UNASSIGNED: Phenylketonuria (PKU) is an inherited metabolic disease. If left untreated, it can lead to severe irreversible intellectual disability and can cause seizures, behavior disturbance, and white matter disease. This study aimed at evaluating the health economic impact of patients with PKU in France.
UNASSIGNED: This retrospective observational study used health insurance claims data from the French SNDS (Système National des Données de Santé) database, which contains data from over 66 million French inhabitants. Patients with PKU were identified by ICD-10 diagnosis codes E70.0 (PKU) and E70.1 (Other hyperphenylalaninemia) documented as a chronic condition (affection de longue durée - ALD) or in the inpatient setting in the SNDS database between 2006 and 2018. Patients with PKU were matched to controls without PKU by age, sex, and region. Patients with early- and late-diagnosed PKU were defined as patients born after and before the implementation of nationwide newborn screening in France in 1972, respectively. Outcomes were analyzed for the year 2018.
UNASSIGNED: Overall, 3549 patients with PKU were identified in the database on January 1st, 2018. Of those, 3158 patients versus 15,703 controls with at least one healthcare consumption in 2018 were available for outcome analyses. Patients with PKU had 7.7 times higher healthcare costs than non-PKU controls in 2018 (€11,144 versus 1456 mean costs; p < 0.0001). Pharmaceutical costs including dietary amino acid supplements were the cost driver and contributed 80.0% of the overall mean difference (MD) between patients with PKU and matched non-PKU controls. More than half (52.4%) of the mean pharmaceutical costs per patient with PKU was attributable to medical foods including dietary amino acid supplements.Of the 3158 patients with PKU, 2548 (80.7%) were classified as early-diagnosed and 610 (19.7%) as late-diagnosed. Increased healthcare costs, in comparison to non-PKU controls, were more evident in early-diagnosed patients (€11,263 versus €855 mean costs; 13.2-fold increase; p < 0.0001). For patients with late-diagnosed PKU, healthcare costs were 2.7-fold higher compared to matched non-PKU controls (€10,644 versus €3951 mean costs; p < 0.0001). Outpatient pharmaceutical costs accounted for 89.1% of the MD between early-diagnosed patients and controls. Among late-diagnosed patients, 55.5% of the MD were attributable to costs for inpatient care, followed by costs for outpatient care (23.9%) and outpatient pharmaceutical costs (20.6%).
UNASSIGNED: The results indicate that PKU is associated with substantially increased health care costs compared to non-PKU controls in France. The health economic impact was most evident in patients with early-diagnosed PKU due to increased outpatient pharmaceutical costs, especially for medical foods including dietary amino acid supplements. For late-diagnosed and by definition older patients with PKU, the excess costs compared with matched controls were mostly driven by costs for inpatient care.

BACKGROUND: As only a few studies have examined the impact of the COVID-19 pandemic on the mental health outpatient system so far, the aim of the COVID Ψ Outpatient Survey was to gain insight from outpatient providers in Germany regarding changes in utilization; associated problems and challenges; telemedicine services; interactions with inpatient and nursing home services; and experiences with post-COVID syndromes.
METHODS: Between July and September 2021, we invited 351 randomly selected outpatient mental health specialists to take part in the online survey via e-mail. Additionally, we extended an invitation to professional associations to encourage their members to participate. N = 105 physicians of most regions of Germany took part in the survey.
RESULTS: Survey participants reported changes in utilization during the high incidence phases (HIP) of the pandemic using pre-formulated categories: For the first HIP in spring 2020, 31% of the survey participants reported a decrease > 20% and 5% an increase > 20% of patient contacts. For the third HIP in spring 2021, 4% reported a decrease > 20% of contacts, while 30% an increase > 20%. Participants chose \"patient\'s fears of infection\" and \"providers protection measures\" as reasons for decreases, and \"pandemic related anxieties\", \"economic stressors\", and \"capacity reductions of the inpatient system\" as reasons for increases of patient contact. Many providers introduced telemedicine services. A majority reported consultations for post-COVID syndromes already in spring 2021.
CONCLUSIONS: The survey hinted at changes in utilization, multiple problems but as well good-practice-solutions in the mental health outpatient system during the COVID-19 pandemic.

