ATME-Needs, requirements and cross-sectoral patient journeys of patients with out-of-hospital mechanical ventilation and intensive care in outpatient settings: study protocol for an observational study.

INTRODUCTION: An increasing number of tracheotomised and/or ventilated patients with high-cost out-of-hospital intensive care needs and, at the same time, a decreasing number of healthcare professionals inevitably lead to challenges in the care of this patient population. In addition, little is known about this population, their health restrictions, needs, patient journeys, care structures and processes. The project 'Needs, requirements and cross-sectoral care pathways of out-of-hospital ventilated intensive care patients' (ATME) aims to analyse these aspects and explore current care structures to inform further development of care in line with patients' needs and requirements. METHODS AND ANALYSIS: Qualitative and quantitative methods will be used. In preparation of a semistandardised survey, exploratory interviews will be conducted with tracheotomised and/or ventilated patients with out-of-hospital intensive care needs (TVPOI) (n=15), nursing care providers (n=30), outpatient medical centres, as well as outpatient medical, medical technology and therapeutic care providers (n=35). Three semistandardised survey questionnaires for TVPOI (n=2,000) will be developed and conducted with nursing care facilities (n=250) and outpatient medical centres for mechanical ventilation (n=25). Content analyses will be conducted for qualitative data; survey data will be analysed descriptively. In addition, healthcare claims data will be analysed descriptively to provide information on patient journeys. Three result workshops and one consensus conference will be carried out with representatives of the relevant target groups to analyse the suitability of care structures and to develop recommendations for action to improve TVPOI. ETHICS AND DISSEMINATION: The ATME study received a positive vote from the Ethics Committee of the Osnabrück University of Applied Sciences and is registered in 'Deutsches Register Klinischer Studien (DRKS)' (registration number: DRKS00030891). The study results will be presented at national conferences and in relevant peer-reviewed journals. Additionally, study results will be published by the funding institution (the Innovation Committee of the Federal Joint Committee) on their website.

[Social inequality in home care: A scoping review on the impact of socio-economic resources on home care arrangements]. / Soziale Ungleichheit in der häuslichen Pflege: ein Scoping-Review zum Einfluss sozioökonomischer Ressourcen auf die Gestaltung häuslicher Pflegearrangements.

INTRODUCTION: Inequalities in long-term home care are still rarely considered in the discourse on health inequalities, although there is reason to assume that opportunities for a successful home care arrangement are not equally distributed among those in need of it. This paper pursues the question how socio-economic resources of people in need of care and their family caregivers are influencing the utilization of care services in Germany. METHODS: A scoping review has been conducted to analyse the current state of research. To identify relevant papers the online databases CINAHL including MEDLINE, PubMed, LIVIVO and Web of Science were searched and supplemented by internet research. According to Bourdieu, the research studies included were arranged in economic, educational and social resources. RESULTS: 29 qualitative and quantitative research papers were included in the analysis. 14 papers represent quantitative research results, nine papers are based on qualitative research. Six further papers are analyses based on an international data record. The utilization of care services increases with the level of income and wealth as well as education. On closer examination of individual care services, however, the evidence is inconsistent and only the so-called 24-hour care service is distinguishable as a care arrangement for high-status groups. A compensation of the lower utilization of professional care by informal support cannot be described in quantitative terms. Caregivers with low income and education levels seem to be more likely to not only provide care but also to provide higher-intensity care. DISCUSSION: Despite increasing research reflected in the literature, the evidence remains incomplete and shows inconsistencies so that a valid statement on the degree of inequalities in care provision is not possible. A conceptual basis for the definition of social inequality in the context of long-term home care is lacking as well as a common understanding of equity in care provision. The perspective of people in need of care and their caregivers has hardly been addressed. CONCLUSION: Home care is not only determined by individual need but seems to be decisively influenced by socio-economic restrictions. For a more targeted approach, further research on the use of care services depending on socio-economic resources is needed, explicitly taking into account the user perspective.

[Homecare arrangements: examining the use of support services in relation to socioeconomic status]. / Häusliche Pflegearrangements: Untersuchung der Inanspruchnahme von Unterstützungsleistungen im Zusammenhang mit dem sozioökonomischen Status.

BACKGROUND: National and international findings indicate that homecare arrangements are influenced by socioeconomic factors. Demographic and social developments justify the assumption of an increasing number of people in need of care from resource-pour groups and therefore a continuously increasing importance of home-based long-term care. OBJECTIVE: It is examined whether income and education of people in need of care and their caregivers are related to the use of support services in homecare arrangements. MATERIAL AND METHODS: Quantitative secondary data analysis of a survey among members of the social association VdK (Sozialverband VdK). The statistical evaluation includes descriptive analyses as well as the investigation of correlations between socioeconomic characteristics and characteristics of the care arrangement. RESULTS: A correlation between income and the use of support services exists regarding so-called 24-hour care, which is more common with high incomes. Other income effects can be seen in the extent to which care services and home help services are used and in measures to adapt the home environment. A higher level of education is related to an increased use of counselling services. The assessment of the care situation is more negative the lower the income. CONCLUSIONS: The results point out that phenomena of social inequality in care exist and that the options for shaping homecare are influenced by socioeconomic factors. The study also shows challenges in dealing with social inequality and provides orientation for further research, which is becoming increasingly important in view of current trends.