1
|
Salem J, Becher KF, Bschleipfer T, Dreikorn K, Höfner K, Madersbacher S, Magistro G, Muschter R, Oelke M, Reich O, Rieken M, Schönburg S, Abt D. [Minimally invasive treatment of benign prostatic hyperplasia : The German S2e guideline 2023-part 4]. Urologie 2024; 63:58-66. [PMID: 38193989 DOI: 10.1007/s00120-023-02249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Lower urinary tract symptoms suggestive for benign prostatic obstruction (LUTS/BPO) are one of the most frequent diseases in men and can have a significant impact on quality of life. Instrumental therapies are common, and many patients seek minimally invasive treatment options. OBJECTIVE Presentation and evidence-based evaluation of the minimally invasive therapy for benign prostatic syndrome. MATERIALS AND METHODS Summary and overview of chapters 11-13 on minimally invasive therapies for LUTS/BPO of the current long version of the German S2e guideline. RESULTS In case of absolute indication for surgery or after unsatisfactory or undesired medical therapy, minimally invasive treatments such as UroLift® (Neotract Inc., Pleasanton, CA, USA), Rezῡm™ (Boston Scientific, Malborough, MA, USA), iTIND™ (Olympus America Inc., Westborough, MA, USA), and prostatic artery embolization (PAE) can be considered. These indirect/delayed ablative therapies offer lower morbidity and the possibility of performing them under local anesthesia, but they are inferior to direct ablative/resective techniques in terms of effectiveness and sustainability. CONCLUSIONS The updated German S2e guideline summarizes evidence-based recommendations for new minimally invasive therapies for LUTS/BPO, which present alternative treatment options for selected patients.
Collapse
Affiliation(s)
- Johannes Salem
- CUROS urologisches Zentrum, Klinik LINKS VOM RHEIN, Schillingsrotterstr. 39-41, 50996, Köln, Deutschland.
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Brandenburg a.d. Havel, MHB Brandenburg Theodor Fontane, Brandenburg a.d. Havel, Deutschland.
| | - Klaus F Becher
- Klinik für Rehabilitation, Klinik Wartenberg Professor Dr. Selmair GmbH & Co. KG, Wartenberg, Deutschland
| | - Thomas Bschleipfer
- Klinik für Urologie und Kinderurologie, Regiomed Klinikum, Coburg, Deutschland
| | | | - Klaus Höfner
- Klinik für Urologie, Evangelisches Krankenhaus, Oberhausen, Deutschland
| | | | - Giuseppe Magistro
- Klinik für Urologie, Asklepios Westklinikum GmbH, Hamburg, Deutschland
| | - Rolf Muschter
- Urologische Abteilung, ALTA Klinik, Bielefeld, Deutschland
| | - Matthias Oelke
- Klinik für Urologie, St. Antonius-Hospital GmbH, Gronau, Deutschland
| | | | | | - Sandra Schönburg
- Universitätsklinik und Poliklinik für Urologie und Nierentransplantation, Martin-Luther-Universität, Halle-Wittenberg, Deutschland
| | - Dominik Abt
- Klinik für Urologie, Spitalzentrum, Biel, Schweiz
| |
Collapse
|
2
|
Magistro G, Abt SD, Becher KF, Bschleipfer T, Dreikorn K, Höfner K, Muschter R, Oelke M, Reich O, Salem J, Schönburg S, Madersbacher S, Rieken M. [Surgical treatment options of lower urinary tract symptoms due to benign prostatic obstruction : The German S2e guideline 2023-part 3]. Urologie 2023; 62:1177-1185. [PMID: 37823934 DOI: 10.1007/s00120-023-02200-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) are one of the most common diagnoses in clinical practice. Bothersome LUTS impact considerably quality of life of men and may cause severe complications without treatment. According to the diagnostic assessment every patient should be treated with an adequate therapy. Management comprises a conservative approach, medication, novel minimally invasive options, and surgical procedures with the aim to remove the obstructing adenoma. The German guideline panel has updated the German guidelines on diagnostic evaluation and management of LUTS due to BPO. OBJECTIVES Evidence-based recommendations of surgical treatment options of LUTS due to BPO are evaluated. MATERIALS AND METHODS Chapters 11.1.1 and 11.2 of the updated German S2e guideline on the management of LUTS due to BPO are summarized as a review article. RESULTS A treatment algorithm based on current evidence has been proposed. It is considered to provide guidance for the selection of the best procedure according to the needs of the patient. Anatomic features of the prostate, the patients' morbidity, and the preservation of ejaculatory function are taken into account for the choice of the best procedures. These surgical options can be divided into techniques with direct, delayed or no removal of the adenoma, procedures with suprapubic access, and embolizing approaches. CONCLUSIONS The updated German S2e guideline on the management of LUTS due to BPO provides evidence-based recommendations for the selection of the best procedure according to the needs of the individual patient.
Collapse
Affiliation(s)
- Giuseppe Magistro
- Klinik für Urologie, Asklepios Westklinikum GmbH, Suurheid 20, 22559, Hamburg, Deutschland.
| | - S Dominik Abt
- Klinik für Urologie, Spitalzentrum Biel, Biel, Schweiz
| | - Klaus F Becher
- Klinik für Rehabilitation, Klinik Wartenberg Professor Dr. Selmair GmbH & Co. KG, Wartenberg, Deutschland
| | - Thomas Bschleipfer
- Klinik für Urologie und Kinderurologie, Regiomed Klinikum, Coburg, Deutschland
| | | | - Klaus Höfner
- Klinik für Urologie, Evangelisches Krankenhaus, Oberhausen, Deutschland
| | - Rolf Muschter
- Urologische Abteilung, ALTA Klinik, Bielefeld, Deutschland
| | - Matthias Oelke
- Klinik für Urologie, Urologische Onkologie und Roboter-assistierte Chirurgie, St. Antonius-Hospital GmbH, Gronau, Deutschland
| | - Oliver Reich
- Urologische Privatpraxis Prof. Dr. Oliver Reich, München, Deutschland
| | - Johannes Salem
- CUROS urologisches Zentrum, Klinik LINKS VOM RHEIN, Köln, Deutschland
- Klinik für Urologie und Kinderurologie, Universitätsklinikum, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg a.d. Havel, Deutschland
| | - Sandra Schönburg
- Universitätsklinik und Poliklinik für Urologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | | | | |
Collapse
|
3
|
Bschleipfer T, Abt SD, Becher KF, Dreikorn K, Höfner K, Madersbacher S, Magistro G, Muschter R, Oelke M, Reich O, Rieken M, Salem J, Michel MC, Schönburg S. [Conservative and pharmacological treatment of benign prostatic hyperplasia : The German S2e-guideline 2023-part2]. Urologie 2023; 62:1048-1056. [PMID: 37796278 DOI: 10.1007/s00120-023-02183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH, in German guidelines: benign prostatic syndrome [BPS]) is considered the most common disease of the lower urinary tract in men and can have a tremendous impact on the quality-of-life of affected patients. Conservative and pharmacological therapy of this disease are of great importance, both in improving LUTS and reducing progression-related complications. OBJECTIVES Presentation of the conservative and pharmacological treatment options according to the current German S2e guideline on BPS. MATERIALS AND METHODS Summary and overview of chapters 9 and 10 of the current German S2e guideline on BPS. RESULTS In addition to a controlled watchful waiting for BPS patients without an absolute indication for prostate surgery, a variety of phytopharmacological formulations and synthetic drugs according to the symptomatology and clinical progress are available. Phytotherapy should, due to inconsistent study data, only be considered for mild to moderate symptoms. Synthetic drugs include alpha-blockers, 5α-reductase inhibitors, phosphodiesterase inhibitors, antimuscarinics and, more recently, the β3-agonist mirabegron in the current guideline. In addition, various combination therapies are listed and evaluated according to their indications, effects and side effects. CONCLUSIONS The current German S2e guideline on the diagnosis and treatment of BPS provides an evidence-based foundation for finding the best possible and most effective medication.
Collapse
Affiliation(s)
- Thomas Bschleipfer
- Klinik für Urologie und Kinderurologie, Regiomed Klinikum, Ketschendorfer Straße 33, 96450, Coburg, Deutschland.
| | - S Dominik Abt
- Klinik für Urologie, Spitalzentrum, Biel, Biel, Schweiz
| | - Klaus F Becher
- Klinik für Rehabilitation, Klinik Wartenberg Professor Dr. Selmair GmbH & Co. KG, Wartenberg, Deutschland
| | | | - Klaus Höfner
- Klinik für Urologie, Evangelisches Krankenhaus, Oberhausen, Deutschland
| | | | - Guiseppe Magistro
- Klinik für Urologie, Asklepios Westklinikum GmbH, Hamburg, Deutschland
| | - Rolf Muschter
- Urologische Abteilung, ALTA Klinik, Bielefeld, Deutschland
| | - Matthias Oelke
- Klinik für Urologie, Urologische Onkologie und Roboter-assistierte Chirurgie, St. Antonius-Hospital GmbH, Gronau, Deutschland
| | - Oliver Reich
- Urologische Privatpraxis Prof. Dr. Oliver Reich, München, Deutschland
| | | | - Johannes Salem
- CUROS urologisches Zentrum, Klinik LINKS VOM RHEIN, Köln, Deutschland
- Klinik für Urologie und Kinderurologie, Universitätsklinikum, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg a.d. Havel, Deutschland
| | - Martin C Michel
- Abteilung Pharmakologie, Johannes-Gutenberg-Universität, Mainz, Deutschland
| | - Sandra Schönburg
- Universitätsklinik und Poliklinik für Urologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| |
Collapse
|
4
|
Schlappa S, Bressel L, Reich O, Münzberg M. Advanced Particle Size Analysis in High-Solid-Content Polymer Dispersions Using Photon Density Wave Spectroscopy. Polymers (Basel) 2023; 15:3181. [PMID: 37571075 PMCID: PMC10421201 DOI: 10.3390/polym15153181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
High-solid-content polystyrene and polyvinyl acetate dispersions of polymer particles with a 50 nm to 500 nm mean particle diameter and 12-55% (w/w) solid content have been produced via emulsion polymerization and characterized regarding their optical and physical properties. Both systems have been analyzed with common particle-size-measuring techniques like dynamic light scattering (DLS) and static light scattering (SLS) and compared to inline particle size distribution (PSD) measurements via photon density wave (PDW) spectroscopy in undiluted samples. It is shown that particle size measurements of undiluted polystyrene dispersions are in good agreement between analysis methods. However, for polyvinyl acetate particles, size determination is challenging due to bound water in the produced polymer. For the first time, water-swelling factors were determined via an iterative approach of PDW spectroscopy error (Χ2) minimization. It is shown that water-swollen particles can be analyzed in high-solid-content solutions and their physical properties can be assumed to determine the refractive index, density, and volume fraction in dispersion. It was found that assumed water swelling improved the reduced scattering coefficient fit by PDW spectroscopy by up to ten times and particle size determination was refined and enabled. Particle size analysis of the water-swollen particles agreed well with offline-based state-of-the-art techniques.
Collapse
Affiliation(s)
- Stephanie Schlappa
- Department of Physical Chemistry, innoFSPEC, University of Potsdam, Am Mühlenberg 3, 14476 Potsdam, Germany (M.M.)
| | - Lena Bressel
- Department of Physical Chemistry, innoFSPEC, University of Potsdam, Am Mühlenberg 3, 14476 Potsdam, Germany (M.M.)
| | - Oliver Reich
- Knowledge and Technology Transfer, Faculty of Science, University of Potsdam, Am Mühlenberg 3, 14476 Potsdam, Germany;
| | - Marvin Münzberg
- Department of Physical Chemistry, innoFSPEC, University of Potsdam, Am Mühlenberg 3, 14476 Potsdam, Germany (M.M.)
