Health services in older psoriasis patients before and after nursing home admission : Aretrospective analysis of health insurance data.

Abstract

Demographic change confers significance to healthcare management of chronic diseases like psoriasis. There are few studies on the care of older people with psoriasis, particularly for the nursing home setting. It was investigated whether the number of psoriasis patients with specialist contact changes before vs. after nursing home admission. We analyzed claims data of aGerman health insurance company including acohort of newly admitted nursing home residents aged 65years and older between 2011 and 2014, who received adiagnosis of psoriasis 1year before nursing home admission. Outpatient care was compared between the years before vs. after nursing home admission. We conducted amultivariate regression analysis for identifying predictors for dermatological care. The study cohort included 718 insured persons (Ø83years). Proportion of patients who had contact to adermatologist significantly decreased after nursing home entry (44.6% before vs. 40.1% after nursing home entry). Strongest predictors for dermatological care after entry were apreviously existing dermatological contact (odds ratio, OR 3.87, 95% confidence interval, CI 2.70-5.54) and prescription for topical steroids (OR 1.61, 95% CI 1.14-2.28). The analysis of health insurance data showed apertinent decrease in the use of outpatient dermatological care after institutionalization. The evaluation of the adequacy of care is difficult due to the used database without clinical information. As long as no further investigations of this vulnerable patient group are available, the care of psoriasis patients of old age should be closely monitored. Dermatological knowledge of the skin in old age is an essential prerequisite for this.