Austrian Health Research Articles

Forecasting the future demand on health workforce – the Austrian model

Abstract Background An aging population and upcoming retirements of health care professionals pose new challenges to the Austrian health care system. On the one hand the health care and nursing needs will increase while at the same time a shortage on health care personnel threatens adequate supply. We as the Austrian Public Health Institute estimate the risk of an undersupply with model-based health workforce forecasting and are therefore able to advise the federal states and the ministry of health on early measures. Methods We developed a forecasting model to estimate the future supply and demand. The main influencing factors are the demographic development as well as the upcoming retirements and graduates. Different environments and needs in different federal states (e.g. changing future skill mix) are considered and can be implemented as additional influencing factors. Usually a baseline scenario as a forward projection of the status quo is developed for defined professions and workplace settings. Then depending on the stakeholder needs additional scenarios are calculated and discussed. A usual forecast horizon is 10 to 15 years. Results Model output are time series of yearly workforce personnel numbers (heads and full-time equivalents) and demand in the defined settings. An analysis of possible gaps shows the need for action. Conclusions The Austrian health workforce model is a flexible tool to estimate future needs on health workforce based on different assumptions. But as assumptions and influencing factors must be represented as data, the data collection can be quite laborious. Comprehensive data is the basis for a comprehensive health workforce planning. Further work is needed to develop practical and evidence-based nursing-sensitive indicators for nursing workfoce reportings on a country level. In Austria the health professionals register forms the basis for the description of the nursing workforce structure, but that there is a need for data sources on care effectiveness. Key messages • Comprehensive data is the basis for a comprehensive health workforce planning. • An aging population and upcoming retirements of health care professionals pose new challenges to the Austrian health care system.

Linking health-related behaviours to quality of life in older adults: A latent class analysis

Abstract Background Life expectancy and healthy life years diverge considerably in Austria, and quality of life (QoL) varies widely among older people. Identifying the factors most relevant to QoL in older people is crucial. We aimed to investigate the association between health behaviour, including lifestyle and preventive behaviour, and QoL in this population. Methods Cross-sectional data from the Austrian Health Interview Survey (2019) were used, including 3,995 individuals aged 65 years and older. We performed latent class analysis (LCA) to identify patterns of health behaviours. Variables were selected based on the WHO framework of Active Ageing including factors related to lifestyle (physical exercise, fruit/vegetable intake, BMI, oral health, smoking, alcohol use) and the health care system (satisfaction, unmet needs, participation in screening, health checks and vaccination). Domain scores of the WHOQOL-BREF were used for QoL assessment. Class differences were assessed by survey regressions. Results In the LCA, four different behavioural classes emerged among the older-aged Austrian population, including (class 1) ‘best preventive behaviour and very good lifestyle’ (17.7%), (class 2) ‘worst lifestyle and worst preventive behaviour, high unmet healthcare needs and unsatisfied with the system’ (16.5%), (class 3) ‘very good preventive behaviour and best lifestyle, but worst vaccination probability’ (24.8%) and (class 4) ‘poor preventive behaviour, good lifestyle, but no physical activity’ (41.0%). The classes with unhealthy lifestyles (classes 2 and 4) had worse QoL in all domains compared to the classes with healthy lifestyles (classes 1 and 3). The four classes differ on demographic, socio-economic and health characteristics. Conclusions To improve the QoL of the older population, policies and interventions need to be tailored to the specific characteristics and needs of each behavioural class. Key messages • This study explores the relationship between health behaviour and QoL in older Austrians. • Findings support the development of differentiated interventions targeting different types of behaviour.

