gms | German Medical Science

Background and Purpose: Nursing care plays a pivotal role in providing long-term intensive care for tracheotomised patients. To address the patients´ complex care needs, specialised nursing services need to be provided, usually around the clock and based on integrated approaches within multi professional care teams. Systemic and structural challenges actually complicate professional cooperation and care coordination in Germany. A first cross-sectoral analysis of the availability and regional distribution of specialised health care structures and services aimed at establishing basic information within the three German federal states of Berlin, Brandenburg and Mecklenburg West-Pomerania to support needs based and integrated care approaches.

Methodological and Theoretical Framework, Methods: Based on the framework of needs-based care and Community Health Assessment principles, an exploratory descriptive approach was used to identify specialised providers in the inpatient (acute care and rehabilitation) and outpatient sector (skilled nursing care services, nursing homes, shared apartments, general practitioners, medical specialists, therapists, providers of medical supplies). Systematic searches of (non-)official databases were conducted. Results were documented tabular and geographically.

Results: Information on specialised nursing care exclusively derived from non-official databases since they are actually not part of public monitoring or statistics. Thus, information on specialised providers are difficult to determine. This is especially true for specialised shared apartments. The structures of specialised services are subject to a considerable level of regional variation with higher density and diversity in urban regions. Numerous home care organisations provide specialised services in patients´ homes or shared apartments. They are often established nearby inpatient care facilities that are mostly concentrated in central regions. In contrast, specialised nursing homes are overall rare. Qualitative information on the services offered (e.g. staff qualification, scope of services) is overall scarce.

Conclusions: This first cross-sectoral overview of specialised health care structures and services for tracheotomised patients in three German federal states enhances transparency within this highly complex field. With regard on nursing care as a crucial part of the multi professional care team, the results implicate the need for more transparency on the services offered. To enhance needs based and integrated care approaches, issues concerning nursing care coordination responsibilities, networking strategies and qualification standards also have to be further clarified and systematically assessed.