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Interventions which have substantial effects in post-ICU patients are rare. Positive effects were seen for ICU-diary interventions for posttraumatic stress disorder. More interventions for the growing number of ICU survivors are needed.

IMPORTANCESepsis survivorship is associated with postsepsis morbidity, but epidemiological data from population-based cohorts are lacking. OBJECTIVE To quantify the frequency and co-occurrence of new diagnoses consistent with postsepsis morbidity and mortality as well as new nursing care dependency and total health care costs after sepsis. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study based on nationwide health claims data included a population-based cohort of 23.0 million beneficiaries of a large German health insurance provider. Patients aged 15 years and older with incident hospital-treated sepsis in 2013 to 2014 were included. Data were analyzed from January 2009 to December 2017. EXPOSURES Sepsis, identified by International Statistical Classification of Diseases and RelatedHealth Problems, Tenth Revision (ICD-10) hospital discharge codes. MAIN OUTCOMES AND MEASURESNew medical, psychological, and cognitive diagnoses; longterm mortality; dependency on nursing care; and overall health care costs in survivors at 1 to 12, 13 to 24, and 25 to 36 months after hospital discharge. RESULTS Among 23.0 million eligible individuals, we identified 159 684 patients hospitalized with sepsis in 2013 to 2014. The mean (SD) age was 73.8 (12.8) years, and 75 809 (47.5%; 95% CI, 47.2%-47.7%) were female patients. In-hospital mortality was 27.0% (43 177 patients; 95% CI, 26.8%-27.3%). Among 116 507 hospital survivors, 86 578 (74.3%; 95% CI, 74.1%-74.6%) had a new diagnosis in the first year post sepsis; 28 405 (24.4%; 95% CI, 24.1%-24.6%) had diagnoses co-occurring in medical, psychological, or cognitive domains; and 23 572 of 74 878 survivors (31.5%; 95% CI, 31.1%-31.8%) without prior nursing care dependency were newly dependent on nursing care.

Zusammenfassung Hintergrund Das Angebot an Palliativversorgung hat in Deutschland stark zugenommen. Weitgehend unbekannt ist, wie viele Menschen am Lebensende welche palliativen Versorgungsformen in Anspruch nehmen und welche regionalen Unterschiede bestehen. Methode Retrospektive Kohortenstudie mit GKV-Routinedaten (BARMER) über Versicherte mit Sterbedatum im Jahr 2016: Anhand einer mindestens einmalig abgerechneten Leistung in den letzten 6 Lebensmonaten wurde die Inanspruchnahme allgemeiner ambulanter Palliativversorgung (AAPV), spezialisierter ambulanter Palliativversorgung (SAPV) sowie stationärer Palliativ- und Hospizversorgung ermittelt. Erstmals wurden auch Abrechnungsziffern kassenärztlicher Vereinigungen und selektivvertragliche Sonderziffern für palliativmedizinische Leistungen sowie SAPV-Leistungsabrechnungen herangezogen. Ergebnisse Von den 95.962 Verstorbenen der Studienpopulation wurden bundesdurchschnittlich 32,7 % palliativ versorgt, mit Schwankungen zwischen 26,4 % in Bremen und 40,8 % in Bayern. AAPV-Leistungen wurden bei 24,4 % abgerechnet (16,9 % in Brandenburg bis 34,1 % in Bayern). SAPV-Leistungen erhielten 13,1 % (6,3 % in Rheinland-Pfalz bis 18,9 % in Brandenburg bzw. 22,9 % in Westfalen-Lippe mit abweichender SAPV-Praxis). Stationär palliativmedizinisch versorgt wurden 8,1 % (6,7 % in Schleswig-Holstein/Hessen bis 13,0 % in Thüringen), Hospizleistungen wurden für 3,3 % abgerechnet (1,6 % in Bremen bis 5,6 % in Berlin). Diskussion SAPV wird häufiger in Anspruch genommen als bisher berichtet, AAPV ist rückläufig. Die jeweilige Inanspruchnahme scheint weniger durch objektiven Bedarf als durch regionalspezifische Rahmenbedingungen begründet. Die Weiterentwicklung der Palliativversorgung sollte zukünftig neben Bedarfskriterien mehr an Outcomes sowie dafür relevanten Rahmenbedingungen orientiert werden.