Guidance on health promoting and climate-friendly hospitals and health services

Abstract The negative impacts of climate change on health and the healthcare system are becoming increasingly evident. The healthcare sector, which accounts for nearly seven percent of Austria’s CO2 emissions, contributes to the exacerbation of climate change on one hand, but is also affected by its consequences on the other. To meet these challenges, it is necessary for healthcare facilities to both adopt climate-protective measures and adapt to the changed conditions. A project launched in 2023, supported by the Austrian Health Promotion Agenda and in cooperation with the Austrian Network of Health Promoting Hospitals and Health Services, has shown that there is a need for support in implementing climate protection measures in healthcare facilities. In response, the WHO Collaborating Centre for Health Promotion in Hospitals and Healthcare, located at the Competence Centre for Health Promotion and Healthcare at the Austrian National Public Health Institute, will work on the development of standards based on international models to support healthcare facilities in the introduction of climate-friendly practices until 2026. The methodology of the project includes the analysis of existing quality criteria and instruments, as well as a modified Delphi process with two rounds of online questionnaires directed at an international panel of experts. After each round, exchange meetings with a smaller group from the panel take place to achieve consensus. Based on the research findings and the Delphi consultations, a draft of standards and an implementation manual will be created. These drafts will be piloted in various healthcare facilities in Austria and other countries to assess their practicability and effectiveness. Following the pilot tests, the standards and the manual will be revised to integrate the practical insights gained. At the time of the conference, the initial results of the Delphi process will be presented, providing insights for the further development of the standards. Key messages • Integrating climate-friendly practices into all aspects of healthcare can reduce its environmental impact, improve health outcomes, and contribute to the broader sustainable development goals. • Climate-friendly approaches yield significant health, economic, and social co-benefits.

Development of an assessment process for digital medical devices in Austria

Abstract Issue/problem Digital medical devices have experienced a rapid development in recent years and are playing an increasingly important role in healthcare. These devices offer numerous benefits and can improve patient care. However, despite their potential benefits, the use of digital medical devices also poses risks and regulation from governmental side is needed from a Public Health Perspective. This is why some countries already implemented assessment processes for Digital Medical Devices (e.g. Germany and France) leading to the question how such a process could be established in Austria too. Description of the problem While digital medical devices must fulfil requirements set by the medical device regulation to enter market, several other aspects are of interests when offering digital medical devices in routine care. These include e.g. medical effectiveness, data security and interoperability. The objective of the ongoing pilot project is to develop a process for the assessment of quality-assured digital medical devices in Austria in 2024. For this, a combination of literature research, interviews and workshops with relevant stakeholders is used in order to gain all necessary information. Process and assessment criteria will be tested and revised in a pilot phase with several digital medical devices. Results At the end of the project, an assessment framework as well as a potential evaluation process will be designed in accordance with relevant stakeholders. Moreover, legals aspects and the potential integration into the austrian health telematics infrastrucutur will be assessed. This will form a basis for implementing digital medical devices within the austrian healthcare system. Key messages • The result of this project aims to build the basis for implementing an evaluation process for digital medical devices in Austria. • The establishment of an evaluation process for digital medical devices supports the integration of quality assured digital medical devices in healthcare.

Prevalence and incidence of chronic wounds in Austria - a population-based real-world data analysis

Abstract Background Chronic wounds are associated with pain, odor, loss of mobility, an increased risk for infection and sepsis and a reduced quality of life. Treatment costs are rising due to the longevity of the population and increasing number of diabetes cases. For service planning in healthcare, it is thus necessary to describe patient characteristics and estimate the prevalence and incidence of chronic wounds. Currently, no data exists on this subject broken down by age group, gender, and province in Austria. Methods A retrospective analysis of real-world data was conducted using two merged datasets from an outpatient wound centre and the Austrian Health Insurance Fund. The study population consisted of people who resided in Austria and were covered by statutory health insurance from 2018 to 2022. We performed a descriptive, socio-demographic analysis of the data of patients, followed by a set of cluster analyses using the unsupervised K-means algorithm. From these clusters, we derived subgroup characteristics and patient trajectories and calculated prevalence and incidence rates for chronic wounds according to diagnoses, different age groups, gender, and different regions. Results Gender was almost evenly distributed in the wound centre’s data set (n = 4963; 49.6% female). The age distribution revealed the age group from 71-80 years being the largest group. In general, more women than men are affected by chronic wounds from the age of 81 onwards. 31% of chronic wound patients had diabetes as an underlying condition. More men were affected by peripheral arterial occlusive disease and diabetic foot syndrome and, conversely, more women by chronic venous insufficiency. These are preliminary results of the analyses. Conclusions Chronic wound patients were characterised by older age and multi-morbidity. Interestingly, gender differences appeared in the occurrence of comorbidities. Key messages • This study makes a crucial contribution in making routine data usable for the epidemiological study of chronic wounds, a cluster of diseases of complex aetiology. • It thus contributes to filling a knowledge gap. The prevalence estimate serves as a basis of knowledge for health care planning and a basis for the health economic assessment of the problem.

