Background Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization. Methods We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization. Results We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting. Conclusion The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care.
Kapitel 1 Pflegepersonal heute und morgen Status quo 2017 (PG 2/KM 6) Je Alters-und Geschlechtsgruppe, differenziert nach Pflegegrad, amb./stat. und Bundesland* Bevölkerung (13. Bevölkerungsvorausberechnung (Anwendung der Variante 2-A auf Bundesländer), Destatis***) Differenziert nach Alter, Geschlecht und Bundesland Personalbedarf 2018-2060 Differenziert nach Berufsqualifikation und Bundesland * Differenzierung nach Bundesland unter zu Hilfenahme von AOK-Routinedaten ** Soweit keine Lieferung durch StLa erfolgt, eigene Berechnung der VZÄ in Anlehnung an Vorgehen DESTATIS *** Variante 2-A basiert auf dem Bevölkerungsbestand zum 31. Dezember 2015; Entwicklung der Geburtenhäufigkeit, Sterblichkeit sowie zur Nettozuwanderung wurden auf höhere Werte angepasst. diese Länder wurde die bundesweite Verteilung auf Vollzeit und Teilzeitquoten angesetzt.
Background: Most older people, and especially those in need of long-term care, suffer from one or more chronic diseases. Consequently, older people have an increased need of medical care, including specialist care. There is little evidence as yet whether older people with greater medical care needs obtain adequate medical care because existing studies do not sufficiently control for differences in morbidity. In this study we investigate whether differences in medical specialist utilization exist between older people with and without assessed long-term care need in line with Book XI of the German Social Code, while at the same time controlling for individual differences in morbidity. Methods: We used data from the 11 German AOK Statutory Health and Long-term Care Insurance funds of 100,000 members aged 60 years or over. Zero-inflated Poisson regression analyses were applied to investigate whether the need for long-term care and the long-term care setting are associated with the probability and number of specialist visits. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner (GP) utilization. Results: Older people in need of long-term care are more likely to have no specialist visit than people without the need for long-term care. This applies to nearly all medical specialties and for both care settings. Yet, despite these differences in utilization probability the number of specialist medical care visits between older people with and without the need for long-term care is similar. Conclusion: Older people in need of long-term care might face access barriers to specialist care. Once a contact is established, however, utilization does not differ considerably between those who need long-term care and those who don't; this indicates the importance of securing an initial contact.
IntroductionNursing home residents typically have greater needs for medical care than community-dwelling elderly. However, restricted cognitive abilities and limited mobility may impede their access to general practitioners and medical specialists. The provision of medical care in nursing homes may therefore be inappropriate in some areas of medical care. The purpose of this mixed-methods study is to systematically assess, evaluate and explain met and unmet medical care needs in German nursing homes and to develop solutions where medical care is found to be inappropriate.Methods and analysisFirst, statutory health insurance claims data are analysed to identify differences in the utilisation of medical care between nursing home residents and community-dwelling elderly with and without need for long-term care. Second, the health status and medical care of 500 nursing home residents are assessed and evaluated to quantify met and unmet medical care needs. Third, qualitative expert interviews and case conferences and, fourth, quantitative analyses of linked data are used to provide structural, case-specific and generalisable explanations of inappropriate medical care among nursing home residents. Fifth, a modified Delphi study is employed to develop pilot projects aiming to improve medical care in nursing homes.Ethics and disseminationThis study was approved by the Ethics Committee of the University of Bremen on 23 November 2017. Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals.Trial registration numberDRKS00012383.
Zusammenfassung Zusammenfassung Der Beitrag liefert ein ausführliches Bild zum Stand der Pflegebedürftigkeit und der gesundheitlichen Versorgung der Pflegebedürftigen in Deutschland. Die Analysen basieren auf GKV-standardisierten AOK-Daten. Sie zeigen Prävalenz, Verläufe und Versorgungsformen der Pflege sowie Kennzahlen zur gesundheitlichen Versorgung der Pflegebedürftigen. Im Fokus stehen die Inanspruchnahme von ärztlichen und stationären Leistungen, Polymedikation und Verordnungen von PRISCUS-Wirkstoffen und Psychopharmaka. Die Ergebnisse werden der Versorgung der Nicht-Pflegebedürftigen gleichen Alters gegenübergestellt und differenziert nach Schwere der Pflegebedürftigkeit und Versorgungssetting ausgewiesen. The article provides empirical insights on the scope and state of long-term care services in Germany. This includes health service provision for persons in need of care. The article lays out key figures regarding the prevalence, pathways and forms of care based on standardised AOK statutory health insurance data. An additional focus lies on the use of out- and inpatient health care services as well as on polypharmacy and prescriptions of PRISCUS medication and psychotropic drugs. Findings are contrasted with data on members of the same age group who are not in need of care and discussed in relation to the severity of the need of care and the care provision setting.
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