Strukturen der akutstationären rheumatologischen Versorgung

Abstract

Severe rheumatological systemic diseases demand high levels of diagnostic and therapeutic measures and differentiated and complex methods of care. In Germany, specialised rheumatologists and, if hospitalisation is indicated, specialised rheumatology hospitals or departments are responsible for the treatment of these patients. Early rehabilitation procedures, provided by a multidisciplinary therapeutic team, are an important component of the treatment concept in these facilities. Early rehabilitation is integrated into the patients acute medical treatment plan, with careful consideration of the patients current health problems and functional capabilities (body functions and structures, activities and participation as outlined in the ICF), thereby providing a comprehensive, integrated therapy strategy which has long been acknowledged as necessary for the successful treatment of rheumatoid patients. This article presents an analysis concerning the development, organisation, facilities and processes of the acute medical in-patient care for patients with rheumatological disorders in Germany. In total there are 4188 beds in 88 acute hospitals exclusively available for rheumatological in-patients in Germany at present. There is at least one facility specialised in rheumatology in every German federal state. The density of care in the German federal states varies between 131.8 beds per 1 million inhabitants in Bremen and 9 beds per 1 million inhabitants in Saxony. In most regions of Germany the acute in-patient care for patients with rheumatological disorders is provided by hospitals specialised in rheumatology. Rheumatological patients are treated in a variety of hospital departments. In the year 2000 only 47% of the inpatients with rheumatoid arthritis, 56% of those with ankylosing spondylitis and 28% of those with systemic lupus erythematosus were treated in a ward specialising in rheumatology. Rheumatoid arthritis, with a total share of nearly 30%, was the most frequently treated rheumatic disease in wards specialising in rheumatology, followed by soft tissue disorders (e.g. fibromyalgia), diseases with systemic involvement of connective tissue and inflammatory spinal disorders such as ankylosing spondylitis.

Sektorenübergreifende Versorgung in der Rheumatologie: Konzept und erste Erfahrungen in einem Modellprojekt

“…Laut Daten der Kerndokumentation von 2004 vergehen im Mittel jedoch immer noch 13 Monate bis zur ersten Vorstellung beim Facharzt [4] . Besser ist die bundesweite Versorgungssituation im Bereich der station ä ren Behandlung: Im Jahr 2003 standen in Deutschland insgesamt 4 188 Betten in 88 Krankenh ä usern f ü r die vollstation ä re Versorgung Rheumakranker zur Verf ü gung, von denen 78 % (3 267) der internistischen Rheumatologie zugeordnet waren [5] . Diese Zahlen d ü rfen jedoch nicht dar ü ber hinwegt ä uschen, dass in Deutschland erhebliche sektorale Unterschiede in der station ä ren Krankenversorgung bestehen.…”

Severe Disease Activity and Complications of Immunosuppressive Therapy: A Challenge for Acute Hospital-based Rehabilitation in Rheumatology

“…In rheumatology, acute rehabilitation mostly refers to rehabilitative interventions at an early stage of disease 6 . In general, acute rehabilitation describes the multidisciplinary treatment of patients in continuing need of integrated acute and rehabilitative care.…”