Our activation and information procedure is effective and beneficial. Further studies might show its usefulness in comprehensive management of patients with inflammatory bowel diseases.

edical rehabilitation (MR) is a "service for participation." In Germany, the DRV (Deutsche Rentenversicherung, German Pension Insurance) is its most important funding agency. The aim of MR is "to prevent impairment on the earning capacity of insured persons or early withdrawal from professional life or to integrate them in professional life as permanently as possible" (section 9 subsection 1 of Book VI of the German Social Code [SGB VI]).A further aim of MR is to avert, eliminate, mitigate or compensate for and prevent progression of impairing chronic diseases (section 42 subsection 1, SGB IX).Anyone wishing to participate in an MR program must submit an application themselves, which the attending physician accompanies with a form-based medical opinion. The DRV reviews whether certain medical and legal requirements are met. With an approval rate of 83%, the DRV funded about 832 936 inpatient MR services for adults in 2018 (1), including 3687 services for insured persons with chronic inflammatory bowel disease (IBD), such as Crohn's disease (CD) and ulcerative colitis (UC). The mean rehabilitation duration was 23 days. The services were usually provided in specialized facilities located far away from the usual place of residence of the patient (2).CD and UC belong to the group of disorders in which multiple areas are usually affected during periods of high disease activity (3). In addition to physical impairments, patients experience psychosocial problems, such as poor sex life, dietary restrictions, stress, or depression) (4). Such complex problems require an equally complex care approach. This is the strength of inpatient MR: It is provided by a multidisciplinary team, "all under one roof". Besides medical specialists, the MR team comprises nursing staff, psychologists, physiotherapists, sports therapists, and occupational therapists, as well as nutritionists, social workers, and vocational counsellors.The German system of inpatient MR is nearly unique; no other country has a directly comparable system in place (5). Thus, the increasing amount of SummaryBackground: The poor evidence base is a major problem for the German rehabilitation sector. This trial focused on testing the efficacy and benefit of inpatient medical rehabilitation compared to routine care in a single common entity, namely, chronic inflammatory bowel disease (IBD).Methods: This pragmatic, multicenter, randomized controlled trial with a parallel group design included gainfully employed patients with IBD who were covered by one of four statutory health insurance providers. Patients in the intervention group were actively advised regarding options for rehabilitation and given support in applying for it; patients in the control group continued with the care they had been receiving before participation in the trial. The primary endpoint was social participation, and there were various secondary endpoints, including disease activity and sick days taken off from work. All parameters were assessed by questionnaire at the beginning of the trial and twel...

Background/aimsPatients with inflammatory bowel disease (IBD) need comprehensive, interdisciplinary and cross-sectoral health care. In Germany, evidence-based care pathways have been developed to improve the quality of care of IBD patients. We aimed to evaluate the effects of the implementation of some of these recommendations on patient-related outcomes.MethodsIn a region of North Germany, outpatients with IBD were recruited by gastroenterologists (intervention group). Three activities based on the recommendations of the IBD pathways were implemented, namely, 1) patient participation in a questionnaire-based assessment of 22 somatic and psychosocial problems combined with individualized care recommendations (patient activation procedure); 2) patient invitation to participate in a 2-day patient education program and 3) invitation to their gastroenterologists to participate in periodic interdisciplinary case conferences. For the control group, IBD patients receiving standard care at gastroenterology practices outside the specified region were recruited by their doctors. At baseline, 6- and 12-month follow-up, study patients were invited to complete questionnaires. Generic health-related quality of life, social participation and self-management skills were the main outcomes.ResultsAt baseline, 349 patients were included in the study (intervention group: 189; control group: 160); 142 patients from the former and 140 from the latter group returned completed questionnaires at the 12-month follow-up. Over time, improvement in health-related quality of life and social participation was similar in both groups. Participants of the intervention group demonstrated improved self-management skills and more often followed steroid-free medication regimens.ConclusionIn a real-world clinical context, patient activation procedure combined with patient education and case conferences was less effective than expected. The observed beneficial effects, however, encourage the evaluation of more intensive and addressee-centered activities.

Rehabilitation hospitals are willing to implement measures of migrant-sensitive health care. Structural and organizational support is necessary in order to overcome existing implementation barriers. In addition, measures need to be cost-effective.

Zusammenfassung Hintergrund Menschen mit Migrationshintergrund nehmen trotz eines höheren Bedarfs rehabilitative Leistungen seltener in Anspruch und weisen ungünstigere Ergebnisse auf als Menschen ohne Migrationshintergrund. Migrationssensible Versorgungsstrategien können einen Beitrag leisten, Barrieren abzubauen, denen Menschen mit Migrationshintergrund im Gesundheitssystem begegnen. Ziel der vorliegenden Studie ist es, hindernde und fördernde Faktoren für die Implementierung solcher Strategien aus der Perspektive von Gesundheitspersonal zu ermitteln. Methodik Die Untersuchung basiert auf 8 qualitativen leitfadengestützten Fokusgruppeninterviews mit insgesamt 50 MitarbeiterInnen unterschiedlicher Berufsgruppen in orthopädischen Rehabilitationseinrichtungen in Nordrhein-Westfalen und Schleswig-Holstein. Ergebnisse Das Gesundheitspersonal erachtet eine migrationssensible Versorgung als notwendig und ist motiviert, entsprechende Maßnahmen umzusetzen. Als Hindernis für die Implementierung werden v. a. fehlende personelle und finanzielle Ressourcen genannt, u.a. für das Einstellen zusätzlicher mehrsprachiger MitarbeiterInnen. Optimierungspotenziale wurden im Hinblick auf die fehlende Migrationssensibilität von Versorgungsträgern gesehen. Schlussfolgerung Die aufgezeigten Barrieren müssen überwunden werden, um den Einsatz migrationssensibler Versorgungskonzepte zu fördern. Diese können der Ausgangspunkt für eine über Migrationssensibilität hinausgehende diversitätssensible Versorgung sein, die auch der Rolle weiterer Diversitätsmerkmale Rechnung trägt.