Publications (26)23.79 Total impact
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Article: Evidenzbasierte Therapie der Depression
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ABSTRACT: Unipolare Depressionen zählen zu den häufigsten Beratungsanlässen und Erkrankungen in der Versorgung. Obwohl die Diagnostik und Therapie der Depression in den letzten Jahren Fortschritte gemacht hat, besteht noch deutliches Optimierungspotenzial. Die Ausrichtung der Behandlung an evidenzbasierten Leitlinien bildet hierbei einen zentralen Ansatzpunkt. Die neue S3- und Nationale Versorgungsleitlinie Unipolare Depression, deren Erstellung von der DGPPN koordiniert und die von 29Fachgesellschaften und Berufsverbänden konsentiert wurde, stellt den ambitionierten Versuch dar, Evidenz und klinischen Konsens zum „state of the art“ in der Depressionsbehandlung abzubilden. Für die Pharmakotherapie der Depression können differenzierte Empfehlungen, auch in Abgrenzung und in Ergänzung zur Psychotherapie, gegeben werden. Unipolar depressive disorders are among the most frequent reasons for utilizing the health care system. Although efficacious treatments are available and further advances have recently been made there is still a need for improving diagnostic and therapeutic procedures. Alignment of treatment on evidence-based treatment guidelines establishes an essential mainstay. The new S3 and National Health Care guidelines on unipolar depression, the compilation of which was coordinated by the German Society of Psychiatry, Psychotherapy and Neurology (DGPPN) and which were approved by 29 scientific and professional associations, is the ambitious effort to present state of the art evidence and clinical consensus for the treatment of depression. For pharmacotherapy of depression differentiated recommendations can be given, also separate from and in addition to psychotherapy. SchlüsselwörterEvidenzbasierte Pharmakotherapie-Leitlinien-Depression-Versorgung-Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde KeywordsEvidence-based pharmacotherapy-Guidelines-Depression-Health care-German Society of Psychiatry, Psychotherapy and NeurologyDer Nervenarzt 04/2012; 81(9):1049-1068. · 0.68 Impact Factor -
Article: [Evidence-based therapy of depression: S3 guidelines on unipolar depression].
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ABSTRACT: Unipolar depressive disorders are among the most frequent reasons for utilizing the health care system. Although efficacious treatments are available and further advances have recently been made there is still a need for improving diagnostic and therapeutic procedures. Alignment of treatment on evidence-based treatment guidelines establishes an essential mainstay. The new S3 and National Health Care guidelines on unipolar depression, the compilation of which was coordinated by the German Society of Psychiatry, Psychotherapy and Neurology (DGPPN) and which were approved by 29 scientific and professional associations, is the ambitious effort to present state of the art evidence and clinical consensus for the treatment of depression. For pharmacotherapy of depression differentiated recommendations can be given, also separate from and in addition to psychotherapy.Der Nervenarzt 09/2010; 81(9):1049-68. · 0.68 Impact Factor -
Article: Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions.
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ABSTRACT: The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach provides guidance to grading the quality of underlying evidence and the strength of recommendations in health care. The GRADE system's conceptual underpinnings allow for a detailed stepwise process that defines what role the quality of the available evidence plays in the development of health care recommendations. The merit of GRADE is not that it eliminates judgments or disagreements about evidence and recommendations, but rather that it makes them transparent. This first article in a three-part series describes the GRADE framework in relation to grading the quality of evidence about interventions based on examples from the field of allergy and asthma. In the GRADE system, the quality of evidence reflects the extent to which a guideline panel's confidence in an estimate of the effect is adequate to support a particular recommendation. The system classifies quality of evidence as high, moderate, low, or very low according to factors that include the study methodology, consistency and precision of the results, and directness of the evidence.Allergy 03/2009; 64(5):669-77. · 6.27 Impact Factor -
Article: Grading quality of evidence and strength of recommendations in clinical practice guidelines
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ABSTRACT: The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach provides guidance to grading the quality of underlying evidence and the strength of recommendations in health care. The GRADE system’s conceptual underpinnings allow for a detailed stepwise process that defines what role the quality of the available evidence plays in the development of health care recommendations. The merit of GRADE is not that it eliminates judgments or disagreements about evidence and recommendations, but rather that it makes them transparent. This first article in a three-part series describes the GRADE framework in relation to grading the quality of evidence about interventions based on examples from the field of allergy and asthma. In the GRADE system, the quality of evidence reflects the extent to which a guideline panel’s confidence in an estimate of the effect is adequate to support a particular recommendation. The system classifies quality of evidence as high, moderate, low, or very low according to factors that include the study methodology, consistency and precision of the results, and directness of the evidence.Allergy 02/2009; 64(5):669 - 677. · 6.27 Impact Factor -
Article: [Rare diseases in professional health care].
