Austrian Health Research Articles

Aging well? Exploring self-reported quality of life in the older Austrian population

Abstract Background The increase of life expectancy around the world sets an ageing society with all its challenges on the global Public Health agenda. In Austria, the additional years of life gained are not spent in good health, as the healthy life expectation is far below the European average. This study aimed to examine the change in self-reported quality of life (QoL) over time in the Austrian older-aged population and explore associated factors. Methods Repeated cross-sectional data was retrieved from three waves of the Austrian Health Interview Survey conducted in 2006, 2014 and 2019, including a total of 10 056 participants aged 65 years and above. To estimate QoL in this age group, domain scores of the WHOQOL-BREF were used. Trends in QoL were descriptively analysed across different age groups, sex and survey years. Adjusted Wald tests were conducted to compare means of older women and men. Linear regression models were estimated to explore the impact of age, sex, family status, education, income, residence and survey year on QoL domains. Results While WHOQOL-BREF domain scores increased over time, a steady decrease with age was observable in all survey waves. Mean scores were significantly higher in men than in women in all QoL domains and in each survey year except for the social domain. In the regression analyses, sex differences disappeared in most domains after adjusting for income and education. Factors associated with significantly higher QoL scores in all domains included younger age, higher education, higher income and living in Western Austria. Conclusions Observed sex differences in QoL seem to be driven mainly by income and education differences in the older-aged Austrian population. Following the WHO's and UN's 10-year global plan of action - The United Nations Decade of Healthy Ageing 2021-2030 - further efforts towards developing sustainable strategies and policies to reduce socioeconomic inequalities also with attention to sex/gender gap are strongly needed. Key messages • This study provides a first in-depth analysis of quality of life in Austrian senior citizens. • Younger age, higher education, higher income and living in Western Austria are associated with better quality of life.

Austrian Health Expenditure Projections and Excess Health Expenditure due to COVID

Abstract According to System of Health Accounts (SHA) data total health expenditures in Austria have grown on average by 3.9% per year from 2000 to 2019. This was followed by high growth rates of 5.1% and 11.9% in 2020 and 2021, respectively. The steep increase was caused by the global COVID-19 pandemic. However, quantifying the effect of the pandemic on health expenditures is not straightforward and significant uncertainties remain about how future health expenditures will be affected and how they can most accurately be projected, particularly given recent high economic uncertainties. In this project we developed several models to predict Austrian health expenditures. Most importantly, we compare models based on demand and cost driving factors with a simple GDP-linked model. We assess the performance of the different models by predicting past health expenditure data up to 2019. Comparing the model predictions for the pandemic years with the actual SHA data provides an approach to estimate the net impact of the pandemic. Several different dynamics play a role in how COVID-19 has been affecting health expenditures. We find that the pandemic has caused sizeable one-time costs in the years 2020-2022, but “regular” health expenditures partially decreased during that time due to forgone elective and preventive care. As COVID-19 becomes an endemic disease it also becomes an additional long-term burden on the health system, but the main driver of health expenditure is currently inflation. The shock of the pandemic has created a structural break for the health sector with many not yet well-known consequences such as systematic changes in work conditions or salaries for health sector employees. With the currently available data and information, many of these effects cannot be directly built into the prediction models. However, we compare our models in their projections of future health expenses until 2030 with past projections from 2019 for the year 2030 under different scenarios. Key messages • The pandemic has caused sizeable one-time costs in the years 2020-2022, but “regular” health expenditures partially decreased during that time due to forgone elective and preventive care. • As COVID-19 becomes an endemic disease it also becomes an additional long-term burden on the health system, but the main driver of health expenditure is currently inflation.

