Processes of psoriasis health care in Germany--long-term analysis of data from the statutory health insurances

BACKGROUND

To evaluate health care provision for psoriasis patients, and to better allocate resources, precise knowledge of the health care situation is essential. The goal of this study is to analyze prescription behavior and resource utilization for psoriasis patients in Germany.

METHODS

We performed a secondary analysis of routinely collected psoriasis data from 2004-2007 from members of a nationwide statutory health insurance company (Gmünder Ersatzkasse). A descriptive analysis was done on physician care, hospitalizations, and medications and related costs.

RESULTS

34,728 of the 913,145 continuously insured patients were diagnosed with psoriasis (one-year prevalence: 2.3-2.5%). At the time of the initial diagnosis, 68% of patients were treated by a dermatologist and 28% by a general practitioner (GP). Over the next 21 months, the proportion of patients seen by a dermatologist decreased to 22% and the proportion seen by a GP increased to around 70%. 15.2% of patients were absent at least once from work. 79.5% received prescriptions with an average cost of € 135 per patient per year. 97.5% of patients received topical therapy; 11% got systemic therapies. Biologics were given to about 0.1% of patients. Significant differences in prescription behavior were seen between regions and physician groups.

CONCLUSION

Psoriasis is an important economic and medical issue. The majority of insured patients take prescription therapies. Dermatologists are most often the first health care provider.

[Post-traumatic and psychotic symptoms in severely traumatised patients]

BACKGROUND

Severely traumatised patients may show a variety of impairments, including psychotic symptoms. The therapist's specific professional background (e. g., trauma-focussed psychotherapy or general psychiatry) may impede adequate diagnosis and treatment of these patients.

METHODS

Three case reports show the development and change of post-traumatic and psychotic symptoms over time and the influence of specific interventions.

CONCLUSIONS

It is important not to jump to conclusions and interpret perceptual disturbances (flashbacks, dissociative or psychotic ones) too quickly in an one-sided way. Further scientific investigations are mandatory in order to understand and treat patients in an adequate way.

Benefit evaluation in the therapy of chronic wounds from the patients' perspective--development and validation of a new method

Assessing therapeutic benefit of any drug and medical device is essential in registration and cost reimbursement decisions in Germany and in many nations. In this study, a method for the assessment of patient-relevant benefits in wound therapy was developed and validated. A total of 83 items on treatment benefit from the patients' perspective were collected in an open survey, including n = 50 patients with chronic wounds. The item pool was compiled to a list of 22 items by an interdisciplinary panel of experts including patients. The item list is presented prior to therapy to assess patient-relevant treatment needs and during or after therapy to establish if benefits have been attained. A weighed patient benefit index (PBI) is calculated from the items of both questionnaires. The instrument was examined for practical feasibility, reliability, and validity in a prospective study involving n = 172 patients with acute or chronic wounds treated by vacuum-assisted therapy. Validation criteria were: change in generic and disease-specific quality of life; judgment of efficacy by patients and physicians; treatment satisfaction; patients' willingness to recommend the therapy to others. Construct validity was given for all criteria applied. Cronbach's alpha was 0.88. The instrument was well-accepted by patients and rated relevant for the assessment of benefit in wound treatment.

Skin cancer screening in Germany - perception by the public

BACKGROUND

In 2008, community skin cancer screening (cSCS) was introduced into routine care of the German statutory health insurances (SHI). In the meantime, more than 13 million individuals have been screened. To date, no data are available on the perception of cSCS by the general public.

AIM

Evaluation of public perception of cSCS in Germany.

PATIENTS AND METHODS

From 10 to 17th March 2011, a phone survey on a population-based sample of n = 1 014 German adults with SHI status was conducted by the Forsa Institute, including 12 questions on the use, knowledge and attitude regarding cSCS.

RESULTS

Of the interviewees 48 % were concerned about skin cancer, 29 % of all persons and 31 % of those eligible had already undergone cSCS. Of these, a major proportion (80 %) had been screened by dermatologists. Of the interviewees 75 % would (again) consult a dermatologist for the next cSCS, and less than 10 % would consult the general practitioner. Although about 93 % considered health screenings useful, only 44 % were informed about the legal right to undergo free cSCS after the age of 35.

CONCLUSIONS

In Germany cSCS is highly accepted in the community. Leading care providers are the dermatologists. Knowledge about the right to free cSCS needs better public propagation.

A new instrument for the assessment of patient-defined benefit in the treatment of allergic rhinitis

BACKGROUND

Allergic rhinitis (AR) is a common disease that affects health-related quality of life (HRQoL). Current and future health policy demands the assessment of patient-relevant treatment benefit for evaluation of treatments.

