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Pogosova NV, Boytsov SA. Preventive Cardiology 2024: State of Problem Perspectives of Development. KARDIOLOGIIA 2024; 64:4-13. [PMID: 38323439 DOI: 10.18087/cardio.2024.1.n2636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
This article presents the current relevance of preventive cardiology, substantiates the increasing importance of the prevention of cardiovascular diseases (CVD) to reduce mortality and the burden of CVD, including in the era of widespread use of modern high-tech methods and effective drug therapy for treating CVD in clinical practice. The article also addresses effectiveness of secondary prevention of CVD and approaches to its improvement. Particular attention is paid to the high importance of introducing into practice comprehensive programs for secondary prevention of CVD and cardiac rehabilitation. The principles of organizing such programs and their most important components are presented in detail.
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Affiliation(s)
- N V Pogosova
- Chazov National Medical Research Center of Cardiology, Moscow; "Russian Peoples' Friendship University named after. P. Lumumba", Moscow
| | - S A Boytsov
- Chazov National Medical Research Center of Cardiology, Moscow
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Amberger OA, Glushan A, Müller A, Beyer M, Karimova K. Overview article: Impact of primary and secondary care collaboration on hospitalization for chronic heart failure: Two comparative studies. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 182-183:125-129. [PMID: 37806814 DOI: 10.1016/j.zefq.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION In the past decade, a legal framework was created in Germany that promotes intense collaboration at the interface between primary and secondary care. This overview article distinguishes between the effects of two complementary programs aimed at improving ambulatory care in Baden-Wuerttemberg: (1) general practitioner-centered care (GPCC), which strengthens the role of general practitioners, and (2) collaborative cardiology care (CCC), which coordinates primary and cardiology care. METHODS The overview article presents two already published studies that assess the impact of the programs on hospitalizations in patients with chronic heart failure (CHF) based on claims data from 2016. The hospitalization rate of patients enrolled in GPCC (N=75,096) and CCC (N=13,404) were compared with corresponding control groups (N=65,618 and N=8,776 respectively). RESULTS The hospitalization rate in GPCC was lower than in the control group (risk ratio 0.97; 95% CI: 0.95-0.99, P=0.0024). GPCC patients with CHF that received specialist cardiology care as part of CCC had significantly lower hospitalization rates than those receiving standard cardiology care (risk ratio 0.92; 0.88-0.97, P=0.0014). DISCUSSION This overwiew study shows that reforming medical care and compensation at the interface between general practice and specialist care can lead to fewer hospital admissions in patients with CHF. CONCLUSION Overall, this article underlines the importance of collaboration between primary care physicians and specialists for patients with CHF that are receiving ambulatory care.
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Affiliation(s)
- Olga A Amberger
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Germany.
| | - Anastasiya Glushan
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Germany
| | - Angelina Müller
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Germany
| | - Martin Beyer
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Germany
| | - Kateryna Karimova
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Germany
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Müller A, Gruhn S, Sawicki OA, Glushan A, Witte C, Klaaßen-Mielke R, Lembeck B, Beyer M, Gerlach FM, Greiner W, Karimova K. Collaborative Ambulatory Orthopaedic Care in Patients with Hip and Knee Osteoarthritis: A Retrospective Comparative Cohort Study on Health Utilisation and Economic Outcomes. Int J Integr Care 2023; 23:22. [PMID: 37275630 PMCID: PMC10237241 DOI: 10.5334/ijic.6442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/09/2023] [Indexed: 06/07/2023] Open
Abstract
Objective To evaluate a novel healthcare programme for the treatment of patients with hip and knee osteoarthritis in southern Germany in terms of clinical and health economic outcomes. The study is based on claims data from 2014 to 2017. Methods We conducted a retrospective comparative cohort study of 9768 patients with hip and knee osteoarthritis, of whom 9231 were enrolled in a collaborative ambulatory orthopaedic care programme (intervention group), and 537 patients received usual orthopaedic care (control group). Key features of the programme are coordinated care, morbidity-adapted reimbursement and extended consultation times. Multivariable analysis was performed to determine effects on health utilisation outcomes. The economic analysis considered annual costs per patient from a healthcare payer perspective, stratified by healthcare service sector. Besides multivariable regression analyses, bootstrapping was used to estimate confidence intervals for predicted mean costs by group. Results Musculoskeletal-disease-related hospitalisation was much less likely among intervention group patients than control group patients [odds ratio (OR): 0.079; 95% CI: 0.062-0.099]. The number of physiotherapy prescriptions per patient was significantly lower in the intervention group (RR: 0.814; 95% CI: 0.721-0.919), while the likelihood of participation in exercise programmes over one year was significantly higher (OR: 3.126; 95% CI: 1.604-6.094). Enrolment in the programme was associated with significantly higher ambulatory costs (€1048 vs. €925), but costs for inpatient care, including hospital stays, were significantly lower (€1003 vs. €1497 and €928 vs. €1300 respectively). Overall annual cost-savings were €195 per patient. Conclusions Collaborative ambulatory orthopaedic care was associated with reduced hospitalisation in patients with hip and knee osteoarthritis. Health costs for programme participants were lower overall, despite higher costs for ambulatory care.
