[Size and type of frequent use of ambulatory medical care among the elderly population in Germany: a study based on statutory health insurance data].
BACKGROUND
The authors report the results of a study on frequent attenders in ambulatory medical care among elderly people in Germany and on the factors related to frequent attendance such as age, sex, multi-morbidity and long-term care dependency.


METHODS
The study was based on claims data of all policy holders aged 65 and over of a statutory health insurance company operating nationwide in Germany in 2004 (n=123,224). Utilisation was analysed by the number of contacts with practices of physicians working in the ambulatory medical care sector and by the number of different practices contacted. The criteria for frequent attendance included greater than or equal to 50 contacts and/or greater than or equal to 10 different practices contacted and/or greater than or equal to 3 practices of the same discipline contacted within one year. Descriptive statistical analysis and logistic regression were used.


RESULTS
19% of the elderly were identified as frequent attenders, which corresponds to some 3.5 million people in Germany. Two main types of frequent attendance were identified: one is characterised by very many contacts, old age, frequent presence of multi-morbidity, and/or long-term care dependency. The other type is the younger, less frequently multi-morbid attender who is considerably less often dependent on long-term care, and characterised by large numbers of contacted practices and/or practices of the same discipline.


CONCLUSIONS
Frequent attendance is due to several factors. The problem of frequent attendance needs further research that is not exclusively based on claims data. We found a high rate of frequent attendance. Further research should clarify if this is to the benefit of elderly people.
Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf. Electronic address: bussche@uke.de.
Hendrik
H
van den Bussche
Hanna
H
Kaduszkiewicz
Detlev
D
Niemann
Ingmar
I
Schäfer
Daniela
D
Koller
Heike
H
Hansen
Martin
M
Scherer
Karl
K
Wegscheider
Gerd
G
Glaeske
Gerhard
G
Schön
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D003284:Contract Services / Q000191:economics / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000191:economics / Q000706:statistics & numerical data; D006302:Health Services Research / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data*; D012737:Sex Factors; D014600:Utilization Review / Q000706:statistics & numerical data
Häufignutzung; Inanspruchnahme; Multimorbidität; Primary care; Vertragsärztliche Versorgung; elderly population; frequent attenders; health services utilisation; high users; multi-morbidity; Ältere Bevölkerung