Das Gesundheitswesen , Thieme Verlag Heft 11-2022, Jahrgang 84) ISSN 1439-4421 Seite(n) 1059 bis 1066 DOI: 10.1055/a-1709-0591 CareLit-Dokument-Nr: 318600 |
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Zusammenfassung Hintergrund Nudges bieten vielfältige Möglichkeiten zur Förderung von gesundheitsbezogenem Verhalten im Alltag, die klassische Public Health-Maßnahmen ergänzen können. Vor diesem Hintergrund führten wir vorläufige Untersuchungen zur Wirksamkeit und zu ethischen Aspekten verschiedener Nudges zur Förderung des Selbstmanagements von Patienten mit Diabetes mellitus Typ 2 im Kontext von Disease-Management-Programmen (DMPs) durch. Methodik Die ethische Bewertung der Nudges erfolgte im systematischen Rahmen von Marckmann et al. (2015) zur Public Health-Ethik. Die bisherige Evidenz zur Wirksamkeit von Nudges wurde mittels einer narrativen Literaturübersicht zusammenfassend dargestellt. Ergebnisse Zielvereinbarungen mit Umsetzungsplänen, Erinnerungen, Feedback, Sammeltermine bei Ärzten, Peer Mentoring sowie Verhaltensverträge sind Nudging-Interventionen mit mäßiger Eingriffstiefe in die Persönlichkeitsrechte der Patienten und ethisch relativ unproblematischen Voraussetzungen, die sich in verschiedenen Kontexten bewährt haben. Automatische Einschreibungen zu Patientenschulungen, Einbindung der Lebenspartner, Konfrontation mit sozialen Normen und Verwendung von Schockbildern können ebenfalls wirksam sein, greifen jedoch tiefer in die Freiheit und Privatsphäre der Patienten ein und unterliegen stärkeren ethischen Voraussetzungen und Beschränkungen. Die Evidenzlage ist insbesondere bei Maßnahmen zur sozialen Unterstützung durch Angehörige und Peers noch unzureichend. Schlussfolgerungen Nudging bietet ein breites Spektrum gezielter Interventionen zur Förderung des Selbstmanage-ments von Patienten mit chronischen Erkrankungen, dessen Potenzial bislang noch zu wenig erschlossen wurde. Besonders vielversprechende Maßnahmen sollten in Pilotstudien auf ihre Akzeptanz, Wirksamkeit und Kosteneffektivität im Rahmen von DMPs evaluiert werden. Abstract Background Nudges offer a wide range of options for protecting health in everyday life that supplements traditional public health measures. Against this background, we conducted initial investigations on the effectiveness and ethical aspects of different nudges for promoting self-management of patients with diabetes mellitus type 2 in the context of Disease Management Programs (DMPs). Methods The ethical assessment of the nudges was done within the systematic framework of Marckmann et al. (2015) for public health ethics. The existing evidence on the effectiveness of nudges was summarised by means of a narrative literature review. Results Target agreements with implementation plans, reminder, feedback reports, shared appointments of patients with physicians, peer mentoring, and behavior contracts are nudging interventions with moderate interference with personal rights and relatively unproblematic ethical requirements, which have demonstrated effectiveness in different contexts. Default enrollment for patient training courses, involvement of partners, confrontation with social norms, and shocking pictures may be effective as well; however, they interfere more deeply with the freedom and privacy of patients and, therefore, are bound to stronger ethical requirements and restrictions. The evidence base is still insufficient, especially for social support measures by relatives and peers. Conclusions Nudging offers a wide range of targeted interventions for supporting self-management of