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Couret A, Lapeyre-Mestre M, Renoux A, Gardette V. Healthcare use according to deprivation among French Alzheimer's Disease and Related Diseases subjects: a national cross-sectional descriptive study based on the FRA-DEM cohort. Front Public Health 2024; 12:1284542. [PMID: 38487186 PMCID: PMC10937384 DOI: 10.3389/fpubh.2024.1284542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/06/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Pluriprofessional and coordinated healthcare use is recommended for Alzheimer's Disease and Related Diseases (ADRD). Despite a protective health system, France is characterized by persistent and significant social inequalities in health. Although social health inequalities are well documented, less is known about social disparities in healthcare use in ADRD, especially in France. Therefore, this study aimed to describe healthcare use according to socioeconomic deprivation among ADRD subjects and the possible potentiating role of deprivation by age. Methods We studied subjects identified with incident ADRD in 2017 in the French health insurance database (SNDS). We described a large extent of their healthcare use during the year following their ADRD identification. Deprivation was assessed through French deprivation index (Fdep), measured at the municipality level, and categorized into quintiles. We compared healthcare use according to the Fdep quintiles through chi-square tests. We stratified the description of certain healthcare uses by age groups (40-64 years, 65-74 years, 75-84 years, 85 years, and older), number of comorbidities (0, 1, 2-3, 4 comorbidities and more), or the presence of psychiatric comorbidity. Results In total, 124,441 subjects were included. The most deprived subjects had less use of physiotherapy (28.56% vs. 38.24%), ambulatory specialists (27.24% vs. 34.07%), ambulatory speech therapy (6.35% vs. 16.64%), preventive consultations (62.34% vs. 69.65%), and were less institutionalized (28.09% vs. 31.33%) than the less deprived ones. Conversely, they were more exposed to antipsychotics (11.16% vs. 8.43%), benzodiazepines (24.34% vs. 19.07%), hospital emergency care (63.84% vs. 57.57%), and potentially avoidable hospitalizations (12.04% vs. 10.95%) than the less deprived ones. Discussion and conclusion The healthcare use of subjects with ADRD in France differed according to the deprivation index, suggesting potential health renunciation as in other diseases. These social inequalities may be driven by financial barriers and lower education levels, which contribute to health literacy (especially for preventive care). Further studies may explore them.
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Affiliation(s)
- Anaïs Couret
- Agence Régionale de Santé Occitanie, Toulouse, France
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Centre Hospitalier Universitaire de Toulouse, Department of Pharmacology, Toulouse, France
- Centre d'Investigation Clinique 1436, Team PEPSS “Pharmacologie En Population cohorteS et biobanqueS,” Centre Hospitalier Universitaire de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Axel Renoux
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Gardette
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Department of Epidemiology and Public Health, Toulouse, France
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Couret A, Lapeyre-Mestre M, Gombault-Datzenko E, Renoux A, Villars H, Gardette V. Which factors preceding dementia identification impact future healthcare use trajectories: multilevel analyses in administrative data. BMC Geriatr 2024; 24:89. [PMID: 38263052 PMCID: PMC10807194 DOI: 10.1186/s12877-023-04643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Healthcare use patterns preceding a diagnosis of Alzheimer's Disease and Related Diseases (ADRD) may be associated with the quality of healthcare use trajectories (HUTs) after diagnosis. We aimed to identify determinants of future favorable HUTs, notably healthcare use preceding ADRD identification. METHODS This nationwide retrospective observational study was conducted on subjects with incident ADRD identified in 2012 in the French health insurance database. We studied the 12-month healthcare use ranging between 18 and 6 months preceding ADRD identification. The five-year HUTs after ADRD identification were qualified by experts as favorable or not. In order to take into account geographical differences in healthcare supply, we performed mixed random effects multilevel multivariable logistic regression model to identify determinants of future favorable HUTs. Analyses were stratified by age group (65-74, 75-84, ≥ 85). RESULTS Being a woman, and preventive and specialist care preceding ADRD identification increased the probability of future favorable HUT, whereas institutionalization, comorbidities, medical transportation and no reimbursed drug during [-18;-6] months decreased it. Besides, some specificities appeared according to age groups. Among the 65-74 years subjects, anxiolytic dispensing preceding ADRD identification decreased the probability of future favorable HUT. In the 75-84 years group, unplanned hospitalization and emergency room visit preceding ADRD identification decreased this probability. Among subjects aged 85 and older, short hospitalization preceding ADRD identification increased the probability of future favorable HUTs. CONCLUSION Regular healthcare use with preventive and specialist care preceding ADRD identification increased the probability of future favorable HUTs whereas dependency decreased it.