Regional Health Coordination: An evaluation of the first pilot training program in Lower Austria

Abstract Background Starting from 2018, the University of Krems and ‘Tut gut!’ Gesundheitsvorsorge GmbH have jointly implemented the two-year academic program ‘Regional Health Coordination’, which trains students to become a Regional Health Coordinator (RHC). It is funded by the Lower Austrian Health and Social Fund. We evaluated the pilot-program and the work of the RHC in the first two years after graduation. The objectives of the evaluation were to provide 1) a basis for further development of the academic program and 2) an assessment of the achievement of the program objectives. Methods The evaluation ran from 2018 to 2022 and followed a mixed-methods approach. Qualitative interviews and focus groups with stakeholders, document analyses of annual RHC activity reports and repeated written community surveys in 13 municipalities were conducted. Results The evaluation showed that RHCs already bundled health promotion (HP) activities and worked on their HP network within the municipalities during the practical training period. HP was given a higher priority in some municipal administrations. The pilot program was consistently rated positively, and the curriculum was optimized. In the first two years after graduation, the RHCs developed and implemented HP measures and endeavoured to engage citizens. However, genuine involvement was rare. The results showed that future HP interventions should especially target older people, less educated and male citizens. RHCs were seldomly involved in health policy decisions, although they often worked with mayors. Personal characteristics, an existing network in the community and support from the local government were success factors for the work of the RHCs. Conclusions RHCs play an important role in the coordination of community HP but should be stronger included in local policy decision-making. Citizens should be more involved in planning and implementing HP measures. Key messages • An academic training program for regional health coordination helped to improve community health promotion. • An existing network and the involvement in the local government facilitated the work of graduated regional health coordinators.

S11-5 Recruitment of physically inactive adults to participate in the standardized program Jackpot.fit. Which strategies within the health system work?

Abstract Purpose The Jackpot.fit program was developed by the Austrian health insurance funds and the organized sport with the aim of offering a standardized training for physically inactive adults. The first semester is free of charge. The original idea was that health insurance companies would use different strategies to recruit participants and that organized sports would offer the standardized program in local sports clubs. In this context, we wanted to investigate which recruitment strategies work well. Methods In one region of the province of Styria (Austria), we wanted to offer a dense network of Jackpot.fit classes, as the sports program was to take place close to home. Adults who signed up for Jackpot.fit received an online questionnaire. One question asked: “How did you find out about Jackpot.fit?” Ten answers were available for selection, with multiple responses possible. Responses could be categorized into four areas: Information from the health care system, from the community, from the sports clubs, and from friends/acquaintances. The questionnaire was sent to 394 persons and 133 (34%) completed it (mean age 56 ± 9 years, 73% women). Results One health insurance company sent letters to its insured, which was the most successful strategy (mentioned by 33 participants = approximately 25%). The second best strategy is word of mouth through friends/acquaintances (28 participants). Other good recruitment strategies are the community newspaper (23 participants), and activities of the sports club trainer (19 participants). 437 general practitioners working within a 10 km radius of a Jackpot.fit course were informed in writing about Jackpot.fit and were asked to inform their inactive patients participating in Jackpot.fit. However, of the 133 participants, only 3 indicated that their primary care physician informed them about the program. Conclusion Health insurance companies can successfully recruit physically inactive adults with a letter to a standardized sports club program near their home. Community information channels and word of mouth have also been successful. Although the network of general practitioners working in the region is dense, written information about the program was not a successful recruitment strategy. Therefore, different recruitment approaches by different actors seem to work best.

Digital Health Applications (DiHA): Approaches to develop a reimbursement process for the statutory health insurance in Austria

