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Abstract：
BACKGROUND: Due to unidentified geriatric needs, elderly patients have a higher risk for developing chronic conditions and acute medical complications. Early geriatric screenings and assessments help to identify geriatric needs. Holistic and coordinated therapeutic approaches addressing those needs maintain the independence of elderly patients and avoid adverse effects. General practitioners are important for the timely identification of geriatric needs. The aims of this study are to examine the spatial distribution of the utilization of outpatient geriatric services in the very rural Federal State of Mecklenburg-Western Pomerania in the Northeast of Germany and to identify regional disparities.
METHODS: Geographical analysis and cartographic visualization of the spatial distribution of outpatient geriatric services of patients who are eligible to receive basic geriatric care (BGC) or specialized geriatric care (SGC) were carried out. Claims data of the Association of Statutory Health Insurance Physicians in Mecklenburg-Western Pomerania were analysed on the level of postcode areas for the quarter periods between 01/2014 and 04/2017. A Moran\'s I analysis was carried out to identify clusters of utilization rates.
RESULTS: Of all patients who were eligible for BGC in 2017, 58.3% (n = 129,283/221,654) received at least one BCG service. 77.2% (n = 73,442/95,171) of the patients who were eligible for SGC, received any geriatric service (BGC or SGC). 0.4% (n = 414/95,171) of the patients eligible for SGC, received SGC services. Among the postcode areas in the study region, the proportion of patients who received a basic geriatric assessment ranged from 3.4 to 86.7%. Several regions with statistically significant Clusters of utilization rates were identified.
CONCLUSIONS: The widely varying utilization rates and the local segregation of high and low rates indicate that the provision of outpatient geriatric care may depend to a large extent on local structures (e.g., multiprofessional, integrated networks or innovative projects or initiatives). The great overall variation in the provision of BGC services implicates that the identification of geriatric needs in GPs\' practices should be more standardized. In order to reduce regional disparities in the provision of BGC and SGC services, innovative solutions and a promotion of specialized geriatric networks or healthcare providers are necessary.
METHODS: Geographical analysis and cartographic visualization of the spatial distribution of outpatient geriatric services of patients who are eligible to receive basic geriatric care (BGC) or specialized geriatric care (SGC) were carried out. Claims data of the Association of Statutory Health Insurance Physicians in Mecklenburg-Western Pomerania were analysed on the level of postcode areas for the quarter periods between 01/2014 and 04/2017. A Moran\'s I analysis was carried out to identify clusters of utilization rates.
RESULTS: Of all patients who were eligible for BGC in 2017, 58.3% (n = 129,283/221,654) received at least one BCG service. 77.2% (n = 73,442/95,171) of the patients who were eligible for SGC, received any geriatric service (BGC or SGC). 0.4% (n = 414/95,171) of the patients eligible for SGC, received SGC services. Among the postcode areas in the study region, the proportion of patients who received a basic geriatric assessment ranged from 3.4 to 86.7%. Several regions with statistically significant Clusters of utilization rates were identified.
CONCLUSIONS: The widely varying utilization rates and the local segregation of high and low rates indicate that the provision of outpatient geriatric care may depend to a large extent on local structures (e.g., multiprofessional, integrated networks or innovative projects or initiatives). The great overall variation in the provision of BGC services implicates that the identification of geriatric needs in GPs\' practices should be more standardized. In order to reduce regional disparities in the provision of BGC and SGC services, innovative solutions and a promotion of specialized geriatric networks or healthcare providers are necessary.
摘要：
背景：由于未知的老年需求，老年患者发生慢性疾病和急性并发症的风险较高.早期的老年筛查和评估有助于确定老年需求。解决这些需求的整体和协调的治疗方法保持了老年患者的独立性并避免了不利影响。全科医生对于及时识别老年需求很重要。这项研究的目的是研究德国东北部非常农村的梅克伦堡-西波美拉尼亚联邦州的门诊老年服务利用的空间分布，并确定地区差异。
方法：对有资格接受基础老年护理（BGC）或专门老年护理（SGC）的患者的门诊老年服务的空间分布进行了地理分析和制图可视化。对梅克伦堡-西波美拉尼亚法定健康保险医师协会的索赔数据进行了2014年1月至2017年4月的季度邮政编码区域水平分析。进行了Moran\'sI分析，以确定利用率的集群。
结果：在2017年符合BGC标准的所有患者中，58.3％（n=129,283/221,654）接受了至少一项BCG服务。77.2%（n=73,442/95,171）符合SGC的患者，接受任何老年服务（BGC或SGC）。0.4%(n=414/95,171)符合SGC的患者，收到SGC服务。在研究区域的邮政编码区域中，接受基本老年评估的患者比例为3.4%~86.7%.确定了具有统计学意义的几个区域，即利用率的集群。
结论：广泛不同的利用率以及高费率和低费率的局部隔离表明，门诊老年护理的提供可能在很大程度上取决于局部结构（例如，多专业,集成网络或创新项目或举措)。提供BGC服务的总体差异很大，这意味着全科医生实践中老年需求的识别应该更加标准化。为了减少提供BGC和SGC服务的地区差异，创新的解决方案和促进专门的老年网络或医疗保健提供者是必要的。
方法：对有资格接受基础老年护理（BGC）或专门老年护理（SGC）的患者的门诊老年服务的空间分布进行了地理分析和制图可视化。对梅克伦堡-西波美拉尼亚法定健康保险医师协会的索赔数据进行了2014年1月至2017年4月的季度邮政编码区域水平分析。进行了Moran\'sI分析，以确定利用率的集群。
结果：在2017年符合BGC标准的所有患者中，58.3％（n=129,283/221,654）接受了至少一项BCG服务。77.2%（n=73,442/95,171）符合SGC的患者，接受任何老年服务（BGC或SGC）。0.4%(n=414/95,171)符合SGC的患者，收到SGC服务。在研究区域的邮政编码区域中，接受基本老年评估的患者比例为3.4%~86.7%.确定了具有统计学意义的几个区域，即利用率的集群。
结论：广泛不同的利用率以及高费率和低费率的局部隔离表明，门诊老年护理的提供可能在很大程度上取决于局部结构（例如，多专业,集成网络或创新项目或举措)。提供BGC服务的总体差异很大，这意味着全科医生实践中老年需求的识别应该更加标准化。为了减少提供BGC和SGC服务的地区差异，创新的解决方案和促进专门的老年网络或医疗保健提供者是必要的。
