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Disease Management & Health Outcomes

, Volume 14, Supplement 1, pp 19–22 | Cite as

New Possibilities for Communication between Hospital Cardiologists and General Practitioners

  • Holger Hänsch
  • Eckart Fleck
Review Article

Abstract

In Germany the healthcare system traditionally distinguishes between hospital (inpatient) and non-hospital (outpatient)-based care and subsequent reimbursement. Communication between the sectors involved in the medical system has always been problematical. New forms of care and subsequent payment are designed to overcome the gap between in- and outpatient treatment. By introducing ‘integrated healthcare’ as a comprehensive sector-spanning system the government is seeking to reach this goal.

A promising field for the introduction of integrated healthcare is cardiology. Cardiology meets several criteria needed for its successful implementation: evidence/guideline-based medicine, good statistical information, large numbers of procedures performed, the performance of procedures in both outpatient and inpatient sectors, the chronic course of long-lasting diseases, a high degree of dependence/involvement of other medical specialists and a great need for the implementation and obvious power of innovations in clinical cardiology.

In addition, the prevalence of cardiovascular disease and associated mortality is high in both sexes in industrialized countries. The cost for the treatment of chronic heart failure alone is estimated at €3 billion per annum. It is estimated that savings of 50% are possible in the treatment of cardiovascular illnesses. This calculation is mainly based on reducing the costs of hospital treatment and improving patient compliance. Better compliance would reduce the number of costly hospital admissions caused by the worsening of disease. By the introduction of telemonitoring, integrated healthcare may tap the full potential of savings.

The precondition for success is the broad participation of all parts of the healthcare system. The motivation of patients alone is not sufficient to achieve success: the interest of general practitioners must also be gained so that they can catalyse interest on the part of patients.

Keywords

Chronic Heart Failure Health Insurance Fund Improve Patient Compliance Integrate Healthcare Compulsory Health Insurance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Fleck E, editor. Open systems in medicine. Amsterdam: IOS Press; 1995, ISBN 90 5199 123 1Google Scholar
  2. 2.
    Statistisches Bundesamt. Available at: http://www.destatis.de. Accessed: 2006
  3. 3.
    Bruckenberger E. Herzbericht, Eigenverlag, Hannover. Available at: http://www.bruckenberger.de Accessed: 14 August 2006
  4. 4.
    McMurray JJ, Stewart S. Epidemiology, aetiology and prognosis of heart failure. Heart 2000; 83: 294–302CrossRefGoogle Scholar
  5. 5.
    Deutsche Gesellschaft für Kardiologie Herz- und Kreislaufforschung. Available at: http://www.dgk.org/leitlinien/index.aspx. Accessed: 14 August 2006
  6. 6.
    European Society of Cardiology. Available at: http://www.escardio.org/knowledge/guidelines. Accessed: 14 August 2006
  7. 7.
    American Heart Asscociation. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3004546. Accessed: 14 August 2006
  8. 8.
    American College of Cardiology. Available at: http://www.acc.org/clinical/statements.htm. Accessed: 14 August 2006
  9. 9.
    Komajda M, Lapuerta P, Hermans N, et al. Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey. Eur Heart J 2005; 26: 1653–9PubMedCrossRefGoogle Scholar
  10. 10.
    Fox R. Compliance, adherence, concordance. Circulation 1998; 97: 127CrossRefGoogle Scholar
  11. 11.
    Wagdi P, Vuilliomenet A, Kaufmann U, et al. Ungenügende Behandlungsdisziplin, Patienteninformation und Medikamentenverschreibung als Ursachen für die Notfallhospitalisation bei chronisch herzinsuffizienten Patienten. [Inadequate treatment compliance, patient information and drug prescription as causes for emergency hospitalization of patients with chronic heart failure]. Schweiz Med Wschr 1993; 123: 108–12PubMedGoogle Scholar
  12. 12.
    AWMF (Arbeitsgemeinschaft der wissenschaftlich medizinischen Fachgesellschaften) [Association of the Scientific Medical Societies in Germany]. Available at: http://leitlinien.net/. Accessed: 14 August 2006
  13. 13.
    Klein W. Gesundheitsökonomische Überlegungen zum Thema Herzinsuffizienz — Kosten der Krankheit [Health economical thoughts about Heart failure — costs of the disease]. J Kardiol 1999; 6: 612–6Google Scholar
  14. 14.
    Zugck Ch, Nelles M, Frankenstein L, et al. Telemedizin als integraler Bestandteil einer klinisch und gesundheitlich-ökonomisch effizienten Versorgung bei chronischer Herzinsuffizienz [Telemedicine as an integrated part of the economical treatment of chronic heart failure]. Telemedizinführer Deutschland, 83–88, ISBN 3-9808837-9-5; 2006Google Scholar
  15. 15.
    Korb H, Baden D, Wähner M, et al. Effektivität eines telemedizinischen Monitorings bei koronarer Herzerkrankung unter klinischen und gesundheitsökonomischen Aspekten [Efficacy of telemonitoring of chronic heart disease — medical and economical aspects]. Telemedizinführer Deutschland, 78–82, ISBN 3-9808837-9-5; 2006Google Scholar
  16. 16.
    Cleland JGF, Louis AA, Rigby AS, et al. Non-invasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death — the Trans-European Network — Home-Care Management System (TEN-HMS) Study. J Am Coll Cardiol 2005; 45(10): 1654–64PubMedCrossRefGoogle Scholar
  17. 17.
    Hänsch H. Strukturierte Dokumentation, Kosten-Nutzen-Relation [Structured documentation — Costs benefit ratio]. Z Kardiol 2005; 94 Suppl. 1: H812Google Scholar
  18. 18.
    Hänsch H, Fleck E. Vernetzung und Integrierte Versorgung — Vor- und Nachteile aus medizinischer Sicht [Networking and integrated disease management. Advantages and disadvantages from the medical point of view]. Bundesgesundheitsblatt 2005; 48(7): 755–60CrossRefGoogle Scholar
  19. 19.
    Schultz C, Bogenstahl C, Zippel B, et al. Sicht der Ärzte auf Telemedizin und integrierte Versorgung [Physicians view on telemedicine and integrated health care]. Poster Telemed [Poster Presentation], Berlin; 2006Google Scholar
  20. 20.
    Roland Berger Strategy Consultants. Auswirkungen der transsektoral integrierten Gesundheitsversorgung, auf die Medizinproduktindustrie 2002 Presentation [Effects of integrated health care on the healthcare industry]. Berlin, 5 November 2002. Available at: www.bvmed.de/linebreak4/mod/net-media_pdf/data/langfassung.pdf. Accessed: 14 August 2006

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  • Holger Hänsch
    • 1
  • Eckart Fleck
    • 1
  1. 1.Department of Internal Medicine/CardiologyGerman Heart Institute BerlinBerlinGermany

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