- Knowledge and Technology Transfer, Faculty of Science, University of Potsdam, Am Mühlenberg 3, 14476 Potsdam, Germany;
| |
Collapse
|
5
|
Oelke M, Abt SD, Becher KF, Dreikorn K, Madersbacher S, Magistro G, Michel MC, Muschter R, Reich O, Rieken M, Salem J, Schönburg S, Höfner K, Bschleipfer T. [Diagnostic work-up of benign prostatic hyperplasia : The German S2e-guideline 2023 part 1]. Urologie 2023:10.1007/s00120-023-02142-0. [PMID: 37401972 DOI: 10.1007/s00120-023-02142-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH; in German guidelines: benign prostatic syndrome [BPS]) is the most frequent urological disease in men and can result in a considerable deterioration of quality-of-life. BPS can be associated with LUTS, benign prostatic enlargement (BPE), and bladder outlet obstruction (BOO) or benign prostatic obstruction (BPO), respectively. The expert group on BPS of the German Society of Urology has re-evaluated the tests for the assessment of BPH and provides evidence-based recommendations. OBJECTIVES Presentation and evidence-based rating of tests for the assessment of patients with BPS. MATERIALS AND METHODS Summary and overview of chapters 5, 6, and 8 of the latest long version of the German S2e guideline on BPS. RESULTS The diagnostic work-up should clarify (1) whether the complaints of the patient are caused by BPS, (2) how relevant the complaints are and whether treatment is necessary, (3) whether complications of the lower or upper urinary tract already exist, and (4) which treatment will be most suitable. Baseline assessment should be done in all BPS patients and include history, measurement of LUTS and quality-of-life, urinalysis, serum prostate-specific antigen, post-void residual, ultrasound of the lower urinary tract, including measurements of prostate volume, intravesical prostatic protrusion and detrusor wall thickness, and ultrasound of the upper urinary tract. Additional tests can follow when questions remain unanswered after baseline assessment. These optional tests include bladder diaries, uroflowmetry, serum creatinine, urethrocystoscopy, other noninvasive tests for the determination of BOO/BPO such as penile cuff test, condom catheter method and near-infrared spectroscopy, and other imagining tests such as X‑ray and MRI investigations. CONCLUSIONS The updated German S2e guideline summarizes evidence-based recommendations on the diagnostic work-up, including the assessment of the BPS components BPE, LUTS, and BOO/BPO.
Collapse
Affiliation(s)
- Matthias Oelke
- Klinik für Urologie, Urologische Onkologie und Roboter-assistierte Chirurgie, St. Antonius-Hospital GmbH, Möllenweg 22, 48599, Gronau, Deutschland.
| | - S Dominik Abt
- Klinik für Urologie, Spitalzentrum Biel, Biel, Schweiz
| | - Klaus F Becher
- Klinik für Rehabilitation, Klinik Wartenberg Professor Dr. Selmair GmbH & Co. KG, Wartenberg, Deutschland
| | | | | | - Giuseppe Magistro
- Klinik für Urologie, Asklepios Westklinikum GmbH, Hamburg, Deutschland
| | - Martin C Michel
- Abteilung Pharmakologie, Johannes Gutenberg Universität, Mainz, Deutschland
| | - Rolf Muschter
- Urologische Abteilung, ALTA Klinik, Bielefeld, Deutschland
| | - Oliver Reich
- Urologische Privatpraxis Prof. Dr. Oliver Reich, München, Deutschland
| | | | - Johannes Salem
- CUROS urologisches Zentrum, Klinik LINKS VOM RHEIN, Köln, Deutschland
- Klinik für Urologie und Kinderurologie, Universitätsklinikum, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg a.d. Havel, Deutschland
| | - Sandra Schönburg
- Universitätsklinik und Poliklinik für Urologie, Martin-Luther Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Klaus Höfner
- Klinik für Urologie, Evangelisches Krankenhaus, Oberhausen, Deutschland
| | - Thomas Bschleipfer
- Klinik für Urologie und Kinderurologie, Regiomed Klinikum, Coburg, Deutschland
| |
Collapse
|
6
|
Reich O, Gleichweit MJ, David G, Leemann N, Signorell R. Hygroscopic growth of single atmospheric sea salt aerosol particles from mass measurement in an optical trap. Environ Sci : Atmos 2023; 3:695-707. [PMID: 37063943 PMCID: PMC10100564 DOI: 10.1039/d2ea00129b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/15/2023] [Indexed: 02/17/2023]
Abstract
Sea salt aerosol is among the most abundant aerosol species in Earth’s atmosphere, and its hygroscopicity is an important parameter to quantify their interaction with solar radiation. Conflicting values for...
Collapse
Affiliation(s)
- Oliver Reich
- Department of Chemistry and Applied Biosciences, ETH Zurich Vladimir-Prelog-Weg 2, CH-8093 Zurich Switzerland
| | - Michael J Gleichweit
- Department of Chemistry and Applied Biosciences, ETH Zurich Vladimir-Prelog-Weg 2, CH-8093 Zurich Switzerland
| | - Grégory David
- Department of Chemistry and Applied Biosciences, ETH Zurich Vladimir-Prelog-Weg 2, CH-8093 Zurich Switzerland
| | - Nicole Leemann
- Department of Chemistry and Applied Biosciences, ETH Zurich Vladimir-Prelog-Weg 2, CH-8093 Zurich Switzerland
| | - Ruth Signorell
- Department of Chemistry and Applied Biosciences, ETH Zurich Vladimir-Prelog-Weg 2, CH-8093 Zurich Switzerland
| |
Collapse
|
7
|
Banning S, Höglinger M, Meyer D, Reich O. Evaluation of the Effect of a Multifunctional Telemedicine Device on Health Care Use and Costs: A Nonrandomized Pragmatic Trial. Telemed J E Health 2022; 29:510-517. [PMID: 36037076 DOI: 10.1089/tmj.2022.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Telemedicine health insurance models are highly prevalent in the Swiss health care system. Nevertheless, the potential of telemedicine is only partly being achieved, since current telemedicine health insurance models are limited to an initial contact by telephone and a gatekeeper role that organizes access to health care providers such as general practitioners, specialists, or hospitals. Against this background, a telemedicine device with diverse visual and auscultatory examination functions was made available to 2,000 telemedicine-insured clients. This device allowed diagnostic information to be sent to a medical care provider and used for telemedical consultation. Objective: To determine whether the additional implementation of a multifunctional telemedicine examination device resulted in fewer physical consultations, reduced service utilization, and lower health care expenditures among telemedicine-insured clients. Methods: Our analysis is based on claims data from 135,636 clients insured in a telemedicine call center model covering the years 2019 and 2020. We compare the use of health care and health care costs of clients who received a telemedicine device with those without such a device, using multivariable regression to adjust for group differences due to self-selection. Results: We found lower total health care expenditures of -229 (Swiss Francs) and lower inpatient costs of -160 (Swiss Francs) on the part of clients with the telemedicine device. However, the implementation of the telemedicine device did not lead to a statistically significant reduction in service utilization. Conclusions: The treatment of telemedicine-insured clients was on average more cost-effective when they received the multifunctional telemedicine device. Accordingly, complementing the existing telemedicine model with telemedicine devices that allow for improved telemedical consultations has the potential to increase the cost-saving potential of the existing telemedicine call center models.
Collapse
Affiliation(s)
- Stefan Banning
- Department of Health Sciences, University of Applied Sciences, Fulda, Germany
| | - Marc Höglinger
- Health Services Research, Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Delia Meyer
- Controlling and Swica Health Insurance, Winterthur, Switzerland
| | - Oliver Reich
- Santé24, Swica Health Insurance, Winterthur, Switzerland
| |
Collapse
|
8
|
Sandmann M, Münzberg M, Bressel L, Reich O, Hass R. Inline monitoring of high cell density cultivation of Scenedesmus rubescens in a mesh ultra-thin layer photobioreactor by photon density wave spectroscopy. BMC Res Notes 2022; 15:54. [PMID: 35168633 PMCID: PMC8845379 DOI: 10.1186/s13104-022-05943-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/01/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Due to multiple light scattering that occurs inside and between cells, quantitative optical spectroscopy in turbid biological suspensions is still a major challenge. This includes also optical inline determination of biomass in bioprocessing. Photon Density Wave (PDW) spectroscopy, a technique based on multiple light scattering, enables the independent and absolute determination of optical key parameters of concentrated cell suspensions, which allow to determine biomass during cultivation. Results A unique reactor type, called “mesh ultra-thin layer photobioreactor” was used to create a highly concentrated algal suspension. PDW spectroscopy measurements were carried out continuously in the reactor without any need of sampling or sample preparation, over 3 weeks, and with 10-min time resolution. Conventional dry matter content and coulter counter measurements have been employed as established offline reference analysis. The PBR allowed peak cell dry weight (CDW) of 33.4 g L−1. It is shown that the reduced scattering coefficient determined by PDW spectroscopy is strongly correlated with the biomass concentration in suspension and is thus suitable for process understanding. The reactor in combination with the fiber-optical measurement approach will lead to a better process management. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-05943-2.
Collapse
|
9
|
Essig S, Merlo C, Reich O, Trottmann M. Potentially inappropriate testing for vitamin D deficiency: a cross-sectional study in Switzerland. BMC Health Serv Res 2020; 20:1097. [PMID: 33246469 PMCID: PMC7694269 DOI: 10.1186/s12913-020-05956-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background There is consensus that vitamin D supplementation is often indicated but population-based screening by laboratory testing for vitamin D deficiency is inadequate. Testing should be restricted to people at high risk of severe deficiency. This study describes the current lab testing for vitamin D deficiency in the adult population of Switzerland. Methods We assessed Swiss health insurance data (SWICA) for incidence of lab testing for vitamin D levels, comparing the years 2015 and 2018. Claims were analyzed for associations between lab testing and age, sex, medical indications, insurance status and geographic location in multivariable regression analyses. We also estimated the costs of vitamin D testing. Results Data from 200,043 and 200,046 persons for 2015 and 2018, respectively, were analyzed. Vitamin D level was tested in 14% of the sample population in 2015 and 20% in 2018. Testing increased by 69% for individuals aged 26–30. Testing was associated with being middle-aged to young senior citizens, female, medical indications (pregnancy, renal disease, osteoporosis, hyperparathyroidism, HIV, glucocorticoid intake), more chronic conditions, having a mandatory insurance with a low deductible, additional insurance coverage, and living in urban areas. We estimate that the total laboratory cost to mandatory insurance was about 90 million Swiss francs in 2018. Conclusions Despite recommendations for routine vitamin D supplementation, vitamin D testing of low risk individuals is common and increasing in Switzerland.
Collapse
Affiliation(s)
- Stefan Essig
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Luzern, Switzerland.
| | - Christoph Merlo
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Luzern, Switzerland
| | - Oliver Reich
- santé24, Palmstrasse 26b, 8401, Winterthur, Switzerland
| | - Maria Trottmann
- SWICA Health Services Research, Römerstrasse 38, 8401, Winterthur, Switzerland
| |
Collapse
|
10
|
Redman CWE, Kesic V, Cruickshank ME, Gultekin M, Carcopino X, Castro Sanchez M, Grigore M, Jakobsson M, Kuppers V, Pedro A, Reich O, Leeson S, Tabuica U, Zodzika J, Ciavattini A, Jach R, Katsyuba M, Koiss R, Martin-Hirsch P, Tjalma WA, Nieminen P. European consensus statement on essential colposcopy. Eur J Obstet Gynecol Reprod Biol 2020; 256:57-62. [PMID: 33171418 DOI: 10.1016/j.ejogrb.2020.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/24/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
This European consensus statement on essential colposcopy provides standards for the general colposcopist seeing women referred for colposcopy with an abnormal cervical screening test (including cytology and HPV tests) or with a clinically suspicious cervix. The article gives guidance regarding the aims and conduct of colposcopy. Recommendations are provided on colposcopy technique, the management of common colposcopy issues, treatment and follow-up of after treatment of CIN or early stage cervical. Colposcopists should make an informed decision on the management of each individual that is referred and organize appropriate follow-up. Cervical cancer is still a major health issue and the quality of care can only improve if there is a structured guidance for women with an abnormal smear or suspicious cervix.
