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Background: High-dose long-term opioid therapy (LTOT) has been associated with increased mortality and hospitalizations. Therefore, the evidence-based German guideline on LTOT for chronic non-cancer pain (CNCP) recommends to only exceed the maximum daily dose (MDD) of opioids in exceptional cases. This study aimed to determine the portion of LTOT patients who exceeded the guideline-recommended MDD and identify predictors of exceeding in administrative claims data. Methods: The retrospective observational analysis of opioid prescriptions in patients receiving LTOT for CNCP was based on administrative claims by a large German statutory health insurance company. Patients with at least two quarters of opioid prescriptions between January 2018 and June 2019 were included and followed up for two years. Predictors were identified by logistic regression. In addition, the number of patients still in opioid therapy and the extent of exceeded MDDs were analyzed over time. Results: The sample consisted of 113,475 patients. Overall, 10.5% of the patients exceeded the guideline-recommended MDD averaged over the observation period. Strong predictors for exceeding the MDD were receiving opioid prescriptions from > 7 physicians (OR = 7.66, p <.001), receiving predominantly strong opioids (OR = 6.79, p <.001) and receiving opioids for at least one year prior to inclusion (OR = 5.35, p <.001). Within the non-exceeding group, 28.1% discontinued opioid therapy. In contrast, 9.9% of patients in the exceeding group discontinued opioid therapy, whereas the vast majority remained on treatment until the end of the observation period. Furthermore, a slight increase in prescribed doses was observed over time. Conclusions: The results indicate that a moderate proportion of patients exceeded the guideline-recommended MDD. However, certain patient groups were more likely to receive high doses. This applied in particular to those who were already on treatment at the time of inclusion and continued to receive opioids until the end of the observation period. Further research should examine whether the continuous opioid therapy among the patients with exceeding the guideline-recommended MDD might be related to specific indications, a lack of therapeutic options or avoidance of withdrawal. Trial registration: German Clinical Trials Register (drks.de/search/en). Identifier: DRKS00024854. Registered 28 April 2021. [ABSTRACT FROM AUTHOR]

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Introduction: In Germany, psychotherapy in outpatient statutory health care is regulated by the Psychotherapy Guideline (PT-GL). A discussion on waiting times and inadequate care for patients resulted in a structural reform of the PT-GL in 2017. The reform aims to improve access to psychotherapy and the entire course of care and treatment. The purpose of the present study was the evaluation of the new elements and identification of obstacles and barriers in their implementation., Methods: Quantitative and qualitative methods were used to evaluate the reform of the PT-GL. In a retrospective cohort-based analysis of anonymized administrative claim data from the statutory health insurances BARMER and AOK, the health care situation before and after the reform were compared. In addition, a cross-sectional questionnaire survey evaluated the implementation of the new care elements from the perspective of psychotherapists, general practitioners and patients. The questionnaires were developed based on focus groups with stakeholders and a literature search. The survey results provided the data basis for the cross-sectional analysis together with the routine data on the care situation after the reform of the PT-GL as well as aggregated, anonymized data from the National Association of Statutory Health Insurance Physicians on statutory health insurance care and on the use of the appointment service centers., Conclusion: By combining quantitative and qualitative data, the effects of the structural reform of the PT-GL of 2016 can be analyzed at the individual and structural level as well as in relation to the entire care and treatment process. Based on this, proposals for a needs-oriented further development of the PT-GL will be prepared, considering the perspectives of various interest groups., Competing Interests: Dieter Best: Mitgliedschaft Deutsche Psychotherapeuten Vereinigung (DPtV), Christa Schaff: Mitgliedschaft Berufsverband für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie in Deutschland e. V. (bkjpp); Helene Timmermann: Mitgliedschaft Vereinigung Analytischer Kinder- und Jugendlichen-Psychotherapeuten in Deutschland e.V. (VAKJP), Kathrin Klipker: Bis Ende März 2023 Beschäftigungsverhältnis beim AOK Bundesverband, Ursula Marschall: Beschäftigungsverhältnis bei der Barmer., (Thieme. All rights reserved.)

