National Health Care Guidelines Research Articles

Effects of Recreational Therapy on Anxiety Levels in Patients with Chronic Illness

Purpose: The aim of the study was to assess the effects of recreational therapy on anxiety levels in patients with chronic illness. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The study indicated that engaging in recreational activities, such as art, music, and physical exercise, can significantly alleviate anxiety symptoms. These activities provide a distraction from pain and discomfort, enhance mood, and promote relaxation. For instance, studies have demonstrated that music therapy can lead to decreased levels of cortisol, the stress hormone, and increased production of endorphins, which are natural mood elevators. Similarly, physical activities like yoga and tai chi help in reducing tension and improving overall mental health by fostering a sense of physical well-being and empowerment. Art therapy, through creative expression, allows patients to process their emotions and experiences, leading to reduced feelings of anxiety and depression. Overall, recreational therapy offers a holistic approach to managing anxiety in chronically ill patients, contributing to improved quality of life and better mental health outcomes. Implications to Theory, Practice and Policy: Cognitive-behavioral theory, biopsychosocial model and flow theory may be used to anchor future studies on assessing the effects of recreational therapy on anxiety levels in patients with chronic illness. Practitioners should consider combining different types of recreational therapies to maximize therapeutic benefits. Policymakers should recognize the value of recreational therapy and integrate it into national healthcare guidelines and policies. This integration can promote the widespread adoption of these therapies in various healthcare settings, ensuring that patients with chronic illnesses have access to comprehensive care options.

Antidepressant drugs-State of the art

Due to their frequency, complications, and sequelae, depressive disorders are of great significance to patients, their environment, and society. They are considered the most frequent form of mental disturbances in old age. The use of antidepressant drugs (AD) represents a cornerstone of the treatment, which is always multidimensional. The classification, mechanism of action, efficacy and tolerability of AD are described. Furthermore, the practical treatment procedure as well as special aspects, such as treatment resistance and special features in old age are presented. Narrative review incorporating the most recent literature and the new edition of the national healthcare guidelines on unipolar depression. In the past 20years, alarge number of so-called 2nd generation ADs have been approved worldwide with comparable efficacy but more favorable side effect profiles than conventional (tricyclic) substances. Almost all ADs act by enhancing monoaminergic, mostly serotonergic, neurotransmission. Other common features include alatency in the onset of action, moderate response rates, and potential efficacy on all core symptoms of depression. Side effects can include cardiovascular, metabolic, or sexual dysfunction, but these may significantly differ between drug classes. This enables individualized treatment taking age, individual risk factors, comorbidities and comedications into account. With the correct interpretation of indications, knowledge of the risks, and consideration of the defined precautionary measures outlined here, treatment with AD is asafe and effective tool in the treatment of moderate and severe depression.

RENaBack: low back pain patients in rehabilitation—study protocol for a multicenter, randomized controlled trial

BackgroundMillions of people in Germany suffer from chronic pain, in which course and intensity are multifactorial. Besides physical injuries, certain psychosocial risk factors are involved in the disease process. The national health care guidelines for the diagnosis and treatment of non-specific low back pain recommend the screening of psychosocial risk factors as early as possible, to be able to adapt the therapy to patient needs (e.g., unimodal or multimodal). However, such a procedure has been difficult to implement in practice and has not yet been integrated into the rehabilitation care structures across the country.MethodsThe aim of this study is to implement an individualized therapy and aftercare program within the rehabilitation offer of the German Pension Insurance in the area of orthopedics and to examine its success and sustainability in comparison to the previous standard aftercare program.The study is a multicenter randomized controlled trial including 1204 patients from six orthopedic rehabilitation clinics. A 2:1 allocation ratio to intervention (individualized and home-based rehabilitation aftercare) versus the control group (regular outpatient rehabilitation aftercare) is set. Upon admission to the rehabilitation clinic, participants in the intervention group will be screened according to their psychosocial risk profile. They could then receive either unimodal or multimodal, together with an individualized training program. The program is instructed in the clinic (approximately 3 weeks) and will continue independently at home afterwards for 3 months. The success of the program is examined by means of a total of four surveys. The co-primary outcomes are the Characteristic Pain Intensity and Disability Score assessed by the German version of the Chronic Pain Grade questionnaire (CPG).DiscussionAn improvement in terms of pain, work ability, patient compliance, and acceptance in our intervention program compared to the standard aftercare is expected. The study contributes to provide individualized care also to patients living far away from clinical centers.Trial registrationDRKS, DRKS00020373. Registered on 15 April 2020

A Qualitative Exploration of the Referral Process of Children with Common Infections from Private Low-Level Health Facilities in Western Uganda.

