Versorgungsforschung in Deutschland Der Beitrag der Transfusionsmedizin. Health Services Research in Germany The Input of Transfusion Medicine

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Dr. Harald Klüter Institute of Transfusion Medicine and Immunology Red Cross

1 Versorgungsforschung in Deutschland Der Beitrag der Transfusionsmedizin Health Services Research in Germany The Input of Transfusion Medicine Prof. Dr. Harald Klüter Institute of Transfusion Medicine and Immunology Red Cross Blood Service Baden-Württemberg Hessen Medical Faculty Mannheim Heidelberg University

First Human-to-Human-Transfusion 1 September 1818 James Blundell (1790-1877), English physician, performed the first successful blood

2 First Human-to-Human-Transfusion 1 September 1818 James Blundell ( ), English physician, performed the first successful blood transfusion in a cachetic patient 1825 Successful transfusion in a female patient after postpartum haemorrhage Father of modern transfusion medicine

3 The Serological Era 1901 The basis for the immunological safety of blood transfusions has been laid by the discovery of the human AB0-blood group properties and of the isoagglutinins Karl Landsteiner ( ) Nobel Prize Laureat 1930

4 Safety Milestones in the development of blood transfusion safety Immunohematology Histocompatibility AB0- system e.g. Rhesus Molecular biology Testing for markers of infection z.b. HBsAg, HIV NAT/PCR Bacterial testing and pathogen - inactivation Health Service Research Demographic Change

5 Demographics of the German Population (prognosis) (prognosis) Source: Statistisches Bundesamt, Wiesbaden, 2006

6 percent of transfusions percent of population Population vs. Transfusion: 2005 population structure 20% 15% 10% 5% 0% 19.7% 65 years age group RBC transfusions 62.1% 65 years 20% 15% 10% 5% 0% age group Greinacher A, Transfusion 2009

Estimated demand for blood in a tertiary care hospital (Mannheim). 2025 2008-2025: +7,2 % Expected increase in the demand for blood in a tertiary care hospital.

7 Estimated demand for blood in a tertiary care hospital (Mannheim) : +7,2 % Expected increase in the demand for blood in a tertiary care hospital. (absolute numbers) Source: DRK-Blood Service of Baden-Württemberg- Hessia. Universitätsmedizin Mannheim. Demand is expected to increase from (2008) to (2030) units. Expected relative increase in the demand for blood in a tertiary care hospital. (compared to 2008) Source: Seifried et al. (2011). How much blood is needed? Vox Sang, 100(1), Demand will increase by 14.5 percent.

Demand for blood in a primary care hospital (Klinikverbund Südwest) To forecast future blood demand in primary care hospitals we collected data on recipients of red blood cell units in 2008 in

8 Demand for blood in a primary care hospital (Klinikverbund Südwest) To forecast future blood demand in primary care hospitals we collected data on recipients of red blood cell units in 2008 in different hospitals belonging to a hospital network (Klinikverbund Südwest). Average use of red blood cell units of each patient was calculated for different age groups. We assumed constant age-specific demand for blood units in the coming years and combined this data with population projections : +7,2 % Average number of red blood cells units needed for each patient in Source: Klinikverbund Südwest

9 Content 1. Challenges of Transfusion Medicine 2. Aims and Methods of Health Services Research 3. Health Services Research in the Field of Safe Blood Supply 3.1 Studies on donor recruitment 3.2 Studies on donor retention 4. Conclusion

10 Donor studies are part of the growing research into health services Health services research examines how people get access to health care, how much care costs, and what happens to patients as a result of this care. The main goals of health services research are to identify the most effective ways to organize, manage, finance, and deliver high quality care; reduce medical errors; and improve patient safety. Source:

11 Research Areas of Health Services Research Need Assessment of subjective and objective need for health services Generation of resources needed for delivery Access Underuse and overuse of indicated health services Allocation of limited resources Delivery Management and quality of health services Technologies and resources used to deliver health services Outcomes Impact on well-being and quality of life Satisfaction from a patient s and a clinician s perspective

12 Health Services Research in the Field of Blood Transfusion Need Estimation of the future blood demand Optimization of donor recruitment and retention to meet future blood demand Access Underuse and overuse of blood products Social and organizational factors associated with access to blood products Delivery Implementation of clinical guidelines Strategies to minimize risks of infections Outcomes Quality of life after blood transfusion Side effects of blood transfusion (e.g. infections, immunization)

13 Content 1. Challenges of Transfusion Medicine 2. Aims and Methods of Health Services Research 3. Health Services Research in the Field of Safe Blood Supply (examples) 3.1 Studies on donor recruitment 3.2 Studies on donor retention 4. Conclusion

14 Examples of interdisciplinary studies that focus on donor recruitment Are there geographical variations in donor recruitment? Which community factors are associated with blood donor rates? Need donor recruitment

15 Geographical variation in blood donor rates in southwest Germany Population 10.6 mio 550,000 donations 90% Red Cross Blood donor rates 2007 Percentage of inhabitants who donated at least once Less then 2 Percent 2 to 4 Percent 4 to 6 Percent 6 to 8 Percent 8 Percent and more