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Affiliation(s)
- Angelina Müller
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, DE
| | - Sebastian Gruhn
- Health Economics and Health Care Management, Bielefeld University, P.O. Box 10 01 31, 33501, Bielefeld, DE
| | - Olga A. Sawicki
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, DE
| | - Anastasiya Glushan
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, DE
| | - Claudia Witte
- aQua, Institute for Applied Quality Improvement and Research in Health Care, 37073 Goettingen, DE
| | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, DE
| | - Burkhard Lembeck
- Joint Practice for Orthopaedic and Trauma Dr. Lembeck und Dr. Pampel, Hindenburgstr. 7/1, 73760, Ostfildern-Nellingen, DE
| | - Martin Beyer
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, DE
| | - Ferdinand M. Gerlach
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, DE
| | - Wolfgang Greiner
- Health Economics and Health Care Management, Bielefeld University, P.O. Box 10 01 31, 33501, Bielefeld, DE
| | - Kateryna Karimova
- Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, DE
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Boytsov SA, Provatorov SI. Possibilities of dispensary observation in reducing mortality from coronary heart disease. TERAPEVT ARKH 2023; 95:5-10. [PMID: 37167109 DOI: 10.26442/00403660.2023.01.202038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Indexed: 02/26/2023]
Abstract
Dispensary observation of patients with coronary artery disease can significantly reduce the likelihood of cardiovascular complications onset. Active outpatient monitoring allows to correct the main risk factors for cardiovascular complications, to estimate the risk of unfavorable cardiovascular events onset and to identificate patients who will get benefit of coronary revascularization. The introduction of a comprehensive assessment of cardiovascular risk and the development of remote monitoring technologies will improve the long-term results of outpatient follow-up of patients with coronary artery disease at high cardiovascular risk.
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Krefting J, Sen P, David-Rus D, Güldener U, Hawe JS, Cassese S, von Scheidt M, Schunkert H. Use of big data from health insurance for assessment of cardiovascular outcomes. Front Artif Intell 2023; 6:1155404. [PMID: 37207237 PMCID: PMC10188985 DOI: 10.3389/frai.2023.1155404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/13/2023] [Indexed: 05/21/2023] Open
Abstract
Outcome research that supports guideline recommendations for primary and secondary preventions largely depends on the data obtained from clinical trials or selected hospital populations. The exponentially growing amount of real-world medical data could enable fundamental improvements in cardiovascular disease (CVD) prediction, prevention, and care. In this review we summarize how data from health insurance claims (HIC) may improve our understanding of current health provision and identify challenges of patient care by implementing the perspective of patients (providing data and contributing to society), physicians (identifying at-risk patients, optimizing diagnosis and therapy), health insurers (preventive education and economic aspects), and policy makers (data-driven legislation). HIC data has the potential to inform relevant aspects of the healthcare systems. Although HIC data inherit limitations, large sample sizes and long-term follow-up provides enormous predictive power. Herein, we highlight the benefits and limitations of HIC data and provide examples from the cardiovascular field, i.e. how HIC data is supporting healthcare, focusing on the demographical and epidemiological differences, pharmacotherapy, healthcare utilization, cost-effectiveness and outcomes of different treatments. As an outlook we discuss the potential of using HIC-based big data and modern artificial intelligence (AI) algorithms to guide patient education and care, which could lead to the development of a learning healthcare system and support a medically relevant legislation in the future.