Collapse
Affiliation(s)
- C W E Redman
- Past-President European Federation of Colposcopy and University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - V Kesic
- Faculty of Medicine, University of Belgrade, Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia
| | - M E Cruickshank
- Aberdeen Centre for Women's Health Research, University of Aberdeen, UK.
| | - M Gultekin
- Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - X Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), University Avignon, CNRS, IRD, IMBE UMR 7263, Marseille, France
| | - M Castro Sanchez
- Department of Obstetrics and Gynaecology, University Hospital Puerto De Hierro Majadahonda, Madrid, Spain
| | - M Grigore
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Romania
| | - M Jakobsson
- HUS Hyvinkää Hospital, University of Helsinki, Finland
| | - V Kuppers
- Obstetrics and Gynecology Koenigsallee 64, Duesseldorf, Germany
| | - A Pedro
- Department of Obstetrics and Gynaecology, Cuf Sintra Hospital, Sintra, Portugal
| | - O Reich
- Department of Obstetrics and Gynecology, Medical University of Graz, Austria
| | - S Leeson
- Department of Obstetrics and Gynaecology, Ysbyty Gwynedd, Bangor, Wales, UK
| | - U Tabuica
- Department of Obstetrics and Gynecology, State University of Medicine and Pharmacy, Referral Center of Colposcopy, Chisinau, Moldavia
| | - J Zodzika
- Department of Obstetrics and Gynaecology, Riga Stradiņš University, Riga East Clinical University Hospital, Riga, Latvia
| | - A Ciavattini
- Department of Woman's Health Sciences, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - R Jach
- Clinic of Endocrynologic Gynecology, University Hospital UJ CM, Krakow, Poland
| | - M Katsyuba
- Department of Oncology, Kazan State Medical Academy, Kazan, Russian Federation
| | - R Koiss
- Department of Obstetrics and Gynecologic Oncology, St. Stephan Hospital, Budapest, Hungary
| | - P Martin-Hirsch
- Department of Obstetrics & Gynaecology, Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire & Royal Preston Hospital, Preston, United Kingdom
| | - W A Tjalma
- Department of Obstetrics and Gynecology, Breast Clinic - Unit Gynecologic Oncology, Antwerp University Hospital and University of Antwerp, Belgium
| | - P Nieminen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and Helsinki University, Finland
| | | |
Collapse
|
11
|
Becker C, Schwenkglenks M, Frueh M, Reich O, Meier CR. Use of selective serotonin reuptake inhibitors, other antidepressant medication, and risk of cataract: a case-control study based on Swiss claims data. Eur J Clin Pharmacol 2020; 76:1329-1335. [PMID: 32504184 DOI: 10.1007/s00228-020-02923-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/28/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Three previous studies reported controversial results regarding selective serotonin reuptake inhibitor (SSRI) exposure and cataract development. We therefore aimed to assess risk of cataract associated with previous exposure to SSRI using data from a large health insurance in Switzerland. METHODS In a case-control study, we analyzed individuals insured by the Helsana Group, a large Swiss health insurance provider. We matched patients aged 40 years or older with cataract extraction (i.e., a proxy for a cataract diagnosis) in 2014 or 2015 to four control patients, on age, sex, date of cataract extraction, and area of residence. Exposure of interest was the number of SSRI claims prior to cataract extraction. We conducted conditional logistic regression analyses to calculate odds ratios (OR) with 95% confidence intervals (CI). We adjusted our analyses for the presence of hypertension, diabetes, glaucoma, systemic steroid use, and use of other antidepressant drugs. RESULTS We identified 13,773 cataract cases and 51,625 matched controls. Compared with non-use, long-term use of SSRI (≥ 20 claims) was not associated with an altered risk of cataract (adjusted OR 0.93, 95% CI 0.84-1.04). The analysis of the individual drug substances also yielded no statistically significant association between drug exposure and the risk of cataract. CONCLUSIONS According to our study, use of SSRI does not change the risk of cataract in the overall population.
Collapse
Affiliation(s)
- Claudia Becker
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, CH-4031, Basel, Switzerland
| | | | - Mathias Frueh
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| | - Oliver Reich
- Sante24, SWICA Health Organization, Winterthur, Switzerland
| | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland. .,Hospital Pharmacy, University Hospital Basel, Spitalstrasse 26, CH-4031, Basel, Switzerland. .,Boston Collaborative Drug Surveillance Program, Lexington, MA, USA.
| |
Collapse
|
12
|
Bressel K, Müller W, Leser ME, Reich O, Hass R, Wooster TJ. Depletion-Induced Flocculation of Concentrated Emulsions Probed by Photon Density Wave Spectroscopy. Langmuir 2020; 36:3504-3513. [PMID: 32162925 DOI: 10.1021/acs.langmuir.9b03642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Stable, creaming-free oil in water emulsions with high volume fractions of oil (ϕ = 0.05-0.40, density matched to water) and polysorbate 80 as an emulsifier were characterized without dilution by Photon Density Wave spectroscopy measuring light absorption and scattering behavior, the latter serving as the basis for droplet size distribution analysis. The emulsion with ϕ = 0.10 was used to investigate flocculation processes induced by xanthan as a semi-flexible linear nonabsorbing polymer. Different time regimes in the development of the reduced scattering coefficient μs' could be identified. First, a rapid, temperature-dependent change in μs' during the depletion process was observed. Second, the further decrease of μs' follows a power law in analogy to a spinodal demixing behavior, as described by the Cahn-Hilliard theory.
Collapse
Affiliation(s)
- Katharina Bressel
- Physical Chemistry-InnoFSPEC, University of Potsdam, Am Mühlenberg 3, 14476 Potsdam, Germany
| | - Wenke Müller
- Physical Chemistry-InnoFSPEC, University of Potsdam, Am Mühlenberg 3, 14476 Potsdam, Germany
| | - Martin E Leser
- Institute of Material Science, Nestlé Research Center, Vers-chez-les-Blanc, 1000 Lausanne, Switzerland
| | - Oliver Reich
- Physical Chemistry-InnoFSPEC, University of Potsdam, Am Mühlenberg 3, 14476 Potsdam, Germany
| | - Roland Hass
- Physical Chemistry-InnoFSPEC, University of Potsdam, Am Mühlenberg 3, 14476 Potsdam, Germany
| | - Tim J Wooster
- Institute of Material Science, Nestlé Research Center, Vers-chez-les-Blanc, 1000 Lausanne, Switzerland
| |
Collapse
|
13
|
Leon-Reyes S, Schäfer J, Früh M, Schwenkglenks M, Reich O, Schmidlin K, Staehelin C, Battegay M, Cavassini M, Hasse B, Bernasconi E, Calmy A, Hoffmann M, Schoeni-Affolter F, Zhao H, Bucher HC. Cost Estimates for Human Immunodeficiency Virus (HIV) Care and Patient Characteristics for Health Resource Use From Linkage of Claims Data With the Swiss HIV Cohort Study. Clin Infect Dis 2020; 68:827-833. [PMID: 30020416 DOI: 10.1093/cid/ciy564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/09/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Comprehensive and representative data on resource use are critical for health policy decision making but often lacking for human immunodeficiency virus (HIV) infection. Privacy-preserving probabilistic record linkage of claim and cohort study data may overcome these limitations. METHODS Encrypted dates of birth, sex, study center, and antiretroviral therapy (ART) from the Swiss HIV Cohort Study (SHCS) records for 2012 and 2013 were linked by privacy-preserving probabilistic record linkage with claim data from the largest health insurer covering 15% of the Swiss residential population. We modeled predictors for mean annual costs adjusting for censoring and grouped patients by cluster analysis into 3 risk groups for resource use. RESULTS The matched subsample of 1196 patients from 9326 SHCS and 2355 claim records was representative for all SHCS patients receiving ART. The corrected mean (standard error) total costs in 2012 and 2013 were $30462 ($582) and $30965 ($629) and mainly accrued in ambulatory care for ART (70% of mean costs). The low-risk group for resource use had mean (standard error) annual costs of $26772 ($536) and $26132 ($589) in 2012 and 2013. In the moderate- and high-risk groups, annual costs for 2012 and 2013 were higher by $3526 (95% confidence interval, $1907-$5144) (13%) and $4327 ($2662-$5992) (17%) and $14026 ($8763-$19289) (52%) and $13567 ($8844-$18288) (52%), respectively. CONCLUSIONS In a representative subsample of patients from linkage of SHCS and claim data, ART was the major cost factor, but patient profiling enabled identification of factors related to higher resource use.
Collapse
Affiliation(s)
- Selene Leon-Reyes
- Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel and University of Basel
| | - Juliane Schäfer
- Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel and University of Basel
| | - Mathias Früh
- Department of Health Sciences, Helsana-Group Zurich, Switzerland
| | | | - Oliver Reich
- Department of Health Sciences, Helsana-Group Zurich, Switzerland
| | - Kurt Schmidlin
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Cornelia Staehelin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology University Hospital Basel and University of Basel, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, University Hospital Lausanne (CHUV), Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Hygiene, University Hospital and University of Zurich, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, Switzerland
| | - Matthias Hoffmann
- Division of Infectious Diseases, Kantonsspital St. Gallen, Switzerland
| | | | - Hongwei Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology & Biostatistics, University Hospital Basel and University of Basel.,Division of Infectious Diseases and Hospital Epidemiology University Hospital Basel and University of Basel, Switzerland
| |
Collapse
|
14
|
Tratz F, Reich O, Cohen CD. [What To Do In Case Of Hematuria? - Step By Step]. Dtsch Med Wochenschr 2020; 145:56-61. [PMID: 31914470 DOI: 10.1055/a-0670-6007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Hematuria is a common clinical finding and has a wide spectrum of possible causes. Erythrocytes can originate from any part of the genitourinary tract. An urine dipstick test is the first step in diagnostic approach. Medical history may help to narrow down the range of causes: arterial hypertension or a family history of renal disease may indicate a renal disease. Risk factors for an urinary tract malignoma point to an urological origin. If the microscopy shows more than 5 % acanthocytes in the urine sediment, a glomerular cause can be assumed. Normal erythrocytes suggest a non-glomerular cause. A nephrologist should be consulted if urine sediment microscopy and other clinical features (e. g. clinically relevant proteinuria, elevated serum creatinine) indicate a renal disease. In this case, a renal biopsy should be considered to confirm the diagnosis of glomerulopathy and to develop a treatment plan. If an urological pathology is suspected, sonography should be complemented by a multi-phasic computed tomography. Based on the imaging results, a retrograde ureteroscopy should be considered. Repeated urinalysis on an annual basis for two consecutive years is recommended, if no diagnosis can be established.
Collapse
|
15
|
Reisinger J, Regauer S, Reich O. Ein HPV-negatives Cervixkarzinom. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1693905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- J Reisinger
- Univ. Frauenklinik Graz, Medizinische Universität Graz
| | - S Regauer
- Diagnostik & Forschungsinstitut für Pathologie, Medizinische Universität Graz
| | - O Reich
- Univ. Frauenklinik Graz, Medizinische Universität Graz
| |
Collapse
|
16
|
Haller E, Watzke B, Blozik E, Rosemann T, Reich O, Huber CA, Wolf M. Antidepressant prescription practice and related factors in Switzerland: a cross-sectional analysis of health claims data. BMC Psychiatry 2019; 19:196. [PMID: 31234895 PMCID: PMC6591836 DOI: 10.1186/s12888-019-2178-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 06/11/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The aim of the study was to examine the prevalence of and factors associated with antidepressant (AD) prescriptions in order to draw a comprehensive picture of prescribing practices in Switzerland. METHOD We conducted a population-based, cross-sectional descriptive study using a large Swiss healthcare claims database, covering approximately 13% of the Swiss population. AD prescription was determined by identifying patients (N = 105,663) with health claims data of at least 1 AD prescription in the year 2016. AD medication was identified using ATC-codes classified by the World Health Organisation. Univariate, bivariate and multivariate analyses using logistic regression were performed. RESULTS The extrapolated 1-year prevalence of AD prescription was 8.7% (95% CI, 8.7-8.8) with two thirds of AD recipients being female and the average age being 59 years (SD = 19.1). The regional distribution of prescription rates varied between cantons and ranged from 6.5 to 11.7%. Logistic regression revealed higher prescription rates among females compared to males (OR: 1.52) and an increased probability of AD prescription by age up until 54 years (OR: 2.25) and ≥ 85 years (OR: 2.32). Comorbidity is associated with higher odds (OR: 3.26 with 1-2 comorbidities) and enrollment in a managed care plan (compared to standard care) with lower odds for an AD prescription (OR: 0.85). CONCLUSION This study is the first in Switzerland to describe the prevalence of and factors associated with AD prescription based on a large health claims database reflecting routine care. The results provide important information about regional variation, prescription source, and potential over-prescription in the treatment of depressive disorders.
