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When? |
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Time 5 |
Time 6 |
Time 7 |
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Where? |
(EE) Intensive Protocol |
(EE) |
(EE) |
(EE) |
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(EE) |
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Questionnaire |
Intake Assessment pp. 18, 19 IP: |
Intake Assessment p. 25 |
Intake Assessment p. 24 |
Intake Assessment p. 24 |
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Intake Assessment pp. 26, 27 |
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SIR Data bank |
ZPK rec/table 10 (Z1EE) IP: rec/table 12 (I1DRUG) |
ZPK rec/table 110 (Z2EE) rec/table 120 (Z2KONST) |
ZPK rec/table 210 (Z3EE) rec/table 220 (Z3KONST) |
ZPK rec/table 310 (Z4EE) rec/table 320 (Z4KONST) |
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ZKP rec/table 610 (Z7EE) |
Literature: Linden, Gilberg, Horgas, & Steinhagen-Thiessen, 1996, 1999; Steinhagen-Thiessen & Borchelt, 1996, 1999.
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Time 1 |
Time 2 |
Time 3 |
Time 4 |
Time 7 |
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Behandlungsbedarf, Medikation |
Treatment needs, medication |
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Medikamenten-Anamnese zu Meßzeitpunkt 1: |
Medication history at Time 1: |
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Haben Sie in den letzten 14 Tagen ärztlich verordnete Arzneimittel eingenommen? 1 = Ja |
Have you taken any prescribed drugs in the last two weeks? 1 = Yes |
Z1E69 |
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Ist darunter ein Medikament zur Beruhigung, für die Nerven, gegen Angst, Depressionen oder zum Schlafen? 1 = Ja |
Are there any tranquilizers, sleeping pills, anti-anxiety, or anti-depressant drugs among them? 1 = Yes |
Z1E70 |
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Nehmen Sie zur Zeit irgendwelche Medikamente? Tabletten, Tropfen, Salben, Spritzen oder ähnliches? 1 = Ja |
Are you presently taking any medication? Tablets, drops, ointments, injections or the like? 1 = Yes |
I1AA1001 |
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2. |
Welche Medikamente nehmen Sie zur Zeit? |
Which drugs are you currently taking? |
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Anzahl der (verordneten) Medikamente |
Number of drugs (prescribed) |
I1DRANZ |
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Laufende Nr. des jeweiligen Medikaments 0 = keinerlei Angaben |
Serial number of drug 0 = no statements |
I1DRNR |
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Erstes Medikament je Studienteilnehmer? 0 = Nein |
First drug of participant? 0 = No |
I1DRFIRS |
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Medikament gesehen? 0 = keine Medikamente |
Drug package or label shown? 0 = no drugs used |
I1DR1008 |
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Code des Medikaments laut ROTER LISTE 1990 (R) |
Code of drug in ROTE LISTE 1990 (R) |
I1DR1009 |
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Applikationsform des Medikaments? 0 = keine Medikamente |
Drug application? 0 = no drugs used |
I1DR1010 |
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Beginn der Einnahme des Medikaments (Monat)? 0 = keine Medikamente |
Start of drug use (month)? 0 = no drugs used |
I1DR1011 |
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Beginn der Einnahme des Medikaments (Jahr)? |
Start of drug use (year)? |
I1DR1012 |
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Wie oft nehmen Sie das Medikament? 00 = bei Bedarf |
How often do you take the medication? 00 = if necessary |
I1DR1013 |
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Wieviel nehmen Sie das Medikament pro Tag (Dosis)? |
How often do you take the drug per day (dosage)? |
I1DR1014 |
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Dosiseinheit? 0 = keine Medikamente |
Dose (unit)? 0 = no drugs used |
I1DR1015 |
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Letzter Record (Medikamente) pro Studienteilnehmer |
Last record (drugs) of participant |
I1DRLAST |
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Diagnosespezifische Bewertung der Medikation zu Meßzeitpunkt 1: |
Diagnosis specific evaluation of medication at Time 1: |
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Code des Medikaments in der ROTEN LISTE 1990 |
Code of drug in ROTE LISTE 1990 |
I10X15 |
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Verordner des Medikaments? 1 = Arzt |
Prescriber ? 1 = physician |
I10X16 |
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Anzahl der Inhaltsstoffe des Medikaments? |
Number of substances contained in the drug |
I10X17 |
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Bewertung der Dosierung des Medikaments? 1 = unterdosiert |
Evaluation of the drug's dosage? 1 = underdosed |
I10X24 |
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Indikationsstufe des Medikaments? 1 = absolut kontraindiziert |
Indication for the drug? 1 = absolutely contraindicated |
I10X25 |
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Längsschnittliche Medikamenten-Anamnese von Meßzeitpunkt 2 bis 4: |
Longitudinal medication history from Time 2 to Time 4: |
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Nehmen Sie zur Zeit irgendwelche Medikamente? Tabletten, Tropfen, Salben, Spritzen oder ähnliches? 1 = Ja |
Are you presently taking any medication? Tablets, drops, ointments, injections or the like? 1 = Yes |
- |
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Code der Medikamente 1 bis 15 laut ROTER LISTE (RL) (Time 2: RL 1994; Time 3: RL 1995; Time 4: RL 1997) |