PurposeTo elaborate a concept for implementing digital health applications (DiHA), including prioritisation criteria (PC) for the Austrian context and an overview of available prioritised DiHAs. MethodsBased on European DiHA-listings and input by Austrian experts, a categorised meta-directory of DiHAs was created. PC were developed to reflect, inter alia, the provisions of the Austrian General Insurance Act, and were applied to the meta-directory to identify DiHAs potentially relevant for the Austrian statutory health insurance. An iterative process with expert involvement was used to tailor an existing reimbursement framework to the Austrian setting. ResultsThe meta-directory comprised 132 DiHAs. Developed PC focused on plausibility (German language) and legal aspects (treatment/monitoring of chronic conditions), while other criteria (e.g. interoperability standards) were considered optional. After applying the PC, 38 DiHAs were potentially relevant in the Austrian setting. Of these, only seven supported current health record integration. Most of the prioritised DiHAs reported on CE marking (29/38) and data protection (35/38), while reporting on risk class (10/38) and technical algorithms (0/38) was sparse. For DiHA reimbursement, a four-step process is proposed: identification (ideally based on needs assessment); filtering based on PC; review of technical, regulatory and evidentiary requirements; and health technology assessment. ConclusionThe proposed concept can offer guidance for policy makers (e.g., on prioritising available DiHAs) and may further foster scientific debate with regard to DiHA implementation. Further discussion on how to fully incorporate regulatory, technical, and evidentiary criteria is needed. Attention should be given to national implementation requirements, re-assessment criteria, and appropriate remuneration schemes.

Healthcare utilization and outcomes in atrial fibrillation patients treated by drug therapy versus a catheter ablation strategy

Abstract Funding Acknowledgements Type of funding sources: None. Background and Aims Atrial fibrillation (AF) is the most prevalent arrhythmia, associated with increased mortality and morbidity and causing relevant costs. Treatment options consist of catheter ablation (PVI) and rate or rhythm control drugs (non-PVI). Methods We analyze inpatient and outpatient data from the Upper Austrian Health Insurance Fund. Data of patients with a first hospitalization for AF in the years 2005 to 2018 were examined, using propensity score matching (PSM) including all CHA2DS2-VASc variables and working collar. Results Out of 21,791 AF patients, PSM identified 1,013 well-matching pairs (PVI and non-PVI). Over a ten-year period, the PVI treatment strategy group reveals significantly higher inpatient and outpatient expenditures (€2,200/year). Positive economic effects can be demonstrated by a 5.1 percentage points (pp) higher employment rate and fewer retirements (7.6pp). Utmost important is the 5.8pp all-cause mortality reduction over 10 years in the PVI treatment strategy. Conclusions A PVI based treatment strategy results in higher healthcare expenditures vs. drug therapy alone. Most of these higher costs are caused by the PVI procedures during this period. Thus, more effective and efficient methods are needed to further reduce costs for the intervention and prevent repeat procedures. The benefit of a PVI treatment strategy is seen in higher employment rates, which is crucial from a societal perspective and should be a strong argument for caregivers. We show a significant reduction in all-cause mortality, which we partly attribute to the PVI procedure itself, to a stricter risk factor assessment and treatment, and a tighter medical adherence.

Socio-economic inequality and healthcare costs over the life course – A dynamic microsimulation approach

ObjectivesAlthough there is well-established evidence for the existence of socio-economic inequalities in virtually all dimensions of health, little is known about the implications of these socio-economic disparities for healthcare costs from a cumulative life course perspective. Accounting for differentials in healthcare use patterns and mortality, we assess how lifetime costs differ between socio-economic groups. Study designThis study used dynamic microsimulation modelling. MethodsCombining price weights for healthcare services with information on healthcare consumption from the 2014 Austrian Health Interview Survey (n = 15,771), we calculated average cost profiles by gender, age and education consistent with aggregate System of Health Accounts. A dynamic microsimulation model was used to project cumulative healthcare costs over the entire lifecycle for the 2019 birth cohort in four different scenarios to illustrate the influence of the different cost determinants on lifetime costs. ResultsBefore considering social inequalities in mortality, men with compulsory education have close to 66% higher lifetime costs than men with tertiary education; for women, the difference is close to 20%. Accounting for longevity differentials reduces this gap to approximately 40% for men and 10% for women. Closing the gap in healthcare use and in longevity between socio-economic groups would reduce lifetime healthcare expenditure by 4.1% in the 2019 birth cohort and by 19% in the whole population. ConclusionsAccounting for mortality differentials between socio-economic groups has a large impact on estimated lifetime healthcare costs. Reducing social inequalities in health can contribute to containing healthcare expenditures against the backdrop of rising life expectancy.