METHODS

We developed, validated and tested a standardized instrument for the assessment of patient-relevant needs and benefits in AR. In an open survey of patients with AR, 100 need and benefit items were generated. The items were condensed to a 25-item list by an expert panel. On this list, patient rates the personal importance of 25 treatment needs on a scale ranging from 'not at all' to 'very' before treatment (Patient Needs Questionnaire, PNQ). At the end of the treatment, patient rates the extent, to which these needs were achieved by treatment from 'did not help at all' to 'helped a lot' (Patient Benefit Questionnaire). The patient benefit index (PBI) is computed to provide a global weighted benefit parameter. This disease-specific instrument was validated in n = 104 patients with AR.

RESULTS

The PBI-AR showed good acceptability and feasibility in clinical routine. Reduction in nose and eye symptoms was rated most important. The PBI amounted to 2.2 (PBI ranges from 0 = 'no benefit' to 4 = 'maximum benefit'). Reliability of the PNQ was high (Cronbach's alpha = 0.9).The PBI was significantly correlated with relevant external validation criteria, such as patient satisfaction (R = 0.54) and HRQoL (R = 0.26).

CONCLUSION

The PBI-AR is a feasible, reliable and valid instrument for the standardized assessment of patient-relevant benefits in the treatment of AR.

Posttraumatic disorders in patients with alcohol dependence: Prevalence and integrated treatment

Over the past decade, the importance of co-occurring posttraumatic disorders in patients with substance dependence has become increasingly apparent. In clinical populations of addicted patients, about 25 to 50 percent receive a lifetime diagnosis of Posttraumatic Stress Disorder (PTSD). The talk will give an overview of the prevalence of PTSD and other trauma related disorders in European samples of patients with substance dependence. Moreover, data on experiences with the German version of an integrated treatment program for PTSD and substance abuse („Seeking Safety”, Najavits 2002) in N = 38 female outpatients with alcohol dependence will be reported. The results suggest that participants’ satisfaction with the content of the treatment, its structure and the session handouts was high. “Seeking Safety” therefore seems to be a promising treatment also for European patients with the dual diagnosis of PTSD and substance abuse.

Quality of life profiles and changes in the course of maintenance treatment among 1,015 patients with severe opioid dependence

INTRODUCTION

Studies indicate that different areas of mental, physical, social and daily life functioning need to be considered in order to improve intervention outcomes in substance user patients. The aim of the study was to assess health-related quality of life (HRQOL) in patients diagnosed with opioid dependence as compared to healthy controls and patients diagnosed with depression and schizophrenia.

METHODS

A total of 1,015 outpatients diagnosed with opioid dependence were investigated during 12 months of maintenance treatment. HRQOL (MSQoL), addiction (EUROP-ASI), and sociodemographic characteristics were assessed.

RESULTS

HRQOL in opioid dependence improved significantly (p < .001), but was lower as compared to that of healthy controls and patients diagnosed with schizophrenia. HRQOL in opioid dependence comprises addiction-specific aspects, most importantly low material satisfaction, physical health, and social stability.

CONCLUSIONS

HRQOL measurement provides valuable information for course and outcome in opioid dependence treatment.

Nail psoriasis as a severity indicator: results from the PsoReal study

BACKGROUND

Although nail psoriasis affects a substantial proportion of psoriasis patients and causes significant psychologic distress, few epidemiologic data characterizing patients with nail involvement are available. The aim of this research was to elucidate differences between patients with nail psoriasis and those without any nail involvement, taking quality indicators of health care from the patient's perspective into account.

METHODS

In total, 2449 patient members of the Deutscher Psoriasis Bund, the largest patient organization for psoriasis in Germany, were interviewed in this nationwide, noninterventional, cross-sectional study. Patients with nail psoriasis were compared with patients without any nail involvement with regard to gender, age, disease duration, affected body surface area, health-related quality of life (Dermatology Life Quality Index [DLQI] ED-5D), patient-defined treatment benefit, amount of inpatient treatments, disease duration, and numbers of work days lost.

RESULTS

Data from 2449 patients with psoriasis were analyzed. Overall, 44.8% (1078) of patients were female, mean age was 57.0 ± 11.7 years, and 72.8% had nail involvement and showed higher values for affected body surface area than those without nail involvement (8.3% versus 5.6%, respectively; P < 0.004). Health-related quality of life was significantly lower in patients with nail psoriasis (DLQI 7.2 versus 5.3; ED-5D 60.1 versus 67.3), who had more days off work (9.8 versus 3.3).

CONCLUSION

Nail involvement is an important symptom of psoriasis and is associated with greater disease severity and quality of life impairment. Accordingly, management of psoriasis should include a special focus on nail involvement.

Quality of life under maintenance treatment with heroin versus methadone in patients with opioid dependence

BACKGROUND

There is increasing evidence that health-related quality of life (HRQOL) is associated with a successful treatment and better outcome in opioid addiction. The aim of the present study was the longitudinal investigation of HRQOL in patients with severe opioid dependence, who were randomly assigned to four groups of medical and psychosocial treatment: heroin (diacetylmorphine) versus methadone and case management (CM) versus psychoeducation (PSE) respectively.

