Supplementary Material for: Limited reimbursement and underuse of digital healthcare concepts are major barriers to clinical allergological care in Germany

Background Allergic diseases represent a broad spectrum of high-prevalence, chronic conditions that remain underdiagnosed or undertreated. The aims of this interdisciplinary, questionnaire-based, non-interventional study were to identify and analyse potential barriers to clinical allergological care in Germany. Methods All hospitals listed in the German hospital register involved in the treatment of allergological patients (n = 899) were invited to participate. The study yielded a response rate of 52.1% (n=468). Results Overall, 88.5% of clinics agreed that allergological care in Germany needs improvement, especially in terms of reimbursement for diagnostics and therapy. More than 80% of participating clinics reported that the decreased availability of test substances and the time-intensity of allergological testing represent relevant barriers. For dermatology and pulmonology, the former is the strongest barrier, while for paediatric and ENT clinics, time-intensity is regarded as the strongest barrier. The availability of good therapy and appropriate guidelines present no barriers to allergological care. Regarding the use of digital healthcare concepts, a very large majority of clinics (n=352; 91.4%) do not offer video consultations or the use of health applications in patient care. Conclusion In conclusion, we have identified several structural barriers to allergological care in Germany. Reimbursement as well as the use of digital healthcare concepts in German clinics providing allergological care need improvement. Based on the results of this study, there is an urgent need for researchers and policymakers to further investigate and support allergology departments in their clinical work and in their implementation of digital healthcare concepts.

研究背景：过敏性疾病是一类高发、慢性的广谱疾病，普遍存在诊断不足或治疗不充分的问题。本项多学科、基于问卷的非干预性研究旨在明确并分析德国临床变态反应诊疗服务（clinical allergological care）面临的潜在障碍。
研究方法：本研究邀请德国医院登记系统中所有收治变态反应患者的医院（n=899）参与，最终有效应答率为52.1%（n=468）。
研究结果：总体而言，88.5%的受访医疗机构认为德国的变态反应诊疗服务亟需改进，尤其体现在诊断与治疗的报销政策方面。超80%的参与医疗机构表示，检测试剂可及性下降以及变态反应检测耗时耗力，是当前面临的主要障碍。其中，皮肤科与肺科医疗机构面临的最突出障碍为检测试剂可及性不足，而儿科与耳鼻喉科（ENT）医疗机构则认为检测耗时耗力是最主要的障碍。优质治疗方案与适宜指南的可及性并未对变态反应诊疗服务构成障碍。在数字化医疗概念的应用方面，绝大多数受访机构（n=352；91.4%）未向患者提供视频问诊或健康应用程序相关服务。
研究结论：综上，本研究明确了德国变态反应诊疗服务面临的多项结构性障碍。德国提供变态反应诊疗服务的医疗机构，其报销政策与数字化医疗概念的应用均有待完善。基于本研究结果，研究人员与政策制定者亟需进一步开展相关研究，并为变态反应科（Allergology Department）的临床工作及数字化医疗概念的落地实施提供支持。