Introduction Hyperalbuminemia, defined as elevated serum albumin levels, may influence healthcare utilization, particularly unscheduled medical visits. The sympathetic nervous system (SNS) regulates serum albumin, which is crucial for maintaining oncotic pressure and substance transport. SNS instability, linked to chronic diseases, can impact albumin levels. This study investigates the association between hyperalbuminemia and unscheduled medical visits in community hospital outpatient departments, aiming to establish its potential as a predictor of healthcare utilization. Methods This retrospective cohort study utilized electronic medical records from Unnan City Hospital, Japan, from September 2021 to August 2023. Participants were over 15 years old and had albumin data available, excluding those with acute albumin conditions. The case group consisted of 321 hyperalbuminemia patients (serum albumin ≥ 5 g/dL), matched monthly with 16 controls. Data on demographics, chronic diseases, and unscheduled medical visits were collected. Multivariate logistic regression analyzed the association between hyperalbuminemia and unscheduled medical visits. Results Among 716 participants, the hyperalbuminemia group (mean age 59.13 years) was younger than the non-hyperalbuminemia group (mean age 74.36 years). Hyperalbuminemia patients had a higher BMI, pulse rate, and prevalence of diabetes, dyslipidemia, and brain stroke. Significant associations were found between hyperalbuminemia and unscheduled medical visits (OR 2.35, 95% CI 1.56-3.53, p < 0.001), age, BMI, pulse rate, and brain stroke. Conclusion Hyperalbuminemia is significantly associated with increased unscheduled medical visits in rural outpatient settings. Routine serum albumin assessments can aid in risk stratification and personalized care, potentially reducing acute healthcare needs. Future research should explore underlying mechanisms and broader populations to enhance clinical applications.

The vast majority of people work a large part of their live, therefore work inevitably has a major impact on health as well. In Germany, great efforts are made to improve health and well-being in the occupational context. To support this, the evaluation of health data especially from employees is one the main scopes in health reporting of the Federal Association of Company Health Insurance Funds (BKK Dachverband). These results are made available to the interested public via various publication channels, including interactive online diagrams. Data from the areas of incapacity to work, outpatient and inpatient care as well as drug prescriptions are applied. Due to the in large parts identically structured representations, comparisons across health care system sectors are also possible. The aim of this article is to describe the provided regional health care data of employees with focus on the interactive data provision, to show by example particularities in single sources and across sources. From this the impact of work as well as workplace health promotion on the health of employees and, in a broader sense, the quality of health care in Germany can be derived.