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ABSTRACT: The treatment of patients with rare diseases is a challenge for all those involved, since it frequently requires decisions on the basis of uncertainty. Uncertainty is of particular importance for the risk/benefit assessment of therapeutic interventions which "normally" imposes extensive requirements on the quality of evidence through explicit specifications. These requirements concern the assessment of potential benefit within the framework of statutory health insurance as well as the proof of efficacy and safety within the framework of pharmaceutical law. As a consequence drugs prescribed to patients with rare diseases are often applied outside approved indications, with immediate effects regarding reimbursement and drug safety. Another concern is that patients with rare diseases may be deprived of potential therapies as the requirements for clinical evidence are not fulfilled because of the rareness of the disease. The Federal Social Court takes this into consideration, but at the same time imposes strict requirements for the proof of efficacy. In contrast, the procedure of the Federal Joint Committee appears more adequate for the special requirements of rare diseases. Using some decisions of the Federal Social Court and of the Federal Court of Justice as examples, it is discussed how the uncertainty associated with the treatment of patients with rare diseases is dealt with and how this might be improved are discussed.Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 06/2008; 51(5):509-18. · 0.66 Impact Factor -
Article: [Development of national guidelines for depression].
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ABSTRACT: Depressive disorders rank among the most frequent causes of consultation and diseases in health care. Although they are treatable, there is further need to optimize diagnostics and therapy, despite sizable progress in recent years. The implementation of evidence- and consensus-based guidelines is an appropriate measure to improve care for depressive patients. An evidence-based guideline for depression is currently being developed for Germany. In order to ensure its acceptance and a wide dissemination, this guideline will be adopted in consensus by all relevant health care providers in this field. According to this, it is a future challenge to anchor guideline-based diagnostics and treatment in routine care.Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 05/2008; 51(4):451-7. · 0.66 Impact Factor -
Article: Seltene Erkrankungen in professionellen Versorgungssystemen
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ABSTRACT: Die Versorgung von Patienten mit seltenen Erkrankungen stellt an alle Beteiligten erhöhte Anforderungen, da häufig Entscheidungen trotz unsicherer Erkenntnisse getroffen werden müssen. Diese Unsicherheit wird bei der Bewertung des Nutzen- und Schadenpotenzials therapeutischer Interventionen – für Patienten mit seltenen Erkrankungen – insofern besonders deutlich, als in diesem Bereich „normalerweise“ mittels expliziter Regeln weitreichende Anforderungen an die jeweilige Nachweisqualität formuliert sind. Dies gilt sowohl für den erforderlichen Nutzennachweis im Rahmen der Gesetzlichen Krankenversicherungen (GKV), als auch für den Nachweis von Wirksamkeit und Unbedenklichkeit im Rahmen des Arzneimittelgesetzes. Bei seltenen Erkrankungen werden viele Arzneimittel außerhalb zugelassener Indikationen verwendet: Hieraus resultieren unmittelbar Folgen für die Erstattungsfähigkeit und die Arzneimittelsicherheit. Eine weitere zu befürchtende Folge besteht darin, dass den Patienten Schaden durch das Vorenthalten von Behandlungsoptionen entsteht, da die üblichen Nachweisanforderungen aufgrund der Seltenheit nicht erreicht werden. Die Rechtsprechung des Bundessozialgerichtes trägt dieser Gefahr Rechnung, gleichzeitig stellt das Gericht selbst aber hohe Anforderungen bezüglich der Wirksamkeitsnachweise, die schwer erfüllbar scheinen. Die dem gegenübergestellte Verfahrensweise des Gemeinsamen Bundesausschusses (GBA) erscheint dem Faktum der „Seltenheit“ angemessener. Durch eine beispielhafte Darstellung von Urteilen des Bundessozialgerichtes in Nachfolge des „Nikolausbeschlusses“ des Bundesverfassungsgerichts (BVerfG) wird der Umgang mit diesen Unsicherheiten verdeutlicht und hinsichtlich möglicher Verbesserungen analysiert. The treatment of patients with rare diseases is a challenge for all those involved, since it frequently requires decisions on the basis of uncertainty. Uncertainty is of particular importance for the risk/benefit assessment of therapeutic interventions which “normally” imposes extensive requirements on the quality of evidence through explicit specifications. These requirements