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1.
Jens-Oliver Bock Dirk Heider Herbert Matschinger Hermann Brenner Kai-Uwe Saum Walter E. Haefeli Hans-Helmut König 《The European journal of health economics》2016,17(2):149-158
Introduction
All elderly Germans are legally obliged to have health insurance. About 90 % of this population are members of social health insurances (SHI) whose premiums are generally income-related and independent of health status. For most of these members, holding social health insurance is mandatory. As a consequence, genuine information about preferences for health insurance is not available. The aim of this study was therefore to determine and analyze the willingness to pay (WTP) for health insurance among elderly Germans.Methods
Data from a population-based 8-year follow-up of a large cohort study conducted in the Saarland, Germany was used. Participants aged 57–84 years passed a geriatric assessment and responded to a health economic questionnaire. Individuals’ WTP was elicited based on a contingent valuation method with a payment card.Results
Mean monthly WTP per capita for health insurance amounted to €260. This corresponded to about 20 % of individual disposable income. Regression analyses showed that WTP increased significantly with higher income, male gender, higher educational level, and privately insured status. In contrast, neither increasing morbidity level nor higher individual health care costs influenced WTP significantly.Discussion
The relatively large extent of average WTP for health insurance indicates that the elderly would probably accept higher contributions to SHI rather than policy efforts to reduce contributions. The identified determinants of WTP might indicate that elderly generally approve the principle of solidarity of the SHI with contributions depending on income rather than morbidity.2.
3.
Hooman Shahsavari Alireza Nikbakht Nasrabadi Mohammad Almasian Heshmatolah Heydari Abdolrahim Hazini 《Asia Pacific family medicine》2018,17(1):1
Background
Because of the variety of services and resources offered in the delivery of home health care, its management is a challenging and difficult task.Objectives
The purpose of this study was to explore the administrative aspects of the delivery of home health care services.Methods
This qualitative study was conducted based on the traditional content analysis approach in 2015 in Iran. The participants were selected using the purposeful sampling method and data were collected through in-depth semi-structured personal interviews and from discussions in a focus group. The collected data were analyzed using the Lundman and Graneheim method.Results
23 individuals participated in individual interviews, and the collected data were categorized into the two main themes of policymaking and infrastructures, each of which consisted of some subcategories.Conclusion
Health policymakers could utilize the results of this study as baseline information in making decisions about the delivery of home health care services, taking into account the contextual dimensions of home care services, leading to improvements in home health care services.4.
Katja Makowsky 《Pr?vention und Gesundheitsf?rderung》2017,12(1):68-72
Background
During the last 10 years, family midwives have become increasingly integrated into the Early Intervention System in Germany. As representatives of the health care professions and based on a trusting relationship with vulnerable families, they use several strategies to promote positive health behavior and health conditions.Objectives
The aim of the study was to obtain insight into subjective theories of family midwives, which influence their dealings with families and taking a guiding role for the families.Methods
Following a qualitative research approach, 13 family midwives were interviewed. The interviews were interpreted according to methods recommendations by Witzel.Results
Structural circumstances influence family midwives’ subjective theories of good quality. In spite of disclaiming controlling function, family midwives who work directly with representatives of child welfare services, by trend follow the aims of child welfare services. Family midwives working in conjunction with a private agency emphasize their strategies of health promotion.Conclusion
Family midwives can be supported in their strategies of health promotion. Association with a private agency seems to be helpful for maintaining the salutogenetic perspective of midwives.5.