BACKGROUND: Rheumatology in Germany is facing major challenges. The need for rheumatological care is increasing and can no longer be met in some regions for capacity reasons. Too many people with an inflammatory rheumatic disease (IRD) have to forego appropriate care or receive it too late. The 4th new edition of the memorandum of the German Society for Rheumatology and Clinical Immunology (DGRh) provides information on rheumatological care in Germany. It was produced under the leadership of the DGRh together with the Professional Association of German Rheumatologists (BDRh), the Association of Acute Rheumatology Clinics (VRA), the German Rheumatism League (DRL) and the German Rheumatism Research Center (DRFZ).
METHODS: The memorandum describes the current state and development of the following areas: number of people with IRD, outpatient, inpatient and rehabilitative care structures, number of specialists in rheumatology, education and training, quality of care, health economic aspects and digital care concepts. Proposals for health policy measures to safeguard rheumatological care are presented.
RESULTS: Prevalence: approximately 1.8 million adults in Germany have an IRD. The prevalence is increasing, due to changes in the demographic structure of the population, improved diagnostics, treatment and longer survival. Care structures: outpatient specialist care (ASV) for rheumatic diseases is developing as a cross-sectoral care model for hospital outpatient clinics and rheumatology practices. Hospitals have been able to be certified as rheumatology centers since 2020, which enables structural developments. Specialists in rheumatology: as of 31 December 2023, there were 1164 specialists in rheumatology working in Germany. This included 715 physicians accredited to work in practices for national health assurance patients, 39% of whom were employees. In hospitals, 39% of doctors worked part-time. At least 2 rheumatology specialists per 100,000 adults are needed, i.e. around 1400, in order to provide adequate care. This means that there is a shortage of around 700 rheumatology specialists in the outpatient sector alone. Of all working specialists, 30% are currently aged 60 years old and over. Medical training: only 10 out of 38 (26%) state universities have an independent chair in rheumatology. In addition, 11 rheumatology departments are subordinate to a nonrheumatology chair. In the rheumatology-integration into student training (RISA) III study, only 16 out of 36 faculties fulfilled the recommended minimum number of compulsory hours of student rheumatology teaching. Continuing education in rheumatology: the annual postgraduate training qualifications do not cover the demand for rheumatology specialists, which is additionally increasing due to intensified workload, reduced capacities through retirement, and part-time work. Quality of care: since the introduction of highly effective medication patients with IRD have a much better chance of achieving remission of their disease. With early initiation of targeted therapy, the lives of many patients are hardly restricted at all: however, waiting times for a first rheumatological visit often last more than 3 months. Quality target is a first consultation within the first 6 weeks after the onset of symptoms. Models for early consultation, delegation of medical services, structured patient training and digital care concepts have been positively evaluated but are not covered financially.
RESULTS: the total annual costs for inflammatory joint diseases alone amount to around 3 billion euros. The direct costs have significantly risen since the introduction of biologics, while the indirect costs for sick leave, disability and hospitalization have fallen.
CONCLUSIONS: The core demands of this memorandum are a significant and sustainable increase in the number of further training positions in the outpatient and inpatient sector, the creation of chairs or at least independent departments for rheumatology at all universities and the further implementation of new and cross-sectoral forms of care. This will ensure modern needs-based rheumatological care for all patients in the future.
