Anti-Diabetic Medication During the First Four Years of Treatment. A Study Based on Claims Data

Background Ever since the UKPDS study reassessed the usefulness of the substance metformin in 1998, it has been the first-line medication in anti-diabetic treatment. In addition, new classes and agents released on the market have given rise to new treatment options. The present study investigates prescription practice at the onset of treatment and in the years thereafter and measures it against German diabetes guidelines. Database and Methods Database: Statutory health insurance sample AOK/KV Hesse; Ages: 40 and over (N = 142514). Study population: New users of anti-diabetic medication in 2008 (no medication during the preceding 730 days) (n = 1882). Investigation of anti-diabetic medication for four years after initial prescription with regard to substance spectrum, combination treatments, changes in treatment. Log-binomial model: factors influences onset of treatment with metformin versus sulfonylureas (age, sex, duration of illness, comorbidity). Results In 2008 67.9 % of patients began treatment exclusively with metformin, 17.8 % exclusively with sulfonylureas, and 6.7 % exclusively with insulin. Patients diagnosed as obese were significantly more likely to receive metformin. Elderly (80 years and over) or who had been diagnosed with diabetes at least three years prior or patients with renal or cerebrovascular illnesses were significantly less likely to receive metformin. Over the course of treatment, the number of patients receiving multiple medications increased from 5 % to 30 %. (The most frequent combinations were metformin/DPP4 inhibitor, metformin/sulfonylureas, and metformin/insulin.) Conclusion The findings show that German patient care guidelines on diabetes are reflected in prescription practice. Renal diseases are taken into account as potential contraindications for metformin treatment. In the wake of the expansion of approval for metformin in 2015 - reducing the creatinine clearance level to which application is possible - this first-line medication will be available for an ever larger circle of patients in the future

Care trajectories of cancer patients. Analysis of the use of inpatient and ambulatory medical services

BackgroundCare trajectories of cancer patients are characterized by cross-sectoral and multidisciplinary treatments. Yet, little is known about the actual use of inpatient and ambulatory services by cancer patients and differences according to cancer type.AimThe goal was to analyze use patterns of inpatient and ambulatory medical services by cancer patients.MethodsBased on routine data of the statutory health insurance AOK Hesse from 2009-2014 (about 1.4million insured persons in 2014), care trajectories of patients with incident breast, prostate, and colorectal cancer, respectively, were analyzed through descriptive statistics.ResultsIn all, 83% of breast, 63% of prostate, and 76% of colorectal cancer patients with incidence in 2013 had at least one hospital stay in the first year after diagnosis. On average, they had2 (breast and prostate cancer) and3 (colorectal cancer) stays, and alength of hospital stay of 15 (breast cancer), 17 (prostate cancer), and 35 (colorectal cancer) nights. The average number of ambulant medical services (number of EBM codes) was between 111 (colorectal cancer) and 127 (breast cancer). Compared to colorectal cancer patients, more patients with breast and prostate cancer, respectively, visited organ-specialists at least once in the first year after diagnosis (breast: 83%, prostate: 87%, colorectal: 15%) than hematologists/oncologists (breast: 14%, prostate: 3%, colorectal: 24%). A total of 78% of breast, 42% of prostate, and 34% of colorectal cancer patients received cancer drugs. Cancer drugs were primarily prescribed ambulatory. The time between operation and beginning of ambulant cancer drug treatment was longer than 42days for 33% of breast and 18% of colorectal cancer patients.DiscussionThe results show the intensity of medical services after cancer diagnoses and highlight the variety of care trajectories for different cancer types

Cancer Patients and the Last Year of Life: Palliative Care, Hospitalization and Place of Death