Collapse
Affiliation(s)
- Elisa Haller
- Department of Psychology, University of Zurich, Binzmühlestrasse 14/16, Zurich, Switzerland
| | - Birgit Watzke
- Department of Psychology, University of Zurich, Binzmühlestrasse 14/16, Zurich, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana, Zurich, Switzerland
| | - Thomas Rosemann
- Department of Primary Care, University of Zurich, Zurich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana, Zurich, Switzerland
| | | | - Markus Wolf
- Department of Psychology, University of Zurich, Binzmühlestrasse 14/16, Zurich, Switzerland
| |
Collapse
|
17
|
Reich O, Greimel E, Dorfer M, Trutnovsky G. Beeinflussen verschiedene Behandlungsstrategien die psychische Belastung von Frauen? – Eine prospektive Follow-up-Studie bei Frauen mit prämalignen HPV-assoziierten Genitalveränderungen. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1678374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- O Reich
- Gynäkologie, Universitäts-Frauenklinik Graz, Österreich
| | - E Greimel
- Gynäkologie, Universitäts-Frauenklinik Graz, Österreich
| | - M Dorfer
- Gynäkologie, Universitäts-Frauenklinik Graz, Österreich
| | - G Trutnovsky
- Gynäkologie, Universitäts-Frauenklinik Graz, Österreich
| |
Collapse
|
18
|
Huber CA, Meyer MR, Steffel J, Blozik E, Reich O, Rosemann T. Post-myocardial Infarction (MI) Care: Medication Adherence for Secondary Prevention After MI in a Large Real-world Population. Clin Ther 2019; 41:107-117. [DOI: 10.1016/j.clinthera.2018.11.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/02/2018] [Accepted: 11/21/2018] [Indexed: 01/07/2023]
|
19
|
Chmiel C, Reich O, Signorell A, Neuner-Jehle S, Rosemann T, Senn O. Effects of managed care on the proportion of inappropriate elective diagnostic coronary angiographies in non-emergency patients in Switzerland: a retrospective cross-sectional analysis. BMJ Open 2018; 8:e020388. [PMID: 30478102 PMCID: PMC6254409 DOI: 10.1136/bmjopen-2017-020388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Guidelines recommend non-invasive ischaemia testing (NIIT) for the majority of patients with suspected ischaemic heart disease in a non-emergency setting. A substantial number of these patients undergo diagnostic coronary angiography (CA) without therapeutic intervention inappropriately due to lacking preceding NIIT. The aim of this study was to evaluate the effect of voluntary healthcare models with limited access on the proportion of patients without NIIT prior to elective purely diagnostic CA. DESIGN Retrospective cross-sectional analysis of insurance claims data from 2012 to 2015. Data included claims of basic and voluntary healthcare models from approximately 1.2 million patients enrolled with the Helsana Insurance Group. Voluntary healthcare models with limited health access are divided into gate keeping (GK) and managed care (MC) capitation models. INCLUSION CRITERIA patients undergoing CA. EXCLUSION CRITERIA Patients<18 years, incomplete health insurance data coverage, acute cardiac ischaemia and emergency procedures, therapeutic CA (coronary angioplasty/stenting or coronary artery bypass grafting). The effect of voluntary healthcare models on the proportion of NIIT undertaken within 2 months before diagnostic CA was assessed by means of multiple logistic regression analysis, controlled for influencing factors. RESULTS 9173 patients matched inclusion criteria. 33.2% (3044) did not receive NIIT before CA. Compared with basic healthcare models, MC was independently associated with a higher proportion of NIIT (p<0.001, OR 1.17, CI 1.045 to 1.312), when additionally controlled for demographics, insurance coverage, inpatient treatment, cardiovascular medication, chronic comorbidities, high-risk status (patients with therapeutic cardiac intervention 1 month after or 18 months prior to diagnostic CA). GK models showed no significant association with the rate of NIIT (p=0.07, OR 1.11, CI 0.991 to 1.253). CONCLUSIONS In a non-GK healthcare system, voluntary MC healthcare models with capitation were associated with a reduced inappropriate use of diagnostic CA compared with GK or basic models.
Collapse
Affiliation(s)
- Corinne Chmiel
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Andri Signorell
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| |
Collapse
|
20
|
Regauer S, Kashofer K, Reich O. Verlaufsanalyse von TP53 Genmutationen in primären und rezidivierten Vulvakarzinomen. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- S Regauer
- Medizinische Universität Graz, Pathologie, Graz, Österreich
| | - K Kashofer
- Medizinische Universität Graz, Pathologie, Graz, Österreich
| | - O Reich
- Medizinische Universität Graz, Frauenklinik, Graz, Österreich
| |
Collapse
|
21
|
Reich O, Regauer S. Are thin HSILs of the cervix at risk to invasion? Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- O Reich
- Univ. Frauenklinik, Gynäkologie, Graz, Österreich
| | - S Regauer
- Institut für Pathologie, Graz, Österreich
| |
Collapse
|
22
|
Blozik E, Reich O, Rapold R, Scherer M. Evidence-based indicators for the measurement of quality of primary care using health insurance claims data in Switzerland: results of a pragmatic consensus process. BMC Health Serv Res 2018; 18:743. [PMID: 30261865 PMCID: PMC6161393 DOI: 10.1186/s12913-018-3477-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/16/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The level of quality of care of ambulatory services in Switzerland is almost completely unknown. By adapting existing instruments to the Swiss national context, the present project aimed to define quality indicators (QI) for the measurement of quality of primary care for use on health insurance claims data. These data are pre-existing and available nationwide which provides an excellent opportunity for their use in the context of health care quality assurance. METHODS Pragmatic 6-step process based on informal consensus. Potential QI consisted of recommendations extracted from internationally accepted medical practice guidelines and pre-existing QI for primary care. An independent interdisciplinary group of experts rated potential QI based on explicit criteria related to evidence, relevance for Swiss public health, and controllability in the Swiss primary care context. Feasibility of a preliminary set of QI was tested using claims data of persons with basic mandatory health insurance with insurance at one of the largest Swiss health insurers. This test built the basis for expert consensus on the final set of QI. RESULTS Of 49 potential indicators, 23 were selected for feasibility testing based on claims data. The expert group consented a final set of 24 QI covering the domains general aspects/ efficiency (7 QI), drug safety (2), geriatric care (4), respiratory disease (2), diabetes (5) and cardiovascular disease (4). CONCLUSIONS The present project provides the first nationwide applicable explicit evidence-based criteria to measure quality of care of ambulatory primary care in Switzerland. The set intends to increase transparency related to quality and variance of care in Switzerland.
Collapse
Affiliation(s)
- Eva Blozik
- Department of Health Sciences, Helsana Group, P.O. Box, Zürich, Switzerland. .,Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Division of General Practice, University Medical Centre Freiburg, Freiburg, Germany.
| | - Oliver Reich
- Department of Health Sciences, Helsana Group, P.O. Box, Zürich, Switzerland
| | - Roland Rapold
- Department of Health Sciences, Helsana Group, P.O. Box, Zürich, Switzerland
| | - Martin Scherer
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | |
Collapse
|
23
|
Zechmann S, Scherz N, Reich O, Brüngger B, Senn O, Rosemann T, Neuner-Jehle S. Appropriateness of bone density measurement in Switzerland: a cross-sectional study. BMC Public Health 2018; 18:423. [PMID: 29606111 PMCID: PMC5879564 DOI: 10.1186/s12889-018-5305-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/13/2018] [Indexed: 11/27/2022] Open
Abstract
Background According to the WHO, osteoporosis is one of the most important non- communicable diseases worldwide. Different screening procedures are controversially discussed, especially concerning the concomitant issues of overdiagnosis and harm caused by inappropriate Dual X-ray Absorptiometry (DXA). The aim of this study was to evaluate the frequency and appropriateness of DXA as screening measure in Switzerland considering individual risk factors and to evaluate covariates independently associated with potentially inappropriate DXA screening. Methods Retrospective cross-sectional study using insurance claim data of 2013. Among all patients with DXA screening, women < 65 and men < 70 years without osteoporosis or risk factors for osteoporosis were defined as receiving potentially inappropriate DXA. Statistics included descriptive measures and multivariable regressions to estimate associations of relevant covariates with potentially inappropriate DXA screening. Results Of 1,131,092 patients, 552,973 were eligible. Among those 2637 of 10,000 (26.4%) underwent potentially inappropriate DXA screening. Female sex (Odds ratio 6.47, CI 6.41–6.54) and higher age showed the strongest association with any DXA screening. Female gender (Odds ratio 1.84, CI 1.49–2.26) and an income among the highest 5% (Odds ratio 1.40, CI 1.01–1.98) were significantly positively associated with potentially inappropriate DXA screening, number of chronic conditions (Odds ratio 0.67, CI 0.65–0.70) and living in the central region of Switzerland (Odds ratio 0.67, CI 0.48–0.95) negatively. Conclusion One out of four DXAs for screening purpose is potentially inappropriate. Stakeholders of osteoporosis screening campaigns should focus on providing more detailed information on appropriateness of DXA screening indications (e.g. age thresholds) in order to avoid DXA overuse. Electronic supplementary material The online version of this article (10.1186/s12889-018-5305-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Stefan Zechmann
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
| | - Nathalie Scherz
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Beat Brüngger
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Stefan Neuner-Jehle
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| |
Collapse
|
24
|
Abstract
Purpose Current evidence on the care-delivering process and the intensity of treatment at the end-of-life of cancer patients is limited and remains unclear. Our objective was to examine the care-delivering processes in health care during the last months of life with real-life data of Swiss cancer patients. Patients and methods The study population consisted of adult decedents in 2014 who were insured at Helsana Group. Data on the final cause of death were provided additionally by the Swiss Federal Statistical Office. Of the 10,275 decedents, 2,710 (26.4%) died of cancer. Intensity of treatment and health care utilization (including transitions) at their end-of-life were examined. Intensity measures included the following: last dose of chemotherapy within 14 days of death, a new chemotherapy regimen starting <30 days before death, more than one hospital admission or spending >14 days in hospital in the last month, death in an acute care hospital, more than one emergency visit and ≥1 intensive care unit admission in the last month of life. Results In the last 6 months of life, 89.5% of cancer patients had ≥1 transition, with 87.2% being hospitalized. Within 30 days before death, 64.2% of the decedents had ≥1 intensive treatment, whereby 8.9% started a new chemotherapy. In the multinomial logistic regression model, older age, higher density of nursing home beds and home care nurses were associated with a decrease, while living in the Italian- or French-speaking part of Switzerland was associated with an increase in intensive care. Conclusion Swiss cancer patients insured by Helsana Group experience a considerable number of transitions and intensive treatments at the end-of-life, whereby treatment intensity declines with increasing age. Among others, increased home care nursing might be helpful to reduce unwarranted treatments and transitions, therefore leading to better care at the end-of-life.
Collapse
Affiliation(s)
- Caroline Bähler
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Andri Signorell
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland.,Department of Medicine, University Medical Centre Freiburg, Freiburg im Breisgau, Germany
| | - Oliver Reich
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| |
Collapse
|
25
|
Panczak R, von Wyl V, Reich O, Luta X, Maessen M, Stuck AE, Berlin C, Schmidlin K, Goodman DC, Egger M, Clough-Gorr K, Zwahlen M. Death at no cost? Persons with no health insurance claims in the last year of life in Switzerland. BMC Health Serv Res 2018. [PMID: 29540161 PMCID: PMC5853076 DOI: 10.1186/s12913-018-2984-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Lack of health insurance claims (HIC) in the last year of life might indicate suboptimal end-of-life care, but reasons for no HIC are not fully understood because information on causes of death is often missing. We investigated association of no HIC with characteristics of individuals and their place of residence. Methods We analysed HIC of persons who died between 2008 and 2010, which were obtained from six providers of mandatory Swiss health insurance. We probabilistically linked these persons to death certificates to get cause of death information and analysed data using sex-stratified, multivariable logistic regression. Supplementary analyses looked at selected subgroups of persons according to the primary cause of death. Results The study population included 113,277 persons (46% males). Among these persons, 1199 (proportion 0.022, 95% CI: 0.021–0.024) males and 803 (0.013, 95% CI: 0.012–0.014) females had no HIC during the last year of life. We found sociodemographic and health differentials in the lack of HIC at the last year of life among these 2002 persons. The likelihood of having no HIC decreased steeply with older age. Those who died of cancer were more likely to have HIC (adjusted odds ratio for males 0.17, 95% CI: 0.13–0.22; females 0.19, 95% CI: 0.12–0.28) whereas those dying of mental and behavioural disorders (AOR males 1.83, 95% CI:1.42–2.37; females 1.65, 95% CI: 1.27–2.14), and males dying of suicide (AOR 2.15, 95% CI: 1.72–2.69) and accidents (AOR 2.41, 95% CI: 1.96–2.97) were more likely to have none. Single, widowed, and divorced persons also were more likely to have no HIC (AORs in range of 1.29–1.80). There was little or no association between the lack of HIC and characteristics of region of residence. Patterns of no HIC differed across main causes of death. Associations with age and civil status differed in particular for persons who died of cancer, suicide, accidents and assaults, and mental and behavioural disorders. Conclusions Particular groups might be more likely to not seek care or not report health insurance costs to insurers. Researchers should be aware of this aspect of health insurance data and account for persons who lack HIC. Electronic supplementary material The online version of this article (10.1186/s12913-018-2984-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Radoslaw Panczak
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.
