Search

OBJECTIVES AND METHODS: To review Switzerland's mixed public and private healthcare system with regard to health technology assessment (HTA). RESULTS: In the past, remarkable work in HTA was done. Accomplishments include the following: (i) Switzerland became an early member of the International Network of Agencies for Health Technology Assessment. (ii) HTA has its legal bases in terms of effectiveness, appropriateness, and efficiency. (iii) The federal law allows the introduction of new technologies for a limited time for evaluation. (iv) A Swiss Network for Health Technology Assessment was established. In 2004, federal HTA activities moved from the Swiss Federal Office "of Social Security" to the one for "Public Health." The Office mainly mandates, manages, and coordinates evaluations attached to its prevention and intervention sections in the fields of AIDS, illegal drugs, and legal drugs. CONCLUSIONS: Because of the absence of a governmental institution assessing and reporting on new health technologies, private and for profit organizations became more important for the decision-making processes. In a regulated market, the implications may be crucial for the public health

Hintergrund und Fragestellung: Die Zungenbeurteilung ist ein zentrales diagnostisches Verfahren der traditionellen chinesischen Medizin. In der vorliegenden Studienserie wurde untersucht, inwieweit unterschiedliche Beurteiler bei der morphologischen Beschreibung von Zungenmerkmalen übereinstimmen. Methoden: In zwei Pilotstudien (jeweils n = 15 Patienten) und einer größeren Untersuchung (Hauptstudie; n = 101) wurden Digitalfotografien der Zungenbefunde von Klinikpatienten durch zwei bzw. drei erfahrene Beurteiler mithilfe von Formularen verblindet bewertet. Das wichtigste Zielkriterium war die Übereinstimmung über die erwartete zufällige Übereinstimmung hinaus (Cohens Kappa). Ergebnisse: In der ersten Pilotstudie wurden in hohem Maße variable Kappa-Werte beobachtet (–0,15 bis 0,76). Bei zahlreichen Merkmalen zeigten sich jedoch nur geringe bis mäßige Übereinstimmungen. In der zweiten, mit einer verbesserten Methode durchgeführten Pilotstudie zeigten sich zwar wiederum in hohem Maße variable Kappa-Werte (–0,10 bis 1,00), bei 7 der 18 erhobenen Merkmale war die überzufällige Übereinstimmung jedoch sehr gut (Kappa ≥0,75). In der Hauptstudie lagen die Kappa-Werte zwischen 0,15 und 0,83. Diskussion: In den vorliegenden Studien wurden erste Schritte hin zu einer systematischen Untersuchung der Reliabilität der Zungendiagnose im Rahmen der traditionellen chinesischen Medizin unternommen. Die Ergebnisse deuten darauf hin, dass die Beurteilung morphologischer Merkmale eine befriedigende Reliabilität haben dürfte.

OBJECTIVES AND METHODS: To review Switzerland's mixed public and private healthcare system with regard to health technology assessment (HTA). RESULTS: In the past, remarkable work in HTA was done. Accomplishments include the following: (i) Switzerland became an early member of the International Network of Agencies for Health Technology Assessment. (ii) HTA has its legal bases in terms of effectiveness, appropriateness, and efficiency. (iii) The federal law allows the introduction of new technologies for a limited time for evaluation. (iv) A Swiss Network for Health Technology Assessment was established. In 2004, federal HTA activities moved from the Swiss Federal Office "of Social Security" to the one for "Public Health." The Office mainly mandates, manages, and coordinates evaluations attached to its prevention and intervention sections in the fields of AIDS, illegal drugs, and legal drugs. CONCLUSIONS: Because of the absence of a governmental institution assessing and reporting on new health technologies, private and for profit organizations became more important for the decision-making processes. In a regulated market, the implications may be crucial for the public health.

Background and objective: Within a large research and reimbursement program by German social health insurance the effectiveness and safety of acupuncture for the treatment of patients suffering from chronic pain was investigated. We provide here the results regarding safety aspects from a large observational study. Methods: Safety aspects were investigated in three ways: Physicians were asked to make a global assessment of safety and to report adverse effects for all 503,397 treatment cycles documented between July 2001 and June 2003. Serious adverse effects had to be reported directly to the research center and were collected up to December 2004. In addition, a sample of 6,140 patients was asked about the side effects they had experienced. Results: Physicians documented at least one adverse effect in 7.8% of all patients, the most frequent being needling pain in 3.9%. Serious adverse events were reported in 17 cases, the most frequent event being pneumothorax (5 cases). 9.3% of patients reported side effects, a quarter of these were considered as truly bothersome. The most frequent side effects reported by patients were pain, fatigue and circulatory disturbances. Conclusions: Serious adverse effects of acupuncture are very rare; however, minor side effects occur frequently. Overall, acupuncture provided by trained physicians is a comparably safe therapy.

