Neeltje van den Berg

University of Greifswald, Griefswald, Mecklenburg-Vorpommern, Germany

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Publications (50)74.12 Total impact

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    ABSTRACT: Objectives: Assessing the spatial distribution of oral morbidity-related demand and the workforce-related supply is relevant for planning dental services. We aimed to establish and validate a model for estimating the spatially specific demand and supply. This model was then applied to compare demand-supply ratios in 2001 and 2011 in the federal state of Mecklenburg-Vorpommern (Northern Germany). Methods: The spatial units were zip code areas. Demand per area was estimated by linking population-specific oral morbidities to working times via insurance claim data. Estimated demand was validated against the provided demand in 2001 and 2011. Supply was calculated for both years using cohort data from the dentist register. The ratio of demand and supply was geographically mapped and its distribution between areas assessed using the Gini coefficient. Results: Between 2001 and 2011, a significant decrease of the general population (-7.0%), the annual demand (-13.1%), and the annual supply (-12.9%) was recorded. The estimated demands were nearly (2001: -4%) and completely (2011: ±0%) congruent with provided demands. The average demand-supply-ratio did not change significantly between 2001 and 2011 (p>0.05), but was increasingly unequally distributed. In both years, few areas were over-serviced, whilst many were under-serviced. Conclusions: The established model can be used to estimate spatially specific demand and supply.
    No preview · Article · Dec 2015 · Journal of Public Health Dentistry
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    ABSTRACT: Background: Severe mental disorders like psychotic disorders including schizophrenia and schizoaffective disorders have a 12-month-prevalence of 2.6, bipolar disorders of 1.5 % in Germany. The relapse risk is high; so many patients need intensive monitoring and lifelong treatment. A high medication adherence is essential for a successful treatment. But in practice, medication adherence is low and decreases over time. Telemedical care concepts might improve treatment and bridge gaps between in- and outpatient treatment. Methods/design: The Tecla study (Post stationary telemedical care of patients with severe psychiatric disorders) is a two-armed prospective randomized controlled trial. The participants in the intervention group receive in addition to usual care regular telephone calls every 2 weeks and weekly text messages on patient-individual topics during a 6 months period. Patients in the control group receive only regular care. Inclusion criteria are a physician-diagnosed bipolar disorder, schizoaffective disorder or schizophrenia and a signed informed consent. Exclusion criteria are planned inpatient treatments within the next 6 months and being non-reachable by phone. After 3 and 6 months both groups receive follow up assessments. Discussion: The primary objective of this study is the medication adherence that is measured with the Medication Adherence Report Scale, German version (MARS-D). The MARS-D is a self-report with five items. Adherent behaviour is mostly overestimated using self-reports. The strength of the MARS-D is to detect non-adherent behaviour. The original Medication Adherence Report Scale in English language (MARS-5) was developed to encourage the patient to answer truthfully to the questions that are asked in a non-threatening and non-judgmental way to minimize social desirability bias in admitting non-adherent behaviour. Trial registration: This study is registered at 2015\05\21at the German Clinical Trials Register DRKS00008548.
    Full-text · Article · Nov 2015 · BMC Psychiatry
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    ABSTRACT: Objectives: To plan dental services, a spatial estimation of future demands and supply is required. We aimed at estimating demand and supply in 2030 in Northern Germany based on the expected local socio-demography and oral-health-related morbidity, and the predicted number of dentists and their working time. Methods: All analyses were performed on zip-code level. Register data were used to determine the number of retiring dentists and to construct regression models for estimating the number of dentists moving into each zip-code area until 2030. Demand was modelled using projected demography and morbidities. Demand-supply ratios were evaluated and spatial analyses applied. Sensitivity analyses were employed to assess robustness of our findings. Results: Compared with 2011, the population decreased (-7% to -11%) and aged (from mean 46 to 51 years) until 2030. Oral-health-related morbidity changed, leading to more periodontal and fewer prosthetic treatments needs, with the overall demand decreasing in all scenarios (-25% to -33%). In contrast, the overall number of dentists did only limitedly change, resulting in moderate decrease in the supplied service quantities (max. -22%). Thus, the demand-supply ratio increased in all but the worst case scenario, but was unequally distributed between spatial units, with several areas being over- and some being under- or none-serviced in 2030. Conclusions: Within the limitations of the underlying data and the required assumptions, this study expects an increasingly polarized ratio of dental services demand and supply in Northern Germany. Our estimation allows to assess the impact of different influence factors on demand or supply and to specifically identify potential challenges for workforce planning and regulation in different spatial units.