Over 50% of sick children are treated by private primary-level facilities, but data on patient referral processes from such facilities are limited. We explored the perspectives of healthcare providers and child caretakers on the referral process of children with common childhood infections from private low-level health facilities in Mbarara District. We carried out 43 in-depth interviews with health workers and caretakers of sick children, purposively selected from 30 facilities, until data saturation was achieved. The issues discussed included the process of referral, challenges in referral completion and ways to improve the process. We used thematic analysis, using a combined deductive/inductive approach. The reasons for where and how to refer were shaped by the patients’ clinical characteristics, the caretakers’ ability to pay and health workers’ perceptions. Caretaker non-adherence to referral and inadequate communication between health facilities were the major challenges to the referral process. Suggestions for improving referrals were hinged on procedures to promote caretaker adherence to referral, including reducing waiting time and minimising the expenses incurred by caretakers. We recommend that triage at referral facilities should be improved and that health workers in low-level private health facilities (LLPHFs) should routinely be included in the capacity-building trainings organised by the Ministry of Health (MoH) and in workshops to disseminate health policies and national healthcare guidelines. Further research should be done on the effect of improving communication between LLPHFs and referral health facilities by affordable means, such as telephone, and the impact of community initiatives, such as transport vouchers, on promoting adherence to referral for sick children.

Burden of Herpes Zoster in Adult Patients with Underlying Conditions: Analysis of German Claims Data, 2007–2018

IntroductionSeveral chronic underlying conditions (UCs) are known to be risk factors for developing herpes zoster (HZ) and to increase the severity of HZ and its risk of recurrence. The aim of this study was to investigate the incidence and recurrence of HZ in adult patients with one or multiple UCs.MethodsA retrospective cohort study based on claims data representing 13% of the statutory health insurance population from 2007 to 2018 in Germany was performed. Patients aged ≥ 18 years were included when at least one of the following UCs was diagnosed: asthma, chronic heart failure, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), depression, diabetes mellitus type 1 or 2, and rheumatoid arthritis (RA). Exact matching was used to account for differences in the distribution of age and sex between the case and matched control cohorts. Multi-morbidity was considered in sensitivity analyses by analyzing patients with only one UC.ResultsPatients with asthma, CHD, COPD, depression, and RA had, on average, a 30% increased risk of developing acute HZ compared to patients without any UC. RA was found to have the highest odds ratio among these conditions, varying from 1.37 to 1.57 for all age groups. Patients with depression also showed a high risk of developing HZ. Analysis of recurrence indicated that patients with at least one UC in the age groups 18–49 years and 50–59 years had the highest risk for a recurrent HZ. After experiencing a first recurrence, patients, regardless of age group, had a two- to threefold higher risk for a second recurrence.ConclusionThis study of representative claims data shows a higher HZ incidence and recurrence frequency in patients with UCs. These results provide relevant information for national health care guidelines and disease management programs.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-021-00535-7.

Measuring the impact of national guidelines: What methods can be used to uncover time-varying effects for healthcare evaluations?

We examine the suitability of three methods using patient-level data to evaluate the time-varying impacts of national healthcare guidelines. Such guidelines often codify progressive change and are implemented gradually; for example, National Institute for Health and Care Excellence (NICE) suspected-cancer referral guidelines. These were revised on June 23, 2015, to include more cancer symptoms and test results ("features"), partly reflecting changing practice. We explore the time-varying impact of guideline revision on time to colorectal cancer diagnosis, which is linked to improved outcomes in decision-analytic models. We included 11,842 patients diagnosed in 01/01/2006-31/12/2017 in the Clinical Practice Research Datalink with England cancer registry data linkage. Patients were classified by whether their first pre-diagnostic cancer feature was in the original guidelines (NICE-2005) or was added during the revision (NICE-2015-only). Outcome was diagnostic interval: time from first cancer feature to diagnosis. All analyses adjusted for age and sex. Two difference-in-differences analyses used either a Pre (01/08/2012-31/12/2014, n=2243) and Post (01/08/2015-31/12/2017, n=1017) design, or event-study cohorts (2006-2017 vs 2015) to estimate change in diagnostic interval attributable to official implementation of the revised guidelines. A semiparametric varying-coefficient model analysed the difference in diagnostic interval between the NICE groups over time. After model estimation, primary and broader treatment effects of guideline content and implementation were measured. The event-study difference-in-differences and the semiparametric varying-coefficient methods showed that shorter diagnostic intervals were attributable to official implementation of the revised guidelines. This impact was only detectable by pre-to-post difference-in-differences when the pre/post periods were selected according to the estimation results from the varying-coefficient model. Formal tests of the parametric models, which are special cases of the semiparametric model, suggest that they are misspecified. We conclude that the semiparametric method is well suited to explore the time-varying impacts of guidelines codifying progressive change.

