‘We can do only what we have the means for’ general practitioners’ views of primary care for older people with complex health problems

Background: Due to demographic change, general practitioners (GPs) are increasingly required to care for older people with complex health problems. Little is known about the subjective appraisals of GPs concerning the demanded changes. Our objective is to explore how general practitioners view their professional mandates and capacities to provide comprehensive care for older people with complex health problems. Do geriatric training or experience influence viewpoints? Can barriers for the implementation of changes in primary care for older people with complex health problems be detected? Methods: Preceding a controlled intervention study on case management for older patients in the primary care setting (OMAHA II), this qualitative study included 10 GPs with differing degrees of geriatric qualification. Semi structured interviews were conducted and audio-taped. Full interview transcripts were analyzed starting with open coding on a case basis and case descriptions. The emerging thematic structure was enriched with comparative dimensions through reiterated inter-case comparison and developed into a multidimensional typology of views. Results: Based on the themes emerging from the data and their presentation by the interviewed general practitioners we could identify three different types of views on primary care for older people with complex health problems: ‘maneuvering along competence limits’, ‘Herculean task’, and ‘cooperation and networking’. The types of views differ in regard to role-perception, perception of their own professional domain, and action patterns in regard to cooperation. One type shows strong correspondence with a geriatrician. Across all groups, there is a shared concern with the availability of sufficient resources to meet the challenges of primary care for older people with complex health problems. Conclusions: Limited financial resources, lack of cooperational networks, and attitudes appear to be barriers to assuring better primary care for older people with complex health problems. To overcome these barriers, geriatric training is likely to have a positive impact but needs to be supplemented by regulations regarding reimbursement. Most of all, general practitioners’ care for older people with complex health problems needs a conceptual framework that provides guidance regarding their specific role and contribution and assisting networks. For example, it is essential that general practice guidelines become more explicit with respect to managing older people with complex health problems

Factors contributing to conductance and outcome of specific immunotherapy: Data from the German National Health Interview and Examination Survey 1998

Background: Allergies are an increasingly relevant public health problem. Specific immunotherapy (sIT) is presently the only causal treatment option. This study aimed to assess the frequency and determinants of sIT use and factors associated with treatment outcome. Methods: A cross-sectional analysis based on data from the German National Health Interview and Examination Survey 1998. Results: 2727 (39.2%) of study participants reported physician-diagnosed allergic disease. Among these, 16.5% (n ¼ 296) stated to have undergone sIT. In this subset 43.4% (n ¼ 129) reported improvement of symptoms, 21.9% (n ¼ 65) had not changed, and 34.6% (n ¼ 102) had discontinued treatment. The majority of patients treated with sIT showed multiple allergic symptoms and sensitisations. Factors significantly correlated with sIT treatment in multivariable analyses included rhinitis, asthma, several sensitisations, higher social status and residence in larger cities. Rhinitis and neurodermatitis were positively, and food allergy was negatively associated with the completion of sIT. No factors predicting improvement due to sIT could retrospectively be identified. Conclusion: Treatment with sIT under ‘real life’ conditions does not exactly follow current clinical guideline recommendations. In addition, patients may be selected for IT by socio-demographic factors. Whether this contributes to considerable discontinuation rates and limited effectiveness as observed here, needs further investigation.Peer Reviewe

Self-assessed quality of care among adults with diagnosed diabetes in Germany

People who have diabetes require regular medical care. The views of patients about the quality of their care are becoming increasingly relevant when it comes to chronic diseases such as diabetes. As part of the nationwide study Disease Knowledge and Information Needs – Diabetes mellitus (2017), data on self-assessed quality of care by people with diagnosed diabetes was collected using the Patient Assessment of Chronic Illness Care – DAWN short form (PACIC-DSF, scale 1 to 5) and analysed for respondents aged 45 years or above. The average score for quality of care was 2.47 and was lower for women than for men (2.33 vs 2.58). The respondents assessed the quality of their care as being worse with rising age and size of the population in their residential area. No significant differences were observed by education group. Overall, people with diabetes in Germany consider the quality of their care to be moderate, which indicates a need for improvement in care

Association between random glucose and all-cause mortality: findings from the mortality follow-up of the German National Health Interview and Examination Survey 1998

