Wirksamkeit und Nutzen eines Screeningverfahrens zur Identifikation von rehabilitationsbedürftigen Personen mit Diabetes mellitus Typ 2: eine randomisierte, kontrollierte Evaluationsstudie unter Versicherten der Hamburg Münchener Krankenkasse

Abstract

In Germany, medical rehabilitation has to be initiated by the members of health insurances. This often leads to delays in the application for and provision of rehabilitation services. Within a randomised controlled trial, a statutory health insurance evaluated a programme aimed at the prevention of activity limitations and restrictions of social participation in patients with type 2 diabetes. Firstly, potential persons with type 2 diabetes were identified. Secondly, their need for a medical rehabilitation was screened using a postal questionnaire. Thirdly, eligible participants were advised to apply for a medical rehabilitation. Potential study participants were identified by the health insurance via diabetes-specific data on hospital stays, work disability and medical prescriptions. Eligible persons were asked for written informed consent and received a screening questionnaire assessing their need for a medical rehabilitation. Respondents indicating need for a rehabilitation according to the algorithm were randomly allocated to an intervention group (IG) or control group (CG). The IG was actively advised to apply for a medical rehabilitation together with information about their individual risks; CG members received usual care. Twelve months after baseline the participants completed a postal follow-up questionnaire on social participation (primary outcome) and subjective health status (secondary outcome). In addition, the health insurance provided data on hospital treatment and sick leave (cases, days). Of 471 insurants with type 2 diabetes who gave written informed consent, the algorithm identified 223 cases with a rehabilitation need. The follow-up questionnaire was completed by 84.5% (IG: n=91, CG: n=93). Although the attendance in medical rehabilitation was low (IG: 25%), an intention to treat analysis showed significant advantages for the IG members compared to the CG (e.g., reduced body mass index, increased disease knowledge, reduced depressive mood and eating disorders). The IG members seemed to benefit at least slightly from the procedure carried out (screening plus recommendation). As in previous studies, the feasibility of randomised controlled trials to evaluate a complex public health intervention was demonstrated.