The rising prevalence of erectile dysfunction is increasingly becoming a significant public health problem in Germany, too, and the active ingredient sildenafil is an established treatment option for affected patients. The aim of the expert opinion was to work out the public health impact associated with a switch from Rx to OTC status for sildenafil 50 mg within the framework of a literature-based study.

The discussion about an OTC switch of sildenafil is characterized by two central leitmotifs. On the one hand, the illegal trade in counterfeit drugs should be reduced as far as possible. Second, low-threshold counseling services in pharmacies about the conditions underlying erectile dysfunction are intended to transfer more patients to structured medical treatment.

Methodology

First, the scientific evidence of successful OTC switches for selected active ingredients was analyzed in the form of case studies. Furthermore, the literature on OTC switches of sildenafil in neighboring European countries (especially the United Kingdom) was evaluated. In addition, expert interviews were conducted with representatives of pharmacy and patient associations to map current assessments. The assessment of the public health impact of a possible OTC switch of sildenafil was based on three domains: patient-relevant, health system-related and socio-economic impact.

Patient-relevant aspects: Since only about one-third of patients with erectile dysfunction consult a physician, and sildenafil is often taken without prior medical consultation, OTC dispensing through pharmacies could lead to low-threshold access to the care system. Pharmacies could seek contact with customers at the point-of-sale and refer patients to medical care if there are signs of the presence of underlying conditions. One estimate found that with an OTC switch, approximately 700,000 men with erectile dysfunction would benefit from an expansion of therapy.

Health system-related aspects: A clearly identifiable advantage of the OTC release of sildenafil for the health care system is the strengthening of the profession as well as the health care competence of pharmacists through sildenafil counseling services, since erectile dysfunction represents a new field of counseling for pharmacists. That pharmacists could also make a public health-relevant contribution in the case of an OTC release of sildenafil is shown by the results of a European observational study that investigated whether pharmacists can make an appropriate recommendation of sildenafil 50 mg for the treatment of erectile dysfunction.

Socio-economic aspects: Initially, an OTC switch from sildenafil does not result in any significant savings in drug costs, as these are to be borne by the patients themselves on the basis of a guideline issued by the Federal Joint Committee. However, since affected patients often do not visit their doctors, there is a risk that the underlying diseases or secondary diseases that promote erectile dysfunction are not diagnosed or are diagnosed only after a time delay, which can lead to more severe courses of the disease with high treatment costs. The goal of an OTC switch should therefore be to enable the diagnosis of the underlying diseases in a larger proportion of patients with erectile dysfunction and thus make a public health-relevant contribution.

Conclusion

In summary, a potential OTC switch of sildenafil 50 mg thus involves a balancing of the resulting patient benefit and patient safety. The current prescription requirement for sildenafil is intended to promote both patient safety and therapy for patients under medical care. However, because in the vast majority of cases the drug is obtained outside of medical treatment, a large proportion of affected patients remain inadequately treated. An OTC switch could help destigmatize sildenafil as well as erectile dysfunction and transition previously untreated patients into medical treatment through pharmacy information and low-threshold consultation.

Photo: freepik | ArtPhoto_studio

The MSD Health Award is awarded annually and has been promoting innovative care models since 2011. In addition to financial support, the MSD Health Award offers award winners the opportunity to further expand their own network and receive new impetus for the project.

The inav GmbH has been supporting MSD Germany since 2012 in various areas related to the MSD Health Award. This includes the documentation and keywording of the participating projects and the award winners for the MSD project database. In addition, we accompany the MSD Health Award with various publications and other communication measures.

Prof. Dr. Volker Amelung is also a member of the jury for the MSD Health Prize.

Download brochure for MSD Health Award 2023 (German language)

Download brochure for MSD Health Award 2022 (German language)

Using a newly developed maturity model, the progress of digitization in German hospitals and the effect of funding from the Hospital Future Fund are to be evaluated. The model enables a standardized and comprehensive assessment based on extensive data collection and the self-assessment of the participating hospitals. It calculates an individual DigitalRadar score and, for international comparability, an EMRAM indicator for each hospital.

For hospitals that have applied for funding under the Hospital Future Act (KHZG), participation in the accompanying evaluation is mandatory. Hospitals that have not applied for funding can also participate in the self-assessment on a voluntary basis. The digital tool is available online and offers the opportunity for a new German public reporting in the health care sector.

The inav was involved in the development of the maturity model and is responsible for the accompanying quantitative and qualitative evaluation.

More information can be found on the DigitalRadar website.

