Introduction of direct-acting antivirals in treatment of chronic hepatitis C virus (HCV) was a significant medical advance. Today, interferon-free treatment regimens with sustained virologic response (SVR) rates of >90%, a favorable toxicity profile and shorter treatment duration, allow most patients to achieve cure. Aim of the study was to understand how the introduction of shorter-duration treatment regimens for HCV will impact the capacity for treatment and value to society. A Markov model of HCV transmission and progression was constructed, incorporating nationally representative data on HCV prevalence, incidence, and progression; mortality, treatment costs, medical expenditures, employment probabilities, and disability payments in Germany. The model is stratified by HCV genotype and exposure route (one-time healthcare exposure, injection drug use, and sexual activity). Treatment scenarios were based on German treatment guidelines and projected treatment capacity. The impact of different treatment scenarios on disease transmission and prevalence, quality-adjusted life years (QALYs), treatment costs, medical expenditures, employment and disability expenditures was calculated. Depending on their adoption profile, new treatment regimens and protocols introduced over the next several years will increase HCV treatment capacity in Germany by 8-30%, reducing disease transmission and prevalence, increasing QALYs, and adding €94-310 million in discounted social value (QALYs plus medical savings net of treatment costs) over a 30-year horizon. Additional social value in the form of higher employment and lower disability would also result. While these results are specific to Germany, similar results may be expected in other countries facing capacity constraints in treating HCV patients. The introduction of shorter HCV treatment regimens and the resulting increased treatment capacity in Germany would result in large gains to society by reducing disease transmission and prevalence plus reducing end stage liver diseases, thus resulting in longer, healthier, more productive lives for current and future generations.

BACKGROUND:Research applying psychological behaviour change theories to hand hygiene compliance is scarce, especially for physicians.AIM:To identify psychosocial determinants of self-reported hand hygiene behaviour (HHB) of physicians and nurses in intensive care units (ICUs).METHODS:A cross-sectional survey using a self-administered questionnaire that applied concepts from the Health Action Process Approach on hygienic hand disinfection was conducted in 10 ICUs and two haematopoietic stem cell transplantation units at Hannover Medical School, Germany. Self-reported compliance was operationalized as always disinfecting one's hands when given tasks associated with risk of infection. Using seven-point Likert scales, behavioural planning, maintenance self-efficacy and action control were assessed as psychological factors, and personnel and material resources, organizational problems and cooperation on the ward were assessed as perceived environmental factors. Multiple logistic regression analysis was employed.FINDINGS:In total, 307 physicians and 348 nurses participated in this study (response rates 70.9% and 63.4%, respectively). Self-reported compliance did not differ between the groups (72.4% vs 69.4%, P = 0.405). While nurses reported stronger planning, self-efficacy and action control, physicians indicated better personnel resources and cooperation on the ward (P < 0.02). Self-efficacy [odds ratio (OR) 1.4, P = 0.041], action control (OR 1.8, P < 0.001) and cooperation on the ward (OR 1.5, P = 0.036) were positively associated with HHB among physicians, but only action control was positively associated with HHB among nurses (OR 1.6, P < 0.001).CONCLUSION:The associations between action control (self-regulatory strategies where behaviour is evaluated continuously and automatically against guidelines) and compliance indicate that HHB is a habit in need of self-monitoring. The fact that perceived cooperation on the ward was the only environmental correlate of HHB among physicians stresses the importance of team-directed interventions.

The aim of the study was a systematical further development of targeted approaches. Research questions were how elderly women and men could be motivated to participate in a preventive intervention and by which approaches elderly with different health risks could be reached. In several stages a specific motivational material was developed. Afterwards two different approaches to the elderly (general practice, health insurance) were tested and evaluated considering its (cost) effectiveness.

Die Studie widmete sich der Weiter­entwicklung von Zugangswegen. Forschungsfragen waren, wie ältere Frauen und Männer für eine präventive Maßnahme motiviert und über welche Zugangswege ältere Menschen mit unterschiedlichen Gesundheitsrisiken erreicht werden können. Die in einem mehrstufigen Verfahren entwickelte zielgruppenspezifische Ansprache wurde über zwei Zugänge (Hausarzt, Krankenkasse) eingesetzt und hinsichtlich ihrer (Kosten-)Effektivität evaluiert.