Coronary Heart Disease In Germany Research Articles

Cost-effectiveness of incentives for physical activity in coronary heart disease in Germany: pre-trial health economic model of a complex intervention following the new MRC framework

ObjectivesThe German Incentives for Physical Activity in Cardiac Patients trial is a three-arm, randomised controlled trial for secondary prevention of coronary heart disease (CHD). Guidance for developing complex interventions recommends...

Use of guideline-recommended drug therapy in patients undergoing percutaneous coronary intervention for stable coronary heart disease in Germany: a multilevel analysis of nationwide routine data

ObjectivesTo determine the prescription of guideline recommended drug therapy in patients with stable coronary heart disease (sCHD) prior to percutaneous coronary intervention (PCI) in Germany and to examine the role...

Health system responsiveness and chronic disease care – What is the role of disease management programs? An analysis based on cross-sectional survey and administrative claims data

Health system responsiveness is an important aspect of health systems performance. The concept of responsiveness relates to the interpersonal and contextual aspects of health care. While disease management programs (DMPs) aim to improve the quality of health care (e.g. by improving the coordination of care), it has not been analyzed yet whether these programs improve the perceived health system responsiveness. Our study aims to close this gap by analyzing the differences in the perceived health system responsiveness between DMP-participants and non-participants.We used linked survey- and administrative claims data from 7037 patients with coronary heart disease in Germany. Of those, 5082 were enrolled and 1955 were not enrolled in the DMP.Responsiveness was assessed with an adapted version of the WHO responsiveness questionnaire in a postal survey in 2013. The survey covered 9 dimensions of responsiveness and included 17 items for each, GP and specialist care. Each item had five answer categories (very good – very bad). We handled missing values in the covariates by multiple imputation and applied propensity score matching (PSM) to control for differences between the two groups (DMP/non-DMP). We used Wilcoxon-signed-rank and McNemar test to analyze differences regarding the reported responsiveness.The PSM led to a matched and well balanced sample of 1921 pairs. Overall, DMP-participants rated the responsiveness of care more positive. The main difference was found for the coordination of care at the GP, with 62.0% of 1703 non-participants reporting a “good” or “very good” experience, compared to 69.1% of 1703 participants (p < 0.001).The results of our study indicate an overall high responsiveness for CHD-care, as well for DMP-participants as for non-participants. Yet, the results also clearly indicate that there is still a need to improve the coordination of care.

Selective enrollment in Disease Management Programs for coronary heart disease in Germany \u2013 An analysis based on cross-sectional survey and administrative claims data

BackgroundIn 2002, Disease Management Programs (DMPs) were introduced within the German healthcare system with the aim to increase the quality of chronic disease care. Due to the enrollment procedures, it can be assumed a) that only certain patients actively decide to enroll in a DMP and/or b) that only certain patients get the recommendation for DMP enrollment from their physician. How strong this assumed effect of self- and/or professional selection is, is still unclear.MethodsWe used data from a cross-sectional postal-survey linked on individual level with administrative claims data from a German sickness fund. The sample consisted of individuals suffering from coronary heart disease (CHD) who i) were either enrolled in the respective DMP or ii) fulfilled the disease related criteria for enrollment but were not enrolled. We applied multivariate logistic regression analyses to assess factors on patient level associated with DMP enrollment.ResultsWe included 7070 individuals in our analyses. Male sex, higher age and receiving old age pension, a higher Charlson Score and a diagnosis of type 2 diabetes increased the odds for DMP-CHD enrollment significantly. Individuals with a diagnosed myocardial infarction (MI) were also more likely to be enrolled in the DMP-CHD. We found a significant interaction effect for MI and sex, indicating that the association between MI and DMP enrollment is stronger for women than for men.ConclusionDMP-enrollees and non-enrollees differ in various factors. Studies analyzing the effectiveness of DMP-CHD should carefully take into account these group differences. Furthermore, the results suggest that the DMP-CHD assessed reaches men better than women.

12-Month prevalence of coronary heart disease in Germany.

The results of the GEDA 2014/2015-EHIS study demonstrate that during the last 12 months, 3.7% of women and 6.0% of men in Germany had coronary heart disease (CHD - defined as myocardial infarction, chronic consequences of myocardial infarction or angina pectoris). The 12-month prevalence of CHD in men and women under 45 years of age is well below 1.0%; however, the prevalence rises rapidly and disproportionately up to 16.0% among women and 24.1% among men aged 75 years and over. Women with a low level of education have a considerably higher prevalence of CHD (7.3%) compared to those with a high level of education (1.2%). Men show fewer education-related differences (6.5% versus 5.2%). As the indicators analysed here were first deployed as part of the 2014/2015 European Health Interview Survey (EHIS), no comparative data is available.