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Affiliation(s)
- Anaïs Couret
- Agence Régionale de Santé Occitanie, Toulouse, France.
- Maintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France.
- Faculté de médecine, 37 allées Jules Guesde, Toulouse, 31000, France.
| | - Maryse Lapeyre-Mestre
- Department of Pharmacology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Centre d'Investigation Clinique 1436, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France
| | - Eugénie Gombault-Datzenko
- Department of Medical Information (DIM), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Axel Renoux
- Maintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Hélène Villars
- Geriatric Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Gardette
- Maintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France
- Department of Epidemiology and Public Health, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Rachas A, Fontaine R, Thomas M, Robine JM, Gavazzi G, Laurent M, Carcaillon-Bentata L, Canouï-Poitrine F. Individual and contextual risk factors for mortality in nursing home residents during the first wave of COVID-19 in France: a multilevel analysis of a nationwide cohort study. Age Ageing 2023; 52:afad165. [PMID: 37651749 PMCID: PMC10471198 DOI: 10.1093/ageing/afad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Mortality amongst nursing home (NH) residents increased by 43% during the first wave of coronavirus disease 2019 (COVID-19). We estimated the 'contextual effect' on mortality, tried to explain it by NH characteristics and identified resident- and NH-level risk factors for mortality. METHODS The contextual effect was measured for two cohorts of NH residents managed by the general scheme in metropolitan France (RESIDESMS data from 03/01/2020 to 05/31/2020 and 03/01/2019 to 05/31/2019) by the intraclass correlation coefficient (ICC) estimated from mixed-effects logistic regression. RESULTS Amongst 385,300 residents (5,339 NHs) included in 2020 (median age 89 years, 25% men), 9.1% died, versus 6.7% of 379,926 residents (5,270 NHs) in 2019. In the empty model, the ICC was 9.3% in 2020 and 1.5% in 2019. Only the geographic location partially explained the heterogeneity observed in 2020 (ICC: 6.5% after adjustment). Associations with mortality were stronger in 2020 than in 2019 for male sex and diabetes and weaker for heart disease, chronic respiratory disease and residence <6 months. Mortality was higher in 2020 (15.1%) than 2019 (6.3%) in NHs with at least one death with a mention of COVID-19 and more heterogeneous (ICC: 8.0%) than in the others (mortality: 6.7% in both years; ICC: 1.1%). CONCLUSION Our results suggest that the COVID-19 crisis had a heterogeneous impact on mortality in NH residents and that geographic location explain a part of the contextual effect, which appears to have had little influence on mortality in NHs not being affected by the virus.
