Prospektive Datenanalyse der rheumatologischen Notfallaufnahmebereitschaft der Kerckhoff-Klinik Bad Nauheim aus dem Jahre 2007 und die Umsetzung ambulanter Therapieempfehlungen im Fall des Ausschlusses einer stationären Versorgung

Abstract

Datenanalyse über die Umsetzung der ambulanten Therapieempfehlung von Patienten mit chronischen, rheumatologischen Erkrankungen. Die Vorstellung der Patienten erfolgte durch niedergelassene Vertragsärzte aufgrund dringender Behandlungsindikation bzw. evtl. bestehender stationärer Therapieindikation in der rheumatologischen Ambulanz der Kerckhoff-Klinik Bad Nauheim im Jahre 2007. Nach Ausschluss einer notwendigen stationären Versorgung wurde eine Therapieempfehlung für die weitere ambulante Versorgung des Patienten ausgesprochen und im Verlauf von 6 - 8 Wochen die ambulante Umsetzung der empfohlenen Therapiemassnahmen evaluiert. More than 100 diseases belong to the rheumatic diseases. In Germany about 1.500.000 people are suffering from rheumatic symptoms (Memorandum DGRh 2008). Especially the severe, inflammatory ones are generating high costs to the health system. This results in a socioeconomic problem as these patients require intensive treatments and these diseases may result in disability, invalidity and early retirement of the patients. To reduce chronic and progressive course of disease, it is required to have an early and intensive treatment of these patients. The treatment of these severe inflammatory diseases needs in particular cost-intensive medication and lower cost-intensive physical therapy, which in Germany have to be prescribed of a general practitioner (physician).We realized a prospective study of all patients seen in the policlinic of the Kerckhoff-Klinik Bad Nauheim, department of rheumatology in 2007. Therefore we defined diseases beforehand, to evaluate numbers of medication prescriptions and physical therapies done in ambulant areas. The presentation of the patients is performed by the general practitioner (physician) for testing the needfulness for admission. The prevalence for Rheumatoid Arthritis and Ankylosing Spondylitis is about 0,5 0,8 % within the German population (Gesundheitsberichterstattung des Bundes im Jahre 2007). We here present the data of therapy recommendation and the ambulant realization of medication prescription and physical therapy of 300 patients.We can demonstrate that for 31 72 % of certain rheumatic diseases physical therapy was insufficiently realized. In addition the medication therapy is not implemented sufficiently for the patients. NSAIDs were prescribed in 70 81 %, Glucocorticoides in 19 78 % and DMARD in 25 88 % of the cases.If you consider patients with prescriptions for physical therapy and an advanced course of disease, you will see that 33 - 96% received a medication therapy with NSAIDs at the same time, with glucocorticoide 21 - 91% and with DMARDs 7 - 100%. Additionly the recommended medication changes towards long-term therapies (e.g. DMARDs) were only poorly realized in about 60 % of the cases.This insufficient realization of the ambulant therapy might be a consequence of budget guidelines and the Heilmittelrichtlinie as well as the fear of recourse claim for the treating doctors by the Kassenärztliche Vereinigung.It requires (laws and also) strict recommendation guidelines to avoid the lack of required ambulant therapy realization of these chronic diseases as this lack leads to disease progress and disability and as a consequence to further costs for the health system.