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Analyzing web searches for axial spondyloarthritis in Germany: a novel approach to exploring interests and unmet needs. Rheumatol Int 2023; 43:1111-1119. [PMID: 36640175 PMCID: PMC10125933 DOI: 10.1007/s00296-023-05273-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023]
Abstract
Axial spondyloarthritis (axSpA) is an underdiagnosed condition with a high disease burden. Due to delayed diagnosis and limited access to specialist care, conventional health data might not sufficiently capture the perspective of affected individuals. The aim of this study was to assess public interest, unmet needs, and disease burden of axSpA in Germany through the analysis of thematic, geographic, and temporal patterns in national web search data. Google Ads Keyword Planner was used to identify axSpA-related keywords and their monthly search volume in Germany between January 2017 and December 2020. Identified keywords were qualitatively categorized into six categories. Overall, 265 axSpA-related keywords with a search volume of 3,881,490 queries were identified. Nearly 81% of the total search volume was assigned to the category terms and definition, while 19% referred to either outcomes, symptoms, diagnosis, management, or causes. In the category outcomes, prognostic outcomes like "life expectancy" generated more searches than physical manifestations like "pain". Less populated cities showed significantly more searches per 100,000 inhabitants than larger cities. Searches were seasonally stable with a Germany-wide peak in July 2017. This study provides an overview of public interest in axSpA based on web search data in Germany. The identified search patterns could be used to guide public health campaigns and optimize axSpA management in Germany.
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2
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Pfeil A, Schuch F, Fleck M. [Further training in rheumatology-Current status 2022]. Z Rheumatol 2022; 81:482-486. [PMID: 35394195 DOI: 10.1007/s00393-022-01196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
For the continued existence of the specialty of internal medicine and rheumatology and the assurance of a qualitative patient care, attractive further education for motivated resident physicians is of central importance. Continuing training in rheumatology takes place primarily in the inpatient setting, although reliable figures on outpatient and inpatient further education positions are not yet available. Further training in rheumatology is predefined by the model further training regulations (Musterweiterbildungsverordnung; MWBO) 2018, which have now been implemented by most state medical associations, in some cases with state-specific changes. Based on the MWBO of 2018, a model curriculum was developed by the German Society of Rheumatology (DGRh) for further training in the specialty of internal medicine and rheumatology. This model curriculum is intended to provide orientation for trainees and trainers as well as to facilitate structured rheumatology training in inpatient and outpatient settings.
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Affiliation(s)
- Alexander Pfeil
- Klinik für Innere Medizin III, Funktionsbereich Rheumatologie und Osteologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - Florian Schuch
- Internistische Praxisgemeinschaft Rheumatologie - Nephrologie, Erlangen, Deutschland
| | - Martin Fleck
- Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Regenburg, Deutschland.,Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum Bad Abbach, Bad Abbach, Deutschland
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3
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Edelmann E, Schuch F. [Rheumatology in private practice: yesterday-today-tomorrow]. Z Rheumatol 2021; 80:801-818. [PMID: 34709435 DOI: 10.1007/s00393-021-01107-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
Rheumatologic practices were still rare in the early 1990s and rheumatologic treatment took place mainly in the rheumatology clinics and university rheumatology clinics. In the following decades, the number of the rheumatologists in private practices increased and in the year 2004 about two thirds of the outpatient care were already carried out in private practices. In 2020 a total of 597 rheumatologists out of 1106 nationwide worked in private practices, including 203 who were employed. Since 2008, the number of rheumatologists in medical care centers increased more than the number of rheumatologists in private practice. In 2020 only 75% of panel rheumatologists in private practice were in full-time employment. This development to an altered work mentality of the incoming generation and an age structure in which approximately 30% of panel rheumatologists are older than 60 years, threatens a further deterioration of the anyway insufficient outpatient care. In contrast, there are developments that strengthen the outpatient care especially in practices, such as the outpatient specialist medical care and quality-oriented selective contracts as well as rheumatological and immunological laboratory diagnostics. These cornerstones give rheumatology a special position in the panel medical care within the group of specialties in internal medicine and an attractive economic basis. In addition to the medically and scientifically interesting discipline, this could be a further incentive for young trainees to choose rheumatology as a specialty and working in a private practice.
