Zusammenfassung.
Der Vorstand der Deutschen Gesellschaft für Rheumatologie hat die „Oliver-Sangha Kommission“ beauftragt, die Aufgaben der stationären Rheumatologie in den kommenden Jahren zu untersuchen und aufzuzeigen. Zielsetzung des vorliegenden Evidenzberichtes ist die Darlegung der Studienlage zum Thema der stationären Versorgung von Patienten am Beispiel der rheumatoiden Arthritis.
Es wurde eine systematische Literaturrecherche in Medline (Zeitraum 1966–2001) durchgeführt. Aus 200 Literaturstellen wurden 23 Arbeiten identifiziert, von denen nach einem systematischen Auswahlprozess 16 Publikationen einer sorgfältigen Einzelbewertung unterzogen wurden.
In die vier in der systematischen Datenanalyse identifizierten, randomisiert kontrollierten Studien wurden nur Patienten eingeschlossen, deren Krankheitszustand auch eine nicht-stationäre Versorgung erlaubte. Zwei dieser Studien belegen eine gewisse Überlegenheit der stationären gegenüber der ambulanten Versorgung, die beiden anderen—Studien zur Äquivalenz stationärer und teilstationärer Versorgung—machen deutlich, dass RA-Patienten nicht generell von einer stationären Versorgung zusätzlich profitieren. Zwei Datenerhebungen geben einen Anhalt für einen gesteigerten Bedarf an stationärer Versorgung von RA-Patienten. Keine der Studien entstammt dem deutschen Versorgungssystem, generell gilt die Einschränkung, dass die stationäre Versorgung aus rheumatologischer Notfallindikation nicht untersucht wurde.
Die Ergebnisse dieser Studien lassen eine allgemeingültige Aussage zur stationären Versorgung von RA-Patienten nicht zu. Die Kommission macht Vorschläge, wie diese wichtige Fragestellung für die Versorgung in der deutschen Rheumatologie zukünftig beantwortet werden kann.
Summary.
Our aim was to analyze the existing body of evidence about inpatient care of patients suffering from rheumatoid arthritis (RA). The report was induced by the executive board of the German Society of Rheumatology which assigned the “Oliver-Sangha committee” to dissect and point out the tasks of inpatient care during the next few years. A systemic search of the literature was performed covering the years 1966 to 2001. A total of 16 studies were selected and thoroughly appraised in a systematic way. Four randomized controlled trials addressing the question could be identified. All of them included only patients in a clinical condition allowing outpatient care as well. Two studies indicate some advantage of inpatient care in comparison to outpatient treatment. Two studies, both equivalence studies from design, reveal that RA patients do not generally experience additional benefit from hospitalization. Consideration of two additional cohort studies demonstrates the increased need of inpatient care in RA patients. None of the studies was derived from the German health care system. Emergency cases were not the subject of any of these trials. General statements about the value of inpatient care of RA patients can not be drawn from the analyzed studies. The committee makes suggestions for future investigations that may help to answer this important question considering the special circumstances of the German health care system.
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Schneider, M., Lelgemann, M., Baerwald, C. et al. Nutzen der stationären Therapie in der Versorgung von Patienten mit Rheumatoider Arthritis. Z Rheumatol 63, 402–413 (2004). https://doi.org/10.1007/s00393-004-0613-4
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DOI: https://doi.org/10.1007/s00393-004-0613-4