[Which chronic diseases are associated with frequent attending of ambulatory medical care in the elderly population in Germany? - A study based on statutory health insurance data].
BACKGROUND
Frequent attenders utilise a high proportion of medical services and therefore produce relatively high costs. Questions of utility and adequacy and, also, about the reasons for high use arise. The authors report the results of a study on the association between morbidity of the elderly and various forms of frequent attendance in ambulatory medical care in Germany.


METHODS
The study is based on claims data of all policyholders 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. Criteria for frequent attendance were ≥ 50 contacts with practices or contacts with ≥ 10 individual practices or ≥ 3 practices of the same discipline per year. We analysed prevalences and relative risks for frequent attendance for 46 chronic diseases.


RESULTS
Frequent attendance in ambulatory medical care among the elderly is related to both severe somatic and psychic diagnoses. Five chronic diseases showed the highest relative risks for all types of frequent attendance in general: urinary incontinence, anaemia, neuropathies, renal insufficiency, and cancer. Psychic syndromes mainly led to the utilisation of many different physicians.


CONCLUSIONS
Frequent attendance in ambulatory medical care among the elderly is related to a large number of diseases, both somatic and psychic. Frequent attendance is a complex phenomenon which cannot be addressed by mono-dimensional approaches.
Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf. Electronic address: bussche@uke.de.
Hendrik
H
van den Bussche
Detlef
D
Niemann
Hanna
H
Kaduszkiewicz
Ingmar
I
Schäfer
Daniela
D
Koller
Heike
H
Hansen
Martin
M
Scherer
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; D003284:Contract Services / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000191:economics / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D014600:Utilization Review / Q000706:statistics & numerical data*
Epidemiologie; Health services utilisation; Häufignutzung; Morbidität; Vertragsärztliche Versorgung; elderly; epidemiology; frequent attendance; high users; ältere Bevölkerung