Outpatient geriatric health care in the German federal state of Mecklenburg-Western Pomerania: a population-based spatial analysis of claims data.

BACKGROUND: Due to unidentified geriatric needs, elderly patients have a higher risk for developing chronic conditions and acute medical complications. Early geriatric screenings and assessments help to identify geriatric needs. Holistic and coordinated therapeutic approaches addressing those needs maintain the independence of elderly patients and avoid adverse effects. General practitioners are important for the timely identification of geriatric needs. The aims of this study are to examine the spatial distribution of the utilization of outpatient geriatric services in the very rural Federal State of Mecklenburg-Western Pomerania in the Northeast of Germany and to identify regional disparities. METHODS: Geographical analysis and cartographic visualization of the spatial distribution of outpatient geriatric services of patients who are eligible to receive basic geriatric care (BGC) or specialized geriatric care (SGC) were carried out. Claims data of the Association of Statutory Health Insurance Physicians in Mecklenburg-Western Pomerania were analysed on the level of postcode areas for the quarter periods between 01/2014 and 04/2017. A Moran's I analysis was carried out to identify clusters of utilization rates. RESULTS: Of all patients who were eligible for BGC in 2017, 58.3% (n = 129,283/221,654) received at least one BCG service. 77.2% (n = 73,442/95,171) of the patients who were eligible for SGC, received any geriatric service (BGC or SGC). 0.4% (n = 414/95,171) of the patients eligible for SGC, received SGC services. Among the postcode areas in the study region, the proportion of patients who received a basic geriatric assessment ranged from 3.4 to 86.7%. Several regions with statistically significant Clusters of utilization rates were identified. CONCLUSIONS: The widely varying utilization rates and the local segregation of high and low rates indicate that the provision of outpatient geriatric care may depend to a large extent on local structures (e.g., multiprofessional, integrated networks or innovative projects or initiatives). The great overall variation in the provision of BGC services implicates that the identification of geriatric needs in GPs' practices should be more standardized. In order to reduce regional disparities in the provision of BGC and SGC services, innovative solutions and a promotion of specialized geriatric networks or healthcare providers are necessary.

Population-Based, Spatial Analysis of Specialised Ambulatory Palliative Care in Mecklenburg-Western Pomerania, Germany, on the Basis of Reimbursement Data.

In rural areas, healthcare providers, patients and relatives have to cover long distances. For specialised ambulatory palliative care (SAPV), a supply radius of max. 30 km is recommended. The aim of this study was to analyse whether there are regional disparities in the supply of SAPV and whether it is associated with the distance between the SAPV team's site and the patient's location. Therefore, anonymised data of the Association of Statutory Health Insurance Physicians of the Federal State of Mecklenburg-Western Pomerania (M-V) were retrospectively analysed for the period of 2014-2017. Identification as a palliative patient was based on palliative-specific items from the ambulatory reimbursement catalogue. In total, 6940 SAPV patients were identified; thereof, 48.9% female. The mean age was 73.3 years. For 28.3% of the identified SAPV patients (n = 1961), the SAPV teams had a travel distance of >30 km. With increasing distance, the average number of treatment days per patient increased. It was found that there are regional disparities in the provision of SAPV services in M-V and that local structures have an important impact on regional supply patterns. The distance between the SAPV team's site and the patient's location is not the only determining factor; other causes must be considered.

Evaluation of a Health Information Exchange System for Geriatric Health Care in Rural Areas: Development and Technical Acceptance Study.

BACKGROUND: Patients of geriatrics are often treated by several health care providers at the same time. The spatial, informational, and organizational separation of these health care providers can hinder the effective treatment of these patients. OBJECTIVE: This study aimed to develop a regional health information exchange (HIE) system to improve HIE in geriatric treatment. This study also evaluated the usability of the regional HIE system and sought to identify barriers to and facilitators of its implementation. METHODS: The development of the regional HIE system followed the community-based participatory research approach. The primary outcomes were the usability of the regional HIE system, expected implementation barriers and facilitators, and the quality of the developmental process. Data were collected and analyzed using a mixed methods approach. RESULTS: A total of 3 focus regions were identified, 22 geriatric health care providers participated in the development of the regional HIE system, and 11 workshops were conducted between October 2019 and September 2020. In total, 12 participants responded to a questionnaire. The main results were that the regional HIE system should support the exchange of assessments, diagnoses, medication, assistive device supply, and social information. The regional HIE system was expected to be able to improve the quality and continuity of care. In total, 5 adoption facilitators were identified. The main points were adaptability of the regional HIE system to local needs, availability to different patient groups and treatment documents, web-based design, trust among the users, and computer literacy. A total of 13 barriers to adoption were identified. The main expected barriers to implementation were lack of resources, interoperability issues, computer illiteracy, lack of trust, privacy concerns, and ease-of-use issues. CONCLUSIONS: Participating health care professionals shared similar motivations for developing the regional HIE system, including improved quality of care, reduction of unnecessary examinations, and more effective health care provision. An overly complicated registration process for health care professionals and the patients' free choice of their health care providers hinder the effectiveness of the regional HIE system, resulting in incomplete patient health information. However, the web-based design of the system bridges interoperability problems that exist owing to the different technical and organizational structures of the health care facilities involved. The regional HIE system is better accepted by health care professionals who are already engaged in an interdisciplinary, geriatric-focused network. This might indicate that pre-existing cross-organizational structures and processes are prerequisites for using HIE systems. The participatory design supports the development of technologies that are adaptable to regional needs. Health care providers are interested in participating in the development of an HIE system, but they often lack the required time, knowledge, and resources.

