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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2020

Open Access 01-12-2020 | Care | Research

Differences in medical specialist utilization among older people in need of long-term care – results from German health claims data

Authors: Maike Schulz, Jonas Czwikla, Chrysanthi Tsiasioti, Antje Schwinger, Daniel Gand, Guido Schmiemann, Annika Schmidt, Karin Wolf-Ostermann, Stephan Kloep, Franziska Heinze, Heinz Rothgang

Published in: International Journal for Equity in Health | Issue 1/2020

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Abstract

Background

Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization.

Methods

We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization.

Results

We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting.

Conclusion

The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care.
Appendix
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Literature
1.
Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10(4):430–9.PubMedCrossRef
2.
Collerton J, Jagger C, Yadegarfar ME, Davies K, Parker SG, Robinson L, et al. Deconstructing complex multimorbidity in the very old: findings from the Newcastle 85+ study. Biomed Res Int. 2016;2016:8745670.PubMedPubMedCentralCrossRef
3.
Motel-Klingebiel A, Wurm S, Tesch-Römer C. Altern im Wandel: Befunde des Deutschen Alterssurveys (DEAS). Stuttgart: Kohlhammer Verlag; 2010.
4.
Kleina T, Horn A, Suhr R, Schaeffer D. Zur Entwicklung der ärztlichen Versorgung in stationären Pflegeeinrichtungen–Ergebnisse einer empirischen Untersuchung. Das Gesundheitswesen. 2017;79(05):382–7.PubMedCrossRef
5.
Bussche H, Schön G, Kolonko T, Hansen H, Wegscheider K, Glaeske G, et al. Patterns of ambulatory medical care utilization in elderly patients with special reference to chronic diseases and multimorbidity-results from a claims data based observational study in Germany. BMC Geriatr. 2011;11(1):54.PubMedPubMedCentralCrossRef
6.
Glynn LG, Valderas JM, Healy P, Burke E, Newell J, Gillespie P, et al. The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract. 2011;28(5):516–23.PubMedCrossRef
7.
Thibault L, Kergoat H. Eye care services for older institutionalised individuals affected by cognitive and visual deficits: a systematic review. Ophthalmic Physiol Opt. 2016;36(5):566–83.PubMedCrossRef
8.
Rothgang H, Müller R, Mundhenk R, Unger R. BARMER GEK Pflegereport 2014. Schwerpunkt: Zahnärztliche Versorgung Pflegebedürftiger. St. Augustin: Asgard-Verlag; 2014.
9.
Schmiemann G, Herget-Rosenthal S, Hoffmann F. Ärztliche Versorgung von Pflegeheimbewohnern. Z Gerontol Geriat. 2015;49(8):727–33.PubMedCrossRef
10.
Balzer K, Butz S, Bentzel J, Boulkhemair D, Lühmann D. Beschreibung und Bewertung der fachärztlichen Versorgung von Pflegeheimbewohnern in Deutschland. Schriftenreihe Health Technology Assessment Bd 125; 2013.
11.
Iliffe S, Davies SL, Gordon AL, Schneider J, Dening T, Bowman C, et al. Provision of NHS generalist and specialist services to care homes in England: review of surveys. Prim Health Care Res Dev. 2015;17(2):122–37.CrossRef
12.
Rothgang H, Borchert L, Müller R, Unger R. GEK Pflegereport 2008. Schwerpunktthema: Medizinische Versorgung in Pflegeheimen. St. Augustin: Asgard-Verlag; 2008.
13.
Cox CA, van Jaarsveld HJ, Houterman S, van der Stegen JC, Wasylewicz AT, Grouls RJ, et al. Psychotropic drug prescription and the risk of falls in nursing home residents. J Am Med Dir Assoc. 2016;17(12):1089–93.PubMedCrossRef
14.
Ouslander JG, Lamb G, Perloe M, Givens JH, Kluge L, Rutland T, et al. Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs. J Am Geriatr Soc. 2010;58(4):627–35.PubMedCrossRef
15.
Lukas A, Mayer B, Onder G, Bernabei R, Denkinger MD. Schmerztherapie in deutschen Pflegeeinrichtungen im europäischen Vergleich. Ergebnisse der SHELTER-Studie Schmerz. 2015;29(4):411–21.
16.
17.
Morin L, Laroche M-L, Texier G, Johnell K. Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. J Am Med Dir Assoc. 2016;17(9):862.e1–9.CrossRef
18.
Colloca G, Tosato M, Vetrano DL, Topinkova E, Fialova D, Gindin J, et al. Inappropriate drugs in elderly patients with severe cognitive impairment: results from the shelter study. PLoS One. 2012;7(10):e46669.PubMedPubMedCentralCrossRef
19.
Reeves D, Pye S, Ashcroft DM, Clegg A, Kontopantelis E, Blakeman T, et al. The challenge of ageing populations and patient frailty: can primary care adapt? BMJ. 2018;362:k3349.PubMedCrossRef
20.
Kojima G. Prevalence of frailty in nursing homes: a systematic review and meta-analysis. J Am Med Dir Assoc. 2015;16(11):940–5.PubMedCrossRef
21.
Björk S, Juthberg C, Lindkvist M, Wimo A, Sandman P-O, Winblad B, et al. Exploring the prevalence and variance of cognitive impairment, pain, neuropsychiatric symptoms and ADL dependency among persons living in nursing homes; a cross-sectional study. BMC Geriatr. 2016;16(1):154.PubMedPubMedCentralCrossRef
22.