Introduction Palliative care patients frequently suffer from cancer diagnoses. Specialised palliative home care (German acronym 'SAPV') enables patients with complex symptoms and intensive care needs to receive home care until death. In the German Federal State of Hesse, the first SAPV teams were set up in 2009. Against this background, the aim of this study was (i) to investigate the utilization of SAPV and specialised inpatient palliative care in the last year of life of cancer patients, (ii) to detect the medical professions prescribing SAPV and (iii) to analyse the place of death and the hospitalization rate in the last 91 days of life. Methods A retrospective secondary data analysis was conducted. Routine data from the statutory health insurance company AOK Hesse in Germany for 2009-2014 were analysed using descriptive statistical methods. The study population comprised breast, prostate, and colorectal cancer patients who died in the year of observation (2010-2014) and who were fully insured 360 days before death. Results Depending on the year of observation, 492-545 breast, 546-625 prostate, and 709-752 colorectal cancer patients were included in the study. The analysis showed an increase of cancer patients receiving palliative care from 2010 to 2014. A higher proportion of breast, prostate, and colorectal cancer patients received SAPV as compared to services from palliative care units or inpatient hospices. All in all, over 90 % of the SAPV prescriptions were issued by family doctors. The hospitalization rate of cancer patients in the last 91 days of life as well as the share of those dying in hospital decreased between 2010 and 2014. Conclusion The results must be assessed in the context of the implementation of SAPV in the state of Hesse. The increase of SAPV services and the reduction of hospitalizations at the end of life indicate a successful introduction of SAPV in the state of Hesse

Impact of EU risk assessment process and administrative regulations for manufacturers of combined hormonal contraceptive prescribing. An analysis of developments in Germany and the implications

Objective: Combined hormonal contraceptives (CHC) exhibit differing risks for cardiovascular and thrombotic events (VTE). A European referral process confirmed higher VTE risks for 3(rd) generation gestagens and drospirenone. CHC are now grouped in risk classes (RC) I, II, and III, with RC III having a higher risk than RC I and X (risk not yet known). Marketing authorization holders were obliged to implement pharmacovigilance measures and risk minimization measures including changes of prescribing information. The study assessed whether these activities induced changes in prescription patterns. Methods: German prescription data for 1.1 million women below 20 years of age were used to analyze the effects of interventions and potential influence factors using logistic regression. Descriptive statistics were calculated for prescriptions for 3.3 million women from January 2011 to March 2016. Results: Shares of RC I and RC X recipients rose substantially over the observation period, while RC III recipient share showed a steady decrease. The referral induced a slightly faster decrease in RC III and increase in RC X. The implementation of pharmacovigilance measures manifested no additional effect. Conclusion: The decrease in RC III share already observed before the referral process can be explained with pre-existing discussions around CHC. The effect attributable to the referral was statistically significant, although very small. While evidence for a connection between interventions and prescription change is only indirect, the study shows that routine data are suitable for impact analyses, and monitoring prescribing patterns can be recommended as feedback after regulatory or political interventions. This is being followed up

Primary and secondary data on dementia care as an example of regional health planning

Health service planning that takes into account as far as possible the regional needs and regional discrepancies is a controversial health issue in Germany. In a pilot scheme, we tested a planning process for regional healthcare services, based on the example of dementia care. The aim of this article is to present the strengths and limitations of this planning process. We developed an indicator set for dementia care based on routine regional data obtained from two German statutory health insurance companies. Additionally, primary data based on a questionnaire sent to all GPs in the area were evaluated. These data were expanded through the addition of official socio-demographic population data. Procedures and evaluation strategies, discussion of the results and the derivation of planning measures followed, in close agreement with a group of local experts. Few epidemiological data on regional variations in health care planning are publicly available. Secondary data from statutory health insurance companies can be assessed to support the estimation of regional health care needs, but interpretation is difficult. The use of surveys to collect primary data, and the assessment of results by the local health board may facilitate interpretation and may contribute towards more valid statements regarding regional health planning. Despite the limited availability of data and the considerable efforts involved in data analysis, the project demonstrates how needs-based health service planning can be carried out in a small region, taking into account the increasing demands of the local health care providers and the special local features

Prevalence of dementia of insured persons with and without German citizenship (vol 61, pg 606, 2018)

There was a higher prevalence of dementia in the very old insured without German citizenship compared to those with German citizenship, especially in men. Korrekt ist: There was a higher prevalence of dementia in the very old insured with German citizenship compared to those without German citizenship, especially in men

Prevalence of dementia of insured persons with and without German citizenship. A study based on statuatory health insurance data

