Der Effektivität von Maßnahmen im Rahmen primärer Prävention am Beispiel kardiovaskulärer Erkrankungen und des metabolischen Syndroms
| Autor: | Korczak, Dieter, Dietl, Markus, Steinhauser, Gerlinde |
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| Jazyk: | němčina |
| Rok vydání: | 2011 |
| Předmět: |
Stoffwechselstörung
LIPIDSTOFFWECHSEL Risikoabschätzung Methodik models economic Meta-Analyse nutritional physiological phenomena Blutglukose randomisierte kontrollierte Studie biomedical technology assessment Effizienz Pflege humans judgment specifity Präventionsprogramm Lebensqualität Übergewicht Ökonomie Übersichtsliteratur HTA review literature as topic clinical trial health policy Rechte BLUTGLUCOSE Diagnose lcsh:R855-855.5 prevention research diabetes mellitus technology metabolisches Syndrom Kostensenkung cerebrovascular accident randomisierte kontrollierte Studien SOZIALÖKONOMISCHE FAKTOREN HYPERTONIE ZEREBROVASKULÄRER INSULT kontrollierte klinische Studien medical evaluation randomisierte Zuordnung Metaanalyse Article methods insult multizentrische Studien Zufall Behandlung Technikfolgen-Abschätzung biomedizinische health education multicenter studies as topic prospektive Studien health technology assessment validation studies HERZKRANKHEITEN Gesundheitsökonomie Genauigkeitsstudie LEBENSSTIL life style health economic studies Fettstoffwechsel randomized clinical trial sensitivity systematische Übersicht cardiovascular diseases Gesundheitsziele META-ANALYSIS AS TOPIC TECHNOLOGIE quality of life randomized controlled trial life qualities GESUNDHEITSWESEN Insulinresistenz meta analysis Ernährung evidence based medicine health care sector costs Apoplexie Gesundheitsaktion PLACEBOS sozioökonomische Faktoren randomised clinical trial METABOLISCHES SYNDROM X Fettleibigkeit gesundheitsökonomische Studien Methoden VERHALTENSTHERAPIE Zuckerkrankheit health economics preventive care kardiovaskuläre Erkrankungen Lebensqualitäten adiposity cost effectiveness Beurteilung Verblindung health RANDOMISIERUNG Sensitivität RANDOM ALLOCATION research article controlled clinical trials as topic Kosten und Kostenanalyse Kosten-Nutzen-Analyse technology evaluation GESUNDHEITSPOLITIK movement evidence-based medicine Herzkrankheit randomisierter Versuch CT sozio-ökonomische Faktoren EBM Forschungsartikel review effectiveness socioeconomic factors Placeboeffekt Prävention preventive medicine costs and cost analysis decision making socioeconomics relaxation Entscheidungsfindung Mensch PLAZEBOS Evaluationsstudien VALIDIERUNGSSTUDIEN Präventivmedizin Sozioökonomie overweight care ÖKONOMIE ÄRZTLICHE cost control therapy controlled clinical trial Technologie medizinische economics meta-analysis health campaign PROGRAMMEVALUIERUNG evaluation studies as topic placebo Entspannung health care action metabolic syndrome X research-article Bluthochdruck economic Bewegung apoplexia Gesundheitskampagne GESUNDHEITSFÖRDERUNG medizinische Beurteilung technology assessment biomedical multicenter trial Kostenminimierung prevention Kostenanalyse cost analysis Vorsorge lcsh:R723-726 HERZ-KREISLAUF-KRANKHEITEN Prophylaxe risk assessment program evaluation technical report 610 Medical sciences Medicine meta analysis as topic Kosten kontrollierte klinische Versuche kardiovaskuläre Erkrankung cost-cutting KLINISCHE STUDIEN Blutzucker evidenzbasierte Medizin Primärprävention cost reduction primäre Prävention COST-BENEFIT ANALYSIS hypertension lcsh:Medical technology effectiveness cost Gesundheitsfinanzierung PLAZEBOEFFEKT randomization biomedical verblindet medical costs rehabilitation apoplexy blinding program effectiveness sickness costs randomisation crossover Technologiebewertung accident technology assessment economic aspect Reha ethics randomised trial prospective studies CCT Gesundheitserziehung lcsh:Medical philosophy. Medical ethics Programmeffektivität randomised controlled trial randomisierte klinische Studie Kostenreduktion Krankheitskosten health promotion efficacy primary prevention kontrollierte klinische Studie randomized controlled trials as topic Pharmaökonomie heart disease cross-over-Studien medical systematic review insulin resistance medizinische Bewertung cost lipid metabolism behavior therapy randomized trial blood glucose cross-over heart diseases Modelle ökonomische technology medical clinical trials as topic treatment juridical CROSS-OVER STUDIES medizinische Technologie Kosteneffektivität Kosten-Effektivität prevention program stroke Technologiebeurteilung social economic factors Recht ddc: 610 economics medical Gesundheitssektor randomisierte Studie Präventionsforschung lipometabolism Wirksamkeit prophylaxis Therapie RCT Ethik Schlaganfall blood sugar metabolic syndrome Kosten- Effektivität models Übersichtsarbeit Spezifität VALIDATION STUDIES AS TOPIC cost-effectiveness GUTACHTENBASIERTE MEDIZIN GESUNDHEIT Vorbeugung medical assessment random review literature Hirnschlag klinische Studie blinded pharmaeconomics ökonomischer Aspekt efficiency placebo effect Kostenkontrolle Effektivität high blood pressure |
