Prevalence and predictors of having no general practitioner - analysis of the German health interview and examination survey for adults (DEGS1).

BACKGROUND: Although patients in Germany are generally free to choose their primary healthcare provider, this role should mainly be assumed by general practitioners (GPs). While some predictors of the frequency of use of GP services have been reported in international studies, there is still a lack in knowledge what could deter people from contacting a GP in Germany. To improve healthcare, it is important to identify characteristics of people without a GP. METHODS: This cross-sectional analysis was based on the first wave of the "German Health Interview and Examination Survey for Adults" (DEGS1) conducted by the Robert Koch Institute in 2008-2011. Descriptive analyses and multiple logistic regression by gender were performed to analyze the association between having no GP and age, gender, residential area, socioeconomic status (SES), marital status, working hours per week, general state of health, chronic diseases and health insurance. RESULTS: Overall, 9.5% (95% confidence interval (CI): 8.4-10.7) of the 7755 participants stated to have no GP, more often men (11.4%) than women (7.6%). Life in urban areas (big cities vs. rural: adjusted odds ratio (aOR): 2.9, 95% CI: 2.1-3.9), younger age (18-29 years vs. 65-79 years: aOR: 4.4, 95% CI: 2.5-7.7) and the presence of chronic diseases (yes vs. no: aOR: 0.4, 95% CI: 0.3-0.6) showed significant associations of not having a GP. For men, the type of health insurance (private vs. statutory: aOR: 2.1, 95% CI: 1.5-3.0; other vs. statutory: aOR: 2.1, 95% CI: 1.4-3.1) and for women, SES (low vs. medium: aOR: 1.8, 95% CI: 1.2-2.7; high vs. medium: aOR: 2.1, 95% CI: 1.4-3.0) increased the risk of having no GP. CONCLUSIONS: Our analysis offers new insights into the use of GPs in Germany and revealed differences between men and women. Public health strategies regarding access to a GP have to focus on men and on women with a low SES. Further analyses are needed to determine whether men with private health insurance prefer to consult a specialist rather than a GP. For young adults, improving the transition process from a pediatrician to a GP could fill a gap in health care.

[Outpatient Emergency Care for Nursing Home Residents: A Status Quo From a Nursing Perspective]. / Ambulante Notfallversorgung von Pflegeheimbewohner: Ein Status Quo aus pflegerischer Sicht.

AIM OF THE STUDY: At present about 2 million people need care in Germany, about one third of them live in old people's homes or nursing homes. Outpatient emergency care of nursing home residents is ensured by primary care physicians, the medical emergency service and the emergency services. Emergency care has rarely been examined from the perspective of nurses. Therefore, in our study, we investigated how the nurses perceive medical care in medical emergencies and what suggestions for improvements they have. METHODS: In 2015/16, guided interviews with a total of 13 females and one male elderly care nurses in northern Rhineland-Palatinate were conducted. The interviews were digitally recorded and literally transcribed. Evaluation was performed using the qualitative content analysis Mayring with MAXQDA® 12. RESULTS: In the case of an acute deterioration in the general condition of a resident, the family doctor in charge was first called in. It was difficult for the nursing staff to contact the physician in charge during consultation hours. The quality of the emergency care was dependent on the respective practice structure. Outside the opening hours of the surgery, the emergency medical service took over care of the patients. These doctors did not know the patients, which, from the point of view of the nursing care, was a burden for the residents since they had to face new doctors. Emergency physicians have long access routes, which led to delays, even in emergencies. Some nurses wanted the "old system" back, where the home care physicians were also available over the weekend by telephone. Overall, the request was a better care of residents. CONCLUSION: GPs are the main contact persons for medical emergencies for the nursing staff. However, most physicians are only available during office hours. From the point of view of care, it would make sense to create incentives for the general practitioners to be available for emergencies even outside their consulting hours.

Determinants of having no general practitioner in Germany and the influence of a migration background: results of the German health interview and examination survey for adults (DEGS1).

