CHARE-GD I Subproject 4: The Influence of Primary Care Provision on Health Care in Nursing Homes
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CHARE-GD I Subproject 4: The Influence of Primary Care Provision on Health Care in Nursing Homes
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Project background
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.
Hospitalization of German and Dutch Nursing Home Residents Depend on Different Long-Term Care Structures: A Systematic Review on Periods of Increased Vulnerability
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.
Implications
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
Comparison of medical care needs and actual care in German and Dutch nursing home residents: a cross-sectional study conducted in neighboring European countries
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.
Implications
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.
Differences in emergency department visits and hospitalization between German and Dutch nursing home residents: a cross-national survey
Aims of the article
Due to their often poor state of health, nursing home residents have a higher need for medical care. This can also translate into a higher risk of (acute) hospital transfers. Many of these transfers are considered potentially avoidable in the international literature. The figures vary not only worldwide, but also between neighboring countries. For example, a recent systematic review in this project found much higher transport figures for Germany than for the Netherlands. However, this work only represents an indirect comparison of different studies, each of which had different study populations and questions. This cross-national nursing home survey was therefore intended to determine the frequency of hospital transports from nursing homes using the identical methodology in both countries and to investigate underlying care processes such as medical involvement in the transport decision.
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 (response: 33%) and 102 Dutch questionnaires (response: 17%). German nursing homes estimated the proportion of hospital admissions within one year to be higher than Dutch facilities (visits to the emergency department: 27% vs. 8%; hospital admissions: 30% vs. 11%). In German nursing homes, the proportion of transfers to hospital where the decision was made by the referring doctor was lower than in Dutch facilities (59% vs. 89%). More German facilities agreed that care home residents were transferred to hospital too frequently (25% vs. 11%). German nursing homes were much more likely than Dutch facilities to agree that there is no alternative to hospitalization when a care home resident has fallen (66% vs. 13%).
Implications
The higher transport figures for Germany are probably mainly due to the different organization of general and medical care in care homes and the immediate availability of multi-professional teams, which simplify the direct care of residents in the Netherlands compared to Germany. Better coordination of medical care for residents is probably the best starting point for reducing unnecessary hospital referrals. Future studies should therefore take a closer look at how many hospital referrals can be avoided through this type of outpatient care in the nursing home and whether overall costs can be saved despite comprehensive care in the facility.
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You can find this study here: https://doi.org/10.1007/s41999-024-00975-2
Fassmer, AM, Zuidema SU, Janus SIM, Hoffman F. Differences in emergency department visits and hospitalization between German and Dutch nursing home residents: a cross-national survey. Eur Geriatr Med. 2024 Apr 29. doi: 10.1007/s41999-024-00975-2. Online ahead of print.
End-of-life care in German and Dutch nursing homes: a cross-sectional study on nursing home staff’s perspective in 2022
Aims of the article
In an increasingly ageing society, the need for nursing home places is growing. Nursing home residents often have multiple chronic conditions. As a result, they tend to spend the last part of their lives in nursing homes. Dignified and appropriate end-of-life care in nursing homes has therefore become much more important in recent years. Despite this, nursing home residents are often transferred to hospital in the last phase of their lives, often against their will. Existing studies suggest that such transfers are less frequent in the Netherlands than in Germany, and that residents' wishes are more often documented and acted upon in Dutch nursing homes. The aim of this transnational study was therefore to examine and evaluate end-of-life care in German and Dutch nursing homes.
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: 33%) and 102 Dutch questionnaires (response: 17%). The German participants estimated that 21% of residents die in hospital, compared to only 6% in the Netherlands. Advance care planning (ACP) was offered less frequently in German nursing homes (39% in Germany, 75% in the Netherlands) and residents' wishes for emergency situations were known much less frequently than in Dutch nursing homes. General practitioners in Germany were considered to be less well trained in end-of-life care. The most important measures to improve end-of-life care were comparable in both countries.
Implications
This study found differences in end-of-life care (and knowledge about it) between Germany and the Netherlands. These may be due to structural differences (in most Dutch nursing homes, doctors are available 24 hours a day) and cultural differences (in the Netherlands, quality of life is discussed more than life-sustaining measures). Because of these differences, a country-specific approach is needed to improve end-of-life care.
Would you like to know more?
You can find this study here: doi.org/10.1186/s13690-024-01316-2
Bauer, AK., Fassmer, A.M., Zuidema, S.U., Janus S.I.M, Hoffman F. End-of-life care in German and Dutch nursing homes: a cross-sectional study on nursing home staff’s perspective in 2022. Arch Public Health 82, 85 (2024).