Regionale fachärztliche Versorgung und demographischer Wandel in Deutschland - Szenarien zur dermatologischen Versorgung im Jahr 2035

Direct-to-Consumer Teledermatology in Germany: A Retrospective Analysis of 1,999 Teleconsultations Suggests Positive Impact on Patient Care

Background: There is a high demand for dermatological care in Germany. As use of teledermatology has increased significantly, this study aimed to investigate the impact of teledermatology on patient care. Methods: This retrospective cross-sectional study used data from a direct-to-consumer teledermatology platform using store-and-forward technology available in Germany between July 2021 and April 2022. Additional patient characteristics were collected using a voluntary follow-up questionnaire, 28 days after teleconsultation. Results: Data of 1,999 enrolled patients were evaluated. Patients had a mean age of 36 years, and 61.2% (1,223/1,999) lived in a rural residence. The most common diagnoses included eczema (36.0%, 701/1,946), fungal diseases (15.4%, 299/1,946), and acne (12.5%, 243/1,946). The follow-up questionnaire was answered by 166 patients (8.3%, 166/1,999). In total, 42.8% (71/166) of patients had undergone no previous medical consultation. The most frequent reason for using teledermatology was the waiting time for a dermatology outpatient appointment (62.0%, 103/166). A total of 62.0% (103/166) participants rated the treatment success as good or very good, while 86.1% (143/166) rated the quality of telemedical care as equal or better to that of an outpatient visit. Conclusion: This study showed that patients often use teledermatology because of functional barriers (waiting times). In this cohort, the diagnoses strongly corresponded to reasons for outpatient presentation. Most patients rated the quality of teledermatology service as at least equivalent to that of outpatient physician visits and reported treatment success. Thus, teledermatology can relieve the burden of outpatient care while providing high benefits from the patient's perspective.

Inpatient care for skin diseases in Germany: multi-source analysis on the current and future health care needs

BACKGROUND

In Germany, skin diseases are mainly treated in the 115 dermatological hospitals.

METHODS

Health care and health economic analysis of dermatological inpatient care and prediction of future care needs based on primary and secondary data.

RESULTS

Outpatient and inpatient care for dermatologic treatment indications is predominantly provided by dermatology specialists. Inpatient treatment was provided for 833,491 cases in 2018, corresponding to 4.21 % of all inpatient cases (19,808,687). Most common treatment cases were: epithelial skin cancer (total 87,386, of which dermatology clinics 52,608), followed by melanoma (23,917/17,774), psoriasis (19,291/13,352), erysipelas (73,337/11,260), other dermatitis (12,671/10,842), atopic dermatitis (AD) (11,421/9,734), and herpes zoster (26,249/9,652). With an average length of stay of 5.69 days, dermatology hospitals were in the bottom third. The proportion of inpatient indications cared for in dermatology hospitals was highest for prurigo (95.2 %), pemphigus (94.9 %), parapsoriasis (94.6 %), pemphigoid (90.3 %), eczema other than AD (85.6 %), and AD (85.2 %). While the total number of inpatient treatment cases in Germany has increased by an average of 17.5 % between 2000 and 2018, this is the case for 26.6 % of skin diseases and over 150 % for individual ones. The projection of current to future inpatient care suggests a continued high demand for inpatient care by dermatology hospitals.

CONCLUSION

Inpatient dermatological care will continue to be an indispensable component of qualified, socially necessary care in Germany.

[Parameters for measuring the regional healthcare situation : A comparison of different healthcare parameters by the example of ophthalmologic care in the metropolitan region Hamburg]

Hintergrund

Die regionale augenärztliche Versorgung wird in Deutschland über die Bedarfsplanungs-Richtlinie mit dem korrigierten Versorgungsgrad gesteuert. Der korrigierte Versorgungsgrad ist ein Instrument, um die medizinische Versorgungssituation abzubilden, allerdings haben frühere Studien Grenzen offenbart. So werden Faktoren wie Erreichbarkeit des öffentlichen Personennahverkehrs (ÖPNV) oder das Vorhandensein von Gesundheitsfachberufen zur Bewertung der Versorgungssituation noch nicht im ausreichenden Maße berücksichtigt. Insbesondere Gesundheitsfachberufe haben eine starke unterstützende Funktion in der regionalen Gesundheitsversorgung.

Ziel der Arbeit

Ziel dieser Studie ist es, verschiedene Parameter zur Überprüfung der regionalen Gesundheitsversorgung am Beispiel der ophthalmologischen Versorgung kritisch zu vergleichen.

