SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.
High-Profile Area Health Sciences, University of Bremen, Bremen, Germany.
BMC Health Serv Res. 2020 Jul 25;20(1):690. doi: 10.1186/s12913-020-05548-0.
Most older people, and especially those in need of long-term care, suffer from one or more chronic diseases. Consequently, older people have an increased need of medical care, including specialist care. There is little evidence as yet whether older people with greater medical care needs obtain adequate medical care because existing studies do not sufficiently control for differences in morbidity. In this study we investigate whether differences in medical specialist utilization exist between older people with and without assessed long-term care need in line with Book XI of the German Social Code, while at the same time controlling for individual differences in morbidity.
We used data from the 11 German AOK Statutory Health and Long-term Care Insurance funds of 100,000 members aged 60 years or over. Zero-inflated Poisson regression analyses were applied to investigate whether the need for long-term care and the long-term care setting are associated with the probability and number of specialist visits. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner (GP) utilization.
Older people in need of long-term care are more likely to have no specialist visit than people without the need for long-term care. This applies to nearly all medical specialties and for both care settings. Yet, despite these differences in utilization probability the number of specialist medical care visits between older people with and without the need for long-term care is similar.
Older people in need of long-term care might face access barriers to specialist care. Once a contact is established, however, utilization does not differ considerably between those who need long-term care and those who don't; this indicates the importance of securing an initial contact.
大多数老年人，尤其是那些需要长期护理的老年人，患有一种或多种慢性病。因此，老年人对医疗保健的需求增加，包括专科护理。目前，尚缺乏充分的证据表明，有更多医疗保健需求的老年人是否获得了足够的医疗保健，因为现有研究没有充分控制发病率的差异。在这项研究中，我们调查了患有和不患有符合德国社会法典第十一章评估的长期护理需求的老年人之间，在医疗专科医生利用方面是否存在差异，同时控制了个体发病率的差异。
我们使用了来自德国 AOK 法定健康和长期护理保险的 11 个基金的 100,000 名 60 岁或以上的成员的数据。我们应用零膨胀泊松回归分析来调查长期护理需求和长期护理设置是否与专科就诊的概率和数量相关。我们控制了年龄、性别、发病率和死亡率、居住密度以及全科医生（GP）的利用情况。
需要长期护理的老年人比不需要长期护理的老年人更有可能没有专科就诊。这适用于几乎所有的医学专业和两种护理设置。然而，尽管在利用概率上存在这些差异，但有长期护理需求和没有长期护理需求的老年人之间的专科医疗保健就诊次数相似。
需要长期护理的老年人可能面临专科医疗保健的准入障碍。然而，一旦建立了联系，利用情况在需要长期护理和不需要长期护理的老年人之间并没有显著差异；这表明确保初始联系的重要性。
