Berloge Christopher, Völkel Anna, Jacobs Hannes, Burger Birte, Stahmeyer Jona T, Brütt Anna Levke, Hoffmann Falk, Schleef Tanja, Stiel Stephanie
Institute for General Practice and Palliative Care, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625, Germany.
Department of Health Services Research, Junior Research Group for Rehabilitation Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany.
BMC Geriatr. 2024 Dec 12;24(1):999. doi: 10.1186/s12877-024-05578-x.
Demographic changes are leading to a rise in the demand for care services, with nursing homes (NHs) playing an increasingly important role in end-of-life care. Evidence suggests that NH residents at the end of life significantly benefit from hospice and palliative care and the implementation of advance care planning (ACP). In 2018, Germany passed a law to promote the implementation of ACP in NHs and to enable the refinancing of ACP services by the statutory health insurance funds. The present study aimed at assessing current hospice and palliative care structures, examining the implementation of ACP and identifying barriers to obtain approval for billing for ACP services under this specific legislative (§ 132 g SGB V).
As a part of the "Gut-Leben" project, the present study administered a cross-sectional quantitative survey in 2023 to evaluate hospice and palliative care structures, the implementation of ACP, and barriers to ACP approval in German NHs. A questionnaire was distributed to a random sample of N = 1,369 NH managers. Responses were analyzed using descriptive statistical methods.
N = 330 NH managers responded to the questionnaire (24.1% response). The majority described the end-of-life care structures in their region as rather good (77.7; n = 256), and very strong collaboration was reported with general practitioners (54.7%), physiotherapists (42.9%), and palliative care physicians (38.6%). Awareness of the legislative for ACP was reported by n = 201 NHs (64.4%), and 100 (50.3%) of these NHs had already obtained approval. The primary barriers to approval identified by 68 NHs included a lack of available staff (48.5%; n = 33) and a small facility size (27.9%; n = 19).
Although half of the NHs have implemented ACP, there is still a need to enhance awareness of the ACP legislative. These efforts should aim to reduce the existing barriers to approval, which could be achieved, for instance, by fostering collaboration between NHs or by cooperating with external ACP service providers.
人口结构的变化导致护理服务需求上升，养老院在临终关怀中发挥着越来越重要的作用。有证据表明，临终养老院居民从临终关怀和姑息治疗以及预先护理计划（ACP）的实施中显著受益。2018年，德国通过了一项法律，以促进养老院实施ACP，并使法定健康保险基金能够为ACP服务再融资。本研究旨在评估当前的临终关怀和姑息治疗结构，检查ACP的实施情况，并确定在这一特定立法（《社会法典》第五卷第132g条）下获得ACP服务计费批准的障碍。
作为“善终生活”项目的一部分，本研究于2023年进行了一项横断面定量调查，以评估德国养老院的临终关怀和姑息治疗结构、ACP的实施情况以及ACP批准的障碍。向N = 1369名养老院管理人员的随机样本发放了问卷。使用描述性统计方法对回复进行分析。
N = 330名养老院管理人员回复了问卷（回复率为24.1%）。大多数人将其所在地区的临终关怀结构描述为相当好（77.7%；n = 256），并报告与全科医生（54.7%）、物理治疗师（42.9%）和姑息治疗医生（38.6%）有非常密切的合作。n = 201家养老院（64.4%）报告了解ACP立法，其中100家（50.3%）养老院已经获得批准。68家养老院确定的批准的主要障碍包括缺乏可用工作人员（48.5%；n = 33）和设施规模小（27.9%；n = 19）。
尽管一半的养老院已经实施了ACP，但仍有必要提高对ACP立法的认识。这些努力应旨在减少现有的批准障碍，例如通过促进养老院之间的合作或与外部ACP服务提供商合作来实现。