André Hajek C. Brettschneider H. van den Bussche H. Kaduszkiewicz A. Oey B. Wiese S. Weyerer J. Werle A. Fuchs M. Pentzek J. Stein T. Luck H. Bickel E. Mösch K. Heser M. Bleckwenn M. Scherer S. G. Riedel-Heller W. Maier H.-H. König AgeCoDe & AgeQualiDe Study Groups 《The journal of nutrition, health & aging》2018,22(6):689-694
Objectives
The aim of this study was to identify determinants of outpatient health care utilization among the oldest old in Germany longitudinally.Design
Multicenter prospective cohort “Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)” (AgeQualiDe).Setting
Individuals in very old age were recruited via GP offices at six study centers in Germany. The course of outpatient health care was observed over 10 months (two waves).Participants
Primary care patients aged 85 years and over (at baseline: n=861, with mean age of 89.0 years±2.9 years; 85–100 years).Measurements
Self-reported numbers of outpatient visits to general practitioners (GP) and specialists in the past three months were used as dependent variables. Widely used scales were used to quantify explanatory variables (e.g., Geriatric Depression Scale, Instrumental Activities of Daily Living Scale, or Global Deterioration Scale).Results
Fixed effects regressions showed that increases in GP visits were associated with increases in cognitive impairment, whereas they were not associated with changes in marital status, functional decline, increasing number of chronic conditions, increasing age, and changes in social network. Increases in specialist visits were not associated with changes in the explanatory variables.Conclusion
Our findings underline the importance of cognitive impairment for GP visits. Creating strategies to postpone cognitive decline might be beneficial for the health care system.6.
Sharifa Ezat Wan Puteh Siti Nurul Akma Ahmad Azimatun Noor Aizuddin Ramli Zainal Ruhaini Ismail 《Asia Pacific family medicine》2017,16(1):5
Background
Malaysia is an upper middle income country that provides subsidized healthcare to ensure universal coverage to its citizens. The challenge of escalating health care cost occurs in most countries, including Malaysia due to increase in disease prevalence, which induced an escalation in drug expenditure. In 2009, the Ministry of Health has allocated up to Malaysian Ringgit (MYR) 1.402 billion (approximately USD 390 million) on subsidised drugs. This study was conducted to measure patients’ willingness to pay (WTP) for treatment of chronic condition or acute illnesses, in an urbanized population.Methods
A cross-sectional study, through face-to-face interview was conducted in an urban state in 2012–2013. Systematic random sampling of 324 patients was selected from a list of patients attending ten public primary cares with Family Medicine Specialist service. Patients were asked using a bidding technique of maximum amount (in MYR) if they are WTP for chronic or acute illnesses.Results
Patients are mostly young, female, of lower education and lower income. A total of 234 respondents (72.2%) were not willing to pay for drug charges. WTP for drugs either for chronic or acute illness were at low at median of MYR10 per visit (USD 3.8). Bivariate analysis showed that lower numbers of dependent children (≤3), higher personal and household income are associated with WTP. Multivariate analysis showed only number of dependent children (≤3) as significant (p = 0.009; 95% CI 1.27–5.44) predictor to drugs’ WTP.Conclusion
The result indicates that primary care patients have low WTP for drugs, either for chronic condition or acute illness. Citizens are comfortable in the comfort zone whereby health services are highly subsidized through universal coverage. Hence, there is a resistance to pay for drugs.7.
Background
Hospitalisation of acutely ill nursing home residents is associated with health risks such as infections, complications, or falls, and results in high costs for the health care system. Taking the case of pneumonia, nursing homes generally can ensure care according to guidelines.Aim
Extrapolation of overall expenditures for the German statutory health insurance system from the hospitalisation of nursing home residents with respiratory infection/pneumonia; developing alternative cost scenarios to compare nursing home care with hospital care in consideration of patients’ condition.Methods
Data provided by health insurance funds were extrapolated to the German statutory health insurance system and weighted via German-DRG case values. Care processes (hospital vs. nursing home) were modelled, and treatment steps were divided into cost categories. The patient’s condition was standardised via the Barthel Index.Results
Total expenditures of € 163.3 million were incurred for inpatient care of nursing home residents transferred to hospitals for respiratory infection/pneumonia in 2013 in Germany. Process modelling reveals lower direct costs for nursing home care as well as better development of patients’ condition. Looking at operators of nursing homes, both care scenarios necessitate additional services without reimbursement.Conclusion
Expenditure projections for the hospital care of nursing home residents with pneumonia reveal high saving potential. Avoidance of hospital admission serves to considerably reduce the insurers’ expenditures but also the duration and severity of illness. The study illustrates economic incentive structures for health care providers and indicates courses of action for health policy and nursing homes operators.8.
