ABSTRACT
OBJECTIVE: The aim of this study was to assess the general attitudes of health insurants with chronic conditions towards a health coaching and their reasons for participation in or refusal of the telephone health coaching provided by their sickness fund. METHOD: The survey was designed as a cross-sectional study on insurants who had either participated in the coaching (n=834), declined participation (n=530) or were members of a control group (n=544). Furthermore, we investigated whether the reasons and attitudes differed with regard to socio-demographic variables of the participants (age, sex, primary condition). RESULTS: The most common reason for participation in health coaching was the feeling of obligation towards the society to take care of one's own health (80.1%). Further reasons included a general interest in prevention (75.4%) and health-related issues (51.1%). The main reason for declining participation was a sufficient care by family members or a general practitioner (96.4%). This was in particular the case with older insured persons. Most people in the control group estimated health coaching as effective and appropriate for them. Those who had declined to participate were more critical in their appraisal. The younger the insured were, the more positive was their attitude towards health coaching. CONCLUSIONS: The results show that, on the one hand, insured feel obligated to participate in prevention programs but, on the other hand, they are also interested in information about their condition and in the possibility to contribute to their treatment. The telephone health coaching by the KKH-Allianz is a new approach in the German health care and can be regarded as a supplement to medical treatment. Specifically, younger insured are highly interested in this new concept. Further studies on its efficacy are required to show the extent to which expectations and needs of insurants can actually be met.
Subject(s)
Attitude to Health , Chronic Disease/psychology , National Health Programs , Patient Acceptance of Health Care/psychology , Patient Education as Topic/methods , Telephone , Adult , Age Factors , Aged , Aged, 80 and over , Caregivers/psychology , Chronic Disease/therapy , Cross-Sectional Studies , Female , Germany , Health Behavior , Health Services Needs and Demand , Humans , Male , Middle Aged , Motivation , Patient Participation/psychology , Physician-Patient Relations , Self Care/psychology , Social Responsibility , Young AdultABSTRACT
BACKGROUND AND OBJECTIVE: The rising prevalence of chronic heart failure (CHF) has led to an increase in total treatment expenditures. A medical care programme of telemetry was developed to reduce the number of patients with decompensated CHF, hospital admissions and overall treatment cost. PATIENTS AND METHODS: As part of a prospective controlled study the body weight of 251 patients with CHF was monitored over one year. The supervising center contacted the patients whenever their body weight exceeded a threshold value. Patients were phoned by a designated personal adviser and received regular informative material and advice by specialist medical personnel. Patients' general practitioners had been involved in recruiting patients and by regularly sending them follow-up reports. Another group of 251 patients who had not received the described telemetric intervention served as control. RESULTS: The mean age of the patients was 71.7 years, lower than the 76.4 years of the control group. More patients in the intervention groups were in NYHA class III and IV than in the control group (52 % vs 36 %). After an average observation period of 12 months the duration of hospital stay had been reduced by 48 % (p = 0.01), the hospital costs by EUR 7128 per patient p = 0.01), while drug expenditure had increased by EUR 245 per patient (not significant). The total costs had thus fallen by EUR 6993 per patient (-39.5 %; p = 0.05). The mortality rate of 14.7 % in the intervention group was significantly lower than that of the control group of 27.1 % (p = 0.001). The reduction in costs and mortality rate was clearly greater for men than women. Total expenditure had been highest for patients who had died. CONCLUSION: The results indicate that total treatment costs and mortality rate can be reduced by telemetric monitoring of patients in CHF, especially in men.
Subject(s)
Heart Failure/economics , Telemedicine/economics , Aged , Body Weight , Chronic Disease , Cost of Illness , Female , Germany , Heart Failure/mortality , Humans , Male , Prospective Studies , Reference Values , Sex Characteristics , Survival Analysis , Treatment OutcomeABSTRACT
In September 2005, the Collaborative Arthritis Center in Hannover, the Hannover Medical School, general practitioners, rheumatologists in private practice, the League against Rheumatism in Lower Saxony (Rheuma-Liga Niedersachsen, a regional patient self-help organization), the State Pension Authority (Deutsche Rentenversicherung Braunschweig-Hannover) and a health insurance fund (Kaufmännische Krankenkasse), in collaboration with the Physician's Association of Lower Saxony, entered a contract for integrated health care in rheumatology in Lower Saxony. The agreement aims at patients with early arthritis or spondyloarthritis. Through close collaboration between primary health care physicians and rheumatologists, the diagnosis of arthritis or spondyloarthritis should be made soon after disease manifestation and an adequate therapy initiated. The article describes the background and contents of the contract.