| | - Viktor von Wyl
- Epidemiology, Biostatistics & Prevention Institute, University of Zürich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Insurance Group, Palmstrasse 26b, 8401, Winterthur, Switzerland.,SWICA Gesunheitsorganisation, sante24, Winterthur, Switzerland
| | - Xhyljeta Luta
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Maud Maessen
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.,University Center for Palliative Care, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 28, 3010, Bern, Switzerland
| | - Andreas E Stuck
- Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Claudia Berlin
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Kurt Schmidlin
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - David C Goodman
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.,The Dartmouth Institute of Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Kerri Clough-Gorr
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.,Section of Geriatrics, Boston University Medical Center, Boston, MA, USA
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| |
Collapse
|
26
|
Schmid MK, Reich O, Blozik E, Faes L, Bodmer NS, Locher S, Thiel MA, Rapold R, Kuhn M, Bachmann LM. Outcomes and costs of Ranibizumab and Aflibercept treatment in a health-service research context. BMC Ophthalmol 2018; 18:64. [PMID: 29486762 PMCID: PMC5830340 DOI: 10.1186/s12886-018-0731-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/23/2018] [Indexed: 11/18/2022] Open
Abstract
Background To compare anti-VEGF treatments for macular disease in terms of costs and clinical outcomes. Methods We identified patients suffering from macular disease and treated either with aflibercept, ranibizumab or both at the largest public eye clinic in Switzerland between January 1st and December 31st 2016 who were insured in one of the two participating health insurance companies. Clinical data were extracted from the electronic health record system. The health insurers provided the health claim costs for the ophthalmologic care and the total health care costs of each patient in the observation period. Using multivariate regression models, we assessed the monthly ophthalmologic and the monthly total costs of patients with no history of switching (ranibizumab vs. aflibercept), patients with a history of switching from ranibizumab to aflibercept, patients switching during the observation period and a miscellaneous group. We examined baseline differences in age, proportion of males, visual acuity (letters), central retinal thickness (CRT) and treatment history before entering the study. We investigated treatment intensity and compared the changes in letters and CRT. Results The analysis involved 488 eyes (361 patients), 182 on ranibizumab treatment, and 63 on aflibercept treatment, 160 eyes with a history of switching from ranibizumab to aflibercept, and 45 switchers during follow-up and 38 eyes of the miscellaneous group. Compared to ranibizumab, monthly costs of ophthalmologic treatment were slightly higher for aflibercept treatment + 175.0 CHF (95%CI: 1.5 CHF to 348.3 CHF; p = 0.048) as were the total monthly costs + 581.0 CHF (95%CI: 159.5 CHF to 1002.4 CHF; p = 0.007). Compared to ranibizumab, the monthly treatment intensity with aflibercept was similar (+ 0.057 injections/month (95%CI -0.023 to 0.137; p = 0.162), corresponding to a projected annual number of 5.4 injections for ranibizumab vs. 6.1 injections for aflibercept. During follow-up, visus dropped by 0.7 letters with ranibizumab and increased by 0.6 letters with aflibercept (p = 0.243). CRT dropped by − 14.9 μm with ranibizumab and by − 19.5 μm with aflibercept (p = 0.708). The monthly costs of all other groups examined were higher. Conclusion These real-life data show that aflibercept treatment is equally expensive, and clinical outcomes between the two drugs are similar.
Collapse
Affiliation(s)
- Martin K Schmid
- University of Zurich, Zurich, Switzerland.,Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Livia Faes
- Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Nicolas S Bodmer
- Medignition Inc. Research Consultants, Verena Conzett-Strasse 9, P.O. 9628, 8036, Zurich, CH, Switzerland
| | - Silvan Locher
- Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Michael A Thiel
- University of Zurich, Zurich, Switzerland.,Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Roland Rapold
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | | | - Lucas M Bachmann
- University of Zurich, Zurich, Switzerland. .,Medignition Inc. Research Consultants, Verena Conzett-Strasse 9, P.O. 9628, 8036, Zurich, CH, Switzerland.
| |
Collapse
|
27
|
Reich O, Berg F, Dorfer M, Greimer E. Zur Psychodynamik von Frauen mit genitaler Dysplasie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1622760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- O Reich
- Abteilung Gynäkologie, Universitäts-Frauenklinik Graz, Österreich
| | - F Berg
- Abteilung Gynäkologie, Universitäts-Frauenklinik Graz, Österreich
| | - M Dorfer
- Abteilung Gynäkologie, Universitäts-Frauenklinik Graz, Österreich
| | - E Greimer
- Abteilung Gynäkologie, Universitäts-Frauenklinik Graz, Österreich
| |
Collapse
|
28
|
Reich O, Schmid MK, Rapold R, Bachmann LM, Blozik E. Injections frequency and health care costs in patients treated with aflibercept compared to ranibizumab: new real-life evidence from Switzerland. BMC Ophthalmol 2017; 17:234. [PMID: 29202760 PMCID: PMC5715627 DOI: 10.1186/s12886-017-0617-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 11/19/2017] [Indexed: 01/07/2023] Open
Abstract
Background Previous analyses of real-life data indicated that injection frequency and health care costs did not differ for anti-VEGF treatment with aflibercept and ranibizumab. The objective of this study was to investigate whether this finding persisted when analysing a longer time period after licensing. Methods Retrospective analysis of health insurance claims data of two large Swiss basic health insurance plans including 28% of the Swiss population. Patients qualified for inclusion if aflibercept or ranibizumab treatment had been initiated between June 1, 2013 and November 1, 2014. Within this set, patients with at least 12 months of continuous insurance enrolment in the previous year, 12-month follow-up, and without change of anti-VEGF drug were considered. We examined the distribution of demographic data and patient characteristics between those receiving ranibizumab and those receiving aflibercept. Numbers of injections and associated health care expenditures observed during the 12-month follow-up period after incident treatment were the two outcomes considered. In multivariate regression analyses, controlling for possible confounding factors, we compared differences in these two outcomes between patients treated with aflibercept as compared to ranibizumab. Results A total of 3′058 patients were analysed, 790 (26%) receiving aflibercept and 2`268 receiving ranibizumab (74%). The use of aflibercept (average number of injections 6.2) as compared to ranibizumab (average number of injections 5.7) in the follow-up period of 1 to 12 months, was associated with a 12% increase in the injection frequency (95% confidence interval (CI) 6–17%; p < 0.001). Conclusions Real-life data contradicts the assumption that aflibercept is used less frequently as compared to ranibizumab. This results in similar total health care expenditures for both anti-VEGF agents.
Collapse
Affiliation(s)
- Oliver Reich
- Department of Health Sciences, Helsana Group, P.O. Box, Zürich, Switzerland
| | - Martin K Schmid
- Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Roland Rapold
- Department of Health Sciences, Helsana Group, P.O. Box, Zürich, Switzerland
| | | | - Eva Blozik
- Department of Health Sciences, Helsana Group, P.O. Box, Zürich, Switzerland. .,Institute of General Practice, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. .,Division of General Practice, University Medical Centre Freiburg, Freiburg, Germany.
| |
Collapse
|
29
|
Bähler C, Vavricka SR, Schoepfer AM, Brüngger B, Reich O. Trends in prevalence, mortality, health care utilization and health care costs of Swiss IBD patients: a claims data based study of the years 2010, 2012 and 2014. BMC Gastroenterol 2017; 17:138. [PMID: 29197335 PMCID: PMC5712179 DOI: 10.1186/s12876-017-0681-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/16/2017] [Indexed: 12/13/2022] Open
Abstract
Background Real-life data on inflammatory bowel disease (IBD) prevalence and costs are scarce. The aims of this study were to provide an overview of the prevalence, mortality, health care utilization and costs of IBD patients in Switzerland in the years 2010, 2012, and 2014. Methods Based on claims data of the Helsana-Group, prevalence of IBD was assessed for 2010, 2012 and 2014. Mortality rates, costs (inpatient, outpatient, medication costs) and utilization (visits, hospitalizations) were compared between patients with and without IBD, and between IBD patients treated with and without biologics. Results were extrapolated to the Swiss general population using national census data. Multivariate linear regression was used to identify socio-demographic and regional factors influencing total costs. Results The overall extrapolated prevalence rates of IBD were 0.32% in 2010, 0.38% in 2012, and 0.41% in 2014. Mortality rate didn’t differ between the IBD and non-IBD population. Costs increased annually by 6% in IBD versus 2.4% in non-IBD subjects, which was solely due to increased outpatient costs. Almost one-fourth of IBD patients were hospitalized at least once a year. Costs were higher in IBD patients treated with biologics (OR = 3.98, CI: 3.72-4.27, p < 0.001) when compared to IBD patients without biologic therapies. Over 70% of the total costs in IBD patients treated with biologics were due to drug costs, compared with 28% in patients without use of biologic therapies, whereas inpatient costs didn’t differ. Conclusions The prevalence of IBD seems to be increasing in Switzerland. Outpatient costs increased substantially, while no decrease in inpatient costs was found. Treatment of IBD is more and more based on biologic therapies. Electronic supplementary material The online version of this article (10.1186/s12876-017-0681-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Caroline Bähler
- Department of Health Sciences, Helsana Group, P.O. Box 8081, Zürich, Switzerland.
| | - Stephan R Vavricka
- Department Gastroenterology and Hepatology, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zürich, Switzerland
| | - Alain M Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois/CHUV, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| | - Beat Brüngger
- Department of Health Sciences, Helsana Group, P.O. Box 8081, Zürich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Group, P.O. Box 8081, Zürich, Switzerland
| |
Collapse
|
30
|
Abstract
Background and purpose - Current evidence suggests that arthroscopic knee surgery has no added benefit compared with non-surgical management in degenerative meniscal disease. Yet in many countries, arthroscopic partial meniscectomy (APM) remains among the most frequently performed surgeries. This study quantifies and characterizes the dynamics of the current use of knee arthroscopies in Switzerland in a distinctively non-traumatic patient group. Methods - We assessed a non-accident insurance plan of a major Swiss health insurance company for surgery rates of APM, arthroscopic debridement and lavage in patients over the age of 40, comparing the years 2012 and 2015. Claims were analyzed for prevalence of osteoarthritis, related interventions and the association of surgery with insurance status. Results - 648,708 and 647,808 people were examined in 2012 and 2015, respectively. The incidence of APM, debridement, and lavage was 388 per 105 person-years in 2012 and 352 per 105 person-years in 2015 in non-traumatic patients over the age of 40, consisting mostly of APM (96%). Between years, APM surgery rates changed in patients over the age of 65 (p < 0.001) but was similar in patients aged 40-64. Overall prevalence of osteoarthritis was 25%. Insurance status was independently associated with arthroscopic knee surgery. Interpretation - APM is widely used in non-traumatic patients in Switzerland, which contrasts with current evidence. Many procedures take place in patients with degenerative knee disease. Surgery rates were similar in non-traumatic middle-aged patients between 2012 and 2015. Accordingly, the potential of inappropriate use of APM in non-traumatic patients in Switzerland is high.