    No preview · Article · Oct 2015 · Community Dentistry And Oral Epidemiology
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    ABSTRACT: Background: Previous predictions of population morbidity consider demographic changes only. To model future morbidity, however, changes in prevalences of risk factors should be considered. We calculated the number of incident cases of first myocardial infarction (MI) in Mecklenburg-Western Pomerania in 2017 considering the effects of demographic changes and trends in the prevalences of major risk factors simultaneously. Methods: Data basis of the analysis were two population-based cohorts of the German Study of Health in Pomerania (SHIP-baseline [1997-2001] and the 5-year follow-up and SHIP-Trend-baseline [2008-2011] respectively). SHIP-baseline data were used to calculate the initial coefficients for major risk factors for MI with a Poisson regression model. The dependent variable was the number of incident cases of MI between SHIP-baseline and SHIP-5-year follow-up. Explanatory variables were sex, age, a validated diagnosis of hypertension and/or diabetes, smoking, waist circumference (WC), increased blood levels of triglycerides (TG) and low-density-lipoprotein cholesterol (LDL), and low blood levels of high-density-lipoprotein cholesterol (HDL). Applying the coefficients determined for SHIP baseline to risk factor prevalences, derived from the new cohort SHIP-Trend together with population forecast data, we calculated the projected number of incident cases of MI in 2017. Results: Except for WC and smoking in females, prevalences of risk factors in SHIP-Trend-baseline were lower compared to SHIP-baseline. Based on demographic changes only, the calculated incidence of MI for 2017 compared to the reference year 2006 yields an increase of MI (males: +11.5%, females: +8.0%). However, a decrease of MI (males: -23.7%, females: -17.1%) is shown considering the changes in the prevalences of risk factors in the projection. Conclusions: The predicted number of incident cases of MI shows large differences between models with and without considering changes in the prevalences of major risk factors. Hence, the prediction of incident MI should preferably not only be based on demographic changes.
    Preview · Article · Jul 2015 · PLoS ONE
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    ABSTRACT: Objective: To assess levels of physical activity the use of objective physical activity measures like accelerometers is promising. We investigated characteristics associated with non-participation in accelerometry within an apparently healthy sample. Methods: Among German participants of a cardiovascular examination program (CEP; 2012-2013), 470 participants aged 40-75 years were invited to wear an accelerometer for 7 days. We used multivariate logistic regression to estimate the association between non-participation and the following characteristics of participants: sex, age, education, smoking, setting of recruitment for the CEP (general medical practices, job agencies, statutory health insurance), self-reported general health, and objective health criteria such as cardiorespiratory fitness and absolute number of cardiometabolic risk factors (elevated waist circumference, blood pressure, triglycerides, blood glucose, and reduced high-density lipoprotein). Subsequently, we stratified this analysis by sex. Results: Among all invited individuals, N = 235 (60.0% women) gave consent to participate in accelerometry. Women were more likely to decline participation (odds ratio, 1.7; 95% confidence interval, 1.1-2.7) compared to men. Stratified analyses revealed the absolute number of risk factors as predictor of non-participation for men (1.4; 1.01-2.0), while there was no predictor found in women. Conclusion: We found a self-selection bias in participation in accelerometry. Women declined study participation more likely than men. The number of cardiometabolic risk factors decreased compliance only in men. Future studies should consider strategies to reduce this bias.
