gms | German Medical Science

Background and objective: Elderly patients are at higher risk for developing chronic conditions and becoming care-depending. Early geriatric assessments can help to timely identify geriatric need. Subsequent holistic therapeutic approaches may maintain the independence of elderly patients. Family doctor practices as first contact point for patients have a great relevance for the timely identification of geriatric needs. The aim of this study is to examine regional differences in the utilization of outpatient geriatric services in Mecklenburg-Western Pomerania (MV).

Research questions: Which proportion of entitled patients receive outpatient geriatric healthcare? Are there regional disparities in the utilization of general (GOGC) and specialized outpatient geriatric care (SOGC) in MV?

Methods: Geographical analysis and cartographic presentation of the spatial distribution of outpatient geriatric services in relation to the population at risk on the level of ZIP-code-areas. Basis of the analysis were reimbursement data of the Association of Statutory Health Insurance Physicians MV (KV MV) of 2017. We included all geriatric patients who are entitled either to GOGC or to SOGC according to the definition of the KV MV. A Moran’s I analysis was carried out in order to identify statistically significant clusters of low or high utilization rates of geriatric services.

Results: Of the 221,654 patients (75.3% of all inhabitants of MW ≥70) who were eligible for GOGC in 2017, 58.3 % (n=129,283) received at least one basic geriatric service. Of 95.171 patients who were entitled to SOGC, 77.2% (n=73,442) received at least GOGC or SOGC once. Only 0.4 percent (n=414) of this group entitled to SOGC received specialized geriatric services. The proportion of patients who received a basic geriatric assessment ranged in the postal-code-areas from 3.4 to 86.7 percent (with 90% of the values between 21.4 and 77.0 percent) and a median of 51.6%. Moran’s I showed 4 regions with clusters of significant high utilization and 4 regions with clusters of low utilization rates of GOGC. Only 3 of overall 12 specialized geriatricians actually provided SOGC. All of them are located in regions with significant clusters of high utilization rates.

Discussion: The proportion of patients who received geriatric care is lower than the entitled population. The wide range of regional variations in the utilization rates and the local segregation of high and low rates in some regions indicates that the provision of outpatient geriatric care not always depends on patient needs, but also on local or regional structures. With respect to SOGC, the provision is limited to a few regions. To what extent a substitution is carried out by inpatient healthcare providers cannot be answered on the basis of these data. However, the presence of active and networking SOGC providers seems to effect regional higher rates of overall geriatric utilization.

Practical implications: The provision of SOGC should be improved, e.g. specialist training for geriatrics should be established in MV, so that in future a state-wide access to SOGC exists.

Appeal for practice: The networking of local geriatric structures and the interdisciplinary exchange of knowledge should be fostered.