Hrudey Ilona, Minow Annemarie, Walter Svenja, March Stefanie, Swart Enno, Stallmann Christoph
Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
Department of Social Work, Health and Media, Magdeburg-Stendal University of Applied Sciences, Magdeburg, Germany.
JMIR Res Protoc. 2022 Jan 12;11(1):e33512. doi: 10.2196/33512.
In Germany, the proportion of people with chronic diseases and multimorbidity is increasing. To counteract the emergence and worsening of age-related conditions, there is a need for preventive care structures and measures. The preventive services that are financed by statutory health insurance (SHI; eg, vaccinations, cancer screening) are only used by part of the German population. There are no current findings about the utilization of these services by older adults in the eastern German federal state of Saxony-Anhalt, which is particularly strongly affected by demographic change.
The aim of this study is to investigate the actual utilization and determinants of, reasons for, and barriers to utilization of preventive services financed by the SHI in Saxony-Anhalt in the 55-plus age group.
In this study, a convergent mixed methods design is used. The actual use of preventive services will be shown by means of (1) a claims data analysis looking at data on statutory outpatient medical care from both the Central Research Institute of Ambulatory Health Care in Germany (Zi) and the Association of Statutory Health Insurance Dentists in Saxony-Anhalt (KZV LSA). The determinants, attitudes, and behaviors associated with use will be analyzed through (2) a cross-sectional survey as well as (3) qualitative data from semistructured interviews with residents of Saxony-Anhalt and from focus group discussions with physicians. (4) A stock take and systematic evaluation of digitally available informational material on colorectal cancer screening, by way of example, provides an insight into the information available as well as its quality. The conceptual framework of the study is the behavioral model of health services use by Andersen et al (last modified in 2014).
(1) The Zi and KZV LSA are currently preparing the requested claims data. (2) The survey was carried out from April 2021 to June 2021 in 2 urban and 2 rural municipalities (encompassing a small town and surrounding area) in Saxony-Anhalt. In total, 3665 people were contacted, with a response rate of 25.84% (n=954). (3) For the semistructured interviews, 18 participants from the 4 different study regions were recruited in the same period. A total of 4 general practitioners and 3 medical specialists participated in 2 focus group discussions. (4) For the systematic evaluation of existing informational material on colorectal cancer screening, 37 different informational materials were identified on the websites of 16 health care actors.
This study will provide current and reliable data on the use of preventive services in the 55-plus age group in Saxony-Anhalt. It will yield insights into the determinants, reasons, and barriers associated with their utilization. The results will reveal the potential for preventive measures and enable concrete recommendations for action for the target population of the study.
German Clinical Trials Register DRKS00024059; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024059.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/33512.
在德国，慢性病和多种疾病并存的人群比例正在上升。为了应对与年龄相关疾病的出现和恶化，需要有预防性保健结构和措施。由法定医疗保险（SHI；例如疫苗接种、癌症筛查）资助的预防性服务仅被部分德国人口使用。目前尚无关于德国东部萨克森-安哈尔特联邦州老年人对这些服务利用情况的研究结果，该州受人口结构变化的影响尤为严重。
本研究旨在调查萨克森-安哈尔特州55岁及以上年龄组中由法定医疗保险资助的预防性服务的实际利用情况、决定因素、利用原因及障碍。
本研究采用了收敛性混合方法设计。预防性服务的实际使用情况将通过以下方式呈现：（1）对德国门诊医疗中央研究所（Zi）和萨克森-安哈尔特州法定医疗保险牙医协会（KZV LSA）的法定门诊医疗数据进行索赔数据分析。与使用相关的决定因素、态度和行为将通过以下方式进行分析：（2）横断面调查以及（3）对萨克森-安哈尔特州居民进行半结构化访谈和与医生进行焦点小组讨论获得的定性数据。（4）以结直肠癌筛查为例，对数字可得信息材料进行盘点和系统评估，可深入了解现有信息及其质量。本研究的概念框架是安徒生等人（2014年最后修订）的卫生服务利用行为模型。
（1）Zi和KZV LSA目前正在准备所需的索赔数据。（2）调查于2021年4月至2021年6月在萨克森-安哈尔特州的2个城市和2个农村市镇（包括一个小镇及其周边地区）进行。总共联系了3665人，回复率为25.84%（n = 954）。（3）在同一时期，从4个不同研究区域招募了18名参与者进行半结构化访谈。共有4名全科医生和3名医学专家参加了2次焦点小组讨论。（4）为了对现有的结直肠癌筛查信息材料进行系统评估，在16个医疗保健机构的网站上识别出37种不同的信息材料。
本研究将提供关于萨克森-安哈尔特州55岁及以上年龄组预防性服务使用情况的当前可靠数据。它将深入了解与其利用相关的决定因素、原因和障碍。研究结果将揭示预防措施的潜力，并为研究目标人群提出具体的行动建议。
德国临床试验注册中心DRKS00024059；https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024059。
国际注册报告识别号（IRRID）：DERR1-10.219,33512。