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Affiliation(s)
- Edmund Edelmann
- Rheumazentrum Bad Aibling Erding, Lindenstr. 2, 83043, Bad Aibling, Deutschland.
| | - Florian Schuch
- Internistische Praxisgemeinschaft Rheumatologie Nephrologie, Erlangen, Deutschland
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4
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Aries P, Welcker M. [Limits of outpatient rheumatology care]. Z Rheumatol 2021; 80:846-854. [PMID: 34605978 DOI: 10.1007/s00393-021-01089-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In recent years outpatient rheumatology has developed into one of the most important pillars of rheumatological care. The better diagnostic possibilities, the well-founded training of rheumatologists and the diverse guidelines have led to increasingly more patients being diagnosed as outpatients and can be treated by the most modern options as outpatients. Nevertheless, limits have also been set for outpatient rheumatology. OBJECTIVE This article aims to highlight what the limits of outpatient rheumatology currently are and who sets the limits. The presentation of the limitations should help all participants in the healthcare system to avoid false expectations and frustration; however, limits can also be relocated or overcome by appropriate motivation. The long-term target should be a further improvement in the interaction between outpatient and inpatient rheumatology and therefore the rheumatological care of patients. RESULTS AND DISCUSSION The medical limits of outpatient rheumatology are relatively clear and predominantly uncontroversial, the unjustified referral to the inpatient section is, for example, relatively rarely a problem. Some theoretically possible outpatient interventions are carried out in the inpatient sector more due to logistical problems. The healthcare political and legal limitations of outpatient rheumatological institutions are greater. Despite further limitations of outpatient rheumatology this discipline and the outpatient activity still represents an exciting, modern and last but not least a very satisfying activity, which is promoted here.
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Affiliation(s)
- P Aries
- Rheumatologie im Struenseehaus, Mörkenstr. 47, 22767, Hamburg, Deutschland.
| | - M Welcker
- MVZ für Rheumatologie Dr Welcker, Planegg, Deutschland
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Froschauer S, Muth T, Bredow L, Feist E, Heinemann-Dammann SP, Zinke S, Fiehn C. [Care atlas rheumatology : Approaches and concepts for improving care in outpatient rheumatology]. Z Rheumatol 2021; 80:819-826. [PMID: 34535817 DOI: 10.1007/s00393-021-01072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
Inflammatory rheumatic diseases affect 1.5 million adults and an estimated 20,000 children and adolescents throughout Germany. The successful treatment of these patients is largely based on the availability of high-quality medical care. To be able to provide sufficient care and prevent long waiting times even though the number of rheumatologists is below demand, efficient practice structures and approaches that go beyond standard care play an important role. The present study takes a look at the current state of rheumatological outpatient care as well as innovative care initiatives to support the service provision structures and to improve the care situation in rheumatology and points out: to ensure guideline-based care despite scarce resources, selective contracts, integrated outpatient specialist care (ASV), early or emergency consultation hours, disease management programs (DMP) and appropriate delegation of medical services play an important role. New care concepts increasingly focus on interdisciplinary cooperation (DMP and ASV), strengthened self-management through structured patient training (DMP) and targeted patient management through screening tools. To ensure an up to date and high-quality treatment in the long term, an increase in further training in rheumatology is necessary. This should be achieved by attracting more students and, if necessary, adjusting the training system.