Shinsuke Miyano Gardner Syakantu Kenichi Komada Hiroyoshi Endo Tomohiko Sugishita 《Cost effectiveness and resource allocation : C/E》2017,15(1):4
Background
In resource-limited settings with a high prevalence of human immunodeficiency virus (HIV) infection such as Zambia, decentralization of HIV/acquired immunodeficiency syndrome (HIV/AIDS) treatment and care with effective use of resources is a cornerstone of universal treatment and care.Objectives
This research aims to analyse the cost effectiveness of the National Mobile Antiretroviral Therapy (ART) Services Programme in Zambia as a means of decentralizing ART services.Methods
Cost-effectiveness analyses were performed using a decision analytic model and Markov model to compare the original ART programme, ‘Hospital-based ART’, with the intervention programme, Hospital-based plus ‘Mobile ART’, from the perspective of the district government health office in Zambia. The total cost of ART services, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were examined.Results
The mean annual per-patient costs were 1259.16 USD for the original programme and 2601.02 USD for the intervention programme, while the mean number of QALYs was 6.81 for the original and 7.27 for the intervention programme. The ICER of the intervention programme relative to the original programme was 2965.17 USD/QALY, which was much below the willingness-to-pay (WTP), or three times the GDP per capita (4224 USD), but still over the GDP per capita (1408 USD). In the sensitivity analysis, the ICER of the intervention programme did not substantially change.Conclusion
The National Mobile ART Services Programme in Zambia could be a cost-effective approach to decentralizing ART services into rural areas in Zambia. This programme could be expanded to more districts where it has not yet been introduced to improve access to ART services and the health of people living with HIV (PLHIV) in rural areas.9.
Background
The nursing sector is characterized by high sick leave and fluctuation rates due to work-related stress. There is a need to raise manager’s awareness in the care sector for goal-oriented operational health management.Objectives
Is a serious game a suitable instrument to change nursing care managers’ behaviors and attitudes and increase their knowledge regarding prevention and health promoting management behavior?Materials and methods
Preliminary investigation into the stress of care providers, evaluation of the initial situation in nursing care services, conception of a serious game including training concept, testing and evaluation in the field.Results
In most companies health promotion is not perceived as important (74%); thus, it is expected that “Serious Games for Health” (SGH) will be an effective and suitable instrument to train managers regarding preventive and health promoting management behavior.Conclusions
Operational health management should be anchored as a management task in the nursing care sector. The innovative educational concept “Stress-Rekord” can counteract multifactorial stress in the workplace.10.
Background
Nursing care insurance funds are supposed to deliver preventive services in nursing homes. The strengthening of cognitive resources is considered as one field of action.Aim
The preventive effectiveness of physical activity on cognitive performance in nursing home residents shall be evaluated.Methods
A systematic search was carried out in the databases MEDLINE, the Cochrane Library, EMBASE, CINAHL, PsycINFO and PEDro. Results were combined in random-effects meta-analyses.Results
Taking into account 13 primary studies, it was shown that those participating in physical activity showed statistically significant greater cognitive performance compared to controls (SMD = 0.43, 95% CI 0.20–0.66, p = 00002). Subgroup analyses suggest that nursing home residents with different cognitive impairments might benefit from long-lasting physical activity interventions. Due to the high risk of bias in included studies, the results must be interpreted with caution.Conclusion
Physical activity might be effective in the inpatient care setting. Further studies with longer intervention periods are required.11.
Erika Berggren Y. Orrevall A. Ödlund Olin P. Strang R. Szulkin L. Törnkvist 《The journal of nutrition, health & aging》2016,20(4):428-438
Objective
Evaluate the effectiveness of a continuing educational intervention on primary health care professionals’ familiarity with information important to nutritional care in a palliative phase, their collaboration with other caregivers, and their level of knowledge about important aspects of nutritional care.Design
Observational cohort study.Setting
10 primary health care centers in Stockholm County, Sweden.Participants
140 district nurses/registered nurses and general practitioners/physicians working with home care.Intervention
87 professionals participated in the intervention group (IG) and 53 in the control group (CG). The intervention consisted of a web-based program offering factual knowledge; a practical exercise linking existing and new knowledge, abilities, and skills; and a case seminar facilitating reflection.Measurements
The intervention’s effects were measured by a computer-based study-specific questionnaire before and after the intervention, which took approximately 1 month. The CG completed the questionnaire twice (1 month between response occasions). The intervention effects, odds ratios, were estimated by an ordinal logistic regression.Results
In the intra-group analyses, statistically significant changes occurred in the IG’s responses to 28 of 32 items and the CG’s responses to 4 of 32 items. In the inter-group analyses, statistically significant effects occurred in 20 of 32 statements: all 14 statements that assessed familiarity with important concepts and all 4 statements about collaboration with other caregivers but only 2 of the 14 statements concerning level of knowledge. The intervention effect varied between 2.5 and 12.0.Conclusion
The intervention was effective in increasing familiarity with information important to nutritional care in a palliative phase and collaboration with other caregivers, both of which may create prerequisites for better nutritional care. However, the intervention needs to be revised to better increase the professionals’ level of knowledge about important aspects of nutritional care.12.