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Affiliation(s)
- Antoine Rachas
- Direction de la Stratégie, des Etudes et des Statistiques, Département des études sur les pathologies et les patients, CNAM, F-75000 Paris, France
| | - Roméo Fontaine
- INED, Mortality, Health and Epidemiology (UR5), F-93300 Aubervilliers, France
| | - Martine Thomas
- Direction de la Stratégie, des Etudes et des Statistiques, Département des études sur les pathologies et les patients, CNAM, F-75000 Paris, France
| | - Jean-Marie Robine
- INED, Mortality, Health and Epidemiology (UR5), F-93300 Aubervilliers, France
- Univ Paris, INSERM, CNRS, EHSS, CERMES3, F-75000 Paris, France
- Univ Montpellier, EPHE, INSERM, MMDN, F-34000 Montpellier, France
- PSL Research University, F-75000 Paris, France
| | - Gaëtan Gavazzi
- Geriatric Department, Grenoble Alpes University Hospital, F-38000 Grenoble, France
- University of Grenoble-Alpes, GREPI TIMC-IMAG, CNRS UMR 552, F-38000 Grenoble, France
| | - Marie Laurent
- Univ Paris Est Creteil, Inserm, IMRB U955, CEpiA Team, F-94000 Creteil, France
- Geriatric Department, APHP, Henri-Mondor Hospital, F-94000 Creteil, France
| | - Laure Carcaillon-Bentata
- Santé Publique France (SpF), Direction des maladies non transmissibles et traumatismes, Unité Traumatismes, avancer en âge et maladies neurodégénératives, F-94410 Saint-Maurice, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Creteil, Inserm, IMRB U955, CEpiA Team, F-94000 Creteil, France
- Public Health Department, APHP, Henri-Mondor Hospital, F-94000 Creteil, France
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Harber-Aschan L, Darin-Mattsson A, Fratiglioni L, Calderón-Larrañaga A, Dekhtyar S. Socioeconomic differences in older adults' unplanned hospital admissions: the role of health status and social network. Age Ageing 2023; 52:7127659. [PMID: 37079867 PMCID: PMC10118263 DOI: 10.1093/ageing/afac290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND the socioeconomic distribution of unplanned hospital admissions in older adults is poorly understood. We compared associations of two life-course measures of socioeconomic status (SES) with unplanned hospital admissions while comprehensively accounting for health, and examined the role of social network in this association. METHODS in 2,862 community-dwelling adults aged 60+ in Sweden, we derived (i) an aggregate life-course SES measure grouping individuals into Low, Middle or High SES based on a summative score, and (ii) a latent class measure that additionally identified a Mixed SES group, characterised by financial difficulties in childhood and old age. The health assessment combined measures of morbidity and functioning. The social network measure included social connections and support components. Negative binomial models estimated the change in hospital admissions over 4 years in relation to SES. Stratification and statistical interaction assessed effect modification by social network. RESULTS adjusting for health and social network, unplanned hospitalisation rates were higher for the latent Low SES and Mixed SES group (incidence rate ratio [IRR] = 1.38, 95% confidence interval [CI]: 1.12-1.69, P = 0.002; IRR = 2.06, 95% CI: 1.44-2.94, P < 0.001; respectively; ref: High SES). Mixed SES was at a substantially greater risk of unplanned hospital admissions among those with poor (and not rich) social network (IRR: 2.43, 95% CI: 1.44-4.07; ref: High SES), but the statistical interaction test was non-significant (P = 0.493). CONCLUSION socioeconomic distributions of older adults' unplanned hospitalisations were largely driven by health, although considering SES dynamics across life can reveal at-risk sub-populations. Financially disadvantaged older adults might benefit from interventions aimed at improving their social network.
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Affiliation(s)
- Lisa Harber-Aschan
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
- Stockholm University Demography Unit, Stockholm University, Stockholm, Sweden
| | - Alexander Darin-Mattsson
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
| | - Laura Fratiglioni
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
| | - Serhiy Dekhtyar
- Demography Unit, Department of Sociology, Stockholm University, Universitetsvägen 10, 114 18 Stockholm, Sweden
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Canouï-Poitrine F, Rachas A, Thomas M, Carcaillon-Bentata L, Fontaine R, Gavazzi G, Laurent M, Robine JM. Magnitude, change over time, demographic characteristics and geographic distribution of excess deaths among nursing home residents during the first wave of COVID-19 in France: a nationwide cohort study. Age Ageing 2021; 50:1473-1481. [PMID: 33984133 PMCID: PMC8406878 DOI: 10.1093/ageing/afab098] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The objectives were to assess the excess deaths among Nursing Home (NH) residents during the first wave of the COVID-19 pandemic, to determine their part in the total excess deaths and whether there was a mortality displacement. METHODS We studied a cohort of 494,753 adults in 6,515 NHs in France exposed to COVID-19 pandemic (from 1 March to 31 May 2020) and compared with the 2014-2019 cohorts using data from the French National Health Data System. The main outcome was death. Excess deaths and standardized mortality ratios (SMRs) were estimated. RESULT There were 13,505 excess deaths. Mortality increased by 43% (SMR: 1.43). The mortality excess was higher among males than females (SMR: 1.51 and 1.38) and decreased with increasing age (SMRs in females: 1.61 in the 60-74 age group, 1.58 for 75-84, 1.41 for 85-94 and 1.31 for 95 or over; males: SMRs: 1.59 for 60-74, 1.69 for 75-84, 1.47 for 85-94 and 1.41 for 95 or over). No mortality displacement effect was observed up until 30 August 2020. By extrapolating to all NH residents nationally (N = 570,003), we estimated that they accounted for 51% of the general population excess deaths (N = 15,114 out of 29,563). CONCLUSION NH residents accounted for half of the total excess deaths in France during the first wave of the COVID-19 pandemic. The excess death rate was higher among males than females and among younger than older residents.
