Outpatient Geriatric Health Care in a Rural Region in Germany: A Population-Based Spatial Analysis of Secondary Data

Abstract

Background and objective: Due to unrecognized and unaddressed geriatric care needs, elderly patients have a higher risk for developing chronic conditions and acute medical complications. Early geriatric screenings and assessments help to timely identify geriatric needs. Holistic and coordinated therapeutic approaches maintain the independence of elderly patients and avoid adverse effects of several uncoordinated treatments. General practitioners’ practices are important for the timely identification of geriatric needs. The aims of this study are to examine the spatial distribution of the utilization of outpatient geriatric services in the Northeast of Germany and to identify regional disparities. Methods: Geographical analysis and cartographic visualization of the spatial distribution of outpatient geriatric services of patients who are eligible to receive basic or specialized geriatric care were carried out. Claims data of the Association of Statutory Health Insurance Physicians in Mecklenburg-Western Pomerania were analysed on the level of postcode areas. A Moran’s I analysis was carried out to identify clusters of low or high utilization rates. Results: Of all patients who were eligible for outpatient geriatric care in 2017, 58.3% (n=129,283/221,654) received at least one basic outpatient geriatric service. 77.2% (n=73,442/95,171) of the patients who were also eligible for specialized services, received any geriatric service (basic or specialized). 0.4% (n=414/95,171) of this group, actually received specialized outpatient geriatric care. Among the postcode areas in the study region, the proportion of patients who received a basic geriatric assessment ranged from 3.4% to 86.7%. Several regions with statistically significant Clusters of utilization rates were identified. Conclusions: Considering the entire federal state, about half of the eligible population received basic geriatric care. Of the subgroup eligible for specialized geriatric care, only 0.4% received specialized services. The wide range of regional variations in the utilization rates and the local segregation of high and low rates indicate that the provision of outpatient geriatric care may depend to a large extent on local structures (e.g., multiprofessional, integrated networks or innovative projects or initiatives). Considering specialized outpatient care, utilization is limited to a few regions. Innovative solutions to improve access to both basic and specialized geriatric outpatient care are necessary.