patients with chronic diseases, the potential of which has not yet been fully realized. Particularly promising interventions should be tested in pilot studies for their acceptance, effectiveness and cost-effectiveness in the context of DMPs. Schlüsselwörter Nudging - Diabetes Mellitus Typ 2 - Ethik - Gesundheitsökonomie Key words nudging - diabetes mellitus type 2 - ethics - health economics Zusätzliches Material Zusätzliches Material 23 June 2022 © 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany Literatur 1 Kahneman D. Thinking, fast and slow. London: Allen Lane; 2011 Google Scholar 2 Matjasko JL, Cawley JH, Baker-Goering MM. et al. Applying behavioral economics to public health policy: Illustrative examples and promising directions. Am J Prev Med 2016; 50: 13-19 CrossrefPubMedGoogle Scholar 3 Vlaev I, King D, Dolan P. et al. The theory and practice of “nudging”. Changing health behaviors. Public Adm Rev 2016; 76: 550-561 CrossrefPubMedGoogle Scholar 4 Shaffer VA. Nudges for health policy: Effectiveness and limitations. Mo L Rev 2017; 82: 727 PubMedGoogle Scholar 5 Loewenstein G, Brennan T, Volpp KG. Protecting people from themselves: Using decision errors to help people improve their health. JAMA 2007; 298: 2415-2417 PubMedGoogle Scholar 6 Thaler RH, Sunstein CR. Nudge: Improving decisions about health, wealth, and happiness. 2008 Google Scholar 7 Hansen PG, Jespersen AM. Nudge and the manipulation of choice. Eur J Risk Regul 2013; 4: 3-28 CrossrefPubMedGoogle Scholar 8 Sunstein CR. The Ethics of Nudging. Yale J. on Reg 2015; 32: 413 PubMedGoogle Scholar 9 King D, Greaves F, Vlaev I. et al. Approaches based on behavioral economics could help nudge patients and providers toward lower health spending growth. Health affairs (Project Hope) 2013; 32: 661-668 CrossrefPubMedGoogle Scholar 10 Wilkinson TM. Nudging and manipulation. Political Stud 2013; 61: 341-355 CrossrefPubMedGoogle Scholar 11 Huster S. Selbstbestimmung, Gerechtigkeit und Gesundheit. Normative Aspekte von Public Health. 1. Aufl Baden-Baden: Nomos; 2015 CrossrefGoogle Scholar 12 Huster S. Die ethische Neutralität des Staates. Eine liberale Interpretation der Verfassung. Tübingen: Mohr Siebeck; 2017 CrossrefGoogle Scholar 13 Mills C. The heteronomy of choice architecture. Rev Philos Psychol 2015; 6: 495-509 CrossrefPubMedGoogle Scholar 14 Jacobs E, Rathmann W. Epidemiologie des Diabetes in Deutschland. In: Deutsche Diabetes Gesellschaft (DDG), diabetesDE – Deutsche Diabetes-Hilfe, Hrsg. Deutscher Gesundheitsbericht Diabetes 2018. Die Bestandsaufnahme. Mainz: Kirchheim+Co GmbH; 2018: 9-22 Google Scholar 15 Mohrmann M, Altin S, Fuhrmann P. et al. Zukünftige Ausgestaltung der Diabetesversorgung. Der Diabetologe 2018; 14: 470-475 CrossrefPubMedGoogle Scholar 16 Fuchs S, Henschke C, Blümel M. et al. Disease management programs for type 2 diabetes in Germany: A systematic literature review evaluating effectiveness. Deutsches Ärzteblatt International 2014; 111: 453-463 PubMedGoogle Scholar 17 Du Y, Heidemann C, Rosario AS. et al. Changes in diabetes care indicators: Findings from German National Health Interview and Examination Surveys 1997–1999 and 2008–2011. BMJ Open Diabetes Res Care 2015; 3: e000135 CrossrefPubMedGoogle Scholar 18 Haller N, Kulzer B. Diabetesschulung. In: Deutsche Diabetes Gesellschaft (DDG), diabetesDE – Deutsche Diabetes-Hilfe, Hrsg. Deutscher Gesundheitsbericht Diabetes 2018. Die Bestandsaufnahme. Mainz: Kirchheim+Co GmbH; 2018: 57-63 Google Scholar 19 Laxy M, Holle R. Selbstmanagement der Patienten: Intensive Einbindung lohnt. Dtsch Arztebl