[Prevalence of patients with HIV receiving outpatient medical care in Germany-an analysis based on secondary data]. / Häufigkeiten von Patienten mit HIV in der ambulanten Versorgung in Deutschland ­ Eine Analyse auf Basis von Sekundärdaten.

BACKGROUND: The Robert Koch Institute (RKI) annually publishes an estimate of the number of new HIV diagnoses and the total number of people diagnosed with HIV in Germany. So far, only medication prescription data have served as secondary data as a basis for such estimates. OBJECTIVES: In this study, we used billing data from the outpatient sector to estimate the number of patients with newly diagnosed HIV, the overall number of patients with HIV, and the HIV test rates in those with statutory health insurance in Germany. MATERIALS AND METHODS: We analyzed billing data from the outpatient sector for all persons covered by statutory health insurance between 2009 and 2018. We designed annual cohorts of patient for the years 2011 to 2017 and analyzed the number of HIV diagnoses, the number of HIV-related care services, and HIV testing rates. RESULTS: Every year, about 6000 new patients with HIV are treated in outpatient care. The total number of patients with HIV in 2011 was about 59,300 (0.106%), which increased to 80,800 (0.141%) in 2017. The average increase in the total number of patients per year of about 3600 was significantly below the estimated number of newly treated patients for each year. CONCLUSION: The results may provide an indication of patients receiving HIV care in the outpatient sector. The secondary data provide the possibility of developing another epidemiological data source for population-based representation of the administrative prevalence of HIV. To clarify over-representation, there is a need for further research on patients who are using outpatient care for the first time.

[Influenza vaccination rates of patients with statutory ambulatory medical care in protective facilities and in nursing and special care homes]. / Influenzaimpfquoten von Patienten mit vertragsärztlicher Versorgung in beschützenden Einrichtungen, Pflege- und Altenheimen.

BACKGROUND: Vaccination is one of the most important and effective preventive measures against seasonal influenza. The German Standing Committee on Vaccination (STIKO) recommends influenza vaccination for specific groups of patients, including those in protective facilities and nursing or special care homes ("bPA-facilities"). The defined aim of the European Commission (EC) is vaccination coverage of 75% or higher among the elderly. In Germany, vaccination rates in bPA-facilities are currently based on surveys in limited samples of patients. OBJECTIVES: The aim of the present study is to gain better insight into nationwide influenza vaccination rates. Specifically, we aim to identify influenza vaccination coverage of patients with ambulatory medical care in bPA-facilities. MATERIAL AND METHODS: The present analysis is a descriptive analysis of Germany's billing data of all ambulatory statutory health insurance physicians (ASHIP) for six study cohorts from 2010 to 2016. RESULTS: On average, 58.5% of patients in bPA-facilities received an influenza vaccination between 2010 (60.3%) and 2016 (56.6%), with strong differences between different ASHIP billing areas (up to 20 percentage points(pp)) and patients who consulted a general practitioner (up to 35 pp). CONCLUSIONS: These results provide initial insights into vaccination coverage in bPA-facilities and show associations between the structural differences in care setting and the use of influenza vaccines. Furthermore, they can help to identify groups with low influenza vaccination rates and complement existing data thereby assisting health policy in increasing vaccination coverage. The present study group has not yet reached the EC goal of 75% influenza vaccination coverage.

[Treatment by panel physicians of patients in protective institutions and homes : Analysis based on secondary data]. / Vertragsärztliche Versorgung von Patienten in beschützenden Einrichtungen und Heimen : Analyse auf Basis von Sekundärdaten.

BACKGROUND: According to the nursing statistics from 2014 a total of 2.6 million patients in Germany required nursing care of which 1.86 million received care at home and approximately 29 % (764,000 patients) received inpatient treatment exclusively in a nursing home. Reports on the number of long-term nursing care patients usually only include patients with a need of long-term care (according to § 14 German Social Code XI) confirmed by the statutory healthcare insurance. Currently, in Germany there is no nationwide report based on routine (billing) data estimating the number of patients in protective residential homes or institutions, nursing homes or homes for the elderly with nursing personnel (private institutions) based on routine data. This needs to be clarified. MATERIAL AND METHODS: The present analysis was based on the nationwide ambulatory statutory healthcare insurance physician (ASHIP) authorized billing data from 2014. An estimation of the number of patients in nursing and retirement homes was made based on the medical services data. Morbidity and outpatient medical healthcare details were analyzed using methods for descriptive analyses. RESULTS: In 2014 a total of 525,863 patients in private nursing homes received ASHIP-authorized treatment, of which 173,233 were treated exclusively in nursing homes by ASHIP-authorized physicians and 352,630 patients were treated in nursing homes as well as in ASHIP-authorized practices. In the year under investigation approximately two thirds of the patients in nursing homes consulted ambulatory practices in addition to care in the nursing home. CONCLUSION: Nationwide ambulatory ASHIP billing data can substantially contribute to assessment of multimorbidities and provision of long-term healthcare by panel physicians for patients in nursing homes.

Physician specialty and long-term survival after myocardial infarction - A study including all German statutory health insured patients.

BACKGROUND: With a mortality rate above European average, myocardial infarction (MI) is the second most common cause of death in Germany. Data about post-MI ambulatory care and mortality is scarce. We examined the association between ambulatory treating physicians' specialty and the mortality of post-MI patients. METHODS: Medical claims data of all 17 German regional Associations of Statutory Health Insurance physicians were analyzed, which cover approximately 90% of the German population. Patients with a new diagnosis of a MI in 2011 were divided into treatment groups with and without ambulant cardiology care within the first year after MI diagnosis. Propensity-score matching based on socio-demographic and clinical variables was performed to achieve comparability between groups. The 18-month mortality rate was derived employing a validated method. RESULTS: 158,494 patients with a new diagnosis of MI had received post-MI ambulatory care in 2011. Half of them (51%) had at least one ambulatory contact with a cardiologist within the first year. During a follow-up of 18months, the mortality rate before and after propensity-score matching was 19% and 14% in patients without cardiology care and 6%, respectively, in patients with cardiology care (χ2=666.7; P<0.000 after propensity adjustment). Patients who only saw a cardiologist and had no additional contact to an ambulant general practitioner (GP)/internist within the first year did not have increased survival rates. CONCLUSIONS: Outpatient follow-up care by a cardiologist in combination with consultations of GP/internists within the first year may be of importance for the prognosis of MI patients.