Over-, under- and misuse of pain treatment in Germany

Autor: Dietl, Markus, Korczak, Dieter
Jazyk: angličtina
Rok vydání: 2011
Předmět:
triple-blind
Schmerzzustände
multicentre
underuse
Risikoabschätzung
Methodik
Nackenschmerz
models
economic

Meta-Analyse
Brustwirbelsäule
verblindete Studie
HEADACHE
Kopfschmerz
supply shortage
Multizenter
randomisierte kontrollierte Studie
biomedical technology assessment
double-blind method
KREUZSCHMERZEN
migraine
Ischialgie
Effizienz
Pflege
Schmerzversorgung
humans
judgment
specifity
triple blind
report
Lebensqualität
integrated care
Frühberentung
Grundrecht
Ökonomie
einfach blind
Versorgungskosten
Übersichtsliteratur
HTA
Opiat
clinical trial
health policy
medizinische Versorgungskosten
pain reduction
lack of work
Rechte
lcsh:R855-855.5
Diagnose
hospice
Rückenschmerz
technology
juricical
Hospiz
Kostensenkung
palliative Behandlung
randomisierte kontrollierte Studien
SOZIALÖKONOMISCHE FAKTOREN
Sozialmedizin
kontrollierte klinische Studien
medical evaluation
singleblind
palliative therapy
randomisierte Zuordnung
sick certificate
einfach-blind
back pain
CLINICAL TRIALS AS TOPIC
Akupunktur
early retirement
Article
methods
Sterbebegleitung
Zufall
placebos
Behandlung
Technikfolgen-Abschätzung
biomedizinische

health care costs
palliativ
prospektive Studien
health technology assessment
HTA-report
Einfachblindmethode
single blind method
HTA report
validation studies
Gesundheitsökonomie
SINGLE-BLIND METHOD
chronisch
Genauigkeitsstudie
MULTICENTER STUDIES AS TOPIC
somatoforme Störungen
health economic studies
Psychotherapie
DOPPELBLINDMETHODE
randomized clinical trial
sensitivity
systematische Übersicht
zweifach verblindet
MULTIZENTRISCHE STUDIEN
META-ANALYSIS AS TOPIC
Palliativmedizin
TECHNOLOGIE
quality of life
randomized controlled trial
life qualities
Schmerzmessung
REVIEW LITERATURE AS TOPIC
meta analysis
Palliativpersonal
evidence based medicine
Arzneimittel
Lendenwirbelschmerzen
costs
randomized controlled study
palliative medicine
sozioökonomische Faktoren
randomised clinical trial
gesundheitsökonomische Studien
Methoden
palliative
Schmerzambulanz
health economics
cost-benefit analyses
cross-over trials
pain
Fehlversorgung
doctor's note
integrierte Versorgung
Schmerzzentrum
cost effectiveness
randomised controlled study
Beurteilung
Verblindung
palliative treatment
thoracic vertebral column
trial
health care
RANDOMISIERUNG
Sensitivität
chronic
randomised clinical study
spondylosis
SCHMERZKLINIKEN
research article
controlled clinical trials as topic
Kosten und Kostenanalyse
Kosten-Nutzen-Analyse
Versorgungsangebot
technology evaluation
multimodales Versorgungsangebot
GESUNDHEITSPOLITIK
evidence-based medicine
randomisierter Versuch
CT
sozio-ökonomische Faktoren
Rückenschmerzen
EBM
Forschungsartikel
review
trial
cross-over

effectiveness
semiverblindeter Versuch
socioeconomic factors
Placeboeffekt
Prävention
costs and cost analysis
decision making
socioeconomics
Entscheidungsfindung
Evaluationsstudien
PLAZEBOS
Sozioökonomie
VALIDIERUNGSSTUDIEN
care
ÖKONOMIE
ÄRZTLICHE

Palliativversorgung
Schmerzen
multimodal supply
cost control
therapy
semi-blinder Versuch
controlled clinical trial
Gesundheitsversorgung
cost-benefit analysis
MENSCH
economics
Analgetika
headache
health
meta-analysis
Schmerzzustand
pain management
evaluation studies as topic
placebo
research-article
random allocation
randomized study
economic
Palliativpflegedienst
diagnosis
Schmerzklinik
pain therapy
doubleblind
misuse
medizinische Beurteilung
Lendenwirbel
doppel-blind
technology assessment
biomedical

Schmerzmedikament
Wirbelsäulenleiden
multicenter trial
Kostenminimierung
prevention
cost analysis
healthcare needs
cross-over studies
low back pain
Vorsorge
lcsh:R723-726
single-blind
risk assessment
technical report
610 Medical sciences
Medicine
Kosten
kontrollierte klinische Versuche
bedarfsgerechte Versorgung
cost-cutting
KLINISCHE STUDIEN
MENSCHENRECHTE
HEALTH
evidenzbasierte Medizin
cost reduction
lcsh:Medical technology
shoulder pain
einfachblind
Gesundheitsfinanzierung
sick note
Plazebo
randomization
biomedical
single blind
verblindet
medical costs
Schmerzmanagement
rehabilitation
HTA Bericht
pain situation
semi-verblindeter Versuch
trial
crossover