    Full-text · Article · May 2015
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    ABSTRACT: Introduction | The demand for outpatient and inpatient oncology care will rise in the next years. In this analysis, the number of new cases and the prevalence in 2 020, the number of hospital days, types of treatment, sickness costs, and the number of oncology specialists are prognosed. Methods | Projections of incidence and prevalence of cancer overall and of the three most common cancers were conducted with data from the German Population-Based Cancer Registries and from the German Federal Statistics Office. The average number of hospital days was extrapolated until 2020 on the basis of these population projections. Outpatient care was analyzed with billing data obtained from the WINHO. Projections of sickness costs in 2020 were calculated based on data from the German Federal Statistics Office under the assumption that cost per prevalent case remains constant within a given age group over the projection period. Numbers of specialists in hematology and oncology were taken from the database of the Association of Statutory Health Insurance Physicians. These forecasts are based on a series of assumptions. Results | The number of new cancer cases will increase by about 67,000 cases until 2020 (reference year 2008). Prevalent cases will increase by about 176,000 cases. The needed number of hospital days will increase about 13 % to 15.513 million days in 2020. An increase of 30 % in cytoreductive and 23 % in chemotherapy treatment of lung cancer was shown between 2008 and 2011. The number of contracted doctors with focus in hematology and oncology has increased in 2011 compared to 2005. Between 2002 and 2008, sickness costs increased by 52 % in the outpatient sector and by 31 % in the inpatient sector. In 2020, the increase of sickness costs is expected to reach about 1.7 billion EUR / year. Conclusions | Due to the increase of incident and prevalent cancer cases, the number of hospital days and sickness costs will increase. The results of the analyses show an increase of medical care services in the outpatient sector. © Georg Thieme Verlag KG Stuttgart · New York.
    No preview · Article · Apr 2015 · DMW - Deutsche Medizinische Wochenschrift
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    ABSTRACT: Background: A telemedicine care concept based on telephone contacts and individualized text messages was developed for patients with mental disorders to continue treatment after therapy in a psychiatric day hospital. The primary objective of this study was to evaluate the effectiveness of the telemedicine interventions. Methods: The study had a 3-armed, randomized design with 2 intervention arms (intervention 1: telephone contacts; intervention 2: telephone contacts and short text messages; both took place over a period of 6 months and in addition to usual care), and a control group with usual care. Primary outcomes were 18-item Brief Symptom Inventory (BSI-18) scores for anxiety, depression and somatization. All participants were recruited from psychiatric day hospitals. The study was registered in the German Clinical Trials Register (DRKS00000662). Results: 113 participants were analyzed 6 months after starting the intervention. The average BSI-18 anxiety score after 6 months was -2.04 points lower in intervention group 2 than in the control group (p value: 0.042). The difference in BSI depression score between these two groups was marginally significant (p value: 0.1), with an average treatment effect of -1.73. In an exploratory sensitivity analysis restricted to the 75% of patients with the highest symptom scores at baseline, intervention group 1 yielded a significant effect for anxiety and depression compared to the control group (p = 0.036 and 0.046, respectively). Conclusions: Telemedicine provides a novel option in psychiatric ambulatory care with statistically significant effects on anxiety. A positive tendency was observed for depression, especially in cases with higher symptom load at baseline. © 2015 S. Karger AG, Basel.
    No preview · Article · Feb 2015 · Psychotherapy and Psychosomatics
  • Neeltje van den Berg · S Schmidt · U Stentzel · H Mühlan · W Hoffmann
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    ABSTRACT: In ländlichen Regionen mit einer geringen Bevölkerungsdichte und (drohenden) Lücken in der wohnortnahen Versorgung sind regionale Versorgungskonzepte mit telemedizinischen Funktionalitäten eine reale Option zur Unterstützung der medizinischen Versorgung. Eine telemedizinische Verbindung kann dabei zwischen Leistungserbringern (z. B. Krankenhäusern) erfolgen oder direkt zwischen Leistungserbringern und Patienten. Für den Einsatz von Telemedizin gibt es verschiedene Szenarien, die vom Monitoring chronisch erkrankter Patienten bis zur Unterstützung der Akutversorgung reichen. In einigen Bereichen werden bereits häufig telemedizinische Konzepte angewendet, Beispiele sind Teleradiologie, telemedizinische Schlaganfallnetzwerke sowie das telemedizinische Monitoring von Patienten mit Herzinsuffizienz. Die Erschließung weiterer Indikationen und Patientengruppen ist in Deutschland offenbar schwierig, eine Ursache könnte darin liegen, dass in nur wenigen Projekten Forschungseinrichtungen beteiligt sind. Dies wäre aber für die Schaffung einer wissenschaftlichen Evidenzbasis von großer Bedeutung. Die Entwicklung geeigneter Evaluationsdesigns zur Analyse der Wirksamkeit und der gesundheitsökonomischen Effekte telemedizinischer Konzepte ist eine wichtige Aufgabe und Herausforderung. Hier gilt es verbindliche Evaluationskriterien zu entwickeln, die bei positiven Ergebnissen die Basis für eine Translation in die Routineversorgung bilden sollten.
