13 results on '"Roehl, Ina"'
Search Results
2. Eine Monitoring-Liste für ein hausärztliches Case Management bei oraler Antikoagulation
- Author
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Ulrich, Lisa-Rebekka, Petersen, Juliana J., Mergenthai, Karola, Roehl, Ina, Rauck, Sandra, Erler, Antje, Kemperdick, Birgit, Schulz-Rothe, Sylvia, Gerlach, Ferdinand M., and Siebenhofer, Andrea
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- 2013
- Full Text
- View/download PDF
3. Evaluation der Hausarztzentrierten Versorgung in Baden-Württemberg
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Götz, Katja, Laux, Gunter, Mergenthal, Karola, Roehl, Ina, Erler, Antje, Miksch, Antje, and Beyer, Martin
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- 2013
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4. Primary care management for optimized antithrombotic treatment [PICANT]: study protocol for a cluster-randomized controlled trial
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Siebenhofer Andrea, Ulrich Lisa R, Mergenthal Karola, Roehl Ina, Rauck Sandra, Berghold Andrea, Harder Sebastian, Gerlach Ferdinand M, and Petersen Juliana J
- Subjects
Oral anticoagulation ,Best-practice model ,Case management ,Medicine (General) ,R5-920 - Abstract
Abstract Background Antithrombotic treatment is a continuous therapy that is often performed in general practice and requires careful safety management. The aim of this study is to investigate whether a best-practice model that applies major elements of case management and patient education, can improve antithrombotic management in primary healthcare in terms of reducing major thromboembolic and bleeding events. Methods This 24-month cluster-randomized trial will be performed with 690 adult patients from 46 practices. The trial intervention will be a complex intervention involving general practitioners, healthcare assistants, and patients with an indication for oral anticoagulation. To assess adherence to medication and symptoms in patients, as well as to detect complications early, healthcare assistants will be trained in case management and will use the Coagulation-Monitoring List (Co-MoL) to regularly monitor patients. Patients will receive information (leaflets and a video), treatment monitoring via the Co-MoL and be motivated to perform self-management. Patients in the control group will continue to receive treatment as usual from their general practitioners. The primary endpoint is the combined endpoint of all thromboembolic events requiring hospitalization and all major bleeding complications. Secondary endpoints are mortality, hospitalization, strokes, major bleeding and thromboembolic complications, severe treatment interactions, the number of adverse events, quality of anticoagulation, health-related quality of life, and costs. Further secondary objectives will be investigated to explain the mechanism by which the intervention is effective: patients’ assessment of chronic illness care, self-reported adherence to medication, general practitioners’ and healthcare assistants’ knowledge, and patients’ knowledge and satisfaction with shared decision making. Practice recruitment is expected to take place between July and December 2012. Recruitment of eligible patients will start in July 2012. Assessment will occur at three time points: baseline and follow-up after 12 months and after 24 months. Discussion The efficacy and effectiveness of individual elements of the intervention, such as antithrombotic interventions, self-management concepts in orally anticoagulated patients, and the methodological tool of case management, have already been extensively demonstrated. This project foresees the combination of several proven instruments, as a result of which we expect to profit from a reduction in the major complications associated with antithrombotic treatment. Trial registration Current Controlled Trials ISRCTN41847489
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- 2012
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5. Werden Personen mit Migrationshintergrund in der Versorgungsforschung ausreichend berücksichtigt? Beispiel einer cluster-randomisierten kontrollierten Studie
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Mergenthal, Karola, Ulrich, Lisa-Rebekka, Guethlin, Corina, Petersen, Juliana J., Hirschfeld, Julia, Roehl, Ina, Rauck, Sandra, and Siebenhofer, Andrea
- Subjects
Versorgungsforschung ,Migrationshintergrund ,Gerinnungsmanagement ,ddc: 610 ,orale Antikoagulation ,610 Medical sciences ,Medicine - Abstract
Hintergrund: Nach bisherigem Forschungsstand ist die gesundheitliche Versorgung von Migranten in Deutschland schlechter als die der deutschen Bevölkerung. Gesundheitsangebote werden von Personen mit Migrationshintergrund (MH) aufgrund von Sprachbarrieren oder Informationsdefiziten seltener genutzt.[for full text, please go to the a.m. URL], 12. Deutscher Kongress für Versorgungsforschung
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- 2013
6. Gerinnungsmanagement im hausärztlichen Bereich - Beispiel einer komplexen Intervention
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Siebenhofer, Andrea, Roehl, Ina, Mergenthal, Karola, Ulrich, Lisa, Rauck, Sandra, Berghold, Andrea, Harder, Sebastian, and Petersen, Juliana J.