Parkinson’s disease is the most common neurogenerative movement disorder in Germany. About 300,000 people are affected, and the disease’s prevalence is expected to increase in the future due to demographic change. Typical symptoms include tremors in the arms and legs as well as impaired gait, speech, and swallowing. In advanced stages, cognitive impairment may occur, sometimes progressing to dementia. Although Parkinson’s disease cannot be cured, its progression can be delayed with the help of medication and an activating therapy consisting of physiotherapy, occupational therapy, and speech therapy. Currently, however, only one third of all Parkinson’s patients receive specific activating therapy.

The Parkinson AKTIV project is committed to enabling more people with Parkinson’s disease to receive an activating therapy. The first priority is to improve the communication between the service providers involved in order to adjust the range of therapies to the individual needs of the patients. Numerous specialists are already part of the multidisciplinary Parkinson’s Network Münsterland. A web-based communication platform and so-called quickcards will be used to further improve the exchange of information within the scope of the project. The quickcards contain patient-relevant information and guideline-based therapy recommendations. They will be made accessible to those providing treatment, so that everyone involved in the care process will have access to the information they need to design and coordinate activating therapy on a patient-specific basis.

The accompanying scientific study will include an evaluation design with an intervention and control group. It will be determined whether the quality of life of people with Parkinson’s disease can be improved by the intervention.

The project will receive ca. 2.6 million euros in funding from the Innovation Fund over a period of three and a half years.

If the project is successful, the networking of all service providers involved can also be implemented in other regions with the help of the web-based communication platform. The quickcards could be established as an important element of the new healthcare concept, regardless of a specific infrastructure.

Photo: freepik | pressfoto

According to current research, about five to ten percent of all tumor diseases are hereditary. Due to genetic changes, there is a significantly increased risk of cancer in individual families, which often already manifests itself as a tumor disease in young people. The so-called tumor risk syndrome (TRS) can be identified by examining a family’s medical history, risk calculations and a genetic test. Based on this, preventive measures can be taken.

However, there is currently still a lack of clinical pathways that offer advice and support to the attending medical specialists in determining the indication and interpreting of the findings. Especially in structurally weaker regions with little exchange between specialists, the hereditary causes of cancer are often not identified.

The aim of the OnkoRisk NET project is to create a cooperative network in which practicing oncologists and specialists in human genetics can exchange information. The project also includes the development of clinical pathways and the establishment of telemedical genetic counseling. This way, the human genetics oncology standard care in structurally weak regions is to be improved.

The inav GmbH was appointed to evaluate the project. Some of the parameters that will be recorded and analyzed as part of the study include patient satisfaction, psychological stress, and the use of genetic counseling by other family members.

The project will be funded for 45 months with a total of approximately 2.5 million euros from the Innovation Fund. If successful, the project will ensure access to genetic counseling, diagnostics and risk-adapted prevention for genetic tumor risk syndromes in structurally weaker regions.

Foto: freepik | kjpargeter

Chronic obstructive pulmonary disease (COPD) is a disease that progresses over several years and results in permanent damage of the lungs. As a result, those affected suffer from severe shortness of breath. With a prevalence of almost six percent, COPD is one of the most common diseases in Germany.

Sudden worsening of the patient’s condition (exacerbations) occur frequently and often lead to hospitalization. The TelementorCOPD project aims to detect these exacerbations at an early stage, initiate appropriate interventions and thus avoid hospitalizations. This is also associated with an increase in the quality of life of COPD patients.

With the help of a special COPD app, participating patients receive a physical and pulmonary training program with a focus on prevention. In addition, vital signs and the results of COPD assessment tests are automatically recorded and transmitted via telemeters. On this basis, the exacerbation risk can be analyzed, which is visualized using a traffic light system. Specially trained COPD nurses who monitor the parameters can then initiate early risk-adapted interventions and contact the patients via video chat or refer them to the treating pulmonologists.

The inav GmbH was assigned with the evaluation of the project. An unblinded randomized controlled trial will determine if the COPD app and the monitoring of vital signs can significantly reduce acute exacerbations in the intervention group compared to the control group.

The project is funded by the Innovation Fund for three years with a ca. 3.76 million euros. If successful, the optimization of outpatient COPD care will lead to an improvement in patients’ health status and increase their quality of life. The care concept can also be transferred to other regions and indications.