concern the assessment of potential benefit within the framework of statutory health insurance as well as the proof of efficacy and safety within the framework of pharmaceutical law. As a consequence drugs prescribed to patients with rare diseases are often applied outside approved indications, with immediate effects regarding reimbursement and drug safety. Another concern is that patients with rare diseases may be deprived of potential therapies as the requirements for clinical evidence are not fulfilled because of the rareness of the disease. The Federal Social Court takes this into consideration, but at the same time imposes strict requirements for the proof of efficacy. In contrast, the procedure of the Federal Joint Committee appears more adequate for the special requirements of rare diseases. Using some decisions of the Federal Social Court and of the Federal Court of Justice as examples, it is discussed how the uncertainty associated with the treatment of patients with rare diseases is dealt with and how this might be improved are discussed.Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 04/2008; 51(5):509-518. · 0.66 Impact Factor -
Article: Entwicklung der S3- und Nationalen Versorgungs-Leitlinie Depression
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ABSTRACT: Depressive Störungen zählen zu den häufigsten Beratungsanlässen und Erkrankungen in der Versorgung. Obwohl sie gut behandelbar sind, besteht – trotz der Fortschritte in den vergangenen Jahren – weiterhin Optimierungsbedarf hinsichtlich der Diagnostik und Therapie. Die Implementierung evidenz- und konsensusbasierter Leitlinien ist eine geeignete Maßnahme, um die Versorgung depressiver Patienten zu verbessern. Zurzeit wird für Deutschland eine evidenzbasierte Leitlinie Depression erarbeitet. Um ihre Akzeptanz und weite Verbreitung sicherzustellen, wird diese Leitlinie im Konsens aller relevanten Akteure verabschiedet. Zukünftige Aufgabe ist es, eine an Leitlinien orientierte Diagnostik und Behandlung regelhaft in der Versorgung zu verankern. Depressive disorders rank among the most frequent causes of consultation and diseases in health care. Although they are treatable, there is further need to optimize diagnostics and therapy, despite sizable progress in recent years. The implementation of evidence- and consensus-based guidelines is an appropriate measure to improve care for depressive patients. An evidence-based guideline for depression is currently being developed for Germany. In order to ensure its acceptance and a wide dissemination, this guideline will be adopted in consensus by all relevant health care providers in this field. According to this, it is a future challenge to anchor guidelinebased diagnostics and treatment in routine care.Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 03/2008; 51(4):451-457. · 0.66 Impact Factor -
Article: [The National Programme for Disease Management Guidelines. Goals, contents, patient involvement].
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ABSTRACT: The Programme for National Disease Management Guidelines (German DM-CPG Programme) aims at the implementation of best practice recommendations for prevention, acute care, rehabilitation and chronic care. The programme, focussing on high priority healthcare topics, has been sponsored since 2003 by the German Medical Association (BAEK), the Association of the Scientific Medical Societies (AWMF), and by the National Association of Statutory Health Insurance Physicians (KBV). It is organised by the German Agency for Quality in Medicine, a founding member of the Guidelines International Network (G-I-N). The main objective of the programme is to establish consensus of the medical professions on evidence-based key recommendations covering all sectors of health care provision and facilitating the coordination of care for the individual patient through time and across disciplines. Within this framework experts from national patient self-help groups have been developing patient guidance based upon the recommendations for healthcare providers. The article describes goals, topics and selected contents of the DM-CPG programme - using asthma as an example.Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 04/2007; 50(3):368-76. · 0.66 Impact Factor -
Article: Das Programm für Nationale VersorgungsLeitlinien von BÄK, AWMF und KBV
