[Regional Influences on Home Visits - Is Care in Rural Areas Secured in the Long Term?] / Regionale Einflüsse auf die Hausbesuchstätigkeit ­ Ist die ländliche Versorgung auf Dauer gesichert?

BACKGROUND: Demographic change and urbanisation are proceeding at a rapid pace in Germany. Although the need for care is increasing due to a growing older and multimorbid generation, the number of home visits by general practitioners has been declining since years. Previous studies have shown that the workload for general practitioners is increasing, especially in rural areas. Research question What kind of structural practice characteristics are associated with the frequency of GP home visits? What influence do regional characteristics of GP practices have? METHODS: In a study of family doctors̓ practices in Saxony, 4286 home visits were documented by questionnaires from 303 participating practices over a period of one year. Each practice surveyed the home visits within a randomly assigned week. In addition to the characteristics of the home visits, information about the practice, such as regional location, home visit organization and patient numbers was also collected. The frequency of home visits was based on information provided by the doctors surveyed. Subsequently, the data based on the postal code were supplemented with structural information from the State Statistical Office and data from the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung-KV). The data were first analysed regarding bivariate associations. Significantly associated variables were finally tested in a multivariate regression model. RESULTS: According to their own statements, the interviewed general practitioners carried out an average of 14.5 (SD 9.5) home visits per week, which included the care of 32.0 (SD 30.0) nursing home patients. The number of home visits correlated significantly negatively with the number of inhabitants and significantly positively with the average age of the region. In the multivariate analysis, the age of the doctor was found to be the largest predictor of the number of home visits per week, with younger doctors making significantly fewer home visits. CONCLUSION: The number of home visits per week continues to decline compared to preliminary studies. In the regression model, the great influence of the doctor̓s age on the number of home visits is striking. While regional-structural characteristics fade into the background, a changed attitude towards home visits must be assumed, with telemedicine and delegation coming to the fore.

[Assessment of care in patients with dementia in house calls by general practitioners]. / Beurteilung der Betreuung dementer Patienten im allgemeinärztlichen Hausbesuch.

BACKGROUND: Patients with dementia (PD) are a special challenge for the healthcare system. They are responsible for 5% of the expenditure in the German healthcare service. The disease-related deficits and the associated need for care leads to the fact that patients are not able to live in their own residence and rely on the care of nursing homes (NH). OBJECTIVE: How is the overall care in PD assessed in house calls (HC)? Does the regional situation influence the living conditions of PD? MATERIAL AND METHODS: As part of the SESAM­5 study 303 participating general practices in Saxony were asked to document their HC within a period of 1 year whereby 4286 HC were documented through questionnaires and analyzed for content and structural data. RESULTS: The prevalence of dementia in HC patients was 27.5% and 72.6% of PD lived in a NH or assisted living home. The medical staff assessed the overall care of PD in the NH to be significantly better than in their own residence. This discrepancy was greater in rural compared to urban regions although in urban regions significantly more patients live in NHs (27% vs. 51%). CONCLUSIONS: The overall care of PD in HC was assessed predominantly as good by medical personnel, whereby PD in NH were assessed comparatively better than those in their own residence. This could be explained by the high need of care in PD. The difference between rural and urban regions is explainable through differences in the infrastructure and also in the organization in rural areas, where relatives participate in care significantly more frequently. In the future more focus could be placed on alternative types of housing because in PD cognitive deficits are in the foreground.