    No preview · Article · Feb 2015 · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz
  • N. Walbaum · W. Hoffmann · N. van den Berg
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    ABSTRACT: Hintergrund Die Erhaltung der Arbeitsfähigkeit ist, in Hinblick auf den demografischen Wandel, die hohen volkswirtschaftlichen Kosten durch Arbeitsunfähigkeit und der negativen Auswirkungen von Arbeitsunfähigkeit auf die Lebensqualität eines jeden Einzelnen von großer Bedeutung. Ziel der Arbeit Ziel der vorliegenden Studie ist die Identifizierung von Determinanten der Arbeitsfähigkeit von Mitarbeitern einer Universitätsklinik in Deutschland. Material und Methoden Die Arbeitsfähigkeit (operationalisiert durch den Work Ability Index, WAI) sowie verschiedene weitere Parameter (z. B.: Alter, Geschlecht, Stressfaktoren, Arbeit in Führungsposition etc.) wurden mit einem standardisierten Fragebogen bei 393 Mitarbeitern der Universitätsmedizin Greifswald erfasst. Die Bestimmung der Determinanten der Arbeitsfähigkeit erfolgte durch multivariable lineare Regressionsanalyse mit dem WAI als abhängige Variable. Ergebnisse Als positive Determinanten des WAI konnten das weibliche Geschlecht (p = 0,014) sowie die Arbeit in Führungsposition (p = 0,004) identifiziert werden. Eine höhere Anzahl an belastenden Stressfaktoren (p = 0,002) und das Alter (p = 0,051) haben einen negativen Einfluss auf den WAI. Die Dauer des Beschäftigungsverhältnisses, die Berufsgruppe, der Rauchstatus sowie die Arbeit im Schichtdienst sind hingegen nicht signifikant mit dem WAI assoziiert. Diskussion Bei der Implementierung von Maßnahmen zur betrieblichen Gesundheitsförderung sind die Determinanten der Arbeitsfähigkeit zu berücksichtigen. Insbesondere Arbeitnehmer ohne Führungsposition oder mit erhöhtem Stresslevel bedürfen dabei spezieller Aufmerksamkeit.
    No preview · Article · Dec 2014 · Zentralblatt für Arbeitsmedizin, Arbeitsschutz und Ergonomie
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    ABSTRACT: Objectives: Little is known about changes in depression and quality of life in East Germany. We examined changes in the prevalence of lifetime and current depressive symptoms and mental health-related quality of life among adults in northeast Germany between 1997-2001 and 2008-2012. Methods: Population-based data were drawn from two repeated cross-sectional surveys conducted 11 years apart within the Study of Health of Pomerania project (Ns of 4,228 and 4,251). Assessments included screening items for lifetime depressive symptoms from the Munich Composite International Diagnostic Interview (M-CIDI), the Depression and Exhaustion Scale (DEEX), and the Short Form Health Survey (SF-12). Results: Lifetime depressive symptoms rose from 13.2 to 27.8%. The increase was stronger in men than in women and in individuals aged 35-64 years. No substantial changes occurred in the overall prevalence of current depressive symptoms (DEEX) and mental health-related quality of life (SF-12). A small decrease in current depressive symptoms was observed in middle-aged men and older women and small improvements in mental health-related quality of life in young adults. Conclusions: Higher reporting of lifetime depressive symptoms might reflect methodological influences as well as lower stigmatization and higher awareness, while the current burden seems similar.