Machine Learning Based Risk Prediction for Major Adverse Cardiovascular Events for ELGA-Authorized Clinics1.

Artificial Intelligence (AI) has had an important impact on many industries as well as the field of medical diagnostics. In healthcare, AI techniques such as case-based reasoning and data driven machine learning (ML) algorithms have been used to support decision-making processes for complex tasks. This is used to assist medical professionals in making clinical decisions. A way of supporting clinicians is providing predicted prognoses of various ML models. Training an ML model based on the data of a hospital and using it on another hospital have some challenges. In this research, we applied data analysis to discover required data filters on a hospital's EHR data for training a model for another hospital. We applied experiments on real-world data of ELGA (Austrian health record system) and KAGes (a public healthcare provider of 20+ hospitals in Austria). In this scenario, we train the prediction model for ELGA- authorized health service providers using the KAGes data since we do not have access to the complete ELGA data. Finally, we observed that filtering the data with both feature and value selection increases the classification performance of the prediction model, which is trained for another system.

From cradle to public care: The Austrian health care system and psychoanalysis

AbstractIn the following text the Austrian health system will be presented as well as its current model for training psychoanalysts. In Austria, everyone has an equal right to health insurance, no matter whether they are working or unemployed, on maternity leave or legally approved as refugees. With regard to psychotherapy, 24 psychotherapeutic modalities are currently recognized by the Austrian health care system. Patients can rely on a partial or full reimbursement when they engage in psychotherapy, no matter what modality they choose. Most training institutions and universities have walk‐in clinics where the general public and students can make their first contacts with psychotherapy. There are also psychoanalytic clinics, specifically tailored towards women, children and refugees at very low or no cost to them. If a patient can obtain a Kassenplatz at a psychoanalyst, s/he can benefit from long‐term therapy that is largely refunded by the Austrian State insurance company.

Digitalisierung in der Rinderpraxis – Ergebnisse einer Online-Umfrage in Österreich

The use of digital technologies is increasing in modern livestock farming and veterinary practice. The aim of this online survey among Austrian cattle practitioners was to increase knowledge concerning the acceptance and use of digital (sensor) technologies. The link to the survey was sent by the Austrian animal health services (TGD) via email to the registered veterinarians. A total of 115 veterinarians participated in the survey. Most of the participants were convinced that digitalisation associated with improvements in their profession in terms of economy, time-savings, collaboration with colleagues and working efficiency. The agreement ranged between 60% and 79%. On the other hand, concerns regarding data security (41%) were also raised. When asked whether they would recommend sensor systems to farmers, approximately 45% of the participants answered yes, 36% declined, 19% were undecided. From a list of specified sensors and technologies, monitoring by cameras (68%), automatic concentrate feeding systems (63%) and activity sensors (61%) were considered as beneficial for animal health. Concerning an assessment of the animals' health status the majority of respondents (58%) would trust conventional methods more than sensor systems. Data provided by farmers is mainly used to improve the understanding of patients' disease progression (67%) as well as to comply with documentation requirements (28%). In addition, we asked whether the participants could imagine running a telemedicine practice. On a scale ranging from 1 to 100, initial agreement amounted to a median of 20 which then decreased to a median of 4 in the repeated question at the end of the questionnaire. The veterinarians saw advantages in using digital technologies both in their daily work and to improve animal health management. In some areas, however, clear reservations were evident . A telemedical offer does not seem to be relevant for the majority of the participants in the context of the description provided. The results are intended to help identify areas in which more information is needed for veterinarians and to capture a picture of opinions that could be relevant for the changing collaboration between farmers and veterinarians.