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Affiliation(s)
- Florence Canouï-Poitrine
- Univ Paris Est Creteil, Inserm, IMRB U955, CEpiA Team, F-94000 Creteil, France
- Public Health Department, APHP, Henri-Mondor Hospital, F-94000 Creteil, France
| | - Antoine Rachas
- Direction de la Stratégie, des Etudes et des Statistiques, CNAM, F-75000 Paris, France
| | - Martine Thomas
- Direction de la Stratégie, des Etudes et des Statistiques, CNAM, F-75000 Paris, France
| | | | - Roméo Fontaine
- INED, Mortality, Health and Epidemiology (UR5), F-93300 Aubervilliers, France
| | - Gaëtan Gavazzi
- Geriatric Department, Grenoble Alpes University Hospital, F-38000 Grenoble, France
- University of Grenoble-Alpes, GREPI TIMC-IMAG, CNRS UMR 552, F-38000 Grenoble, France
| | - Marie Laurent
- Univ Paris Est Creteil, Inserm, IMRB U955, CEpiA Team, F-94000 Creteil, France
- Geriatric Department, APHP, Henri-Mondor Hospital, F-94000 Creteil, France
| | - Jean-Marie Robine
- INED, Mortality, Health and Epidemiology (UR5), F-93300 Aubervilliers, France
- Univ Paris, INSERM, CNRS, EHSS, CERMES3, F-75000 Paris, France
- Univ Montpellier, EPHE, INSERM, MMDN, F-34000 Montpellier, France
- PSL Research University, F-75000 Paris, France
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Feldman SF, Lesuffleur T, Olié V, Gastaldi-Ménager C, Juillière Y, Tuppin P. French annual national observational study of 2015 outpatient and inpatient healthcare utilization by approximately half a million patients with previous heart failure diagnosis. Arch Cardiovasc Dis 2021; 114:17-32. [DOI: 10.1016/j.acvd.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023]
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How Do German General Practitioners Assess Medical Specialist Care Needs of Nursing Home Residents? Results of a Postal Survey in North-Western Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197126. [PMID: 33003384 PMCID: PMC7579638 DOI: 10.3390/ijerph17197126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022]
Abstract
The frequency of contacts of nursing home residents with medical specialists is lower compared to the general population of the same age group in Germany. The aim of this study was to assess general practitioners’ (GPs) views on specialist care needs of nursing home residents, on questions of qualification and care coordination. A cross-sectional study was conducted with a postal questionnaire among a representative sample of 1121 GPs in north-western Germany in 2018. The perceptions of GPs about the relative importance of the type of specialist care that is required in nursing homes was assessed on a five-point Likert scale (0 = very low to 4 = very high). A total of 375 GPs (response 33.5%; mean age 54.4 years; 57.6% male) participated in the survey. GPs assessed care needs as highest for neurologists and psychiatrists (68.7%) and lowest for gynecologists (6.5%). Almost all respondents (96.2%) strongly agreed that medical care for nursing home residents should be coordinated by GPs and that GPs should initiate the referral for further specialist care when required (87.5%). A minority (25.7%) agreed that quality of medical care would improve when care for a nursing home was provided by only one GP practice. GPs perceive the needs of nursing home residents for specialist care as high only in relation to care by neurologists and psychiatrists. GPs consider their own coordination function for medical care in nursing homes as very important.