Adherence to Secondary Prevention Measures after Acute Myocardial Infarction and Its Impact on Patient Outcome-A Nationwide Perspective.

Objectives: Secondary prevention is crucial for reducing morbidity and mortality in patients following acute myocardial infraction (MI). However, adherence to cardiac rehabilitation (CR) and pharmacotherapy remains suboptimal despite strong guideline recommendations. This study investigated the adherence to CR, dual antiplatelet therapy (DAPT), and statins following acute MI and evaluated their impact on patient outcomes from a nationwide perspective in Austria. Methods: In this national observational study, all patients diagnosed with acute MI, defined as STEMI or NSTEMI, between April 2011 and August 2015 in Austria were included. Patient characteristics and comorbidities were derived from the Austrian national health insurance system using ICD-10 codes. Adherence to CR, high-intensity statins, and DAPT was assessed based on health insurance records and pharmacy prescription submissions. Cox Regression hazard analysis was used to explore the impact of non-adherence to CR on mortality. Results: Among 16,518 acute MI patients, only 13.4% adhered to the recommended CR programs, which was associated with a significantly lower risk of mortality (adjusted hazard ratio [HR] 0.73; 95% CI: 0.54-0.98; p = 0.036). In contrast, 66.4% of 23,240 patients did not comply with high-intensity statin therapy, correlating with an increased mortality risk (adjusted HR 1.16; 95% CI: 1.06-1.25; p < 0.001). Furthermore, among 22,331 patients analyzed for DAPT adherence, only 29.3% followed the guidelines, yet this adherence was linked to a 21% reduction in mortality over the observation period (adjusted HR 0.79; 95% CI: 0.72-0.88; p < 0.001). Conclusions: This nationwide study reveals alarmingly low adherence to CR and secondary preventive medications among acute MI patients, which is significantly linked to higher mortality rates. Enhanced efforts to promote awareness and adherence are crucial, involving structured referrals and personalized follow-ups to improve patient outcomes. Addressing these gaps through comprehensive healthcare strategies could substantially enhance cardiovascular health.

Smart FOX - Enabling Citizen-Based Donation of EHR-Standardised Data for Clinical Research in Austria.

Access to healthcare data for secondary use in clinical research is often restricted due to privacy concerns or business interests, hindering comprehensive analysis across patient pathways. The Smart FOX project seeks to address this challenge by developing concepts, methods, and tools to facilitate citizen/patient-driven donations of health data for clinical research. Leveraging the groundwork, laid by the national Electronic Health Record implementation in Austria (called ELGA), Smart FOX aims to harness structured datasets from ELGA for research purposes through an opt-in approach. With funding secured from the Austrian Research Promotion Agency, the project embarks on innovative solutions encompassing governance frameworks, community engagement, and technical infrastructure. The Smart FOX consortium, comprising key stakeholders across various healthcare-associated domains, will evaluate these efforts through demonstrators focusing on clinical registries, patient-generated data, and recruitment services. The project targets to accompany the development of future data donation infrastructure while ultimately advancing clinical research efficiency and bolstering Austria's preparedness for the European Health Data Space. This paper presents the first systematic evaluation of the technical concept and proposal for the federated system architecture of the Austrian Health Data Donation Space, which is the socio-technical goal of Smart FOX.

A Comparative Analysis of Mammography Uptake between Migrant and Non-Migrant Women in Austria-Results of the Austrian Health Interview Survey.

Mammography can reduce breast cancer incidence and mortality. Studies on the utilization of mammography among migrant and non-migrant women are inconsistent. Many of these studies do not take the heterogeneity of migrants in terms of ethnicity and country of origin into account. The aim of the present study was to examine disparities in the use of mammography between non-migrant women and the five largest migrant groups in Austria. The study used data from a nationwide population-based survey of 5118 women aged 45 years and older and analyzed the participation in mammography as a dependent variable. Multivariable logistic regression was used to compare mammography uptake between the aforementioned groups of women, while adjusting for socioeconomic and health variables. The study shows that all migrant groups involved tended to use mammography less frequently than non-migrant women; statistically significant differences, however, were only observed for Hungarian migrant women (adjusted OR = 0.36; 95%-CI: 0.13, 0.95; p = 0.038) and women from a Yugoslavian successor state (adjusted OR = 0.55; 95%-CI: 0.31, 0.99; p = 0.044). These findings are consistent with other studies in Europe and beyond, highlighting the heterogeneity of migrant populations and emphasizing the need for a diversity-sensitive approach to health care.

