Versorgungsgeschehen

Grobe, Thomas; Dörning, Hans

doi:10.1007/978-3-540-70920-6_2

Cited by 4 publications

(7 citation statements)

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“…Although differences between AOK and other SHI funds with regard to the prevalence of chronic diseases have been reported in the literature [43,44], published age- and sex-specific health care utilization rates from another large German SHI were very close to those of AOK Middle Franconia [25,26]. …”

Section: Discussionmentioning

confidence: 99%

“…First, data were partly collected at different times: Whereas the majority of KORA-Age participants were assessed in 2009 and the official statistics on long-term care utilization also refer to 2009, the AOK claims data date back to 2006. Published statistics showed that, with the exception of long-term care use, utilization of health care services has increased during this 3-year period [25,26]. This was most pronounced for pharmaceuticals [27,28].…”

Section: Methodsmentioning

confidence: 99%

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Official statistics and claims data records indicate non-response and recall bias within survey-based estimates of health care utilization in the older population

Hünger

Schwarzkopf

Heier

et al. 2013

BMC Health Serv Res

366

408

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BackgroundThe validity of survey-based health care utilization estimates in the older population has been poorly researched. Owing to data protection legislation and a great number of different health care insurance providers, the assessment of recall and non-response bias is challenging to impossible in many countries. The objective of our study was to compare estimates from a population-based study in older German adults with external secondary data.MethodsWe used data from the German KORA-Age study, which included 4,127 people aged 65–94 years. Self-report questions covered the utilization of long-term care services, inpatient services, outpatient services, and pharmaceuticals. We calculated age- and sex-standardized mean utilization rates in each domain and compared them with the corresponding estimates derived from official statistics and independent statutory health insurance data.ResultsThe KORA-Age study underestimated the use of long-term care services (−52%), in-hospital days (−21%) and physician visits (−70%). In contrast, the assessment of drug consumption by postal self-report questionnaires yielded similar estimates to the analysis of insurance claims data (−9%).ConclusionSurvey estimates based on self-report tend to underestimate true health care utilization in the older population. Direct validation studies are needed to disentangle the impact of recall and non-response bias.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Official statistics and claims data records indicate non-response and recall bias within survey-based estimates of health care utilization in the older population

Hünger

Schwarzkopf

Heier

et al. 2013

BMC Health Serv Res

366

408

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“…heart failure) were the primary reasons patients 80 years and older visited a physician in our study. These diseases are also the main reasons patients aged 80 years or older are treated in conventional settings in Germany [ 25 ]. Compared to elderly patients treated by conventional physicians, the patients in this present study showed a lower proportion of diseases associated with a modern lifestyle, such as disorders of lipoprotein metabolism and diabetes mellitus [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Pharmacotherapy of elderly patients in everyday anthroposophic medical practice: a prospective, multicenter observational study

et al. 2010

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BackgroundPharmacotherapy in the older adult is a complex field involving several different medical professionals. The evidence base for pharmacotherapy in elderly patients in primary care relies on only a few clinical trials, thus documentation must be improved, particularly in the field of complementary and alternative medicine (CAM) like phytotherapy, homoeopathy, and anthroposophic medicine. This study describes diagnoses and therapies observed in elderly patients treated with anthroposophic medicine in usual care.MethodsTwenty-nine primary care physicians in Germany participated in this prospective, multicenter observational study on prescribing patterns. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients were at least 60 years of age. Multiple logistic regression analysis was used to determine factors associated with anthroposophic prescriptions.ResultsIn 2005, a total of 12 314 prescriptions for 3076 patients (68.1% female) were included. The most frequent diagnoses were hypertension (11.1%), breast cancer (3.5%), and heart failure (3.0%). In total, 30.5% of the prescriptions were classified as CAM remedies alone, 54.4% as conventional pharmaceuticals alone, and 15.1% as a combination of both. CAM remedies accounted for 41.7% of all medications prescribed (35.5% anthroposophic). The adjusted odds ratio (AOR) for receiving an anthroposophic remedy was significantly higher for the first consultation (AOR = 1.65; CI: 1.52-1.79), treatment by an internist (AOR = 1.49; CI: 1.40-1.58), female patients (AOR = 1.35; CI: 1.27-1.43), cancer (AOR = 4.54; CI: 4.12-4.99), arthropathies (AOR = 1.36; CI: 1.19-1.55), or dorsopathies (AOR = 1.34; CI: 1.16-1.55) and it decreased with patient age (AOR = 0.97; CI: 0.97-0.98). The likelihood of being prescribed an anthroposophic remedy was especially low for patients with hypertensive diseases (AOR = 0.36; CI: 0.32-0.39), diabetes mellitus (AOR = 0.17; CI: 0.14-0.22), or metabolic disorders (AOR = 0.17; CI: 0.13-0.22).ConclusionThe present study is the first to provide a systematic overview of everyday anthroposophic medical practice in primary care for elderly patients. Practitioners of anthroposophic medicine prescribe both conventional and complementary treatments. Our study may facilitate further CAM-research on indications of, for example, dementia or adverse drug reactions in the elderly.

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“…Leider finden sich in der Versorgungsrealität nicht nur eine Unter-bzw. Fehlbehandlung auf der pharmakologischen Ebene, sondern auch eine noch viel stärker ausgeprägte Unterbehandlung auf der psychotherapeutischen [4,40]. Die Bereitstellung psychotherapeutischer Kompetenz für ältere Menschen ist deshalb besonders zu fördern, da Längsschnittuntersuchungen zeigen konnten, dass die Rezidivraten gerade über eine Kombination aus medikamentösen und psychotherapeutischen Maßnahmen verringert werden können, wenngleich auch dieser Befund noch weiter geprüft werden muss [41,42] …”

Section: Behandlungsmöglichkeitenunclassified

“…Die Annahme, dass die Häufigkeit von Depressionen mit zunehmendem Lebensalter abnimmt, scheint inzwischen widerlegt. Entsprechende Daten aus dem deutschen Versorgungssystem belegen zumindest eine häufigere Diagnosestellung mit zunehmendem Lebensalter [4]. Dies ist kompatibel mit der im Alter ansteigenden Suizidrate, die im Wesentlichen auf Depressionen zurück-geht (s. unten).…”

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Depressionen im Alter

Stoppe

2008

Bundesgesundheitsbl.

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Depression is the most frequent psychiatric disorder in old age. Some patients have had depressive episodes or other psychological disorder in an earlier part of their life span. Older people show more somatic or cognitive complaints compared to younger depressives. Risk factors for depression in old age are (incident) physical disorders, sleep disorders or loss of spouse. Depression worsens course and prognosis of comorbid somatic disorders. A major consequence is the high suicide rate in the elderly. Depression is also a risk factor for other disorders like dementia or institutionalisation. The interplay between depression and dementia and other organic brain disorders is complex und still unresolved. Depression in the elderly is a challenge for our health system. Recognition and treatment rates are still too low. Integrative treatment plans for depression with comorbid physical disorders or in various settings should be developed. With the growing elderly population the available evidence for treatment urgently has to be increased. In current practice drug therapies--mostly inadequate--dominate. Psychotherapy should be promoted and the number of old age psychotherapists increased.

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Versorgungsgeschehen

Cited by 4 publications

References 0 publications

Official statistics and claims data records indicate non-response and recall bias within survey-based estimates of health care utilization in the older population

Official statistics and claims data records indicate non-response and recall bias within survey-based estimates of health care utilization in the older population

Pharmacotherapy of elderly patients in everyday anthroposophic medical practice: a prospective, multicenter observational study

Depressionen im Alter

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