Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen
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Z Evid Fortbild Qual Gesundhwes · Jan 2010
[In which categories should we think in when spending public health resources: value for money or rights for money?].
IQWiG, Germany's equivalent to Britain's NICE, has adopted an unorthodox method of cost-effectiveness analysis. The method does not use QALYs. ⋯ The present contribution assesses the controversy that has arisen over IQWiG's methods by discussing whether a. comparative judgements of the value of health will at least implicitly be made anyway as soon as IQWiG makes reimbursement recommendations in more than one medical area, and whether b. the well-known fairness objections to QALY maximization can plausibly be dealt with by equity weighting or, generally, by moving on to "societal value" maximization which tries to include fairness values besides efficiency. The conclusion is that the answer is no in both cases.
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Z Evid Fortbild Qual Gesundhwes · Jan 2010
[Letter on the publication "Community recommendations of the Community Professional Society of Medicine of the German Quality Control Society in combination with the German Society for Occupational and Environmental Medicine in the development of guidelines and recommendations for judgement and improvement of occupational diseases" (AWDQ 1/20/10. S/60)].
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Z Evid Fortbild Qual Gesundhwes · Jan 2010
Multicenter Study[Emergency medical treatment of paediatric palliative care patients: a problem for emergency medical care services? A retrospective, multicentre observational study].
In Germany a few specialised palliative care teams (PCTs) enable paediatric palliative care patients to stay at home in the final stage of their life. During this stage patients often experience episodes of acute symptoms requiring rapid medical intervention. In this case care-giving relatives can call emergency medical care services. The present investigation aims to show the meaning of emergency medical care services in treating paediatric palliative care patients in a home-care setting. Moreover, mental strain of emergency medical staff in paediatric medical emergencies and end-of-life care will be discussed. ⋯ Our data demonstrate that emergency medical treatment is less frequently provided to paediatric than to adult palliative care patients. However, these paediatric patients also need help that is based on the principles of palliative care like adult patients do. In the context of quality standard optimisation, specialised PCTs should get more involved in paediatric palliative home and pre-hospital care, even in cases of medical emergencies in these patients. After end-of-life decisions relating to paediatric patients, psychological support to the emergency medical team seems to be both helpful and reasonable.
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Z Evid Fortbild Qual Gesundhwes · Jan 2010
[Innovation in health care: the role of HTA in the introduction of new technologies].
Innovation in health care is a complex process taking place within a network of different stakeholders. From their specific perspective they need to continuously assess the technology under consideration to make the necessary decisions about the development and adoption of the technology. This is supported by HTA, but mainly with regard to reimbursement. ⋯ The availability of data for both the decision criteria and the structures of decision-making processes have a role in this context. In the present contribution, we discuss the role of HTA in the innovation process. Amendments to assessment criteria, in particular from the perspective of patients, health care professionals, producers and macro-economics, are proposed to improve the basis for decisions of all relevant stakeholder groups.