ABSTRACT
Aim: This mixed-methods cross-sectional study examined the cooperation between nursing home staff and physicians in Bavarian nursing homes in order to understand which organisational and communication measures are resulting in satisfying teamwork among professional groups in nursing homes. Methods: In 3 interview rounds nursing home staff, general practitioners, medical specialists, dentists, nursing home residents, and relatives in 52 nursing homes were interviewed using a questionnaire that was enhanced after every round. Additionally, focus group interviews have been performed in 2 nursing homes. Results: 443 persons involved in patient care, 50 residents and 47 relatives participated in the structured interviews. 22 persons attended the focus group interviews. 65% of the nursing homes required regular visits of general practitioners and 36% or, respectively, 27% required regular or on demand visits of specialists. 47% of the nursing home staff that was asked about this issue stated that it would make their work easier if only a small number of physicians were in charge of their institution. Measures for improvement of medical care in nursing homes most frequently suggested by interview partners responsible for patient care were: better communication (9%), better remuneration of physicians' nursing home visits (7%, nurses and physicians) and less bureaucracy and regular physicians' visits (5% in each question). Conclusion: Because of the composition of our study sample it cannot be assumed that the results are representative for all Bavarian nursing homes. Confidence in one another, low number of persons in charge, binding agreements and regular physicians' nursing home visits are essential for a successful cooperation between providing physicians and nursing home staff.
Subject(s)
Interprofessional Relations , Models, Organizational , Nursing Homes/organization & administration , Nursing Staff/organization & administration , Physicians/organization & administration , Referral and Consultation/organization & administration , Communication , Cross-Sectional Studies , Germany , Health Care Surveys , Intersectoral Collaboration , Organizational Objectives , Physician-Patient Relations , Process Assessment, Health CareABSTRACT
OBJECTIVE: The aim of this survey is the assessment of health and social situation of elderly persons in rural regions as well as their requests and needs concerning accommodation and medical care in the old age. METHODS: In a cross-sectional survey, inhabitants of the rural commune Markt Heiligenstadt, Upper Franconia, aged over 50 years were interviewed. Sixty-eight questions were asked regarding wishes and needs concerning accommodation and living in the old age. RESULTS: 513 (39%) inhabitants participated. Their mean age was 66 years (± 11 years) and 53% were female. 49% are suffering from hypertension and 17% from diabetes mellitus. Reduced autonomy in everyday life is predominantly caused by diseases of the musculoskeletal system. 40% of the respondents aged over 70 years reported hearing and visual impairments. Most of the participants are living in their privately owned home (81%) despite their comparatively low income and express their wish to live and be cared for in their own home in old age (90%). 75% of the respondents are married or living in a partnership. 90% have children and in 55% the children are living in the same house or in the commune. There are 2 local family doctors' practices, but no specialists' practices and no hospitals in the commune. Almost all the respondents (98%) have a regular family doctor. 17% of the participants would relocate if there was no family doctor nearby, 6% if there was no specialist and 4% if there was no hospital nearby. CONCLUSION: Health problems and functional limitations among the inhabitants of Markt Heiligenstadt are similar to those reported in German nationwide surveys. Medical care is strongly depending on general practitioners. The strong social networks of the participants and the predominant presence of residential property are important resources needed to accomplish the preference for home care in old age. This implies increasing challenges for the primary care providers. In future, the general practitioner will be a central coordinator of medical care and professional nursing together with the care by family members.
