[Delegation of Medical Treatment to Non-physician Health Care Professionals: The Medical Care Structure agneszwei in Brandenburg - A Qualitative Acceptance Analysis]. / Delegation ärztlicher Leistungen an nichtärztliche Fachkräfte: Der Versorgungsansatz agneszwei in Brandenburg ­ eine qualitative Akzeptanzanalyse.

Backround: To address the increasing shortage of primary care physicians in rural regions, pilot model projects were tested, where general practitioners delegate certain physician tasks including house calls to qualified physician assistants. Evaluations show a high level of acceptance among participating physicians, medical assistants and patients. This study aims to measure the quality of cooperation among professionals participating in an outpatient health care delegation structure agneszwei with a focus on case management in Brandenburg. Methods: We conducted 10 qualitative semi-structured expert interviews among 6 physicians and 4 physician's assistants. Results: Physicians and physicians' assistants reported the cooperative action to be successful and as an advantage for patients. The precondition for successful cooperation is that non-physician health care professionals strictly respect the governance of the General Practitioners. Physicians report that the delegation of certain medical tasks reduces their everyday workload. Physician assistants derive professional satisfaction from the confidential relationship they have with the patients. All physician assistants are in favor of medical tasks being delegated to them in regular medical outpatient care, while most physicians are skeptical or reluctant despite their reported positive experience. Conclusion: Despite the high level of acceptance of delegating some medical tasks to physician assistants, the negotiation process of introducing cooperative working structures in the outpatient health care system is still at the beginning.

[The care of obese persons from the perspective of executives of inpatient care facilities. Results of qualitative expert interviews]. / Versorgung adipöser Menschen aus der Perspektive von Leitungskräften vollstationärer Pflegeeinrichtungen. Ergebnisse qualitativer Experteninterviews.

BACKGROUND: Although nursing home residents are increasingly suffering from obesity, little research has been done on the appropriate care for them. The present study examines how executives of long-term care facilities perceive obese residents, which meaning does obesity have for them, and whether they associate the care of the obese with additional expenditures. MATERIALS AND METHODS: In all, 15 guideline-based interviews were conducted with executive managers of nursing homes in Berlin, Saxony and Bavaria. The analysis of the interviews was based on the method of Meuser and Nagel. RESULTS: The results demonstrate that obese nursing home residents are hardly noticed by executives. This results from the fact that they attribute only minor significance to obesity as a nutritional and health problem. The care of obese residents is associated with additional instrumental and personnel-related expenditures. However, facilities do not have sufficient resources to provide them. Obesity is a serious, but unrecognized problem in long-term care. CONCLUSION: To improve the awareness of obesity, intense professional discussions are required. The provision of additional instrumental and human resources becomes necessary to ensure appropriate care of obese nursing home residents.

[Are complaints an element for health-care monitoring? Analysis of the user statistics of the federal commissioner for patient issues between 2004 and 2007]. / Beschwerden als Baustein eines gesundheitlichen Versorgungsmonitorings? Eine Nutzeranalyse des Amtes der Bundespatientenbeauftragten für den Zeitraum 2004 bis 2007.

BACKGROUND: The inclusion of patient perceptions in the assessment of health-care quality has gained in importance in recent years. The main instruments applied for this purpose are different types of patient interviews. Complaint data have rarely been used thus far. METHODS: On the basis of 19 117 complaints and inquiries to the office of the federal government commissioner for patient issues, this article examines to what extent this data source can be systematically used in health-care research and describes which groups of persons addressed their concerns to the commissioner for patient issues between the years 2004 and 2007. In this context, an investigation is done to determine whether reported or reconstructed data on sociodemographic characteristics are sufficient for analysis. A comparison with population-wide data also indicates to what extent the results can be considered representative for the concerns of patients or insurants in Germany. The letters and inquiries were subjected to a quantitative content analysis. RESULTS: The terms "gender", "region" and "insurance status" can be consistently encoded in a high percentage of those who make complaints and inquiries. The items "age" and "employment status" can be reconstructed to a lesser degree. However, a structural comparison of "responders" and "non-responders" shows that the results from the sample with these characteristics can be generalised for all concerns addressed. Data on the education and migration background were insufficient for analysis. Compared to the general population, a disproportionately high number of older and/or retired people (EM/EU pension) as well as unemployed persons and persons from Berlin and the new federal states contact the commissioner for patient issues. However, changes over time show a successive approach to population-wide distributions. CONCLUSIONS: The results recommend this unique data source for continuous coverage. The data documentation should thus be further standardised and integrated into a complaint management system that includes all relevant complaint offices in Germany.

