleistungen bereits während der Schwangerschaft. Die meisten Leistungen werden nach der Geburt in Anspruch genommen. Leistungen der Geburtshilfe machen nur 0,65% aller abgerechneten Leistungen aus. Die individuellen Kosten für Hebammenhilfe liegen bei durchschnittlich 716 Euro. Bei der Inanspruchnahme zeigen sich deutliche regionale Differenzen. Sowohl die sehr jungen, als auch die älteren Frauen weisen geringere Inanspruchnahmeraten auf als Frauen aus mittleren Altersgruppen. Diese Ergebnisse können auf Über- bzw. Unterversorgung bestimmter Bevölkerungsgruppen hinweisen. Die Möglichkeiten der umfassenden Betreuung durch Hebammen werden derzeit nicht ausgeschöpft.Masterarbeit1147 625 - Some of the metrics are blocked by yourconsent settings
Item-typ:Veröffentlichung, Verbesserung der Lebensqualität und Gesundheit durch Versorgungsoptimierung mittels einer intensiveren Integration und Kooperation von Zahnmedizin und Medizin(2017-08-31); ; ; The following dissertation illustrates, from various professional perspectives, how our public health care could be optimised through more intensive cooperation and integration of dentistry and medicine. The foundation and starting point for this work is presented on the basis of relevant literature, from a public health care perspective. In addition to the theoretical literature elaboration, qualitative, guided expert interviews were also conducted. The methodical evaluation of these discussions took place, following the qualitative content analysis, according to Mayring, using the evaluation MAXQDA 12 programme. The results of the expert interviews provide an insight into the organisation and handling of the individual professions. Six dentists, six general practitioners, six representatives of care facilities, six institutions and six diabetes patients were interviewed. The results of the expert surveys provide an exciting impression of their respective daily work, from a large number of different perspectives. In addition to these anticipated results, experiences could also be gathered, which had not been considered at the outset. This thesis represents interdisciplinary findings and enriches the basis for discussion of possible action that could be taken within health services research on the above-mentioned topic. The dissertation is of interest to readers from the public health care sector as well as those from the dental, medical and nursing sectors.Dissertation572 759 - Some of the metrics are blocked by yourconsent settings
Item-typ:Veröffentlichung, Theorie und Praxis der evidenzbasierten Medizin in der Antibiotikaverordnung : unkomplizierte Harnwegsinfektionen bei Frauen(2016-12-07); ; ; The aim of this PhD thesis is to analyze the medical care of adult women in Germany suf-fering from uncomplicated urinary tract infections, as these are the most common bacterial infections encountered in ambulatory care settings. Acute uncomplicated cystitis is one of the most common indications for prescribing of an-timicrobials to otherwise healthy community-dwelling women. Antimicrobial use, whether appropriate or inappropriate, leads to a continuing increase in antimicrobial resistance. The use of administrative data from statutory health insurance funds offers great opportu-nities to assess information about the antibiotic prescribing and it may allow concordance with prescribing guidelines to be assessed. First, computerized literature searches and a review of international MEDLINE-published literature concerning uncomplicated urinary tract infections and antimicrobial resistance in uropathogens have been conducted. Second, epidemiological data were collected as a basis for the following analyses. Based on diagnosis claims data 7,3 % of the BARMER GEK women population, aged 12 years and older, had at least once an urinary tract infection in the year 2013, 1,7 % had at least once cystitis and 0,16 % had at least once pyelonephritis. Despite published national and international guidelines for the optimal selection of an an-timicrobial agent and the duration of therapy, this study demonstrated a wide variation in prescribing practices. Most patients with urinary tract infection were not treated according to the current guidelines. A broad regional variability in antimicrobial prescribing among the German federal states has been manifested, particularly in the prescribing rates of fluoroquinolones. The prescribing rates of fluoroquinolones for cystitis varied 2013 among the different age groups between 27 and 40 %. An optimal approach to therapy must include consideration of antimicrobial resistance and collateral damage such as the selection of drug-resistant organisms and colonization or infection with multidrug-resistant organisms. This could be achieved by evidence based guidelines and a constant monitoring of the antimicrobial prescribing. Informational pro-grams should be initiated to raise the physiciansa awareness of the problem of antimicrobial resistance and improve their guideline adherence.Dissertation339 523 - Some of the metrics are blocked by yourconsent settings