Ama de-Graft Aikins Mawuli Kushitor Kwadwo Koram Stella Gyamfi Gbenga Ogedegbe 《BMC public health》2014,14(Z2):S3
Background
The rising burden of chronic non-communicable diseases in low and middle income countries has major implications on the ability of these countries to achieve universal health coverage. In this paper we discuss the impact of cardiovascular diseases (CVD) on primary healthcare services in urban poor communities in Accra, Ghana.Methods
We review the evidence on the evolution of universal health coverage in Ghana and the central role of the community-based health planning services (CHPS) programme and the National Health Insurance Scheme in primary health care. We present preliminary findings from a study on community CVD knowledge, experiences, responses and access to services.Results
The rising burden of NCDs in Ghana will affect the achievement of universal health coverage, particularly in urban areas. There is a significant unmet need for CVD care in the study communities. The provision of primary healthcare services for CVD is not accessible, equitable or responsive to the needs of target communities.Conclusions
We consider these findings in the context of the primary healthcare system and discuss the challenges and opportunities for strengthening health systems in low and middle-income countries.13.
Sylviana Haji Moris Orla Carty Kristina L. Wanyonyi Jennifer E. Gallagher 《Zeitschrift fur Gesundheitswissenschaften》2017,25(6):601-610
Objective
To evaluate patients’ views on health service initiatives established to improve uptake of NHS primary dental care amongst adult patients in a socially deprived area, comparing practices with extended and regular contract capacity.Study design
Service evaluation and cross-sectional survey.Method
Questionnaire survey of patients attending a random sample of dental practices in three inner-metropolitan boroughs of south London following initiatives to improve access to dental care (across dental practices delivering regular and extended contracts for services) exploring attendance patterns and the influence and awareness of local initiatives to promote access.Results
Four hundred fifty adults across 12 dental practices completed questionnaires: 79% reported attending for routine and 21% for urgent care. Patients were most aware of banners outside practices, followed by dental advertisements in newspapers. Vouchers for free treatments were considered of the highest possible influence, followed by vouchers for reduced treatment costs and an emergency out-of-hours helpline. Awareness and influence were not aligned, and there was no evidence of difference by practice contract type whilst there were differences by age and type of attendance.Conclusion
The findings suggest that financial incentives and emergency services are considered the most influential initiatives for adult patients whose attendance patterns appear to be related to personal circumstances rather than merely being influenced by the provision of information.14.
Background
Nationally and internationally, participatory approaches are increasingly seen as being important in many parts of society, and in Anglosaxon countries a range of participatory arts projects are carried out both in health care settings and in health promotion. However, such approaches are not commonly recognised in Germany.Objectives
In this article, we would like to show the potential of participatory arts in a health context.Materials and methods
We give a brief overview of developments and activities internationally, as well as of the situation in Germany. We present systematic literature reviews that examine the effects of arts projects in a health context and we describe artistic experiences with participatory elements relevant to health in Germany.Results
Both the results of the literature review and practical experience suggest that participatory arts projects can have a positive effect in a health context. Although the evidence is limited, positive effects may be possible both at a personal level and at the community level. The reviews examined point to future research needs.Conclusion
This overview has shown that there is a large potential for participatory arts projects in a health context. In Germany, there is much less research activity in this area. It would be desirable to develop this field and to initiate more interdisciplinary collaborations in this area.15.