Further information: www.telementor-copd.de

Photo: freepik | DCStudio

Six Local Health Centers (LGZ) are currently being established in Hamburg to improve healthcare in socially and health-wise disadvantaged districts. The concept for the LGZs follow the PORT concept of the Robert Bosch Stiftung: The foundation has already been funding “Patient-Oriented Centers for Primary and Long-term Care” in Germany since 2015. The establishment of the Hamburg LGZ is funded by the Senate of Hamburg over a period of three years. The LGZs will operate at the interface of healthcare and social services. Characteristics are:

• Patient-oriented care in locally organized centers
• Cross-sectoral care
• Multiprofessional teamwork of medical, nursing and social counseling staff at eye level
• Interdisciplinary cooperation of local counseling centers
• Cross-sectional/primary counseling to improve the social situation
• Offers for prevention and health promotion
• Good integration in the districts

The Hamburg Social Authority and the Robert Bosch Foundation have concluded a cooperation agreement to evaluate the conception and implementation of the new centers in Hamburg. Together with the aQua Institute, inav GmbH is conducting an accompanying evaluation of the six LGZs. The aim of the evaluation is to provide scientific support for the transition of the primary care centers to regular care and to measure the achievement of the goals. The evaluation is based on a mixed-methods design and includes the following elements:

• Participant observation in all six LGZs
• Guideline-based interviews with stakeholders in the LGZs and in the districts
• Interviews with patients and users of the service
• Small-scale routine data analysis (impact analysis at district level)
• Secondary data analysis of the performance data of the LGZs

The evaluation is financed by the Robert Bosch Center for Innovative Health at the Bosch Health Campus in Stuttgart (formerly the health funding department of the Robert Bosch Foundation).

The inav and the OptiMedis AG are jointly supporting the Swiss health insurance company SWICA in the development of a sustainable, population-oriented health care model. After a literature review, a best practice evaluation and stakeholder interviews, a “big picture” for the possible implementation of value-based care concepts in Switzerland was outlined. The specification was conducted in cooperation with central stakeholders of a selected region in the framework of a business plan for a possible health care ecosystem. Based on existing regional health insurance data, potential analyses were conducted and used as a baseline for the definition of initial integrated care products. In addition, potential financing models were developed and the governance and organizational structures for a pilot implementation with selected service partners were designed.

In Switzerland, there is already extensive experience with new forms of controlling and financing, on the one hand in cooperation with office-based physician groups, and on the other hand through the development of different tariffs with, in part, telemedical access models. Overall, however, these attempts have not yet led to a comprehensive cross-sectoral regional coordination and provision of services that reflects international experience and also rewards the maintenance of a healthy population.

The conclusions from the best practice analysis are relevant for SWICA – just as they are for other parties involved in the development of an innovative care model:

1. New health care delivery systems must be aligned with today’s health care stakeholders’ demands for entrepreneurial activity and work-life balance. Compensation should therefore increasingly reward benefits rather than service volumes.
2. The changes toward integrated care are particularly complex. Therefore, the health care models and their governance structures must relate to larger population collectives, include a variety of professional groups and their partially conflicting interests, and thus be resilient enough to withstand disputes.
3. In predominantly privately organized healthcare systems, regional “healthcare ecosystems” are developing more frequently, becoming contract partners for payers either on the level of a few professional groups and indications or across entire populations and their diseases. It seems reasonable to include some of the regional providers in the governance body structures.
4. The examples show that these types of regional “healthcare ecosystems” experiment with population sizes between 20,000 and 200,000. It appears reasonable to include the largest proportion possible of the region’s total population. It is also important for the participating local healthcare players to care for the largest possible proportion of their patients within the framework of the new integrated healthcare approach, to ensure the processes can be implemented effectively and sustainably.
5. In many best practices, digital innovations such as the introduction of telemedicine or an integrated patient record are the basis for implementing more efficient health care pathways. They support the joint definition of standards and guidelines for communication and collaboration between stakeholders.
6. All best practices under consideration are increasingly focusing on prevention, i.e., on earlier intervention in the outpatient setting, in particular to enhance patient satisfaction, but also to reduce the need for more cost-intensive hospital treatments. Intelligent use of health care data and population risk stratification enable identification of relevant risk groups and thus an earlier and more targeted approach to the affected populations. Interdisciplinary cooperation between the various professional groups and stronger links between the healthcare and social systems are important factors in this context.

Photo: freepik | freepic.diller

Lifestyle changes can reduce the risk of developing type 2 diabetes mellitus. The evaluated aha!2.0 program (“Different from today!”) focuses on the recognition of the diabetes mellitus type 2 risk and on the modification of lifestyle to reduce known risk factors. The aim of aha!2.0 was to estimate the point prevalence of participating individuals with a very high risk of type 2 diabetes mellitus in Schleswig-Holstein at the start of the study using FINDRISK. Furthermore, the development of the relevant endpoints body weight, waist circumference and body mass index was investigated.

