Morbiditätsentwicklung im demographischen Wandel

[Frequency and characteristics of interventions by community paramedics on people in need of care : Analysis of 2,410 deployment protocols for people aged 65+ years]

BACKGROUND

The aim of this study was to obtain a differentiated view of interventions delivered by community paramedics (Gemeindenotfallsanitäter, G‑NFS) in older people in need of care living in nursing homes and at home.

MATERIALS AND METHODS

A retrospective analysis of G‑NFS documentation from 2021 with a focus on patients aged ≥65 years was performed. Data were grouped into callouts to nursing homes or private homes. Interventions, urgency, transport, and further recommendations were analyzed descriptively.

RESULTS

Of 5,900 G-NFS protocols, 43.0% (n = 2,410) were related to elderly people (mean age 80.8 years, 49.7% female). A total of 20.6% of these callouts involved nursing home residents, 38.4% (n = 926) were homecare patients, and 41% (n = 988) of callouts were to persons who did not rely on care. No specific interventions except advice were given to 48.4% of nursing home residents, and to even 82.1% of those in homecare and 83.7% of those without care needs. About 60% of the G‑NFS interventions were classified as non-urgent. Transport was waived for 63.1% of nursing home residents, for 58.1% in homecare, and for 60.6% of persons without care needs. A visit to the emergency department was recommended to 29.4% of nursing home residents, 37.6% of homecare patients, and 33.6% of persons without need of care. Measures related to urine catheters were documented much more often in nursing homes (38.5%) than in patients in homecare (15.1%) or without need of care (9.3%).

CONCLUSION

Community paramedics perform primary care tasks and can contribute to a reduction in unnecessary transport. It should be discussed whether the emergency medical service is responsible for such interventions and how older people in need of care can be cared for according to their needs in the future.

[How do general practitioners evaluate collaborative care of elderly depressed patients? Results of a qualitative study]

BACKGROUND

Depression is a very common disease among the elderly. Various studies demonstrated the need to improve the care for elderly depressed patients. Within the GermanIMPACT trial specifically trained care managers were engaged to cooperate with general practitioners (GPs). This study investigates how GPs evaluate this cooperation and their attitude towards collaborative care.

METHODS

To explore the perspective of GPs a qualitative study design with semi-structured interviews was chosen. The guideline-based interviews were conducted with GPs from the intervention group, the control group and with GPs who had decided not to participate in the trial. The interviews were audio-taped, fully transcribed and analysed.

RESULTS

Eighteen GPs were interviewed. Almost all GPs from the intervention group appreciated the support by care managers. Advantages they mentioned included their own relief by the committed conversation between patient and care manager, the continuous monitoring of the patients as well as the regular feedback via protocols. GPs who refused to take part in the study expressed different attitudes towards collaborative care.

CONCLUSION

Due to the general overall positive valuation of care managers as well as their positive attitude towards collaborative care a continuation of the IMPACT program in Germany should be considered. More investigation needs to be done to answer the question how care managers can be integrated in everyday primary care.