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Affiliation(s)
- Johannes Krefting
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- *Correspondence: Johannes Krefting
| | - Partho Sen
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Diana David-Rus
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Ulrich Güldener
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Johann S. Hawe
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Moritz von Scheidt
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Heribert Schunkert
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Mueller A, Sawicki OA, Günther MP, Glushan A, Witte C, Klaaßen-Mielke R, Gerlach FM, Beyer M, Karimova K. General practitioner-centred paediatric primary care reduces risk of hospitalisation for mental disorders in children and adolescents with ADHD: findings from a retrospective cohort study. Eur J Gen Pract 2022; 28:150-156. [PMID: 35712903 PMCID: PMC9225782 DOI: 10.1080/13814788.2022.2082409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background General practitioners (GPs) play an essential role in the sustainable management of attention-deficit/hyperactivity disorder (ADHD). To our knowledge, the healthcare programme described here is the first integrated care programme for paediatric ambulatory care embedded in GP-centred-healthcare in Germany. Objectives To compare the health-service-utilisation of patients with ADHD enrolled in a GP-centred-paediatric-primary-care-programme with usual care in terms of disease-related hospitalisation, pharmacotherapy and psychotherapy. Methods In 2018, we conducted a retrospective cohort study of 3- to 18-year-old patients with ADHD in Baden-Wuerttemberg, southern Germany. The intervention group (IG) comprised patients enrolled in a GP-centred-paediatric-primary-healthcare-programme and consulted a participating GP for ADHD at least once. GP-centred-paediatric-primary-care provides high continuity of care, facilitated access to specialist care, extended routine examinations and enhanced transition to adult healthcare. Patients in the control group (CG) received usual care, meaning they consulted a non-participating GP for ADHD at least once. Main outcomes were disease-related hospitalisation, pharmacotherapy and psychotherapy. Multivariable logistic regression was performed to compare groups. Results A total of 2317 patients were included in IG and 4177 patients in CG. Mean age was 8.9 ± 4.4. The risk of mental-disorder-related hospitalisations was lower in IG than CG (odds ratio (OR): 0.666, 95% confidence interval (CI): 0.509–0.871). The prescription rate for stimulants was lower in IG (OR: 0.817; 95% CI: 0.732–0.912). There was no statistically significant difference in the participation rate of patients in cognitive behavioural therapy between groups (OR: 0.752; 95% CI: 0.523–1.080). Conclusion Children and adolescents with ADHD enrolled in GP-centred-paediatric-primary-care are at lower risk of mental-disorder-related hospitalisation and less likely to receive stimulants.
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Affiliation(s)
- Angelina Mueller
- Institute of General Practice, Goethe University, Frankfurt, Germany
| | - Olga A Sawicki
- Institute of General Practice, Goethe University, Frankfurt, Germany
| | - Moritz Philipp Günther
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Claudia Witte
- aQua, Institute for Applied Quality Improvement and Research in Health Care, Goettingen, Germany
| | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University, Bochum, Germany
| | | | - Martin Beyer
- Institute of General Practice, Goethe University, Frankfurt, Germany
| | - Kateryna Karimova
- Institute of General Practice, Goethe University, Frankfurt, Germany
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Smetak N. [Intensified collaborative care: a model of successful acting in ambulatory cardiology]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2022; 63:930-938. [PMID: 35943538 DOI: 10.1007/s00108-022-01385-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 10/15/2022]
Abstract
In the cardiological care of outpatients in Germany, selective contracts have been established in in addition to the usual representation in the collective system, i.e., in the system of the associations of statutory health insurance physicians (Kassenärztliche Vereinigungen, KV). One example is the KardioExpert (Cardioexpert) contract between the Professional Association of Cardiologists in Private Practice (BNK) and the Barmer Ersatzkasse and Ford Betriebskrankenkasse (BKK). This supplementary contract extends regular outpatient care for patients with heart failure; more than 20,000 patients are now included nationwide. Another example is a full care contract in accordance with § 73c or § 140a of Book V of the German Social Code (SGBV), which in Baden-Württemberg regulates all cardiological care for participating patients as an alternative to the collective contract. The cardiology contract according to § 73c, which has been in place in Baden-Württemberg since 2010, was scientifically evaluated and was able to show a 24% reduction in mortality within 1 year and a 16% reduction in the hospitalization rate for patients with heart failure. Furthermore, overall health care costs were reduced in the intervention group. At the same time, participating physicians also benefit through non-budgeted reimbursement, which is approximately 15-20% above KV levels. The Cardioexpert contract also shows similar data and benefits. Overall, these cardiology contracts show in a model way that better care can be implemented more cost-effectively and with a win-win situation for all sides. Nationwide expansion, especially of the full care contracts, has so far failed due to the reluctance of the cost bearers. A start could be made here with legal regulations, such as the obligation of health insurance companies to enter into such contracts.
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Affiliation(s)
- Norbert Smetak
- Kardiologisch-angiologische Praxis, Hahnweidstr. 21, 73230, Kirchheim, Deutschland.
