General practitioner care in nursing homes during the first wave of the COVID-19 pandemic in Germany: a retrospective survey among nursing home managers
Tóm tắt
Though evidence on the detrimental impact of the COVID-19 pandemic in nursing homes is vast, research focusing on general practitioners’ (GP) care during the pandemic in nursing homes is still scarce. A retrospective online survey among 1,010 nursing home managers in Germany was conducted during the first wave of the COVID-19 pandemic between November 2020 and February 2021. Associations between perceived deficits in GP care (routine and acute visits) and both general and COVID-19-related characteristics of nursing homes were analysed using multiple logistic regression analyses. The majority of nursing home managers reported no deficits in GP care (routine visits, 84.3%; acute visits, 92.9%). Logistic regression analyses revealed that deficits in GP care (routine visits) were significantly associated with visiting restrictions for GPs and nursing home size. Small nursing homes (1–50 residents) were significantly more likely to report deficits in GP care (routine visits) compared to medium (51–100 residents) and large nursing homes (> 100 residents). Further, deficits in GP care (acute visits) were significantly associated with dementia as a focus of care and the burden of insufficient testing for SARS-CoV-2 among residents. Moreover, visiting restrictions for GPs were significantly associated with dementia as the focus of care and the COVID-19 incidence at the federal state level. Finally, COVID-19 cases in nursing homes were significantly associated with size of nursing homes, COVID-19-incidence on the federal state level and the burden of insufficient testing capacities for SARS-CoV-2 among residents. We found structural factors associated with GP care deficits during the pandemic. New concepts for GP care should be implemented in pandemic preparedness plans to ensure high quality, consistent, and reliable GP care as well as effective infection prevention measures in nursing homes.
Tài liệu tham khảo
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, Niu P, Zhan F, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W. China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–33. https://doi.org/10.1056/NEJMoa2001017. (Epub 2020 Jan 24. PMID: 31978945; PMCID: PMC7092803).
Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91(1):157–60. https://doi.org/10.23750/abm.v91i1.9397. (PMID:32191675;PMCID:PMC7569573).
World Health Organization (WHO). Naming the coronavirus disease (COVID-19) and the virus that causes it. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it. Accessed 31 Dec 2021. Last checked 08 Mar 2022.
World Health Organization (WHO). Listings of WHO's response to COVID-19 (2020). Available from: https://www.who.int/news-room/detail/29-06-2020-covidtimeline. Accessed 12 Mar 2022.
World Health Organization (WHO). WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020. Accessed 30 Dec 2021.
Gardner W, States D, Bagley N. The Coronavirus and the Risks to the Elderly in Long-Term Care. J Aging Soc Policy. 2020;32(4–5):310–5. https://doi.org/10.1080/08959420.2020.1750543. (Epub 2020 Apr 3. PMID: 32245346).
Kohl R, Schwinger A, Jürchott K, Hering C, Gangnus A, Steinhagen-Thiessen E, Kuhlmey A, Gellert P: Mortality among hospitalized nursing home residents with COVID-19. Dtsch Arztebl Int 2022; 119 DOI: https://doi.org/10.3238/arztebl.m2022.0140.
Robert Koch Institute (RKI). Coronavirus Disease 2019 (COVID-19) Daily Situation Report of the Robert Koch Institute, 02/04/2020. Available from: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/2020-04-02-en.pdf?__blob=publicationFile. Accessed 2 Feb 2022.
Wirth R, Becker C, Djukic M, Drebenstedt C, Heppner HJ, Jacobs AH, Meisel M, Michels G, Nau R, Pantel J, Bauer JM. COVID-19 im Alter – Die geriatrische Perspektive [COVID-19 in old age-The geriatric perspective]. Z Gerontol Geriatr. 2021;54(2):152–60. https://doi.org/10.1007/s00391-021-01864-0. (German. Epub 2021 Feb 17. PMID: 33595696; PMCID: PMC7887547).
Comas-Herrera, A., Zalakaín, J., Litwin, C., Hsu, A. T., Lemmon, E., Henderson, D. et al. (2020). Mortality associated with COVID-19 outbreaks in care homes: early international evidence. Last updated 26 June 2020. Available from: https://ltccovid.org/wp-content/uploads/2020/10/Mortality-associated-with-COVID-among-people-who-use-long-term-care-26-June.pdf. Accessed 30 Dec 2021. Last checked 20 May 2022.
Davidson PM, Szanton SL. Nursing homes and COVID-19: We can and should do better. J Clin Nurs. 2020;29(15–16):2758–9. https://doi.org/10.1111/jocn.15297. (Epub 2020 May 11. PMID: 32281165; PMCID: PMC7262177).
