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Die digitale Pille für chronische Krankheiten

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Abstract

Laut WHO sind chronische Krankheiten wie Herz-Kreislauf-Erkrankungen, Krebs, Diabetes oder Asthma weltweit für circa 70 % aller Todesfälle verantwortlich. Leistungserbringer haben allerdings nur beschränkte Ressourcen und können den Gesundheitszustand im Alltag von Patienten nicht kontinuierlich erheben und daher auch nicht immer rechtzeitig intervenieren, bevor es zu einer allfälligen Hospitalisierung kommt. Vor diesem Hintergrund diskutiert dieser interdisziplinäre Beitrag das Potenzial digitaler Pillen. Das Ziel digitaler Pillen besteht darin, Gesundheitszustände mithilfe von Informations- und Kommunikationstechnologie möglichst kontinuierlich, zweckdienlich und bequem zu erheben und nur dann zu intervenieren, wenn es unbedingt sein muss, kurzum Patienten den Umgang mit ihrer chronischen Krankheit im Alltag zu erleichtern. Nach einer Einleitung wird das Konzept digitaler Pillen näher erläutert. Danach werden fünf digitale Pillen aus den Bereichen Gesundheitskompetenz, Prävention und Therapie näher vorgestellt. Abschließend wird das Konzept der digitalen Pille kritisch reflektiert und Potenziale sowie Herausforderungen werden diskutiert.

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Background: Diabetes is a common chronic disease that is increasingly managed in primary care. Different systems have been proposed to manage diabetes care. Objectives: To assess the effects of different interventions, targeted at health professionals or the structure in which they deliver care, on the management of patients with diabetes in primary care, outpatient and community settings. Search strategy: We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, the Cochrane Controlled Trials Register (Issue 4 1999), MEDLINE (1966-1999), EMBASE (1980-1999), Cinahl (1982-1999), and reference lists of articles. Selection criteria: Randomised trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITS) analyses of professional, financial and organisational strategies aimed at improving care for people with Type 1 or Type 2 diabetes. The participants were health care professionals, including physicians, nurses and pharmacists. The outcomes included objectively measured health professional performance or patient outcomes, and self-report measures with known validity and reliability. Data collection and analysis: Two reviewers independently extracted data and assessed study quality. Main results: Forty-one studies were included involving more than 200 practices and 48,000 patients. Twenty-seven studies were RCTs, 12 were CBAs, and two were ITS. The studies were heterogeneous in terms of interventions, participants, settings and outcomes. The methodological quality of the studies was often poor. In all studies the intervention strategy was multifaceted. In 12 studies the interventions were targeted at health professionals, in nine they were targeted at the organisation of care, and 20 studies targeted both. In 15 studies patient education was added to the professional and organisational interventions. A combination of professional interventions improved process outcomes. The effect on patient outcomes remained less clear as these were rarely assessed. Arrangements for follow-up (organisational intervention) also showed a favourable effect on process outcomes. Multiple interventions in which patient education was added or in which the role of the nurse was enhanced also reported favourable effects on patients' health outcomes. Reviewer's conclusions: Multifaceted professional interventions can enhance the performance of health professionals in managing patients with diabetes. Organisational interventions that improve regular prompted recall and review of patients (central computerised tracking systems or nurses who regularly contact the patient) can also improve diabetes management. The addition of patient-oriented interventions can lead to improved patient health outcomes. Nurses can play an important role in patient-oriented interventions, through patient education or facilitating adherence to treatment.
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To examine patient- and provider-reported psychosocial problems and barriers to effective self-care and resources for dealing with those barriers. Cross-sectional study using face-to-face or telephone interviews with diabetic patients and health-care providers in 13 countries in Asia, Australia, Europe and North America. Participants were randomly selected adults (n = 5104) with Type 1 or Type 2 diabetes, and providers (n = 3827), including primary care physicians, diabetes specialist physicians and nurses. Regimen adherence was poor, especially for diet and exercise; provider estimates of patient self-care were lower than patient reports for all behaviours. Diabetes-related worries were common among patients, and providers generally recognized these worries. Many patients (41%) had poor psychological well-being. Providers reported that most patients had psychological problems that affected diabetes self-care, yet providers often reported they did not have the resources to manage these problems, and few patients (10%) reported receiving psychological treatment. Psychosocial problems appear to be common among diabetic patients worldwide. Addressing these problems may improve diabetes outcomes, but providers often lack critical resources for doing so, particularly skill, time and adequate referral sources.
Health literacy video clips for children with asthma. Poster presented at the CSS Meets & Greets CDHI event
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