The Impact of COVID-19 on Forensic Rehabilitation in Austria

IntroductionIn general, forensic psychiatric patients experience major restrictions of freedom. To mitigate the risk for the coronavirus disease 2019 (COVID-19), even more restrictions were implemented in Austrian mental health institutions in 2020. Besides potential deterioration of psychopathological symptoms, exaggerated freedom-restricting measures may limit the forensic rehabilitation of offenders.ObjectivesGiven that rehabilitative efforts and social visits were suspended for more than a year, this study aimed to evaluate the impact of the COVID-19 pandemic on the psychosocial rehabilitation of forensic psychiatric patients.MethodsThis retrospective longitudinal observational study evaluated institutional data before and after the enactment of freedom-restricting measures in an Austrian forensic mental health institution. Data were obtained from 97 offenders treated at the institution Justizanstalt Göllersdorf during two time periods (January 2019 – March 2020 and March 2020 – May 2021). Statistical differences between both periods were assessed by means of Wilcoxon signed-rank tests. Study outcomes included the number of visits by relatives and legal guardians as well as rehabilitative activities.ResultsAfter the outbreak of the pandemic, access to penal institutions was limited for external visitors, which led to a decrease in visits by relatives (1440 vs. 394, p < .001) and legal guardians (286 vs. 122, p = .003). Further, the total number of one-day temporary releases of patients (64 vs. 3, p < .001) and group excursions (103 vs. 10, p < .001) decreased in the second study period.ConclusionsFocusing on social contacts and rehabilitative activities, this study highlights the impact of the current pandemic in forensic psychiatry. While COVID-19-related protective measures may reduce the risk for disease transmission, enforced quarantine and other restrictions of freedom impair the rehabilitation of forensic psychiatric patients. This implies the necessity for guidelines to uphold an appropriate standard of care during future pandemics.Disclosure of InterestNone Declared

The motility of posted workers during the COVID-19 pandemic: policies, trends and worker experiences in Austria

PurposeTo analyse the policies, posting trends and worker experiences during the pandemic, this study uses the concept of motility, i.e. workers' mobility capital, and examines how posted workers' geographical mobility, their access to and conditions of employment and social protection were impacted. The authors discuss how the measures against the pandemic undertaken at the European Union (EU) and national level have affected labour mobility, the impact these measures have had on macro trends of posting to Austria, and lastly, how the pandemic and the actions against it have influenced the lives of posted workers at the individual level.Design/methodology/approachIn this article, the authors focus on the specific case of posting to Austria. The authors ask whether, and if so, how EU and national policies which came about during the COVID-19 pandemic influenced the motility of posted workers, and how these workers used their mobility capital in this unfolding context. The authors address the research questions with analyses of EU and national level policies, use administrative data on posting, and individual-level data based on interviews with posted workers and public authorities.FindingsThe authors find that the Austrian government's public health and economic priorities were jointly influential on the motility of cross-border workers. The specific case of the posted workers shed new light on the limits to such a national sovereignty approach when it comes to economic interests in an increasingly interdependent European labour market. This study’s findings show that despite the access provided at the policy levels, the motility of posted workers was also affected by their individual circumstances, or competences, which produced different forms of appropriation.Originality/valueThe authors apply the theoretical framework of motility by studying policy developments through the element of access options and conditions, and the posting trends to Austria and worker experiences at the individual level through the lenses of appropriation and competences. The authors find that while the EU and national public policy in enhancing access options have been successful during the COVID-19 period, amelioration attempts in access conditions have not been realised as observed in our analysis of the competence and appropriation dimensions of the posted workers in Austria. This highlights the need for a more integrated approach in the study of policies by exploring beyond the national and EU level policies and focussing on the implementation and observations at the individual level.