Methods

The study was conducted between July 2014 and December 2016 in a single-arm longitudinal study design and 15-month follow-up (including 12 weeks of intervention) with a total of five control time points (t-1 to t3). Study participants were recruited in family practices in Schleswig-Holstein. Legally insured individuals aged 18 years and older who had identifiable abdominal obesity and/or a relevant family history and/or a sedentary lifestyle were included. The intervention consisted of the FINDRISK test (Module 1), which estimates the ten-year risk of developing type 2 diabetes mellitus by means of a score, and the lifestyle intervention itself (Module 2). Building on a doctor-insured discussion, participants received the aha! starter set, consisting of a Chip List©, a diet and exercise diary, an exercise band with exercise poster and a measuring tape to measure waist circumference.

Results

The point prevalence for individuals with a very high risk (50% according to FINDRISK) of developing type 2 diabetes mellitus in the next ten years was 12.2% [95% CI: 10.3, 14.5] in the population of individuals recruited in GP practices in Schleswig-Holstein with a GP-suspected type 2 diabetes mellitus risk. The 205 participants who completed the program over the 15-month follow-up period reduced their body weight by 4.5 kg [CI-95%: -5.6, -3.4], their waist circumference by -5.7 cm [95%-CI: -6.5, -4.7], and their body mass index by 1.6 kg/m² [95%-CI: -2.0, -1.2].

Conclusion

aha!2.0 proved to be implementable in Schleswig-Holstein. Participants were able to reduce modifiable risk factors for type 2 diabetes mellitus during the 15-month follow-up. Data from 205 of the original 935 participants (21.9%) could be evaluated at the last follow-up. Future studies of lifestyle interventions related to reduction of behavioral risk factors of DMT2 in the primary care setting should evaluate the effect of adherence-enhancing interventions.

Building on the results of aha!2.0, the project Dimini – Diabetes mellitus? Not for me! followed, which was funded by the Innovation Fund at the Federal Joint Committee from 2017 to 2020.

Publication

Binder, S., Püschner, F., Bertram, N., Weber, V., Amelung, V. E., Göhl, M. & Petersen, C. (2019). Lebensstilintervention Aha!2.0 zur Reduktion von modifizierbaren Risikofaktoren des Diabetes mellitus Typ 2 bei Risikopersonen: eine Longitudinalstudie im Hausarztsetting in Schleswig-Holstein. Diabetologie Und Stoffwechsel. https://doi.org/10.1055/a-0903-2468

Foto: freepik

The white paper ” Care of Early Alzheimer’s Disease” examines the current state of research and highlights the causes, diagnosis, and treatment approaches of early Alzheimer’s disease.

The number of people affected by dementia in Germany is steadily increasing, with Alzheimer’s disease being the main cause in two-thirds of cases. Nevertheless, early Alzheimer’s disease is being diagnosed too rarely. Thus, the stigma associated with the disease keeps many people from seeing a doctor. The white paper “Care of Early Alzheimer’s Disease” deals with the current state of research and sheds light on causes, diagnostics and therapeutic approaches of early Alzheimer’s disease. In addition, the white paper provides proposed solutions to address existing and future care challenges. Experts consider prevention and early diagnosis to be crucial in this context.

At the beginning of the 2000s, Alzheimer’s disease could only be reliably diagnosed post-mortem by performing a brain autopsy. Today, the disease can be diagnosed prior to the onset of dementia. This became possible by detecting Alzheimer’s biomarkers, such as beta-amyloid or tau, in the cerebrospinal fluid or in positron emission tomography (PET), and likely in the near future also in the blood. These advances in Alzheimer’s research have far-reaching implications for the care of those affected and the reorganization of health care structures.

Among the most important learnings: Alzheimer’s care must start at an early stage. “We need interventions as early as possible to halt or slow the course of this progressive disease,” said Dr. Uwe Meier, chairman of the board of the Professional Association of German Neurologists (BDN) and a patron of the project. “In the case of advanced neurodegenerative degeneration, we can only accompany the course of the disease.”

In addition to the hope for pharmacological therapies, lifestyle aspects will also become more relevant in the future. “Whereas a decade ago dementia in Alzheimer’s disease was seen as a fateful event, today we assume that up to 40 percent of the risk of developing dementia depends on modifiable factors. It therefore seems possible to influence one’s own dementia risk by adopting an active and healthy lifestyle,” explains Prof. Dr. Frank Jessen, Director of the Department of Psychiatry and Psychotherapy at the University Hospital Cologne, who is a co-author and also a patron of the publication.

The National Dementia Strategy (NDS) signed by the German government in 2020 was an essential step. The task now is to set a new course in Germany to identify and treat early cognitive impairment and Alzheimer’s disease in a timely manner. The care of patients in the early stages of Alzheimer’s disease also requires significant effort. In the future, the care provision will also be concerned with ensuring that the expense of (differential) diagnostic procedures is appropriately remunerated and that appropriate structures are created. In addition, due to the expected growing needs, Alzheimer’s care will require a higher degree of networking between the treatment providers involved. In the view of the experts involved, pilot models, digital solutions and the expansion of outpatient memory clinics will therefore be key components of future care.