[Geriatric care in rural areas: Results from two standardized surveys of care providers]. / Geriatrische Versorgung in ländlichen Regionen: Ergebnisse aus zwei standardisierten Befragungen von Leistungserbringern und Akteuren.

BACKGROUND: Due to a growing elderly population the number of age-related diseases increases and thus the need for geriatric care. In rural areas with low population density and few healthcare providers there is a risk of inadequate care. AIM OF THE STUDY: The aim of our investigation was to identify gaps in care and preferred improvement approaches in rural areas from the perspective of local care providers. METHODS: 1,545 healthcare providers from two rural regions were surveyed on the care situation (assessment according to the German school grading system), improvement approaches and problems (simple frequencies). The participants' answers were categorized and analyzed by their work location according to the central-place concept of high-order, middle-order and lower-order (basic) centers. RESULTS: 348 healthcare providers participated (response rate: 22.5 %). The outpatient and inpatient care situation in geriatrics was rated "satisfactory" on average. Geriatric care is most often jeopardized by long waiting times for specialist treatment (71.0 %). Significant differences in the rating were found in the coverage of geriatric care by inpatient care (p=0.0018) and the accessibility of medical facilities by public transport (p=<0.001). These were better rated in the higher-order centers. The preferred approach to improve care was intersectoral networking (62.3 %) among care providers. CONCLUSIONS: In rural areas, supply problems in geriatrics exist, in particular accessibility and waiting times in middle-order and basic centers. Solutions of regional, intersectoral and interprofessional care were approved by a majority of the participants.

Prevalence of impaired functional reading ability and its association with quality of life, daily activity, mobility and social participation among general older adults in Germany.

BACKGROUND: The prevalence of visual impairment and of impaired functional reading ability rapidly increase with age. However, functional reading ability is essential for an autonomous lifestyle. We analyzed the prevalence of impaired functional reading ability in the general elderly population and the association of impaired functional reading ability with quality of life, daily activities, mobility, and social participation. METHODS: Cross-sectional data from a population-based cohort were analyzed. Participants aged ≥65 years were tested for their functional reading ability using (1) Nieden charts (cognitive reading ability) and (2) a test in which a telephone number had to be found (reading comprehension). Prevalences of impaired functional reading ability were calculated. In multivariable regression models, the associations of cognitive reading ability (1) with quality of life, daily activities, mobility, and social participation were examined. RESULTS: 60 of 780 participants (7.69%) were able to read the third last text of the Nieden test (good cognitive reading ability), whereas 7 participants (0.9%) were unable to read any of the texts. 716 participants (91.8%) identified the phone book entry successfully (good reading comprehension). Multivariable regression models revealed no significant associations of the cognitive reading ability (1) with quality of life, daily activities, social participation, and mobility. CONCLUSION: Our results showed a high prevalence of impaired cognitive reading ability (1). Reading comprehension (2) was slightly affected. The loss of cognitive reading ability usually progresses over years; signs and symptoms might remain unrecognized when compensated by other functions.

Economic efficiency versus accessibility: Planning of the hospital landscape in rural regions using a linear model on the example of paediatric and obstetric wards in the northeast of Germany.