Versorgung
blinding
program effectiveness
sickness costs
SCHULTERSCHMERZEN
randomisation
crossover
thoracic spine
multimodal
Cross-over-Studien
Technologiebewertung
doppelblind
Plazeboeffekt
accident
Medikamente
clinical study
technology assessment
Palliativpflege
economic aspect
doppel blind
Reha
ethics
randomised trial
prospective studies
CCT
psychotherapy
Schmerzpatient
HUMAN RIGHTS
METAANALYSE
rights
pain care
Schmerztherapie
lcsh:Medical philosophy. Medical ethics
Programmeffektivität
randomised controlled trial
randomisierte klinische Studie
Kostenreduktion
Spondylose
Krankheitskosten
efficacy
neck pain
kontrollierte klinische Studie
Arbeitsausfall
Pharmaökonomie
multicenter
pain clinic
medical
verblindeter Versuch
systematic review
medizinische Bewertung
HTA-Bericht
randomized trial
Sterben
Evaluation
cross-over
pain disorder
controlled clinical study
Schmerzlinderung
TECHNOLOGIE
MEDIZINISCHE

palliative care
Modelle
ökonomische

technology
medical

treatment
ischialgia
analgesia
chronischer Schmerz
Sterbende
somatoform disorders
medizinische Technologie
Kosteneffektivität
Kosten-Effektivität
Schmerzstörung
Technologiebeurteilung
social economic factors
Versorgungsalltag
Recht
Wirbelsäule
ddc: 610
economics
medical

randomisierte Studie
medical care
Wirksamkeit
double-blind
Therapie
Schmerz
chronic pain
RCT
Krankmeldung
vertebral column
Gutachtenbasierte Medizin
RANDOMIZED CONTROLLED TRIALS AS TOPIC
Ethik
Unterversorgung
palliative treatments
Krankschreibung
Migräne
semiblinder Versuch
lumbar pain
overuse
ANALGESIE
pain measurement
dreifach verblindet
models
Übersichtsarbeit
randomized clinical study
Spezifität
Verhaltenstherapie
Überversorgung
VALIDATION STUDIES AS TOPIC
Hospizdienst
cost-effectiveness
medical assessment
spinal column
cross over
pain clinics
delivery of health care
double blind
Gesundheit
random
randomised study
review literature
stoppage
klinische Studie
Versorgungsdefizit
blinded
pharmaeconomics
ökonomischer Aspekt
efficiency
pain patient
placebo effect
Palliativtherapie
Kostenkontrolle
tripleblind
Effektivität
Zdroj: GMS Health Technology Assessment; VOL: 7; DOC03 /20110419/
GMS Health Technology Assessment
GMS Health Technology Assessment, Vol 7, p Doc03 (2011)
ISSN: 1861-8863
DOI: 10.3205/hta000094
Popis: Background The HTA-report (Health Technology Assessment) deals with over- and undertreatment of pain therapy. Especially in Germany chronic pain is a common reason for the loss of working hours and early retirement. In addition to a reduction in quality of life for the affected persons, chronic pain is therefore also an enormous economic burden for society. Objectives Which diseases are in particular relevant regarding pain therapy? What is the social-medical care situation regarding pain facilities in Germany? What is the social-medical care situation in pain therapy when comparing on international level? Which effects, costs or cost-effects can be seen on the micro-, meso- and macro level with regard to pain therapy? Among which social-medical services in pain therapy is there is an over- or undertreatment with regard to the micro-, meso- and macro level? Which medical and organisational aspects that have an effect on the costs and/or cost-effectiveness have to be particularly taken into account with regard to pain treatment/chronic pain? What is the influence of the individual patient's needs (micro level) in different situations of pain (e. g. palliative situation) on the meso- and macro level? Which social-medical and ethical aspects for an adequate treatment of chronic pain on each level have to be specially taken into account? Is the consideration of these aspects appropriate to avoid over- or undertreatment? Are juridical questions included in every day care of chronic pain patients, mainly in palliative care? On which level can appropriate interventions prevent over- or undertreatment? Methods A systematic literature research is done in 35 databases. In the HTA, reviews, epidemiological and clinical studies and economic evaluations are included which report about pain therapy and in particular palliative care in the years 2005 till 2010. Results 47 studies meet the inclusion criteria. An undertreatment of acupuncture, over- and misuse with regard to opiate prescription and an overuse regarding unspecific chest pain and chronic low back pain (LBP) can be observed. The results show the benefit and the cost-effectiveness of interdisciplinary as well as multi-professional approaches, multimodal pain therapy and cross-sectoral integrated medical care. Only rough values can be determined about the care situation regarding the supply of pain therapeutic and palliative medical facilities as the data are completely insufficient. Discussion Due to the broad research question the HTA-report contains inevitably different outcomes and study designs which partially differ qualitatively very strong from each other. In the field of palliative care hospices for in-patients and palliative wards as well as hospices for out-patients are becoming more and more important. Palliative care is a basic right of all terminally ill persons. Conclusion Despite the relatively high number of studies in Germany the HTA-report shows a massive lack in health care research. Based on the studies a further expansion of out-patient pain and palliative care is recommended. Further training for all involved professional groups must be improved. An independent empirical analysis is necessary to determine over or undertreatment in pain care.
GMS Health Technology Assessment; 7:Doc03; ISSN 1861-8863
Databáze: OpenAIRE