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ddc: 610 ,610 Medical sciences ,Medicine - Abstract
Zielsetzung: In der PICANT (Primary Care Management for Optimized Antithrombotic Treatment) Studie werden ab März 2012 Optimierungsstrategien des Gerinnungsmanagements im hausärztlichen Bereich in einem cluster-randomisierten Design untersucht (BMBF Fkz 01GY1145). Die komplexe Intervention[for full text, please go to the a.m. URL], Komplexe Interventionen – Entwicklung durch Austausch; 13. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin
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- 2012
7. Prävalenz von Fehlverordnungen beim älteren Patienten mit eingeschränkter Nierenfunktion - eine Erhebung aus dem hausärztlichen Bereich
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Roehl, Ina
- Subjects
ddc:610 - Abstract
Hintergrund und Problemstellung: Viele vermeidbare Medikamentennebenwirkungen bei älteren Patienten haben ihre Ursache in der fehlenden Dosisanpassung bei Niereninsuffizienz. Beim Patienten über 65 Jahre liegen die Serumkreatininwerte oft noch im Normbereich, während die tatsächliche Nierenfunktion schon deutlich beeinträchtigt ist. Eine genauere Beurteilung der Nierenfunktion ist mit der Berechnung der glomerulären Filtrationsrate möglich. In der vorliegenden Untersuchung wurde in einer Praxisgemeinschaft einer hausärztlich tätigen Internistin und einer Fachärztin für Allgemeinmedizin in Frankfurt retrospektiv exploriert, ob niereninsuffiziente Patienten als solche erkannt wurden und wenn ja, ob sie dosisadaptiert mit Medikamenten versorgt wurden, bzw. in wie vielen Fällen sie fehlerhafte Verordnungen erhielten. Methode: Eine Zielpopulation von 100 Patienten mit moderater bis schwerer Nierenfunktionseinschränkung (Kreatinin-Clearance von 60 oder kleiner) wurde retrospektiv hinsichtlich der verordneten Medikation untersucht. Dabei wurde die glomeruläre Filtrationsrate mittels Cockroft-Gault-Formel errechnet. Bei nierensensiblen Substanzen wurde die in der Fachinformation empfohlene Dosis mit der tatsächlich verordneten Dosis verglichen. Ergebnisse: Die Ergebnisse dieser Untersuchung zeigen, dass von 232 auswertbaren Patienten 102 eine errechnete Kreatinin-Clearance von weniger als 60 ml/min aufwiesen, obwohl bei 48 Patienten der Serumkreatininlevel noch im Normbereich lag. Eine Dosisanpassung wegen Niereninsuffizienz war bei 261 von 613 Verordnungen erforderlich und wurde in 189 Fällen wie empfohlen umgesetzt. In 72 Fällen (27%) wurde sie nicht korrekt durchgeführt. Hier wurde die Dosis 32 mal nicht angepasst, 40 mal wurde trotz Kontraindikation verordnet. Das Risiko einer Fehlverordnung war signifikant assoziiert mit dem Vorliegen einer schweren Nierenfunktionsstörung (GFR < 30ml/min). Mit dem Vorliegen eines normalen Serumkreatininwerts waren keine signifikanten Assoziationen nachweisbar. Die Substanzen Metformin, Ramipril, Enalapril, HCT, Spironolacton und Simvastatin machten den Hauptanteil der Fehlverordnungen im Bereich der Dauermedikation aus. Bei den temporären Verordnungen waren im Schwerpunkt Antibiotika (Cefuroxim, Cefpodoxim, Levofloxacin) und Antiphlogistika (Diclofenac, Ibuprofen) betroffen. Schlussfolgerung: In einer durchschnittlichen Hausarztpraxis kommen in signifikanten Maße Fehlverordnungen vor. Die Gründe hierfür sind vielfältig. Insbesondere das Verschreibungsverhalten von Hausärzten hat eine zentrale Bedeutung für die Patientensicherheit bei Medikamentenverordnung und sollte unbedingt Gegenstand weiterer Untersuchungen sein. Context: Many avoidable adverse drug reactions in elderly patients are due to an absence of dose adjustment according to renal function. Serum creatinine concentration may be normal in patients over the age of 65 years while renal function is already reduced. The estimated GFR (eGFR) allows a more precise evaluation of the renal function, especially in the early stages of chronic renal insufficiency. This retrospective study was carried out in a GP practice, consisting of 2 GPs, in Frankfurt/ Main, Germany. The exploration aimed at invesitgating if patients with renal insufficiency were recognised and if they received medication according to renal function. Methods: In elderly patients (65yrs. and older) with renal insufficiency (creatinine clearance < 60 ml/min) prescribed medication was retrospectively explored. The Cockroft-Gault formula was used to calculate creatinine clearance as estimate for the GFR. The recommended dosage of each prescribed substance in the SmPC ( „Fachinformation“) was compared to the dosage that had been prescribed relating to the patients individual renal function. Results: Out of 232 analysed patients 102 had a calculated creatinine clearance
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- 2011
8. Prevalence of dosing errors in elderly patients with impaired renal function: a survey in ambulatory patients [meeting abstract]
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Roehl, Ina and Harder, Sebastian
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ddc:610 - Abstract