Stolle C, Schmidt A, Domhoff D, Friedrich AC, Heinze F, Preuß B, Seibert K, Rothgang H, Wolf-Ostermann K. Bedarfe der Langzeitpflege in der COVID-19-Pandemie [Needs of long-term nursing in the COVID-19 pandemic]. Z Gerontol Geriatr. 2020;53(8):788–95. https://doi.org/10.1007/s00391-020-01801-7. (German. Epub 2020 Oct 28. PMID: 33113017; PMCID: PMC7592453).
de Sutter A, Llor C, Maier M, Mallen C, Tatsioni A, van Weert H, Windak A, Stoffers J; Editorial Board, Jelle Stoffers, Editor-in-Chief, the European Journal of General Practice. Family medicine in times of 'COVID-19': A generalists' voice. Eur J Gen Pract. 2020 Dec;26(1):58–60. doi: https://doi.org/10.1080/13814788.2020.1757312. PMID: 32349550; PMCID: PMC7241505.
Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502. https://doi.org/10.1111/j.1468-0009.2005.00409.x. (PMID:16202000;PMCID:PMC2690145).
van den Bussche, Hendrik & Weyerer, Siegfried & Schäufele, Martina & Lübke, N. & Schröfel, S.-C & Dietsche, Stefan. (2009). Die ärztliche Versorgung von Pflegeheimbewohnern in Deutschland – eine kritische Würdigung der vorliegenden Studien. [Medical care in nursing homes in Germany – A critical review of actual studies]. Z Allg Med 2009; 85: 240–246. https://doi.org/10.3238/zfa.2009.0240.
Schröder AK, Fassmer AM, Allers K, Hoffmann F. Needs and availability of medical specialists’ and allied health professionals’ visits in German nursing homes: a cross-sectional study of nursing home staff. BMC Health Serv Res. 2020;20(1):332. https://doi.org/10.1186/s12913-020-05169-7. (PMID:32317028;PMCID:PMC7171863).
Spreckelsen O, Schmiemann G, Fassmer AM, Engel B, Hoffmann F, Freitag MH. How Do German General Practitioners Assess Medical Specialist Care Needs of Nursing Home Residents? Results of a Postal Survey in North-Western Germany. Int J Environ Res Public Health. 2020;17(19):7126. https://doi.org/10.3390/ijerph17197126. (PMID:33003384;PMCID:PMC7579638).
Kleina T, Horn A, Suhr R, Schaeffer D. Zur Entwicklung der ärztlichen Versorgung in stationären Pflegeeinrichtungen – Ergebnisse einer empirischen Untersuchung [Current Status of Medical Care for Nursing Home Residents in Germany - Results of an Empirical Study]. Gesundheitswesen. 2017;79(5):382–7. https://doi.org/10.1055/s-0035-1549971. (German. Epub 2015 Jun 25. PMID: 26110241).
Schulz M, Czwikla J, Tsiasioti C, Schwinger A, Gand D, Schmiemann G, Schmidt A, Wolf-Ostermann K, Kloep S, Heinze F, Rothgang H. Differences in medical specialist utilization among older people in need of long-term care - results from German health claims data. Int J Equity Health. 2020;19(1):22. https://doi.org/10.1186/s12939-020-1130-z. (PMID:32033606;PMCID:PMC7006141).
Rothgang, H.; Borchert, L.; Müller, R.; Unger, R. GEK-Pflegereport 2008. Schwerpunktthema: Medizinische Versorgung in Pflegeheimen. 2008. [GEK Nursing Report 2008. Main topic: Medical care in nursing homes. 2008.] Available from: https://www.barmer.de/resource/blob/1022880/514fa59ad0e7951c3919ff92bbcd419a/gek-pflegereport-2008-data.pdf. Accessed 29 May 2022.
Hugelius K, Harada N, Marutani M. Consequences of visiting restrictions during the COVID-19 pandemic: An integrative review. Int J Nurs Stud. 2021;121:104000. https://doi.org/10.1016/j.ijnurstu.2021.104000. (Epub 2021 Jun 12. PMID: 34242976; PMCID: PMC8196532).
World Health Organization (WHO). Maintaining essential health services: operational guidance for the COVID-19 context: interim guidance, 1 June 2020. Available from: https://apps.who.int/iris/handle/10665/332240. Accessed 3 Jan 2022.
Hower KI, Pfaff H, Pförtner TK. Pflege in Zeiten von COVID-19: Onlinebefragung von Leitungskräften zu Herausforderungen, Belastungen und Bewältigungsstrategien. [Nursing care in times of COVID-19: Online survey of leaders on challenges, burdens, and coping strategies]. Pflege. 2020;33(4):207–18. https://doi.org/10.1024/1012-5302/a000752. (PMID: 32811325).