Heterogeneity in the Utilization of Fecal Occult Blood Testing and Colonoscopy among Migrants and Non-Migrants in Austria: Results of the Austrian Health Interview Survey

Many European studies report lower participation in colorectal cancer screening among migrants than non-migrants. A major limitation of these studies is that usually, the heterogeneity of migrants cannot be accounted for. The aim of this investigation was to examine differences in the utilization of fecal occult blood testing and colonoscopy between non-migrants and the five largest migrant groups residing in Austria using data from the Austrian Health Interview Survey 2019. The two outcomes were compared between non-migrants and migrants using multivariable logistic regression adjusted for socioeconomic and health variables. Migrants from a Yugoslav successor state (OR = 0.61; 95%-CI: 0.44–0.83), Turkish (OR = 0.35; 95%-CI: 0.22–0.55), Hungarian (OR = 0.37; 95%-CI: 0.16–0.82) and German migrants (OR = 0.70; 95%-CI: 0.51–0.98) were less likely to have used a fecal occult blood test compared to non-migrants. Participation in colonoscopy was lower among Turkish migrants (OR = 0.42; 95%-CI: 0.27–0.67) and migrants from a Yugoslav successor state (OR = 0.56; 95%-CI: 0.42–0.75) than among non-migrants. The findings are consistent with studies from other countries and highlight barriers migrants face in accessing the health care system. To address these barriers, the heterogeneity of the population must be taken into account when developing educational materials in order to promote informed decisions about whether or not to participate in colorectal cancer screening.

The effect of antibiotic versus no treatment at dry-off on udder health and milk yield in subsequent lactation: A retrospective analysis of Austrian health recording data from dairy herds.

Bovine mastitis is the most commonly diagnosed disease of dairy cows worldwide and causes extensive economic losses to milk producers. Intramammary infection status before dry-off plays a decisive role with respect to udder health and milk yield in the subsequent lactation. The aim of this study was to compare the effect of antibiotic dry cow therapy (DCT) versus no treatment at dry-off on milk yield, somatic cell count (SCC), inflammation of the mammary gland (IMG), and the incidence of clinical mastitis in the subsequent lactation. Dairy herd data from 251 Austrian dairy farms were recorded over an observation period of 12 mo and subsequently analyzed. The data set included 5,018 dairy cows: 2,078 were treated with antibiotics (abDCT group) and 2,940 were not treated (noDCT group) at dry-off. The abDCT group was subdivided, based on the antimicrobial active substances used for drying off, into 4 different groups (penicillins, cloxacillin, cephalosporins, and rifaximin). Based on bacteriological culture results, infections were grouped into those caused by major, minor, and other pathogens. Additionally, the IMG was defined via SCC from milk recording data using a cutoff of 200,000 cells/mL before drying off and after calving. The incidence of clinical mastitis cases within 30 and 90 d in milk was calculated using veterinary diagnosis data. To investigate the effect of different dry cow therapies on the following parameters: milk yield, SCC, and diagnosed clinical mastitis cases, different linear mixed models were constructed. Overall, the abDCT group was determined to have a significantly higher milk yield over 305 d in milk in the subsequent lactation (increase of 6.18%), compared with the noDCT group (increase of 4.29%). Both groups (abDCT and noDCT) demonstrated a decrease in the first SCC after calving compared with the SCC before dry-off, although the treated cows had a significantly higher reduction. Regarding the different antibiotic groups, with exception of the rifaximin treated cows, all antibiotic groups showed a significant difference from not treated cows with respect to SCC. Additionally, we were able to demonstrate that cows with IMG before dry-off had a 2.073 times higher chance of an increased SCC (>200,000 cells/mL) after calving. With respect to the veterinary diagnosis data, neither the IMG before drying off nor the type of DCT had a significant influence on the probability of developing clinical mastitis within 30 or 90 d in milk. Only a small number of treatments was accompanied with a bacteriological examination before drying off. However, the existing data in this study indicates that the intramammary infection status before dry-off in combination with different dry cow treatments influences udder health and milk yield after calving. Nevertheless, further studies with larger data sets of bacteriological examinations are necessary to enable a more in-depth investigation into the effects of different antibiotic substances used for DCT.

