Die Gesundheitsversorgung Pflegebedürftiger nach Schlaganfall

Abstract Background: According to the WHO, stroke is the third leading cause of death and the most frequent reason for disability. As a disease of the central nervous system, stroke results in different somatic disorders which affect cognition, sensomotor function, the spinal cord, muscles and cardiorespiratory system. Applying different medical and therapeutic approaches with learning of compensation strategies and the use of technical aids, neurological rehabilitation following stroke utilises plasticity of brain structures. The aim of this study is to quantify health care needs and utilisation of patients who are requiring long term nursing care after ischaemic stroke. Health care is analyzed in medical, therapeutic and nursing care. Due to these findings appropriateness of health care is going to be assessed. Methods: The study is based on routine data from the BARMER GEK , a nationwide German Statutory Health Care Fund and Nursing Care Fund. The data cover the years 2000 to 2009, and were provided in pseudonymous way. Data of routine care were linked with data about nursing needs which were obtained from the medical expert unit of all Statutory Health Insurances (MDK). Results: Stroke leads to increasing additional expenditures in health care, which is demonstrated for all analyzed sections. Costs for long term care increase by 50% due to stroke, additional expenditures for therapeutic needs average 1000 per patient and year. Besides the financial consequences, health care shows different deficits in quality and organization, for instance in type or frequency of therapeutic interventions. Conclusion: Stroke increases medical, therapeutic, rehabilitation needs and corresponding costs for health and nursing care. This means severe need for action regarding the structure of supply, especially for elderly persons with long term nursing care. The concept of managed care may be an appropriate model of health care integrating the different health care sectors, which are necessary for stroke patients.