Meeting Abstract : Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 17. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Osnabrück, 25.-26.11.2010. ntroduction: Several drugs require dose adjustment in patients with impaired renal function, which however, often goes undetected. Serum creatinine may be normal in patients while renal function is already reduced. The estimated GFR (eGFR) allows a more precise evaluation of the renal function. This study was carried out in a group practice for family medicine, in Frankfurt/ Main, Germany. The exploration aimed at investigating if patients with renal insufficiency were recognised and if their prescriptions were appropriate in terms of dose adjustment or contra-indications. Methods: In patients (>65yrs) with renal insufficiency (creatinine clearance 65 yrs, 102 had an eGFR
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- 2010
9. Prevalence of dosing errors in elderly patients with impaired renal function: a survey in ambulatory patients
- Author
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Roehl, Ina and Harder, Sebastian
- Subjects
ddc: 610 ,610 Medical sciences ,Medicine ,urologic and male genital diseases - Abstract
Introduction: Several drugs require dose adjustment in patients with impaired renal function, which however, often goes undetected. Serum creatinine may be normal in patients while renal function is already reduced. The estimated GFR (eGFR) allows a more precise evaluation of the renal function. This[for full text, please go to the a.m. URL], 17. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie
- Published
- 2010
10. Anticoagulant treatment in German family practices : screening results from a cluster randomized controlled trial
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Ulrich-Müssig, Lisa-Rebekka, Mergenthal, Karola, Petersen, Juliana, Roehl, Ina, Rauck, Sandra, Kemperdick, Birgit, Schulz-Rothe, Sylvia, Berghold, Andrea, Siebenhofer-Kroitzsch, Andrea, Ulrich-Müssig, Lisa-Rebekka, Mergenthal, Karola, Petersen, Juliana, Roehl, Ina, Rauck, Sandra, Kemperdick, Birgit, Schulz-Rothe, Sylvia, Berghold, Andrea, and Siebenhofer-Kroitzsch, Andrea
- Abstract
Background: Oral anticoagulation (OAC) with coumarins and new anticoagulants are highly effective in preventing thromboembolic complications. However, some studies indicate that over- and under-treatment with anticoagulants are fairly common. The aim of this paper is to assess the appropriateness of treatment in patients with a long-term indication for OAC, and to describe the corresponding characteristics of such patients on the basis of screening results from the cluster randomized PICANT trial. Methods: Randomly selected family practices in the federal state of Hesse, Germany, were visited by study team members. Eligible patients were screened using an anonymous patient list that was generated by the general practitioners? software according to predefined instructions. A documentation sheet was filled in for all screened patients. Eligible patients were classified into 3 categories (1: patients with a long-term indication for OAC and taking anticoagulants, 2: patients with a long-term indication for OAC but not taking anticoagulants, 3: patients without a long-term indication for OAC but taking an anticoagulant on a permanent basis). IBM SPSS Statistics 20 was used for descriptive statistical analysis. Results: We screened 2,036 randomly selected, potentially eligible patients from 52 family practices. 275 patients could not be assigned to one of the 3 categories and were therefore not considered for analysis. The final study sample comprised 1,761 screened patients, 1,641 of whom belonged to category 1, 78 to category 2, and 42 to category 3. INR values were available for 1,504 patients of whom 1,013 presented INR values within their therapeutic ranges. The majority of screened patients had very good compliance, as assessed by the general practitioner. New antithrombotic drugs were prescribed in 6.1% of cases. Conclusions: The screening results showed that a high proportion of patients were receiving appropriate anticoagulation therapy. The numbers of patients w
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- 2014
11. Anticoagulant treatment in German family practices – screening results from a cluster randomized controlled trial
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Ulrich, Lisa-R, primary, Mergenthal, Karola, additional, Petersen, Juliana J, additional, Roehl, Ina, additional, Rauck, Sandra, additional, Kemperdick, Birgit, additional, Schulz-Rothe, Sylvia, additional, Berghold, Andrea, additional, and Siebenhofer, Andrea, additional
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- 2014
- Full Text
- View/download PDF
12. Primary care management for optimized antithrombotic treatment [PICANT]: study protocol for a cluster-randomized controlled trial
- Author
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Siebenhofer-Kroitzsch, Andrea, Ulrich-Müssig, Lisa-Rebekka, Mergenthal, Karola, Roehl, Ina, Rauck, Sandra, Berghold, Andrea, Harder, Sebastian, Gerlach, Ferdinand M., Petersen, Juliana, Siebenhofer-Kroitzsch, Andrea, Ulrich-Müssig, Lisa-Rebekka, Mergenthal, Karola, Roehl, Ina, Rauck, Sandra, Berghold, Andrea, Harder, Sebastian, Gerlach, Ferdinand M., and Petersen, Juliana
- Abstract
