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Aim: The purpose of this study was to analyze treatment compliance in osteoporotic patients treated with osteoporosis medications in Germany.
Methods: Patients included in the analysis had been diagnosed with osteoporosis with or without fractures and started anti-osteoporotic therapy (bisphosphonates, denosumab, or strontium ranelate) between 2011 and 2014 in a general (GP) or orthopedic practice (OP) setting in Germany. Data pertaining to 6,221 individuals followed in GP and 4,044 individuals followed in OP were analyzed retrospectively. The last follow-up was in December 2015. The main outcome measure was the compliance within the one-year period after the index prescription date. Compliance was measured indirectly and was based on the mean possession ratio (MPR). A multivariate logistic regression model was used to determine the association between MPR (dependent variable) and age, gender, type of practice, type of osteoporosis treatment, therapy frequency, and history of fracture (covariates).
Results: The mean age of the study group was 73.3 years, and 13.2% of subjects were men. Regarding type of practice, 60.6% of individuals were followed in GP and 39.4% in OP. Noncompliance was observed in 55.2% of the patients. Patients in the age group ≤60 years were at a higher risk of being noncompliant when compared to those in the age group of 61–70 years. Men and patients who received oral drugs were also more likely to be noncompliant than women and patients who received injectable or intravenous drugs. Finally, therapies that were given every three or six months were associated with a decrease in the risk of noncompliance when compared to weekly therapy, whereas daily and monthly treatments were associated with an increased risk.
Conclusion: Compliance is insufficient in osteoporotic patients treated with osteoporosis medications.
Background: As health workforce policy is gaining momentum, data sources and monitoring systems have significantly improved in the European Union and internationally. Yet data remain poorly connected to policy-making and implementation and often do not adequately support integrated approaches. This brings the importance of governance and the need for innovation into play.
Case: The present case study introduces a regional health workforce monitor in the German Federal State of Rhineland-Palatinate and seeks to explore the capacity of monitoring to innovate health workforce governance. The monitor applies an approach from the European Network on Regional Labour Market Monitoring to the health workforce. The novel aspect of this model is an integrated, procedural approach that promotes a ‘learning system’ of governance based on three interconnected pillars: mixed methods and bottom-up data collection, strong stakeholder involvement with complex communication tools and shared decision- and policy-making. Selected empirical examples illustrate the approach and the tools focusing on two aspects: the connection between sectoral, occupational and mobility data to analyse skill/qualification mixes and the supply–demand matches and the connection between monitoring and stakeholder-driven policy.
Conclusion: Regional health workforce monitoring can promote effective governance in high-income countries like Germany with overall high density of health workers but maldistribution of staff and skills. The regional stakeholder networks are cost-effective and easily accessible and might therefore be appealing also to low- and middle-income countries.
Purpose: The Action Plan for Medication Safety by the German Federal Ministry of Health introduced a standardized medication plan (MP), a printable document for the patient. The practical handling needs to be tested before the nationwide implementation in Germany. Therefore, the aims of our study were 1) to develop an instrument to evaluate the usage of the standardized MP, 2) to assess if patients can locate, and 3) understand important information. Moreover, we explored patients’ opinion and suggestions regarding the standardized MP template.
Patients and methods: We conducted a cross-sectional study to evaluate the practical handling of the standardized MP. We interviewed 40 adult patients in seven community pharmacies in Germany, who took at least five medicines regularly and gave their written informed consent. The interview consisted of questions regarding finding and understanding information provided on a mock-up MP, patients’ opinion and the execution of the information on the MP by filling pill boxes. We eventually developed a new evaluation method to quantify the practical handling of the MP by rating the pill boxes filled by the patients.
Results: Overall, the participants rated the MP positively. Thirty-nine (98%) participants found important information on a mock-up standardized MP. Patients were questioned to identify if they understood information on medical intake as it relates to meals. In particular, they were questioned about medicine intake "1 hour before a meal", which 98% (n=39) interpreted correctly, and "during a meal", which 100% (n=40) interpreted correctly. The less precise advice of "before a meal" was interpreted correctly by 73% (n=29), and only 15% (n=6) correctly interpreted the term "after the meal". The evaluation of the filled pill boxes resulted in the "Evaluation Tool to test the handling of the Medication Plan" (ET-MP) – a weighted scoring system.
Conclusion: The standardized MP is clearly arranged, and patients are able to find important information. The findings of this study resulted in minor but important revisions of the standardized MP template. The developed evaluation tool ET-MP may serve as an objective instrument to assess patients’ ability to transfer written information on the MP into practical handling of medicines.
Radicalisation is a phenomenon that has been striking not only in parts of Asia and Africa but also in the heart of Europe. While the number of Muslims in Germany is estimated by 4,7 millions (5,8%), 70% of the almost 900,000 asylum-seekers have arrived in recent years are believed to be Muslims. It is undeniable that there is discrimination in Germany, and it is equally undeniable that more on issues of integration and conflict prevention should be done. Thus, could effective integration processes prevent radicalisation of the Muslim youth in Europe?
This is the 18. article in our series Trouble on the Far-Right.
When it comes to change in social environments, a parable of philosopher Charles Handy gets pulled out quickly. If you drop a frog in boiling water, it jumps out immediately; but placed in cold water slowly warming up, it acclimates itself and falls to sleep, unaware of being boiled alive. The parable reminds us of the perceptional relativity of change: Within communities creeping developments cause habituation, abrupt breaks an arousing shock. In terms of social movements this truism becomes apparent in a double way: On the one hand, erupting crises may destabilize social orders and create the necessary space for dissident actors to gain momentum – while they would fail to mobilize outside the scenario of an anxious community gasping for a new guarantor of order. On the other hand, the rise of a dissident actor with unconventional performances may work as a shock triggering withdrawal reflexes in the broader society – while dissidents with relative habitual sentiments can find resonance in communities disappointed by the ruling order.
Does this perspective offer a potential to explain the rise of far right movements in Europe? Let’s examine it by the example of Germany where, in the last two years, far right actors have experienced a remarkable gain in political acceptance – on the streets, in the booths and in the talk shows. In this case, it could be argued that their success in protest and electoral mobilizations as well as their disproportionate high presence in the media rests on communication politics that effect a normalization of far right positions previously disreputed in public discourse. Through this creeping habituation by society, they are able to gain momentum in situations of crisis, producing themselves successfully as a legitimate agent of the “anxious citizens” disappointed by the government. To test this little argument, a finger exercise in frame analysis seems to be proper, a tool common in social movement studies to explain why certain ideas in certain contexts are potent to mobilize audiences – and are not in others.
This is the 15. article in our series Trouble on the Far-Right.
Germany’s political culture currently faces a shift to the right as anti-immigrant violence and attacks on refugee camps are on the brink of becoming a daily routine. The populist party Alternative für Deutschland (Alternative for Germany) did achieve successes in every recent federal state election. Through their success politics gained a new political quality. Anti-immigrant groups such as PEGIDA in Dresden regularly mobilize hundreds and sometimes thousands of people. The increased number of refugees that came to Germany in 2015 is instrumentalized to fuel racism and to spread nationalist sentiments...