Code of drugs 1 to 15 in ROTE LISTE (RL) (Time 2: RL 1994; Time 3: RL 1995; Time 4: RL 1997) |
- |
Z2E91NA - NF |
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Medikamente 1 bis 15: Originalpackung lag vor? 1 = Ja |
Drugs 1 to 15: Original package shown? 1 = Yes |
- |
Z2E91NAA - NFA |
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Medikamente 1 bis 15: Regelmäßige Anwendung? 1 = Ja |
Drugs 1 to 15: Regular application? 1 = Yes |
- |
Z2E91NAB - NFB |
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Medikamente 1 bis 15: Ärztlich verordnet? 1 = Ja |
Drugs 1 to 15: Prescribed by physician? 1 = Yes |
- |
Z2E91NAC - NFC |
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Waren Sie in den letzten 12 Monaten wegen folgender Erkrankungen in Behandlung? |
Have you been under medical trearment due to the following diseases during the last 12 months? |
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Schlaganfall |
stroke |
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Nehmen Sie Medikamente zur Behandlung dieser Erkrankung? |
Are you taking any medication to treat this disease? |
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Bluthochdruck |
hypertension |
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Nehmen Sie Medikamente zur Behandlung dieser Erkrankung? |
Are you taking any medication to treat this disease? |
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niedriger Blutdruck |
low blood pressure |
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Nehmen Sie Medikamente zur Behandlung dieser Erkrankung? |
Are you taking any medication to treat this disease? |
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Osteoporose |
osteroporosis |
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Nehmen Sie Medikamente zur Behandlung dieser Erkrankung? |
Are you taking any medication to treat this disease? |
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Arthrose |
arthrosis |
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Nehmen Sie Medikamente zur Behandlung dieser Erkrankung? |
Are you taking any medication to treat this disease? |
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Diabetes |
diabetes |
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Nehmen Sie Medikamente zur Behandlung dieser Erkrankung? |
Are you taking any medication to treat this disease? |
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erhöhte Bluttfette |
elevated blood lipids |
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Nehmen Sie Medikamente zur Behandlung dieser Erkrankung? |
Are you taking any medication to treat this disease? |
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Durchblutungsstörungen des Gehirns |
circulatory disturbance in the brain |
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Nehmen Sie Medikamente zur Behandlung dieser Erkrankung? |
Are you taking any medication to treat this disease? |
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neurologische Erkrankungen |
neurological diseases |
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wenn ja, welche? |
if so, which one? |
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Nehmen Sie Medikamente zur Behandlung dieser Erkrankung? |
Are you taking any medication to treat this disease? |
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Krebserkrankungen |
cancer |
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wenn ja, welche? |
if so, which one? |
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Nehmen Sie Medikamente zur Behandlung dieser Erkrankung? |
Are you taking any medication to treat this disease? |
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Lungenerkrankungen |
pulmonary diseases |
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wenn ja, welche? |
if so, which one? |
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Nehmen Sie Medikamente zur Behandlung dieser Erkrankung? |
Are you taking any medication to treat this disease? |
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Herzerkrankungen (u.a. schwere Herzrhythmusstörungen, Herzinfarkt, Herzinsuffizienz) |
heart diseases (e.g. serious cardiac arrhythmia, cardiac infarction, cardiac insufficiency |
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wenn ja, welche? |
if so, which one? |
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Nehmen Sie Medikamente zur Behandlung dieser Erkrankung? |
Are you taking any medication to treat this disease? |
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sonstige Erkrankungen |
other diseases |
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wenn ja, welche? |
if so, which one? |
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Nehmen Sie Medikamente zur Behandlung dieser Erkrankung? |
Are you taking any medication to treat this disease? |
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Time 1 |
Time 2 |
Time 3 |
Time 4 |
Time 7 |
|
1. |
Number of prescribed drugs |
- |
K2Z91MV |
- |
- |
- |
|
2. |
Number of drugs used regularly |
- |
K2Z91MR |
- |
- |
- |
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3. |
Number of drugs prescribed regularly |
- |
K2Z91MRV |
- |
- |
- |
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4. |
Drugs 1 to 15: Code of drugs, year |
- |
- |
K3Z91N1J-N9J /K3Z91NAJ-NFJ |
- |
- |
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5. |
Global medication rating |
K1Z69GMR |
- |
- |
- |
- |
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6. |
Medical aids |
K1Z8SUM |
- |
- |
- |
- |
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7. |
Number of illnesses reported |
- |
- |
- |
- |
K7Z9iSUM |