Background Random glucose is widely measured in epidemiological studies and in the clinical setting when standardized fasting protocols and oral glucose tolerance testing or HbA1c measuring are not feasible. The relationship between random glucose and all-cause mortality has hardly been studied so far and was examined in the present study. Methods We ascertained mortality status among 5955 persons aged 18–79 years and free of known diabetes when participating in the German National Health Interview and Examination Survey 1998 (mean observation time 11.7 years, 458 deaths). Cox regression was applied to analyze the association of random serum glucose with all-cause mortality taken potential confounders into account. Relative mortality risks were estimated as hazard ratios (HRs) with 95% confidence intervals (CIs) modeling random glucose as categorical or continuous variable. Results Compared to random glucose levels of 4.3 - < 5.3 mmol/L, HRs (95% CIs) were 1.94 (0.85–4.45) for levels < 4.3 mmol/L and 1.16 (0.89–1.50), 1.20 (0.91–1.58), 1.42 (0.88–2.29), 2.02 (1.26–3.25) and 4.71 (2.20–10.10) for levels 5.3 - < 5.8, 5.8 - < 6.8, 6.8 - < 7.8, 7.8 - < 11.1 and ≥ 11.1 mmol/L, adjusted for age, sex, lifestyle, anthropometry and chronic diseases. An additional adjustment for fasting time or HbA1c yielded similar estimates. Modeling continuous random glucose by restricted cubic spline functions revealed comparable findings. Conclusions In the present epidemiological study drawn from the general population, random glucose showed a significant association with all-cause mortality, independent of main potential confounders. Thus, random glucose measures are highly relevant to health risk assessment among people without known diabetes when fasting glucose or HbA1c are difficult to obtain.Peer Reviewe

Non-utilisation of health care services during the COVID-19 pandemic: Results of the CoMoLo study

Based on data from the CORONA-MONITORING lokal (CoMoLo) study conducted in four municipalities particularly affected by the COVID-19 pandemic, this article investigates the non-utilisation of health care services in the population aged 18 years and older (n=9,002) in relation to the period after the introduction of the containment measures in March 2020. The results show that about one third of the respondents (35.5%) gave up at least one of the surveyed health care services. The most frequent cancellations were dental (15.2%) and specialist check-ups (11.8%), followed by postponement of physiotherapy, ergotherapy or speech therapy (6.1%), cancellation of general practitioner (GP) check-ups (5.8%), postponement of psychotherapy (2.0%), postponement of planned hospital treatment (1.8%) and not going to an emergency room (0.7%). Almost 10% of the respondents reported not visiting a physician despite health complaints. Compared to respondents without such a waiver, these respondents were more often female and younger than 35 years, less often rated their health as very good or good, more often had a diagnosis of depression and more often used telemedical contacts as an alternative to visiting the practice during the pandemic. Further analyses of trends in utilisation behaviour and changes in health status over the course of the COVID-19 pandemic are important

Gesundheitliche Lage älterer und hochaltriger Menschen in Deutschland: Ergebnisse der Studie Gesundheit 65+

Hintergrund: Aufgrund des demografischen Wandels ist eine umfassende Gesundheitsberichterstattung zur Gesundheit im höheren Alter wichtig. Methode: Gesundheit 65+ ist eine epidemiologische Längsschnittstudie zur gesundheitlichen Lage der Personen ab 65 Jahren in Deutschland. Auf Grundlage einer zweistufigen, geschichteten Zufallsstichprobe aus 128 Einwohnermeldeämtern nahmen zwischen Juni 2021 und April 2022 3.694 Personen an der Basisbefragung teil (47,9 % Frauen, Durchschnittsalter 78,8 Jahre). Es werden gewichtete Prävalenzen für 19 Indikatoren der Basisbefragung insgesamt und nach Alter, Geschlecht, Bildung sowie Wohnregion dargestellt. Ergebnisse: Insgesamt berichteten 52,0 % aller Teilnehmenden der Basisbefragung über eine gute oder sehr gute Gesundheit und 78,5 % über eine hohe oder sehr hohe Lebenszufriedenheit. Demgegenüber standen eine Vielzahl von gesundheitlichen/funktionellen Einschränkungen mit Prävalenzen von 5,3 % bei schwerwiegenden Seheinschränkungen bis 69,2 % bei Multimorbidität. Die gesundheitliche Lage der Frauen war deutlich schlechter als die der Männer, die der Personen ab 80 Jahren schlechter als zwischen 65 und 79 Jahren. Es zeigte sich ein deutlicher Bildungsgradient der gesundheitlichen Lage, jedoch keine Unterschiede zwischen West- und Ostdeutschland. Schlussfolgerungen: Die Studie Gesundheit 65+ liefert eine umfangreiche Datenbasis zur Beschreibung der gesundheitlichen Lage älterer und hochaltriger Personen in Deutschland, auf deren Grundlage Handlungsempfehlungen für Politik und Praxis abgeleitet werden können

