IntroductionStudies have investigated the relationships between chronic systemic and dental conditions, but it remains unclear how such knowledge can be used in clinical practice. In this article, we provide an overview of existing systematic reviews, identifying and evaluating the most frequently reported dental–chronic disease correlations and common risk factors.MethodsWe conducted a systematic review of existing systematic reviews (umbrella review) published between 1995 and 2017 and indexed in 4 databases. We focused on the 3 most prevalent dental conditions and 10 chronic systemic diseases with the highest burden of disease in Germany. Two independent reviewers assessed all articles for eligibility and methodologic quality using the AMSTAR criteria and extracted data from the included studies.ResultsOf the initially identified 1,249 systematic reviews, 32 were included for qualitative synthesis. The dental condition with most frequently observed correlations to chronic systemic diseases was periodontitis. The chronic systemic disease with the most frequently observed correlations with a dental condition was type 2 diabetes mellitus (T2DM). Most dental–chronic disease correlations were found between periodontitis and T2DM and periodontitis and cardiovascular disease. Frequently reported common risk factors were smoking, age, sex, and overweight. Using the AMSTAR criteria, 2 studies were assessed as low quality, 26 studies as moderate quality, and 4 studies as high quality.ConclusionThe quality of included systematic reviews was heterogeneous. The most frequently reported correlations were found for periodontitis with T2DM and for periodontitis with cardiovascular disease. However, the strength of evidence for these and other disease correlations is limited, and the evidence to assess the causality of these disease correlations remains unclear. Future research should focus on the causality of disease links in order to provide more decisive evidence with respect to the design of intersectoral care processes.

Background Mental disorders (MD), such as depression, anxiety, and cognitive impairment, are highly prevalent in patients with coronary heart disease (CHD). Current guidelines on cardiovascular diseases recommend screening and appropriate treatment of MD; however, the degree of implementation of such recommendations in clinical practice is unknown. This study aims to analyze the quality of health care of patients with CHD and MD. Specifically, we aim to analyze (1) the quality of care, (2) trajectories of care, and (3) barriers regarding the detection and treatment of MD. Moreover, we want to identify potentials of changes in health care delivery towards more patient-centered care. The results of this study shall be the first step towards value-based care of people with CHD and comorbid mental disorders. Methods We aim to include the following participants: adult patients with CHD ( n = 400), their relatives ( n = 350) and physicians ( n = 80). A particular focus will be on the vulnerable subgroups of patients with CHD and congestive heart failure (left ventricular ejection fraction < 40%) and on the underrepresented group of women with CHD. We will apply a mixed-method approach with a quantitative and a qualitative part. Patient-related outcomes (e.g., health-related quality of life, needs, and preferences regarding health care, reasons for non-detection, and lack of treatment of MD) will be explored in a multi-perspective approach including patients, relatives, and physicians’ perspectives. Furthermore, routine data from four statutory health insurance funds (SHI) will be analyzed regarding the frequency and treatment of MD in CHD patients. Discussion MenDis-CHD will provide important insights into the trajectories of health care, quality of health care, barriers, patient needs and preferences as well as expectations and satisfaction with health care in patients with CHD and MD. Potential implications of MenDis-CHD are to enable health care providers to redesign care pathways concerning the treatment of mental comorbidity in patients with CHD by proposing value-based changes in health care and by understanding the barriers to and facilitators of change towards patient-centered care. Trials registration German clinical trials register (Deutsches Register Klinischer Studien, DRKS) ieRegistration Number: DRKS00012434, date of registration: May 11th, 2017.

Objective People with cancer are often confronted not only with the burdens of medical treatment but also with psychological strain, which can lead to mental disorders (MD). To date, the prevalence of MD in newly diagnosed cancer patients and their utilization of mental health services (MHS) are mainly estimated through data of primary studies than considering healthcare‐related claims data. Methods Statutory health insurance claims data of the AOK/KV Hesse from 2011 to 2014 was analyzed. The number of incident cancer patients with MD and the utilization of MHS within the period of the quarter of incident cancer diagnosis and three subsequent quarters were determined. For incident cancer patients with an incident MD, the predictive values of sex, age group, and tumor entity on the documentation of MD diagnosis and utilization were investigated. Results The 12‐month prevalence of MD in incident cancer patients was 31.1% for depression, 11.2% for anxiety disorders, and 9.2% for post‐traumatic stress/adjustment disorder (PTSD/AD). Of these, 65.9% received outpatient psychotherapy and 43.0% at least one psychopharmacological drug prescription. Men had a significantly lower chance of receiving an MD diagnosis following cancer. Conclusions The prevalence of MD observed was higher for depression and lower for PTSD/AD compared to meta‐analyses of clinical trials. Male cancer patients had a lower chance of receiving an MD diagnosis than females, which coincides with existing results.