Item-typ:Veröffentlichung, Analyse der Arzneimitteltherapie von Rheumapatienten im Erwachsenenalter : das Versorgungsgeschehen im Lichte der Leitlinienempfehlungen(2015-10-02); ; ; The aim of this dissertation is to demonstrate the further developments in the provision of rheumatological health care with particular focus on evidence-based guideline recommendations. One of the issues to be examined is to identify "gaps" - defined as conditions of insufficient medical care between practical daily care and (theoretical) guideline recommendations differentiating various aspects of care. Are there still references about a lack of provison of medical care or is it possible to reveal further developments that can be assessed as positive respectively? Avenues for future action are to be pointed out against the background of these findings with regard to measures which have already been established as well as to aspired solutions in order to optimate the provision of rheumatological health care. A further glimpse of the future is disclosed by taking up the biosimilar-issue: As many bio-pharmaceuticals lose patent protection in coming years, biosimilar products are expected to play a key role in controlling pharmaceutical expenditure - while maintaining consistent quality of medical care. Assessing opportunities and challenges of these new medical products will round off this dissertation.Dissertation389 2558 - Some of the metrics are blocked by yourconsent settings
Item-typ:Veröffentlichung, Analyse der medikamentösen Versorgung von Patienten mit Multipler Sklerose anhand von Routinedaten der gesetzlichen Krankenversicherung(2024-03-07); ; ; Multiple sclerosis (MS) is the most common chronic inflammatory autoimmune disease of the central nervous system (CNS). While the use of MS drugs in routine care is well studied quantitatively, current data on the implementation of the requirements within the Summary of Product Characteristics (SmPC) and the consideration of guideline recommendations are insufficient. In addition, little is known about the implementation of a cost-effective drug therapy. Therefore, the aim of this thesis is to answer these open questions about drug use in MS. A routine data analysis was conducted on the use of drugs for MS between 2017 and 2020 using claims data from around 10 million insured members of the Techniker Krankenkasse (TK). This data was used to determine the outpatient prescription prevalence of various MS drugs. Overall, 54.95 % of MS patients were prescribed disease-modifying therapies (DMTs) for immunotherapy. Only 0.37 % of MS patients received rituximab off-label. Glatiramer acetate was prescribed to 13.04 % of MS patients. Of these only a small proportion were generic prescriptions. 23.15 % of MS patients were treated with glucocorticoids for acute relapse therapy without having previously received DMTs. Prescriptions for symptom-related drugs were given to a total of 51.38 % of patients. This included fampridine prescriptions for 11.29 % of patients, of whom 57.91 % received the drug for a continuous period of at least seven months. The observed proportion of 45.05 % of MS patients without a DMT prescription suggests that at least some of these patients may be undersupplied with DMTs. The low relevance of rituximab in MS therapy despite its designation as a recognised alternative treatment in the guidelines could be attributed to the barriers to off-label use in Germany. The low relevance of generic glatiramer acetate compared to the originator product is striking. The observation that 57.91 % of fampridine treatments continued for at least seven months raises questions as the SmPC requires the initial therapy attempt in non-responders to be limited to two to four weeks whilst the literature assumes a responder rate of less than 40 %. It is possible that the time-limit for treatment of non-responders is not adequately considered by physicians. Further research is needed to verify the assumptions made.Dissertation384 473 - Some of the metrics are blocked by yourconsent settings
Item-typ:Veröffentlichung, Entlassung von Arzneimitteln aus der Verschreibungspflicht. Eine Analyse von OTC-Switches unter pharmakologischen und versorgungsrelevanten Gesichtspunkten(2024-07-05); ; ; ; Prospektive Analyse von Wirkstoffen und Wirkstoffkombinationen hinsichtlich ihrer Geeignetheit für einen OTC-Switch anhand der EU-Switch-Leitlinie und Bewertung nach einem Ampelschema. Retrospektive Betrachtung bereits erfolgter OTC-Switches bezüglich ihrer Auswirkungen auf die AMTS anhand von Krankenkassendaten und Nebenwirkungsmeldungen sowie auf die Versorgungssituation in der GKV.Dissertation179 682 - Some of the metrics are blocked by yourconsent settings