Prevalence and correlates of frailty among older adults: findings from the German health interview and examination survey

Background: Despite having the third highest proportion of people aged 60 years and older in the world, Germany has been recently reported as having the lowest prevalence of frailty of 15 European countries. The objective of the study is to describe the prevalence of frailty in a large nationwide population-based sample and examine associations with sociodemographic, social support and health characteristics. Methods: We performed a cross-sectional analysis of the first wave of the German Health Interview and Examination Survey for Adults (DEGS1) conducted 2008–2011. Participants were 1843 community-dwelling people aged 65–79 years. Frailty and pre-frailty were defined, according to modified Fried criteria, as 3 and more or 1–2 respectively, of the following: exhaustion, low weight, low physical activity, low walking speed and low grip strength. The Oslo-3 item Social Support Scale (OSS-3) was used. Patient Health Questionnaire (PHQ-9) measured depressive symptoms and the Digit Symbol Substitution Test (DSST) measured cognition. Associations between participants’ characteristics and frailty status were examined using unadjusted and adjusted multinomial logistic regression models estimating relative risk ratios (RRR) of frailty and pre-frailty. Results: The prevalence of frailty among women was 2.8% (CI 1.8-4.3) and pre-frailty 40.4% (CI 36.3-44.7) and among men was 2.3% (CI 1.3-4.1) and 36.9% (CI 32.7-41.3) respectively. Independent determinants of frailty, from unadjusted models, included older age, low socioeconomic status, poor social support, lower cognitive function and a history of falls. In adjusted models current depressive symptoms (RRR 12.86, CI 4.47-37.03), polypharmacy (RRR 7.78, CI 2.92-20.72) and poor hearing (RRR 5.38, CI 2.17-13.35) were statistically significantly associated with frailty. Conclusions: Frailty prevalence is relatively low among community-dwelling older adults in Germany. Modifiable characteristics like low physical activity provide relevant targets for individual and population-level frailty detection and intervention strategies

Health status of the old and very old people in Germany: results of the Gesundheit 65+ study

Background: The demographic change makes comprehensive health reporting on health at older age an important topic. Methods: Gesundheit 65+ is a longitudinal epidemiological study on the health status of persons aged 65 and older in Germany. Based on a two-stage stratified random sample from 128 local population registers, 3,694 persons participated in the baseline survey between June 2021 and April 2022 (47.9 % women, mean age 78.8 years). Weighted prevalences for 19 indicators of the baseline survey are presented overall and by age, sex, education and region of residence. Results: Overall, 52.0 % of all participants of the baseline survey reported to be in good or very good health, and 78.5 % reported high or very high satisfaction with their life. This was in contrast to the large number of health/functional limitations whose prevalences ranged from 5.3 % for severe visual limitations to 69.2 % for multimorbidity. The health status of women was clearly worse than that of men, and the health status of persons aged 80 and older was worse than between 65 and 79 years of age. There was a clear educational gradient evident in the health status, but there were no differences between West and East Germany. Conclusions: Gesundheit 65+ provides a comprehensive database for description of the health status of old and very old people in Germany, on the basis of which recommendations for action for policy and practice can be derived

Utilisation of outpatient medical services by people with diagnosed diabetes during the COVID-19 pandemic in Germany

People with diabetes regularly need outpatient medical care due to their disease and possible concomitant and secondary illnesses. Using data from the nationwide GEDA 2019/2020-EHIS survey conducted from April 2019 to September 2020, the present study examines developments in outpatient utilisation behaviour during the measures put in place to contain the SARS-CoV-2 pandemic. During the observation period, people with diabetes had a significantly higher rate of utilisation of medical services provided by general practitioners (GPs) and specialists than the population as a whole. In the spring of 2020, when the restrictions were put in place, utilisation of specialist medical services by people with diabetes decreased temporarily by 46% compared to the 2019 reference period. In contrast, no relevant decline in the utilisation of medical services provided by GPs was observed, but this could be related to adaptations of care provision through telephone consultations for people with regularly requiring GP office visits. The issue examined here requires further observations in view of the renewed containment measures

Diabetes surveillance – Laying the groundwork for non-communicable disease surveillance in Germany

Not Peer Reviewe