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Background: Chronic diseases are associated with a high disease burden. Under- and overprovision of care as well as quality variation between health care providers persists, while current quality indicators rarely capture the patients' perspective. Capturing patient-reported outcome measures (PROMs) as well as patient-reported experience measures (PREMs) is becoming more and more important to identify gaps in care provision, prioritize services most valuable to patients, and aid patients' self-management., Objective: This study aims to measure the potential benefits and effectiveness of using electronic patient-reported outcome measures (ePROMs) and electronic patient-reported experience measures in a structured and population-based manner to enhance health care for chronic disease patients in Germany., Methods: This prospective cohort study aims to evaluate the potential benefits of PROM usage in patients with chronic diseases. We evaluate whether (1) digitally collected PROMs and PREMs can be used for health system performance assessment by generating a representative response of chronically diseased individuals with asthma, chronic obstructive pulmonary disease, diabetes, and coronary artery disease across Germany, and (2) based on the PROMs and PREMs, low-value care can be identified. As patient-reported outcomes (PROs) are rarely presented back to patients, (3) this study also examines patients' reactions to their PROM scores in the form of digital PRO feedback. For these purposes, randomly selected patients from a nationwide German insurer are digitally surveyed with generic and disease-specific PROMs and PREMs, as well as additional questions on their health-related behavior, 4 times over 1 year. Individual PRO feedback is presented back to patients longitudinally and compared to a peer group after each survey period. Patient-reported data is linked with health insurance data. Response rates, changes in health and experience outcomes over time, self-reported changes in health behavior, and health care system usage will be analyzed., Results: The PROMchronic study explores the usage of PROMs in patients with chronic diseases. Data collection began in October 2023, after the initial invitation letter. All the 200,000 potential patients have been invited to participate in the study. Data have not yet been analyzed. Publication of the interim results is planned for the autumn of 2024, and the results are planned to be published in 2025., Conclusions: We aim to fill the research gap on the population-based usage of PROMs and PREMs in patients with chronic diseases and add to the current understanding of PROM data-sharing with patients. The study's results can thereby inform whether a health care system-wide approach to collecting PROMs and PREMs can be used to identify low-value care, assess quality variation within and across chronic conditions, and determine whether PRO feedback is helpful and associated with any changes in patients' health behaviors., Trial Registration: German Clinical Trials Register DRKS00031656; https://drks.de/search/en/trial/DRKS00031656., International Registered Report Identifier (irrid): DERR1-10.2196/56487., (©Janis Nikkhah, Viktoria Steinbeck, Thomas G Grobe, Thorben Breitkreuz, Christoph Pross, Reinhard Busse. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 05.08.2024.)

Background: A structural reform of the German psychotherapy guideline in 2017 was intended to facilitate access to outpatient guideline psychotherapy. In the present study, we evaluate the effects of this reform in particular for patients with a comorbidity of mental disorders and chronic physical conditions (cMP)., Methods: Pre-post analyses of the two primary endpoints "percentage of mentally ill persons who have made an initial contact with a psychotherapist" and "waiting time for guideline psychotherapy" were carried out employing population-based and weighted routine statutory health insurance data from the German BARMER. The secondary endpoints included evaluations from the patients' perspective, based on a representative survey of patients in psychotherapy, and an overview of the health care situation based on data from the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV) (study registration number: DRKS00020344)., Results: From 2015 to 2018, the percentage of mentally ill persons who had made an initial contact with a psychotherapist rose moderately, from 3.7% (95% confidence interval, [3.6; 3.7]) to 3.9% [3.8; 3.9] among persons with cMP and from 7.3% [7.2; 7.4] to 7.6% [7.5; 7.7] among those with mental disorders but without any chronic physical condition (MnoP). The new structural elements were integrated into patient care. The interval of time between the initial contact and the beginning of guideline psychotherapy became longer in both groups, from a mean of 80.6 [79.4; 81.8] to 114.8 [113.4; 116.2] days among persons with complex disease and from 80.2 [79.2; 81.3] to 109.6 [108.4; 111.0] days among persons with non-complex disease; most patients considered the waiting time. Approximately 8% of the patients who sought psychotherapy reported that they had not obtained access to a psychotherapist., Conclusion: Neither in general nor for patients with cMP did the introduction of the structural reform appreciably lower the access barriers to psychotherapy. Further steps are needed so that outpatient care can meet the needs of all patients and particularly those with cMP.