Collapse
Affiliation(s)
- Leander L S Muheim
- Institute of Primary Care, University of Zurich, Zurich, Switzerland;,Correspondence:
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Mathias Früh
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | | |
Collapse
|
31
|
Andrews NLP, Ferguson T, Rangaswamy AMM, Bernicky AR, Henning N, Dudelzak A, Reich O, Barnes JA, Loock HP. Hadamard-Transform Fluorescence Excitation-Emission-Matrix Spectroscopy. Anal Chem 2017; 89:8554-8564. [PMID: 28718629 DOI: 10.1021/acs.analchem.7b02400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present a fluorescence excitation-emission-matrix spectrometer with superior data acquisition rates over previous instruments. Light from a white light emitting diode (LED) source is dispersed onto a digital micromirror array (DMA) and encoded using binary n-size Walsh functions ("barcodes"). The encoded excitation light is used to irradiate the liquid sample and its fluorescence is dispersed and detected using a conventional array spectrometer. After exposure to excitation light encoded in n different ways, the 2-dimensional excitation-emission-matrix (EEM) spectrum is obtained by inverse Hadamard transformation. Using this technique we examined the kinetics of the fluorescence of rhodamine B as a function of temperature and the acid-driven demetalation of chlorophyll-a into pheophytin-a. For these experiments, EEM spectra with 31 excitation channels and 2048 emission channels were recorded every 15 s. In total, data from over 3000 EEM spectra were included in this report. It is shown that the increase in data acquisition rate can be as high as [{n(n + 1)}/2]-fold over conventional EEM spectrometers. Spectral acquisition rates of more than two spectra per second were demonstrated.
Collapse
Affiliation(s)
- N L P Andrews
- Department of Chemistry, Queen's University , Kingston, Ontario K7L 3N6, Canada
| | - T Ferguson
- Department of Chemistry, Queen's University , Kingston, Ontario K7L 3N6, Canada
| | - A M M Rangaswamy
- Department of Chemistry, Queen's University , Kingston, Ontario K7L 3N6, Canada
| | - A R Bernicky
- Department of Chemistry, Queen's University , Kingston, Ontario K7L 3N6, Canada
| | - N Henning
- Department of Chemistry, Queen's University , Kingston, Ontario K7L 3N6, Canada
| | - A Dudelzak
- Department of Chemistry, Queen's University , Kingston, Ontario K7L 3N6, Canada.,GasTOPS Ltd. , 1011 Polytek Street, Ottawa, Ontario K1J 9J3, Canada
| | - O Reich
- innoFSPEC, Physical Chemistry, University of Potsdam , Potsdam D-14476, Germany
| | - J A Barnes
- Department of Chemistry, Queen's University , Kingston, Ontario K7L 3N6, Canada
| | - H-P Loock
- Department of Chemistry, Queen's University , Kingston, Ontario K7L 3N6, Canada
| |
Collapse
|
32
|
Biétry FA, Hug B, Reich O, Susan JS, Meier CR. Iron supplementation in Switzerland - A bi-national, descriptive and observational study. Swiss Med Wkly 2017; 147:w14444. [PMID: 28695564 DOI: 10.4414/smw.2017.14444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Iron deficiency is the most common nutritional disorder in the world, and it is the only common nutrient deficiency in industrialised nations. It is thought to be the most common cause of anaemia. Use of iron supplementation in Switzerland has not been previously quantified in detail. OBJECTIVES We quantified use of iron supplementation from Swiss data and compared it with data from the UK. We assessed the frequency of serum ferritin and haemoglobin tests prior to newly started iron therapy to see whether use was based on documented low iron levels or blood parameters, especially in the case of parenteral iron supplementation. METHODS We conducted a retrospective descriptive study of prescription iron supplementation use, and compared use of oral or parenteral iron drugs between Switzerland (CH) and the UK. We retrieved Swiss data from the Swiss Health Insurance Helsana Group, and UK data were from the Clinical Practice Research Datalink (CPRD). The study period was 2012 to 2014. RESULTS The 3-year prevalence of iron supplementation was 9.4% in Switzerland and 4.4% in the UK. Iron use increased slightly between 2012 and 2014 in both countries (CH +0.3%, UK +0.2%). Recorded parenteral iron administration was roughly a thousand times higher in Switzerland (1.9%) than in the UK in 2014. In Switzerland, iron supplements were mostly given to patients aged 20 to 49 years or older than of 80 years. In the UK, iron supplementation was less frequent in younger people, but more prevalent in the elderly. Prior to a first iron prescription, ferritin tests were done more frequently in Switzerland (oral 67.2%, parenteral 86.6%) than in the UK (oral 43.3%, parenteral 65.5%). Haemoglobin was measured before a new parenteral iron therapy rarely in Switzerland (oral 14.9%, parenteral 11.7%), but frequently in the UK (oral 77.4%, parenteral 85.6%). CONCLUSIONS Iron supplementation is more common in Switzerland than in the UK, particularly parenteral iron supplementation. Haemoglobin measurements prior to a new parenteral iron therapy are relatively infrequent in Switzerland despite the required documentation of haemoglobin prior to therapy.
Collapse
Affiliation(s)
- Fabienne A Biétry
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Switzerland, and Hospital Pharmacy, University Hospital Basel, Switzerland
| | | | - Oliver Reich
- Department of Health Sciences, Helsana Insurance Group, Zurich, Switzerland
| | - Jick S Susan
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, MA, USA
| | - Christoph Rudolf Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Switzerland; Boston Collaborative Drug Surveillance Pro
| |
Collapse
|
33
|
Le Pogam MA, Quantin C, Reich O, Tuppin P, Fagot-Campagna A, Paccaud F, Peytremann-Bridevaux I, Burnand B. Geriatric Patient Safety Indicators Based on Linked Administrative Health Data to Assess Anticoagulant-Related Thromboembolic and Hemorrhagic Adverse Events in Older Inpatients: A Study Proposal. JMIR Res Protoc 2017; 6:e82. [PMID: 28495660 PMCID: PMC5445236 DOI: 10.2196/resprot.7562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/13/2017] [Accepted: 04/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background Frail older people with multiple interacting conditions, polypharmacy, and complex care needs are particularly exposed to health care-related adverse events. Among these, anticoagulant-related thromboembolic and hemorrhagic events are particularly frequent and serious in older inpatients. The growing use of anticoagulants in this population and their substantial risk of toxicity and inefficacy have therefore become an important patient safety and public health concern worldwide. Anticoagulant-related adverse events and the quality of anticoagulation management should thus be routinely assessed to improve patient safety in vulnerable older inpatients. Objective This project aims to develop and validate a set of outcome and process indicators based on linked administrative health data (ie, insurance claims data linked to hospital discharge data) assessing older inpatient safety related to anticoagulation in both Switzerland and France, and enabling comparisons across time and among hospitals, health territories, and countries. Geriatric patient safety indicators (GPSIs) will assess anticoagulant-related adverse events. Geriatric quality indicators (GQIs) will evaluate the management of anticoagulants for the prevention and treatment of arterial or venous thromboembolism in older inpatients. Methods GPSIs will measure cumulative incidences of thromboembolic and bleeding adverse events based on hospital discharge data linked to insurance claims data. Using linked administrative health data will improve GPSI risk adjustment on patients’ conditions that are present at admission and will capture in-hospital and postdischarge adverse events. GQIs will estimate the proportion of index hospital stays resulting in recommended anticoagulation at discharge and up to various time frames based on the same electronic health data. The GPSI and GQI development and validation process will comprise 6 stages: (1) selection and specification of candidate indicators, (2) definition of administrative data-based algorithms, (3) empirical measurement of indicators using linked administrative health data, (4) validation of indicators, (5) analyses of geographic and temporal variations for reliable and valid indicators, and (6) data visualization. Results Study populations will consist of 166,670 Swiss and 5,902,037 French residents aged 65 years and older admitted to an acute care hospital at least once during the 2012-2014 period and insured for at least 1 year before admission and 1 year after discharge. We will extract Swiss data from the Helsana Group data warehouse and French data from the national health insurance information system (SNIIR-AM). The study has been approved by Swiss and French ethics committees and regulatory organizations for data protection. Conclusions Validated GPSIs and GQIs should help support and drive quality and safety improvement in older inpatients, inform health care stakeholders, and enable international comparisons. We discuss several limitations relating to the representativeness of study populations, accuracy of administrative health data, methods used for GPSI criterion validity assessment, and potential confounding bias in comparisons based on GQIs, and we address these limitations to strengthen study feasibility and validity.
Collapse
Affiliation(s)
- Marie-Annick Le Pogam
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Dijon University Hospital and University of Bourgogne Franche-Comté, Dijon, France.,Inserm, CIC 1432, Clinical epidemiology / clinical trials unit, Dijon University Hospital, Dijon, France.,Inserm, UMR 1181, B2PHI: Biostatistics, Biomathematics, PHarmacoepidemiology and Infectious diseases, Institut Pasteur and Université de Versailles St-Quentin-en-Yvelines, Université Paris-Saclay, Paris, France
| | - Oliver Reich
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | - Philippe Tuppin
- Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - Anne Fagot-Campagna
- Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - Fred Paccaud
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
34
|
Regauer S, Eberz B, Reich O. Human papilloma virus (HPV) – induced SQUAMOUS INTRAEPITHELIAL LESIONS in vulvar Lichen Planus. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1602305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- S Regauer
- Institut für Pathologie, Medizinische Universität Graz
| | - B Eberz
- Institut für Pathologie, Medizinische Universität Graz
| | - O Reich
- Praxis Mürschzuschlag; Universitätsklinik für Frauenheilkunde und Geburtshilfe, Mediznische Universität Graz
| |
Collapse
|
35
|
Berger A, Bachmann N, Signorell A, Erdin R, Oelhafen S, Reich O, Cignacco E. Perinatal mental disorders in Switzerland: prevalence estimates and use of mental-health services. Swiss Med Wkly 2017; 147:w14417. [PMID: 28322424 DOI: 10.4414/smw.2017.14417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Perinatal mental disorders (PMDs) are the most common complication of pregnancy and the first postpartum year. Since PMD prevalence and use of mental-health services by perinatal women in Switzerland are unknown, we analysed existing health statistics. METHODS We used statistics from a large health insurance company, hospitals and freelance midwives. We assessed the annual rates of mental-healthcare use in perinatal women (n = 13 969). We ascertained the annual rates of PMD treatment in obstetric inpatients (n = 89 699), and annual rates of PMD records by freelance midwives (n = 57 951). In 15 104 women who gave birth in 2012 or 2013, we assessed use of mental healthcare before and during pregnancy, and in the postpartum year. For the same sample, we determined proportions of medication and consultation treatments. We used multiple regression analysis to estimate the influence of PMD on overall healthcare costs of mandatory health insurance. RESULTS The annual rate of mental-healthcare use by perinatal women was 16.7%. The annual rate of PMD treatment in obstetric inpatients was 1.1%. The annual rate of PMD records in the midwifery care setting was 2.9%. Women with PMD use mental health services mainly in non-obstetric outpatient settings. Medication was the most frequent treatment. Primary care providers and mental health specialists contributed almost equally to consultation treatments. PMD during pregnancy raised overall costs of healthcare in the postpartum year by 1214 Swiss francs. CONCLUSIONS Health-system research and perinatal healthcare should take into consideration the high prevalence of PMD. Real PMD prevalence may be even higher than our data suggest and could be assessed with a survey using our model of PMD prevalence.
Collapse
Affiliation(s)
- Anke Berger
- Bern University of Applied Sciences, Health Division, Discipline of Research & Development in Midwifery, Bern, Switzerland
| | - Nicole Bachmann
- University of Applied Sciences and Arts Northwestern Switzerland, School of Social Work, Institute for Social Work and Health, Olten, Switzerland
| | - Andri Signorell
- Helsana Group, Department of Health Sciences, Zurich, Switzerland
| | - Rebekka Erdin
- Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Stephan Oelhafen
- Bern University of Applied Sciences, Health Division, Discipline of Research & Development in Midwifery, Bern, Switzerland
| | - Oliver Reich
- Helsana Group, Department of Health Sciences, Zurich, Switzerland
| | - Eva Cignacco
- Bern University of Applied Sciences, Health Division, Discipline of Research & Development in Midwifery, Bern, Switzerland
| |
Collapse
|
36
|
Biétry FA, Pfeil AM, Reich O, Schwenkglenks M, Meier CR. Benzodiazepine Use and Risk of Developing Alzheimer's Disease: A Case-Control Study Based on Swiss Claims Data. CNS Drugs 2017; 31:245-251. [PMID: 28078633 DOI: 10.1007/s40263-016-0404-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND A possible association between benzodiazepine use and Alzheimer's disease (AD) has been hypothesized in previous studies. OBJECTIVES Using claims data from the Helsana Group, a large Swiss health insurance provider, we examined the association between previous benzodiazepine use and the risk of AD. METHODS We conducted a matched case-control study and identified 1438 incident AD cases between 2013 and 2014 based on recorded first-time use of drugs used to treat AD [i.e., acetylcholinesterase inhibitors (donepezil, rivastigmine, and galantamine) and the N-methyl-D-aspartate receptor antagonist memantine] and matched one control to each case on age, sex, index date, and residence (canton). Because the initiation of benzodiazepine use shortly before the AD diagnosis date may occur as a result of symptomatic treatment of prodromal symptoms of early major neurocognitive disorder, we introduced an induction period of 2 years before the AD diagnosis date. Additionally, we categorized medication use by duration of use prior to the index date using prescriptions. We applied conditional logistic regression analyses to calculate odds ratios with 95% confidence intervals and adjusted for use of antidepressants. RESULTS The crude odds ratio (95% confidence interval) of developing AD for patients starting benzodiazepine treatment was 1.71 (1.17-2.99) in the year before diagnosis and 1.19 (0.82-1.72) in the third year before diagnosis. After accounting for benzodiazepine use initiated during the prodromal phase, benzodiazepine use was not associated with an increased risk of developing AD; long-term benzodiazepine use (≥30 prescriptions) yielded an adjusted odds ratio of 0.78 (0.53-1.14). CONCLUSIONS After taking into consideration a possible protopathic bias in the 2 years preceding the AD diagnosis date, benzodiazepine use was not associated with an increased risk of developing AD.