Stock S, Ihle P, Simic D, Rupprecht C, Schubert I, Lappe V, et al. Prävalenz von Demenz bei Versicherten mit und ohne deutsche Staatsangehörigkeit. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz. 2018;61(4):404–11.PubMedCrossRef
23.
Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: A systematic review and metaanalysis. Alzheimers Dement. 2013;9(1):63–75.e2.PubMedCrossRef
24.
Hoffmann F, Kaduszkiewicz H, Glaeske G, van den Bussche H, Koller D. Prevalence of dementia in nursing home and community-dwelling older adults in Germany. Aging Clin Exp Res. 2014;26(5):555–9.PubMedCrossRef
25.
Niesten D, van Mourik K, van der Sanden W. The impact of frailty on oral care behavior of older people: a qualitative study. BMC Oral Health. 2013;13(1):61.PubMedPubMedCentralCrossRef
26.
Wu B, Plassman BL, Crout RJ, Liang J. Cognitive function and oral health among community-dwelling older adults. J Gerontol Ser A Biol Med Sci. 2008;63(5):495–500.CrossRef
27.
Cooper C, Lodwick R, Walters K, Raine R, Manthorpe J, Iliffe S, et al. Inequalities in receipt of mental and physical healthcare in people with dementia in the UK. Age Ageing. 2017;46(3):393–400.PubMed
28.
Burton LC, German PS, Gruber-Baldini AL, Hebel JR, Zimmerman S, Magaziner J. Medical care for nursing home residents: differences by dementia status. Epidemiology of dementia in nursing homes research group. J Am Geriatr Soc. 2001;49(2):142–7.PubMedCrossRef
29.
Bussche H, Kaduszkiewicz H, Schäfer I, Koller D, Hansen H, Scherer M, et al. Overutilization of ambulatory medical care in the elderly German population?–An empirical study based on national insurance claims data and a review of foreign studies. BMC Health Serv Res. 2016;16(1):129.PubMedPubMedCentralCrossRef
30.
Demographic change in the euro area: projections and consequences. European Central Bank Monthly Bulletin. 2006, 49–64.
31.
Balzer K, Butz S, Bentzel J, Boulkhemair D, Lühmann D. Beschreibung und Bewertung der fachärztlichen Versorgung von Pflegeheimbewohnern in Deutschland. Schriftenreihe Health Technology Assessment Bd 125. Köln: DIMDI; 2013.
32.
Bähler C, Huber CA, Brüngger B, Reich O. Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study. BMC Health Serv Res. 2015;15(1):23.PubMedPubMedCentralCrossRef
33.
Beaujean AA, Morgan GB. Tutorial on using regression models with count outcomes using R. Pract Assess Res Eval. 2016;21:2.
34.
Tenand M, Bakx P, van Doorslaer E. Long-term care use in the Netherlands: equal care for equal needs? An assessment using adminstrative data. mimeo; 2018.
35.
Iwagami M, Tamiya N. The long-term care insurance system in Japan: past, present, and future. JMA J. 2019;2(1):67–9.CrossRef
36.
Jeon B, Kwon S. Health and long-term care systems for older people in the republic of Korea: policy challenges and lessons. Health Syst Reform. 2017;3(3):214–23.PubMedCrossRef
37.
Vethanayagam N, Orrell A, Dahlberg L, McKee KJ, Orme S, Parker SG, et al. Understanding help-seeking in older people with urinary incontinence: an interview study. Health Soc Care Community. 2017;25(3):1061–9.PubMedCrossRef
38.
Horrocks S, Somerset M, Stoddart H, Peters TJ. What prevents older people from seeking treatment for urinary incontinence? A qualitative exploration of barriers to the use of community continence services. Fam Pract. 2004;21(6):689–96.CrossRef
39.
Hoffmann F, Icks A. Structural differences between health insurance funds and their impact on health services research: results from the Bertelsmann health-care monitor. Gesundheitswesen. 2012;74(5):291–7.PubMedCrossRef
40.
Scott LJ. Regression models for categorical and limited dependent variables. In: Advanced quantitative techniques in the social sciences; 1997. p. 7.
41.
Bremer D, Inhestern L, von dem Knesebeck O. Social relationships and physician utilization among older adults—a systematic review. PLoS One. 2017;12(9):e0185672.PubMedPubMedCentralCrossRef
42.
Hoebel J, Rattay P, Prütz F, Rommel A, Lampert T. Socioeconomic status and use of outpatient medical care: the case of Germany. PLoS One. 2016;11(5):e0155982.PubMedPubMedCentralCrossRef
43.
Hoebel J, Rommel A, Schröder LS, Fuchs J, Nowossadeck E, Lampert T. Socioeconomic Inequalities in Health and Perceived Unmet Needs for Healthcare among the Elderly in Germany. Int J Environ Res Public Health. 2017;14(10):1127.PubMedCentralCrossRef
44.
Terraneo M. Inequities in health care utilization by people aged 50+: evidence from 12 European countries. Soc Sci Med. 2015;126:154–63.PubMedCrossRef
Metadata
Title
Differences in medical specialist utilization among older people in need of long-term care – results from German health claims data
Authors
Maike Schulz
Jonas Czwikla
Chrysanthi Tsiasioti
Antje Schwinger
Daniel Gand
Guido Schmiemann
Annika Schmidt
Karin Wolf-Ostermann
Stephan Kloep
Franziska Heinze
Heinz Rothgang
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Care
Published in
International Journal for Equity in Health / Issue 1/2020
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-020-1130-z

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