Buczak-Stec Elżbieta W, Löbner Margrit, Stein Janine, Stark Anne, Kaduszkiewicz Hanna, Werle Jochen, Heser Kathrin, Wiese Birgitt, Weyerer Siegfried, Wagner Michael, Scherer Martin, Riedel-Heller Steffi G, König Hans-Helmut, Hajek André
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
Front Med (Lausanne). 2022 Jul 22;9:924309. doi: 10.3389/fmed.2022.924309. eCollection 2022.
The aim of this study was to investigate the longitudinal impact of depressive symptoms on utilization of healthcare in terms of GP visits as well as specialist visits and hospital admission in late life among community-dwelling individuals.
Longitudinal data (baseline and follow-up) were derived from the German multicentre, prospective cohort study "Late-life depression in primary care: needs, health care utilization and costs" study (AgeMooDe). At baseline, = 1,230 patients aged 75 years and older were recruited from primary care practices. Main outcomes of interest were use of health care services: the number of GP visits, the number of medical specialist visits, and hospital admission. We used the Geriatric Depression Scale (GDS-15) to measure depression. Outcomes were analyzed with multilevel random intercept negative binominal regression and logistic random-effects models.
At baseline ( = 1,191), mean age was 80.7 (SD 4.6) years, 62.9% were female, and 196 individuals (16.5%) had depression (GDS-15 ≥6). Our longitudinal analyses indicated that older individuals with more depressive symptoms visited their GP more often (IRR=1.03; CI [1.01-1.04], < 0.001), were visiting medical specialists more frequently (IRR=1.03; CI [1.01-1.04], < 0.01), and had higher odds of being hospitalized (OR=1.08; CI [1.02-1.13], < 0.01).
Based on this large longitudinal study we showed that, after adjustment for important covariates, older individuals with more depressive symptoms had higher health care utilization over time. They visited their GP and specialists more frequently and they had higher odds of being hospitalized. This may suggest that higher utilization of specialist care and increased likelihood of being hospitalized may be also attributable to unspecific symptoms or symptoms that are elevated through depressive symptoms.
本研究旨在调查社区居住个体晚年抑郁症状对医疗保健利用的纵向影响，包括全科医生就诊、专科医生就诊和住院情况。
纵向数据（基线和随访）来自德国多中心前瞻性队列研究“初级保健中的晚年抑郁症：需求、医疗保健利用和成本”研究（AgeMooDe）。在基线时，从初级保健机构招募了1230名75岁及以上的患者。主要关注的结果是医疗保健服务的使用情况：全科医生就诊次数、专科医生就诊次数和住院情况。我们使用老年抑郁量表（GDS - 15）来测量抑郁。结果采用多层次随机截距负二项回归和逻辑随机效应模型进行分析。
在基线时（n = 1191），平均年龄为80.7（标准差4.6）岁，62.9%为女性，196名个体（16.5%）患有抑郁症（GDS - 15≥6）。我们的纵向分析表明，抑郁症状较多的老年人更频繁地拜访全科医生（发病率比=1.03；可信区间[1.01 - 101.04]，P < 0.001），更频繁地拜访专科医生（发病率比=1.03；可信区间[1.01 - 1.04]，P < 0.01），并且住院几率更高（比值比=1.08；可信区间[1.02 - 1.13]，P < 0.01）。
基于这项大型纵向研究，我们表明，在对重要协变量进行调整后，随着时间的推移，抑郁症状较多的老年人医疗保健利用率更高。他们更频繁地拜访全科医生和专科医生，并且住院几率更高。这可能表明，专科护理利用率的提高和住院可能性的增加也可能归因于非特异性症状或因抑郁症状而加重的症状。
