Ärztliche Versorgung von Pflegeheimbewohnern

Schmiemann, Guido; Herget–Rosenthal, Stefan; Hoffmann, Falk

doi:10.1007/s00391-015-1010-0

Cited by 29 publications

(25 citation statements)

References 8 publications

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“…The primary aim of the IMREN study was to determine the prevalence of renal insufficiency in nursing home residents, for which a total sample size of 856 residents in 19 care units was estimated. Further analyses have been published elsewhere [21–23]. …”

Section: Methodsmentioning

confidence: 99%

Influence of age and sex on hospitalization of nursing home residents: A cross-sectional study from Germany

Hoffmann

Schmiemann

2017

BMC Health Serv Res

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BackgroundNursing homes residents (NHR) are frequently transferred to hospitals. There is some evidence that male NHR are more often hospitalized than females, but the influence of age is less clear and predictors might differ between sexes. Analyses according to age groups between males and females have only been investigated once and none of the existing studies have conducted multivariate analyses stratified by sex. Aim of this study was to fill this gap.MethodsWe used data of the “Inappropriate Medication in patients with REnal insufficiency in Nursing homes” (IMREN) study, which was conducted between October 2014 and April 2015 in nursing homes in northwestern Germany (Bremen and Lower Saxony). Anonymised data was obtained by nursing staff of the participating nursing homes. All residents living in the participating care units were included. We assessed whether they were hospitalized at least once during the preceding 12 months. Cluster-adjusted multivariate logistic regression was applied to identify variables associated with hospitalizations. All analyses were stratified by sex.ResultsOf 852 residents from 21 nursing homes (mean age 83.5 years; 76.5% females), 43.1% (95% confidence intervals [95% CI]: 35.6–50.5) were hospitalized at least once during the preceding 12 months. This proportion was higher in residents institutionalized within the last 6 months compared to those with a longer length of stay (65.7% vs. 39.5%). Although not statistically significant, males were more often hospitalized than females (52.4% vs. 40.3%) and differences between sexes are particularly remarkable for age, health status and length of stay. In females, the chance of being hospitalized decreased steadily with age (OR: 2.40 [95% CI: 1.24–4.64] and 1.60 [95% CI: 1.05–2.43] for age groups <75 and 75–84 years compared to 85+ years). On the other hand, males aged 75–84 years had a statistically significant lower chance compared to 85+ years olds (OR: 0.41; 95% CI: 0.19–0.90).ConclusionsDifferences in factors associated with hospitalizations might exist between sexes. We strongly suggest that further studies on hospitalizations of NHR should stratify their analyses by sex.

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Section: Methodsmentioning

confidence: 99%

Influence of age and sex on hospitalization of nursing home residents: A cross-sectional study from Germany

Hoffmann

Schmiemann

2017

BMC Health Serv Res

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“…Specialists' contacts or treatment decisions without GP's involvement contrast with this role. On the other side, the NH staff might think that GPs have less expertise in providing adequate care in all possible scenarios -although in Germany, GPs provide the bulk of medical care in this population [4,44]. Such disagreements can be caused by communication difficulties between nurses and physicians and uncertain responsibilities which are known to contribute to acute hospital transfers of NH residents [46].…”

Section: Discussionmentioning

confidence: 99%

“…Usually, nursing staff are the first ones identifying a resident's deterioration and they know the complexity of the decision-making process [37]. General practitioners (GPs) provide most medical care for NH residents [4,44] and both groups play essential roles for the transfer decision [36,41,43,45,46]. In Germany, NH residents can be admitted to a hospital with a physician's (e.g., GP's) referral, however, the transfer process can also be initiated by the NH staff calling the emergency medical service without involvement of a physician which is common practice in German speaking countries [23,47].…”

