title: [Medical services for nursing home residents : Results of the study on inappropriate medication in patients with renal insufficiency in nursing homes].
abstract: BACKGROUND
  In Germany approximately 800,000 people are living in nursing homes. Outpatient medical treatment is provided by general practitioners (GP) and a variety of medical specialists. While nearly all residents have regular contact with GPs, care by specialists differs between the various disciplines.
  
  
  OBJECTIVE
  In this study an assessment of medical treatment for nursing home residents by GPs and specialists was made and compared with the available diagnoses.
  
  
  METHODS
  Between October 2014 and April 2015 a cross-sectional study was conducted in nursing homes in Bremen and the surrounding areas. Anonymized data based on residents' files were collated by nursing staff. Every contact with various specialists within the preceding 12 months was assessed and grouped into (a) no physician visit, (b) resident visited physician and (c) physician visited resident. Analyses were stratified for age, sex and level of care dependency as well as dementia and further comorbidities.
  
  
  RESULTS
  A total of 852 residents in 21 nursing homes were included (mean age 83.5 years, 76.5 % female) in the study. Dementia was diagnosed in 57.7 %. Nearly all residents had had contact with their GP in the previous 12 months, mostly by home visits (96.9 %). The majority (54.5 %) had not seen a dentist in the preceding 12 months and 25.4 % had been visited by a dentist. Of the residents 47.4 % were visited by a neurologist or psychiatrist but only 4.5 % visited these specialists in their practice. Higher care dependency and younger age were associated with more frequent visits by neurologists and psychiatrists. Contact rates to ophthalmologists (29.3 %) and urologists (20.5 %) were less frequent. A diagnosis of diabetes mellitus had no influence on the contact rate with ophthalmologists.
  
  
  CONCLUSIONS
  Medical care by specialists is characterized by huge variations. Besides a frequent contact rate with GPs there seems to be an undersupply regarding care by dentists and ophthalmologists.
authors.affiliation: Abteilung Versorgungsforschung, Institut für Public Health und Pflegeforschung (IPP), Universität Bremen, Grazer Str. 4, 28359, Bremen, Deutschland. schmiema@uni-bremen.de.|Health Sciences Bremen, Universität Bremen, Bremen, Deutschland. schmiema@uni-bremen.de.
authors.forename: Guido
authors.initials: G
authors.lastname: Schmiemann
authors.affiliation: Medizinische Klinik, Rotes Kreuz Krankenhaus, Bremen, Deutschland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Herget-Rosenthal
authors.affiliation: Department für Versorgungsforschung, Fakultät für Medizin und Gesundheitswissenschaft, Carl von Ossietzky Universität, Oldenburg, Deutschland.
authors.forename: Falk
authors.initials: F
authors.lastname: Hoffmann
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000188:drug therapy / Q000453:epidemiology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data; D005858:Germany / Q000453:epidemiology; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D009732:Nursing Care / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000706:statistics & numerical data*; D009819:Office Visits / Q000706:statistics & numerical data; D012076:Renal Agents / Q000627:therapeutic use*; D051437:Renal Insufficiency / Q000188:drug therapy* / Q000453:epidemiology; D017678:Sex Distribution
chemical_list: D012076:Renal Agents
keywords: Health services research; Home visits; Office visits; Physicians, family; Specialists