Organization of Care

Einleitung / Introduction

During the outbreak of the novel coronavirus (COVID-19), many individuals did not know what to do or whom to ask. Since most of the questions about COVID-19 were very similar, it is possible to answer these questions in a standard way. In order to combat false information about pandemic-related questions and relieve the burden on health care personnel, various health care organizations made use of Conversational Agents (CAs). The research question of this study is: Where can CAs be implemented to facilitate the physicians’ workload along the patient journey in an outpatient care setting? Thereby simplifying the patients’ journey as a process of prevention, diagnostics, therapy, and monitoring. The study objective is to identify application scenarios of CAs that have the potential to support outpatient physicians in their mundane tasks and workflows.

Methode / Method

A mixed-methods approach was chosen to validate already existent Use Cases from the literature and identify new application scenarios from the expert interviews. In the first step, a broad literature review was performed in nine databases to analyze currently used CAs from a physicians’ perspective. The review reflects already published studies and is hence an analysis of secondary data. The interview guideline for the primary data collection is based on the gathered knowledge and implications of the identified papers.

Ergebnisse / Results

The systematic search found 1,911 publications. After abstract- and full-text screening, 13 studies were included in the review. The results of the systematic review identified ten specific CA application areas, which could be assigned to the patient journey. Nine out of ten CA application scenarios focused primarily on patient uses. Through 15 semi-structured expert interviews (1,367 interview minutes) 22 application areas were identified. In this regard, it is important to note that six Use Cases were not classified along the patient journey as these reflect more generic application areas for administrative tasks. Of all CA Use Cases, the most applications are in the diagnostics area, primarily facilitating medical data collection for physicians.

Zusammenfassung / Conclusion

Physicians are willing to implement digital tools like CAs in their mundane outpatient workflows. Health care providers believe in a workload reduction associated with CAs, depending on the respective technical development and implementation.

AutorInnen

Alexandra Lehmann, Universität Bayreuth

Einleitung / Introduction

In primary care, significant healthcare resources are allocated to frequent attenders – patients with high numbers of consultations rates with their GP. Although frequent attendance is usually temporary, many patients become persistent frequent attenders. For a certain number of these patients, frequent attendance is independent of morbidity. These patients are important to the healthcare system as they may be a sign that the responsiveness of the system is not sufficient enough and the needs of them are not met. Understanding the determinants of persistent frequent attender could be useful from a clinical perspective and to reduce the economic burden associated with it. The aim of this longitudinal study is to identify the risk factors for persistent frequent attenders.

Methode / Method

We used longitudinal data (FU wave 7-9) from the Study on needs, health service use, costs and HrQoL in a large sample of oldest-old primary care patients (85+) (AgeQualiDe), covering primary care patients ≥ 85 years (FU7 n = 741, mean age 88.9 years (SD 2.9; 85-100). Persistent frequent attender of GP services (the patients in the top decile of the number of GP consultations in two or more consecutive waves) was our main outcome of interest. The covariates used in the analysis were selected on the basis of research on persistent frequent attendance. We also considered Andersen’s model of health services use which segregates factors into physical needs factors (e.g. we controlled for cognitive impairment: GDS, depression: Geriatric Depression Scale, frailty: CSHA-CFS), predisposing factors (e.g. widowhood, education), and enabling factors (e.g. type of healthcare insurance). We used a logistic random-effects models with participant level random effects.

Ergebnisse / Results

In total, across three waves (FU7-FU9), our analysis included 766 individuals. Altogether, we identified 56 persistent frequent attenders. Results of random-effects logistic regressions showed that odds of being persistent frequent attender were higher for widowed individuals (OR=4.57; 95%CI [1.07-19.45]. Moreover, a one-point increase in the frailty score and having one more chronic condition increased the odds of being persistent frequent attender by 68% (OR =1.68; 95%CI [1.05-2.69]) and 23% (OR=1.23, 95%CI [1.05-1.44]), respectively. Furthermore, compared to individuals with a private health insurance, individuals with statutory health insurance had lower odds of being a persistent frequent attender (OR=0.18, 95%CI [0.04-0.76]).