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Affiliation(s)
- Sonja Froschauer
- Berufsverband Deutscher Rheumatologen e. V., Dr.-Max-Str. 21, 82031, Grünwald, Deutschland.
| | | | | | - Eugen Feist
- Rheumatologie, Helios Fachklinik Vogelsang-Gommern, Vogelsang-Gommern, Deutschland
| | | | - Silke Zinke
- Rheumatologische Schwerpunktpraxis, Berlin, Deutschland
| | - Christoph Fiehn
- Rheumatologie Baden-Baden GbR, Tätigkeitsschwerpunkt Klinische Immunologie, Medical Center Baden-Baden, Baden-Baden, Deutschland
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6
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Kleinert S, Bartz-Bazzanella P, von der Decken C, Knitza J, Witte T, Fekete SP, Konitzny M, Zink A, Gauler G, Wurth P, Aries P, Karberg K, Kuhn C, Schuch F, Späthling-Mestekemper S, Vorbrüggen W, Englbrecht M, Welcker M. A Real-World Rheumatology Registry and Research Consortium: The German RheumaDatenRhePort (RHADAR) Registry. J Med Internet Res 2021; 23:e28164. [PMID: 34014170 PMCID: PMC8176344 DOI: 10.2196/28164] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/19/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023] Open
Abstract
Real-world data are crucial to continuously improve the management of patients with rheumatic and musculoskeletal diseases (RMDs). The German RheumaDatenRhePort (RHADAR) registry encompasses a network of rheumatologists and researchers in Germany providing pseudonymized real-world patient data and allowing timely and continuous improvement in the care of RMD patients. The RHADAR modules allow automated anamnesis and adaptive coordination of appointments regarding individual urgency levels. Further modules focus on the collection and integration of electronic patient-reported outcomes in between consultations. The digital RHADAR modules ultimately allow a patient-centered adaptive approach to integrated medical care starting as early as possible in the disease course. Such a closed-loop system consisting of various modules along the whole patient pathway enables comprehensive and timely patient management in an unprecedented manner.
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Affiliation(s)
- Stefan Kleinert
- Praxisgemeinschaft Rheumatologie-Nephrologie, Erlangen, Germany.,Medizinische Klinik 3, Rheumatology/Immunology, Universitätsklinik Würzburg, Würzburg, Germany
| | | | - Cay von der Decken
- Medizinisches Versorgungszentrum Stolberg, Stolberg, Germany.,Klinik für Internistische Rheumatologie, Rhein-Maas-Klinikum, Würselen, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Torsten Witte
- Department of Rheumatology and Clinical Immunology, Hanover Medical School, Hanover, Germany
| | - Sándor P Fekete
- Department of Computer Science, TU Braunschweig, Braunschweig, Germany
| | - Matthias Konitzny
- Department of Computer Science, TU Braunschweig, Braunschweig, Germany
| | - Alexander Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georg Gauler
- Rheumatologische Schwerpunktpraxis, Osnabrück, Germany
| | - Patrick Wurth
- Rheumatologische Schwerpunktpraxis, Osnabrück, Germany
| | - Peer Aries
- Rheumatologie im Struenseehaus, Hamburg, Germany
| | - Kirsten Karberg
- Praxis für Rheumatologie und Innere Medizin, Berlin, Germany
| | | | - Florian Schuch
- Praxisgemeinschaft Rheumatologie-Nephrologie, Erlangen, Germany
| | | | | | | | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr M Welcker GmbH, Planegg, Germany
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Lakomek HJ, Rudwaleit M, Hentschel A, Broge B, Abrolat J, Bessler F, Hellmich B, Klemann A, Krause A, Klass M, Strunk J, Fiori W, Roeder N, Braun J. [Quality in acute inpatient rheumatology 2021 : Current aspects of the KOBRA quality label of the Association of Rheumatological Acute Care Clinics]. Z Rheumatol 2021; 80:758-770. [PMID: 33999267 PMCID: PMC8127451 DOI: 10.1007/s00393-021-01015-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 12/02/2022]