| Zdroj: | GMS Health Technology Assessment, Vol 7, p Doc02 (2011) GMS Health Technology Assessment GMS Health Technology Assessment; VOL: 7; DOC02 /20110401/ |
| ISSN: | 1861-8863 |
| Popis: | Background The HTA-report (HTA = Health Technology Assessment) deals with the primary prevention of cardiovascular diseases and diabetes mellitus type 2. In 2009 approximately 356,000 people died in Germany due to cardiovascular diseases. According to estimations about 6.3 million people are suffering from diabetes mellitus type 2. The interventions that are subsidized by the public health insurance are mainly focused on sufficient physical activities, healthy nutrition, stress management and the reduction of the consumption of addictive drugs and luxury food. Objectives Which lifestyle-related measures and/or programmes for primary prevention of cardiovascular diseases and of the metabolic syndrome are effective? To what extent will the health status be improved by these offers? To what extent will existing health resources and skills be strengthened by these offers? Are there any differences regarding the effectiveness among the interventions with respect to different settings or subgroups? Which lifestyle-related interventions and/or programmes for primary prevention of cardiovascular diseases and of the metabolic syndrome are sustainable and cost-effective? Which outcome parameters are in the view of the contributors decisive for the evaluation of the effectiveness? In the view of the contributor are there different values between the outcome parameters? In the view of the payers and other actors are there different values between the outcome parameters? Which ethical and juridical factors have to be considered? Which social and/or socio-economic parameters influence the use of the services and effectiveness? Methods A systematic literature research is done in 35 databases. For the period 2005 to 2010, reviews, epidemiological and clinical studies as well as economical evaluations which deal with primary prevention programmes regarding cardiovascular diseases or the metabolic syndrome are included. Results 44 publications meet the inclusion criteria. These studies confirm the effectiveness of the primary prevention programmes. Physical activity programs seem to have a stronger effect than nutrition programmes. Psychological programmes prove as well effectiveness, if they include cognitive behaviour therapy. The identified economical studies indicate that programmes for cardiovascular prevention can be conducted cost-effectively. Interventions that focus on the general population turn out to be particularly cost-effective and sustainable. Discussion There is a wide range of primary preventive effective lifestyle-related interventions with high evidence. The outcomes and results are consistent with the recommendations of the two identified evidence-based guidelines regarding the recommendations on lifestyle and healthy nutrition. Furthermore, the cost-effectiveness of primary prevention services is proven. With regard to the economical studies it is however worth noting that this result is based on very few publications. The transferability has to be critically assessed as the studies mainly originate from the American health system. Conclusion On the whole a comprehensive setting approach with educative, somatic, psychosocial and activity therapeutic components is recommended. The sustainability of a prevention intervention must be ensured from programme to programme. Long-term studies are necessary to make valid statements regarding the sustainable effectiveness: There is an essential deficit in the current practiced evaluation of the use of primary prevention services provided by the health insurance – mainly regarding the comprehensive setting approach – regarding the evidence-based evaluation of the prescribed preventive interventions. With regard to the ethical, social and economical evaluation the research situation is deficient. The situation has to be particularly analyzed for the socially deprived and one has to respond to their specific needs for prevention. GMS Health Technology Assessment; 7:Doc02; ISSN 1861-8863 |
| Databáze: | OpenAIRE |
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