title: How do people with dementia utilise primary care physicians and specialists within dementia networks? Results of the Dementia Networks in Germany (DemNet-D) study.
abstract: Outpatient dementia healthcare is predominantly fragmented, and dementia networks (DNs) represent an integrated care concept to overcome this problem. Little is known about the patients of these networks with regard to utilisation of physicians and associated factors. We interviewed 560 caregivers of people with dementia in 13 different DNs in Germany in 2013 and assessed socio-demographics, clinical data and physician utilisation. Networks were categorised in predominantly medical DNs and community-oriented DNs. Descriptive and multivariate statistical models were used to identify associated factors between DNs and users' data. Overall, the users of networks received high rates of physician care; 93% of the sample stated at least one contact with a primary care physician within the last 6 months, and 74% had been treated by a specialist (neurology/psychiatry physician). Only 5% of the sample had no contact with a physician in the 6 months preceding the interview. Females showed a lower odds for physician specialist consultations (OR = 0.641). Users of medical DNs receive greater specialist consultations overall (OR = 8.370). Compared to the German general population and people with dementia in other settings, users of DNs receive physician care more regularly, especially with regard to the consultations of neurologist/psychiatrists. Therefore, DNs seem to perform a supportive role within the integration of physician healthcare. More research is needed on the appropriate relationship between the needs of the people with dementia and utilisation behaviour.
authors.affiliation: German Center for Neurodegenerative Diseases (DZNE), Working Group "Interventional Health Care Research", Site Rostock/Greifswald, Greifswald, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Wübbeler
authors.affiliation: German Center for Neurodegenerative Diseases (DZNE), Working Group "Interventional Health Care Research", Site Rostock/Greifswald, Greifswald, Germany.
authors.forename: Jochen René
authors.initials: JR
authors.lastname: Thyrian
authors.affiliation: German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Michalowsky
authors.affiliation: German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany.
authors.forename: Pia
authors.initials: P
authors.lastname: Erdmann
authors.affiliation: German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Hertel
authors.affiliation: German Center for Neurodegenerative Diseases (DZNE), Working Group "Care Structures" Site Witten, Witten, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Holle
authors.affiliation: Department of Human and Health Science, University of Bremen, Bremen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Gräske
authors.affiliation: IfaS Zentrum für kooperative Forschung an der DHBW Stuttgart, Fakultät Sozialwesen, Stuttgart, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Schäfer-Walkmann
authors.affiliation: German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Greifswald, Germany.|Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hoffmann
mesh_terms: D000368:Aged; D019033:Delivery of Health Care, Integrated; D003704:Dementia / Q000628:therapy*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D011570:Psychiatry; D012017:Referral and Consultation; D012959:Socioeconomic Factors; D013038:Specialization
keywords: dementia; integrated healthcare systems; medical specialists; networks; outpatient; primary care; utilisation