[Health care research to improve the quality of health care provision for older people]. / Versorgungsforschung zur angemessenen Gesundheitsversorgung im Alter.

This article addresses the contribution that health care research can make to facilitating appropriate health care provision for older adults. First, the major risks in this age group are described. These include multiple illnesses, the increasing need for nursing care with age, but also the growing numbers of older adults with psychological disorders, primarily dementia. The second section of the article presents a critical assessment of the current health care situation in light of the risks identified. On this basis, the third section specifies the areas of health care research that can contribute to improving the quality of the health care provision for this population. The article is based on a presentation made by the author at the 2010 Berlin Talks on Social Medicine: "The New Old--Health Care Research for a Changed Society."

[Do gatekeeping programs increase equality of health care in Germany? A comparison of the health care situation of participants and nonparticipants]. / Führt das Hausarztmodell zu mehr Gleichheit im Gesundheitssystem? Ein Vergleich der Versorgungssituation von Hausarztmodellteilnehmern und Nichtteilnehmern.

This article compares the health care situation of participants in programs of general practitioner-centered health care (gatekeeping) in Germany (participants) with that of statutory health insurance holders who are not participating in such programs (nonparticipants). Because a key objective of the general practitioner model is to reduce the number of visits to specialists, the article also examines factors influencing frequent utilization of specialists in both groups. The analysis draws on a survey conducted by the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, 2010) based on a sample representative of the German population. In this context, 5,232 holders of statutory health insurance aged between 18 and 79 years were interviewed on health care policy issues. The results show that regulating the utilization of specialists through the gatekeeping function of general practitioners succeeds in facilitating similar utilization rates across educational levels, between cities and towns, and between men and women. Thus, gatekeeping programs contribute to the reduction of health care inequalities.

[Use of health insurance data to analyse pain management practices in the nursing-home setting]. / Sekundärdatenanalyse von Routinedaten einer Krankenkasse - Ein Zugangsweg zur Beschreibung schmerzbezogener Versorgungsleistungen von Pflegeheimbewohnern.

Pain is the most common health-related complaint in older persons. International estimations mention up to 80% of nursing home residents suffering from pain. In the meantime, no reliable epidemiological data on pain in nursing home residents are available for Germany, because of restricted access to the nursing-home population. This pilot study aimed to evaluate whether routine data from a German statutory health insurance fund can be used to generate data on pain prevalence and analgesic therapy in nursing home residents. To this end, data of all insured persons of Deutsche BKK who received long-term care insurance benefits for nursing-home care between April and June 2007 were selected anonymously. These data were combined with data on diagnoses and analgesic prescriptions. 3 pain-related diagnoses were selected: R 52 (pain, not elsewhere classified), M 16 (coxarthrosis) and G 53.0 (postherpetic neuralgia) and analysed for corresponding prescriptions. The study sample shows similar characteristics regarding age distribution and care needs in terms of long-term care insurance benefits compared to the official data on nursing-home residents for Germany in 2007. The rate of dementia was within the expected range, too. Therefore, external validity of the sample is assumed. One of the 3 selected diagnoses had been documented in 15% of the sample. About 58% of those received an analgesic prescription. Deficits were discovered regarding the documentation of postherpetic neuralgia, the combination of different analgesics and prescriptions for adjuvant drugs. Prevalence rate and numbers of prescriptions were as frequent as expected. The routine method for this analysis proved to be practicable and reliable. Data quality is deemed sufficient so that the main study will proceed to include a longer period of time and additional data.

[Knowledge and evaluation of health-system reforms as reflected in social determinants]. / Kenntnisstand und Bewertung gesundheitspolitischer Reformen im Spiegel sozialer Determinanten.