Depression risk in patients with coronary heart disease in Germany

AIMTo determine the prevalence of depression and its risk factors among patients with coronary heart disease (CHD) treated in German primary care practices.METHODSLongitudinal data from nationwide general practices in Germany (n = 1072) were analyzed. Individuals initially diagnosed with CHD (2009-2013) were identified, and 59992 patients were included and matched (1:1) to 59992 controls. The primary outcome measure was an initial diagnosis of depression within five years after the index date among patients with and without CHD. Cox proportional hazards models were used to adjust for confounders.RESULTSMean age was equal to 68.0 years (SD = 11.3). A total of 55.9% of patients were men. After a five-year follow-up, 21.8% of the CHD group and 14.2% of the control group were diagnosed with depression (P < 0.001). In the multivariate regression model, CHD was a strong risk factor for developing depression (HR = 1.54, 95%CI: 1.49-1.59, P < 0.001). Prior depressive episodes, dementia, and eight other chronic conditions were associated with a higher risk of developing depression. Interestingly, older patients and women were also more likely to be diagnosed with depression compared with younger patients and men, respectively.CONCLUSIONThe risk of depression is significantly increased among patients with CHD compared with patients without CHD treated in primary care practices in Germany. CHD patients should be routinely screened for depression to ensure improved treatment and management.

Social disparities in Disease Management Programmes for coronary heart disease in Germany: a cross-classified multilevel analysis

BackgroundDisease Management Programmes (DMPs) aim to improve effectiveness and equity of care but may suffer from selective enrolment. We analysed social disparities in DMP enrolment among elderly patients with coronary...

Analysing horizontal equity in enrolment in Disease Management Programmes for coronary heart disease in Germany 2008-2010.

BackgroundDisease Management Programmes (DMPs) have been introduced in Germany ten years ago with the aim to improve effectiveness and equity of care, but little is known about the degree to which enrolment in the programme meets the principles of equity in health care. We aimed to analyse horizontal equity in DMP enrolment among patients with coronary heart disease (CHD).MethodsCross-sectional analysis of horizontal inequities in physician-reported enrolment in the DMP for CHD in a large population-based cohort-study in Germany (2008–2010). We calculated horizontal inequity indices (HII) and their 95% confidence intervals [95%CI] for predicted need-standardised DMP enrolment across two measures of socio-economic status (SES) (educational attainment, regional deprivation) stratified by sex. Need-standardised DMP enrolment was predicted in multi-level logistic regression models.ResultsAmong N = 1,280 individuals aged 55–84 years and diagnosed with CHD, DMP enrolment rates were 22.2% (women) and 35.0% (men). Education-related inequities in need-standardised DMP enrolment favoured groups with lower education, but HII estimates were not significant. Deprivation-related inequities among women significantly favoured groups with higher SES (HII = 0.086 [0.007 ; 0.165]. No such deprivation-related inequities were seen among men (HII = 0.014 [−0.048 ; 0.077]). Deprivation-related inequities across the whole population favoured groups with higher SES (HII estimates not significant).ConclusionNeed-standardised DMP enrolment was fairly equitable across educational levels. Deprivation-related inequities in DMP enrolment favoured women living in less deprived areas relative to those living in areas with higher deprivation. Further research is needed to gain a better understanding of the mechanisms that contribute to deprivation-related horizontal inequities in DMP enrolment among women.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-015-0155-1) contains supplementary material, which is available to authorized users.

Einfluss von Patientenalter und Patientengeschlecht auf ärztliche Entscheidungen bei koronarer Herzkrankheit

Studies from the United Kingdom und the United States show that there are variations in doctors' decision making regarding coronary heart disease (CHD) and that patient attributes as well as physician characteristics have an impact on medical decisions regardless of the presented symptoms. This study examines how gender and age of patients influence primary care doctors' diagnostic and management decisions regarding CHD in Germany. An experimental design with portrayed videotapes is used. Professional actors play the role of patients with symptoms of CHD. Videotapes were identical apart from varying patients' gender and age (55 vs. 75 years). A randomly selected sample of 128 primary care physicians viewed these videotapes in their practices. Afterwards physicians were asked to describe how to diagnose and treat the patient. Women were less likely to be asked about health related behaviours, less likely to get a CHD diagnosis and less likely to be referred to a cardiologist or other specialist. Younger patients were asked about medical history and smoking more frequently, but they were less likely to be asked about symptoms of pain and discomfort. Moreover, among older patients CHD diagnosis was mentioned more often and with higher certainty and medication appropriate for CHD was prescribed more often. Age and gender of patients influence primary care doctors' diagnostic and management strategies relating to CHD in Germany regardless of the presented symptoms.