Background In Germany, geriatricians deliver acute geriatric care during an acute hospital stay and subacute rehabilitation after transfer to a rehabilitation clinic. However, the proportion of patients who receive acute geriatric care (AGC) or are transferred to subacute rehabilitation (TSR) differs considerably between hospitals. The aim of this study was to analyse the association between the two geriatric treatment systems and care home admission or mortality in patients following hip fracture. Methods Health insurance claims data were used to identify the rate of AGC per hospital and the rate of TSR per hospital following hip fracture surgery in patients aged ≥ 80 years. Outcomes were cumulative admission to a care home and cumulative mortality within 6 months after hospital admission. Results Data from 23,046 hip fracture patients from 561 hospitals were analysed. The rate of AGC was not associated with care home admission. However, compared to high rates of AGC medium rates or no AGC were associated with increased death rates by 12% or 20%, respectively. Treatment in hospitals with low rates of TSR was associated with a 8% higher risk of care home admission and a 10% increased risk of death compared to treatment in hospitals with high rates of TSR. Conclusions Our study suggests potential effects of geriatric treatment: reduction of mortality in hospitals with high rates of AGC or reduction of care home admission and mortality in hospitals with high rates of TSR.
Background Fractures are a major health problem in aging societies. Preventive approaches combining bone health and fall prevention are rare. The osteoporotic fracture prevention program in rural areas (OFRA) is a health care fund-driven program for older people in randomly selected districts in Germany. The components of the program were falls prevention exercise classes, examination of bone health by a dual-energy X-ray absorptiometry (DXA) scan, and a consultation about “safety in the living environment.” The aim of this study was to evaluate this complex preventive intervention in a routine health care setting. Methods This cluster-randomized trial was performed from October 2015 to October 2018 and took place in 186 administrative districts in five federal states, 47 districts served as intervention districts, and 139, as controls. Within these districts, we included (a) all community-living women and men aged 70–85 years with prior fragility fractures and (b) all community-living women aged 75–80 years. The analysis used routine data collected by a health insurance company. The primary endpoint was all fragility fractures combined. Fracture types, mortality, and nursing home admission were explorative endpoints. Cox frailty models were used for comparative analyses with a median follow-up time of 365 days (interquartile range: 0 days). Results Nine thousand four hundred eight individuals were approached to participate in one of the program components, 27,318 individuals served as controls. The mean age was 78.7 years. Of those approached to participate, nearly 30% joined the exercise classes. DXA measurement was reimbursed for 13.6%, and 51.8% received advice about measures to increase “safety in the living environment.” The incidence of fragility fractures did not differ between the intervention and the control group (HR 0.94; 95% CI 0.80–1.11). However, femoral fractures, the most frequent fracture type, were reduced in the intervention group (HR 0.76; 95% CI 0.59–0.99). Mortality and nursing home admission did not differ between the intervention and the control group. Conclusions A comprehensive fracture prevention program for older people living in rural areas was implemented. The program did not affect the primary endpoint of all fragility fractures combined. It has to be considered that we used a modified intention to treat approach based on geographic randomization and information about endpoints relied exclusively on routine data of the health care insurance. Trial registration German Clinical Trials Register DRKS-ID: 00009000
ZusammenfassungIm vorliegenden Beitrag wird die veränderte Inanspruchnahme des psychiatrischen Versorgungsangebots während der Covid-19-Pandemie im Jahr 2020 im Vergleich zum Vorjahr analysiert. Betrachtet werden die Entwicklung der Krankenhausfälle im Rahmen von voll- und teilstationären Versorgungsleistungen sowie die Auslastung in Hochschulambulanzen und psychiatrischen Institutsambulanzen während der Lockdown-Maßnahmen über verschiedene Diagnosegruppen hinweg. Ein zweiter Fokus des Beitrags liegt auf der Entwicklung der Verschreibungen von Psychopharmaka während der Pandemie. Die Analysen beruhen auf einer Stichprobe von Versicherten der AOK bzw. auf Daten des Wissenschaftlichen Instituts der AOK (WIdO) aus den Jahren 2019 und 2020. Wichtige Ergebnisse zeigen einen starken Rückgang der Fallzahlen in allen psychiatrischen Versorgungsbereichen, der insbesondere während des ersten Lockdowns im Frühjahr 2020 stärker ausgeprägt war. Im Hinblick auf die Verschreibung von Psychopharmaka fand sich keine absolute Zunahme, aber eine Häufung von Verordnungen im Frühjahr sowie Herbst 2020. Die vorgelegten Auswertungen zeigen die deutlichen Auswirkungen der Covid-19-Pandemie auf psychiatrische Versorgungsleistungen.
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