ABSTRACT
According to Sixth Book of the Social Code (SGB VI), the German Pension Insurance (GPI) has the mandate to maintain or restore the employability of its insured persons. In order to achieve this goal, the GPI offers its insurees rehabilitation benefits. These are, on the one hand, services for prevention and medical rehabilitation (rehab) and, on the other hand, services for return-to-work or stay-at-work, respectively. In order to fulfill this mandate in the best possible way, in 1990 the GPI introduced instruments of external quality assurance (EQS) with scientific support. The system was firmly established in 1997. Since then, all rehab facilities owned and managed by the GPI are obliged to participate in the EQS system.Over the years, a large number of instruments and procedures have been developed that can map various aspects of quality as structure, process, and outcome. Until 2017, results of the EQS had no influence on the cooperation between the GPI and service providers. With the binding decision of the Federal Executive Board of the GPI in 2017, for the first time the GPI linked the allocation of rehab services for specific patients with the results of EQS. On this basis - confirmed by article 3 of the Digital Pension Overview Act - new paths are being taken. As part of the technically supported selection of a suitable facility for insured persons, quality should systematically and transparently acquire special importance and be consistently taken into account when occupying rehab facilities.This article gives an overview of the development of the proved and tested instruments of rehab quality assurance (QA), their current application, and an outlook on the rehab QA of the future.
Subject(s)
Insurance , Pensions , Germany , Humans , National Health Programs , Rehabilitation CentersABSTRACT
BACKGROUND: The treatment of palmar hyperhidrosis with botulinum toxin type A (BTX A) injections is one of the most effective therapeutic options. However, without adequate anaesthesia this treatment is not feasible in most patients. The anaesthesia of the radial, median and ulnar nerves (wrist block) is despite the absence of good data considered effective but risky. PATIENTS AND METHODS: Between 1.10.1999 and 30.9.2001 retrospectively the efficacy, side effects and the patient satisfaction regarding the overall performance of the wrist block prior to the treatment of the palmar hyperhidrosis with BTX A was investigated. The study took place at the department of dermatology in Mannheim. RESULTS: Of the 38 patients treated, 33 were finally included into the trial. The patients chose the average score of 7,9 +/- 2,1 (sd) on a scale from "0" to "10" (not at all effective--maximally effective) for the efficacy of the wrist block in reducing pain. The patients were very content with the wrist block and granted it the average score of 7,7 +/- 2,1 (sd) on a scale from "0" to "10" (not at all content--maximum content). Unwanted effects could be seen in 31/33 patients (93,9%): these were dizziness, headache or haematoma at the spot of injection as well as pain caused by the injections of the local anaesthesia or paresthesias such as tickling of the hand or arm. All side effects caused by the wrist block were reversible and lasted--except in one patient--only for a short time. 29/33 patients (87,9%) recommended the wrist block prior to treating palmar hyperhidrosis with BTX A and 28/33 patients (84,9%) could not imagine to agree to such a treatment without local anaesthesia. CONCLUSION: The wrist block effectively reduces pain due to the treatment of palmar hyperhidrosis with BTX A. Major side effects are rare; patient acceptance and satisfaction are high.