Collapse
Affiliation(s)
- Fabienne A Biétry
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, Hospital Pharmacy, University of Basel, Spitalstrasse 26, 4031, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Alena M Pfeil
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland
| | | | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, Hospital Pharmacy, University of Basel, Spitalstrasse 26, 4031, Basel, Switzerland. .,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland.
| |
Collapse
|
37
|
Reich O, Berg F, Dorfer M, Greimel E. Zur Psychodynamik von Frauen mit genitaler Dysplasie. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1598130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- O Reich
- Universitäts-Frauenklinik der Medizinischen Universität Graz, Österreich
| | - F Berg
- Universitäts-Frauenklinik der Medizinischen Universität Graz, Österreich
| | - M Dorfer
- Universitäts-Frauenklinik der Medizinischen Universität Graz, Österreich
| | - E Greimel
- Universitäts-Frauenklinik der Medizinischen Universität Graz, Österreich
| |
Collapse
|
38
|
Wertli MM, Reich O, Signorell A, Burgstaller JM, Steurer J, Held U. Changes over time in prescription practices of pain medications in Switzerland between 2006 and 2013: an analysis of insurance claims. BMC Health Serv Res 2017; 17:167. [PMID: 28241764 PMCID: PMC5327558 DOI: 10.1186/s12913-017-2086-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Europe, scant information is available about prescription practices for pain medications. The aim of this research was to assess changes in prescription rates of non-opioid, weak opioid, and strong opioid medications between 2006 and 2013 in the Swiss population. METHODS Using insurance claims data covering one-sixth of the Swiss population, we analyzed the numbers of reimbursed pain medications, the number of reimbursements per persons, and the cumulative dose in milligrams. For opioids, the morphine equivalent dose and treatment days were calculated. Data were extrapolated to the dose per day per 100'000 population stratified by age, gender, and canton. RESULTS In total, 4'746'942 paracetamol, 2'156'620 NSAIDs or Coxibs, 931'129 metamizole, 1'322'272 weak opioid, and 807'835 strong opioid claims were analyzed. Between 2006 and 2013, the increase in claims per 100'000 persons was 32% for paracetamol, 242% for metamizole, 107% for NSAIDS, 86% for Coxibs, 13% for weak opioids, and 121% for strong opioids. For strong opioids the total MED in mg /100'000 increased by 117%, the treatment days /100'000 by 101%. For strong opioids, fentanyl was most frequently used (increase between 2006 and 2013 by 91% for MED/100'000 persons and 94% treatment days / 100'000) followed by buprenorphine and oxycodone. The highest proportional increase in MED / 100'000 was observed for methadone (+1414%) and oxycodone (+313%). Marked geographical variation was detected in the use of metamizole, paracetamole, and strong opioids in different cantons. CONCLUSION The analysis of insurance claims data provides evidence that the prescription rates for pain medications increased in Switzerland within the last ten years, in particular for metamizole and strong opioids. Furthermore, the prescription rates for metamizole, paracetamol, and strong opioids varied substantially between different cantons in Switzerland.
Collapse
Affiliation(s)
- Maria M Wertli
- Horten-Centre for patient oriented research and knowledge transfer, University of Zurich, CH-8032, Zurich, Switzerland. .,Department of General Internal Medicine, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland.
| | - Oliver Reich
- Department of Health Sciences, Helsana, Zürichstrasse 130, CH-8600, Dübendorf, Switzerland
| | - Andri Signorell
- Department of Health Sciences, Helsana, Zürichstrasse 130, CH-8600, Dübendorf, Switzerland
| | - Jakob M Burgstaller
- Horten-Centre for patient oriented research and knowledge transfer, University of Zurich, CH-8032, Zurich, Switzerland
| | - Johann Steurer
- Horten-Centre for patient oriented research and knowledge transfer, University of Zurich, CH-8032, Zurich, Switzerland
| | - Ulrike Held
- Horten-Centre for patient oriented research and knowledge transfer, University of Zurich, CH-8032, Zurich, Switzerland
| |
Collapse
|
39
|
Reich O, Rapold R, Blozik E. [The Patient Enrolled in a Managed Care Insurance Plan or the Physician Being Part of a Network: What Drives the Efficiency Gain?]. Praxis (Bern 1994) 2017; 106:351-358. [PMID: 28357898 DOI: 10.1024/1661-8157/a002640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. Fragestellung: Um zu untersuchen, wie stark der Einfluss von arzt- gegenüber patientenseitigen Faktoren ist, verglichen wir die Effizienzgewinne durch die Teilnahme eines Versicherten in einem Managed-Care(MC)-Modell mit denen durch die Einbindung des behandelnden Arztes in einem Ärztenetzwerk. Methoden: Sekundäranalyse von Daten der obligatorischen Krankenpflegeversicherung der Helsana-Gruppe. Mit einem multivariaten linearen Regressionsmodell wurden die Kosteneinsparungen in Abhängigkeit davon berechnet, ob der Versicherte in einem MC-Modell eingeschrieben war und/oder ob der behandelnde Hausarzt Mitglied eines Ärztenetzwerks war. Ergebnisse: Versorgung von MC-Versicherten bei Netzwerk-Ärzten führte zu den erwarteten Resultaten (−13 %). Hingegen werden Nicht-MC-Patienten bei den selben Netzwerk-Ärzten deutlich weniger effizient behandelt (−2 %). Das rein patientenseitige «Gatekeeping» ohne Netzwerk-Arzt wurde auf −10 % geschätzt. Schlussfolgerung: Offensichtlich differenziert die Behandlung durch Netzwerk-Ärzte je nach der Versichertendeckung.
Collapse
Affiliation(s)
- Oliver Reich
- 1 Gesundheitswissenschaften, Helsana Gruppe, Zürich
| | | | - Eva Blozik
- 1 Gesundheitswissenschaften, Helsana Gruppe, Zürich
- 2 Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
- 3 Lehrbereich Allgemeinmedizin, Universitätsklinikum, Universität Freiburg, Freiburg i.Br., Deutschland
| |
Collapse
|
40
|
Werner P, Münzberg M, Hass R, Reich O. Process analytical approaches for the coil-to-globule transition of poly(N-isopropylacrylamide) in a concentrated aqueous suspension. Anal Bioanal Chem 2017; 409:807-819. [PMID: 27830315 PMCID: PMC5233752 DOI: 10.1007/s00216-016-0050-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/14/2016] [Accepted: 10/21/2016] [Indexed: 11/30/2022]
Abstract
The coil-to-globule transition of poly(N-isopropylacrylamide) (PNIPAM) microgel particles suspended in water has been investigated in situ as a function of heating and cooling rate with four optical process analytical technologies (PAT), sensitive to structural changes of the polymer. Photon Density Wave (PDW) spectroscopy, Focused Beam Reflectance Measurements (FBRM), turbidity measurements, and Particle Vision Microscope (PVM) measurements are found to be powerful tools for the monitoring of the temperature-dependent transition of such thermo-responsive polymers. These in-line technologies allow for monitoring of either the reduced scattering coefficient and the absorption coefficient, the chord length distribution, the reflected intensities, or the relative backscatter index via in-process imaging, respectively. Varying heating and cooling rates result in rate-dependent lower critical solution temperatures (LCST), with different impact of cooling and heating. Particularly, the data obtained by PDW spectroscopy can be used to estimate the thermodynamic transition temperature of PNIPAM for infinitesimal heating or cooling rates. In addition, an inverse hysteresis and a reversible building of micrometer-sized agglomerates are observed for the PNIPAM transition process.
Collapse
Affiliation(s)
- Peter Werner
- Physical Chemistry - innoFSPEC, University of Potsdam, Am Mühlenberg 3, 14476, Potsdam-Golm, Germany.
| | - Marvin Münzberg
- Physical Chemistry - innoFSPEC, University of Potsdam, Am Mühlenberg 3, 14476, Potsdam-Golm, Germany
| | - Roland Hass
- Physical Chemistry - innoFSPEC, University of Potsdam, Am Mühlenberg 3, 14476, Potsdam-Golm, Germany
| | - Oliver Reich
- Physical Chemistry - innoFSPEC, University of Potsdam, Am Mühlenberg 3, 14476, Potsdam-Golm, Germany
| |
Collapse
|
41
|
Abstract
Zusammenfassung. Hintergrund: Präoperatives Thorax-Röntgen bei Patienten ohne Verdacht auf intrathorakale Pathologie wird auf der Top-5-Liste der «Smarter Medicine»-Initiative aufgeführt. Diese Studie untersucht den Anteil unnützer präoperativer Röntgenthorax-Aufnahmen in der Schweiz. Methoden: Sekundäranalyse von Abrechnungsdaten von hospitalisierten Patienten in der obligatorischen Krankenpflegeversicherung. Die Häufigkeit präoperativer Thorax-Röntgen wurde stratifiziert nach Soziodemografie und den chronischen Erkrankungsgruppen «kardiovaskuläre Erkrankung» und «Atemwegserkrankung» untersucht. Ergebnisse: Von 47 215 hospitalisierten Individuen erhielten 6 121 (13 %) ein ambulantes präoperatives Thorax-Röntgen. Es zeigte sich erhebliche interkantonale Variation. Diskussion: Unsere Untersuchung ergab keine Hinweise auf einen übermässigen Einsatz von unnützen präoperativem Thorax-Röntgen in der Schweiz. Die interkantonalen Schwankungen könnten auf unerwünschte Varianz hinweisen. Die Studie liefert Argumente, zukünftige Top-5-Listendaten aus der Versorgungsrealität miteinzubeziehen.
Collapse
Affiliation(s)
- Eva Blozik
- 1 Gesundheitswissenschaften, Helsana Gruppe, Zürich
- 2 Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
- 3 Lehrbereich Allgemeinmedizin, Universitätsklinikum Freiburg, Freiburg i. Br., Deutschland
| | | | - Oliver Reich
- 1 Gesundheitswissenschaften, Helsana Gruppe, Zürich
| |
Collapse
|
42
|
Blozik E, Rapold R, Eichler K, Reich O. Epidemiology and costs of multiple sclerosis in Switzerland: an analysis of health-care claims data, 2011-2015. Neuropsychiatr Dis Treat 2017; 13:2737-2745. [PMID: 29138568 PMCID: PMC5677381 DOI: 10.2147/ndt.s143180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Medical therapy for multiple sclerosis (MS) is expensive. Quantifying the burden of MS is fundamental for health-care planning and the allocation of resources for the management of MS. This study provides current national estimates of prevalence, incidence, mortality, and costs of MS in Switzerland using claims data between 2011 and 2015. METHODS We analyzed health insurance claims of adult persons enrolled with a large health insurance group covering about 13% of the Swiss population between 2011 and 2015. The identification of patients with MS was based on prescription data of MS-specific medication using the Anatomical Therapeutic Chemical Classification system as proxy for clinical diagnosis. We estimated prevalence, mortality, and costs of basic health insurance between 2011 and 2015. Furthermore, incidence of MS was calculated for 2015. All results were weighted with census data to achieve an extrapolation to the Swiss general population level. Cost of illness was estimated as direct medical cost from the perspective of a Swiss health insurance using multivariate linear regression analysis. RESULTS Of the 943,639 subjects in the year 2015, 1,606 were identified as MS patients resulting in a prevalence of 190 per 100,000 (95% CI: 180-190 per 100,000). Incidence was 16 per 100,000 (95% CI: 13-19 per 100,000). According to regression analysis, the total cost of illness for basic mandatory health insurance was 26,710 Swiss Francs (CHF) (95% CI: 26,100-27,300) per person per year with the cost of medication being almost identical 26,960 CHF (95% CI: 26,170-27,800). CONCLUSIONS MS affects 10,000-15,000 persons in Switzerland, and the prevalence has increased over the last 22 years. These persons have high need and demand for health care. High costs are primarily due to expenses for medication. Given the imbalance of MS medication therapy from the perspective of basic health insurance on the disposable resources, it is crucial to increase transparency related to the volume, type, and allocation of expenses.