Material und Methoden

Hierfür wurde exemplarisch für die Metropolregion Hamburg ein Score aus den Parametern „Dichte der Arztstandorte mit orthoptischem Angebot (Angebote/100.000 Einwohner) auf Kreisebene“, der „Bevölkerungsanteil mit ÖPNV-Erreichbarkeit zum nächstgelegenen Augenarzt <30 min auf Kreisebene“, der „Bevölkerungsanteil mit ÖPNV-Erreichbarkeit zum nächstgelegenen Augenarzt mit orthoptischem Angebot <30 min auf Kreisebene“ gebildet und dem korrigierten Versorgungsgrad gegenübergestellt.

Ergebnisse

Während der korrigierte Versorgungsgrad in keinem der Teilräume eine Unterversorgung feststellen kann, offenbaren die anderen betrachteten Parameter durchaus deutliche Versorgungsunterschiede.

Diskussion

Die Betrachtung unterschiedlicher Parameter zeigt ein heterogenes Bild der Versorgungssituation. Dies sollte in der Bedarfsplanung für die Bewertung berücksichtigt werden.

Digitalisierung in der Medizin während der COVID-19-Pandemie – Möglichkeiten und Grenzen der Teledermatologie

Bei Hautkrankheiten handelt es sich initial oft um Blickdiagnosen. Daher bieten sich dermatologische Fragestellungen für telemedizinische Konsultationen an. Die Ergebnisse zahlreicher internationaler Studien weisen darauf hin, dass die Teledermatologie sowohl von den Patienten als auch den Ärzten in zunehmendem Maße angenommen wird. Nach der Lockerung des Verbots der ausschließlichen Fernbehandlung durch den Ärztetag im Jahr 2018 können Ärzte ihre Patienten auch ohne vorherigen persönlichen Erstkontakt ausschließlich telefonisch oder per Internet behandeln. Durch die Zulassung und den Ausbau der telemedizinischen Tätigkeit in verschiedenen deutschen Bundesländern wurde und wird die Teledermatologie insbesondere während der COVID-19-Pandemie erfolgreich eingesetzt.

Dermatological conditions presenting to the emergency dermatological unit of a university hospital in Germany

BACKGROUND AND OBJECTIVES

Recently, there have been increasing numbers of patients consulting emergency units in all medical disciplines. Our aim was to analyze the demographics, referral mode, symptoms, localization of lesions, prior treatment, diagnoses and hospitalization rate of dermatological patients.

PATIENT AND METHODS

The study was conducted as a prospective single center survey over six months in the dermatology unit of a university hospital in Germany. 1552 consultations were included with consecutive sampling.

RESULTS

The study cohort had a mean age of 41 years and included 53 % females. Nearly half of the patients lived less than 10 kilometers from the study center. 72 % of patients referred themselves. The main symptoms were itching and occurrence of a rash; these symptoms had been present for more than a week on average. A general manifestation was present on the skin in most cases. 55 % of patients were seen by a dermatologist or a general practitioner before the consultation. Prior treatment had been received in 49 % of cases. Eight percent of patients were hospitalized. Eczema was the most common diagnosis, followed by urticaria and scabies.

CONCLUSIONS

This study confirms that a considerable number of patients present with non-urgent diagnoses. Careful prescreening and sensitization of the population may be necessary to reverse this trend.

[Real world data sources for health services research on skin cancer]

Health services research in dermatology with the objective to improve prevention, efficient diagnostics and treatment of skin cancer requires real world data from all sectors. This article provides an overview of currently available relevant real world data sources and the utilization potential. It lists exemplary results of existing studies: secondary data analyses based on billing data from statutory health insurance funds were used among other things to estimate the participation rate in the statutory skin cancer screening. This was approximately 31% in the 2‑year period and was higher in the western German federal states than in the eastern ones. Furthermore, participation was higher for women than for men. Regional data in combination with sociostructural and sociodemographic indicators are available for planning of dermatological care and the analysis points to an association with the prevalence of skin cancer. Primary data are available and necessary for recording patient reported endpoints and evaluating the treatment of skin cancer patients by dermatologists. Extensive histopathological databases record not only clinical markers of skin cancer but also sociodemographic characteristics of the patients and indicate a correlation between the time of diagnosis or therapy and the insurance status and place of residence. In addition to the utilization potential, specific limitations of the data sources are listed.