16 Characteristics of municipalities with high and low donor rates results of a regression model Municipalities with high donor rates high percentage between 18 and 24 years high voter turnout high numbers of mobile donation sites high donor rates in neighboring municipalities Municipalities with low donor rates high percentage between 50 and 65 years high population figure high unemployment rate high percentage of non-german inhabitants Weidmann, C. et al. (2011), Vox Sang, in press

17 Examples of interdisciplinary studies that focus on donor retention Is the motivation of first-time donors associated with donor return? Are altruistic donors more likely to return for further donations? Need donor retention

18 Donor Survey of the German Red Cross In 2010/11, the German Red Cross Blood Service Baden-Württemberg Hessia conducted a donor survey. We send a self-administered questionnaire to a random group of 8,000 first-time donors Who donated in ,077 (38.5%) of the questionnaires were sent back. Results of the questionnaires were linked to donor return within 24 months.

19 Measuring of initial donor motivation Respondents were asked to disagree (1) or agree (5) to six motivational statements on a 5-point-scale. Three motivational indices were calculated by adding the answers of two statements (indices ranging from 2 to 10). Item Range Additive Index Range I enjoy helping others 1 to 5 I believe that I have a responsibility to help others 1 to 5 Altruism 2 to 10 Getting the results of a general health screen 1 to 5 Health- Getting the results of an infectious diseases screen 1 to 5 check-ups 2 to 10 Receiving a gift such as a coffee mug 1 to 5 Receiving a reward, such as a pin or a certificate 1 to 5 Incentives 2 to 10

20 Results: Altruistic donors are more likely to return First-time donors motivated by altruism are more likely to return. Recruiting campaigns should continue to appeal to altruism. Health check-ups are not an adequate tool for recruiting first-time donors who are likely to become regular donors. Activation by incentives is not directly associated with donor return. But interestingly, donors who were activated by non-monetary incentives are more likely to become regular donors when returning a second time. Further steps: We are planning to validate the results in a prospective study design.

21 Examples of interdisciplinary studies that focus on donor retention What are characteristics of lapsed donors that had not donated within the last 24 months? Need donor retention What are major reasons preventing lapsed donors from continuing to donate blood?

23 Characteristics of lapsed donors Lapsed donors are likely to be: Female Between 26 and 33 years old Not employed Moved house in the last years Dissatisfied with last donation experience Felt physically poor after the last donation Have no friends or relatives donating Most important self-reported barriers of lapsed donors are: Medical reasons Having moved Travel to foreign countries and New jobs or schools

To avoid donor loss it may be helpful to encourage FT donors to return as soon as possible collect and use email addresses to invite donors that have been moved to another city invite donors to

24 To avoid donor loss it may be helpful to encourage FT donors to return as soon as possible collect and use addresses to invite donors that have been moved to another city invite donors to online communities to stay in contact help donors that move to another city to find a convenient place To reactivate lapsed donors it may be helpful to use phone calls or letters to remind lapsed donors offer information addressing health concerns and the duration of temporary deferral especially for older donors ask active donors to encourage their friends and relatives that had not donated in the last years

25 Content 1. Challenges of Transfusion Medicine 2. Aims and Methods of Health Services Research 3. Health Services Research in the Field of Safe Blood Supply 3.1 Studies on donor recruitment 3.2 Studies on donor retention 4. Conclusion

26 Interdisciplinary studies are needed to understand and to meet future blood demand In times of demographic change donor studies are needed to optimize donor recruitment and to secure future blood demand. Donor studies are part of Health Services Research and require interdisciplinary perspectives and methods. Donor studies should therefore be a joint approach of experts from transfusion medicine, epidemiology, social sciences, and psychology. Furthermore, national and international cooperation between blood establishments could help to identify best-practices in donor recruitment and to share expertise in facing the demographic change.

27 Examples of international cooperation DRK Blutspendedienst Baden-Württemberg Hessen ggmbh Foundation of a joint working group of the Schweizer Blutspendedienst SRK and the DRK-Blutspendedienst Baden- Württemberg Hessen in The aim of these meetings is to share expertise in methods related to donor research, conduct Health Services research and to prepare a scientific symposium in 2012.

28 What is DOMAINE? DOMAINE is a European project that focuses on good donor management. DOMAINE concentrates on various aspects of donor management: donor recruitment strategies, donor retention strategies, deferral procedures and blood bank policy regarding patients requiring longterm transfusion. DOMAINE aims to create a safe and sufficient blood supply by comparing and recommending good donor management practice.

29 Thank you very much for your attention!

Donor Satisfaction with a New German Blood Donor Questionnaire and Intention of the Donor to Return for Further Donations

Original Article DOI: 10.1159/000354844 Received: May 31, 2012 Accepted: December 13, 2012 Published online: August 26, 2013 Donor Satisfaction with a New German Blood Donor Questionnaire and Intention