Background: The frequency of medical diagnoses is a figure of central importance in epidemiology and health services research. Prevalence estimates vary depending on the underlying data. For a better understanding of such discrepancies, we compared patients' diagnoses as reported by themselves in response to our questioning with their diagnoses as stated in the routine data of their health insurance carrier., Methods: For 6558 adults insured by BARMER, one of the statutory health insurance carriers in Germany, we compared the diagnoses of various illnesses over a twelve-month period, as reported by the patients themselves in response to our questioning (October to December 2021), with their ICD-10-based diagnosis codes (Q4/2020-Q3/2021). The degree of agreement was assessed with two kappa values, sensitivity, and specificity., Results: The patients' stated diagnoses of diabetes and hypertension agreed well or very well with their diagnosis codes, with kappa and PABAK values near 0.8, as well as very high sensitivity and specificity. Moderately good agreement with respect to kappa was seen for the diagnoses of heart failure (0.4), obesity, anxiety disorder, depression, and coronary heart disease (0.5 each). The poorest agreement (kappa ≤ 0.3) was seen for posttraumatic stress disorder, alcohol-related disorder, and mental and somatoform disorder. Agreement was worse with increasing age., Conclusion: Diagnoses as stated by patients often differ from those found in routine health insurance data. Discrepancies that can be considered negligible were found for only two of the 11 diseases that we studied. Our investigation confirms that these two sources of data yield different estimates of prevalence. Age is a key factor; further reasons for the discrepancies should be investigated, and avoidable causes should be addressed.

Introduction: In 2017, in Germany, a structural reform of the outpatient psychotherapy guideline took place, aiming to reduce waiting times, to facilitate flexible low-threshold access (eg, general reachability by phone) and to lower access barriers for specific patient groups. The reform included new service elements, such as the implementation of additional psychotherapeutic consultations, acute short-term psychotherapeutic interventions and relapse prophylaxis as well as the promotion of group therapies, the facilitation of psychotherapists' availability, and the installation of appointment service centres. The ES-RiP project aims to thoroughly evaluate the effects of the reform with a special focus on patients with a comorbidity of mental disorders and chronic physical conditions (cMPs) compared with patients with a mental disorder but no long-term physical condition (MnoP). The project aims to evaluate (a) the extent to which the reform goals were achieved in the large group of patients with cMPs compared with MnoP, (b) the barriers that might hinder the implementation of the new guideline and (c) the procedures required for further developing and improving outpatient psychotherapy., Methods and Analysis: A mixed-methods design (quantitative, qualitative) along with a multilevel approach (patients, service providers, payers) triangulating several data sources (primary and secondary data) will be applied to evaluate the reform from different perspectives., Ethics and Dissemination: Ethical approval was obtained from the coordinating committee as well as one local ethics committee, Justus Liebig University Giessen and Marburg - Faculty of Medicine (approval number: AZ 107/20) and Heidelberg (approval number: S-466/2020). The results of this study will be disseminated through expert panels, conference presentations and publications in peer-reviewed journals., Trial Registration Number: DRKS00020344., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim of the Study: The aim of this study was to assess risk factors for prescription of potentially inappropriate medication (PIM) to nursing home residents using the PRISCUS list in 2017., Methods: Using claims data (AOK) we analysed insured nursing home residents aged 65 or older in 2017. The PRISCUS list was used to identify PIMs. A multivariate logistic regression analysis was performed to analyse risk factors., Results: The study population in 2017 included 259 328 nursing home residents, out of them 25.5% received at least one potentially inappropriate medication (women: 25.6%/men: 24.9%). Female and younger aged nursing home residents had a higher risk for at least one PRISCUS prescription. Polypharmacy, an increasing number of attending physicians, and hospital stays were additional risk factors for a PRISCUS prescription. Furthermore, regional (Bundesland) variations contributed to differences in PRISCUS prescriptions., Conclusion: The frequent PIM prescriptions in nursing home residents are a relevant topic regarding drug therapy safety. Regional differences, which cannot be explained by nursing home resident characteristics, show options for modifications and the need for further research., Competing Interests: PA Thürmann erklärt, dass Sie vom BMBF (Förderkennzeichen 01ET0721) Drittmittel zur Erstellung der PRISCUS-Liste erhielt bzw. für ein Up-date erhält (Förderkennzeichen 01KX1812)., (Thieme. All rights reserved.)

