IntroductionPeripheral artery disease (PAD) is the third most prevalent cardiovascular disease worldwide, with smoking and diabetes being the strongest risk factors. The most prominent symptom is leg pain while walking, known as intermittent claudication. To improve mobility, first-line treatment for intermittent claudication is supervised exercise programmes, but these remain largely unavailable and economically impractical, which has led to the development of structured home-based exercise programmes. This trial aims to determine the effectiveness and cost advantage of TeGeCoach, a 12-month long home-based exercise programme, compared with usual care of PAD. It is hypothesised that TeGeCoach improves walking impairment and lowers the need of health care resources that are spent on patients with PAD.Methods and analysisThe investigators conduct a prospective, pragmatic randomised controlled clinical trial in a health insurance setting. 1760 patients diagnosed with PAD at Fontaine stage II are randomly assigned to either TeGeCoach or care-as-usual. TeGeCoach consists of telemonitored intermittent walking exercise with medical supervision by a physician and telephone health coaching. Participants allocated to the usual care group receive information leaflets and can access supervised exercise programmes, physical therapy and a variety of programmes for promoting a healthy lifestyle. The primary outcome is patient reported walking ability based on the Walking Impairment Questionnaire. Secondary outcome measures include quality of life, health literacy and health behaviour. Claims data are used to collect total health care costs, healthcare resource use and (severe) adverse events. Outcomes are measured at baseline, 12 and 24 months.Ethics and disseminationEthical approval has been obtained from the Medical Association Hamburg. Findings are disseminated through peer-reviewed journals, reports to the funding body, conference presentations and media press releases. Data from this trial are made available to the public and researchers upon reasonable request.NCT03496948 (www.clinicaltrials.gov), Pre-results.
Background This presentation analyses the dynamics of digital health from a governance perspective. It aims to explore the driving forces for the implementation of digital health in Germany. Germany is chosen as a case study of a social health insurance system, which is based on joint self-governance of sickness funds and providers, and strong corporatist power of the medical profession. Methods A qualitative explorative approach is applied, drawing on document analysis and other secondary sources. The research is based on a governance approach adapted from Glassman and Buse's model of public health policy reform. Results The WHO Global Strategy for Digital Health 2020-2024 serves as a key international policy framework. However, the analysis reveals firstly that implementation is shaped by national healthcare systems and may create different results; secondly, the global strategy provides only a weak guidance on the national level. In Germany, strong corporatism and weak state intervention is supporting market forces and private actors. Poorly developed digital health governance has opened a window of opportunity for market powers as driving forces for digital health, thus creating new risks of social inequalities. There is an urgent need for public health to step up advocacy for health literacy to improve the accessibility to digital health for all citizens. Conclusions National healthcare systems strongly shape the implementation of international digital health frameworks, which makes digital health an issue of governance. Stronger public health orientation and a people-centred approach are needed to counteract new emergent social inequalities created by market power. Key messages Market power and private actors are important drivers of digital health in the German healthcare system. Social health insurance systems may be vulnerable to market powers and new digital health inequalities.
Zusammenfassung Hintergrund und Ziel Digitale Gesundheitsanwendungen (DiGA) gehören seit 2020 zu den Leistungen der gesetzlichen Krankenkassen. Insbesondere für Menschen mit depressiven Erkrankungen bieten DiGA eine Möglichkeit, Wartezeiten auf eine fachärztliche oder therapeutische Versorgung zu überbrücken. Derzeit ist unklar, ob und wie Hausärzt*innen (HÄ) DiGA einsetzen. Deshalb wurde untersucht, wie sich HÄ über DiGA informieren, wie sie diese beurteilen und welche Erfahrungen sie mit der Verordnung gemacht haben. Material und Methode In einer qualitativen Studie wurden von 01/22 bis 04/22 Interviews mit HÄ (n = 17) durchgeführt und durch eine inhaltlich strukturierenden Inhaltsanalyse ausgewertet. Ergebnisse Angesichts langer Wartezeiten empfinden HÄ die Vermittlung von Patient*innen mit depressiven Erkrankungen in die fachärztliche oder therapeutische Versorgung als herausfordernd. Die zeitintensive Versorgung während dieser Wartezeit stellt eine Belastung für die hausärztlichen Ressourcen dar. Digitale Interventionen werden hier bisher von den HÄ nur begrenzt eingesetzt, das eigene Wissen über bestehende Angebote ist bislang eher gering. Chancen von DiGA liegen in der Überbrückung von Wartezeiten und der zeitnahen Verfügbarkeit in unterschiedlichen Sprachen. Die Stärkung des Selbstmanagements der Erkrankten und die Erweiterung des hausärztlichen Handlungsspektrums sind weitere positive Argumente. Kritisch betrachtet werden hingegen die unklare Evidenzlage und die im Vergleich zur persönlichen Versorgung hohen Preise von DiGA. Auch sehen HÄ bei ihren eigenen Patient*innen nur ein begrenztes Interesse für DiGA und betonen, dass der Einsatz von DiGA eine zusätzliche persönliche Begleitung benötigt. Schlussfolgerungen Insgesamt ist die Einschätzung von DiGA durch HÄ durchaus ambivalent: Depressive Erkrankungen stellen eine hohe Arbeitsbelastung dar. Obwohl mit DiGA inzwischen eine Möglichkeit zur Unterstützung der Versorgung besteht, werden sie nur verhalten eingesetzt.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.