Attitudes of the general population and mental health practitioners towards blended therapy in Austria.

Mental health problems are steadily increasing worldwide. In Austria, the overall supply of mental health services is low, especially in rural areas. Mobile technology and ablended care approach have the potential to overcome problems with service provision. The aim of this study was to map the attitudes of practitioners and people living in Austria towards blended therapy. Two individual online questionnaires (including the Unified Theory of Acceptance and Use of Technology, advantages and disadvantages, useful features) were distributed to practitioners and the general population in Austria. The questionnaires were answered by 152 members of the general public and 129 practitioners. The general population and practitioners seem to be cautious, but slightly positive about blended therapy. Previous experience of practitioners with blended therapy was low. Practitioners are most worried about the therapeutic process and their work-life balance, while the general population is worried about being overwhelmed by the concept, mainly due to the time investment. Tracking, recording and reminding functions (e.g., for mood, homework) were seen as especially valuable features and accessibility was deemed the biggest advantage by both samples. Practitioners' attitudes are important for implementation of blended therapy. More awareness might help against the cautiousness as well as implementing digital health applications in Austrian health policies.

Trends over time in the deficit of (instrumental) activities of daily living in the Austrian population aged 65years and older : Results from the Austrian Health Interview Survey series.

Difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults are associated with diminished quality of life and increased demand for long-term care. The present study examined the prevalence of disability among individuals aged 65years and older in Austria, using data from the Austrian Health Interview Surveys (ATHIS). The ATHIS 2014 and 2019 surveys were used (N = 5853) for the analysis. Binary logistic regression was performed to measure the association between disability in at least one ADL or IADL limitation and independent variables adjusted for sociodemographic, health-related behavior and survey year. The prevalence of ADL or IADL limitations increased in both sexes during the 5‑year follow-up period. For ADL limitations, the prevalence rose from 12.8% to 17.9% in men (p < 0.001) and from 19.2% to 25.7% in women (p < 0.001). The IADL limitations increased from 18.9% to 35.1% in men (p < 0.001) and from 38.2% to 50.8% in women (p < 0.001). Women reported significantly higher odds for ADL (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 0.93-1.26) and IADL limitations (OR: 1.74, 95% CI: 1.53-1.98). In both sexes, participants aged 80years and older reported higher odds for ADL (OR: 4.37, 95% CI:3.77-5.07) and IADL limitations (OR: 4.43, 95% CI: 3.86-5.09) compared to the younger group. Participants with at least one chronic disease reported higher odds for ADL (OR: 4.00, 95% CI: 3.41-4.70) and IADL limitations (OR: 4.37, 95% CI: 3.85-4.96). Primary education, single status, being born in non-EU/EFTA countries, and residing in Vienna were associated with higher odds of ADL and IADL limitations. Gender, age, education, country of birth, residence, partnership status, number of chronic diseases, noncompliance with physical activity, and nutrition recommendations had astrong association with increased vulnerability to disability. Public health policy must address these factors for disability prevention strategies.

Facing the complex challenges of people with epidermolysis bullosa in Austria: a mixed methods study on burdens and helpful practices

BackgroundWith approximately 500 people affected in Austria, epidermolysis bullosa (EB) is a rare genetic skin disease reducing the quality of life of those affected and their relatives. The intensive efforts of the patient organisation DEBRA Austria during the last decades have led to a unique situation of those affected and their relatives, with increased support and broader knowledge about the disease in the general population. The aim of the study is to evaluate the current situation of patients and their relatives living in Austria, with a focus on burdens and helpful practices.ResultsThe mixed-methods study consisted of two parts: a qualitative interview study to identify psychosocial aspects of EB in those affected and their relatives, and a subsequent online survey to further assess those aspects in a larger sample, resulting in a total of n=78 Austrian participants. The impact of EB on the quality of life of EB patients and their relatives in Austria is related to the current health status, psychological burden, mobility, visibility, financial situation as well as job prospects. Personal and social resources and external support have a significant influence on the individual situation.ConclusionsThe outcome is mapped to concrete implications regarding targeted support for EB patients and their relatives on an individual level and their needs in regard to the Austrian health care system.

