1
|
Hunzelar C, Krumpholtz Y, Schlack R, Weltermann B. More GP Consultations by Violence Victims: Results from the Representative German DEGS1 Study. Int J Environ Res Public Health 2023; 20:4646. [PMID: 36901654 PMCID: PMC10001473 DOI: 10.3390/ijerph20054646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Violence is a growing public health problem influencing physical and mental health. Victims tend to contact medical care in the first place, yet a discrepancy between patients' violence experiences (VE) and general practitioners' (GP) awareness is reported. The number of GP visits by victims is of interest. Using data of the nationally representative German Health Interview and Examination Survey for Adults (DEGS1), associations between the prevalence of ≥1 recent VE (last 12 months) and the number of GP contacts were analyzed with respect to age, gender, socio-economic status, and health conditions. The DEGS1 dataset comprised persons aged 18 to 64 years (n = 5938). The prevalence of a recent VE was 20.7%. Compared to non-victims, VE victims visited their GP significantly more often in the preceding 12 months (3.47 vs. 2.87, p < 0.001), which increased markedly in those who were strongly impaired by a recent physical VE (3.55 GP visits) or psychological VE (4.24). The high frequency of GP contacts in VE victims constitutes opportunities to professionally support this vulnerable patient group and underlines the necessity for GPs to integrate VE as a bio-psycho-social problem in a holistic treatment approach.
Collapse
Affiliation(s)
- Carmen Hunzelar
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Yelda Krumpholtz
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Robert Schlack
- Robert-Koch-Institute, Nordufer 20, 13353 Berlin, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| |
Collapse
|
2
|
Offenberg LK, Sommer ST, Schmidt M, Kasten S, Bockheim F, Gavrilov B, Hunzelar C, Ikar N, Oberholz MPS, Paños-Willuhn JL, Weltermann B. Higher chronic stress and less satisfaction with GP communication in migrants with unemployment experience: data from the representative German DEGS1 and the GPCare-1 study. BMC Prim Care 2022; 23:89. [PMID: 35443617 PMCID: PMC9020157 DOI: 10.1186/s12875-022-01691-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/04/2022] [Indexed: 11/12/2022]
Abstract
Background The impact of unemployment on health is well studied. However, information on associations of unemployment, migration background and general practitioner-patient communication is scarce. Methods Data from the representative German Health Interview and Examination Survey for Adults (DEGS1) of individuals in working age (n = 5938) were analysed stratified by unemployment and migration background. Using official weighting factors, the prevalence of chronic stress, having ≥1 chronic disease, having a GP and GP visits in the last 12 months was determined. Multivariate regression models were analysed for associations between unemployment, migration background, and other socio-demographic characteristics with GP visits and chronic stress. Data from the General Practice Care-1 (GPCare-1) study (n = 813 patients) were analysed for differences in patient-physician communication between unemployed with and without migration background. Reverse proportional odds models were estimated for associations of unemployment and migration background with physician-patient communication. Results In the DEGS1, 21.5% had experienced unemployment (n = 1170). Of these, 31.6% had a migration background (n = 248). Compared to unemployed natives, unemployed with migration background had higher chronic stress (mean: 14.32 vs. 13.13, p = 0.02), while the prevalence of chronic disease was lower (21.7% vs. 30.2%, p = 0.03). They were less likely to have a GP (83.6% vs. 90%, p = 0.02), while GP visits were similar (mean: 3.7 vs. 3.3, p = 0.26). Migration background and unemployment experience were not associated with GP visits, while both factors were significantly associated with higher chronic stress (both: p < 0.01). In GPCare-1, 28.8% had ever experienced unemployment (n = 215). Of these, 60 had a migration background (28.6%). The unemployed with migration background reported less frequently that the GP gives them enough space to describe personal strains (46.5% vs. 58.2%; p = 0.03), and that their problems are taken very seriously by their GP (50.8% vs. 73.8%; p = 0.04). In multivariate analyses, migration background showed a lower probability of having enough space to describe personal strains and feeling that problems were taken very seriously. Conclusion Unemployment experience and migration background were associated with higher chronic stress. Only migration background was associated with less satisfaction regarding physician-patient communication.
