[Recommendation for rehabilitation measures of elderly disabled patients by the medical service of hospital insurance in Berlin and Brandenburg].
According to the German Nursing Care insurance law (Pflegeversicherungsgesetz) experts of the Medical Advisory Board of the statutory sickness funds (Medizinischer Dienst der Krankenversicherung, MDK) must consider recommending rehabilitative measures for persons in need of nursing care. This study measures the proportion of proposed rehabilitative therapies (physiotherapy, ergotherapy, speech therapy) as well as clinical and non-clinical predictors for these recommendations. The study population of the cross-sectional study consisted of all persons aged 60 years and older in Berlin and Brandenburg for whom the MDK experts had diagnosed a need for nursing care (stages I to III) by means of home visits in the second half of 1995. Data on recommendations and potential predictors were taken from the expert records. Recommendation rates were 6.6% (physiotherapy), 0.7% (ergotherapy) and 0.8% (speech therapy) respectively, for Berlin and Brandenburg taken together. While clinical variables (impairments and disabilities) had a considerable impact on the recommendations, also non-clinical variations were noted. Physiotherapy recommendation rates differed 3-fold by region (Brandenburg: 10.3%; Berlin: 3.4%). Variations also existed for age (60-70 years: 10.7%; > 90 years: 2.5%) and the presence of a professional care institution (present: 8.6%; not present: 5.4%). The strongest effect had an already existing prescription of physiotherapy from the patient's physician (current physiotherapy: 23.5%, no current physiotherapy: 4.6%). Multiple logistic regression demonstrated that these variables had independent effects after accounting for their overlapping influences and clinical characteristics. Variations of physiotherapy recommendation rates were also found for profession of the MDK experts (physician: 5.9%; nurse: 9.2%; physician and nurse together: 7%), but the effects were only partially independent. The observed low rates of recommended physiotherapy, ergotherapy and speech therapy as well as the non-clinical variations question the appropriateness of current recommendation practices.
Wolf
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N
Humboldt-Universität Berlin, Institut für Rehabilitationswissenschaften.
Matthesius
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G
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D004608:Eligibility Determination / Q000331:legislation & jurisprudence; D005104:Expert Testimony / Q000331:legislation & jurisprudence; D005260:Female; D016330:Frail Elderly; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000331:legislation & jurisprudence*