The impact of the SARS-CoV2 pandemic on the prescription of thyroid medication in Austria – A nationwide population-based registry analysis

BackgroundCase reports indicate a clinical connection between SARS-CoV-2 and thyroid dysfunctions. However, evidence from large population-based registry analyses is sparse, especially in Europe, where iodine deficiency is common. This study aimed to analyze the impact of the COVID-19 pandemic on healthcare provision for thyroid diseases in Austria. MethodsWe performed a retrospective, population-based registry analysis of the Austrian health insurance fund database, covering more than 9 million inhabitants. Data from all patients with prescriptions of thyroid-specific drugs and/or inpatient thyroid-related diagnoses from 2017 to 2019 (pre-pandemic years) were compared to 2020 and 2021 (pandemic years; characterized by high numbers of SARS-CoV2 infections and population-wide vaccination strategy). The incidence rates of thyroid medication prescriptions for hypothyroidism and hyperthyroidism were calculated for every year to evaluate the impact of the pandemic. ResultsThe incidence rate for total thyroid medication prescription was 539.07/100,000 individuals (534.23–543.93 95%CI) in 2018 and declined during the pandemic (2020: 387.19/100,000 (383.12–391.29 95%CI); 2021: 336.90/100,000 (333.11–340.73 95%CI)). Similarly, the incidence rate for levothyroxine prescription was higher pre-pandemic (2018: 465.46/100,000 (460.97–469.98 95%CI) and declined during the pandemic (2020: 348.14/100,000 (344.28–352.03 95%CI); 2021: 300.30/100,000 (296.7–303.91 95%CI). The incidence rates of thiamazole prescriptions (2018: 10.24/100,000 (9.58–10.93 95%CI); 2020: 8.62/100,000 (8.03–9.26 95%CI); 2021: 11.17/100,000 (10.49–11.89 95%CI) were stable. ConclusionsThese findings suggest no clinically significant impact of SARS-CoV2 and/or vaccination on thyroid function at a population level.

Experiences of Vegans with General Practitioners in the Austrian Health Care System: A Qualitative Study.

This article explores the factors influencing the choice of general practitioners (GPs) and their role in the health care of vegans in Austria. The number of people identifying as vegan is on the rise, and GPs are increasingly confronted with vegan patients. A qualitative method was chosen for this study, and 14 semi-structured interviews with vegans were conducted between April 2022 and July 2022. Participants were recruited primarily through vegan social media groups. In their experiences with health care, vegans felt treated unequally or sometimes incorrectly. The experiences described highlight that participants felt that most GPs were biased against their veganism. Information exchange among vegans primarily takes place online and through publications of vegan associations, while GPs play a minor role in information provision. As the number of vegans grows, an appreciative way of communicating between GPs and vegan patients ought to be promoted. Voluntary interdisciplinary nutritional training, collaboration of the medical field with support organizations, provision of evidence-based information, and collaboration with dietitians and nutritionists could enrich the care of patients with a vegan diet.

The impact of the COVID-19 pandemic on rates of adolescents receiving psychopharmacological medication in Austria

BackgroundThe COVID-19 pandemic has impacted many aspects of everyday life, including the (mental) healthcare system. An increase in depression and anxiety symptoms has been reported worldwide, and is particularly pronounced in females and young people. We aimed to evaluate changes in prescription rates for psychopharmacological medication, which is often used to treat depression and anxiety.MethodBased on data from the Austrian public health insurance institutions, we conducted an interrupted time series analysis of antidepressants and antipsychotics, comparing prescription rate developments before and throughout the COVID-19 pandemic (2013 to 2021), with a special focus on adolescents (10–19 years) in comparison to the general population. Data were based on all public prescriptions in the outpatient sector nationwide. Age- and sex-stratified time-series models were fitted to the pre-COVID period (first quarter (Q1) of 2013 to second quarter (Q2) of 2020). These were used to generate forecasts for the period from the third quarter (Q3) of 2020 to the fourth quarter (Q4) of 2021, which were subsequently compared to observed developments in order to assess significant deviations from the forecasted development paths.ResultsFor the majority of the evaluated period, we found a significant excess of antidepressant prescriptions among both male and female adolescents (10–14 and 15–19 years) compared to the forecasted development path, while the general population was mostly within 97.5% confidence intervals of the forecasts. Regarding antipsychotics, the interrupted time series analysis revealed a significant excess in the group of female adolescents in almost all quarters, which was especially pronounced in the 15–19 age group. Prescription rates of antipsychotics in the general population only showed a significant excess in two quarters.ConclusionIncreased rates of adolescents receiving psychopharmacological treatment echo the epidemiological trends of an increase in depression and anxiety symptoms reported in the literature. This increase is especially pronounced in female adolescents.