Section: Introductionmentioning

confidence: 99%

Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies

et al. 2020

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Background: Visits in emergency departments and hospital admissions are common among nursing home (NH) residents and they are associated with significant complications. Many of these transfers are considered inappropriate. This study aimed to compare the perceptions of general practitioners (GPs) and NH staff on hospital transfers among residents and to illustrate measures for improvement. Methods: Two cross-sectional studies were conducted as surveys among 1121 GPs in the German federal states Bremen and Lower Saxony and staff from 1069 NHs (preferably nursing staff managers) from all over Germany, each randomly selected. Questionnaires were sent in August 2018 and January 2019, respectively. The answers were compared between GPs and NH staff using descriptive statistics, Mann-Whitney U tests and χ2-tests. Results: We received 375 GP questionnaires (response: 34%) and 486 NH questionnaires (response: 45%). GPs estimated the proportion of inappropriate transfers higher than NH staff (hospital admissions: 35.0% vs. 25.6%, p < 0.0001; emergency department visits: 39.9% vs. 20.9%, p < 0.0001). The majority of NH staff and nearly half of the GPs agreed that NH residents do often not benefit from hospital admissions (NHs: 61.4% vs. GPs: 48.8%; p = 0.0009). Both groups rated almost all potential measures for improvement differently (p < 0.0001), however, GPs and NH staff considered most areas to reduce hospital transfers importantly. The two most important measures for GPs were more nursing staff (91.6%) and better communication between nursing staff and GP (90.9%). NH staff considered better care / availability of GP (82.8%) and medical specialists (81.3%) as most important. Both groups rated similarly the importance of explicit advance directives (GPs: 77.2%, NHs: 72.4%; p = 0.1492). Conclusions: A substantial proportion of hospital transfers from NHs were considered inappropriate. Partly, the ratings of possible areas for improvement differed between GPs and NH staff indicating that both groups seem to pass the responsibility to each other. These findings, however, support the need for interprofessional collaboration.

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“…Trotz des großen Bedarfs haben ca. 90 % der Pflegeheimbewohner monatlichen direkten Kontakt zu ihren Hausärzten [6,7,10] Weiterhin zeigt sich ein Einfluss der regionalen Lage. In der Großstadt wird die Betreuung von Demenzkranken in der Häuslichkeit mit 2,3 (±1,0 SD) bewertet, im Kleinstadtbereich mit 2,1 (±1,3 SD).…”

Section: Hintergrund Und Fragestellungunclassified

Assessment of care in patients with dementia in house calls by general practitioners

et al. 2020

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Zusammenfassung Hintergrund Demenzpatienten (DP) sind eine besondere Herausforderung für das Gesundheitssystem. Auf sie entfallen 5 % der Gesamtausgaben im Gesundheitswesen. Die krankheitsbedingten Defizite und der damit verbundene Versorgungsbedarf führen dazu, dass viele Patienten nicht mehr in der eigenen Häuslichkeit leben können und auf die Versorgung in Pflegeheimen (PH) angewiesen sind. Fragestellung Wie wird die gesamtheitliche Betreuung von DP im Hausbesuch (HB) eingeschätzt? Hat die regionale Lage Einfluss auf die Wohnsituation bei DP? Material und Methoden Im Rahmen von SESAM‑5 wurden von 303 sächsischen Hausarztpraxen in einem Zeitraum von einem Jahr 4286 HB mittels Fragebogen dokumentiert und sowohl inhaltliche als auch strukturelle Merkmale erfasst. Ergebnisse Die Prävalenz von Demenz bei HB-Patienten betrug 27,5 %. Von diesen bewohnten 72,6 % ein PH oder betreutes Wohnen. Das medizinische Personal schätzte die gesamtheitliche Betreuung von DP im PH signifikant besser ein als in der eigenen Häuslichkeit. Diese Diskrepanz fiel im Vergleich von ländlichen und städtischen Gebieten noch deutlicher aus, obwohl in städtischen Gebieten signifikant mehr Patienten in PH wohnten (27 % vs. 51 %). Diskussion Die Betreuung dementer HB-Patienten wird vom versorgenden Personal überwiegend als gut eingeschätzt, wobei diese bei DP im PH vergleichsweise besser bewertet wird als in der eigenen Häuslichkeit. Dies kann durch einen hohen Versorgungsbedarf der DP erklärt werden. Der Kontrast zwischen ruralen und städtischen Gebieten ist durch infrastrukturelle, aber auch durch organisatorische Unterschiede in ländlichen Bereichen erklärbar, wo signifikant häufiger eine Mitbetreuung durch Angehörige erfolgt. Da bei DP kognitive Defizite im Vordergrund stehen, könnten alternative Wohnformen zukünftig mehr in den Fokus rücken.

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Ärztliche Versorgung von Pflegeheimbewohnern

Abstract: Medical care by specialists is characterized by huge variations. Besides a frequent contact rate with GPs there seems to be an undersupply regarding care by dentists and ophthalmologists.

Cited by 29 publications

References 8 publications

Influence of age and sex on hospitalization of nursing home residents: A cross-sectional study from Germany

Influence of age and sex on hospitalization of nursing home residents: A cross-sectional study from Germany

Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies

Assessment of care in patients with dementia in house calls by general practitioners

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