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ABSTRACT: Das Programm für Nationale VersorgungsLeitlinien (NVL-Programm) ist eine Initia tive zur Förderung von Qualität und Transparenz in der strukturierten medizinischen Versorgung (Disease Management und Integrierte Versorgung). Das Programm wird seit 2003 gemeinsam von der Bundes ärztekammer (BÄK), der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) und der Kassenärztlichen Bundesvereinigung (KBV) verantwortet und durch das Ärztliche Zentrum für Qualität in der Medizin realisiert. Es zielt auf die Entwicklung und Implementierung versorgungsbereichübergreifender Leitlinien zu ausgesuchten Erkrankungen hoher Prävalenz unter Berücksichtigung der Methoden der evidenz basierten Medizin. In diesem Rahmen haben die mit den Themenbereichen Asthma, chronisch obstruktive Lungenerkrankung (COPD), koronare Herzkrankheit (KHK) sowie Typ-2-Diabetes befassten Fachgesellschaften im letzten Jahr entsprechende evidenzbasierte Versorgungsleitlinien konsentiert. Seit 2005 wird die Beteiligung von Patientenvertretern im NVL-Programm umgesetzt. Sie beinhaltet die Mitarbeit an der Erstellung der NVL und die Erarbeitung NVL-basierter Patientenleitlinien. Der vorliegende Aufsatz beschreibt Ziele, bisher bearbeitete Themen und exemplarische Inhalte des NVL-Programms. The Programme for National Disease Management Guidelines (German DM-CPG Programme) aims at the implementation of best practice recommendations for prevention, acute care, rehabilitation and chronic care. The programme, focussing on high priority healthcare topics, has been sponsored since 2003 by the German Medical Association (BAEK), the Association of the Scientific Medical Societies (AWMF), and by the National Association of Statutory Health Insurance Physicians (KBV). It is organised by the German Agency for Quality in Medicine, a founding member of the Guidelines International Network (G-I-N). The main objective of the programme is to establish consensus of the medical professions on evidence-based key recommendations covering all sectors of health care provision and facilitating the coordination of care for the individual patient through time and across disciplines. Within this framework experts from national patient self-help groups have been developing patient guidance based upon the recommendations for healthcare providers. The article describes goals, topics and selected contents of the DM-CPG programme – using asthma as an example.Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 02/2007; 50(3):368-376. · 0.66 Impact Factor -
Chapter: Glossar zur Evidenzbasierten Medizin
01/2007: pages 497-511; -
Article: [Evidence based guidelines and clinical pathways: complementation or contradiction?].
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ABSTRACT: Even methodological sound guidelines will only achieve their goals when the recommendations are transferred into practice. Guideline introduction and dissemination must therefore be accompanied by active implementation measures. For inpatient care clinical pathways can serve as tools, especially taking advantage of their sequential character. Complementary evidence based guidelines can serve as an optimal source of systematically appraised evidence in developing clinical pathways. Considering them is of major help to assure that the content of clinical pathways is in accordance with evidence. The article highlights methodological requirements in guideline and pathway development and gives prospects on how both tools can be used together.Der Internist 08/2006; 47(7):690, 692-7. · 0.30 Impact Factor -
Article: [Online continuing medical education based on national disease management guidelines. The e-learning platform leitlinien-wissen.de].
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ABSTRACT: Effective translation of relevant knowledge into clinical practice is essential for modern health care systems. National Disease Management Guidelines (NDMG) are considered relevant instruments to support this transfer. To implement NDMG Internet-based continuing medical education (CME), modules and online case-based learning objects were designed and published. To ensure high quality the contents are based on NDMG and subjected to multi-step review processes. Presentation on the web was realized through a modified content management system. To obtain a CME certificate, completing an online questionnaire using a four-point Likert scale was mandatory. Between June 2003 and April 2005, 3,105 physicians were registered and used the platform: 95% of the physicians expressed positive feedback in the evaluation questionnaire, and 35% actually used the corresponding NDMG in practice. This prompted the development of interactive medical case-based learning objects as a second learning pathway. An Internet platform for CME including case-based learning objects can be a helpful tool to assure the provision of scientific knowledge for patient care.Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 06/2006; 49(5):412-7. · 0.66 Impact Factor -
Article: An e-learning platform for guideline implementation--evidence- and case-based knowledge translation via the Internet.