Frailty predicts all-cause and cause-specific mortality among older adults in Austria: 8-year mortality follow-up of the Austrian Health Interview Survey (ATHIS 2014)

BackgroundThe frailty index (FI) is an established predictor of all-cause mortality among older adults, but less is known with regard to cause-specific mortality, and whether the predictive power of the FI varies between men and women and by socio-economic position.MethodsWe assessed all-cause and cause-specific mortality during 8 years of follow-up (median = 7 years) among the population-representative sample of older adults (65 + , n = 2,561) from the European Health Interview Survey in Austria (ATHIS 2014). A FI at baseline was constructed from 41 health deficits. Official cause of death information from Statistics Austria was linked with the survey data by the Austrian Micro Data Center (AMDC). Next to all-cause mortality, we differentiated between mortality from cardiovascular diseases (CVD), cancer, and other causes. Cox proportional hazard models adjusted for socio-demographic variables and causes of death as competing risks were used to assess mortality prediction.ResultsAmong the participants, 43.5% were robust (FI < 0.10), 37.7% pre-frail (FI = 0.10–0.21), and 18.7% were frail (FI > 0.21). 405 (15.8%) participants died during follow-up. Among the deceased, 148 (36.5%) died from CVD, 127 (31.4%) died from cancer, and 130 (32.1%) died from other causes of death. The FI predicted all-cause (hazard ratio, HR = 1.33 per 0.1 FI and HR = 2.4 for frail compared to robust older adults) and cause-specific mortality risk (HRCVD = 1.25/2.46, HRcancer = 1.19/1.47, HRother = 1.49/3.59). Area under the curve (AUC) values were acceptable for CVD mortality (0.78) and other causes of death (0.74), and poor for cancer mortality (0.64).ConclusionsThe FI predicts all-cause and cause-specific mortality (CVD, other causes) well, which points to its relevance as a potential screening tool for risk stratification among community-dwelling older adults.

Factors associated with informal, and professional care, and unmet care needs in persons with deficits in activities of daily living in Austria. Results of two repetitive population-based surveys in people aged ≥65 years.

Introduction: Europe’s population is growing older, a trend that is projected to continue. Increased life expectancy means, older individuals are at risk of falls, hip fractures, long-term health conditions, re-hospitalization, which leads to the possibility of increased time spent in poor health. Hence, it is paramount to identify the diverse factors influencing the ageing process and subsequent limitation in Activities of Daily Living (ADLs)—eating and drinking independently, getting up and sitting down, dressing and undressing, using the toilet, and bathing or showering. Evidence shows worsening disability and developing new difficulty in ADLs has become more common with age, and leads to reduced quality of life, loss of independence and increased dependency and the increased need for care.&#x0D; Methods: Data was obtained from the Austrian Health Interview Surveys. 2931 and 2922 study participants aged ≥65 from 2014 and 2019, respectively, were included in the analysis. Three binary logistic regression was conducted with informal care, professional care and unmet care needs as dependent variable, and socio-demographic, health-related, and lifestyle-related parameters as independent variables, and the latter were mutually adjusted for each other.&#x0D; Results: In 2014, 12.8% of men and 17.9% of women, respectively, had difficulty in at least one ADL domain, compared to 19.2% and 25.7%, in 2019 (p&lt;0.001). Of men and women with ADL deficits, 50.2% and 50.0% sought help from family members or friends, 14.1% and 27.5% received help from professional caregivers, and 17.4% and 30.4% said they would need more help than they actually get. The probability of both informal and professional care with ADL deficits increased significantly from 2014 to 2019 (OR; 95% CI: 1.88; 1.47-2.41; 2.42; 1.76 -3.33), however, there was no change in unmet care needs (1.06; 0.81-1.39). Male sex was associated with professional care (1.67; 1.16-2.40) and unmet care needs (2.04; 1.48-2.82). Higher age was associated with all three measures of care (2.54; 1.96-3.30; 2.77; 2.00-3.85; 2.09; 1.56-2.79). Lower education was associated with informal care (2.90; 1.57-5.35 for primary education; 2.53; 1.38-4.64 for secondary education). Being born in other European states (EU or EFTA) was associated with a higher chance for professional care (3.11; 1.93-5.02) and unmet care needs (1.90; 1.22-2.95). Living in a big city was negatively associated with informal care (0.60; 0.44-0.83). Not living in a relationship was negatively associated with informal (0.55; 0.42-0.73) and positively with professional care (2.18; 1.56-3.06). Having at least one chronic disease was associated with informal care (2.16; 1.56-3.00) and unmet care needs (2.56; 1.69-3.88). Lack of physical activity was associated with all three care parameters (2.90; 1.32-4.28; 11.87; 2.03-69.45; 2.09; 1.02-4.29). Being underweight was associated with a higher chance for informal care (3.33; 1.11-10.01), and obesity with unmet care needs (1.49; 1.05-2.13).&#x0D; Conclusions: Socio-economic, health and lifestyle-related factors are significantly associated with formal and professional and unmet care needs in older people with ADL deficits. To deliver a sustainable integrated care for older people in Europe, the importance of physical health, social, cultural, and emotional needs must be recognized and supported in all levels of care.

