AOK

BackgroundAs part of the German Burden of Disease Study, population-based prevalences of important diseases are estimated. This allows regional patterns and temporal trends to be identified.MethodsThe 10-year prevalence of stroke in the population was estimated cross-sectionally for the years 2017 to 2022 at the level of the Spatial Planning Regions using routine data of persons insured in the statutory health insurance AOK, adjusted for age, sex and morbidity (administrative 10-year prevalence).ResultsIn 2022, 1.4 % of the population in Germany was living with the consequences of a stroke that had occurred up to 10 years ago (women: 1.3 %, men: 1.6 %). Prevalence increases continuously with age – from 1.2 % (women) and 2.3 % (men) in the 60 – 64 age group to 8.3 % and 9.8 % in the 90 – 94 age group. Over time, age-standardised prevalence has remained largely stable since 2017. The age-standardised regional distribution shows a variation of up to 60 % between regions. Low values (below 1.1 %) are found mainly in southern German regions, while the highest values (above 1.5 %) without a clear pattern are found, for example, in the Emscher-Lippe, Saar, and southern Thuringia regions.ConclusionsMeasured in terms of administrative 10-year prevalence, the significance of stroke for public health remains high, not least because of the high mortality rate, with high prevalence rates continuing to be achieved, especially in older age groups. In order to achieve a decline, more low-threshold, evidence-based prevention services are needed in addition to targeted interventions.

ZusammenfassungBeim innovativen Ansatz der rehabilitativen Kurzzeitpflege werden Leistungsinhalte der stationären Kurzzeitpflege um rehabilitative Maßnahmen ergänzt. Für eine Überleitung in die Regelversorgung wurden Vergütungs- und Finanzierungsmodelle auf Basis einer Literaturrecherche entwickelt, kriteriengestützt bewertet und in einem Stakeholder-Workshop diskutiert. Die Ansätze zur Finanzierung umfassen eine reine Finanzierung durch die GKV, eine Zuordnung der Finanzierungsträger GKV und SPV nach Leistungsbestandteilen sowie die Zuordnung der Finanzierungsverantwortung nach Rehabilitationsrisiko über Transferzahlungen von der SPV an die GKV. Die Vergütungsmodelle unterscheiden Fallpauschalen und Tagessätze, die entweder aufwandsspezifisch differenziert, durch eine Pay-for-Performance-Komponente ergänzt oder einheitlich ausgestaltet sind. Die kriteriengestützte Bewertung zeigte Trade-offs hinsichtlich der Zielerreichung der verschiedenen Kriterien.

OBJECTIVE: Media-based educational interventions applied by healthcare providers may improve women‘s adherence, health literacy and awareness of LRRFs, and off-spring health outcomes. This study aims to investigate whether exposure to media-based educational interventions in gynecological and obstetric care are associated with self-assessed levels of knowledge on LRRFs during pregnancy and lactation. DESIGN: We conducted a cross-sectional observational study. SETTING: The study was carried out across 14 randomly generated sample points in the twelve most-populated cities in Ba-den-Wuerttemberg, South-West Germany. Women were recruited in gynecological and obstetric institutions. SAMPLE: The study sample comprised of 219 women who met our inclusion criteria and completed the quantitative questionnaire. METHODS: We applied ordinal logistic regression analyses to calculate Odds Ratios (ORs) and 95% Confidence Intervals (CIs). MAIN OUTCOME MEASURES: Women’s self-assessed level of knowledge in relation to the exposure to media-based educational interventions by healthcare providers. RESULTS: Media-based educational interventions on LRRFs during pregnancy through gynecologists and/or midwifes are significantly associated with women’s self-assessed level of knowledge (gynecologists: OR 4.26 (95% CI 2.04, 8.90; p <.001); midwifes: OR 3.86 (95% CI 1.66, 8.98; p=.002)). Similar results were found for media-based educational interventions through gynecologists and/or midwifes on LRRFs during lactation and its association with women’s self-assessed level of knowledge (gynecologists: OR 4.76 (95% CI 2.15, 10.59; p <.001); midwifes: OR 7.61 (95% CI 3.13, 18.53; p<.001)). CONCLUSION: The study suggests that exposure to media-based educational interventions in gynecological and obstetric care increases women’s level of knowledge on LRRFs during pregnancy and lactation.

Non-communicable diseases (NCDs) account for 73% of the global mortality in 2017, with an estimated financial impact of up to US$ 47 trillion by 2030. This escalating prevalence poses a significant challenge to healthcare systems and insurers, particularly in the context of an aging population with multiple NCDs. Digital health technologies (DHTs) have emerged as a potential solution, offering scalability, accessibility, and cost-effectiveness. However, integrating DHTs into healthcare services remains a complex task. We conducted a semi-structured interview with an industry expert from Germany’s largest statutory health insurance group to explore this issue and derive first hypothesis for improvement. Results indicate seven key insights into Germany’s dynamic digital health ecosystem and offer critical reflections for all stakeholders, providing a foundation for further discussions and actions in this transformative field.