UNASSIGNED: HINTERGRUND: Die Rheumatologie in Deutschland steht vor großen Herausforderungen: der Bedarf an rheumatologischer Versorgung steigt und kann aus Kapazitätsgründen bereits jetzt in einigen Regionen nicht mehr gedeckt werden. Zu viele Menschen mit einer entzündlich-rheumatischen Erkrankung (ERE) müssen auf eine angemessene Versorgung verzichten oder erhalten diese zu spät. Die 4. Neuauflage des Memorandums der Deutschen Gesellschaft für Rheumatologie und Klinische Immunologie e. V. (DGRh) informiert über die rheumatologische Versorgung in Deutschland. Es wurde unter Führung der DGRh mit dem Berufsverband Deutscher Rheumatologen (BDRh), dem Verband Rheumatologischer Akutkliniken (VRA), der Deutschen Rheuma-Liga (DRL) und dem Deutschen Rheuma-Forschungszentrum (DRFZ) erstellt.
METHODS: Das Memorandum beschreibt den aktuellen Stand und die Entwicklung folgender Bereiche: Anzahl der Personen mit ERE, ambulante, stationäre und rehabilitative Versorgungsstrukturen, Anzahl an Fachärzt:innen für Rheumatologie, Aus- und Weiterbildung, Versorgungsqualität, gesundheitsökonomische Aspekte und digitale Versorgungskonzepte. Vorschläge für gesundheitspolitische Maßnahmen zur Sicherung der rheumatologischen Versorgung werden dargestellt.
UNASSIGNED: Prävalenz: Etwa 1,8 Mio. Erwachsene in Deutschland haben eine ERE. Die Prävalenz steigt aus verschiedenen Gründen: Veränderungen der Altersstruktur der Bevölkerung, verbesserte Diagnostik und Therapie mit längerem Überleben. Versorgungsstrukturen: Neben der regulären kassenärztlichen Versorgung hat sich die ambulante spezialfachärztliche Versorgung (ASV) als sektorenübergreifendes Versorgungsmodell etabliert. Krankenhäuser können sich seit 2020 als rheumatologische Zentren zertifizieren lassen, was strukturelle Weiterentwicklungen ermöglicht. Fachärzt:innen (FÄ) für Rheumatologie: Zum 31.12.2023 waren in Deutschland 1164 FÄ für Rheumatologie berufstätig. Vertragsärztlich waren dies 715 FÄ, davon 39 % angestellt. In Krankenhäusern waren 39 % der FÄ in Teilzeit tätig. Für eine bedarfsgerechte ambulante Versorgung benötigen wir mindestens 2 FÄ für Rheumatologie pro 100.000 Erwachsene, das sind rund 1400. Es fehlen also allein im ambulanten Bereich zum jetzigen Zeitpunkt etwa 700 FÄ für Rheumatologie. Von allen berufstätigen FÄ sind 30 % derzeit 60 Jahre und älter. Ärztliche Ausbildung: Nur 10 von 38 (26 %) staatlichen Universitäten verfügen über einen eigenständigen rheumatologischen Lehrstuhl. Darüber hinaus sind 11 rheumatologisch geführte Abteilungen einem nicht-rheumatologischen Lehrstuhl untergeordnet. Nur 16 von 36 Fakultäten erfüllten in der RISA III-Studie die empfohlene Mindestzahl an Pflichtstunden studentischer rheumatologischer Lehre. Rheumatologische Weiterbildung: Die jährlichen Weiterbildungsabschlüsse für Rheumatologie decken nicht den Bedarf an rheumatologischen FÄ, der durch steigende Arbeitsbelastung, reduzierte Kapazitäten durch Pensionierung und zunehmende Teilzeittätigkeit noch zunimmt. Versorgungsqualität: Rheuma-Betroffene haben seit Einführung hochwirksamer Medikamente eine deutlich bessere Aussicht auf eine Remission ihrer Erkrankung. Bei frühzeitiger adäquater Therapie ist die Lebensführung vieler Betroffener kaum noch eingeschränkt. Die Wartezeit auf eine rheumatologische Erstvorstellung beträgt aber oft mehr als 3 Monate. Qualitätsziel ist eine Vorstellung innerhalb der ersten 6 Wochen nach Symptombeginn. Frühsprechstunden, Delegation ärztlicher Leistungen, strukturierte Patientenschulungen und digitale Versorgungskonzepte wurden positiv evaluiert, sind aber nicht finanziell gedeckt. Kosten: Die jährlichen Gesamtkosten allein für entzündliche Gelenkerkrankungen belaufen sich auf etwa 3 Mrd. €. Die direkten Kosten sind seit Einführung der Biologika deutlich gestiegen, während indirekte Kosten für Krankschreibung, Erwerbsunfähigkeit und stationäre Aufenthalte gesunken sind.
UNASSIGNED: Kernforderungen dieses Memorandums sind: die deutliche und nachhaltige Steigerung der Zahl von Weiterbildungsstellen im ambulanten und stationären Bereich, die Schaffung von Lehrstühlen oder mindestens eigenständigen Abteilungen für Rheumatologie an allen Universitäten sowie die weitere Umsetzung neuer und sektorenübergreifender Versorgungsformen. Dies stellt eine bedarfsgerechte, moderne rheumatologische Versorgung für alle Betroffenen auch in Zukunft sicher.