Item-typ:Veröffentlichung, Immunological peculiarities in a "traditional" worm infested Papua New Guinean society and possible implications for the increase of allergies in fast changing "modern" societies(2017-12-11); ; ; The objective of this study is to describe the peculiarities of allergic sensitization in a Papua New Guinean society largely following a traditional lifestyle and to develop a theory explaining the increase of allergies in "modern" industrialized societies. At the beginning, we intend to give a coherent introduction to the pathophysiology of allergic reactions, particularly to the immunoglobulin E (IgE) composition, a crucial characteristic of the IgE system. Subsequently mites are identified as the clinically most relevant allergen source on Karkar Island. We confirmed the association of worm infestation and highly elevated total IgE levels. Moreover a significant positive correlation of total IgE and specific IgE (in-vitro sensitisation measured by RAST) was shown. Thus we deduce that the entire IgE system is triggered by helminth infections i.e. not only total IgE (contested allergy protective variable) but also allergen specific IgE (undisputed allergy mediating variable). Interestingly, triggering the allergy mediating part of the IgE system (specific IgE) dos not seem to lead to an increased prevalence of positive skin prick test (SPT) reactivity or allergy on Karkar as we have previously found that only 4.4% of the islanders suffer from allergic rhinoconjunctivitis/asthma (atopic dermatitis was absent). The worm induced elevated total IgE levels appear to protect the islanders from allergic reactions and may explain the striking epidemiological discrepancy between high in-vitro (RAST) and low in-vivo (SPT) sensitisation. We were able to show a significant protective effect of a low ratio of specific IgE to total IgE (i.e. a low allergen specific activity): The prevalence of positive skin prick test reactions upon contact with house dust mite extracts was significantly reduced when mite specific activity was lower than 0.1%. The pattern of sensitization on Karkar is an image/picture/reflection of the allergens existing in the island`s environment - irrespective of the allergological potency of the different allergens. The assumed "general/twofold IgE boost" in worm infested individuals seems to have two consequences: firstly we see the already described dissociation of RAST and SPT/allergy. Secondly it is possible that the IgE boost reveals a pre-existing clinically and serologically invisible (not measurable) "low level" immunological sensitization against multiple environmental antigens. Pushing levels of allergic sensitisation over the detection limit, worms may act like a magnifying glass which shows us that the immune system generally controls/samples a much larger array of antigens than previously thought - including many allergologically "unsuspicious" substances. Based on the hypothesis that there exists the same basically universal "subliminal" immunological "screening" of innumerable environmental substances in Western countries (just serologically invisible due to the lack of worm boosts), we developed our "change hypothesis of allergogenesis": In a "modern environment" with immensely accelerated change resulting in largely increased antigen diversity there is much more possibility for cross-reactivity than in a "traditional" society. Recent studies show that even low concentration/affinity cross-reactive IgE can induce considerable histamine release/clinical reactivity. Thus the rise of allergies in industrialized societies may be a consequence of generally increased specific activities (disappearance of parasitism) and increased cross-reactivity ("confusion" of the immune system).Dissertation334 661 - Some of the metrics are blocked by yourconsent settings
Item-typ:Veröffentlichung, ADHS (Aufmerksamkeitsdefizit- Hyperaktivitätsstörung) bei jungen Erwachsenen(2010-06-17); ; ; Background: Over the last years, there has been an increasing recognition of the persistence of attention-deficit/hyperactivity disorder (ADHD) into adulthood. ADHD was once perceived to be exclusively a childhood disorder.Objective: The aim of the study is to give an overview on diagnosis and prescription prevalence for ADHD in 17 to 20 year old patients and their prescribing physicians.Methods: A statutory health insurance companys' (Gmuender ErsatzKasse GEK) - person-specific but not identifying - prescription and diagnosis data for people aged 17 to 20 was analysed. The analysis was done in a longitudinal section design from 2004 to 2007 and then in a cross sectional design for each year from 2004 to 2007. Especially for the year 2007, data concerning people with and without ADHD diagnosis were compared with regard to some selected diagnoses und prescriptions.Results: The results of the longitudinal section study show that 24% of the young people with an ADHD diagnosis (ICD-10, F90-, Hyperkinetic Disorder) in the year 2004 kept this diagnosis until 2007. The proportion of men to women is 5:1.The results of the cross section study, conducted for every year from 2004 to 2007, show that the ratio of persons with ADHD diagnosis rose from 0.69% in 2004 to 1.4% in 2007. People with ADHD diagnosis get more prescriptions and comorbidity diagnoses than people without ADHD. They often change the attending physician - that points to a problem of transitional care at the transition from youth to adulthood.Conclusion: The ratio for people aged 17 to 20 years with an ADHD diagnosis rose in the observed period. These patients need a medical contact with special knowledge about ADHD for leading them through the time of transition from youth to adulthood.Dissertation973 505