Classical Massage and Acupuncture in Chronic Back Pain - Non-Inferiority Randomised Trial.

Currently, there is a need for scientific evidence on the efficacy of classical massage therapy for chronic, unspecific back pain, especially for the improvement in functional impairment and long-term pain reduction. According to the National Health Care Guidelines, classical massage for nonspecific low back pain may only be prescribed in combination with exercise therapy and a share of the remuneration. Acupuncture, on the other hand, is recognised in the guidelines as an independent treatment for chronic back pain and is remunerated by health insurance companies. This raises the question of whether classical massage therapy is not inferior compared to acupuncture, based on the therapy of the GERAC study. The Clinic of Naturopathy in Blankenstein, Hattingen uses classical massage therapy subjectively successfully in patients with back pain. To objectify the success of the treatment, a randomised controlled, non-inferiority study was conducted. The efficacy of classical massage (KMT, n = 66) was compared with acupuncture therapy (AKU, n = 66) in patients with chronic back pain. The primary endpoint was the non-inferiority of classical massage compared with the acupuncture treatment in respect of the impairment in everyday life, with the help of the Hannover function questionnaire (HFAQ) and the reduction in pain ("Von Korff"-Questionnaire) at the follow-up after one month. In the per-protocol analysis during the period between enrollment in the study and follow-up, the responder rate of the KMT was 56.5% and thus tended to be inferior to the responder rate of the AKU with 62.5% (Δ = - 6%; KIΔ: - 23.5 to + 11.4%). The results show that classical massage therapy is not significantly inferior to acupuncture therapy in the period from admission to follow-up. Thus, the non-inferiority of the KMT to the AKU cannot be proven in the context of the defined irrelevance area.

Protection against the overuse and underuse of health care \u2013 methodological considerations for establishing prioritization criteria and recommendations in general practice

BackgroundInitiatives such as “Choosing Wisely” in the USA and “Smarter Medicine” in Switzerland have published lists of widely overused health care services. The German initiative “Choosing Wisely Together (Gemeinsam Klug Entscheiden)” follows this example. The goal of our study was to prioritize important recommendations against the overuse and underuse of health care services. The final list of recommendations will be published in the German guideline “Protection against the overuse and underuse of health care”.MethodsFirst, a multidisciplinary expert panel established a catalogue of prioritization criteria. Second, we extracted all the recommendations from evidence- and consensus-based German College of General Practice and Family Medicine (DEGAM) guidelines and National Health Care Guidelines (NVL). Third, the recommendations were rated by two independent panels (general practitioners and other health care professionals involved/not involved in guideline development). The prioritization process was finalized in a consensus conference held by DEGAM’s Standing Guideline Committee (SLK).ResultsEleven prioritization criteria were established. A total of 782 recommendations were extracted and rated by 98 physicians and other health care professionals in a survey. In the voting process, more than 80% of the recommendations were eliminated. After the final consensus conference, twelve recommendations from DEGAM guidelines, nine DEGAM addenda and 17 NVL recommendations were chosen for inclusion in the guideline, for a total of 38 recommendations.ConclusionThe selection procedure proved helpful in identifying the highest priority recommendations with which to combat the overuse and underuse of health care services. To date, in Germany there has been no attempt to compile such a list by using a systematic and transparent methodology. Hence, the guideline that results from this process can fill an important gap.

The dichotomy of the application of a systems approach in UK healthcare the challenges and priorities for implementation

There is increasing demand for a systems approach within national healthcare guidelines to provide a systematic and sustainable framework for improvements in patient safety. Supported by this is the growing body of evidence within Human Factors/Ergonomics (HFE) healthcare literature for the inclusion of this approach in health service design, provision and evaluation. This paper considers the current interpretation of this within UK healthcare systems and the dichotomy which exists in the challenge to implement a systems approach. Three case studies, from primary and secondary care, present a systems approach, offering a novel perspective of primary care and blood sampling. These provide practical illustrations of how HFE methods have been used in collaboration with healthcare staff to understand the system for the purpose of professional education, design and safety of clinical activities. The paper concludes with the challenge for implementation and proposes five roles for systems HFE to support patient safety.Practitioner Summary: healthcare is classified as a complex and dynamic system within this paper and as such HFE system methods are presented as desirable to understand the system, to develop HFE tools, to deliver education and integrate HFE within healthcare systems.