Chronic pain is prevalent in the Veteran population at a disproportionate rate. Given the concerns for traditional pharmacologic management of pain, many are turning to nonpharmacologic alternatives for the treatment of pain. Virtual reality (VR) is an evidence-based tool, which has been demonstrated to reduce pain in hospitalized patients, and has been used for this purpose within the VA Sierra Nevada Healthcare System (VASNHCS) since 2019. Given the ongoing demonstrated benefit in this setting, these authors set to assess benefit for pain when used in an outpatient setting (demonstrations in the clinic, treatments in the patient\'s home) and demonstrate safety when used outside of a supervised setting. In this analysis, pain intensity decreased by an average of 22% when comparing pre- and postimmersion pain scores, and by 12.7% when comparing baseline pain scores with the end of the analysis. Patients also reported that the use of VR reduced their stress, decreased pain, and improved their mood, and some participants were able to reduce use of their as-needed pain medications with the use of VR. These findings are limited by a small sample size; however, this study provides encouraging evidence of benefit and a framework for future, larger scale analyses.

UNASSIGNED: Catheter ablation is a widely accepted intervention for atrial fibrillation (AF) management. Prior to undertaking this procedure, thorough patient education on its efficacy and potential complications is crucial. Additionally, educating patients about stroke risk management and anticoagulant therapy is imperative. At Mater Private Hospital in Dublin, we implemented a solution, integrating a customized treatment pathway and a mobile application. This patient-centred approach aims to optimize the clinical management of AF catheter ablation candidates, focusing on knowledge gaps and adherence to guideline-based care to enhance overall outcomes.
UNASSIGNED: The application automates pre-operative assessments and post-operative support, facilitating seamless patient-clinician communication. During the observation period (September 2022-April 2023), 63 patients installed the app. Patient adherence to the pathway was strong, with 98% of patients actively engaging in the treatment pathway and with 81% completing all pre-operative tasks. The average enrolment-to-admission duration was 14 days, and post-ablation tasks were fulfilled by 62% of patients within an average of 36 days. Operators perceived the solution as user-friendly and effective in enhancing patient connectivity. Patient satisfaction was high, and knowledge about AF improved notably through the solution, particularly concerning the recognition of symptoms and anticoagulation therapy-related complications.
UNASSIGNED: Our findings demonstrate the successful implementation of the app-based Ablation Solution, showcasing widespread patient use, improved adherence, and enhanced understanding of AF and its treatments. The system effectively connects healthcare providers with patients, offering a promising approach to streamline AF catheter ablation management and improve patient outcomes.

Outpatient letters are an essential communication tool in healthcare. Yet doctors receive little training on letter writing and what details recipients consider important. We surveyed 106 hospital doctors and 63 general practitioners (GPs), identifying differences in each group\'s preferences; GPs preferred more structured, detailed letters. Opportunities for feedback, formal templates and advanced software systems can improve communication in outpatient clinics.

BACKGROUND: Compared to patients with solid malignancies, less is known about the role of palliative care in patients with hematologic malignancies, leading to underutilization of palliative care.
OBJECTIVE: Evaluate the timing and impact of palliative care referrals on end-of-life outcomes over a 5-year period with intent to improve the utilization of palliative care in patients with advanced hematologic malignancies.
METHODS: A retrospective cohort of patients from an urban, NCI-designated comprehensive cancer center, aged 18 years and older with a diagnosis of an advanced hematologic malignancy were separated into groups of early, late, very late, or no specialty palliative care. Logistic regression models were constructed to examine variables associated with timing of palliative care referral. Groups were compared using the Kruskal Wallis test and Dunn\'s test with a Bonferroni correction method.
RESULTS: 222 patients with advanced hematologic malignancies who died between July 1, 20218 and June 30, 2023 were included. 50 (23%), 41 (18%), and 51 (23%) patients received an early, late, and very late palliative care referral, respectively and 80 (36%) patients did not receive a palliative care referral. There was a significantly high completion of ACP documentation among the palliative care cohorts. There was no significant difference among all cohorts in end-of-life outcomes in the last 14 or 30 days of life.
CONCLUSIONS: ACP documentation improved with palliative care, however, end-of-life outcomes did not. These results are likely due to the majority of late, inpatient palliative care referrals. Future studies with targeted interventions are needed to improve these outcomes.

The move from psychiatric hospitals to community-based care is the goal of policies in many countries. Latvia has attempted to reach this goal by establishing two outpatient centers in Riga. Since 2005, when the first outpatient centers opened, the ability of day clinics to reduce the total length of stay for hospital inpatients has been observed, although using the outpatient centers did not affect the number of patients treated. The open-door inpatient wards of the centers also attracted a new patient group. However, due to the COVID-19 pandemic, the number and length of stay of both outpatients and inpatients at psychiatric hospitals decreased. Therefore, other factors that can affect the move from psychiatric hospital inpatient care to outpatient centers should be further investigated.