International 2014; 111: 20 PubMedGoogle Scholar 20 Laxy M, Mielck A, Hunger M. et al. The association between patient-reported self-management behavior, intermediate clinical outcomes, and mortality in patients with type 2 diabetes: results from the KORA-A study. Diabetes care 2014; 37: 1604-1612 CrossrefPubMedGoogle Scholar 21 Mogler BK, Shu SB, Fox CR. et al. Using insights from behavioral economics and social psychology to help patients manage chronic diseases. J Gen Intern Med 2013; 28: 711-718 CrossrefPubMedGoogle Scholar 22 Montori VM, Swiontkowski MF, Cook DJ. Methodologic issues in systematic reviews and meta-analyses. Clinical Orthopaedics and Related Research extregistered 2003; 413: 43-54 CrossrefPubMedGoogle Scholar 23 Möllenkamp M, Zeppernick M, Schreyögg J. The effectiveness of nudges in improving the self-management of patients with chronic diseases: A systematic literature review. Health Policy 2019; 123: 1199-1209 CrossrefPubMedGoogle Scholar 24 Marckmann G, Schmidt H, Sofaer N. et al. Putting public health ethics into practice: A systematic framework. Frontiers in Public Health 2015; 3: 23 CrossrefPubMedGoogle Scholar 25 Broers VJV, Breucker de C, van den Broucke S. et al. A systematic review and meta-analysis of the effectiveness of nudging to increase fruit and vegetable choice. Eur J Public Health 2017; 27: 912-920 CrossrefPubMedGoogle Scholar 26 Blaga OM, Vasilescu L, Chereches RM. Use and effectiveness of behavioural economics in interventions for lifestyle risk factors of non-communicable diseases: A systematic review with policy implications. PPH 2018; 138: 100-110 PubMedGoogle Scholar 27 Kemmerer A, Möllers C, Steinbeis M. et al. Choice architecture in democracies: Exploring the legitimacy of nudging. 2016 Google Scholar 28 Kreßner M. Gesteuerte Gesundheit: Grund und Grenzen verhaltenswissenschaftlich informierter Gesundheitsförderung und Krankheitsprävention. Nomos; Verlag: 2018 CrossrefGoogle Scholar 29 Loewenstein G, Bryce C, Hagmann D. et al. Warning: You are about to be nudged. Behavioral Science & Policy 2015; 1: 35-42 CrossrefPubMedGoogle Scholar 30 Benartzi S, Beshears J, Milkman KL. et al. Should governments invest more in nudging?. Psychol Sci 2017; 28: 1041-1055 CrossrefPubMedGoogle Scholar 31 Chapman GB, Li M, Leventhal H. et al. Default clinic appointments promote influenza vaccination uptake without a displacement effect. Behavioral Science & Policy 2016; 2: 40-50 CrossrefPubMedGoogle Scholar 32 Lehmann BA, Chapman GB, Franssen FME. et al. Changing the default to promote influenza vaccination among health care workers. Vaccine 2016; 34: 1389-1392 CrossrefPubMedGoogle Scholar 33 Kassenärztliche Bundesvereinigung (KBV). Entwicklung der Teilnehmerzahlen: DMP Diabetes Typ 2 – Anzahl der eingeschriebenen Patienten. Online: https://www.kbv.de/html/8444.php letzter Zugriff: 11.02.2019 34 Allcott H. Social norms and energy conservation. J Public Econ 2011; 95: 1082-1095 CrossrefPubMedGoogle Scholar 35 Dolan P, Hallsworth M, Halpern D et al. MINDSPACE: influencing behaviour for public policy. Institute of Government, London, UK 2010. Online: https://www.instituteforgovernment.org.uk/sites/ default/files/publications/MINDSPACE.pdf letzter Zugriff: 11.02.2019 36 Hou C, Xu Q, Diao S. et al. Mobile phone applications and self-management of diabetes: A systematic review with meta-analysis, meta-regression of 21 randomized trials and GRADE. Diabetes Obes Metab 2018; 20: 2009-2013 CrossrefPubMedGoogle Scholar 37 Alsaleh E, Windle R, Blake H. Behavioural intervention to increase physical activity in adults with