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Spreckelsen O, Schmiemann G, Freitag MH, Fassmer AM, Engel B, Hoffmann F. Are there changes in medical specialist contacts after transition to a nursing home? an analysis of German claims data. BMC Health Serv Res 2020; 20:716. [PMID: 32753058 PMCID: PMC7405335 DOI: 10.1186/s12913-020-05575-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Provision of ambulatory care by medical specialists for nursing home residents (NHR) is discussed to be inadequate in Germany, however with only incomplete evidence on this topic. We wanted to know whether the transition to a nursing home is associated with a general decrease in medical specialist care and therefore compared contact rates before and after institutionalization. METHODS Claims data of 18,779 newly admitted NHR in 2013 were followed for the whole year prior to and up to two years after admission. The frequencies of contacts to specialists were assessed and stratified by sex, age, care level, dementia diagnosis and chronic conditions. Multivariate analyses were conducted to identify predictors for contacts to specialists. RESULTS One year after institutionalization the most pronounced decrease was found in contacts with ophthalmologists (38.4% vs. 30.6%) whereas with most other specialties only small changes were found. The only specialty with a large increase were neurologists and psychiatrists (27.2% vs. 43.0%). Differences depending on sex and age were rather small while NHR with dementia or a higher care level had lower contact rates after institutionalization. Before institutionalization most patients were referred to a specialist by a general practitioner (61.7-73.9%) while thereafter this proportion decreased substantially (27.8-58.6%). The strongest predictor for a specialist contact after admission to a nursing home was a contact to a specialist before (OR 8.8, CI 7.96-9.72 for contacts to neurologists or psychiatrists). A higher nursing care level and a higher age were also predictors for specialist contacts. CONCLUSIONS Relevant decreases of ambulatory specialist care utilization after institutionalization are restricted to ophthalmologists. NHR of higher age and higher nursing care level had a lower chance for a specialist contact. The assessment of the adequacy of the provided care after institutionalization remains inconclusive due to little investigated but assumable changes in care needs of NHR. The decreased coordination of care by general practitioners after institutionalization conflicts with health policy goals.
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Affiliation(s)
- Ove Spreckelsen
- Department of Health Services Research, Division of General Practice, Carl von Ossietzky University of Oldenburg, 26111, Oldenburg, Germany.
| | - Guido Schmiemann
- Department of Health Services Research, Institute for Public Health and Nursing Science, University of Bremen, Bremen, Germany.,Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Michael H Freitag
- Department of Health Services Research, Division of General Practice, Carl von Ossietzky University of Oldenburg, 26111, Oldenburg, Germany
| | - Alexander M Fassmer
- Department of Health Services Research, Division of Outpatient Care and Pharmacoepidemiology, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Bettina Engel
- Department of Health Services Research, Division of General Practice, Carl von Ossietzky University of Oldenburg, 26111, Oldenburg, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Division of Outpatient Care and Pharmacoepidemiology, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Kalseth J, Halvorsen T. Health and care service utilisation and cost over the life-span: a descriptive analysis of population data. BMC Health Serv Res 2020; 20:435. [PMID: 32429985 PMCID: PMC7236310 DOI: 10.1186/s12913-020-05295-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/05/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Current demographic changes affect both the level and composition of health and care needs in the population. The aim of this study was to estimate utilisation and cost for a comprehensive range of health and care services by age and gender to provide an in-depth picture of the life-span pattern of service needs and related costs. METHODS Data on service use in 2010 for the entire population in Norway were collected from four high-quality national registers. Cost for different services were calculated combining data on service utilisation from the registries and estimates of unit cost. Data on cost and users were aggregated within four healthcare services and seven long-term care services subtypes. Per capita cost by age and gender was decomposed into user rates and cost per user for each of the eleven services. RESULTS Half of the population is under 40 years of age, but only a quarter of the health and care cost is used on this age group. The age-group of 65 or older, on the other hand, represent only 15% of the population, but is responsible for almost half of the total cost. Healthcare cost dominates in ages under 80 and mental health services dominates in adolescents and young adults. Use of other healthcare services are high in middle aged and elderly but decreases for the oldest old. Use of care services and in particular institutional care increases in old age. Healthcare cost per user follows roughly the same age pattern as user rates, whereas user cost for care services typically are either relatively stable or decrease with age among adults. Gender differences in the age pattern of health and care costs are also revealed and discussed. CONCLUSION The type of services used, and the related cost, show a clear life-span as well as gender pattern. Hence, population aging and narrowing gender-gap in longivety calls for high policy awarness on changing health and care needs. Our study also underscores the need for an attentive and pro-active stance towards the high service prevalence and high cost of mental health care in our upcoming generations.
