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Regional differences in health care of patients with inflammatory bowel disease in Germany.

Lange A, Prenzler A, Bachmann O, Linder R, Neubauer S, Zeidler J, Manns MP, von der Schulenburg JM - Health Econ Rev (2015)

Bottom Line: No difference in the frequencies of TNF-alpha inhibitor therapies was found.The results revealed that some aspects had positive effects on the probability of implementing healthcare in accordance with pathways and guidelines.No clear evidence of a general healthcare undersupply in rural areas was found.

View Article: PubMed Central - PubMed

Affiliation: Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Koenigsworther Platz 1, D-30167, Hannover, Germany. al@ivbl.uni-hannover.de.

ABSTRACT

Background: The regional availability of specialized physicians is an important aspect in healthcare of patients with IBD. The association between physician density and healthcare is not yet clear. Most studies did not consider district type, which reflects population density. Our research question was, "Do specialist density and district type influence the healthcare of IBD patients in Germany?"

Methods: We combined a claims dataset from a German health insurance fund with population and physician data. Four main aspects were investigated: regular specialist visits, drug therapies, surveillance colonoscopy, and IBD-related hospitalizations. Various regression analyses were performed.

Results: The study cohort was comprised of 21,771 individuals, including 9282 patients with Crohn disease and 12,489 patients with ulcerative colitis. Patients who were living in districts with higher specialist densities were more likely to attend specialist visits on a regular basis. No difference in the frequencies of TNF-alpha inhibitor therapies was found. However, individuals from urban areas were more likely to receive a permanent immunosuppressive therapy with continuous specialist support.

Conclusions: The results revealed that some aspects had positive effects on the probability of implementing healthcare in accordance with pathways and guidelines. No clear evidence of a general healthcare undersupply in rural areas was found.

No MeSH data available.


Related in: MedlinePlus

Probability of receiving medication in accordance with the IBD pathways
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Fig3: Probability of receiving medication in accordance with the IBD pathways

Mentions: Three different main drug therapies were analyzed. Of the study population, 22 % (4708), 16 % (3434), and 4 % (900) received a permanent steroid medication, permanent immunosuppressive therapy, and TNF-α inhibitor therapy, respectively. The probability of receiving one of the three drug therapies hardly changed, subject to specialist density and district types. Table 1 shows that the proportion of patients who received such drug therapies in combination with regular specialist visits was highest for the TNF-α inhibitor therapy. The plot of the predicted probabilities (Fig. 3) revealed that the probability of receiving a permanent steroid medication or immunosuppressive therapy in combination with regular specialist visits was significantly positively associated with specialist density. Furthermore, this relationship was strongest in the urban district types. However, Fig. 3 shows that the probability of receiving a TNF-α inhibitor therapy in combination with regular specialist visits took a highly different course. As a result, the probability increased and decreased with the higher specialist density in the rural and urban areas, respectively. However, this model is statistically not significant in contrast to all the other regression models in the present study.Fig. 3


Regional differences in health care of patients with inflammatory bowel disease in Germany.

Lange A, Prenzler A, Bachmann O, Linder R, Neubauer S, Zeidler J, Manns MP, von der Schulenburg JM - Health Econ Rev (2015)

Probability of receiving medication in accordance with the IBD pathways
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608952&req=5

Fig3: Probability of receiving medication in accordance with the IBD pathways
Mentions: Three different main drug therapies were analyzed. Of the study population, 22 % (4708), 16 % (3434), and 4 % (900) received a permanent steroid medication, permanent immunosuppressive therapy, and TNF-α inhibitor therapy, respectively. The probability of receiving one of the three drug therapies hardly changed, subject to specialist density and district types. Table 1 shows that the proportion of patients who received such drug therapies in combination with regular specialist visits was highest for the TNF-α inhibitor therapy. The plot of the predicted probabilities (Fig. 3) revealed that the probability of receiving a permanent steroid medication or immunosuppressive therapy in combination with regular specialist visits was significantly positively associated with specialist density. Furthermore, this relationship was strongest in the urban district types. However, Fig. 3 shows that the probability of receiving a TNF-α inhibitor therapy in combination with regular specialist visits took a highly different course. As a result, the probability increased and decreased with the higher specialist density in the rural and urban areas, respectively. However, this model is statistically not significant in contrast to all the other regression models in the present study.Fig. 3

Bottom Line: No difference in the frequencies of TNF-alpha inhibitor therapies was found.The results revealed that some aspects had positive effects on the probability of implementing healthcare in accordance with pathways and guidelines.No clear evidence of a general healthcare undersupply in rural areas was found.

View Article: PubMed Central - PubMed

Affiliation: Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Koenigsworther Platz 1, D-30167, Hannover, Germany. al@ivbl.uni-hannover.de.

ABSTRACT

Background: The regional availability of specialized physicians is an important aspect in healthcare of patients with IBD. The association between physician density and healthcare is not yet clear. Most studies did not consider district type, which reflects population density. Our research question was, "Do specialist density and district type influence the healthcare of IBD patients in Germany?"

Methods: We combined a claims dataset from a German health insurance fund with population and physician data. Four main aspects were investigated: regular specialist visits, drug therapies, surveillance colonoscopy, and IBD-related hospitalizations. Various regression analyses were performed.

Results: The study cohort was comprised of 21,771 individuals, including 9282 patients with Crohn disease and 12,489 patients with ulcerative colitis. Patients who were living in districts with higher specialist densities were more likely to attend specialist visits on a regular basis. No difference in the frequencies of TNF-alpha inhibitor therapies was found. However, individuals from urban areas were more likely to receive a permanent immunosuppressive therapy with continuous specialist support.

Conclusions: The results revealed that some aspects had positive effects on the probability of implementing healthcare in accordance with pathways and guidelines. No clear evidence of a general healthcare undersupply in rural areas was found.

No MeSH data available.


Related in: MedlinePlus