Background: Mental illnesses cause both individual and social burdens. The main goal of the structural reform of the Psychotherapy Guideline of 2017 was to improve access to psychotherapeutic care. The focus groups, which were conducted as part of the research project "Evaluation of the Psychotherapy Guideline (Eva PT-RL)" funded by the Innovation Fund, address the implementation of the goals of the reform and the individual newly introduced care elements as well as hurdles to implementation from the perspective of service providers, patients and insurers., Methods: Six focus groups and five individual interviews were conducted with people from the three stakeholder groups mentioned above. The basis was a semistructured interview guide adapted to the respective group of people based on a structured literature research. The interviews were conducted by a team of moderators via video conference, recorded and transcribed. The analysis was carried out via a qualitative content analysis based on Mayring., Results: The initial psychotherapeutic consultation received a generally positive assessment particularly with regard to timely initial access to psychotherapeutic care. At the same time a delayed transition to subsequent guideline psychotherapy due to a lack of capacity was criticized by all participant groups. Beneficial effects of telephone accessibility as well as increased networking of psychotherapeutic care also with other psychosocial services were mentioned. However the implementation of acute treatment and relapse prophylaxis was found to be inadequate. The central finding was that the impulse for a paradigm shift aimed at by the reform was perceived and implemented differently by the psychotherapists - from a focus on individual therapy processes to a public mental health perspective with a commitment to care coordination., Conclusion: Some elements of the reform were criticized by stakeholders, the transition from initial appointments to continuous treatment was considered as not timely enough, and the design of other elements (acute treatment and relapse prevention regulations) was assessed as improvable. There is a need for further research. The results of the focus groups serve as a basis for following project steps including a survey of psychotherapists, patients and GPs., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: The digitization of health care led to a steady increase in the adoption and use of mobile health (mHealth) apps. Germany is the first country in the world to cover the costs of mHealth apps through statutory health insurance. Although the benefits of mHealth apps are discussed in detail, aspects of problems and barriers are rarely studied., Objective: This scoping review aimed to map and categorize the evidence on problems and barriers related to the use of mHealth apps., Methods: Systematic searches were conducted in the MEDLINE, Embase, and PsycINFO databases. Additional searches were conducted on JMIR Publications and on websites of relevant international organizations. The inclusion criteria were publications dealing with apps similar to those approved in the German health care system, publications addressing problems and barriers related to the use of mHealth apps, and articles published between January 1, 2015, and June 8, 2021. Study selection was performed by 2 reviewers. The manuscript was drafted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The analysis of the included publications and categorization of problems and hurdles were performed using MAXQDA (VERBI Software GmbH)., Results: The database search identified 1479 publications. Of the 1479 publications, 21 (1.42%) met the inclusion criteria. A further 8 publications were included from citation searching and searching in JMIR Publications. The identified publications were analyzed for problems and barriers. Problems and barriers were classified into 10 categories ("validity," "usability," "technology," "use and adherence," "data privacy and security," "patient-physician relationship," "knowledge and skills," "individuality," "implementation," and "costs"). The most frequently mentioned categories were use and adherence (eg, incorporating the app into daily life or dropouts from use; n=22) and usability (eg, ease of use and design; n=19)., Conclusions: The search identified various problems and barriers in the context of mHealth apps. Although problems at the app level (such as usability) are studied frequently, problems at the system level are addressed rather vaguely. To ensure optimal use of and care with mHealth apps, it is essential to consider all types of problems and barriers. Therefore, researchers and policy makers should have a special focus on this issue to identify the needs for quality assurance., International Registered Report Identifier (irrid): RR2-10.2196/32702., (©Godwin Denk Giebel, Christian Speckemeier, Carina Abels, Felix Plescher, Kirstin Börchers, Jürgen Wasem, Nikola Blase, Silke Neusser. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 12.05.2023.)

Aim of the Study: The aim of the study was to compare the timeliness of reimbursement for new examination and treatment methods in outpatient care in the social (SHI) and private insurance system (PHI) in Germany., Methodology: For the reimbursement in the SHI system, the decisions and further documentation of the Joint Federal Committee and the evaluation committee could be used. For the reimbursement in the PHI system, for example, the resolutions of the Central Consultation Committee for Fee Schedule Questions and those of the Fee Schedule Committee, but also evaluations of the North Rhine Medical Association and a working group of the German Association of PHI were used. Included were medical methods finally assessed for use in outpatient medical care by the Joint Federal Committee between 2010 and 2019., Results: A total of 17 individual resolutions, two series of resolutions consisting of several individual resolutions, and regulations concerning companion diagnostics were included. The time intervals between the start of the procedure and the introduction of the new method into the SHI system varied widely (14 to 216 months). At the same time, the study showed that for the majority of the methods, reimbursement in PHI was possible earlier than in SHI. Furthermore, five methods showed a potential limitation of reimbursement in PHI dependent on individual insurance contracts, but in two cases also reimbursement by PHI for services later assessed as without benefit by SHI., Conclusion: Medical procedures based on the included new methods in most cases were reimbursed in the PHI earlier than in the SHI system. However, this also implies a risk of reimbursing services that are subsequently assessed by the Joint Federal Committee as having no medical benefit. If the joint federal committee assessment is used as a benchmark, this could lead to a reduction in the cost-effectiveness of care and, in individual cases, to patient harm due to overuse or misuse of care. Thus, there is a conflict between early access to new examination and treatment methods (especially in the case of very long Joint Federal Committee procedures) and (cost) effectiveness and assurance of the quality of care., Competing Interests: Das Projekt, aus dem der Artikel entstand, wurde finanziert durch das Wissenschaftliche Institut der PKV (WIP)., (Thieme. All rights reserved.)