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Affiliation(s)
- Jorid Kalseth
- Department of Health Research, SINTEF Digital, P.O. Box 4760, Sluppen, NO-7465 Trondheim, Norway
| | - Thomas Halvorsen
- Department of Health Research, SINTEF Digital, P.O. Box 4760, Sluppen, NO-7465 Trondheim, Norway
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Bège T, Pauly V, Orleans V, Boyer L, Leone M. Epidemiology of trauma in France: mortality and risk factors based on a national medico-administrative database. Anaesth Crit Care Pain Med 2019; 38:461-468. [DOI: 10.1016/j.accpm.2019.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/18/2019] [Accepted: 02/02/2019] [Indexed: 12/01/2022]
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Czwikla J, Schulz M, Heinze F, Kalwitzki T, Gand D, Schmidt A, Tsiasioti C, Schwinger A, Kloep S, Schmiemann G, Wolf-Ostermann K, Gerhardus A, Rothgang H. Needs-based provision of medical care to nursing home residents: protocol for a mixed-methods study. BMJ Open 2019; 9:e025614. [PMID: 31471429 PMCID: PMC6720143 DOI: 10.1136/bmjopen-2018-025614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 05/11/2019] [Accepted: 08/01/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Nursing home residents typically have greater needs for medical care than community-dwelling elderly. However, restricted cognitive abilities and limited mobility may impede their access to general practitioners and medical specialists. The provision of medical care in nursing homes may therefore be inappropriate in some areas of medical care. The purpose of this mixed-methods study is to systematically assess, evaluate and explain met and unmet medical care needs in German nursing homes and to develop solutions where medical care is found to be inappropriate. METHODS AND ANALYSIS First, statutory health insurance claims data are analysed to identify differences in the utilisation of medical care between nursing home residents and community-dwelling elderly with and without need for long-term care. Second, the health status and medical care of 500 nursing home residents are assessed and evaluated to quantify met and unmet medical care needs. Third, qualitative expert interviews and case conferences and, fourth, quantitative analyses of linked data are used to provide structural, case-specific and generalisable explanations of inappropriate medical care among nursing home residents. Fifth, a modified Delphi study is employed to develop pilot projects aiming to improve medical care in nursing homes. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the University of Bremen on 23 November 2017. Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER DRKS00012383.
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Affiliation(s)
- Jonas Czwikla
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Maike Schulz
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Franziska Heinze
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Thomas Kalwitzki
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Daniel Gand
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Annika Schmidt
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Care Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | | | | | - Stephan Kloep
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Competence Center for Clinical Trials (KKSB), University of Bremen, Bremen, Germany
| | - Guido Schmiemann
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Karin Wolf-Ostermann
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Care Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Ansgar Gerhardus
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Heinz Rothgang
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
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12
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Leutgeb R, Berger SJ, Szecsenyi J, Laux G. Potentially avoidable hospitalisations of German nursing home patients? A cross-sectional study on utilisation patterns and potential consequences for healthcare. BMJ Open 2019; 9:e025269. [PMID: 30670526 PMCID: PMC6347959 DOI: 10.1136/bmjopen-2018-025269] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Demand for nursing home (NH) care is soaring due to gains in life expectancy and people living longer with chronic illness and disability. This is dovetailing with workforce shortages across the healthcare profession. Access to timely and appropriate medical care for NH residents is becoming increasingly challenging and can result in potentially avoidable hospitalisations (PAHs). In light of these factors, we analysed PAHs comparing NH patients with non-NH patients. DESIGN Cross-sectional study with claims data from 2015 supplied by a large German health insurance company within the federal state of Baden-Wuerttemberg. SETTING One-year observation of hospitalisation patterns for NH and non-NH patients. PARTICIPANTS 3 872 245 of the 10.5million inhabitants of Baden-Wuerttemberg were covered. METHODS Patient data about hospitalisation date, sex, age, nationality, level of care and diagnoses were available. PAHs were defined based on international classification of diseases (ICD-10) diagnoses belonging to ambulatory care sensitive conditions (ACSCs). Adjusted ORs for PAHs for NH patients in comparison with non-NH patients were calculated with multivariable regression models. RESULTS Of the 933 242 hospitalisations in 2015, there were 23 982 for 13 478 NH patients and 909 260 for 560 998 non-NH patients. Mean age of hospitalised NH patients and level of care were significantly higher than those of non-NH patients. 6449 PAHs (29.6%) for NH patients and 136 543 PAHs (15.02%) for non-NH patients were identified. The adjusted OR for PAHs was significantly heightened for NH patients in comparison with non-NH patients (OR: 1.22, CI (1.18 to 1.26), p<0.0001). Moreover, we could observe that more than 90% of PAHs with ACSCs were unplanned hospitalisations (UHs). CONCLUSIONS Large numbers of PAHs for NH patients calls for improved coordination of medical care, especially general practitioner service provision. Introduction of targeted training programmes for physicians and NH staff on health problem management for NH patients could perhaps contribute to reduction of PAHs, predominantly UHs.