BackgroundInfluenza and pneumococcal vaccination can prevent disease and potentially life-threatening complications like sepsis. Elderly people have an increased risk of severe disease and therefore constitute a major target group for vaccination. To increase vaccination coverage, targeted interventions are needed that take theory-based specific determinants of vaccination behaviour into account. Moreover, message and campaign design should consider specific age-related characteristics (e.g., information processing, media use). The aim of this study is (i) to identify the specific informational and interventional needs of this risk group, (ii) to design and implement a targeted intervention aiming to decrease vaccine hesitancy, increase vaccine uptake and decrease the health and economic burden due to the respective diseases, and (iii) to measure the effect of this evidence-informed intervention on various levels.MethodsProspective, multi-methods intervention study targeting individuals aged ≥60 years in a model region in Germany (federal state of Thuringia, 500,000 inhabitants ≥60 years old). The development of the intervention follows theory-based and evidence-informed principles: Data from a cross-sectional representative study provide insights into specific determinants of the target group’s vaccination behaviour. Additionally, media use is analysed to identify adequate communication channels for specific subgroups.In pilot studies, the intervention materials are adapted to the specific cognitive requirements of the target group. For development and implementation of the intervention, an interdisciplinary and trans-sectoral approach is used, including psychology, communication science, design, medical science, epidemiology and various public health players. The intervention will be implemented in autumn and winter 2017/18 and 2018/19 and adjusted in between. Evaluation of the intervention includes: awareness, use and recall of intervention materials, effects on changes in determinants of vaccination behaviour, self-reported vaccine uptake, and vaccination coverage in the intervention area (primary outcomes), as well as disease incidences (secondary outcomes) and the economic burden of influenza, pneumonia, invasive pneumococcal disease and sepsis for the healthcare system (tertiary outcomes).DiscussionThe data will add to the body of evidence on the effectiveness of evidence-informed vaccination campaign development as well as on the clinical and economic effects of pneumococcal and influenza vaccination. The effect of the intervention will teach valuable lessons about the principles of campaign development and evaluation, and can motivate a subsequent nationwide intervention.Trial registration DRKS00012653. Registered 24.11.2017. Retrospectively registered.

Background: General Practitioners (GPs) are the main providers of primary palliative care (PPC). At the same time they are the main initiators of specialised palliative homecare (SPHC). In Germany, little is known about factors which influence GPs in their involvement of SPHC. Aim of our study is to identify factors that drive GPs to give value to and involve SPHC. Methods: A cross-sectional survey was performed. In 2018, questionnaires were mailed to 6000 randomly selected GPs from eight German federal states, focusing on the extent of GPs' palliative care activities and their involvement of SPHC. Results: With a response rate of 19.4% and exclusion of GPs working in SPHC-teams, n = 1026 questionnaires were appropriate for analysis. GPs valued SPHC support as the most "important/very important" for both "technical/ invasive treatment measures" (95%) and availability outside practice opening hours (92%). The most relevant factor influencing perceived SPHC-importance was GPs' self-reported extent of engagement in palliative care (β = − 0.283; CI 95% = − 0.384;−0.182), followed by the perceived quality of utilised SPHC (β = 0.119; CI 95% = 0.048;0.190), involvement in treatment of palliative patients after SPHC initiation (β = 0.088; CI 95% = 0.042; 0.134), and conviction that palliative care should be a central part of GPs' work (β = − 0.062; CI 95% = − 0.116; −0.008). Perceived SPHC-importance is also associated with SPHC-referrals (β =0.138; p < 0.001). The lower the engagement of GPs in palliative care, the more they involve SPHC and vice versa. Conclusions: GPs with low reported activity in palliative care are more likely to initialise SPHC for palliative care activities they do not deliver themselves for various reasons, which might mean that the involvement of SPHC is substitutive instead of complementary to primary palliative care. This finding and its interpretation should be given more attention in the future policy framework for (specialised) palliative homecare.

Background. Depression is the most common type of mental disorder in Germany. It is associated with a high level of suffering for individuals and imposes a significant burden on society. The aim of this study was to estimate the depression related costs in Germany taking a societal perspective. Materials and Methods. Data were collected from the primary care monitoring for depressive patients trial (PRoMPT) of patients with major depressive disorder who were treated in a primary care setting. Resource utilisation and days of sick leave were observed and analysed over a 1-year period. Results. Average depression related costs of €3813 were calculated. Significant differences in total costs due to sex were demonstrated. Male patients had considerable higher total costs than female patients, whereas single cost categories did not differ significantly. Further, differences in costs according to severity of disease and age were observed. The economic burden to society was estimated at €15.6 billion per year. Conclusion. The study results show that depression poses a significant economic burden to society. There is a high potential for prevention, treatment, and patient management innovations to identify and treat patients at an early stage.

BackgroundSepsis sequelae include critical illness polyneuropathy, myopathy, wasting, neurocognitive deficits, post-traumatic stress disorder, depression and chronic pain. Little is known howlong-term sequelae following hospital discharge are treated. The aim of our study is to determine the effect of a primary care-based, long-term program on health-related quality of life in sepsis survivors.Methods/DesignIn a two-armed randomized multicenter interventional study, patients after sepsis (n = 290) will be assessed at 6, 12 and 24 months. Patients are eligible if severe sepsis or septic shock (ICD-10), at least two criteria of systemic inflammatory response syndrome (SIRS), at least one organ dysfunction and sufficient cognitive capacity are present. The intervention comprises 1) discharge management, 2) training of general practitioners and patients in evidence-based care for sepsis sequelae and 3) telephone monitoring of patients. At six months, we expect an improved primary outcome (health-related quality of life/SF-36) and improved secondary outcomes such as costs, mortality, clinical-, psycho-social- and process-of-care measures in the intervention group compared to the control group.DiscussionThis study evaluates a primary care-based, long-term program for patients after severe sepsis. Study results may add evidence for improved sepsis care management. General practitioners may contribute efficiently to sepsis aftercare.Trial registrationU1111-1119-6345. DRKS00000741, CCT-NAPN-20875 (25 February 2011).