Prosthetic treatment patterns in the very old: an insurance database analysis from Northeast Germany

Abstract

Objectives We assessed dental prosthetic services utilization in very old Germans. Methods A comprehensive sample of 404,610 very old (≥ 75 years), insured at one large statutory insurer (Allgemeine Ortskrankenkasse Nordost, acting in the federal states Berlin, Brandenburg, Mecklenburg-Vorpommern), were followed over 6 years (2012-2017). Our outcome was the utilization of prosthetic services, in total and seven subgroups: (1) Crowns/partial crowns, (2) fixed dental prostheses (FDPs), (3) partial removable prostheses (RDPs), (4) full RDPs, (5) temporary services, (6) relining/rebasing/repairing/extending RDPs, (7) repairing FDPs. Association of utilization with (1) gender, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses and (6) German diagnoses related groups (G-DRG) was explored. Results The mean (SD) age of the sample was 81.9 (5.4) years; mean follow-up was 1689 (705) days. The mean utilization of any prosthetic service was 27.0%; the most often utilized service type were total RDPs (13.2% utilization), crowns (8.1%), and partial RDPs (7.1%). Utilization decreased with age for nearly all services (except relining/rebasing/repairing/extending RDPs). Utilization of prosthetic services was significantly higher in Berlin and most cities compared with rural municipalities and in individuals with common, less severe conditions according to ICD-10 and DRGs compared with life-threatening conditions or dementia. In multivariable analysis, gender (OR; 95% CI: 0.95; 0.93-0.98), social hardship status (1.19; 1.17-1.21), federal state (Brandenburg 0.57; 0.56-0.59; Mecklenburg-Vorpommern: 0.66; 0.64-0.67) and age significantly affected utilization (0.95; 0.95-0.95/year). Conclusions Patient-related and healthcare factors determine the utilization of prosthetic services in very old Germans. Interventions to maintain sufficient prosthetic care up to high age are required. Clinical significance The utilization of prosthetic services in the very old in Northeast Germany showed significant disparities within populations and service types. There seems to be great need to better understand the drivers of utilization, and to develop and evaluate interventions to maintain sufficient prosthetic care up to high age.

Underscreening and undertreatment? Periodontal service provision in very old Germans

“…Fifth, we assessed the impact of social hardship status on utilization. Hardship status is a proxy for low income but does otherwise not directly impact on accessibility of dental care in Germany except for prosthetic care (where additional costs are decreased when having this status; this was found with an increased utilization in the investigated cohort) [5]. In line with previous research, hardship status was found to be associated with decreased utilization, possibly acting as marker of not only low income but also low health literacy and unfavorable health behaviors.…”

Dental service utilization in the very old: an insurance database analysis from northeast Germany

“…Such status is a proxy for low income. It has been found associated with increased utilization of prosthetic services, as individuals with this status usually pay very low or no additional fee at all for any prosthetic service; that is, financial utilization barriers for this type of dental treatment are very low or absent [7]. For the present analysis, hardship status was used only as a social marker, as the analyzed dental services (examination, restorations, surgery, prevention, outreach care) are coming at no costs for all statutorily insured individuals, regardless of their age.…”

“…In a previous study and building on claims data, we found a disparate utilization of prosthetic services in the very old, with those aged 85 years or older, those living rural, and those with severe general health conditions utilizing prosthetic services, by large, to a lower degree than younger, urban living and only limitedly sick seniors [7]. The only service the former group used more often was maintenance of existing prosthetics.…”

“…For reasons of comparability, the design and conduct of this study largely aligns with that of a previous publication on prosthetic treatment patterns in the same population [7]. The investigated cohort was evaluated based on routinely collected claims data from a statutory (public) health insurance in Germany.…”

Protocolo de atención odontológica para el adulto mayor

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