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Müller A, Amberger OA, Glushan A, Klaaßen-Mielke R, Witte C, van den Akker M, Brünn R, Gerlach FM, Beyer M, Karimova K. Differences in opioid prescription rates between patients with musculoskeletal disorders enrolled in coordinated ambulatory healthcare and patients receiving usual care: a retrospective observational cohort study. BMJ Open 2022; 12:e062657. [PMID: 35940832 PMCID: PMC9364404 DOI: 10.1136/bmjopen-2022-062657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To compare opioid prescription rates between patients enrolled in coordinated ambulatory care and patients receiving usual care. DESIGN In this retrospective cohort study, we analysed claims data for insured patients with non-specific/specific back pain or osteoarthritis of hip or knee from 2014 to 2017. SETTING The study was based on administrative data provided by the statutory health insurance fund 'Allgemeine Ortskrankenkasse', in the state of Baden-Wurttemberg, Germany. PARTICIPANTS The intervention group consisted of patients enrolled in a coordinated ambulatory healthcare model; the control group included patients receiving usual care. Outcomes were overall strong and weak opioid prescriptions. Generalised linear regression models were used to analyse the effect of the intervention. RESULTS Overall, 46 001 (non-specific 18 787/specific 27 214) patients with back pain and 19 366 patients with osteoarthritis belonged to the intervention group, and 7038 (2803/4235) and 963 patients to the control group, respectively. No significant difference in opioid prescriptions existed between the groups. However, the chance of being prescribed strong opioids was significantly lower in the intervention group (non-specific back pain: Odds Ratio (OR) 0.735, 95% Confidential Interval (CI) 0.563 to 0.960; specific back pain: OR 0.702, 95% CI 0.577 to 0.852; osteoarthritis: OR 0.644, 95% CI 0.464 to 0.892). The chance of being prescribed weak opioids was significantly higher in patients with specific back pain (OR 1.243, 95% CI 1.032 to 1.497) and osteoarthritis (OR 1.493, 95% CI 1.037 to 2.149) in the intervention group. CONCLUSION Coordinated ambulatory healthcare appears to be associated with a lower prescription rate for strong opioids in patients with chronic musculoskeletal disorders. TRIAL REGISTRATION NUMBER German Clinical Trials Register (DRKS00017548).
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Affiliation(s)
- Angelina Müller
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
| | | | - Anastasiya Glushan
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
| | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-Universitat Bochum, Bochum, Germany
| | - Claudia Witte
- Institute for Applied Quality Improvement and Research in Health Care, AQUA, Gottingen, Germany
| | | | - Robin Brünn
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
| | - Martin Beyer
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
| | - Kateryna Karimova
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
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Müller A, Amberger OA, Glushan A, Witte C, Klaaßen-Mielke R, Lembeck B, Beyer M, Gerlach FM, Karimova K. Evaluation of a collaborative ambulatory orthopedic care program for patients with hip and knee osteoarthritis: a comparative observational cohort study. BMC Musculoskelet Disord 2022; 23:740. [PMID: 35922853 PMCID: PMC9347081 DOI: 10.1186/s12891-022-05697-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/26/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In 2014, the novel orthopedic care program was established by the AOK health insurance fund in southern Germany to improve ambulatory care for patients with musculoskeletal disorders. The program offers extended consultation times, structured collaboration between general practitioners and specialists, as well as a renewed focus on guideline-recommended therapies and patient empowerment. The aim of this study was to assess the impact of the program on health service utilization in patients with hip and knee osteoarthritis (OA). METHODS This retrospective cohort study, which is based on claims data, evaluated health service utilization in patients with hip and knee OA from 2014 to 2017. The intervention group comprised OA patients enrolled in collaborative ambulatory orthopedic care, and the control group received usual care. The outcomes were participation in exercise interventions, prescription of physical therapy, OA-related hospitalization, and endoprosthetic surgery rates. Generalized linear regression models were used to analyze the effect of the intervention. RESULTS Claims data for 24,170 patients were analyzed. Data for the 23,042 patients in the intervention group were compared with data for the 1,128 patients in the control group. Participation in exercise interventions (Odds Ratio (OR): 1.781; 95% Confidence Interval (CI): 1.230-2.577; p = 0.0022), and overall prescriptions of physical therapy (Rate Ratio (RR): 1.126; 95% CI: 1.025-1.236; p = 0.0128) were significantly higher in the intervention group. The intervention group had a significantly lower risk of OA -related hospitalization (OR: 0.375; 95% CI: 0.290-0.485; p < 0.0001). Endoprosthetic surgery of the knee was performed in 53.8% of hospitalized patients in the intervention group vs. 57.5% in the control group; 27.7% of hospitalized patients underwent endoprosthetic surgery of the hip in the intervention group versus 37.0% in the control group. CONCLUSIONS In patients with hip and knee OA, collaborative ambulatory orthopedic care is associated with a lower risk of OA-related hospitalization, higher participation in exercise interventions, and more frequently prescribed physical therapy.
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Affiliation(s)
- Angelina Müller
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Olga A Amberger
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Anastasiya Glushan
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Claudia Witte
- aQua, Institute for Applied Quality Improvement and Research in Health Care, 37073, Goettingen, Germany
| | - Renate Klaaßen-Mielke
- Institute of Medical Informatics, Biometry and Epidemiology, Ruhr University, 44789, Bochum, Germany
| | - Burkhard Lembeck
- Joint Practice for Orthopaedic and Trauma, Hindenburgstr. 7/1, 73730, Ostfildern, Germany
| | - Martin Beyer
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Kateryna Karimova
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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