METHODS

HRQOL (MSQoL) and physical health (OTI) were investigated in 938 subjects, who participated in the German multi-centre study examining the effects of heroin-assisted treatment in patients with severe opioid dependence. Data for the present analysis were taken from baseline and 12-month follow up.

RESULTS

Under both forms of maintenance and psychosocial treatment HRQOL improved significantly during the observation period. HRQOL improvement under maintenance with heroin exceeded improvement under methadone, especially with regard to subjective physical health. HRQOL improvement was significantly associated with better expert-rated physical health. Further analyses showed significant better improvement of HRQOL in subjects treated with PSE compared with CM.

CONCLUSIONS

The advantage of heroin with regard to the improvement of HRQOL may be partially explained by a better improvement of physical health under maintenance with heroin compared with methadone, which highlights the importance of a comprehensive model of health care for patients with severe opioid dependence. Future studies need to investigate the benefits of PSE for patients in maintenance therapy.

Prevalence of chronic pruritus in Germany: results of a cross-sectional study in a sample working population of 11,730

BACKGROUND

Pruritus is a frequent symptom in many diseases; its prevalence in German adults is unknown.

OBJECTIVE

Our purpose was to assess the prevalence, severity and health care of chronic pruritus in the German working population.

METHODS

A cross-sectional observational study was conducted in employees of 144 German companies. Pruritus-specific data were obtained by standardized questions.

RESULTS

11,730 people (53.2% male, 16-70 years, mean = 43.7 years) were suitable for analysis. The point prevalence of chronic pruritus (at least 6 weeks prior to data collection) was 16.8%. The prevalence increased with age from 12.3% (16-30 years) to 20.3% (61-70 years). A quarter of the affected persons had suffered from pruritus for >5 years, 47% had never sought medical advice, and 94% had not undergone any treatment.

CONCLUSIONS

Chronic pruritus is a prevalent symptom in the working age population. A high proportion of people affected are not medically treated.

Quality of life evaluation in wounds: validation of the Freiburg Life Quality Assessment-wound module, a disease-specific instrument

Many patients with chronic wounds suffer not only directly from their wounds but also from high financial, social and psychological impairments, significantly reducing their quality of life. In order to provide an instrument both applicable to different patient populations and sensitive to areas of impact specific to certain skin diseases, the modular instrument 'Freiburg Life Quality Assessment' has been developed. Each disease-specific version of the instrument consists of a core module of generic items and items specific for a distinct skin disease. Objective of the study was to assess reliability, sensitivity to change, and validity of the module for chronic ulcers. The instrument was implemented in a longitudinal observational study on vacuum-seal therapy (n = 175), in a cross-sectional observational study involving patients with chronic leg ulcers (n = 384) and in a randomised clinical trial on keratinocyte transplantation (n = 198). The instrument showed good internal consistency (Cronbach's alpha ≥0·85). There were minor floor effects ≤4·3%, but no ceiling effects. Retest-reliability and convergent validity with the EuroQol quality of life questionnaire (EQ-5D) (visual analogue scale) were satisfactory. Change scores correlated with change in other quality-of-life instruments (r = 0·59-0·61), but not with change in wound status.

[Epidemiology of psoriasis in Germany--analysis of secondary health insurance data]

BACKGROUND

In Germany, population-based data on the epidemiology of psoriasis are still rare. This study aims to assess the prevalence of psoriasis in the total population as well as for subgroups relevant to health care. As further epidemiological parameters the severity and regional distribution of psoriasis were analysed.

METHODS

A secondary analysis of data collected routinely for the members of a nationwide statutory health insurance company was conducted. Prevalences were calculated for a closed cohort of continuously insured persons in 2005. Defined criteria for the existence of psoriasis were at least one diagnoses of psoriasis (ICD-10) relating to ambulatory or hospital treatment or disability.

RESULTS

33,981 of the 1,344,071 continuously insured persons in 2005 were diagnosed with psoriasis, thus the one-year-prevalence in this cohort was 2.53%. Up to the age of 80 years the prevalence rate was increasing with increasing age and highest for the age groups from 50 to 79 years (range: 3.99-4.18%). Insured persons up to 20 years had a prevalence of 0.73%. Regional differences showed up after stratification for broad categories (1 digit) of ZIP codes: Lowest prevalence rates were seen in the south (2.17%) and highest (2.78%) in the north and western regions of Germany.

CONCLUSIONS

If the prevalence rate of 2.5% assessed in this study is applied to the total resident population, 2 million people are treated because of psoriasis in Germany. Routine data from health insurance companies are a relevant and suitable data source to assess the prevalence of chronic diseases (under medical treatment) in the population.