Claims data analysis of medical specialist utilization among nursing home residents and community-dwelling older people

Abstract

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.

COVID-19 related decline in cancer screenings most pronounced for elderly patients and women in Germany: a claims data analysis

“…AOK consists of 11 regional health-care funds and together they represent the largest SHI fund in Germany. With 27 million insured persons, around one-third of the entire German population is covered by AOK (AOK-Bundesverband 2022 ; Schulz et al 2020 ).…”

Fachärztliche Unterversorgung bei Heimbewohnern – Prävalenzstudie und Hochrechnung

“…Das Projekt wurde mit Mitteln des Innovationsausschusses beim Gemeinsamen Bundesausschuss unter dem Förderkennzeichen 01VSF16039 gefördert. Teilergebnisse des Projekts wurden bereits veröffentlicht [ 13 , 14 ]; ein Gesamtbericht des Projekts mit weiteren Analysen auf Basis dieser Daten wird nach Ende des Projekts durch den Mittelgeber veröffentlicht.…”

“…Zwar weisen Pflegebedürftige mehr Hausarztkontakte auf als Nichtpflegebedürftige [ 8 ]; ob diese allerdings fachärztliche Kontakte ersetzen können, ist fraglich. Lediglich hinsichtlich der neurologischen Versorgung zeigt sich bei Pflegebedürftigen eine höhere Inanspruchnahme, selbst wenn für die Tatsache kontrolliert wird, dass Pflegebedürftige mehr neurologische Erkrankungen aufweisen als Nichtpflegebedürftige [ 13 ]. Darüber hinaus konnte gezeigt werden, dass es mit höherer Pflegestufe umso wahrscheinlicher ist, bei einer Erkrankung keinen entsprechenden Facharztkontakt zu haben [ 14 ].…”

Contacts with general practitioners, dentists, and medical specialists among nursing home residents: a cross-sectional study in 44 German nursing homes

“…Most nursing home residents suffer from multimorbidity, frailty, cognitive impairments, and polypharmacy, all of which necessitate access to and utilization of medical care [4][5][6][7]. In nursing homes, almost all residents have regular contact with general practitioners (GPs) [8][9][10][11][12].…”

“…This is surprising, since nursing home residents usually have high dental care needs resulting from poor oral health, which is negatively associated with quality of life [14][15][16][17]. Moreover, it has been shown that, with the exception of neurologists and psychiatrists, the proportion of individuals having contact with medical specialists at least once per year is lower among nursing home residents than among community-dwelling elderly [4,5], and contact rates also vary widely among nursing homes [10,11]. However, the influence of nursing home characteristics has not been studied in detail so far.…”