Does transpersonal trust moderate the association between chronic conditions and general practitioner visits in the oldest old? Results of the AgeCoDe and AgeQualiDe study

Frequency and Correlates of Online Consultations With Doctors or Therapists in Middle-Aged and Older Adults: Nationally Representative Cross-sectional Study

Background

A few studies have identified the frequency and correlates of online consultations with doctors or therapists. However, there is a lack of studies using nationally representative data from middle-aged and older adults in Germany.

Objective

This study aims to determine the frequency and correlates of online consultations with doctors or therapists in Germany.

Methods

For this study, cross-sectional data were taken from the nationally representative German Ageing Survey (DEAS; n=3067 in the analytical sample; age range 46-98 years). As part of the DEAS, a short survey was conducted between June 8 and July 22, 2020, examining the everyday life and living conditions among these middle-aged and older individuals during the COVID-19 pandemic. The frequency of online consultations with doctors or therapists served as the dependent variable (daily, several times a week, once a week, 1-3 times a month, less often, and never). Multiple logistic regressions were performed.

Results

In sum, 10.02% (381/3806) of individuals with access to the internet had online consultations with doctors or therapists. Multiple logistic regressions showed that the likelihood of using online consultations with doctors or therapists (compared with those never using such services) was positively associated with higher education (compared with medium education; odds ratio [OR] 1.31, 95% CI 1.01-1.70), living with a partner in the same household (compared with single; OR 1.53, 95% CI 1.05-2.22), poorer self-rated health (OR 1.42, 95% CI 1.16-1.74), increased loneliness (OR 1.45, 95% CI 1.10-1.90), and increased satisfaction with life (OR 1.30, 95% CI 1.03-1.64).

Conclusions

Study findings suggest that a non-negligible proportion of about 1 out of 10 individuals aged 46 years and over had online consultations with doctors or therapists. However, compared with other countries, this proportion remains small. Knowledge about the correlates of (non)use may assist in identifying corresponding individuals. In times of reshaping the health care system, these efforts in online consultations with doctors or therapists may contribute to addressing patient needs. Moreover, increased use of such services may reduce the risk of getting infected with SARS-CoV-2 by reducing social contact.

Self-perceptions of ageing, GP visits and frequent attendance. Longitudinal findings from the German Ageing Survey

OBJECTIVES

The aim of this study was to clarify the link between self-perceptions of ageing and the number of general practitioner (GP) visits, as well as frequent GP visits, longitudinally.

METHODS

In this study, longitudinal data with n = 7,062 observations from 2014 (wave 5) to 2017 (wave 6) were taken from the German Ageing Survey (representative sample of middle aged and older individuals residing in private households). The five-item Attitudes Toward Own Ageing subscale of the Philadelphia Geriatric Center Morale Scale (PGCMS) was used to quantify self-perceptions of ageing. The frequency of GP visits in the past 12 months served as outcome measure (first model: measured continuously; second model: top 10% were defined as frequent attenders). To exploit the features of panel data, and to mitigate the problem of unobserved heterogeneity, fixed effects regressions were used.

RESULTS

Adjusting for predisposing characteristics, enabling resources and need-factors, regressions showed that an increase in self-perceptions of ageing was associated with decreases in the number of GP visits (IRR= .83 (95% CI: .77-.91)), and a decreased likelihood of becoming a frequent attender (OR= .44 (95% CI: .29-.66)).

CONCLUSIONS

Using data from a longitudinal study and exploiting the longitudinal data structure, the current study adds to our current knowledge by demonstrating that self-perceptions of ageing contribute to the frequency of GP visits as well as frequent attendance. Since self-perceptions of ageing are modifiable, this may help to manage health care use.

Training General Practitioners and Medical Assistants Within the Framework of HoPES3, a Holistic Care Program for Elderly Patients to Integrate Spiritual Needs, Social Activity, and Self-Care into Disease Management in Primary Care

Background

This study presents a concept for training general practitioners (GPs) in taking a spiritual history. In the same workshop, medical assistants (MAs) were trained in counselling elderly, chronically ill patients on social activities and home remedies. After the training, GPs and MAs will apply the acquired skills in their practices within the scope of the HoPES3 intervention study, which aims at raising patients’ self-efficacy.