Adoption of criteria of blood donors selection for blood screening in hospitals of Islamabad

The study was conducted with the objective to determine the adoption of criteria of blood donor selection for blood screening in hospitals of Islamabad, Pakistan. The criteria of blood donor selection were supposed to be based on World Health Organization (WHO) standards and National Health care guidelines. It was observed that blood donors were mostly the relatives of patients. The age, weight, physical condition, temperature, history of addiction and alcohol effect at time of blood donation was in accordance with WHO blood donation criteria. However, pulse, hemoglobin, respiratory diseases and skin diseases were not determined in all the blood banks of hospitals in Islamabad and were in clear violation of WHO standards and National Health care guidelines, indicating that only few WHO standards and national healthcare guidelines were followed, but majority of them were missing or not followed appropriately. The study revealed that the criteria of blood donor selection were not fully followed in hospitals of Islamabad, and this needs to be rectified. Moreover, blood donors should be motivated to donate blood on voluntary basis. Similarly, the study may be conducted in other part of Pakistan as well. Key words: Blood donor selection, World Health Organisation (WHO) standards, hospitals, Islamabad

A New Independent Authority Is Needed To Issue National Health Care Guidelines

Health experts emphasize that getting doctors to follow clinical guidelines can save both lives and money. Less attention has been paid to how the guidelines are developed and the variability in the recommendations they include. We examined the quality and content of screening guidelines as a proxy for guidelines in general and found that the source of the guidelines affects their quality. Guidelines with inconsistent recommendations are unlikely to serve patients or physicians well. The creation of an independent organization that would work with multiple stakeholders to develop guidelines holds the potential to improve their quality.

Method for the development of national health care guidelines in Austria

Context: In Austria there are two main sources of law concerning quality in health system: the ‘Gesundheitsqualitatsgesetz’ (health quality law) and the so-called ‘Vereinbarung gemas Artikel 15a B-VG’ (agreement according to article 15a of the Federal Constitution) which regulates organisation and financing of the health care system. Both postulate transsectoral, transdisciplinal and evidence-based health care although there is no systematic approach for putting this aim into practice yet. Purpose: A national strategy for guideline development shall be designed and published as an own guideline, the so-called ‘MetaLeitlinie’. This consistent method assures that international accepted rules of guideline development as well as national boundaries, such as legal aspects and practice of health care delivery are considered in future guideline development. Description: To follow the principle of transsectoral and transdisciplinal guidelines an expert panel, consisting of main stakeholders of health care system as well as representatives of health professionals and patients, guides the whole development process and assures consensual and accepted outcomes. As this approach is novel, the whole process is proposed as work in progress. Conclusions: Experiences of the current development of national health care guidelines are integrated in the development of the ‘MetaLeitlinie’ and lead to the fact that both development processes influence each other. The practical guideline development provides the opportunity to learn from the practice while defining the methodical framework. The first draft of the guideline is expected to undergo a national public consultation process in Summer 2009 and shall be discussed with some international experts until the end of 2009. Discussion: Development and implementation of a national framework for guideline development in health care system is a great challenge and means the integration of different perceptions and requirements. The chosen way of integrating evidence and expertise as well as learning from practical guideline development work is challenging but seams to assure acceptance and practicability of the final results.

Representation of complementary and alternative medicine (CAM) in German treatment guidelines — An appraisal

In the German medical care system CAM still seems to be more or less ignored. To evaluate the occurrence of CAM in German treatment guidelines and in the 4 national health care guidelines (NHCG). The treatment guidelines and NHCG published by the Working Groups of the Scientific Medical Societies (www.AWMF.de) between 2004 and 2009 were searched for CAM with respect to occurrence and rating (recommendations: positive, negative, still unclear) in August 2009. Eighty-eight scientific medical societies have published altogether 728 treatment guidelines. Only 75 guidelines and the NHCGs list any CAM; of these, 9 guidelines and 2 NHCGs mention kinesitherapy, dietetic treatment, relaxation techniques, physical therapy and physiotherapy mainly without supplying further details. In the guidelines and NHCGs altogether 168 CAM measures are validated as positive, 48 as negative and 88 as unclear. Main reasons for the rating “unclear” are low quality or missing clinical trials. In Germany, CAM methods are subsumed under the generic terms physical medicine and balneotherapy/climate therapy (measures of physical therapy, physiotherapy, balneotherapy and climate therapy) or naturopathy (which includes measures of physical medicine, balneotherapy and climate therapy and several other methods). From the measures of physical therapy, etc., mentioned in the guidelines, 95 are validated as positive, 12 as negative and 22 as unclear. If measures of physical medicine, etc. are excluded, of the remaining naturopathic methods 67 are rated as positive, 40 as negative and 43 as unclear. Alternative methods are rated as positive (n=9), negative (n=6) and unclear (n=13). The notification of CAM in German medical guidelines increased in the last few years. Also, some naturopathic methods beyond physical medicine are rated as positive. However, CAM is still far from being a substantial part of medical care in Germany.