BACKGROUND: Costs for the provision of regional hospital care depend, among other things, on the population density and the maximum reasonable distance to the nearest hospital. In regions with a low population density, it is a challenge to plan the number and location of hospitals with respect both to economic efficiency and to the availability of hospital care close to residential areas. We examined whether the hospital landscape in rural regions can be planned on the basis of a regional economic model using the example which number of paediatric and obstetric wards in a region in the Northeast of Germany is economically efficient and what would be the consequences for the accessibility when one or more of the three current locations would be closed. METHODS: A model of linear programming was developed to estimate the costs and revenues under different scenarios with up to three hospitals with both a paediatric and an obstetric ward in the investigation region. To calculate accessibility of the wards, geographic analyses were conducted. RESULTS: With three hospitals in the study region, there is a financial gap of €3.6 million. To get a positive contribution margin for all three hospitals, more cases have to be treated than the region can deliver. Closing hospitals in the parts of the region with the smallest population density would lead to reduced accessibility for about 8% of the population under risk. CONCLUSIONS: Quantitative modelling of the costs of regional hospital care provides a basis for planning. A qualitative discussion to the locations of the remaining departments and the implementation of alternative healthcare concepts should follow.

Predictors of medication adherence among patients with severe psychiatric disorders: findings from the baseline assessment of a randomized controlled trial (Tecla).

BACKGROUND: Schizophrenia and bipolar disorder are characterized by a high disease burden. Antipsychotic medication is an essential part of the treatment. However, non-adherence is a major problem. Our aim was to examine potential determinants of non-adherence for patients with severe mental disorders. METHODS: Baseline data of the study "Post stationary telemedical care of patients with severe psychiatric disorders" (Tecla) were used. Medication adherence was assessed with the Medication Adherence Report Scale German version (MARS-D). A logistic regression was calculated with age, sex, education, employment status, level of global functioning, social support and intake of typical and atypical antipsychotics as predictors. RESULTS: N = 127 participants were included in the analysis (n = 73 men, mean age 42 years). The mean MARS-D Score was 23.4 (SD 2.5). The most common reason for non-adherence was forgetting to take the medicine. Significant positive determinants for adherence were older age (OR 1.02, 95% CI 1.011-1.024, p < 0.0001), being employed (OR 2.46, 95% CI 1.893-3.206, p < 0.0001), higher level of global functioning (overall measure of how patients are doing) (OR 1.02, 95% CI 1.012-1.028, p < 0.0001), having social support (OR 1.02, 95% CI 1.013-1.026, p < 0.0001), and intake of typical antipsychotics (OR 2.389, 95% CI 1.796-3.178, p < 0.0001). A negative determinant was (female) sex (OR 0.73, 95% CI 0.625-0.859, p = 0.0001). CONCLUSIONS: Especially employment, functioning and social support could be promising targets to facilitate adherence in patients with schizophrenia or bipolar disorder. TRIAL REGISTRATION: This study is retrospectively registered at the German Clinical Trials Register with the trial registration number DRKS00008548 at 21/05/2015.

[Prognosis of population-related morbidity for common cancers in Germany--Effects on health care]. / Deutschlandweite, regionalisierte Prognose der bevölkerungsbezogenen Morbidität für häufige Krebserkrankungen--Auswirkungen auf die Versorgung.

INTRODUCTION: The demand for outpatient and inpatient oncology care will rise in the next years. In this analysis, the number of new cases and the prevalence in 2020, the number of hospital days, types of treatment, sickness costs, and the number of oncology specialists are prognosed. METHODS: Projections of incidence and prevalence of cancer overall and of the three most common cancers were conducted with data from the German Population-Based Cancer Registries and from the German Federal Statistics Office. The average number of hospital days was extrapolated until 2020 on the basis of these population projections. Outpatient care was analyzed with billing data obtained from the WINHO. Projections of sickness costs in 2020 were calculated based on data from the German Federal Statistics Office under the assumption that cost per prevalent case remains constant within a given age group over the projection period. Numbers of specialists in hematology and oncology were taken from the database of the Association of Statutory Health Insurance Physicians. These forecasts are based on a series of assumptions. RESULTS: The number of new cancer cases will increase by about 67,000 cases until 2020 (reference year 2008). Prevalent cases will increase by about 176,000 cases. The needed number of hospital days will increase about 13% to 15.513 million days in 2020. An increase of 30% in cytoreductive and 23% in chemotherapy treatment of lung cancer was shown between 2008 and 2011. The number of contracted doctors with focus in hematology and oncology has increased in 2011 compared to 2005. Between 2002 and 2008, sickness costs increased by 52% in the outpatient sector and by 31% in the inpatient sector. In 2020, the increase of sickness costs is expected to reach about 1.7 billion EUR/year. CONCLUSIONS: Due to the increase of incident and prevalent cancer cases, the number of hospital days and sickness costs will increase. The results of the analyses show an increase of medical care services in the outpatient sector.