Zusammenfassung / Conclusion

Our study stressed the longitudinal association between, among other things, frailty, widowhood as well as chronic diseases and persistent frequent attendance among the oldest old in Germany. Efforts to avoid or at least postpone frailty and chronic conditions may be beneficial for the German healthcare system.

AutorInnen

Elzbieta Buczak-Stec, Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, HCHE

André Hajek, Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, HCHE

Wolfgang Maier, Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn; German Center for Neurodegenerative Diseases (DZNE)

Michael Wagner, Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn; German Center for Neurodegenerative Diseases (DZNE)

Steffi G. Riedel-Heller, Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig

Martin Scherer, Department of General Practice and Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf

Hans-Helmut König, Department of Health Economics and Health Services Research University Medical Center Hamburg-Eppendorf / HCHE

Einleitung / Introduction

Health insurances can use their market power to lower prices for generic drugs with multiple suppliers when they sign exclusive contracts with one of several possible manufacturers. Manufacturers are willing to sign these rebate contracts as they guarantee a high number of consumers. Such exclusivity can however harm patients if the pharmacy does not have the exact rebated generic in stock and patients have to wait until they get their pharmaceutical.

Methode / Method

In this paper, we analyze a natural experiment in Germany where from April 2007 onwards, that made rebate contracts easier to enforce for health insurances. We use data on 90% of pharmaceuticals issued for patients in the social health insurance by ambulatory doctors in North-West Germany from 2006 to 2017. The data contain information on roughly 100 million prescriptions to 14 million patients each year. We analyze three different outcomes: latency (days between the prescription was issued and the pharmaceutical was issued at the pharmacy), substitution (whether the issued pharmaceutical differed from the prescribed one) and physician intervention (when the physician mandates the prescription of one specific pharmaceutical irrespective of potential rebate contracts).

Ergebnisse / Results

Our empirical analysis is based on a generalized difference in differences approach where we first estimate the effect of exogenous increases in rebate contracts on our outcome measures. Second, we analyze the effects of changes in the pharmaceuticals within a rebate contract group. We find statistically significant but economically small increases in latency for the first months after the introduction of the first rebate contract. This increase only holds for the first months after rebate contracts were introduced. There were no reactions in physician intervention after the introduction of rebate contracts. Changes in the composition in rebate contract pharmaceuticals also do not seem to influence our three outcome measures.

Zusammenfassung / Conclusion

This is the first empirical analysis of the introduction of rebate contracts on patient-relevant outcomes on this scale and wide range of pharmaceuticals. We do not find that rebate contracts influence drug availability for patients. The absence of an effect of rebate contracts on waiting times for drugs does not seem to be driven by physician intervention or substitution. We conclude that the design of rebate contracts in Germany did achieve the intended cost saving effects without harming access to pharmaceuticals.

AutorInnen

Harald Tauchmann, FAU-Erlangen-Nürnberg

Simon Reif, ZEW – Leibniz Centre for European Economic Research

Franz Josef Zorzi, FAU-Erlangen-Nürnberg

Einleitung / Introduction

Understanding the health of children is important because a large body of literature suggests that early-life health is connected to well-being throughout the life cycle, including adult health, educational attainment, and labor market outcomes. Insufficient access to health care could not only affect childrens' health in the short term, but also have negative long-term consequences. In this paper, we analyze the health of children by linking administrative databases from Austria with information on health care utilization and objective health status. Based on health insurance claims data, we show large variation among children regarding pediatricians, ophthalmologists and dentists visits. Children whose parents have a rather low income or children with migration background visit these physicians less often than their counterparts. Information from school health examinations, however, reveal poorer outcomes of low income and migrant children in several health domains including worse eyesight and dental health. The finding that this group of children utilize less health services in areas where they have more health issues implies that the lower health care utilization can not be explained by better health status, but instead could indicate an underuse of specific preventive health care services. In comparison to health checks in primary care physician offices, routine school health examination can be considered a preventive health measure with very low entry barriers, because physicians visit schools to assess and document the health status of all students. We follow individuals over time and show that health care utilization in fact increases after physicians detect health problems during these examinations. Notably, the increase is stronger for migrant children compared to native children, suggesting that school health examinations serve as a low-threshold measure to increase access to the health care system.

AutorInnen

Thomas Schober, New Zealand Work Research Institute

Katrin Zocher, Johannes Kepler University