    Full-text · Article · Dec 2014 · International Journal of Public Health
  • Neeltje van den Berg · Wolfgang Hoffmann
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    ABSTRACT: Für eine Deponie in Mecklenburg-Vorpommern soll ein Konzept für ein individualisiertes betriebliches Gesundheitsmanagements entwickelt werden. In diesem Konzept sollen die Betriebsmedizin, die Gesundheitsförderung und Prävention sowie der Arbeitsschutz und die Sicherheit integriert werden. Basis des Konzeptes ist ein detailliertes Assessment zur Identifikation des individuellen Präventionsbedarfes der einzelnen Mitarbeiter Innen. Anhand klinischer und subklinischer Befunde, Besonderheiten aus dem jeweiligen Arbeitsbereich, Ergebnisse aus toxikologischen Untersuchungen sowie soziodemografischer Faktoren werden individualisierte Risikoprofile definiert. Auf dieser Basis werden individuelle Zielstellungen und daraus Präventionsmodule entwickelt. Aus den Modulen werden dann individualisierte Präventionsprogramme zusammengestellt. Nach Durchführung der Präventionsprogramme soll eine objektive und subjektive Ergebnismessung der einzelnen Präventionsmodule durchgeführt werden. Primärer Endpunkt hierbei ist die Erreichung des individuell erreichten Zieles.
    No preview · Article · Sep 2014 · Zentralblatt für Arbeitsmedizin, Arbeitsschutz und Ergonomie
  • W Hoffmann · N van den Berg · U Stentzel · R Großjohann · C Jürgens · F Tost
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    ABSTRACT: Demographic change not only affects patients with ophthalmological diseases but also ophthalmologists. The aim of this article is to evaluate the consequences of an aging society on health care provision. How can these challenges be overcome? Evaluation of publications from the German Federal Statistical Office about the current and projected population, analysis of own studies about health care provision, utilization, and delivery as well as the presentation and discussion of regulatory and organizational conditions. There is a continuous increase in chronic and age-related diseases. At the same time the prevalence of multimorbidity and the number of patients dependent on long-term care is rising, leading to an increase in the demand for ophthalmological care. Regarding health care providers we observed a cutback in qualified ophthalmological personnel, especially for remote areas thus causing difficulties in providing adequate eye care to the population. To deliver health care to a growing number of patients with a decreasing number of medical professionals is the major challenge of demographic change. This will have an enormous impact on ophthalmological health care in terms of maintaining high quality health services covering a nationwide area.
    No preview · Article · May 2014 · Der Ophthalmologe
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    ABSTRACT: Hintergrund: Die chronische Herzinsuffizienz ist eine der häufigsten Ursachen für Morbidität und Mortalität. Trotz verbesserter Behandlungsmöglichkeiten ist die Prognose schlecht. Die Entwicklung individualisierter an den Patienten angepasster Lebensstilinterventionen wie z.B. körperliche Trainingsprogramme stellt eine vielversprechende Ergänzung zur medikamentösen und apparativen Therapie dar. Die meisten früheren Studien haben die Effekte eines Ausdauertrainings mit kurzen Trainingsphasen und zeitlich begrenzten Nachbeobachtungsphasen untersucht. Für die am häufigsten bei diesen Patienten eingesetzten Trainingsmodalitäten - moderates kontinuierliches Ausdauertraining (MCT) und aerobes Intervalltraining (AIT) - gibt es wenige Langzeitdaten. Die eingesetzten Trainingsprotokolle sind zudem wenig geeignet, im häuslichen Bereich langfristig umgesetzt zu werden und sind häufig durch eine sehr niedrige Adhärenz gekennzeichnet. In der geplanten Studie soll ein dem Prinzip des „individualisierten Trainings“ („preferred Training“) folgendes Programm getestet werden, das in der Häuslichkeit selbstständig durchgeführt, in den Alltag integriert und langfristig umgesetzt werden kann. Ziel ist es zu untersuchen, ob ein individualisiertes Trainingsprogramm der alleinigen Standardtherapie bei chronischer Linksherzinsuffizienz in Bezug auf eine Steigerung der Belastungstoleranz überlegen ist. Explorativ wird zudem untersucht, ob ergänzende eine Ergänzung des Trainingsprogramms um motivationale Interventionselemente zu einer Steigerung der Trainingsadhärenz führt und somit Langzeiteffekte begünstigt. Methoden/Design: In HOMEX-HF werden 120 PatientInnen im Alter von 30 bis 75 Jahren mit mindestens 6 Monaten bestehender chronischer Herzinsuffizienz (NYHA II oder III) und einer LVEF ≤ 40% eingeschlossen. In einem randomisiert-kontrollierten Design werden 3 Gruppen verglichen: In Gruppe 1 erhalten alle Probanden die Standardtherapie (leitliniengerechte medikamentöse und apparative Herzinsuffizienztherapie). Probanden der Gruppen 2 und 3 erhalten zusätzlich ein individualisiertes körperliches Trainingsprogramm, wobei sie in den ersten drei Monaten im Trainingszentrum im MCT und AIT geschult und trainiert werden. Anschließend wird ein individualisiertes, den Bedürfnissen der Patienten angepasstes Trainingsprogramm entwickelt, welches zu Hause dauerhaft weitergeführt wird. Probanden der Gruppe 3 erhalten zusätzlich individuelle motivationssteigernde Maßnahmen (z.B. zusätzliches supervidiertes Training, Aktimetrie, klientenkonzentrierte Beratung). Der primäre Endpunkt der Studie ist die Änderung der kardiopulmonalen Leistungsfähigkeit nach 9 Monaten, gemessen als Änderung der O2-Aufnahme an der anaeroben Schwelle. Neben verschiedenen Biomarkern, werden zahlreiche andere Parameter (u.a. Spiroergometrie, Echokardiographie, Lebensqualität) als weitere Endpunkte untersucht. Diskussion: HOMEX-HF ist die erste größere Interventionsstudie zum körperlichen Training bei chronischer Linksherzinsuffizienz, die das Prinzip des „individualisierten Trainings“ umsetzt. Es wird untersucht, ob ein Trainingsprogramm, das die persönlichen Präferenzen des Patienten berücksichtigt, geeignet ist, selbstständig und langfristig in der Häuslichkeit umgesetzt zu werden und zu einer langfristigen Verbesserung der Belastungstoleranz führt. Die umfangreiche Phänotypisierung der Probanden ermöglicht weitergehende Sekundäranalysen, z.B. zur Identifikation neuer Therapieprädiktoren.
    No preview · Conference Paper · Apr 2014
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    ABSTRACT: An analysis of reimbursement claims in Mecklenburg West-Pomerania from the year 2007 showed that of all reimbursement claims made for outpatient treatment of patients with mental disorders, the majority has been claimed by general practitioners. Using the reimbursement claims from the last 3 months from 2010, again, most treatment claims were made by general practitioners. The patients were treated by general practitioners in 50.5%. neurologists/psychia-trists 16%, internal practitioners 10.6%, gynaecologists 5.3% and by psychotherapists in 2.3%. The actual analyses of reimbursement claims show again that the majority of patients with psychiatric disorders is not treated by the respective professional group.