The Tyrolean Federal Institute for Integrated Care (LIV Tyrol)

A constantly increasing life expectancy of society leads to an increase in severe chronic diseases, which are accompanied by negative effects on the quality of life for patients and an increasing number of hospital admissions as well as long hospital stays. This poses major challenges for the healthcare system and requires innovative and integrated approaches in order to provide high quality healthcare.&#x0D; Therefore, the Tyrolean Federal Institute for Integrated Care (LIV Tyrol) was founded from a joint initiative of the federal state government of the Province of Tyrol and the social insurance institutions to target the above mentioned challenges and reduce burdens for the health care system by developing and implementing integrated care approaches and programs for different chronic diseases. Integrated care is understood to be patient-oriented, continuous, cross-sectoral, interdisciplinary and/or multiprofessional care based on standardized care concepts.&#x0D; LIV Tyrol aims for optimal care for patients – especially patients suffering from chronic diseases – at their homes in order to increase their quality of life on the one hand and, on the other hand, to relieve the healthcare system through innovative approaches. As a result, different disease management programs are developed, implemented, coordinated, operated and evaluated.&#x0D; They include disease management programs for patients with heart failure (HerzMobil Tirol), dementia (Demenz Tirol), patients who suffered a stroke (Schlaganfallpfad Tirol) or in need of palliative care (Hospiz- und Palliativversorgung). LIV Tyrol also coordinates the care management for the Province of Tyrol, Austria and the post-Covid care. Some of these programs are supported by telemedical solutions including telemonitoring systems to provide a secure framework for patient care outside the hospital and to allow for immediate measures when needed. Furthermore, different registries, such as the Austrian birth registry, the Tyrolean cancer registry, the Tyrolean arthroplasty registry, or the Tyrolean diabetes registry are located and operated at the Institute of Clinical Epidemiology, which is part of LIV Tyrol. LIV Tyrol also supports data management and analytics for (clinical) problems but also provides an important contribution to quality assurance within the Tyrolean healthcare system.&#x0D; In order to implement such disease management programs, a close collaboration of different stakeholders is needed. Stakeholders of LIV Tyrol include but are not limited to health-policy makers, social insurance institutions, healthcare providers (hospitals, resident practitioners, other health-related professions), research institutions, and patients. &#x0D; An institution like LIV Tyrol is unique in the Austrian health care system and contributes to optimal care security for patients in Tyrol and poses hub for new, innovative and flexible integrated care models.&#x0D; To make the health care system fit for the future, the federal and state governments have agreed to expand integrated care. The federal government of Tyrol has therefore commissioned the Tyrolean Federal Institute for Integrated Care to implement these targets and to design, organize and coordinate integrated care initiatives throughout the province of Tyrol.&#x0D;

Community Health Nursing Education in Austria-The Need for Competences in Planning, Management and Collaboration: A Problem-Centered Qualitative Study.