Methods

Sixteen GPs and 18 MAs were trained in a 5-hour workshop and completed an evaluation questionnaire.

Results

All participants reported great satisfaction. In particular, 85% of GPs (n=11) affirmed increased capacity to address patients’ spiritual needs. About 88% (n=15) of MAs were satisfied with the training, yet expressed difficulties in integrating theoretical knowledge into daily professional routine.

Discussion

While the evaluation of the workshop is promising, the results of the randomized-controlled trial evaluating the effectiveness of the complete HoPES3 intervention have to be awaited.

Conclusion

To our knowledge, this is the first interdisciplinary, holistic care training in primary care in Germany. It fosters GPs’ and MAs’ competency in providing a proactive support in spirituality, social activities, and home remedies to their patients. If the concept proves to be effective, it could be integrated into existing care models and curriculums and provide clear guidance on how to consider elderly patients’ spiritual needs and strengthen their self-efficacy in primary care settings.

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The incidence of multimorbidity and patterns in accumulation of chronic conditions: A systematic review

Multimorbidity, the presence of 1+ chronic condition in an individual, remains one of the greatest challenges to health on a global scale. Although the prevalence of multimorbidity has been well-established, its incidence is not fully understood. This systematic review determined the incidence of multimorbidity across the lifespan; the order in which chronic conditions accumulate to result in multimorbidity; and cataloged methods used to determine and report accumulation of chronic conditions resulting in multimorbidity. Studies were identified by searching MEDLINE, Embase, CINAHL, and Cochrane electronic databases. Two independent reviewers evaluated studies for inclusion and performed quality assessments. Of 36 included studies, there was high heterogeneity in study design and operational definitions of multimorbidity. Studies reporting incidence (n = 32) reported a median incidence rate of 30.7 per 1,000 person-years (IQR 39.5 per 1,000 person-years) and a median cumulative incidence of 2.8% (IQR 28.7%). Incidence was notably higher for persons with older age and 1+ chronic conditions at baseline. Studies reporting patterns in accumulation of chronic conditions (n = 5) reported hypertensive and heart diseases, and diabetes, as among the common starting conditions resulting in later multimorbidity. Methods used to discern patterns were highly heterogenous, ranging from the use of latent growth trajectories to divisive cluster analyses, and presentation using alluvial plots to cluster trajectories. Studies reporting the incidence of multimorbidity and patterns in accumulation of chronic conditions vary greatly in study designs and definitions used. To allow for more accurate estimations and comparison, studies must be transparent and consistent in operational definitions of multimorbidity applied.

Are perceived bad working conditions and perceived workplace bullying associated with doctor visits? Results of the nationally representative German General Social Survey

BACKGROUND

The reason for doctor visits associated with bad working conditions (and workplace bullying) remains unknown. Therefore, the aim of this study was to examine the association between perceived working conditions as well as workplace bullying and the number of doctor visits as well as the reason for seeing a doctor.

METHODS

Data were derived from the German General Social Survey, a representative cross-section of the population in the year 2014. Self-reported doctor visits in the last 3 months were used as outcome measure. Self-rated working conditions (noise, bad air; time/performance pressure; bad working atmosphere; overtime; shifts/night work; hard physical labour) and workplace bullying were assessed. The reason for seeing a doctor was also recorded (acute illness; chronic illness; feeling unwell; requesting advice; visit to the doctor's office without consulting the doctor (e.g., need to get a prescription); preventive medical check-up/vaccination). Regression analysis stratified by sex was conducted.

RESULTS

Adjusting for various potential confounders, Poisson regressions showed that workplace bullying was associated with increased doctor visits in men, but not in women. Contrarily, time/performance pressure at work was only associated with increased doctor visits in women, but not in men. Furthermore, the probability of visiting the doctor for reasons of acute illness or feeling unwell increased with workplace bullying in men. The probability of visiting the doctor because of feeling unwell increased with time/performance pressure in women.

CONCLUSIONS

Our findings stress the association between adverse working conditions (workplace bullying as well as time/performance pressure at work) and doctor visits, with remarkable gender differences. Longitudinal studies are required to confirm the present findings and to obtain further insights into this relationship.