    No preview · Article · Sep 2013 · PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie
  • Thomas Fiß · Claudia Meinke-Franze · Neeltje van den Berg · Wolfgang Hoffmann
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    ABSTRACT: Background Drug related problems (DRPs) are impairing patients' health and cause high costs. Neither delegation of home medication review nor regular pharmaceutical care are common in Germany. Objective We aimed to reduce several DRP by the implementation of a three party healthcare team [AGnES-practice assistant, pharmacist, general practitioner (GP)] and adherence supporting strategies (using a medication reminder chart, medication compliance aid). Setting The setting was ambulatory primary healthcare in German rural areas with a cohort of home-dwelling, elderly, mostly multimorbid patients with limited mobility (study period: 06/2006-12/2008). Methods We conducted a prospective non-randomized implementation cohort study with home medication review (home medication review module; mean participation time: 9 months). Data collection was delegated to additionally qualified AGnES-practice assistants (AGnES: GP-supporting, community-based, e-health-assisted systemic intervention). The intervention comprised pharmaceutical care by the local pharmacy in addition to medical interventions by the GP. 408 patients (mean age: women: 80.7 years; men: 75.3 years) received both pharmaceutical care and at least one follow-up visit. Main outcome measurement Outcome measurements comprised self-reported DRPs, objectively evaluated DRP, and prevalence of adherence supporting strategies. Results The three party healthcare team approach reduced self-reported forgetfulness (7.7-3.2 %; p = 0.001), the proportion of patients with intermittent drug intake (5.3-1.3 %; p < 0.001), and the proportion of patients with potentially clinical relevant drug-drug interaction (61.6-51.2 %; p < 0.001). Self-reported adverse drug reactions decreased non-significantly (5.4-4.6 %; p = 0.564; all tests χ(2)-McNemar). The median number of active substances taken was reduced from 8 to 7 (p < 0.001; Wilcoxon signed rank test). The proportions of patients using medication charts and compliance aids increased significantly (75.2-90.3 %; p < 0.001) and (70.0-80.1 %; p > 0.001), respectively. Conclusion This is the first study evaluating effects of a three party team on DRPs in a primary healthcare setting in Germany. This approach led to reduction in the occurrence of several DRPs and improved adherence supporting strategies. However, the study is a pre-post analysis, and had no control group.
    No preview · Article · Jul 2013
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    ABSTRACT: Background Data of the German population-based cohort SHIP (Study of Health in Pomerania) were analysed to examine treatment rates, antihypertensive substances prescribed, and the proportion of hypertensive study participants reaching target values for blood pressure as well as determinants. Methods The study population was defined using baseline data of the cohort (collected between 1997 and 2001). Participants with blood pressure values ≥140/90 mmHg and/or antihypertensive medication with known hypertension and participants with risk-comorbidity (diabetes, stroke, angina pectoris, and/or myocardial infarction) and blood pressure values ≥130/80 mmHg were included. The analysis of treatment and target values was based on the 5-year follow-up of the cohort (collected between 2002 and 2006). Logistic regression was used to identify determinants for a normotensive blood pressure. Results 3278 SHIP-participants with hypertensive blood pressure values were included (mean age: 55.5 years; SD 13.6, range 21–80 years). The raw hypertension prevalence was 50.9% (N = 1761). 58.7% (N = 1074) of all hypertensive patients reported some form of antihypertensive treatment. Thereof 65.1% (N = 728) received combination therapy. Of the patients without risk-comorbidity, 42.1% (N = 489) reached their target blood pressure values at the time of the 5-year follow-up of the cohort. Of the patients with any risk-comorbidity this proportion was only 21.7% (N = 131). Significant determinants for reaching the target values were being female and having antihypertensive combination therapy. Increasing age, having risk-comorbidities, and obesity were negatively associated with reaching the target values. Conclusions Both the proportion of participants receiving therapy and the number of participants reaching their target blood pressure values are very low. Combination therapy is associated with better blood pressure control as compared to mono therapy. However, even in the subgroup of hypertensive patients under combination therapy only 36% (both patients with and without comorbidity) reach target values.
    Full-text · Article · Jun 2013 · BMC Public Health
  • W Hoffmann · N van den Berg
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    ABSTRACT: The proportion of older people will increase strongly in Germany in the coming years. A consequence is an increase in patient numbers particularly for age-associated diseases and multimorbidity. Higher numbers of patients mean greater use of medical services and a higher demand for home visits with older patients. Although the total population is declining, the need for doctors will increase in certain medical areas, for example in the primary care sector. In many rural areas the reoccupation of vacant practices is already becoming a problem. Innovative, flexible and regionally organized healthcare concepts are necessary to ensure adequate medical care. Duties and responsibilities must be transferred between health professions and across sector boundaries, for example on the basis of delegation concepts, telemedicine and better cooperation between the outpatient and inpatient settings.
