Health Care in rural areas of Brandenburg region

Health Care in rural areas of Brandenburg region

Stefanie Fischer¹ ; Stephanie Hoffmann¹; Antje Löffler¹; Jacob Spallek¹
Mirko Paul²; Juliane Eichhorn²
Anja Walter³; Mirko Paul³; Peter Arends*; Henrike Hölzer*; Christoph Bohne*; Julia Schendzielorz*; Gerhard Danzer*

¹ Specialty of Health Services, Institute for Health, Brandenburg Technical University Cottbus-Senftenberg
² Specialty of Nursing Science and Clinical Nursing, Institute for Health, Brandenburg Technical University Cottbus-Senftenberg
³ Specialty of Nursing Science and Nursing Didactics, Institute for Health, Brandenburg Technical University Cottbus-Senftenberg in cooperation with the Medical University of Brandenburg*

Background

Demographic changes mainly affecting rural areas. Brandenburg is a mostly rural state of Germany. In future, an increasing number of older people will require age-appropriate care structures as well as specific health care and nursing services. Germany's lowest density of general practitioners and an unfavourable age pattern [1] have an impact on the healthcare provision in economically and structurally weak areas of Brandenburg. A lack of nursing practitioners and the decline in informal care potential in rural areas, further intensify the adverse effects of demographic changes in Brandenburrg. [2]

A detailed understanding of the situation of the elderly population as well as innovative approaches that can facilitate and improve the life and care of older people in rural areas are required. For this reason, A1-A3 of the research project DIGILOG in the context of the Health Campus Brandenburg focus on different aspects of healthcare in rural areas of Brandenburg:

  1. Subproject A1 (Prof. Spallek) aims at examining the level of satisfaction of the elderly population with access to general practitioners and medical specialist care.
  2. Subproject A2 (Prof. Eichhorn) aims at making key statements on the attitude, needs and the desired support of older people in the implementation and further development of eHealth services. It is equally important to include the point of view of nursing professionals in these considerations.
  3. Subproject A3 (Prof. Walter) aims at promoting interprofessional thought and action in healthcare, already during the occupational qualifying phase of students.

Methodology

  1. In early 2018, a standardized questionnaire with both, closed and open questions, was used to assess the level of satisfaction among the elderly with regard to access to general medical and specialist care 3.006 randomly selected 50-70-year-old residents in the district of Oberspreewald-Lausitz were surveyed on socio-demographic characteristics as well as current and future general and specialist medical care. The response is 17.5% and gives a random sample with an average age of 62 years (51% female).
  2. An interview guide based on available literature was developed, and three focus group interviews were conducted in order to identify key statements on the attitude, needs and the desired support of older people on the subject of e-health. 270 minutes of recorded audio statements from 19 participants (11 women, 8 men) with an age range of 53 - 84 years were included in the analyses. The sample in this study corresponds regarding the use of internet, email and online-banking to the sample of the extensive German-wide ARD / ZDF online study [3]. In addition, three more focus group interviews with eight nurses were conducted to get an insight into the perspective of nursing professionals.
  3. An IP learning unit was developed, implemented and evaluated within this project during the preparatory phase, catalogues of competencies as well as the concrete curricula of the fields of study were analysed with regard to objectives for IP cooperation. The cooperatively designed IP learning unit took place in October 2018 with the support of nine lecturers from the Brandenburg Technical University and the Medical University of Brandenburg. The participants were students of Nursing Science and Therapeutic Sciences of the BTU as well as medical students of MHB. The implementation included an online survey (before-and-after) on attitudes and beliefs of students by applying the Interprofessional Collaboration Scale (IPC scale) as well as a process evaluation (observations and audio recordings). The focus of the implementation was the methodically variable processing of authentic cases for IP cooperation in mixed small groups.

Conclusions

  1. Access to general practitioners and medical specialists is considered satisfactory (general practitioner (GP) 93%, specialist (87.8%). Future retirement of physicians, a lack of sufficient succession and long waiting times are among the most frequently mentioned fears. 84% consulted a medical specialist during the past year (Most commonly: ophthalmologist (93 times), urologists, orthopaedic surgeons (each 74 times). The GP can be reached in approximately x̃=4 kilometres [0-64] and 10 minutes [0-90], the medical specialist in x̃=15 kilometres [0-338] and 20 minutes [0-338], mostly by car (GP 60,9%, specialist 77%). The average waiting time at the GP was 59 minutes [0-180], at the specialist 57 minutes [0-240].
  2. Qualitative analyses indicate that interviewees consider eHealth as an important and necessary further development. Nevertheless, they fear that they might not be given enough consideration by decision-makers. Concern regarding potential data misuse has also been reported frequently. Respondents are also worried about the potential loss of personal relationships with caregivers and other healthcare providers. A general and repeatedly voiced concern was the desire for training that was focused on specific target groups. Nursing staff, on the other hand, have expressed their concern that digitalisation in times of staff shortages could easily contribute to an even greater work load and might lead to “a substitution of medical staff”. They also remarked that any digital solution must be compatible with a view to interoperability. Any possible advantages regarding distinct health or care related activities are not perceived. If at all, such solutions are rather seen to have supporting functions within the organisation and documentation of care and in communication.
  3. The analysis of the documents identified similar objectives with regard to IP collaboration. These were used in the project as a guideline. The online survey has shown that attitudes and beliefs about each other's profession were reflected. Likewise, an increase in knowledge and understanding for the other occupational group could be recorded – for example, the approval to the item "The other occupational group and my professional group have similar ideas as to how patients should be cared for" has increased significantly. From the point of view of the students, the event made them aware of the importance of IP cooperation, triggered a critical reflection of the situations and gave them opportunities for a change of perspective. The informal framework was experienced as conducive to rapprochement.

Conclusions

  1. Although currently, access to healthcare is still deemed satisfactory despite vacant medical positions, supply shortfalls are likely to occur in the near future, particularly and most imminently within medical specialist services [2,3,4]. New healthcare concepts, such as Community Nursing or digital solutions have the potential to counteract such supply shortfalls and reduce waiting times in acute cases.
  2. The qualitative analysis regarding attitude, needs and desired support of older people on the subject of eHealth does not allow a clear statement on Pros and Cons. Senior citizens as well as nursing staff are open-minded about eHealth offers, however, the acceptance of respective interventions or solutions should be considered case-dependent. Transparency and support appropriate to the target group is urgently needed. The development and establishment of special training programs as well as interoperability based on the findings of the study is strongly recommended. User- and resource-friendly eHealth applications also seem to be of great importance.
  3. The IP training should become more established in Brandenburg. The MHB and the Institute of Health have laid the foundation for this, which are currently being expanded in the context of the health campus by the call for professorships. IP teaching should be anchored in the curricula and extended to IP learning in care practice. The IP training also places high demands on teachers. These demands should be addressed in appropriate further education.

References

[1] KVBB (2016) Daten und Fakten. www.kvbb.de. Aufgerufen: 6.3.2018
[2] Landesamt für Soziales und Versorgung des Landes Brandenburg (2016) Brandenburger Sozialindikatoren. Aktuelle Daten zur sozialen Lage im Land Brandenburg, online, URL: lasv.brandenburg.de, Abfrage: 29.11.2017
[3]Koch, W. & Frees, B. (2016) Ergebnisse der ARD/ZDF-Onlinestudie 2016 – Dynamische Entwicklung bei mobiler Internetnutzung sowie Audios und Videos. Media Perspektive, 9, 418 – 437

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