Publication

Free download of the white paper “Care of Early Alzheimer’s Disease” is available under: https://alzheimer-dialog.de/ (German language version only)

Transparency Note

The White Paper was prepared with the financial support of Biogen GmbH.

Physical activity has been shown to be one of the most important factors influencing mental and physical health, especially among elderly and high-aged people. However, the willingness to exercise declines with increasing age. At the same time, projections show that the number of elderly and high-aged people living in Germany will increase by 20 percent from 2015 to 2030.

This is one of the reasons why physical activity promotion is one of the priorities of the World Health Organization’s European Region Strategy for Physical Activity Promotion (2016-2025). This is also being addressed in Germany with the “Ich bewege mich – mir geht es gut!” (“I’m moving – I’m doing well!”) campaign.

The campaign, which is supported by the State Center for Health Promotion (LZG) in Rhineland-Palatinate e.V. in cooperation with the Rhineland-Palatinate Gymnastics Association and State Sports Association, provides information about the positive effects of physical activity in everyday life and is aimed at senior citizens. With the help of volunteer physical activity guides as multipliers, low-threshold physical activity programs close to home are to be implemented in public places and facilities and made easily accessible to the targeted group. The aim is to motivate the elderly and high-aged to engage in more physical activity and, at the same time, to prevent social isolation.

The aim of the evaluation, which will be conducted using the RE-AIM model, is to accompany the campaign in its implementation process, to provide support and to achieve a sustainability of the campaign. For this purpose, supporting and limiting factors are to be identified, which also consider the respective local conditions. Furthermore, the effect of the programs for the participating seniors will be examined.

The accompanying evaluation is funded by the SHI Alliance for Health – a joint initiative of the Statutory Health Insurance Funds for the further development of health promotion and prevention in life settings. The Federal Center for Health Education (BZgA) assigned the inav with the evaluation on behalf of the SHI Alliance for Health.

Photo: freepik

Around ten percent of children aged two to six are currently considered overweight and up to seven percent are considered obese. Overweight in early childhood is associated with the development of type 2 diabetes mellitus, lipid metabolism disorders, joint damage, high blood pressure, ischemic heart disease and bronchial asthma. Preventable risk factors, such as an unfavorable diet pattern and lack of exercise, as well as social disadvantages, are often responsible. They are especially manifested in children in families with a low social status. The risk of developing childhood obesity is three times higher here compared to peers with a high social status.

Daycare centers have become an essential environment for children outside the family. Therefore, they offer the opportunity to positively influence the development and course of health at an early age. The prevention concept Accredited Kindergarten for Physical Activity with the Plus Point Nutrition and the Add-on Module Mental Health (“Anerkannter Bewegungskindergarten mit dem Pluspunkt Ernährung”, ABmPE) includes programs for behavioral and environmental prevention and is intended to improve activity and nutrition behavior, especially in socially disadvantaged neighborhoods. Since the mental health of children is also of high relevance and the triad of contemporary health promotion for children is taught in a practice-oriented approach, these topics are complemented by the subject of mental health.

The ABmPE is an initiative of the state government of North Rhine-Westphalia (NRW) and the state’s statutory health insurance funds in cooperation with the NRW State Sports Association (Landessportbund NRW).

An already completed preliminary evaluation confirmed increased health awareness and improvements in physical activity and in food and beverage options at participating facilities.

The evaluation currently being conducted by the inav, funded by the SHI Alliance for Health and commissioned by the Federal Center for Health Education (BZgA), is focused, among other things, on the implementation of the mental health module. The aim is to highlight the benefits of the ABmPE project for the daycare centers and their providers, to demonstrate the effects of the nutrition element and to enable a sustainable implementation of the project.

Photo: freepic | nensuria

The aim of the project is to increase the individual adherence of patients with cystic fibrosis (CF, cystic fibrosis) on the basis of continuous telemonitoring and coaching in order to achieve a reduction in exacerbations and hospitalizations as well as an improvement in the quality of life. In addition, the strain on patients and their relatives caused by the time required for therapy shall be reduced.

In Germany, approximately 8,000 patients are affected by CF, an incurable genetic disorder. This rare disease affects the function of various organs, such as the liver, lungs and pancreas, and often causes irreversible damage in progress of the disease. The treatment of CF, which consists of daily inhalation and medication, is associated with an immense time investment on the part of those affected. As a result, only 30 to 50 percent of CF patients consistently comply with the therapy.