Simvastatin therapy in higher dosages deteriorates bone quality: Consistent evidence from population-wide patient data and interventional mouse studies

BackgroundCombining mouse experiments with big data analysis of the Austrian population, we investigated the association between high-dose statin treatment and bone quality. MethodsThe bone microarchitecture of the femur and vertebral body L4 was measured in male and ovariectomized female mice on a high-fat diet containing simvastatin (1.2 g/kg). A sex-specific matched big data analysis of Austrian health insurance claims using multiple logistic regression models was conducted (simvastatin 60–80 mg/day vs. controls; males: n = 138,666; females: n = 155,055). ResultsHigh-dose simvastatin impaired bone quality in male and ovariectomized mice. In the trabecular femur, simvastatin reduced bone volume (µm3: ♂, 213 ± 15 vs. 131 ± 7, p < 0.0001; ♀, 66 ± 7 vs. 44 ± 5, p = 0.02) and trabecular number (1/mm: ♂, 1.88 ± 0.09 vs. 1.27 ± 0.06, p < 0.0001; ♀, 0.60 ± 0.05 vs. 0.43 ± 0.04, p = 0.01). In the cortical femur, bone volume (mm3: ♂, 1.44 ± 0.03 vs. 1.34 ± 0.03, p = 0.009; ♀, 1.33 ± 0.03 vs. 1.12 ± 0.03, p = 0.0002) and cortical thickness were impaired (µm: ♂, 211 ± 4 vs. 189 ± 4, p = 0.0004; ♀, 193 ± 3 vs. 169 ± 3, p < 0.0001). Similar impairments were found in vertebral body L4. Simvastatin-induced changes in weight or glucose metabolism were excluded as mediators of deteriorations in bone quality. Results from mice were supported by a matched cohort analysis showing an association between high-dose simvastatin and increased risk of osteoporosis in patients (♂, OR: 5.91, CI: 3.17–10.99, p < 0.001; ♀, OR: 4.16, CI: 2.92–5.92, p < 0.001). ConclusionHigh-dose simvastatin dramatically reduces bone quality in obese male and ovariectomized female mice, suggesting that direct drug action accounts for the association between high dosage and increased risk of osteoporosis as observed in comparable human cohorts. The underlying pathophysiological mechanisms behind this relationship are presently unknown and require further investigation.

Healthcare Utilization and Outcomes in Atrial Fibrillation Patients Treated by Drug Therapy versus a Catheter Ablation Strategy-A Middle European Propensity Score Matched Cohort Study.

Atrial fibrillation (AF) is the most prevalent arrhythmia, associated with increased mortality and morbidity and causing relevant costs. Treatment options consist of catheter ablation (PVI) and rate or rhythm control drugs (non-PVI). We analyze inpatient and outpatient data from the Upper Austrian Health Insurance Fund. Data of patients with a first hospitalization for AF in the years 2005 to 2018 were examined, using propensity score matching (PSM) including all CHA2DS2-VASc variables and working "collar". Out of 21,791 AF patients, PSM identified 1013 well-matching pairs (PVI and non-PVI). Over a ten-year period, the PVI treatment strategy group reveals significantly higher inpatient and outpatient expenditures (€2200/year). Positive economic effects can be demonstrated by a 5.1 percentage points (pp) higher employment rate and fewer retirements (7.6pp). Of utmost important is the 5.8pp all-cause mortality reduction over 10 years in the PVI treatment strategy. A PVI based treatment strategy results in higher healthcare expenditures vs. drug therapy alone. Most of these higher costs were caused by the PVI procedures during this period. Thus, more effective and efficient methods are needed to further reduce costs for the intervention and prevent repeat procedures. The benefit of a PVI treatment strategy is seen in higher employment rates, which are crucial from a societal perspective and should be a strong argument for caregivers. We show a significant reduction in all-cause mortality, which we partly attribute to the PVI procedure itself, to a stricter risk factor assessment and treatment, and a tighter medical adherence.