Aim: There are differences in the prevalence estimates of depressive disorders based on primary and secondary data. The reasons for this are, for instance, the use of divergent indicators and varying observation periods. This study examines the prevalence of depressive disorders using survey and routine data for a comparable survey period and age range. Effects of differences between data sources and indicators are estimated., Methods: For 2010, 3 indicators are compared: in a population survey collected a) self-reported medical diagnosis of depression, b) diagnosis of depressive disorders identified by clinical interviews and c) administrative depression diagnoses collected from routine data of a statutory health insurance. In sensitivity analyses, privately insured participants of the population survey were excluded, and insured persons with care needs were excluded from routine data. The definition of administrative depression diagnosis was varied depending on the frequency of coded diagnoses and the specificity of the diagnoses., Results: The highest prevalence (9.8%) was found for depression diagnoses from administrative data, the lowest prevalence (5.9%) in self-reported medical diagnoses of depression in the population survey. The prevalence of depression identified by clinical interviews was 8.4%. Differing age and gender-related courses of illness were found. The administrative prevalence dropped significantly if unspecific diagnoses (F3x.8, F3x.9) were excluded., Discussion: Depending on the definition of depression diagnoses used in administrative data, there was a reduction in differences of prevalence compared to the self-reported medical diagnoses. Differences in prevalence based on a diagnosis of a depressive disorder identified in a clinical interview remained stable, which indicates different groups of persons., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background and Objectives: Attention deficit hyperactivity disorders (ADHD) are among the most common mental disorders in children and adolescents. For a number of years there has been evidence of regional differences in Germany. This article provides current results on the frequency of diagnosis and treatment and also discusses methodological aspects., Materials and Methods: The analysis is based on routine data of a statutory health insurance company including annual diagnoses and drug prescriptions from 2005 to 2015 of at least 1.34 million children and adolescents between 0 and 19 years of age. Small-area results of ADHD diagnosis rates and methylphenidate prescriptions are presented with a standardized differentiation according to 413 districts pursuant to territorial status from the end of 2008., Results: From 2005 to 2014, ADHD diagnoses were documented for an increasing proportion of 0 to 19-year-olds in Germany. In 2015 the proportion was 4.2%; boys aged 10 were affected most frequently with a proportion of 11.1%. Regional diagnosis rates vary considerably. Two counties showed diagnosis and prescription rates that were more than twice as high as regionally expected for all years in question; other districts showed rates that were continually lower than expected by at least a third., Discussion: Analyses on the level of administratively defined districts have some advantages but alternative regional structuring would be desirable due to very heterogeneous population figures. Regarding ADHD diagnoses and documented methylphenidate prescriptions on an outpatient basis, significant regional differences in Germany were detected, for which plausible medical justifications do not yet exist. Specialist discussions seem urgently needed.

Background and Objectives: With the introduction of a new occupational classification at the end of 2011, employment characteristics are reported by employees to social insurance agencies in Germany in more detail than in previous years. In addition to other changes, the new classification allows a distinction between full- and part-time work to be made. This provided a reason to consider the health-related aspects of part-time work on the basis of data from a statutory health insurance scheme., Materials and Methods: Our analysis is based on the data of 3.8 million employees insured with the Techniker Krankenkasse (TK), a statutory health insurance scheme, in 2012. In addition to daily information on employment situations, details of periods and diagnoses of sick leave and the drugs prescribed were available., Results: Although approximately 50 % of women of middle to higher working age worked part-time in 2012, the corresponding percentage of men employed in part-time work was less than 10 %. Overall, part-time employees were on sick leave for fewer days than full-time employees, but among men, sick leave due to mental disorders was longer for part-time employees than for full-time employees, whereas women working part time were affected to a lesser extent by corresponding periods of absence than those working full time., Discussion: The results provide indications for the assertion that men in gender-specifically atypical employment situations are more frequently affected by mental disorders. Further evidence supports this assertion. With the long-term availability of these new employment characteristics, longitudinal analyses could help to clarify this cause-effect relationship.