Elderly people with a non-German background are a fast growing population in Germany. Is administrative prevalence of dementia and uptake of nursing-home care similar in the German and non-German insured? Based on routine data, administrative prevalence rates for dementia were calculated for 2013 from a full census of data from one large sickness fund. Patients with dementia (PWD) were identified via ICD-10 codes (F00; F01; F03; F05; G30). Administrative prevalence of dementia was 2.67% in the study population; 3.06% in Germans, and 0.96% in non-Germans (p value < 0.001). Age and sex adjusted prevalence was comparable in the insured with and without German citizenship, except in women aged 80-84 (17.2 vs. 15.4) and for men in the age groups 80-84 (16.5 vs. 14.2), 85-89 years (23.4 vs. 21.5), and above 90 years of age (32.3 vs. 26.3). Standardized to the population of all investigated insured, 31.4% of all Germans with dementia had no longterm care entitlement vs. 35.5% of all patients without German citizenship. Of German patients, 55.1% were institutionalized vs. 39.5% of all patients without German citizenship. There was a higher prevalence of dementia in the very old insured without German citizenship compared to those with German citizenship, especially in men. Non-Germans showed lower uptake of nursing home care compared to Germans. Additionally, Germans had slightly higher nursing care entitlements. It should be investigated further how much of the difference is due to underdiagnosis, cultural differences, or lack of adequate diagnostic work-up

Gestational diabetes in Germany—prevalence, trend during the past decade and utilization of follow-up care: an observational study

Abstract Gestational diabetes mellitus (GDM) is one of the most common medical complications in pregnancy. Information on key figures such as screening rates, prevalence of GDM or utilization of follow-up care and associated factors varies widely and is often lacking. The aim of our study is to provide information on screening rates for and prevalence of GDM as well as utilization of follow-up care in Germany. We used data (2010–2020) from a large, nationwide statutory health insurance containing information on inpatient and outpatient care, including diagnoses, medication and treatments. Descriptive analyses were performed to assess screening rates, prevalence of GDM and participation rates in follow-up care. A log-binomial regression model was calculated to analyze associated factors. Screening rates among pregnant women increased from 40.2% (2010) to 93.3% (2020) and prevalence from 9.4% (2010) to 15.1% (2020). The proportion of women attending follow-up care remained stable over time (around 42%). Age, educational level, insulin prescription, hypertension and obesity were positively associated with participation in follow-up care. Although over 90% of women in Germany are screened for GDM during pregnancy, follow-up care is used much less. Further research is needed to understand the trends in GDM healthcare (from screening to follow-up care) and the reasons for women's (non-)participation, as well as the attitudes and routines of the healthcare providers involved

Multimedication Guidelines: Assessment of the Size of the Target Group for Medication Review and Description of the Frequency of Their Potential Drug Safety Problems with Routine Data

Lappe V, Dinh TS, Harder S, et al. Multimedication Guidelines: Assessment of the Size of the Target Group for Medication Review and Description of the Frequency of Their Potential Drug Safety Problems with Routine Data. Pharmacoepidemiology. 2022;1(1):12-25.(1) Background: About 10 years ago, several guidelines for the better management of patients with polypharmacy were issued. A central issue is the definition of the target group. The primary aim of this study is therefore to assess the size of the target group, applying the criteria of the German guidelines. A further aim is to describe the frequency of occurrence of medication safety issues for patients of the target group. (2) Methods: The study is based on administrative data of one large statutory health insurer in Germany (n = 9,012,523). (3) Results: The criteria of multimorbidity (at least three chronic diseases) and utilization of five or more concurrent drugs over at least 91 days is fulfilled by 14.1% of the insured patients, or almost 1.3 million persons. About 5% of this multimorbid and poly-medicated population fulfilled at least three of out of five additional occasion-related criteria. Medication safety issues occur frequently: treatment prevalence with potentially inadequate medication, QT-drugs, benzodiazepine or Z-drugs and proton pump inhibitors was 30.4%, 28.9%, 11.1% and 52.4%, respectively. (4) Conclusions: The analysis shows the scope of patients eligible for a structured medication review and demonstrates the relevance for counselling based on the high percentage potentially at risk due to medication therapy safety problems