The Austrian Health Information System “ÖGIS” – supporting implementation of the Public Health Action Cycle in Austria

The Austrian National Public Health Institute (GÖG) started to develop the Austrian Health Information System (ÖGIS) by combining technology of Geographic Information Systems (GIS) and common approaches of epidemiology in the early 1990ies. Today, ÖGIS is designed as a specific GIS-application, continuously maintained and developed further by in-house development within GÖG and accessible to all employees of GÖG as well as to interested external institutions and persons. ÖGIS covers all major data sources relevant to health, health determinants and the health care system in Austria. It is used for epidemiological research, health reporting, health services monitoring and research as well as for integrated planning of the health care system. After ÖGIS has proven itself as a useful support for implementation of the Public Health Action Cycle in Austria over many years, the maintenance of the ÖGIS databases will be continued and the employment of ÖGIS for purposes of regional health services research will be intensified in the upcoming years.

Undersupply of child and adolescent psychiatric outpatient clinics in Austria that can meet minimum requirements

This article is intended to provide an overview of the supply situation with independent outpatient clinics and dislocated Hospital ambulances for Child and Adolescent Psychiatry, taking into account minimum professional standards. The level of care, the mandate to provide care, requirements, structural quality criteria and implementation recommendations are described. 13outpatient clinics and dislocated Hospital ambulances are described in a data matrix.Acomprehensive Austria-wide survey of the staffing and care offerings identified 13 outpatient clinics and outpatient clinics that meet minimum standards. This proves a difference between the current situation and the number of outpatient clinics required nationwide of 26 to 36 (depending on the assessment 1/350k or 1/250k)Thus, the findings provided here, lead us to the conclusion that the patient care in Austria's child and adolescent psychiatric outpatient clinics is not sufficiently guaranteed due to the largely tolerated but technically incorrect interpretation of the legally valid minimum standards.If the current deficiencies are retained, acentral child and adolescent psychiatric care level remains with an effectiveness of less than 50% of the Austrian health structure plan (OSG).

The Timing of Pregnancies After Bariatric Surgery has No Impact on Children’s Health—a Nationwide Population-based Registry Analysis

PurposeBariatric surgery has a favorable effect on fertility in women. However, due to a lack of data regarding children’s outcomes, the ideal time for conception following bariatric surgery is unknown. Current guidelines advise avoiding pregnancy during the initial weight loss phase (12–24 months after surgery) as there may be potential risks to offspring. Thus, we aimed to analyze health outcomes in children born to mothers who had undergone bariatric surgery. The surgery-to-delivery interval was studied.Materials and MethodsA nationwide registry belonging to the Austrian health insurance funds and containing health-related data claims was searched. Data for all women who had bariatric surgery in Austria between 01/2010 and 12/2018 were analyzed. A total of 1057 women gave birth to 1369 children. The offspring’s data were analyzed for medical health claims based on International Classification of Diseases (ICD) codes and number of days hospitalized. Three different surgery-to-delivery intervals were assessed: 12, 18, and 24 months.ResultsOverall, 421 deliveries (31%) were observed in the first 2 years after surgery. Of these, 70 births (5%) occurred within 12 months after surgery. The median time from surgery to delivery was 34 months. Overall, there were no differences noted in frequency of hospitalization and diagnoses leading to hospitalization in the first year of life, regardless of the surgery-to-delivery interval.ConclusionPregnancies in the first 24 months after bariatric surgery were common. Importantly, the surgery-to-delivery interval had no significant impact on the health outcome of the children.Graphical

Assertive care as new treatment perspective for Austria

Although intensive, assertive treatment options in child and adoledcent psychiatry have been successfully evaluated and established in several countries, this development is just beginning in Austria. As part of the so called home-treatment, care is provided by amultiprofessional team to patients with severe mental disorders, who would otherwise be treated in an inpatiet setting at their own home. This opens up the opportunity for abetter generalizability of therapeutic progress and an intensive work with the family system. Alternative models for inpatient care like home-treatment, show the potential for intensive therapeutic options independent of building structures. Further development of this therapeutic option based on evaluated model projects is desirable within the Austrian health care system.