Abstract Background Lifestyle-related risk factors can increase complications during pregnancy and negatively impact the health of a mother and her child. Knowledge about these compliances among many pregnant women and women of childbearing age is lacking. In the study AOK-Family+, we propose the evaluation of a newly developed counselling intervention. The intervention aims to raise awareness and to provide relevant information about the impact of lifestyle-related risk factors during pregnancy. The aim of the proposed study is to evaluate the effect of this counselling intervention on women’s knowledge of lifestyle-related risk factors during pregnancy and the concomitant healthy behaviours. Methods A cluster-randomised trial with three arms in Baden-Wuerttemberg, Germany, is proposed. Pregnant women and women of childbearing age will be allocated to one of three groups: online intervention, on-site intervention, or a waiting-list control. Trained counsellors from AOK Baden-Wuerttemberg, a German statutory health insurer, will conduct the counselling sessions. Data collection is conducted throughout validated questionnaires administered at three intervals: before counselling (t0), directly after counselling (t1), and at a six-week follow-up (t2). The primary outcomes will be health knowledge and healthy behaviours relating to LRFFs during pregnancy. A process evaluation will examine the processes, used resources, and future implementations through additional quantitative questions and qualitative interviews and focus groups. Discussion Based on this study, an implementation strategy for future conduction of lifestyle consultation during pregnancy could be developed with the aim of reducing pre- and post-mortem mobility and mortality. Trial registration This study is registered in the German Clinical Trials Register, https://www.bfarm.de/DE/Das-BfArM/Aufgaben/Deutsches-Register-Klinischer-Studien/_node.html, as DRKS00027804, 2022/01/12.

The National Cancer Plan emphasises the importance of medical communication and calls for its integration into medical education and training. In this context, the Milestone Communication Approach meets the communicative challenges in dealing with lung cancer patients. Interprofessional tandems, consisting of doctors and nurses, conduct structured conversations at defined moments with patients and their relatives. The concept aims at shared decision making, continuity in the care of lung cancer patients and the early integration of palliative care. During the symposium on the Heidelberg Milestone Communication in January 2020, recommendations on the care situation of lung cancer patients in advanced stages were developed. In addition, the further adaptability of HeiMeKOM to other settings and hospitals and to other diseases was discussed as well as the possibility of implementing such a concept in standard care. This article presents the experiences, best practice examples and recommendations discussed during the symposium in order to enable their extrapolation to other similarly oriented projects. The long-term goal is to transfer the milestone concept to other hospital, primarily certified lung cancer centers, and to ensure permanent funding. For further dissemination of the concept and, above all, to have it established in standard care, health policy awareness and support are required in addition to the integration of the concept in competence catalogues of continuing medical and nursing education.

BackgroundProviding care for someone with a disease or chronic condition can have a negative psychological, physical, social, and economic impact upon informal caregivers. Despite the socio-economic relevance and more than three decades of caregiver intervention research only very few translational efforts of successful interventions are reported. Still less of these interventions have been implemented into routine services. The aim of the ReDiCare study (German acronym BerTA) is to evaluate the effectiveness of a stepped counselling approach for burdened caregivers delivered by care counsellors of two long-term care insurances and registered psychotherapists.Methods/ designA pragmatic randomised controlled trial with 572 caregivers of older adults (≥ 60 years) receiving benefits of one of the two participating long-term care insurances. Participants are assigned (t0) to either the ReDiCare intervention or a control group receiving routine care and counselling. Data are collected at baseline (-t1), 3-month (t1), 9-month (t2) and 15-month (t3). The 9-month post-intervention assessment (t2) is the primary endpoint to evaluate the results on the primary and secondary outcomes, measured by self-reported questionnaires. Depressive symptoms measured with the CES-D are the primary outcome. The main secondary outcomes are physical complaints, utilization of psychosocial resources, caregiver self-efficacy and burden, positive aspects of caregiving and perceived care quality. A process evaluation, including audio tapes, self-report questionnaires and documentation will be conducted to examine internal and external validity of the intervention. Data on direct and indirect costs are collected for the (health) economic evaluation, using a health care perspective and a societal perspective.DiscussionWhile comparable previous caregiver interventions have been developed and evaluated for specific caregiver groups (e.g. dementia caregivers, stroke caregivers), the ReDiCare study will indicate whether a stepped approach will be effective also in a broader group of caregivers. The intervention is one of the very few translational studies in caregiver intervention research and will provide valuable insights into relevant factors for training, intervention protocol adherence, effectiveness, and costs for future implementation steps.Trial registrationDeutsches Register Klinischer Studien (German Clinical Trials Register), DRKS00014593 (www.drks.de, registered 14 May 2018) and International Clinical Trials Registry Platform, DRKS00014593 (https://apps.who.int/trialsearch/).

Zielsetzung Gerade in der Frauengesundheit rückt die Bedeutung der Prävention zunehmend in den Vordergrund des Interesses. Das Kooperationsprojekt zwischen dem Universitätsklinikum Tübingen, dem Institut für Allgemeinmedizin und Interprofessionelle Versorgung des Universitätsklinikums Tübingen sowie der Universitätsfrauenklinik Heidelberg und der AOK Baden-Württemberg hat das Ziel, anonymisierte Versicherungsdaten systematisch auszuwerten, um Erkenntnisse und Hypothesen für die Prävention ableiten zu können. Anhand der Daten sollen evidenzbasierte präventionsmedizinische Erkenntnisse generiert und in die Patientenversorgung, sowie in die ärztliche Aus- und Weiterbildung integriert werden. In der aktuellen Auswertung liegt der Fokus auf der Präeklampsie und deren Langzeitfolgen.