Roanna Lobo Lester Mascarenhas David Worthington Judith Bevan Donna B. Mak 《BMC health services research》2015,15(1):399
Background
Nurse-supported shared care services for patients living with hepatitis C have been implemented in some regional areas of Western Australia to provide access to local treatment and care services for patients and to improve currently low levels of treatment uptake. This study collected data from health professionals involved in managing the care of patients living with hepatitis C and from patients engaged in regional nurse-supported hepatitis C shared care services in Western Australia.Methods
Key informant qualitative interviews were conducted with health professionals in regions operating a nurse-supported shared care service and in regions without this service. Patients engaged in the shared care program at the time of the study were invited to complete a short questionnaire.Results
Nurse-supported shared care services reduced patient transport costs to tertiary centres, accelerated access to treatment and delivered >98 % compliance with treatment schedules. Patients engaged with regional hepatitis C shared care services expressed high levels of satisfaction and indicated that they would delay treatment if it was not available locally. Telehealth support from tertiary liver clinics and allied health services were available to health professionals engaged in regional shared care services and were used effectively. There was limited participation by general practitioners in regional hepatitis C shared care services and regional patients’ access to treatment was influenced by the availability and capacity of health professionals. Uptake of treatment and engagement in the regional shared care program was limited for Aboriginal people and younger people although these groups had the highest rates of hepatitis C notifications in Western Australia.Discussion
The patients consulted for this study preferred to access hepatitis C treatment and care locally rather than travel to tertiary liver clinics, up to 1500 kilometres away. The reasons for limited engagement in the shared care program by some groups with high rates of hepatitis C notifications requires further investigation. Health professionals identified several benefits of the shared care program including continuity of care for patients, shorter waiting times, longer appointment times and high levels of treatment compliance.Conclusions
Hepatitis nurses in regional areas can coordinate effective patient treatment and care when supported by treatment protocols and access to physicians and liver specialists, including through telehealth. Treatment and care options to suit individual preferences are required to avoid further stigmatising marginalised groups. The role of primary care in facilitating hepatitis C treatment uptake should be explored further including strategies for improving the participation of general practitioners in regional shared care services.16.
Perspectives on the causes of undernutrition of community-dwelling older adults: A qualitative study
Rachel van der Pols-Vijlbrief H. A. H. Wijnhoven M. Visser 《The journal of nutrition, health & aging》2017,21(10):1200-1209
Objectives
Undernutrition is a major health concern particularly in vulnerable older adults. The present study aimed to reveal the causes of undernutrition as reported by community-dwelling older adults.Design
Twenty-five semi-structured interviews and two focus group discussions were performed and analyzed.Setting
Community-dwelling.Participants
Older adults.Measurements
A questionnaire on demographics, Short Nutritional Assessment Questionnaire 65+ and interviews on the potential causes of undernutrition.Results
33 older adults agreed to participate in the interviews and focus groups. Our findings indicate that a wide variety of causes of undernutrition, both modifiable and non-modifiable, were mentioned by the older adults. Many modifiable causes of undernutrition were reported in the mental, social or food & appetite theme, such as poor food quality provided by meal services, the inability to do groceries, loneliness and mourning. Non-modifiable causes included, forgetfulness, aging, surgery and hospitalization.Conclusions
This study provides guidance to better understand the underlying causes of undernutrition from an older adult’s perspective. The modifiable causes provide specific direction towards practical implications that might decrease or prevent undernutrition. Non-modifiable causes should raise awareness of an increased risk of undernutrition by health professionals in primary and secondary care, caregivers and family members.17.
Objectives
The purpose was to assess the association between neck circumference, dysphagia, and undernutrition in elderly individuals requiring long-term care.Design
Cross-sectional study.Setting
Geriatric health services facilities, acute hospitals, and the community.Participants
Elderly individuals ≥65 years of age with dysphagia or possible dysphagia (N=385).Measurements
Neck circumference, the Dysphagia Severity Scale (DSS) and the Mini Nutritional Assessment Short Form (MNA-SF).Results
Participants included 130 males and 255 females with a mean age (± standard deviation) of 83 ± 8.0 years. Sixty-six were in acute hospitals, 195 were in geriatric health services facilities, and 124 were community-dwelling. The mean neck circumference in males and females was 37.1 ± 3.0 cm and 33.3 ± 3.3 cm, respectively. Based on the DSS, 81 participants were within normal limits, 137 had dysphagia without aspiration, and 167 had dysphagia with aspiration. The MNA-SF revealed that 173 were malnourished, 172 were at risk of malnutrition, and 40 had a normal nutritional status. Neck circumference was not significantly correlated with the DSS (r=?0.080) but was significantly correlated with the MNA-SF (r=0.183) in the Spearman rank correlation analysis. In the logistic regression, neck circumference was not independently associated with the DSS after adjusting for the MNA-SF, the Barthel Index, age, sex, setting, and cerebrovascular disorders. However, the multiple regression analysis showed that neck circumference had an independent effect on the MNA-SF after adjusting for the Barthel Index, age, sex, setting and cerebrovascular disorders.Conclusions
Neck circumference is not associated with dysphagia but with undernutrition in elderly individuals requiring long-term care.18.