Statistisches Bundesamt (Destatis), 2020. Pflegestatistik 2019. Pflege im Rahmen der Pflegeversicherung Deutschlandergebnisse. [Federal Statistical Office of Germany, 2020. Nursing care statistics 2019. Nursing care within the scope of German nursing care insurance results 2019.] Available from: https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Pflege/Publikationen/Downloads-Pflege/pflege-deutschlandergebnisse-5224001199004.pdf;jsessionid=D81463028245578189DFB04F503970F4.live721?__blob=publicationFile. Accessed: 13 Nov 2022.
Hallauer, J., C. Bienstein, U. Lehr und H. Rönsch. SÄVIP – Studie zur ärztlichen Versorgung in Pflegeheimen. 2005. [SÄVIP – Study on medical care in nursing homes. 2005.] Available from: https://docplayer.org/7768209-Saevip-studie-zur-aerztlichen-versorgung-in-pflegeheimen.html. Accessed: 12 Nov 2022.
van den Bussche H, Schröfel S-C, Löschmann C, Lübke N. Organisationsformen der hausärztlichen Versorgung von Pflegeheimbewohnern in Deutschland und im benachbarten Ausland. 2009. [Organizational Concepts of Primary Medical Care in Nursing Homes in Germany and Its Neighbour Countries. 2009] online-zfa.de; 296–301 DOI: https://doi.org/10.3238/zfa.2009.0296; Avaible from: https://www.online-zfa.com/fileadmin/user_upload/Heftarchiv/ZFA/article/2009/07/1BCDA0F0-942C-47EE-9FEC 192DFA695511/1BCDA0F0942C47EE9FEC192DFA695511_bussche_1_original.pdf; Accessed 12 November 2022.
Wolf-Ostermann, K., Rothgang, H., Domhoff, D., Friedrich, A. C., Heinze, F., Preuß, B. & Stolle, C. (2020). Zur Situation der Langzeitpflege in Deutschland während der Corona-Pandemie. Ergebnisse einer Online-Befragung in Einrichtungen der (teil) stationären und ambulanten Langzeitpflege. [On the situation of long-term care in Germany during the corona pandemic. Results of an online survey in (semi) residential and ambulant long-term care facilities]. Available from: https://media.suub.uni-bremen.de/handle/elib/4331. Accessed 13 Nov 2022.
Robert Koch Institute (RKI). Coronavirus Disease 2019 (COVID-19) Daily Situation Report of the Robert Koch Institute, 04/03/2020. Available from: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/2020-03-04-en.pdf?__blob=publicationFile. Accessed 14 Oct 2021.
Robert Koch Institute (RKI). Coronavirus Disease 2019 (COVID-19) Daily Situation Report of the Robert Koch Institute, 30/06/2020. Available from: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/2020-06-30-en.pdf?__blob=publicationFile. Accessed 6 Feb 2022.
Furr RM. Scale construction and psychometrics for social and personality psychology. Thousand Oaks: Sage Publications Ltd; 2011. p. 153. https://doi. org/10.4135/9781446287866.
Rothgang H, Domhoff D, Friedrich AC, Heinze F, Preuss B, Schmidt A, Seibert K, Stolle C, Wolf-Ostermann K. Pflege in Zeiten von Corona: Zentrale Ergebnisse einer deutschlandweiten Querschnittsbefragung vollstationärer Pflegeheime. [Long-term care during the Corona pandemic – Main results from a nationwide online survey in nursing homes in Germany] Pflege. 2020;33(5):265–275. doi: https://doi.org/10.1024/1012-5302/a000760. PMID: 32996856.
O'Neill D, Briggs R, Holmerová I, Samuelsson O, Gordon AL, Martin FC; Special Interest Group in Long Term Care of the European Geriatric Medicine Society. COVID-19 highlights the need for universal adoption of standards of medical care for physicians in nursing homes in Europe. Eur Geriatr Med. 2020 Aug;11(4):645–650. doi: https://doi.org/10.1007/s41999-020-00347-6. Epub 2020 Jun 17. PMID: 32557250; PMCID: PMC7298916.
Dutour M, Kirchhoff A, Janssen C, Meleze S, Chevalier H, Levy-Amon S, Detrez MA, Piet E, Delory T. Family medicine practitioners’ stress during the COVID-19 pandemic: a cross-sectional survey. BMC Fam Pract. 2021;22(1):36. https://doi.org/10.1186/s12875-021-01382-3. (PMID:33583410;PMCID:PMC7882249).