Patients with CF receive individual coaching to increase adherence, depending on their telemedically monitored therapy compliance. At the same time, telemedicine-enabled home spirometry is used to monitor the patient’s state of health (lung function). The attending physicians receive not only regular reports in preparation for an upcoming visit, but also indications of any deterioration via an alarm feature. This enables the physician to intervene at short notice with the aim of preventing a deterioration by adjusting the therapy. An integrated video consultation is available for this purpose, which can also be held at the patient’s request. In addition to the low-threshold intervention option, the video consultation also serves as a form of relief for patients and their relatives.

Methods

A randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of the project in terms of treatment adherence, quality of life, and health status. Due to the nature of the intervention (coaching, video consultation), blinding is not feasible for either patients or physicians. Qualitative interviews with physicians, patients and their relatives as well as a health economic evaluation will be conducted in order to quantify and demonstrate the potentials of the improvement.

Funding

The project is funded by the Innovation Fund over a period of 3.5 years with an amount of ca. 3.8 million euros.

Vulnerable groups often have a greater need for preventive health care, but they are significantly less likely to engage in prevention and health promotion services. To be able to reach vulnerable groups, the SHI Alliance for Health recommends implementing interventions at the communal level. The “Confidence Coach” project is aimed at vulnerable populations and is being implemented at the municipal level in Rhineland-Palatinate. The aim of the project is to promote the competence to act and the personal responsibility of these groups and to encourage them to adopt a health-conscious behavior. The project’s target group includes elderly people, people with disabilities, people with a migration background, single parents, as well as children and young people from families struggling with addiction and/or mental health. Within the framework of this project, the groups of people listed above are sensibilized to the topic of health and exercise by qualified trust coaches (VC) and motivated to participate in health-promoting and primary preventive activities, especially regarding physical activity. The VCs can be located within the local municipality, welfare organizations, clubs, adult education centers, social insurance institutions, religious communities, etc.

The evaluation of the project is funded by the SHI Alliance for Health – a joint initiative of the statutory health insurance funds for the further development of health promotion and prevention in living environments. The Federal Center for Health Education (BZgA) on behalf of the SHI Alliance for Health has appointed the inav to evaluate the project. The aim of the evaluation is to examine how the project is implemented in the communities or settings, with regard to, e.g., the activities of the VC, the participation of the vulnerable target groups in physical activity programs, and supporting or inhibiting factors. It will also present how the project reaches the vulnerable target groups and the extent to which physical activity programs stimulate health and behavioural changes. The data collection will be carried out by qualitative and quantitative methods using a mixed methods approach.

Photo: freepik | shurkin-son

A significant proportion of elderly people have a core need to be able to live self-determined and as independently as possible in their own homes. At the same time, elderly people living alone tend to get injured, for example by falling. To address this, the World Health Organization recommends building a supportive environment in which the elderly can live independently without any restrictions.

The project Community Nurse ^plus adresses people aged 80+ who live in their own homes and require support. The goal of this project is to maintain their participation and self-determined life for as long as possible.

The activities of the professionals focus on:

• Outreach, preventive, and health-promoting counseling through preventive home visits
• Referral to appropriate additional support programs
• Strengthening regional and social networks and support programs
• Activation of existing resources of the very old and their environment to meet the challenges of aging
• Participation in the needs-oriented advancement of the communal and socio-spatial infrastructure
• Identifying and communicating local opportunities for support and participation

The sponsors of the project, which is implemented at the municipal level, are the Ministry of Labor, Social Affairs, Transformation and Digitalization Rhineland-Palatinate (MASTD) and the Rhineland-Palatinate statutory health insurance funds and health insurance associations of AOK, BKK, IKK, vdek, Knappschaft, SVLFG. The project was already implemented and evaluated in its first phase from 2015 to 2018 and has been in a second project phase from 2019 to 2021, which is currently being evaluated.

The Federal Center for Health Education (BZgA) appointed inav to evaluate the project on behalf of the SHI Alliance for Health. The main objectives of the evaluation, which is based on the RE-AIM model, are to examine the density of programs and services offered to the target group, to evaluate the implementation and realization process (as well as facilitating and inhibiting factors), and to assess the effectiveness of the project with regard to the project’s target group, the very elderly aged 80 and older without an existing level of care (“Pflegegrad”).

The evaluation uses both qualitative and quantitative survey methods and is structured in three modules.