M. S. van Loon K. M. van Leeuwen R. W. J. G. Ostelo J. E. Bosmans G. A. M. Widdershoven 《Quality of life research》2018,27(5):1181-1189
Purpose
Economic evaluation of services and interventions in care services tends to focus on quality of life(QoL) based on health-related measures such as EQ5D, with a major focus on health and functioning. The Capability Approach (CA) provides an alternative framework for measuring QoL and challenges some of the conventional issues in the current practice of measurement of QoL. The Adult Social Care Outcomes Toolkit (ASCOT) aims to measure social care-related QoL in a broad sense. This article investigates whether and, if so, how the ASCOT addresses issues put on the agenda by the CA.Methods
Literature analysis concerning theoretical assumptions and arguments of CA and ASCOT.Results
The Capability Approach (CA) puts three issues on the agenda regarding QoL. First, the focus of evaluation should not be on functioning, but on freedom of choice. Second, evaluation should be critical about adaptive preferences, which entail that people lower expectations in situations of limited possibilities. Third, evaluation should not only address health, but also other domains of life. Our analysis shows that freedom of choice is reflected in the response option ‘as I want’ in the ASCOT questionnaire. The problem of adaptive preferences is countered in the ASCOT by developing a standard based on preferences of the general population. Third, the ASCOT contains several domains of life.Conclusions
We conclude that the CA and the ASCOT contribute to the discussion on QoL, and that the ASCOT operationalizes core assumptions of the CA, translating the issues raised by the CA in a practical way.19.
Lilli Neumann U. Dapp W. von Renteln-Kruse C. E. Minder 《The journal of nutrition, health & aging》2017,21(9):1016-1023
Objectives
An RCT of a health promotion and preventive care intervention was done in 2001-2002. Here, long-term analyses based on 12 years of follow-up of survival and of change in functional competence between intervention and control group are presented. Positive 1-year results (significantly higher use of preventive services and better health behaviour) were presented earlier.Design
Parallel group randomised controlled trial (RCT) with 878 participants in the intervention and 1,702 participants in the control group.Setting
The study took place in Hamburg, Germany and made use of health care structures and professionals of a geriatrics centre.Participants
Study participants were initially community-dwelling, aged 60 years and older and without B-ADL-restrictions, cognitive impairment, or need of nursing care, with sufficient command of the German language.Interventions
Health promotion and preventive care interventions relied on an extensive health questionnaire and the subsequent offer to participate in multi-topic personal reinforcement performed in small group sessions or at preventive home visits.Measurements
Primary outcome: Survival time; in some analyses, adjustments were made for gender, age and self-perceived health. Secondary outcome: Functional competence (LUCAS Functional Ability Index) based on responses to self-administered questionnaires at 1-year follow-up and 12 years after 1-year follow-up (2013/2014).Results
Mean time under observation was 10.3 years. 38.3% (987/2,580) of the participants died; intervention group (IG): 35.7% (313/878), control group (CG): 39.6% (674/1,702); HR=0.89; p=0.09. Functional competence at 1-year follow-up: IG: ROBUST 67.4% (391/580), FRAIL 11.9% (69/580) vs. CG: ROBUST 62.9% (861/1,368), FRAIL 14.8% (203/1,368); p=0.12. 12-years after 1-year follow-up: IG: ROBUST 50.0% (160/320), FRAIL 30.9% (99/320) vs. CG: ROBUST 48.9% (307/628), FRAIL 34.1% (214/628); p=0.56.Conclusions
Insignificant but consistent effects on survival and the dynamics of functional competence suggest effectivity of the complex intervention. We plan to take a closer look at the effect of each reinforcement separately.20.