In 2005, the Working Group for the Survey and Utilisation of Secondary Data (AGENS) of the German Society for Social Medicine and Prevention (DGSMP) and the German Society for Epidemiology (DGEpi) first published "Good Practice in Secondary Data Analysis (GPS)" formulating a standard for conducting secondary data analyses. GPS is intended as a guide for planning and conducting analyses and can provide a basis for contracts between data owners. The domain of these guidelines does not only include data routinely gathered by statutory health insurance funds and further statutory social insurance funds, but all forms of secondary data. The 11 guidelines range from ethical principles and study planning through quality assurance measures and data preparation to data privacy, contractual conditions and responsible communication of analytical results. They are complemented by explanations and practical assistance in the form of recommendations. GPS targets all persons directing their attention to secondary data, their analysis and interpretation from a scientific point of view and by employing scientific methods. This includes data owners. Furthermore, GPS is suitable to assess scientific publications regarding their quality by authors, referees and readers. In 2008, the first version of GPS was evaluated and revised by members of AGENS and the Epidemiological Methods Working Group of DGEpi, DGSMP and GMDS including other epidemiological experts and had then been accredited as implementation regulations of Good Epidemiological Practice (GEP). Since 2012, this third version of GPS is on hand and available for downloading from the DGEpi website at no charge. Especially linguistic specifications have been integrated into the current revision; its internal consistency was increased. With regards to contents, further recommendations concerning the guideline on data privacy have been added. On the basis of future developments in science and data privacy, further revisions will follow., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: The Internet provides ways for patients to obtain information about doctors. The study poses the question whether it is possible and how long it takes to find a suitable doctor with an Internet search. It focuses on the effectiveness and efficiency of the search. Specialised physician rating and searching portals and Google are analysed when used to solve specific tasks., Methods: The behaviour of volunteers when searching a suitable ophthalmologist, dermatologist or dentist was observed in a usability lab. Additionally, interviews were carried out by means of structured questionnaires to measure the satisfaction of the users with the search and their results. Three physician rating and searching portals that are frequently used in Germany (Jameda.de, DocInsider.de and Arztauskunft.de) were analysed as well as Google., Results: When using Arztauskunft and Google most users found an appropriate physician. When using Docinsider or Jameda they found fewer doctors. Additionally, the time needed to locate a suitable doctor when using Docinsider and Jameda was higher compared to the time needed when using the Arztauskunft and Google. The satisfaction of users who used Google was significantly higher in comparison to those who used the specialised physician rating and searching portals., Conclusion: It emerged from this study that there is no added value when using specialised physician rating and searching portals compared to using the search engine Google when trying to find a doctor having a particular specialty. The usage of several searching portals is recommended to identify as many suitable doctors as possible., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: The study determines how often Depersonalization-Derealization Disorder (ICD-10: F48.1) is diagnosed in the general population and analyzes the associations of other diseases with F48.1., Methods: The sample consists of 1.567 million insured persons of a statutory health insurance fund in Germany. We analyzed the prevalence of F48.1 and the associations of F48.1 with other diseases according to ICD-10., Results: We found a 1-year prevalence of 0.007 % for the diagnosis of F48.1. After adjustment for age, sex, depression and anxiety, several somatic disease groups were found to be associated with an increased likelihood of F48.1, e.g., abnormalities of breathing (R06), cardiac arrhythmias (I47-I49), epilepsy (G40), dizziness (H81, H82, R42) and headache (G43, G44, R51)., Conclusions: According to epidemiological studies, the prevalence of depersonalization-derealization disorder is 1-2 %. We therefore conclude that F48.1 is severely underdiagnosed. Increased awareness for the detection of F48.1 and further health care research are urgently warranted.

Since the 1990s, administrative data sources of statutory health insurance companies in Germany have significantly expanded. However, general statements with regard to data availability are not possible. Taking the example of the Gmünder Ersatzkasse (GEK) with currently about 1.6 million insured persons, this article will give an impression, which data, and since when, could have been used for scientific analysis. Examples of different topics (unemployment, alcohol abuse, outpatient psychotherapy, coronary revascularization) are given. Data exist on almost all sectors of health insurance coverage since the availability of information on outpatient care in the year 2004. Research opportunities - and hence the scientific value of these data - are mainly resulting from the acquisition of data at the personlevel. Only with person-level data can longitudinal and trans-sectoral analysis capabilities with clearly defined denominator populations arise. Due to the availability of data for large populations, previously nonexisting analysis options are now available.

Objectives: The aim of this study is to compare information on hospitalisations for acute myocardial infarction (AMI) from three different sources., Methods: (A) The national hospital discharge statistics, covering all hospitalisations in Germany, is representative for this population. However, the information is limited, as data are collected case-related containing only few characteristics. (B) In contrast, claims data of sickness funds can be analysed longitudinally and contain more characteristics. The data have to be collected from single sickness funds. As for the data from registries (C) these data cannot be assumed to be representative., Results: Data from the included sickness fund showed good consistency when compared to data from the national hospital discharge statistics regarding most, but not all, results. Comparisons with the register in Augsburg lead to divergent results regarding case fatality rates and rates of utilisation of technologies., Conclusions: None of the three sources can be considered ideal. Part of the differences could be explained by methodological and regional effects. More insight could be gained by comparing data at the individual level. According to recent legislation, data from all statutory sickness funds are supposed to be merged. This would simplify such comparisons and most likely would allow for more valid information regarding the incidence and treatment of AMI and many other diseases.

Background: Depressive disease is becoming increasingly relevant in industrialised countries. For public health policy and planning it is important to know about the epidemiology of this disease as well as the extent to which this epidemiology impacts on health service provision., Method: Analysis of data from a major German statutory health insurance company: Longitudinal micro-level claims data containing information about diagnoses obtained from inpatient and outpatient sources as well as information collected from prescriptions issued for antidepressants. Data was analysed with regard to the differences in drug utilisation and the risk of being diagnosed with depression according to age, sex, marital status and area of residence., Results: Results correspond significantly with the findings of population surveys on depression epidemiology. They also confirm the finding of a lower prevalence of depression in East Germany compared to West Germany. However, the claims data revealed an unexpectedly high prevalence of depression diagnosis in older age groups., Conclusion: Statutory health insurance data seems to be a reliable source of epidemiological information that is both easily accessible and longitudinally available, and thus provides important information that is needed for health policy and service planning. With regard to service provision it should be considered that depression in old age is a greater problem than is suggested by most epidemiological surveys.