Collapse
|
3
|
Ikar N, Sommer S, Schmidt M, Löwe C, Kasten S, Gavrilov B, Hunzelar C, Bockheim F, Paños-Willuhn J, Offenberg L, Oberholz M, Weltermann B. Unemployed individuals contact GPs more frequently but report lower satisfaction: results of the population-based DEGS1 and the GPCare-1 patient survey. Sci Rep 2022; 12:6670. [PMID: 35461341 PMCID: PMC9035161 DOI: 10.1038/s41598-022-10621-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/08/2022] [Indexed: 11/09/2022] Open
Abstract
Unemployment is associated with a variety of adverse health-related outcomes, yet little data on primary care services for this risk group exist. Using data from two surveys, we analyzed the frequency of GP contacts and patients' experiences with GPs comparing unemployed with employed individuals. Data of the German Health Interview and Examination Survey for Adults (DEGS1), a nationwide cross-sectional study (n = 8151), were analyzed regarding associations between employment status and the number of GP visits. The General Practice Care-1 study (GPCare-1), a cross-sectional questionnaire survey (n = 813), evaluated patients' communication with their GP. Data were collected from June to August 2020 in 12 teaching practices affiliated with our university. The statistical analysis included individuals of working age (18-64 years old) (DEGS1 n = 5659, GPCare-1 n = 587). In both studies, working age subpopulations were analyzed (DEGS1: n = 5659 of 8151, GPCare-1: n = 587 of 813). In DEGS1, the prevalence of unemployment was 6.5% (n = 372). Unemployed individuals had more GP contacts in the last 12 months (4.50 vs. 2.86, p < 0.001). In the GPCare-1 study, unemployed individuals (6.6%, n = 39) were significantly less satisfied with GP communication: enough space in consultations (42.9% vs. 60.3%, p = 0.043), feeling comfortable to address sensitive topics (44.1% vs. 65.9%, p = 0.010), problems taken very seriously by GP (48.6% vs. 70.6%, p = 0.007). Yet, they were more willing to accept GPs' help for psychosocial burdens (67.6% vs. 47.6%, p = 0.024). GPs should be aware that patients with unemployment wish more support to cope with their burdening situation.
Collapse
Affiliation(s)
- N Ikar
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - S Sommer
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - M Schmidt
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - C Löwe
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - S Kasten
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - B Gavrilov
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - C Hunzelar
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - F Bockheim
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - J Paños-Willuhn
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - L Offenberg
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - M Oberholz
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - B Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| |
Collapse
|
4
|
Gavrilov B, Schmidt M, Kasten S, Sommer S, Hunzelar C, Bockheim F, Paños-Willuhn J, Offenberg L, Oberholz M, Ikar N, Weltermann B. More GP contacts and poorer health of informal caregivers with low socioeconomic status in Germany: results from the population-based DEGS1 and the cross-sectional GPCare-1 study. BMJ Open 2021; 11:e053146. [PMID: 36916141 PMCID: PMC8719219 DOI: 10.1136/bmjopen-2021-053146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Informal caregivers are known to have poorer mental health. Risk factors for caregiver burden include low education, female gender, cohabitation with the care recipient and lack of resources. General practitioners (GPs) have an important role in supporting caregivers. Drawing on data from two surveys, associations between caregivers' socioeconomic status (SES), psychophysical health and GP contacts are analysed. DESIGN Cross-sectional study. The study draws on data from two surveys (German Health Interview and Examination Survey for Adults, DEGS1 and General Practice Care-1, GPCare-1). SETTING Germany. PARTICIPANTS DEGS1: German general population (18+ years) n=7987. GPCare-1: general practice patients (18+ years) n=813. PRIMARY OUTCOME Psychophysical health, GP contacts and communication. METHODS Using representative DEGS1 data, the prevalence of informal caregivers, caregivers' burden, chronic stress, various health conditions and frequency of GP contacts were evaluated stratified by SES. Data from the GPCare-1 study addressed caregivers' experiences and communication preferences with GPs. RESULTS In the DEGS1, the prevalence of caregivers was 6.5%. Compared with non-caregivers, caregivers scored significantly higher for chronic stress (15.45 vs 11.90), self-reported poor health (37.6% vs 23.7%) and GP visits last year (3.95 vs 3.11), while lifestyle and chronic diseases were similar. Compared with caregivers with medium/high SES, those with low SES had a significantly lower prevalence of high/medium caregiver burden (47.9% vs 67.7%) but poorer self-reported health (56.9% vs 33.0%), while other characteristics did not differ. In the GPCare-1 study, the prevalence of caregivers was 12.6%. The majority of them felt that their GP takes their problems seriously (63.6%) without difference by SES. CONCLUSION Caregivers with low SES constitute an especially high-risk group for psychological strain, requiring special GP attention to support their needs.
Collapse
Affiliation(s)
- Boris Gavrilov
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Manuela Schmidt
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Stefanie Kasten
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Samira Sommer
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Carmen Hunzelar
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Florian Bockheim
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Joana Paños-Willuhn
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Luisa Offenberg
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Maja Oberholz
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Nur Ikar
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University Hospital Bonn, Bonn, Germany
| |
Collapse
|