1. Module: Online survey of those responsible for the project and the professionals of Community Nurse ^plus
2. Module: Focus groups and telephone interviews with representatives of the project sponsors, the professionals, and the project supervisors
3. Module: Written survey of the very elderly

Photo: freepik

In Germany, adolescents have their first experiences with alcohol at an early age. In addition to personal reasons for drinking alcohol, there are structural conditions that promote or at least encourage adolescent consumption. A key factor influencing the consumptive behavior of adolescents is the availability of alcoholic beverages. Alcohol consumption can have serious health and social consequences. Despite the positive cumulative trend in recent years, the proportion of alcohol consumption that is associated with health risks has increased in Germany, particularly among young adults over the age of 18.

The prevention program “HaLT – Hard at LimiT” promotes quality-assured prevention of alcohol abuse by adolescents and young adults throughout Germany. The prevention program “HaLT – Hart am LimiT” stands for quality-assured prevention of alcohol abuse by adolescents and young adults throughout Germany. It is intended to promote the responsible consumption of alcohol. As of September 2020, there are 161 HaLT locations in 14 German states, operating under different organizational and financial frameworks. To ensure the quality of the nationwide program without losing sight of the individual needs of HaLT sites, the HaLT program has revised its framework. In the new module-based structure, additional modules and prevention programs have been integrated and quality management, quality development and network coordination aspects have been addressed. In addition, a new range of topics and target groups have been defined to be included in the HaLT program.

The evaluation of the HaLT program will not only include adolescents and young adults between the ages of twelve and 21, but also the professionals on site, multipliers, and the state and location coordinators of the program. The aim of the evaluation is to examine how the modules that have been developed around the new topics are implemented in the field and what facilitating and inhibiting factors are recorded during the implementation process. Data will be collected through qualitative and quantitative methods using a mixed-methods approach. In addition, the instruments of network and document analysis are used.

The evaluation during the implementation of the new framework concept is funded by the SHI Alliance for Health – a joint initiative of the statutory health insurance funds for the further development of health promotion and prevention in living environments. The Federal Center for Health Education (BZgA) has assigned the inav with the evaluation on behalf of the SHI Alliance for Health.

Photo: freepik | drobotdean

It is estimated that around six percent of all children and adolescents in Germany support their relatives in caring for a family member or bear the responsibility for care themselves. This is equivalent to approximately two adolescents per school class.

Often, this responsibility of support or care is experienced as stressful by the adolescents. In the long term, this can have a negative impact on the physical and mental health of the young people affected and, among other things, also negatively affect their educational opportunities or social life.

In order to avoid these negative effects and to strive for equal opportunities compared to peers without care responsibilities, the project “Truly irreplaceable” (“Echt unersetzlich”) pursues the goal of providing adolescents and young adults between the ages of 13 and 25 with a low-threshold counseling service. The counseling is provided free of charge and can be accessed via Internet, telephone, or on-site at the counseling center. The aim is to provide adolescents with hands-on and psychosocial counseling to support them in their everyday lives and living situations.

“Truly irreplaceable” is an initiative of the counseling center “Pflege in Not” (“Care in Need”) at Diakonisches Werk Berlin Stadtmitte e.V. (“Diaconal Service Berlin City Center”). The evaluation is sponsored by the SHI Alliance for Health – a joint initiative of the statutory health insurance funds for the further development of health promotion and prevention in living environments. The Federal Center for Health Education (BZgA) assigned the inav with the evaluation of the project on behalf of the GKV Alliance for Health. The main objective is to evaluate the training for professionals offered by”Truly irreplaceable” and the implementation of the counselling services.

For the collection of data, both qualitative and quantitative survey methods are used in a mixed methods approach. The evaluation focuses primarily on a process and outcome evaluation. This includes e.g. the evaluation of training courses for professionals and their implementation as well as the examination of existing obstacles for the practical implementation of the training contents. The evaluation also considers the perspectives of the individuals using the support services. In addition to counseling services, changes at the individual level are also considered. In addition, the outreach of the project is analyzed in association with the network and the public relations activities.

Photo: freepik | Yanalya

PANOS has the goal of sustainably improving the care of Parkinson’s patients in the region of Eastern Saxony. This is based on a digitally supported integrated and cross-sectoral care concept.

The care of people with chronic, age-related diseases such as Parkinson’s disease represents a core medical care challenge. The Saxony region is particularly affected in this regard: Firstly, the population has the highest average age in Germany, and secondly, more than 50 percent of the population lives in rural areas far from a highly diversified medical infrastructure.

The prevalence of idiopathic Parkinson’s syndrome will continue to increase with the demographic development. Today, there are already more than 32,000 Parkinson’s patients living in Saxony, 41 percent of these patients are not treated by neurologists but by general practitioners. In order to meet the increasing number of people affected and the increasing therapeutic requirements, it is necessary to join forces in a specialized care network.

