Friedrich Anna-Carina, Czwikla Jonas, Schulz Maike, Wolf-Ostermann Karin, Rothgang Heinz
Universität Bremen, IPP Institut für Public Health und Pflegeforschung, Pflegewissenschaftliche Versorgungsforschung, Bremen, Deutschland.
Universität Bremen, SOCIUM Forschungszentrum Ungleichheit und Sozialpolitik, Gesundheit, Pflege und Alterssicherung, Bremen, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2023 Apr;177:57-64. doi: 10.1016/j.zefq.2022.11.011. Epub 2023 Mar 22.
Empirical studies in nursing homes show that people in need of long-term care have less contact with medical specialists (except for neurologists) compared to those of the same age who are not in need of long-term care, which can be an indication of insufficient health care provision. Against this background, a cooperative agreement between medical specialists and nursing homes was first made legally possible, then requested and finally made mandatory (section 119b SGB V [Social Code Book V] in the currently valid version).
The aim of this study is to investigate to what extent contact density to physicians and the needs-based medical treatment of nursing home residents in nursing homes with and without a cooperative agreement differ from each other and, hence, how effective such cooperation agreements are in this context.
Using data from 396 people in need of care from 44 nursing homes in Lower Saxony and Bremen we compared facilities with and without cooperative agreements with respect to the number of home visits, practice visits and telephone contacts and the realization of adequate specialist medical treatment. At the time of the survey, 26 of the 44 nursing homes had cooperative agreements with dentists, 17 with general practitioners and 7 with neurologists.
The number of personal contacts to general practitioners tends to be higher if cooperation agreements between general practitioners and nursing homes exist. In nursing homes having cooperation agreements with dentists the number of home visits is twice as high as in nursing homes without such an agreement, whereas cooperation agreements with neurologists have no effect on the number of contacts with these specialists. Furthermore, cooperation agreements with dentists promote appropriate dental care.
The results show that cooperation agreements can be a useful instrument to ensure medical care in nursing homes. To guarantee the effectiveness of the cooperation agreements, however, the number of medical visits should be stipulated in the agreements.
养老院的实证研究表明，与不需要长期护理的同龄人相比，需要长期护理的人与医学专家（神经科医生除外）的接触较少，这可能表明医疗保健服务不足。在此背景下，医学专家与养老院之间的合作协议首先在法律上成为可能，然后被要求实施，最终成为强制性规定（现行有效版本的《社会法典第五卷》第119b条）。
本研究的目的是调查有合作协议和没有合作协议的养老院中，居民与医生的接触密度以及基于需求的医疗治疗在何种程度上存在差异，从而了解这种合作协议在这方面的效果如何。
我们使用来自下萨克森州和不来梅44家养老院的396名护理对象的数据，比较了有合作协议和没有合作协议的养老院在家庭访视、诊所就诊和电话联系的次数以及充分的专科医疗治疗的实现情况。在调查时，44家养老院中有26家与牙医签订了合作协议，17家与全科医生签订了合作协议，7家与神经科医生签订了合作协议。
如果全科医生与养老院之间存在合作协议，与全科医生的个人接触次数往往会更高。在与牙医签订合作协议的养老院中，家庭访视次数是没有此类协议的养老院的两倍，而与神经科医生的合作协议对与这些专家的接触次数没有影响。此外，与牙医的合作协议促进了适当的牙科护理。
结果表明，合作协议可以成为确保养老院医疗护理的有用工具。然而，为了保证合作协议的有效性，应在协议中规定医疗访视的次数。
