[Active health promotion among the aged in a rural region. Participants, acceptance, and implementation]

Implementation of evidence-based health promotion and disease prevention interventions: theoretical and practical implications of the concept of transferability for decision-making and the transfer process

Evidence-based health promotion and disease prevention require incorporating evidence of the effectiveness of interventions into policy and practice. With the entry into force of the German Act to Strengthen Health Promotion and Prevention (PrävG), interventions that take place in people’s everyday living environments have gained in importance. Decision-makers need to assess whether an evidence-based intervention is transferable to their specific target context. The Federal Centre for Health Education (BZgA) recommends that transferability of an intervention should be clarified before any decision to implement it. Furthermore, transferability needs to be finally determined after an evaluation in the target context. In this article, we elaborate on theoretical and practical implications of the concept of transferability for health promotion and disease prevention based on the Population–Intervention–Environment–Transfer Models of Transferability (PIET-T). We discuss how decision-makers can anticipate transferability prior to the intervention transfer with the help of transferability criteria and how they can take transferability into account in the further process. This includes the steps of the analysis of a health problem and identification of effective interventions, the steps of the initial transferability assessment and identification of the need for adaptation, and the steps of the implementation and evaluation. Considering transferability is a complex task that comes with challenges. But it offers opportunities to select a suitable intervention for a target context and, in the transfer process, to understand the conditions under which the intervention works in this context. This knowledge helps to establish an evidence base, which is practically relevant.

[Analysis of extent and quality of treatment of arthrosis patients based on routine data from German statutory health insurance]

BACKGROUND

In an epidemiological context arthrosis is becoming more important due to demographic changes. This study describes the routine medical treatment of patients with arthrosis.

METHODS

Claims data of a German statutory health insurance fund for the period from 2005 to 2008 were analyzed. All insured patients aged 60 years and older residing in Kinzigtal were included. In detail all 1,551 insured persons with a validated ambulatory diagnosis of gonarthrosis or coxarthrosis (ICD-10: M16/M17) were analyzed.

RESULTS

The treatment prevalence of arthrosis documented by practice-based physicians rose from 14 % (60-69 years old) to 25 % (80 years and older). At least one hospital admission between 2006 and 2008 was documented for two thirds of the patients whereby 86 and 95 patients were admitted because of coxarthrosis or gonarthrosis, respectively. A total of 112 and 96 insured patients received an implantation or revision of an endoprosthesis of the hip or knee, respectively. The need for nursing care did not decrease in cases of surgical compared to conservative treatment.

CONCLUSION

Claims data allow a differentiated analysis of medical treatment and quality of care as well as a comparison of alternatives of medical care for patients with arthrosis. Results of such analyses can be used to identify patients with increased vulnerability.