CitationIncidence, prevalence and 1-year all-cause mortality of heart failure in Germany: a study based on electronic healthcare data of more than six million persons.
Abstract AimsData on the epidemiology of atrial fibrillation (AF) and its antithrombotic management in elderly populations are scarce. The aims of this study were to estimate the incidence and prevalence of AF in the elderly in Germany and to describe antithrombotic management of AF cases.
MethodsEstimation of prevalence and incidence was based on data of three German statutory health insurances, which insured more than 800,000 people aged 65 years and older in the study Treatment was less common among women and older people.
ConclusionIncidence and prevalence of AF are relatively high in the elderly in Germany. A considerable fraction of new AF cases did not receive antithrombotic drugs in routine care.
In Deutschland berichten 11,3 % der Frauen und 8,1 % der Männer, innerhalb eines Jahres psychotherapeutische oder psychiatrische Hilfe in Anspruch zu nehmen. Unter Befragten mit depressiver Symptomatik sind dies 35,0 % der Frauen bzw. 31,0 % der Männer. Rund zwei Drittel der Personen mit solchen Symptomen haben also keine dieser Berufsgruppen aufgesucht. Neben einer depressiven Symptomatik weisen das Leben ohne Partnerin bzw. Partner sowie eine geringe soziale Unterstützung einen Zusammenhang mit der Inanspruchnahme auf. Außerdem liegt der Anteil der Personen mit depressiver Symptomatik, die psychotherapeutische oder psychiatrische Hilfe nutzen, in gut versorgten Regionen etwa 15 Prozentpunkte höher als in Regionen mit geringer Versorgungsdichte. Um bessere Bedingungen für die Nutzung der betreffenden Versorgungsangebote zu schaffen, sollten neben der Erhöhung der Zahl an Leistungserbringern auch flankierende Maßnahmen angestrebt werden. Ansätze, die auf einen kurzfristigen und niedrigschwelligen Zugang und eine stärkere Kooperation zwischen haus-und fachärztlich Behandelnden setzen, sollten auf ihre Effekte hinsichtlich einer Weiterentwicklung der Erstversorgung evaluiert werden.
BackgroundSocially disadvantaged people have an increased need for medical care due to a higher burden of health problems and chronic diseases. In Germany, outpatient care is chiefly provided by office-based general practitioners and specialists in private practice. People are free to choose the physician they prefer. In this study, national data were used to examine differences in the use of outpatient medical care by socioeconomic status (SES).MethodsThe analyses were based on data from 6,754 participants in the Robert Koch Institute’s German Health Interview and Examination Survey for Adults (DEGS1) aged between 18 and 69 years. The number of outpatient physician visits during the past twelve months was assessed for several medical specializations. SES was determined based on education, occupation, and income. Associations between SES and physician visits were analysed using logistic regression and zero-truncated negative binomial regression for count data.ResultsAfter adjusting for sociodemographic factors and health indicators, outpatients with low SES had more contacts with general practitioners than outpatients with high SES (men: incidence rate ratio [IRR] = 1.25; 95% confidence interval [CI] = 1.08–1.46; women: IRR = 1.20; 95% CI = 1.07–1.34). The use of specialists was lower in people with low SES than in those with high SES when sociodemographic factors and health indicators were adjusted for (men: odds ratio [OR] = 0.68; 95% CI = 0.51–0.91; women: OR = 0.56; 95% CI = 0.41–0.77). This applied particularly to specialists in internal medicine, dermatology, and gynaecology. The associations remained after additional adjustment for the type of health insurance and the regional density of office-based physicians.ConclusionThe findings suggest that socially disadvantaged people are seen by general practitioners more often than the socially better-off, who are more likely to visit a medical specialist. These differences may be due to differences in patient preferences, physician factors, physician-patient interaction, and potential barriers to accessing specialist care.
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