Within the framework of PANOS, a digitally supported, intersectoral and pathway-based care concept is to be established in a sustainable manner. It focuses on the late phase of the disease. The basis for a standardized, quality-assured and efficient patient care is a structured medical pathway.

The treatment concept of PANOS is based on six pillars:

1. Network: Development of an intersectional and integrated care network
2. Care pathway: structure as the foundation of quality and efficiency
3. Intersectoral electronic medical record and digital sensors: digital innovation as base for collaborative pathway-based patient care
4. Parkinson’s disease guides as intersectoral case managers and personal points of contact for patients and service providers: the personnel backbone of the network
5. School for patients and further education as a foundation for standardized treatment: knowledge dissemination for patients and care providers
6. Evaluation: what are the effects of PANOS as a care delivery intervention?

In the PANOS project, the inav is particularly responsible for activities in the area of network and quality management. This includes the identification, prioritization and approach of potential network partners. The aim is to establish a lively network of actors involved in Parkinson’s care in Eastern Saxony. Furthermore, the inav gathers and processes data together with other consortium partners to ensure the network structure as well as the process and outcome quality.

PANOS is funded by the German government based on a decision of the German Bundestag. The project is also co-financed from tax revenues under the budget passed by the Saxon state parliament.

Further information

www.panos.care

The inav supports various Parkinson’s networks in Germany since 2020. Within the framework of the working group “Networks and Digital Care” of the German Society for Parkinson’s Disease and Movement Disorders, we manage networking activities on a national level. The Parkinson Network Germany will be a meta structure in the future, which will take over tasks of coordination, communication, quality assurance, public relations and nationwide networking.

Parkinson’s Network Conference 2022

An important forum for know-how transfer and networking among the regional networks is the Parkinson’s Network Conference, which took place for the third time in 2022. After the events in 2020 and 2021 were held online due to the pandemic, the 2022 conference took place in Berlin in person for the first time. A total of 100 participants attended the event at the Willy Brandt Haus, including physicians, therapists, scientists, and representatives of health insurers and industry.

In keynote speeches, panel discussions, workshops and sponsored symposia, the participants developed solutions for the challenges of Parkinson’s care. One of the topics discussed was the great importance of multi-professional cooperation at eye level, which involves all care providers for Parkinson’s patients. In addition to general practitioners, specialists and clinics, this includes, for example, physiotherapeutic and speech therapy practices, case managers, specialized nursing staff, pharmacies, providers of remedies and aids, and other initiatives such as exercise programs for Parkinson’s disease patients.

Another important point of discussion was also the remuneration of network tasks. “Parkinson’s networks play a decisive role in improving the care of Parkinson’s patients. But network tasks also involves more effort, and this should be remunerated. In the workshop, we discussed intensively how this could be done. A model could be the field of psychiatry, where such services have already become part of standard care,” said co-moderator Sebastian Wachtarz, Director Government Affairs & Public Affairs, AbbVie Deutschland GmbH & Co. KG.

Download the results report here (German language version).

On behalf of the working group “Networks and Digital Care” we would like to thank the conference sponsors for their support of the event.

Gold sponsor: AbbVie Deutschland GmbH & Co. KG

Silver sponsors: Esteve Pharmaceuticals GmbH, STADAPHARM GmbH

Bronze sponsors: Abbott Medical GmbH, Bial Deutschland GmbH, Boston Scientific Medizintechnik GmbH, Zambon GmbH

The next Parkinson’s Network Congress is scheduled for December 2-3, 2023.

In January 2020, the German Bundestag (Parliament) passed a number of reforms to the legislation on organ donation. The so-called decision solution that has existed to date remains unchanged. However, in the future, the discussion and education about organ and tissue donation will be promoted and the personal decision will be better documented. As part of the Act to Encourage the Willingness to Donate Organs, an online registry is to be set up and general practitioners will be given the opportunity to provide their patients with open and unbiased advice on organ and tissue donation every two years.

In light of these changes, the Federal Centre for Health Education (BZgA) aimed to update the existing information material for general practitioners and to include the needs of general practitioners in the revision process in order to ensure maximum acceptance within the target group.

The aim of the evaluation was to have the contents of the brochure “Information on Organ and Tissue Donation. A Guideline for General Practitioners” reviewed by the target group. The intention was to analyze the support needs of general practitioners on the subject of organ and tissue donation and to determine which form of presentation the target group would prefer. The evaluation was commissioned by the Federal Center for Health Education (BZgA).

Both qualitative and quantitative survey methods were used in a mixed methods approach. This included assessing the target group’s views on the potential for optimizing the presentation of the brochure and its content. In addition, potential needs for support and the practicability of various forms of presentation were surveyed.

Photo: freepik | tirachardz