BACKGROUND: It is aspired in the German healthcare system that general practitioners (GPs) act as initial contact for patients and guide through at all steps of medical treatment. This study aims at identifying factors associated with the odds of having no GP within the general population and especially among people with migration background. METHODS: This cross-sectional analysis was based on the "German Health Interview and Examination Survey for Adults" (DEGS1) conducted by the Robert Koch Institute. Descriptive analyses as well as multiple logistic regression models were performed to analyse the impact of a migration background, age, gender, residential area, socioeconomic status (SES) and other factors on having no GP among 7755 participants. RESULTS: 9.5% of the total study population and 14.8% of people with a migration background had no GP, especially men, adults living in big cities and without chronic diseases. The odds of not having a GP were higher for people with a two-sided migration background (aOR: 1.90, 95% CI: 1.42-2.55). Among the population with a migration background, particularly young adults, men, people living in big cities and having a private health insurance showed higher odds to have no GP. CONCLUSIONS: It is necessary to investigate the causes of the differing utilization of healthcare of people with a migration background and, if necessary, to take measures for an equal access to healthcare for all population groups. Further research needs to be done to evaluate how to get young people into contact with a GP.

Prevalence and comorbidity of osteoporosis- a cross-sectional analysis on 10,660 adults aged 50 years and older in Germany.

BACKGROUND: Knowledge on prevalence of osteoporosis stratifying for socioeconomic background is insufficient in Germany. Little is known in Europe about other diseases that go along with it although these aspects are important for implementing effective public health strategies. METHODS: This cross-sectional analysis was based on the national telephone survey "German Health Update" (GEDA 2012) performed in 2012/2013. GEDA 2012 provides information on self-reported diseases and sociodemographic characteristics for nearly 20,000 adults. Descriptive statistical analysis and multiple logistic regression were used to examine the association between osteoporosis and age, sex, other diseases and education defined by ISCED. Analyses were limited to participants aged 50 years and older. RESULTS: Overall, 8.7% of the 10,660 participants aged 50+ years had osteoporosis (men 4.7%, women 12.2%). More than 95% of the adults with osteoporosis had at least one coexisting disease. The odds for arthrosis (OR 3.3, 95% CI 2.6-4.1), arthritis (OR 3.0, 95% CI 2.2-4.2), chronic low back pain (OR 2.8, 95% CI 2.3-3.5), depression (OR 2.3, 95% CI 1.7-3.1) and chronic heart failure (OR 2.3, 95% CI 1.6-3.1), respectively, were greater for adults with osteoporosis. Education showed no significant association with osteoporosis. CONCLUSIONS: There was no clear evidence of socioeconomic differences regarding osteoporosis for adults in Germany. However, clinicians need to be aware that multimorbidity is very common in adults with osteoporosis. Health care interventions for osteoporosis could be improved by offering preventive care for other diseases that go along with it. Over- or under-diagnosis in different socioeconomic levels has to be further explored.

[Prevention of nosocomial infections and antibiotic resistance in nursing homes]. / Prävention von nosokomialen Infektionen und Antibiotikaresistenzen in Altenpflegeheimen.

BACKGROUND: Nosocomial infections and multidrug-resistant organisms are an increasing problem in nursing homes worldwide; therefore, new approaches for infection control need to be developed. OBJECTIVES: This article gives an overview of infections in nursing homes, their medical treatment and previous measures for infection prevention. MATERIALS AND METHODS: The article is based on a selective literature search including the literature database PubMed. In particular, scientific studies on the prevalence of nosocomial infections in German nursing homes, publications for medical care in long-term care facilities in Europe and international studies for infection prevention were evaluated. RESULTS: The basis for an effective reduction of infections is the establishment of a surveillance system. All participating medical professionals provide feedback about local infections and resistance situations and the presence of risk factors, such as urinary catheters or chronic wounds. Only then can targeted antibiotic strategies be adapted and the effectiveness of preventive measures, such as hand disinfection is continuously reviewed. So far, in particular multimodal, multidisciplinary prevention projects were successful. These included frequent staff training, reduction of urinary catheters and a rational use of antibiotics. CONCLUSIONS: Most prevention models have been previously tested in hospitals. A possible applicability of the results to the infection prevention in long-term care facilities has so far hardly been studied. Accordingly, further studies on infection control in nursing homes are absolutely necessary.