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ABSTRACT: Effective knowledge translation in medicine is an essential element of a modern health care system. Evidence-based clinical practice guidelines (CPGs) are considered relevant instruments for the transfer of knowledge into clinical practice. To improve this transfer we have created Internet-based continuing medical education (CME) modules and online case-based learning objects. Building upon existing CPGs, an e-learning platform including a multi-step review process was developed to generate CME modules. These CME modules were presented through a modified content management system (CMS) that fulfils specific requirements of CME. An online questionnaire using a four-point Likert scale was designed to receive mandatory feedback from participating physicians. In the second step of development, case-based learning objects were added to the CMS. Existing clinical practice guidelines allowed a rapid development of CME modules specific to individual clinical indications. The modified CMS proved to be technically stable but also resource-intensive. 3105 physicians registered and used the platform between June 2003 and April 2005. 95% of the physicians expressed positive feedback in an evaluation questionnaire; only 35% of physicians actually used the corresponding CPGs in practice. Suggestions from the CME users led to the development of interactive medical case-based learning objects related to the main topics of the CPGs. To support the implementation of CPGs, an Internet platform for CME including case-based learning objects and examination tests was developed. An interactive online CME platform can support active learning and may establish an additional stimulus for knowledge translation into daily medical practice.Methods of Information in Medicine 02/2006; 45(4):389-96. · 1.53 Impact Factor -
Article: Evidenzbasierte Leitlinien und Behandlungspfade
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ABSTRACT: Auch methodisch hochwertige Leitlinien knnen nur dann wirksam werden, wenn die in Ihren enthaltenen Empfehlungen in Handeln bertragen werden. Ihre Einfhrung und Verbreitung mssen daher durch Implementierungsmanahmen begleitet werden. Fr den stationren Bereich eignen sich hierzu prozessbezogene Behandlungsablufe, die dort anfangen, wo Leitlinien aufhren. Bei der Erstellung von Behandlungspfaden kann der systematische Rckgriff auf evidenzbasierte Leitlinien als Quellen aufbereiteter Evidenz gewhrleisten, das die in Behandlungspfaden beschriebenen Manahmen dem medizinischen Standard entsprechen. Im vorliegenden Beitrag werden die notwendigen methodischen Voraussetzungen zur Nutzung der Synergieeffekte beschrieben und ein Ausblick auf weitere Ergnzungsmglichkeiten gegeben.Even methodological sound guidelines will only achieve their goals when the recommendations are transferred into practice. Guideline introduction and dissemination must therefore be accompanied by active implementation measures. For inpatient care clinical pathways can serve as tools, especially taking advantage of their sequential character. Complementary evidence based guidelines can serve as an optimal source of systematically appraised evidence in developing clinical pathways. Considering them is of major help to assure that the content of clinical pathways is in accordance with evidence. The article highlights methodological requirements in guideline and pathway development and gives prospects on how both tools can be used together.Der Internist 01/2006; 47(7):690-698. · 0.30 Impact Factor -
Chapter: Leitlinien — Stellenwert und Nutzung im klinischen Alltag
12/2005: pages 787-794; -
Article: [Clinical guidelines. What do doctors and patients get from them].
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ABSTRACT: Now more than ever physicians need effective management of the constantly increasing flood of medical information. The authors discuss possibilities for developing clinical guidelines as a core element of this information management and the requirements of these possibilities. The development of clinical guidelines is a process also suitable for involving patient and consumer expertise in health care. Models of involving patients are described and how these processes can build an important base for shared decision making of physicians and patients.Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 03/2005; 48(2):215-20. · 0.66 Impact Factor -
Article: Leitlinien
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ABSTRACT: In der heutigen Zeit der Informationsflut besteht fr rzte mehr denn je die Notwendigkeit eines Informationsmanagements. Es wird die Frage diskutiert, ob klinische Leitlinien eines der zentralen Elemente eines solchen Informationsmanagements darstellen knnen und welche diesbezglichen Voraussetzungen sie erfllen sollten. Klinische Leitlinien bieten eine sinnvolle Mglichkeit, die Expertise von Patienten systematisch in die Gesundheitsversorgung einzubinden. Leitlinien knnen auf diese Weise eine wertvolle Grundlage fr die gemeinsame, informierte Entscheidungsfindung von rzten und Patienten sein. Im vorliegenden Beitrag werden die verschiedenen Anstze der Einbeziehung von Patienten in die Erstellung und Verbreitung klinischer Leitlinien dargestellt.Now more than ever physicians need effective management of the constantly increasing flood of medical information. The authors discuss possibilities for developing clinical guidelines as a core element of this information management and the requirements of these possibilities. The development of clinical guidelines is a process also suitable for involving patient and consumer expertise in health care. Models of involving patients are described and how these processes can build an important base for shared decision making of physicians and patients.Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 01/2005; 48(2):215-220. · 0.66 Impact Factor -
Article: [Value of inpatient care in rheumatoid arthritis-an evidence based report].
