Das Gesundheitswesen
-
Das Gesundheitswesen · Apr 1997
[Reliability of expert assessment in disability evaluation within the scope of disability insurance].
With the introduction of the law on the statutory nursing care insurance in Germany ("Pflegeversicherung") in 1995, new benefits are provided for the most severely disabled people. Provision of benefits is contingent on a standardised examination performed by the medical service of the German statutory health insurance system (MDK). Results of the first study on the inter-rater reliability of this standardised examination are presented in this paper. ⋯ Between the 2 rater groups there was no substantial difference in reliability. However, there was a trend for higher agreement within the group of nurses. Although the overall reliability of the assessment of disability is relatively high in comparison to many other diagnostic procedures (such as x-ray readings), efforts should be made towards further improvement of this standardised examination.
-
The financing of personal health care services has become the crucible to test elected governments in the 21st century. Governments are caught between slow economic growth, lower personal income for most workers, and the clamour of health care for more money. The Western world with an aging population, marginal employment and rising unemployment, does not appear to have the capacity to pay for all that science and technology can produce and the public wants. ⋯ The art and science of medicine coupled with the human quest for health may simply exceed our productive capacity. The organisation and financing of twenty-First Century science and technology is nearly dysfunctional, bound by Nineteenth Century values, traditions and custom, as we face the next century. This may be the question.
-
Das Gesundheitswesen · Feb 1997
[Drug utilization by elderly patients in Bremen old age and nursing homes with special reference to psychotropic drugs].
In five homes for the aged in the city of Bremen that were also nursing homes, we studied the drug supply and drug intake of 301 inmates with particular reference to psychotropics, basing on the available records. The average regular drug intake covered 3.99 drugs. Furthermore, prescriptions for an average of 1.16 additionally required drugs were issued. ⋯ More than one half of the inmates (50.8%) were given prescriptions for psychotropics; 45.2% took at least one psychotropic permanently. Prescription of benzodiazepines of medium or long half-time was strikingly frequent; these are in fact drugs that are usually unsuitable for administration to elderly persons. As far as antidepressants/tranquilisers are concerned, we noticed that tricyclic antidepressants were prescribed almost exclusively.