Significant reforms have been instituted in Germany's health system in recent years. Although a number of studies have examined the population's knowledge of and attitudes towards the new regulations, little information is available on status-specific differences. This article examines the extent to which knowledge and evaluation of health policy measures is influenced by social determinants. The analysis draws on a survey conducted by the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, 2009) based on a sample representative of the German population. In this context, 2 032 respondents aged between 18 and 79 years were interviewed on health-care policy issues. Results of bivariate analysis and logistic regression show that knowledge of the reform measures is significantly associated with educational level, age, and nationality. For example, respondents with the lowest level of formal education have an approximately four times higher risk as those with a higher level of formal education of not knowing about the health fund, and non-Germans have around twice the risk as Germans of not knowing about the reform measures. The main difference to emerge in respondents' EVALUATION of the reform measures is between East and West Germans. West Germans are significantly more likely than East Germans to evaluate the reform measures in negative terms. These status-specific differences in respondent knowledge can be attributed at least to some extent to the information asymmetry between patients and physicians/health-care providers. There is an urgent need for policy makers and care providers to render the reform measures transparent, accessible and comprehensible - especially to disadvantaged groups - to facilitate their effective implementation and positive evaluation.

[Special care requirements of elderly and old people: as reflected in the new Council of Experts Report]. / Spezielle Versorgungsanforderungen bei älteren und alten Menschen: Im Spiegel des neuen Sachverständigenratsgutachtens.

This contribution refers to the 2009 Council of Experts Report on health system development and discusses the special care requirements of old people. This includes the geriatric phenomenon of multimorbidity, polypharmacy in old people with multiple diseases, and the need for care. The probability and complexity of multiple diseases increase with age. About half the German citizens who are over 65 have three or more relevant chronic diseases. Multimorbity often causes elderly people to concomitantly consume many different pharmaceuticals. Twenty percent of the insurance holders aged 70-99 who were prescribed drugs in 2005 received 13 or more pharmaceutical agents. However, multimorbidity also has a negative effect on the quality of life, subjective state of health and physical functioning. As a result, particularly people over 80 will eventually need help and care. At present, 2.13 million German citizens are considered to be in need of care in terms of Social Code Book XI. The Council of Experts predicts that the number will increase to 4.35 million by 2050. Finally, the discussion also focuses on the steps health policy makers must take to cope with these requirements. Apart from expanding prevention, these include improving the quality of outpatient treatment and care, upgrading case and care management, and modernizing institutional care.

[High utilization of health care services by older adults]. / Alte Frauen und Männer mit starker Inanspruchnahme des Gesundheitswesens--Ein Beitrag zur altersspezifischen Versorgungsforschung.

Present discussions on health-care policy focus on fundamental restructuring, which will supposedly enable a more efficient provision of health care to patients with chronic ailments and also to elderly persons. Apart from increasing health care expenditure, the need for reform arises from demographically determined aging of the German population. A total of 54% of the 'GKV's' turnover in medical drugs is attributed to the health insurance agency's enrollees, who are aged 60 years and older, although they make up just 25% of total membership. Elderly men and women are therefore a significant group of health care users. In spite of its enormous political relevance, the provision of health care for the elderly has seen only marginal examination in Germany. This study on the "high utilization of health care services by older men and women" focuses on the examination of health care utilization by people aged 60 years and over. The following article will first introduce the study design. It will then review the literature on aging and health and on health care utilization by the elderly. The article goes on to present interim findings on the characteristics of the examined cohort and on ist consumption of medical drugs. The analysis is based on data regularly recorded by a North German health insurance agency. The examined cohort consists of 54% men and 46% women, whereby the average age is 68.3 years. The data analysis shows that 73,454 of the enrollees aged 60 years and older consumed 1,395,515 prescribed drugs in 2000. Each enrollee received an average of 19 medications annually; 5% of all those men and women examined received more than 58 medicines and were thus responsible for approximately a fifth of the volume in prescriptions. Of the drugs prescribed, 28.4% were for the treatment of cardio-vascular diseases, 13.9% for alimentary and metabolic disorders and 13.1% for the treatment of neurological diseases. Men and women aged 60 years and over are responsible for expenditure on medical drugs of 81,856,139 Deutsche Mark (41,926,298 Euro). On the average each enrollee generates costs of 1,114,00 Deutsche Mark (570 Euro), whereby every second one is responsible for an amount of less than 570 Deutsche Mark (291 Euro). A mere 5% of all enrollees is responsible for one third (32.1%) of the total drug expenditure. In closing the article will outline this research project's further course of action.

[Seniors in the new German states]. / Senioren in den neuen Bundesländern.

The contribution comprises data collection by gerontologists and statistical analyses of living conditions of elderly people in the five new German states (formerly the GDR). Particular attention is paid to recent changes in the living conditions of East German senior citizens. This includes observations on the psycho-sociological situation of large cohorts of old people.