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ABSTRACT: Our aim was to analyze the existing body of evidence about inpatient care of patients suffering from rheumatoid arthritis (RA). The report was induced by the executive board of the German Society of Rheumatology which assigned the "Oliver-Sangha committee" to dissect and point out the tasks of inpatient care during the next few years. A systemic search of the literature was performed covering the years 1966 to 2001. A total of 16 studies were selected and thoroughly appraised in a systematic way. Four randomized controlled trials addressing the question could be identified. All of them included only patients in a clinical condition allowing outpatient care as well. Two studies indicate some advantage of inpatient care in comparison to outpatient treatment. Two studies, both equivalence studies from design, reveal that RA patients do not generally experience additional benefit from hospitalization. Consideration of two additional cohort studies demonstrates the increased need of inpatient care in RA patients. None of the studies was derived from the German health care system. Emergency cases were not the subject of any of these trials. General statements about the value of inpatient care of RA patients can not be drawn from the analyzed studies. The committee makes suggestions for future investigations that may help to answer this important question considering the special circumstances of the German health care system.Zeitschrift für Rheumatologie 11/2004; 63(5):402-13. · 0.46 Impact Factor -
Article: Nutzen der stationären Therapie in der Versorgung von Patienten mit Rheumatoider Arthritis
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ABSTRACT: Der Vorstand der Deutschen Gesellschaft fr Rheumatologie hat die Oliver-Sangha Kommission beauftragt, die Aufgaben der stationren Rheumatologie in den kommenden Jahren zu untersuchen und aufzuzeigen. Zielsetzung des vorliegenden Evidenzberichtes ist die Darlegung der Studienlage zum Thema der stationren Versorgung von Patienten am Beispiel der rheumatoiden Arthritis.Es wurde eine systematische Literaturrecherche in Medline (Zeitraum 1966–2001) durchgefhrt. Aus 200 Literaturstellen wurden 23 Arbeiten identifiziert, von denen nach einem systematischen Auswahlprozess 16 Publikationen einer sorgfltigen Einzelbewertung unterzogen wurden.In die vier in der systematischen Datenanalyse identifizierten, randomisiert kontrollierten Studien wurden nur Patienten eingeschlossen, deren Krankheitszustand auch eine nicht-stationre Versorgung erlaubte. Zwei dieser Studien belegen eine gewisse berlegenheit der stationren gegenber der ambulanten Versorgung, die beiden anderen—Studien zur quivalenz stationrer und teilstationrer Versorgung—machen deutlich, dass RA-Patienten nicht generell von einer stationren Versorgung zustzlich profitieren. Zwei Datenerhebungen geben einen Anhalt fr einen gesteigerten Bedarf an stationrer Versorgung von RA-Patienten. Keine der Studien entstammt dem deutschen Versorgungssystem, generell gilt die Einschrnkung, dass die stationre Versorgung aus rheumatologischer Notfallindikation nicht untersucht wurde.Die Ergebnisse dieser Studien lassen eine allgemeingltige Aussage zur stationren Versorgung von RA-Patienten nicht zu. Die Kommission macht Vorschlge, wie diese wichtige Fragestellung fr die Versorgung in der deutschen Rheumatologie zuknftig beantwortet werden kann.Our aim was to analyze the existing body of evidence about inpatient care of patients suffering from rheumatoid arthritis (RA). The report was induced by the executive board of the German Society of Rheumatology which assigned the Oliver-Sangha committee to dissect and point out the tasks of inpatient care during the next few years. A systemic search of the literature was performed covering the years 1966 to 2001. A total of 16 studies were selected and thoroughly appraised in a systematic way. Four randomized controlled trials addressing the question could be identified. All of them included only patients in a clinical condition allowing outpatient care as well. Two studies indicate some advantage of inpatient care in comparison to outpatient treatment. Two studies, both equivalence studies from design, reveal that RA patients do not generally experience additional benefit from hospitalization. Consideration of two additional cohort studies demonstrates the increased need of inpatient care in RA patients. None of the studies was derived from the German health care system. Emergency cases were not the subject of any of these trials. General statements about the value of inpatient care of RA patients can not be drawn from the analyzed studies. The committee makes suggestions for future investigations that may help to answer this important question considering the special circumstances of the German health care system.Zeitschrift für Rheumatologie 09/2004; 63(5):402-413. · 0.46 Impact Factor
Top co-authors
Top Journals
Institutions
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2010–2012
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Universität Hamburg
- • Department of Medical Psychology
- • Department of Psychiatry and Psychotherapy
Hamburg, Hamburg, Germany
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2008–2009
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Universität Bremen
Bremen, Bremen, Germany -
Universitätsklinikum Gießen und Marburg
Marburg an der Lahn, Hesse, Germany -
Universitätsklinikum Freiburg
- Abteilung für Psychiatrie und Psychotherapie
Freiburg, Lower Saxony, Germany
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2002–2005
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German Cochrane Centre
Freiburg, Lower Saxony, Germany
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