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„Treat-To-Target“ aus der Sicht der niedergelassenen Rheumatologie

Treat-to-target from the perspective of office-based rheumatology

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Zusammenfassung

Die evidenzbasierte Formulierung fester Therapieziele mittels der „Treat-To-Target“-Empfehlungen schließt für den Rheumatologen eine wichtige Lücke; ihre Umsetzung verspricht für die Versorgung der Rheumakranken wesentliche Verbesserungen. Es ist jedoch zu hinterfragen, inwieweit die vorgegebenen Ziele in der Praxis für den niedergelassenen Rheumatologen in Deutschland umsetzbar sind. Hinderungsgründe könnten die zu geringe Zahl an Spezialisten und eine unzureichende Fallwertvergütung mit der notwendigen Folge einer Steigerung der Fallzahl sein – beides geht zu Lasten der pro Patient verfügbaren Zeit. Weiterhin behindert das Drohszenario von Regressen die adäquate medikamentöse Versorgung der Patienten und das Erreichen des Therapieziels der Remission. Ein wichtiger Ansatz für die Verringerung solcher Defizite könnte die flächendeckende Etablierung rheumatologischer Strukturverträge sein.

Abstract

The development of evidence-based treat-to-target (T2T) recommendations alleviates decision-making for the rheumatologist and simultaneously promises substantial improvement of outcome for rheumatoid arthritis (RA) patients. For the office-based rheumatologist in Germany, however, implementation of T2T recommendations contains several difficulties. Limitations arise as a result of an insufficient number of rheumatologists as well as a lack of adequate remuneration both resulting in a lack of time for the individual RA patient. Furthermore budget limitations hinder the appropriate use of antirheumatic drugs and insofar counteract treating to the target of remission. Establishment of selective contracts for rheumatologists by health insurance funds might reduce many of these problems in future for the office-based rheumatologist in Germany.

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Authors and Affiliations

  1. Rheumatologisches Praxiszentrum St. Bonifatius, St.-Bonifatius-Str. 5, 81541, München, Deutschland

    K. Krüger

  2. Schwerpunktpraxis Rheumatologie, Berlin, Deutschland

    K. Karberg

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  1. K. Krüger
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  2. K. Karberg
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Correspondence to K. Krüger.

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Krüger, K., Karberg, K. „Treat-To-Target“ aus der Sicht der niedergelassenen Rheumatologie. Z. Rheumatol. 70, 664–669 (2011). https://doi.org/10.1007/s00393-011-0852-0

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  • DOI: https://doi.org/10.1007/s00393-011-0852-0

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