CHARE-GD I Subproject 4: The Influence of Primary Care Provision on Health Care in Nursing Homes
Although nursing home residents in Germany and the Netherlands hardly differ from one another, there are major discrepancies in terms of their medical care. Sub-project 4 of the CHARE-GD I study therefore aims to identify differences and similarities in healthcare between German and Dutch nursing home residents. The consequences of these differences will also be assessed.
Aims of the article
Hospitalisation is a major difference in the use of health services. Hospitalisation of nursing home residents is associated with far-reaching complications (e.g. hospital-acquired infections) and leads to increased health care costs. Many of these hospitalisations are considered potentially preventable. The proportion of residents with hospitalisations varies widely between countries, including between neighbouring countries such as Germany and the Netherlands. However, there has been no systematic comparison. The aim of a systematic literature review was therefore to compare the proportions of nursing home residents with hospital admissions between the two countries. The focus was on periods when the risk of hospitalisation is particularly high, i.e. the first six months after admission to a nursing home and the last six months before death.
The main results
3 biomedical literature databases (MEDLINE via Pubmed, EMBASE and CINAHL) were searched to assess the eligibility of all observational studies up to the publication date of 3 May 2022. After reviewing 1,856 records, 9 studies were finally included, published in 14 articles (Germany: 8; Netherlands: 6). One study per country examined the first 6 months after institutionalisation. In total, 10% of Dutch and 42% of German nursing home residents were hospitalised during this period. A total of 7 studies reported on deaths in hospital, with the proportion fluctuating around 29% in Germany and between 1% and 16% in the Netherlands. The proportion of hospitalisations in the last 30 days of life ranged from 8% to 16% (Netherlands: n = 2) and from 49% to 58% (Germany: n = 3). Only the German studies analysed differences by age and sex. Although hospitalisations were less frequent in older age, they were more frequent in male residents.
The higher figures for Germany may be explained by differences in care systems. There is a lack of research, especially on the first months after admission to a nursing home. The results of this study will be included in future studies that look more closely at the care processes of nursing home residents. Unnecessary hospital transport should be avoided for the benefit of nursing home residents.
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You can find this study here: www.jamda.com/article/S1525-8610(23)00108-1/pdf
Fassmer AM, Allers K, Helbach J, Zuidema S, Freitag M, Zieschang, T, Hoffmann F. Hospitalization of German and Dutch Nursing Home Residents Depend on Different Long-Term Care Structures: A Systematic Review on Periods of Increased Vulnerability. Journal of the American Medical Directors Association 2023. Volume 24, Issue 5, P609-618.E6, May 2023
Aims of the article
In Germany, nursing home residents are cared for by general practitioners (GPs) and other specialists. In the Netherlands, care is organised differently depending on the type of institution. In Verpleeghuizen (the majority of homes), residents receive medical care from Elder Care Physicians (ECPs) who are employed directly by the homes. In Verzorgingshuizen, similar to Germany, GPs in private practice are responsible for the care of residents. In general, specialist medical care is not provided on an outpatient basis in the Netherlands. Until now, very little information has been available on the need for and actual medical care of nursing home residents in both countries. This study therefore aimed to compare the characteristics of German and Dutch nursing homes, their residents and the need for and actual use of medical care.
The main findings
Two surveys were conducted among 600 randomly selected nursing homes in Germany and the Netherlands. The questionnaires were sent out in May 2022. We received 199 German questionnaires (response rate: 33%) and 102 Dutch questionnaires (response rate: 17%). The characteristics of the residents were similar in both countries. While the German homes rated residents' need for general medical care higher than the Dutch homes (88% vs. 78%), the opposite was true for the need for dental care (81% vs. 71%). For all 4 medical specialities surveyed, German homes were more likely to see a need for treatment than Dutch homes, e.g. 48% versus 12% for neurology. In addition, Dutch homes were significantly more likely to think that GPs/ECPs were able to meet these needs. The number of GP/ECP contacts per resident per year was similar in both countries (Germany: 27; Netherlands: 29). Almost all Dutch homes had other permanently employed health professionals (e.g. physiotherapists), whereas this was rarely the case in Germany.
We found large differences in the medical care provided to nursing home residents. It seems that GPs/ECPs in the Netherlands cover the needs that require specialist consultation in Germany. Some of the differences between the countries may be explained by system-cultural differences. The results of this study will be used to design individual interviews with caregivers and GPs/ECPs in both countries to obtain more information about the different organisation of medical care.
Would you like to know more?
You can find this study here: https://pubmed.ncbi.nlm.nih.gov/37716216/
Fassmer, AM, Zuidema SU, Janus SIM, Hoffman F. Comparison of medical care needs and actual care in German and Dutch nursing home residents: a cross-sectional study conducted in neighboring European countries. Archives of Gerontology and Geriatrics.