Evidenzbasierte und interdisziplinär konsentierte Versorgungspfade für Patientinnen und Patienten mit Morbus Crohn oder Colitis ulcerosa

Zusammenfassung

Morbus Crohn und Colitis ulcerosa sind charakterisiert durch rezidivierende Schübe, ein frühes Manifestationsalter und Einschränkungen in Aktivitäten und Teilhabe. Sie erfordern eine wohnortnahe, krankheitsbegleitende und problemorientierte Versorgung. Die entwickelten Versorgungspfade sollen die Wege für kooperatives Handeln zwischen den verschiedenen Versorgungssektoren, ärztlichen und nicht-ärztlichen Berufsgruppen, Einrichtungen und Kostenträgern ebnen.

Grundlage sind die S3-Leitlinien der beiden Krankheitsbilder, klinische Überlegungen, Interviews mit Fachleuten, systematisch gesuchte Evidenz und Ergebnisse einer Betroffenenbefragung.

Die Probleme der Erkrankten wurden erfasst, abgegrenzt und operationalisiert. Allen relevanten Problemsituationen wurden medizinische und nicht-medizinische Leistungen und Leistungserbringer zugeordnet. Abhängig von der Schwere des Krankheitsverlaufs wurde die Koordination der Versorgungsaufgaben den verschiedenen medizinischen Versorgungsebenen und -sektoren zugeteilt. Ein regelmäßiges umfassendes Assessment im Rahmen der medizinischen Betreuung soll erforderliche individuelle Interventionen feststellen. Weitere Säulen sind die leitliniengerechte medizinische Versorgung, eine bedarfsgerechte Information und Schulung der Kranken mit dem Ziel einer Befähigung zu partizipativer Entscheidungsfindung und Selbstmanagement sowie die Anregung zu Forschung und Entwicklung.

Die Versorgungspfade sind evidenzbasiert und interdisziplinär konsentiert (S3). Ihre Anwendbarkeit soll im Rahmen einer Implementierung evaluiert werden.

Abstract

Crohn’s disease and ulcerative colitis are diseases characterized by remission and relapse, an early age of onset and restrictions on activities and participation. IBD patients need a comprehensive, easily accessible and problem-oriented health care. This requires the integration and coordination of different health care sectors, medical and non-medical professionals, social and health care facilities and funding agencies.

The pathways to guide patients through integrated health care were based on clinical considerations, interviews with patients and specialists, systematically searched evidence and results of a questionnaire survey. Within a systematic assessment-assignment approach relevant problems were identified and subsequently related to different medical and non-medical professionals, health care services and medical sectors.

The pathways further imply (1) medical care according to evidence-based guideline recommendations, (2) patient education programs to foster shared decision making and self-management and (3) suggestions for further research.

The pathways were consented in a consensus conference using nominal group process methods. Their feasibility and effect will be evaluated within a regional implementation project.

Schlüsselwörter

chronisch-entzündliche Darmerkrankungen - Morbus Crohn - Colitis ulcerosa - evidenzbasierte Versorgung - Leitlinien

Key words

inflammatory bowel diseases - Crohn’s disease - ulcerative colitis - evidence based care - guidelines

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