Abstract
Mit einer umfassenden gesundheitspolitischen Qualitätsoffensive ab 2021 sollen die Qualität und Transparenz in der Versorgung von Menschen mit Krankheiten in Krankenhäusern in Deutschland verbessert werden. Gesetzliche Vorgaben zu Mindestmengen und die Ausweitung von Qualitätsverträgen zwischen Kostenträgern und Krankenhäusern sowie die Verwendung von planungsrelevanten Qualitätsindikatoren für eine bedarfs- und qualitätsorientierte Weiterentwicklung der stationären Versorgung werden den Wettbewerb in der Versorgungsqualität zwischen den Krankenhäusern verstärken. Dem Thema „Entwicklung und Definition von Qualität in der Medizin“ hat sich auch der Verband der Rheumatologischen Akutkliniken e. V. (VRA) schon früh nach der Gründung im Jahr 1998 umfassend angenommen. Im Zentrum der akutstationären Qualitätssicherung stehen verbindlich festgelegte Strukturkriterien in Verknüpfung mit dem 2003 in der Rheumatologie gestarteten und bis heute kontinuierlich durchgeführten KOBRA-Projekt (Kontinuierliches Outcome Benchmarking in der Rheumatologischen Akutversorgung) mit der Messung von Prozess- und Ergebnisqualität. Auf der Basis dieses Rahmenkonzeptes (Erfüllung der Strukturkriterien und Durchführung des KOBRA-Projektes) können erfolgreich teilnehmende rheumatologische Einrichtungen für jeweils 2 Jahre das KOBRA-Label erwerben, welches von der Projektleitung – dem aQua-Institut – vergeben wird. Die herausragende Stellung des KOBRA-Projektes wird beispielhaft anhand von Datenauswertungen des Projektzyklus 2018 gezeigt mit Auswertungen zum Therapiestrategiewechsel bei aktiver rheumatoider Arthritis, Diagnosesicherung von Kollagenosen und Vaskulitiden während des stationären Aufenthaltes sowie zur partizipativen Entscheidungsfindung bei rheumatoider Arthritis. Auf den gesundheitspolitisch geforderten „Paradigmenwechsel – weg vom Bett, hin zu einer leistungs-, bedarfs- und qualitätsorientierten Planung“ – ist die akutstationäre Rheumatologie mit der Verankerung von Projekten zur Struktur‑, Prozess- und Ergebnisqualität sehr gut vorbereitet. Für die in der vom Gemeinsamen Bundesausschuss (G-BA) erstellten Richtlinie zu „Rheumatologischen Zentren“ geforderten Qualitätssicherung ist das KOBRA-Projekt ebenfalls eine sehr gute Voraussetzung.
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Affiliation(s)
- H-J Lakomek
- Universitätsklinik für Geriatrie, Johannes-Wesling-Klinikum Minden, Hans-Nolte-Str. 1, 32429, Minden, Deutschland.
| | - M Rudwaleit
- Universitätsklinik für Innere Medizin und Rheumatologie, Klinikum Bielefeld Rosenhöhe, Bielefeld, Deutschland
| | - A Hentschel
- aQua - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Deutschland
| | - B Broge
- aQua - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Deutschland
| | - J Abrolat
- Klinik an der Weißenburg, Uhlstädt-Kirchhasel, Deutschland
| | - F Bessler
- Geschäftsbereich Medizin, Ev. Stiftung Volmarstein, Wetter, Deutschland
| | - B Hellmich
- Innere Medizin, Rheumatologie und Immunologie, medius Klinik Kirchheim, Kirchheim unter Teck, Deutschland
| | - A Klemann
- St.-Josef-Stift Sendenhorst, Sendenhorst, Deutschland
| | - A Krause
- Rheumatologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin-Wannsee, Deutschland
| | - M Klass
- Rheumatologie und Physikalische Therapie, Helios Klinikum Duisburg, Duisburg, Deutschland
| | - J Strunk
- Abteilung Rheumatologie, Krankenhaus Porz am Rhein, Köln, Deutschland
| | - W Fiori
- Roeder & Partner, Ärzte Partnerschaftsgesellschaft, Senden, Deutschland
| | - N Roeder
- Roeder & Partner, Ärzte Partnerschaftsgesellschaft, Senden, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Herne, Deutschland
- Ruhr-Universität Bochum, Herne, Deutschland
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