Collapse
Affiliation(s)
- Eva Blozik
- Department of Health Sciences, Helsana Group, Zürich, Switzerland.,Institute of General Practice, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of General Practice, University Medical Center Freiburg, Freiburg, Germany
| | - Roland Rapold
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| | - Klaus Eichler
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| |
Collapse
|
43
|
Reich O, Regauer S. Thin HSIL of the Cervix: detecting a variant of high-grade squamous intraepithelial lesions with a p16INK4a-antibody. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
44
|
Biétry FA, Reich O, Schwenkglenks M, Meier CR. Statin use and risk of cholecystectomy – A case-control analysis using Swiss claims data. Expert Opin Drug Saf 2016; 15:1577-1582. [DOI: 10.1080/14740338.2016.1240782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
45
|
Münzberg M, Hass R, Dinh Duc Khanh N, Reich O. Limitations of turbidity process probes and formazine as their calibration standard. Anal Bioanal Chem 2016; 409:719-728. [PMID: 27695985 PMCID: PMC5233748 DOI: 10.1007/s00216-016-9893-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/11/2016] [Accepted: 08/18/2016] [Indexed: 12/03/2022]
Abstract
Turbidity measurements are frequently implemented for the monitoring of heterogeneous chemical, physical, or biotechnological processes. However, for quantitative measurements, turbidity probes need calibration, as is requested and regulated by the ISO 7027:1999. Accordingly, a formazine suspension has to be produced. Despite this regulatory demand, no scientific publication on the stability and reproducibility of this polymerization process is available. In addition, no characterization of the optical properties of this calibration material with other optical methods had been achieved so far. Thus, in this contribution, process conditions such as temperature and concentration have been systematically investigated by turbidity probe measurements and Photon Density Wave (PDW) spectroscopy, revealing an influence on the temporal formazine formation onset. In contrast, different reaction temperatures do not lead to different scattering properties for the final formazine suspensions, but give an access to the activation energy for this condensation reaction. Based on PDW spectroscopy data, the synthesis of formazine is reproducible. However, very strong influences of the ambient conditions on the measurements of the turbidity probe have been observed, limiting its applicability. The restrictions of the turbidity probe with respect to scatterer concentration are examined on the basis of formazine and polystyrene suspensions. Compared to PDW spectroscopy data, signal saturation is observed at already low reduced scattering coefficients.
Collapse
Affiliation(s)
- Marvin Münzberg
- Physical Chemistry - innoFSPEC, University of Potsdam, Am Mühlenberg 3, 14476, Potsdam-Golm, Germany.
| | - Roland Hass
- Physical Chemistry - innoFSPEC, University of Potsdam, Am Mühlenberg 3, 14476, Potsdam-Golm, Germany
| | - Ninh Dinh Duc Khanh
- Physical Chemistry - innoFSPEC, University of Potsdam, Am Mühlenberg 3, 14476, Potsdam-Golm, Germany
| | - Oliver Reich
- Physical Chemistry - innoFSPEC, University of Potsdam, Am Mühlenberg 3, 14476, Potsdam-Golm, Germany
| |
Collapse
|
46
|
Bähler C, Signorell A, Reich O. Health Care Utilisation and Transitions between Health Care Settings in the Last 6 Months of Life in Switzerland. PLoS One 2016; 11:e0160932. [PMID: 27598939 PMCID: PMC5012658 DOI: 10.1371/journal.pone.0160932] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 07/27/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Many efforts are undertaken in Switzerland to enable older and/or chronically ill patients to stay home longer at the end-of-life. One of the consequences might be an increased need for hospitalisations at the end-of-life, which goes along with burdensome transitions for patients and higher health care costs for the society. AIM We aimed to examine the health care utilisation in the last six months of life, including transitions between health care settings, in a Swiss adult population. METHODS The study population consisted of 11'310 decedents of 2014 who were insured at the Helsana Group, the leading health insurance in Switzerland. Descriptive statistics were used to analyse the health care utilisation by age group, taking into account individual and regional factors. Zero-inflated Poisson regression model was used to predict the number of transitions. RESULTS Mean age was 78.1 in men and 83.8 in women. In the last six months of life, 94.7% of the decedents had at least one consultation; 61.6% were hospitalised at least once, with a mean length of stay of 28.3 days; and nursing home stays were seen in 47.4% of the decedents. Over the same time period, 64.5% were transferred at least once, and 12.9% experienced at least one burdensome transition. Main predictors for transitions were age, sex and chronic conditions. A high density of home care nurses was associated with a decrease, whereas a high density of ambulatory care physicians was associated with an increase in the number of transitions. CONCLUSIONS Health care utilisation was high in the last six months of life and a considerable number of decedents were being transferred. Advance care planning might prevent patients from numerous and particularly from burdensome transitions.
Collapse
Affiliation(s)
- Caroline Bähler
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081 Zürich, Switzerland
| | - Andri Signorell
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081 Zürich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081 Zürich, Switzerland
- * E-mail:
| |
Collapse
|
47
|
Abstract
INTRODUCTION Transitions between different levels of health care, such as hospital admission and discharge, pose a significant threat to the quality and continuity of medication therapy. This study aims to explore the role of hospitalization on medication changes as patients are transferred from and back to ambulatory care. METHODS Secondary analysis of claims data from Swiss residents with basic health insurance at the Helsana Group was performed. We evaluated medication invoices of patients who were hospitalized in a Swiss private hospital group in the year 2013. Medication changes were defined as discontinuation, new prescription, or change in the Anatomical Therapeutic Chemical (ATC) Classification System level 4, which is equivalent to a change in the chemical/therapeutic/pharmacological subgroup. Multiple Poisson regression analysis was applied to evaluate whether medication change was predicted by socioeconomic or clinical patient characteristics or by a system factor (physician dispensing of medication allowed in canton of residence). RESULTS We investigated a total of 10,123 hospitalized patients, among whom a mean number of 3.85 (median 3.00) changes were identified. Change most frequently affected antihypertensives, analgesics, and antirheumatics. If patients were enrolled in a managed care plan, they were less likely to undergo changes. If a patient resided in a canton, in which physicians were allowed to dispense medication directly, the patient was more likely to experience change. CONCLUSION There is considerable change in medication when patients shift between ambulatory and inpatient health care levels. This interruption of medication continuity is in part desirable as it responds to clinical needs. However, we hypothesize that there is also a significant proportion of change due to unwarranted factors such as financial incentives for change of products.
Collapse
Affiliation(s)
- Eva Blozik
- Department of Health Sciences, Helsana Group, Zürich, Switzerland; Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Hamburg; Department of Medicine, University Medical Centre Freiburg, Freiburg im Breisgau, Germany
| | - Andri Signorell
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| |
Collapse
|
48
|
Trottmann M, Frueh M, Telser H, Reich O. Physician drug dispensing in Switzerland: association on health care expenditures and utilization. BMC Health Serv Res 2016; 16:238. [PMID: 27391118 PMCID: PMC4938921 DOI: 10.1186/s12913-016-1470-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 06/17/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Several countries recently reassessed the roles of drug prescribing and dispensing, either by enlarging pharmacists' rights to prescribe (e.g. the US and the United Kingdom) or by limiting physicians' rights to dispense (e.g. Taiwan and South Korea). While integrating the two roles might increase supply and be convenient for patients, concern is that drug mark-ups incite providers to prescribe unnecessary drugs. We aimed to assess the association of physician dispensing (PD) in Switzerland on various outcomes. METHODS We performed a retrospective cohort study, using health care claims data for patients in the year 2013. The analysis of the association of PD was perfomed using a large patient level dataset and several target variables, including the number of different chemical agents, share of generic drugs, number of visits to physicians and expenditures. Different multivariate econometric models were applied in order to capture the association PD on the target variables. RESULTS A total of 101'784 patients were enrolled in 2013, whereas 54 % were PD patients. We find that PD is associated with lower pharmaceutical expenditure per patient, which can be explained by an increased use of generic drugs. The decrease is compensated by higher use of physician services. We find no significant impact of physician dispensing on total health care expenditure. CONCLUSIONS Our study offers insights for policy makers who are (re-)considering the separation between drug prescribing and dispensing, either by allowing physicians to dispense or pharmacists to prescribe certain drugs. In terms of total health care expenditures, we find no difference between the two systems, so we are doubtful that changing dispensing rights are a good measure to contain cost, at least in Switzerland.
Collapse
Affiliation(s)
| | - Mathias Frueh
- />Department of Health Sciences, Helsana Group, Zurich, Switzerland
| | - Harry Telser
- />Polynomics, Baslerstrasse 44, Olten, Switzerland
| | - Oliver Reich
- />Department of Health Sciences, Helsana Group, Zurich, Switzerland
| |
Collapse
|
49
|
Andrews NLP, Ross R, Munzke D, van Hoorn C, Brzezinski A, Barnes JA, Reich O, Loock HP. In-fiber Mach-Zehnder interferometer for gas refractive index measurements based on a hollow-core photonic crystal fiber. Opt Express 2016; 24:14086-14099. [PMID: 27410569 DOI: 10.1364/oe.24.014086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We describe an in-fiber interferometer based on a gas-filled hollow-core photonic crystal fiber. Expressions for the sensitivity, figure of merit and refractive index resolution are derived, and values are experimentally measured and theoretically validated using mode field calculations. The refractive indices of nine monoatomic and molecular gases are measured with a resolution of δns < 10-6.
Collapse
|
50
|
Huber CA, Rapold R, Brüngger B, Reich O, Rosemann T. One-year adherence to oral antihyperglycemic medication and risk prediction of patient outcomes for adults with diabetes mellitus: An observational study. Medicine (Baltimore) 2016; 95:e3994. [PMID: 27368004 PMCID: PMC4937918 DOI: 10.1097/md.0000000000003994] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Medication adherence is essential in preventing adverse intermediate outcomes, but little is known on hard outcomes. The aims of this study were to determine the 1-year adherence to oral antihyperglycemic drugs (OADs) and to predict the risk of subsequent health outcomes among (non)adherent patients with diabetes.Using a large Swiss healthcare claims database from 2011 to 2014, we identified all patients aged ≥18 years with diabetes and treated with at least 1 OAD prescription. Adherence to OADs was measured as the proportion of days covered (PDC) over 1 year and subdivided into 2 categories: adherent (PDC ≥ 80%), nonadherent (PDC < 80%). We estimated the relative risk of hospitalization and mortality at follow-up using multivariate Cox proportional hazard models.Based on a sample of 26,713 patients, adherence to OADs was quite low: 42% of the patients achieved a PDC of ≥80% during the 1-year observation period. A 7% reduction in the hospitalization risk and a 10% reduction in the risk of mortality could be observed in adherent patients compared to nonadherent patients (hazard ratio [HR], 0.93 [95% CI, 0.89-0.97]; HR, 0.90 [95% CI, 0.82-0.99]). Subgroup analysis showed that an intensified diabetes therapy had no significant influence on the risk of both outcomes in adherent patients.Poor medication adherence increases the risk of subsequent hospitalizations and premature mortality in patient with diabetes, regardless of disease severity and comorbidities. This emphasizes the need for an earlier identification of patients with poor medication adherence. The awareness of physicians and patients regarding the importance of adherence in diabetes treatment should be increased.
Collapse
Affiliation(s)
- Carola A. Huber
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
- Correspondence: Carola A. Huber, Department of Health Sciences, Helsana Group, P.O. Box 8081, Zürich, Switzerland (e-mail: )
| | - Roland Rapold
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| | - Beat Brüngger
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| | - Oliver Reich
- Department of Health Sciences, Helsana Group, Zürich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zürich, University Hospital Zürich, PestalozzistrasseZürich, Switzerland
| |
Collapse
|