BACKGROUND: Legal requirements for quality assurance in German rehabilitation hospitals include comparisons of providers. Objective is to describe and to compare outcome quality of care offered by three hospitals providing in-patient rehabilitative treatment exemplified for patients with chronic headache. METHODS: We performed a prospective three center observational study on patients suffering from chronic headache. Patients underwent interventions commonly used according to internal guidelines of the hospitals. Measurements were taken at three points in time (at admission, at discharge and 6 months after discharge). Indicators of outcome quality included pain intensity and frequency of pain, functional ability, depression, quality of life and health related behavior. Analyses of differences amongst the hospitals were adjusted by covariates due to case-mix situation. RESULTS: 306 patients from 3 hospitals were included in statistical analysis. Amongst the hospitals, patients differed significantly in age, education, diagnostic subgroups, beliefs, and with respect to some pain-related baseline values (covariates). Patients in all three hospitals benefited from intervention to a clinically relevant degree. At discharge from hospital, outcome quality differed significantly after adjustment according to case-mix only in terms of patients' global assessment of treatment results. Six months after discharge, the only detectable significant differences were for secondary outcomes like improved coping with stress or increased use of self-help. The profiles for satisfaction with the hospital stay showed clear differences amongst patients. CONCLUSION: The results of this case study do not suggest a definite overall ranking of the three hospitals that were compared, but outcome profiles offer a multilayer platform of reliable information which might facilitate decision making.

The aim of the present study was to compare the reduction of subjective complaints by 3 treatment strategies in 90 "amalgam patients" whose complaints could not be explained by a medical or psychological disorder. The individuals were randomly assigned either to removal of dental amalgam only (removal group), or removal in combination with a "biological detoxification" therapy with high doses of vitamins and trace elements (removal-plus group), or participation in a health promotion program without removal of dental amalgam (no-removal group). Between baseline and month 12, the sum score of main complaints decreased by 3.5 (SD = 2.2) points on average in the removal group as well as in the removal-plus group, and by 2.5 (SD = 2.4) points in the no-removal group (p = 0.152). Both removal groups showed a significant decrease in steady-state levels of inorganic mercury compared with the no-removal group. Thus, all 3 interventions were associated with clinically relevant improvements.

Zielsetzung: Darstellung eines Programms zur Evaluation der stationären Patientenversorgung (PEP) mit Naturheilverfahren am Beispiel einer Rehabilitationsfachklinik für Naturheilverfahren mit Schwerpunkt auf Beschreibung der behandelten Patienten und der Ergebnisqualität. Methoden: Prospektive Kohortenstudie aller stationär aufgenommenen Patienten über 2 Jahre; Arztfragebogen zur Erhebung medizinischer Basisdaten sowie Patientenfragebögen bei Aufnahme, Entlassung und 3 Nachbefragungen (2, 6 und 12 Monate nach Entlassung) zur Erfassung der Beschwerdeintensität, der gesundheitsbezogenen Lebensqualität (SF-36), des Gesundheitsverhaltens, der Inanspruchnahme medizinischer Leistungen, der Arbeitsunfähigkeitstage sowie der Patientenzufriedenheit. Bei Beginn der Intervention: Erhebung soziodemografischer Merkmale und medizinischer Basisdaten, Erfahrungen mit Naturheilverfahren und Behandlungserwartungen. Ergebnisse: 5278 Patienten (83% weiblich, Alter 54,7 ± 11,6 Jahre) mit Diagnosen hauptsächlich aus den Bereichen «Psychovegetatives Erschöpfungssyndrom» (36,8%), «Chronische Rückenerkrankungen» (19,5%) und «Chronische Kopfschmerzen » (11,9%) und medianer Beschwerdedauer von 6 Jahren gingen in die Analysen ein (Rücklauf nach 6 Monaten 80,6%, nach 12 Monaten 73,6%). Die Stärke der Hauptbeschwerde reduzierte sich von anfangs 59 ± 25 um durchschnittlich 25 Punkte bei Entlassung (nach 6 Monaten um 19 Punkte), was einer Effektstärke von 0,86 (0,62 nach 6 Monaten) entspricht. 6 Monate nach Entlassung wies knapp die Hälfte der Patienten einen klinisch relevanten Anstieg der Lebensqualität auf (Summenscores des SF-36 um =5 Punkte erhöht). Die Einnahme von Medikamenten ging zurück, nach dem Klinikaufenthalt waren weniger Arbeitsunfähigkeitstage zu verzeichnen. Die Zufriedenheit der Patienten war durchschnittlich «gut», bezogen auf die Verpflegung in der Klinik war die Zufriedenheit geringer. Eine Subgruppenanalyse bezüglich der Hauptdiagnose der Patienten zeigte unterschiedliche Akz