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Zusammenfassung Einleitung Palliativ versorgte Patientinnen und Patienten haben zu einem hohen Anteil onkologische Diagnosen. Die spezialisierte ambulante Palliativversorgung (SAPV) richtet sich an Erkrankte mit komplexem Symptomgeschehen und intensivem Betreuungsbedarf und soll eine Betreuung im häuslichen Umfeld bis zum Lebensende ermöglichen. In Hessen wurden ab 2009 die ersten SAPV-Angebote geschaffen. Entsprechend untersucht diese Studie (i) die Inanspruchnahme von SAPV und spezialisierten stationären palliativen Leistungen im letzten Lebensjahr von Krebserkrankten, (ii) die SAPV verordnende Arztgruppe und (iii) den Sterbeort und Krankenhausaufenthalte in den letzten 91 Lebenstagen. Methoden In der retrospektiven Sekundärdatenanalyse wurden Daten der AOK Hessen für 2009–2014 deskriptiv ausgewertet. Studienpopulation waren an Brust-, Prostata- oder Darmkrebs Erkrankte, die im jeweiligen Beobachtungsjahr (2010–2014) verstarben und 360 Tage vor ihrem Tod durchgängig versichert waren. Ergebnisse In die Studie konnten je nach Beobachtungsjahr 492–545 Personen mit Brust-, 546–625 mit Prostata- und 709–752 mit Darmkrebs eingeschlossen werden. In allen 3 Gruppen Krebserkrankter stieg zwischen 2010 und 2014 der Anteil mit Inanspruchnahme von mindestens einer Palliativleistung. Die Häufigkeit der Inanspruchnahme von SAPV-Leistungen lag bei den betrachteten Krebserkrankten meist höher im Vergleich zu Palliativstationen bzw. stationären Hospizen. SAPV wurde bei den 3 Krebsdiagnosen zu über 90% von Hausärztinnen bzw. -ärzten verordnet. Sowohl der Anteil von Personen mit einem Krankenhausaufenthalt in den letzten 91 Lebenstagen als auch der im Krankenhaus Verstorbenen ging von 2010 bis 2014 bei allen 3 Krebsarten zurück. Schlussfolgerung Die Ergebnisse sind vor dem Hintergrund des Aufbaus der SAPV in Hessen zu bewerten. Die Zunahme an SAPV-Leistungen und der Rückgang an Krankenhauseinweisungen am Lebensende weist auf eine gelungene Etablierung der SAPV in Hessen hin.

Background: Uncontrolled inflammatory disease activity can impact pregnancy outcomes and the health of the mother and child. This retrospective claims database analysis assessed treatment patterns before, during, and after pregnancy among women with inflammatory rheumatic disease (IRD; axial spondyloarthritis [axSpA], psoriatic arthritis [PsA], and rheumatoid arthritis [RA]) or psoriasis (PSO) in Germany. Methods: Data were extracted from the BARMER sickness fund (2013)(2014)(2015)(2016)(2017). Pregnant women (18-45 years) with documented IRD or PSO diagnoses were compared with age-matched controls from the same database for the analysis of patient characteristics, healthcare resource utilization, and pharmacological treatment during pregnancy. Reported measures included the proportion of women with pharmacological prescriptions or hospitalization/new prescription of corticosteroids or biologics in the 180 days before pregnancy, during pregnancy, and 180 days after delivery. Pre-specified prescription categories (such as disease-specific drugs [not including biologics]) were identified by anatomical therapeutic chemical classification codes. Extrapolated values to the German statutory health insurance population are reported. Results: Overall, 2702 pregnant women with IRD (axSpA: 1063; PsA: 660; RA: 979) and 6527 with PSO were identified. The proportion of women with IRD receiving prescriptions for disease-specific drugs reduced during pregnancy and remained stable after delivery (before: 15.0%; during: 9.0%; after: 9.7%). The proportion of women with PSO receiving prescriptions for disease-specific drugs was low (before: 0.6%; during: 0.3%; after: 0.1%). The proportion of women with hospitalization/new prescription of corticosteroids or biologics decreased during pregnancy, compared with pre-pregnancy, and increased after delivery in women with IRD

Objectives: The purpose of this study was to provide an overview of methodological approaches to assess the relationship between dental diseases and other noncommunicable diseases on the basis of claims data. Methods: Based on the methodological framework of Arksey and O'Malley, a scoping study was conducted. By searching electronic databases (PubMed, Web of Science, and LILACS), appropriate articles were identified. After extracting relevant information and entering it into a data-charting form, the study characteristics and the methodological approaches were summarized descriptively.Results: Fifty-one articles were identified for inclusion in the analysis. Most of the selected studies (78 percent) originated from Taiwan and employed a cohort design. The majority of studies considered dental diseases, particularly periodontal disease (PD) measures, but no common standard was identified for the definition of PD. Unmeasured confounding, misclassification, and surveillance bias were reported to be the main limitations of the claims data analyses. Conclusions: Claims data provide a very useful information source to further delineate the relationship between PDs and other noncommunicable diseases. If diagnostic codes are available, they seem to be the most suitable tool to assess PD in claims-based studies. In databases that do not contain dental diagnostic codes, e.g., databases in Germany and the United States, the identification of PD is a particular challenge. The inclusion of dental diagnostic codes in all claims databases is strongly recommended. Due to the public health relevance of PD, there is a need for more comprehensive documentation of dental parameters within claims data.

There is empirical evidence of an association between periodontitis and coronary heart disease (CHD). However, it is uncertain whether periodontal treatment in CHD patients might lead to reduced healthcare costs. This study aims to assess the association between periodontal treatment and healthcare costs in newly diagnosed CHD patients. Data from 21,263 adults who were continuously insured between 2011 and 2016 and who were newly diagnosed with CHD in 2013 were selected from a German claims database. The study population was differentiated by the utilization of periodontal treatment. The average treatment effect (ATE) of periodontal treatment on healthcare costs (total, inpatient, outpatient, drugs) was investigated using weighted Poisson regression models conditional on covariates and is shown as a ratio (of geometric means). Periodontal treatment was documented for 4.7% of the persons in the study population. Newly diagnosed CHD patients showed an ATE of 0.98 for total healthcare cost (95% CI 0.90–1.06), 0.79 for inpatient costs (95% CI 0.61–1.04), and 0.95 for drug costs (95% CI 0.87–1.04). A statistically significant 7% increase in outpatient costs was shown (95% CI 1.01–1.13). Despite a lack of statistical significance in most cases, the study provides evidence of a meaningful decrease in inpatient costs after periodontal treatment. Further studies are needed.