Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs

BackgroundEvidence is lacking on the differences between hospitalisation of people with dementia living in nursing homes and those living in the community. The objectives of this study were: 1) to describe the frequency of hospital admission among people with dementia in eight European countries living in nursing homes or in the community, 2) to examine the factors associated with hospitalisation in each setting, and 3) to evaluate the costs associated with it.MethodsThe present study is a secondary data analysis of the RightTimePlaceCare European project. A cross-sectional survey was conducted with data collected from people with dementia living at home or who had been admitted to a nursing home in the last 3 months, as well as from their caregivers. Data on hospital admissions at 3 months, cognitive and functional status, neuropsychiatric symptoms, comorbidity, polypharmacy, caregiver burden, nutritional status, and falls were assessed using validated instruments. Multivariate regression models were used to investigate the factors associated with hospital admission for each setting. Costs were estimated by multiplying quantities of resources used with the unit cost of each resource and inflated to the year 2019.ResultsThe study sample comprised 1700 people with dementia living in the community and nursing homes. Within 3 months, 13.8 and 18.5% of people living in nursing homes and home care, respectively, experienced >= 1 hospital admission. In the nursing home setting, only polypharmacy was associated with a higher chance of hospital admission, while in the home care setting, unintentional weight loss, polypharmacy, falls, and more severe caregiver burden were associated with hospital admission. Overall, the estimated average costs per person with dementia/year among participants living in a nursing home were lower than those receiving home care.ConclusionAdmission to hospital is frequent among people with dementia, especially among those living in the community, and seems to impose a remarkable economic burden. The identification and establishment of an individualised care plan for those people with dementia with polypharmacy in nursing homes, and those with involuntary weight loss, accidental falls, polypharmacy and higher caregiver burden in the home care setting, might help preventing unnecessary hospital admissions

Patient Choice in the Post-Semashko Health Care System

The opportunity for patient choice in the health care system in CIS countries was created by the partial destruction of the referral system and the development of paid medical services. The data of two population surveys conducted in Russia in 2009 and 2011 show that patient choice of medical facility and physician is taking place in the post-Semashko health care system, and it is not restricted to the area of paid medical services. However for the majority of population the choice of medical facility and physician is not a necessity. Part of reason for patient choice is caused by the failure of the patient referral system to ensure the necessary treatment. For some Russian citizens, the choice of health care provider is a means to obtain better quality care, and in this respect the enhancement of patient choice is leading to the improved efficiency of the emerging health care system.Была создана возможность для выбора пациента в системе здравоохранения в странах СНГ путем частичного разрушения системы направлений и развития платных медицинских услуг. Данные двух исследований, проведенных в области народонаселения в России в 2009 и 2011 показывают, что выбор медицинского учреждения и врача пациентом происходит в после-семашковской системе здравоохранения, и не ограничивается областью платных медицинских услуг. Однако для большинства населения выбор медицинского учреждения и врача не является необходимостью. Часть причины для выбора пациента вызвано неспособностью пациента реферальной системы в обеспечить необходимое лечение. Для некоторых российских граждан, выбор медицинских услуг является средством для получения лучшего качества медицинской помощи, и в этом отношении поощрение выбора пациента ведет к повышению эффективности создаваемой системы здравоохранения

The impact of financial incentives on physician empathy: a study from the perspective of patients with private and statutory health insurance.

OBJECTIVE: We hypothesized that patients' ratings of physician empathy (PE) would be higher among those with private health insurance (PHI, referring to financial incentive) than among patients with statutory health insurance (SHI). METHODS: A postal survey was administered to 710 cancer patients. PE was assessed using the consultation- and- Relational-Empathy measure. T-tests were conducted to analyse whether PHI and SHI-patients differ in their ratings of PE and variables relating to contact time with the physician. Structural-equation-modelling (SEM) verified mediating effects. RESULTS: PHI-patients rated physician empathy higher. SEM revealed that PHI-status has a strong significant effect on frequency of talking with the physician, which has a strong significant effect (1) on PE and (2) has a moderate effect on patients' perception of medical staff stress, thereby also affecting patients' ratings of PE. CONCLUSIONS: Our findings suggest that PHI-status is one necessary precondition for physicians spending more time with the patient. Spending more time with the PHI-patient has two major effects: it results in a more positive perception of PE and positively impacts PHI-patients' perception of medical staff stress, which in turn, again influences PE. PRACTICAL IMPLICATIONS: Health policy should discuss these findings in terms of equality in receiving high-quality care. (aut. ref.

Eight Questions About Physician-Rating Websites: A Systematic Review

BACKGROUND: Physician-rating websites are currently gaining in popularity because they increase transparency in the health care system. However, research on the characteristics and content of these portals remains limited. OBJECTIVE: To identify and synthesize published evidence in peer-reviewed journals regarding frequently discussed issues about physician-rating websites. METHODS: Peer-reviewed English and German language literature was searched in seven databases (Medline (via PubMed), the Cochrane Library, Business Source Complete, ABI/Inform Complete, PsycInfo, Scopus, and ISI web of knowledge) without any time constraints. Additionally, reference lists of included studies were screened to assure completeness. The following eight previously defined questions were addressed: 1) What percentage of physicians has been rated? 2) What is the average number of ratings on physician-rating websites? 3) Are there any differences among rated physicians related to socioeconomic status? 4) Are ratings more likely to be positive or negative? 5) What significance do patient narratives have? 6) How should physicians deal with physician-rating websites? 7) What major shortcomings do physician-rating websites have? 8) What recommendations can be made for further improvement of physician-rating websites? RESULTS: Twenty-four articles published in peer-reviewed journals met our inclusion criteria. Most studies were published by US (n=13) and German (n=8) researchers; however, the focus differed considerably. The current usage of physician-rating websites is still low but is increasing. International data show that 1 out of 6 physicians has been rated, and approximately 90% of all ratings on physician-rating websites were positive. Although often a concern, we could not find any evidence of "doctor-bashing". Physicians should not ignore these websites, but rather, monitor the information available and use it for internal and ex-ternal purpose. Several shortcomings limit the significance of the results published on physician-rating websites; some recommendations to address these limitations are presented. CONCLUSIONS: Although the number of publications is still low, physician-rating websites are gaining more attention in research. But the current condition of physician-rating websites is lacking. This is the case both in the United States and in Germany. Further research is necessary to increase the quality of the websites, especially from the patients’ perspective