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Affiliation(s)
- Rüdiger Leutgeb
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Sarah Jane Berger
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Gunter Laux
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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13
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Dahlberg L, Agahi N, Schön P, Lennartsson C. Planned and Unplanned Hospital Admissions and Their Relationship with Social Factors: Findings from a National, Prospective Study of People Aged 76 Years or Older. Health Serv Res 2018; 53:4248-4267. [PMID: 29952093 PMCID: PMC6232498 DOI: 10.1111/1475-6773.13001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine the relationship between social factors and planned and unplanned hospital admissions among older people. DATA SOURCES/STUDY SETTING 2011 data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) and data from the Swedish National Patient Register until December 31, 2012. STUDY DESIGN The study had a prospective design. Data were analyzed via Cox proportional hazard regressions with variables entered as blocks (social factors, sociodemographic and ability factors, health factors). DATA COLLECTION Data were collected via interviews with people aged 76+ (n = 931). PRINCIPAL FINDINGS Living in institutions was negatively associated with planned admissions (hazard ratio (HR): 0.29; confidence interval (CI): 0.09-0.88), while being in receipt of home help was positively associated with unplanned admissions (HR: 1.57; CI: 1.15-2.14). Low levels of social contacts and social activity predicted unplanned admissions in bivariate analyses only. Higher ability to deal with public authorities was positively associated with planned admissions (HR: 1.77; CI: 1.13-2.78) and negatively associated with unplanned admissions, although the latter association was only significant in the bivariate analysis. CONCLUSIONS Hospital admissions are not only due to health problems but are also influenced by the social care situation and by the ability to deal with public authorities.
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Affiliation(s)
- Lena Dahlberg
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Neda Agahi
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Pär Schön
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Carin Lennartsson
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
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14
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Kalinowski S, Dräger D, Kuhnert R, Kreutz R, Budnick A. Pain, Fear of Falling, and Functional Performance Among Nursing Home Residents: A Longitudinal Study. West J Nurs Res 2018; 41:191-216. [DOI: 10.1177/0193945918759958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to analyze the impact of being pain-affected and fear of falling on functional performance among nursing home residents, longitudinally. We used 6-month follow-up data from a cluster-randomized trial of 12 nursing homes (cluster level) with 239 nursing home residents at baseline (mean age, 95% confidence interval [CI] = 83.04 [81.40, 84.69], 70% women). The longitudinal analysis provided data on pain, fear of falling, functional mobility, and activities of daily living (individual level). The data revealed a trend indicating that pain-relieved nursing home residents showed better functional mobility over time. The results on fear of falling demonstrate obvious differences in the functional performance of nursing home residents cross-sectionally but not longitudinally. Nevertheless, the results underline the importance of an effective pain treatment to prevent decline in functional mobility among nursing home residents. Further longitudinal surveys are needed to verify the findings on functional performance.
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Affiliation(s)
- Sonja Kalinowski
- Institute of Medical Sociology and Rehabilitation Science, Charité–Universitätsmedizin Berlin, Germany
| | - Dagmar Dräger
- Institute of Medical Sociology and Rehabilitation Science, Charité–Universitätsmedizin Berlin, Germany
| | - Ronny Kuhnert
- Institute of Medical Sociology and Rehabilitation Science, Charité–Universitätsmedizin Berlin, Germany
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité–Universitätsmedizin Berlin, Germany
| | - Andrea Budnick
- Institute of Medical Sociology and Rehabilitation Science, Charité–Universitätsmedizin Berlin, Germany
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