Schäfer I, Hansen H, Menzel A, Eisele M, Tajdar D, Lühmann D, Scherer M. The effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and performed services in primary care: results of a longitudinal observational study. BMC Fam Pract. 2021;22(1):125. https://doi.org/10.1186/s12875-021-01471-3. (PMID:34162343;PMCID:PMC8221278).
Giri S, Chenn LM, Romero-Ortuno R. Nursing homes during the COVID-19 pandemic: a scoping review of challenges and responses. Eur Geriatr Med. 2021;12(6):1127–36. https://doi.org/10.1007/s41999-021-00531-2. (Epub 2021 Jun 16. PMID: 34136990; PMCID: PMC8208072).
Arons MM, Hatfield KM, Reddy SC, Kimball A, James A, Jacobs JR, Taylor J, Spicer K, Bardossy AC, Oakley LP, Tanwar S, Dyal JW, Harney J, Chisty Z, Bell JM, Methner M, Paul P, Carlson CM, McLaughlin HP, Thornburg N, Tong S, Tamin A, Tao Y, Uehara A, Harcourt J, Clark S, Brostrom-Smith C, Page LC, Kay M, Lewis J, Montgomery P, Stone ND, Clark TA, Honein MA, Duchin JS, Jernigan JA; Public Health–Seattle and King County and CDC COVID-19 Investigation Team. Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility. N Engl J Med. 2020 May 28;382(22):2081–2090. doi: https://doi.org/10.1056/NEJMoa2008457. Epub 2020 Apr 24. PMID: 32329971; PMCID: PMC7200056.
Abrams HR, Loomer L, Gandhi A, Grabowski DC. Characteristics of U.S. Nursing Homes with COVID-19 Cases. J Am Geriatr Soc. 2020;68(8):1653–6. https://doi.org/10.1111/jgs.16661. (Epub 2020 Jul 7. PMID: 32484912; PMCID: PMC7300642).
Costa AP, Manis DR, Jones A, Stall NM, Brown KA, Boscart V, Castellino A, Heckman GA, Hillmer MP, Ma C, Pham P, Rais S, Sinha SK, Poss JW. Risk factors for outbreaks of SARS-CoV-2 infection at retirement homes in Ontario, Canada: a population-level cohort study. CMAJ. 2021;193(19):E672–80. https://doi.org/10.1503/cmaj.202756. (PMID:33972220;PMCID:PMC8158001).
Suñer C, Ouchi D, Mas MA, et al. Risk factors for mortality of residents in nursing homes with Covid-19: A retrospective cohort study. Nat Aging. 2021. https://doi.org/10.1038/s43587-021-00079-77.
Soldevila L, Prat N, Mas MÀ, Massot M, Miralles R, Bonet-Simó JM, Isnard M, Expósito-Izquierdo M, Garcia-Sanchez I, Rodoreda-Noguerola S, Moreno N, Badia E, López G, Sevilla J, Estrada O, Vallès X. The interplay between infection risk factors of SARS-CoV-2 and mortality: a cross-sectional study from a cohort of long-term care nursing home residents. BMC Geriatr. 2022;22(1):123. https://doi.org/10.1186/s12877-022-02779-0. (PMID:35164680;PMCID:PMC8842505).
Sizoo EM, Monnier AA, Bloemen M, Hertogh CMPM, Smalbrugge M. Dilemmas With Restrictive Visiting Policies in Dutch Nursing Homes During the COVID-19 Pandemic: A Qualitative Analysis of an Open-Ended Questionnaire With Elderly Care Physicians. J Am Med Dir Assoc. 2020;21(12):1774-1781.e2. https://doi.org/10.1016/j.jamda.2020.10.024. (Epub 2020 Oct 23. PMID: 33197412; PMCID: PMC7584414).
Gordon AL, Goodman C, Achterberg W, Barker RO, Burns E, Hanratty B, Martin FC, Meyer J, O’Neill D, Schols J, Spilsbury K. Commentary: COVID in care homes-challenges and dilemmas in healthcare delivery. Age Ageing. 2020;49(5):701–5. https://doi.org/10.1093/ageing/afaa113. (PMID:32402088;PMCID:PMC7239229).
Grimm F, Hodgson K, Brine R, Deeny SR. Hospital admissions from care homes in England during the COVID-19 pandemic: a retrospective, cross-sectional analysis using linked administrative data. Int J Popul Data Sci. 2021;5(4):1663. https://doi.org/10.23889/ijpds.v5i4.1663. (PMID:34286106;PMCID:PMC8267611).
Birnbaum MH. Human research and data collection via the internet. Annu Rev Psychol. 2004;55:803–32. https://doi.org/10.1146/annurev.psych.55.090902.141601. (PMID: 14744235).