coronary heart disease in Jordan. BMC public health 2016; 16: 643 CrossrefPubMedGoogle Scholar 38 Cruz J, Brooks D, Marques A. Walk2Bactive: A randomised controlled trial of a physical activity-focused behavioural intervention beyond pulmonary rehabilitation in chronic obstructive pulmonary disease. Chronic Respir Dis 2016; 13: 57-66 CrossrefPubMedGoogle Scholar 39 Steiner JF, Shainline MR, Dahlgren JZ. et al. Optimizing number and timing of appointment reminders: a randomized trial. The American journal of managed care 2018; 24: 377-384 PubMedGoogle Scholar 40 Austin S, Wolfe BL. The effect of patient reminders and gas station gift cards on patient adherence to testing guidelines for diabetes. WMJ 2011; 110: 132-137 PubMedGoogle Scholar 41 Tamban C, Isip-Tan IT, Jimeno C. Use of short message services (sms) for the management of type 2 diabetes mellitus: A randomized controlled trial. JAFES 2013; 28: 143-149 CrossrefPubMedGoogle Scholar 42 Arora S, Peters AL, Burner E. et al. Trial to examine text message-based mHealth in emergency department patients with diabetes (TExT-MED): A randomized controlled trial. Ann Emerg Med 2014; 63: 745-754 CrossrefPubMedGoogle Scholar 43 Thrasher JF, Rousu MC, Hammond D. et al. Estimating the impact of pictorial health warnings and “plain” cigarette packaging: Evidence from experimental auctions among adult smokers in the United States. Health Policy 2011; 102: 41-48 CrossrefPubMedGoogle Scholar 44 Donnelly GE, Zatz LY, Svirsky D. et al. The effect of graphic warnings on sugary-drink purchasing. Psychol Sci 2018; 29: 1321-1333 CrossrefPubMedGoogle Scholar 45 Altmann S, Traxler C. Nudges at the dentist. European Economic Review 2014; 72: 19-38 CrossrefPubMedGoogle Scholar 46 Chamany S, Walker EA, Schechter CB. et al. Telephone intervention to improve diabetes control: A randomized trial in the New York City A1c Registry. Am J Prev Med 2015; 49: 832-841 CrossrefPubMedGoogle Scholar 47 Nadkarni A, Kucukarslan SN, Bagozzi RP. et al. A simple and promising tool to improve self-monitoring of blood glucose in patients with diabetes. Diabetes Res Clin Pract 2010; 89: 30-37 CrossrefPubMedGoogle Scholar 48 Volpp KG, John LK, Troxel AB. et al. Financial incentive-based approaches for weight loss: A randomized trial. JAMA 2008; 300: 2631-2637 CrossrefPubMedGoogle Scholar 49 John LK, Loewenstein G, Troxel AB. et al. Financial incentives for extended weight loss: A randomized, controlled trial. J Gen Intern Med 2011; 26: 621-626 CrossrefPubMedGoogle Scholar 50 Gupta L, Khandelwal D, Lal PR. et al. Factors determining the success of therapeutic lifestyle interventions in diabetes – Role of partner and family support. Eur J Endocrinol 2019; 15: 18 CrossrefPubMedGoogle Scholar 51 Seidel AJ, Franks MM, Stephens MAP. et al. Spouse control and type 2 diabetes management: Moderating effects of dyadic expectations for spouse involvement. Fam Relat 2012; 61: 698-709 CrossrefPubMedGoogle Scholar 52 Edelman D, Gierisch JM, McDuffie JR. et al. Shared medical appointments for patients with diabetes mellitus: A systematic review. J Gen Intern Med 2015; 30: 99-106 CrossrefPubMedGoogle Scholar 53 Long JA, Jahnle EC, Richardson DM. et al. Peer mentoring and financial incentives to improve glucose control in African American veterans: A randomized trial. Ann Intern Med 2012; 156: 416-424 CrossrefPubMedGoogle Scholar 54 Köberlein-Neu J, Hoffmann F. Das Stepped Wedge Design: Stufenlos regelbar?. Z Evidenz Fortbild Qual Gesundheitswes 2017; 126: 1-3 CrossrefPubMedGoogle Scholar
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