    No preview · Article · Mar 2013 · Der Chirurg
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    ABSTRACT: Drug intake is associated with a risk of drug-related problems, for example, the intake of potentially inappropriate medication (PIM), especially for cognitively impaired individuals. The proportion of PIM taken by immobile individuals, especially patients with suspicion of dementia in the AGnES studies (German: Arzt-entlastende Gemeinde-nahe E-Health-gestützte Systemische Intervention), and possible determinants were analyzed. In a community-based, prospective cohort study in the ambulatory healthcare sector, a sample of 342 patients aged ≥65 years were screened for dementia and received a home medication review. The screening for dementia was positive in 111 cases (32.5%). Data assessment included sociodemographic variables and medical diagnoses. The German PRISCUS list was used to detect PIM and drug–condition interactions. Potentially inappropriate medication in dementia was identified in 22 (19.8%) patients with suspicion of dementia. A multivariate binary logistic regression revealed that the number of drugs taken (one to four drugs: OR = 0.059; 95% CI 0.006–0.55, p = 0.0133; Ref.: >9 drugs) and female gender (OR = 10.362; 95% CI: 1.28–83.87) were risk factors for PIM intake in patient with suspicion of dementia. Inappropriate medication use in a community-based sample positively screened for dementia appears to be determined by sex and the number of drugs taken. The intake of fewer than five drugs and receiving support with regard to drug intake protects from the intake of PIM. Patients could benefit from medication management in a collaborative network of healthcare professionals. The implementation of systematic medication review and drug documentation should be extended and standardized in both research studies and routine primary health care. Copyright
    No preview · Article · Feb 2013 · International Journal of Geriatric Psychiatry
  • W Hoffmann · N van den Berg · A Dreier
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    ABSTRACT: To manage the current demographics and the expected medical, nursing, and social care needs of the population, structural changes are needed in the German health care system. On the regional level, there is a shortage of general practitioners in Germany. In the future, the number of affected regions will likely increase. These trends require new support strategies, which include the delegation of medical tasks to nonphysician professionals of which nurses and medical assistants are the primary profession. Thus, they will expand their traditional scope of work. However, their traditional training does not qualify them to perform medical tasks responsibly and with high quality. Hence, there is a need for further development of advanced training programs. The goal is to tailor modular advanced training to the specific support needs of the patients. A recent law (GKV-Versorgungsstrukturgesetz, GKV-VStG, 1 January 2012) was passed that specifies and extends the delegation options of medical tasks beyond the restrictions defined in previous German legislation (§ 63, SGB V in 2008). In this article, we present a three-stage model for qualifying nonphysician medical professionals for defined ranges of medical tasks.
    No preview · Article · Jan 2013 · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz
  • Neeltje van den Berg · Claudia Meinke-Franze · Thomas Fiss · Wolfgang Hoffmann
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    ABSTRACT: Background: The AGnES-concept (GP-supporting, community-based, e-health-assisted, systemic intervention) includes the delegation of general practitioner (GP)-home visits to qualified practice assistants, especially in underserved areas. Most visited patients were elderly, multimorbid patients with limited mobility. We analyzed a subgroup of hypertension patients to assess the proportion of patients with controlled hypertension, the number of patients that changed between different categories of blood pressure during the project, and to identify possible determinants for these changes. Materials and methods: Eligible patients were selected by the participating GPs. Hypertensive patients with at least two blood pressure measurements were included. Two-level mixed-effects multiple binary logistic regression analyses were conducted to evaluate possible determinants for the found effects. Results: Overall, 776 patients (mean age 79.2 years; SD 8.1 years; range 38-98 years) were included in the analysis. During the project, the mean values for systolic (from 136.1 to 131.0 mmHg, P<0.0001) and diastolic (from 77.0 to 75.7 mmHg, P=0.0026) blood pressure decreased. In 26.0% of the patients there was a change from hypertensive blood pressure values to normotensive values and vice versa in 14.3% (P<0.0001). Multilevel regression models did not show single elements of the complex intervention as determinants for changing to normotensive blood pressure values. Conclusion: Although the study was conducted under real life conditions and therefore had some methodological limitations, the delegation of home visits to qualified practice assistants may have had a positive influence on changes of blood pressure with elderly hypertension patients. The study population represents a relevant population for medical care, which might benefit from the implementation of the AGnES-concept.
    No preview · Article · Jan 2013 · Blood pressure monitoring