Background: Antithrombotic treatment is a continuous therapy that is often performed in general practice and requires careful safety management. The aim of this study is to investigate whether a best practice model that applies major elements of case management, including patient education, can improve antithrombotic management in primary health care in terms of reducing major thromboembolic and bleeding events. Methods: This 24-month cluster-randomized trial will be performed in 690 adult patients from 46 practices. The trial intervention will be a complex intervention involving general practitioners, health care assistants and patients with an indication for oral anticoagulation. To assess adherence to medication and symptoms in patients, as well as to detect complications early, health care assistants will be trained in case management and will use the Coagulation-Monitoring-List (Co-MoL) to regularly monitor patients. Patients will receive information (leaflets and a video), treatment monitoring via the Co-MoL and be motivated to perform self-management. Patients in the control group will continue to receive treatment-as-usual from their general practitioners. The primary endpoint is the combined endpoint of all thromboembolic events requiring hospitalization, and all major bleeding complications. Secondary endpoints are mortality, hospitalization, strokes, major bleeding and thromboembolic complications, severe treatment interactions, the number of adverse events, quality of anticoagulation, health-related quality of life and costs. Further secondary objectives will be investigated to explain the mechanism by which the intervention is effective: patients' assessment of chronic illness care, self-reported adherence to medication, general practitioners' and health care assistants' knowledge, patients' knowledge and satisfaction with shared decision making. Practice recruitment is expected to take place between July and December 2012. Recruitment of eligible patie
- Published
- 2012
13. [Guideline compliance in the treatment of patients with chronic heart failure through family doctor-centred health care: results of an evaluation study].
- Author
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Roehl I, Beyer M, Gondan M, Rochon J, Bauer E, Kaufmann-Kolle P, and Gerlach FM
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- Adolescent, Adrenergic beta-Antagonists therapeutic use, Adult, Aged, Aged, 80 and over, Angiotensin II Type 1 Receptor Blockers therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Cross-Sectional Studies, Female, Germany, Heart Failure epidemiology, Humans, Male, Management Quality Circles standards, Middle Aged, Quality Improvement standards, Quality Indicators, Health Care standards, Retrospective Studies, Young Adult, Family Practice standards, Guideline Adherence standards, Heart Failure drug therapy, Patient-Centered Care standards
- Abstract
Problem: Family doctor centred health care (German abbreviation: HzV) agreements in Baden-Wuerttemberg provides that every year the strategies and results of at least two high-quality guidelines shall be discussed and worked on in quality circles. In this regard, the 'heart failure' guideline by the German Society of General Practice and Family Medicine (DEGAM) is especially important due to the high treatment costs and the continuously increasing prevalence of this medical condition. Another specified objective of the HzV agreements is to increase the DMP participation rate. The study addressed two questions: Is the medical care provided to patients with chronic heart failure who are being treated under HzV more compliant with guidelines than routine care? Does further improvement result from working on the guidelines in quality circles?, Methods: Routine data were provided by the AOK Baden-Wuerttemberg statutory health insurance company. Patients with heart failure receiving treatment under an HzV agreement (HzV group) were compared with patients receiving routine care (control group) with regard to quality of care eight months before and eight months after working on the guideline on heart failure in quality circles. Primary endpoints were the prescription of ACE inhibitors, AT1 antagonists and beta blockers in accordance with guidelines. Adjustment for various covariates was done by means of multivariate multilevel regression., Results: Data were available for 3,667 practices [1,295 HzV practices; 2,158 non-HzV practices]. After applying validated diagnosis criteria, 16,584 patients were included in the intervention group and 28,992 in the control group. The HzV group received significantly better care in terms of the primary endpoint "prescription of ACE inhibitors or AT1 antagonists" (73.1 % vs. 69.3 % of the patients received ACE inhibitors or AT1 antagonists at T0 (OR 1.40; 95% CI [1,25; 1,57]; p < .001). 54.2 % vs. 52.3 % of the patients received beta blockers at T0 (not significant after adjustment, p = .260). No further improvement could be demonstrated to result from working on guidelines in quality circles., Discussion and Conclusion: The treatment of HzV patients with chronic heart failure is more compliant with guidelines than that of patients receiving routine care. Quality of care was already high at the beginning, and working on guidelines in quality circles had no noticeable effect. The increased DMP participation rate, which is one of the specified objectives of the HzV agreements, appears to have a mediation effect., (Copyright © 2013. Published by Elsevier GmbH.)
- Published
- 2013
- Full Text
- View/download PDF
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