(1) Background: The Austrian health care system is extremely fragmented. Primary care is mainly provided by self-employed GPs. Other health professionals are rarely integrated into primary care. But, according to the political plans of the Austrian government, a system of community nurses and community health nurses should be implemented and several pilot projects have already been started. (2) Objective: The present study explores the skills and competences needed in the planning, management and collaboration for the change in the system and gives recommendations for community health nurse education in Austria. (3) Methodology: Fifteen qualitative, problem-centered interviews were conducted with experts in the field of community health nursing and analyzed using qualitative content analysis. (4) Results: The skills and competences often and widely mentioned are interprofessional collaboration, cooperation with other actors, systems thinking, project and change management, and basic management skills, including strategic planning, communication, accounting and finance. Areas such as health planning and lobbying are also highlighted. The main competences are broken down into subcompetences, making it possible to create a detailed competence grid. Competences in planning, management and collaboration are particularly important in the initial stages of the first implementation of a community health nursing system. (5) Conclusions: Skills and competences in these areas occupy a central position. A multilayered breakdown of these competences is required in order to create a targeted requirements profile. Due to the small-scale fragmentation of the Austrian health care system, collaboration and coordination are more difficult and costly, but all the more important. The aforementioned skills and competences represent an essential expansion of nursing education in Austria.

Policy implications of heterogeneous demand reactions to changes in cost-sharing: Patient-level evidence from Austria

Cost-sharing is a prominent tool in many healthcare systems, both for raising revenue and steering patient behaviour. Although the effect of cost-sharing on demand for healthcare services has been heavily studied in the literature, researchers often apply a macro-perspective to these issues, opening the door for policy makers to the fallacy of assuming uniform demand reactions across a spectrum of different forms of treatments and diagnostic procedures. We use a simple classification system to categorize 11 such healthcare services along the dimensions of urgency and price to estimate patients’ (anticipatory) demand reactions to a reduction in the co-insurance rate by a sickness fund in the Austrian social health insurance system. We use a two-stage study design combining matching and two-way fixed effects difference-in-differences estimation. Our results highlight how an overall joint estimate of an average increase in healthcare service utilization (0.8%) across all healthcare services can be driven by healthcare services that are deferrable (+1%), comparatively costly (+1.4%) or both (+1.6%) and for which patients also postponed their consumption until after the cost-sharing reduction. In contrast, we do not find a clear demand reaction for inexpensive or urgent services. The detailed analysis of the demand reaction for each individual healthcare service further illustrates their heterogeneity. We show that even comparatively minor changes to the costs borne by patients may already evoke tangible (anticipatory) demand reactions. Our findings help policy makers better understand the implications of heterogeneous demand reactions across healthcare services for using cost-sharing as a policy tool.

Parental anxiety and depression are associated with adverse mental health in children with special needs during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has led to restrictions in various areas of life, including social life, work, leisure, health, and education. Vulnerable groups, such as children with special needs and their parents, may be at increased risk of experiencing exacerbated mental health problems during stressful periods such as the COVID-19 lockdowns. Telephone interviews were conducted with 954 parents of children with special needs. We assessed parental levels of generalized anxiety and depression using the validated GAD-7 and PHQ-8 scales. Parents were asked to rate family burden and their worry about the COVID-19 crisis, as well as their children's adverse mental health symptoms and health behaviors. Parents also reported their children's worries about the COVID-19 crisis. We conducted regressions to examine the relationship between parents' mental health problems and their children's adverse mental health symptoms and health behaviors. Qualitative data from open-ended questions were coded thematically and major themes of parental worry about the COVID-19 crisis were identified. Parental anxiety and depression symptoms predicted adverse mental health symptoms and behaviors in children with special needs. Criteria for current depression were met by 7.9% of parents of children with special needs, whereas 4.7% of the general population in Vorarlberg met the criteria for current depression according to data from the Austrian Health Interview Survey in 2019. Parental self-ratings of both depression and anxiety were highly correlated. The majority of parents reported being burdened (79.1%) or worried (67.8%) about the COVID-19 crisis. The main themes of parental worry about the COVID-19 crisis included COVID-19 infection (40.6%), economic situation (13.1%), uncertainty (8.4%), lack of social contact with family and friends (8.1%), family health status (7.5%), and school life (7.5%). Mental health symptoms in parents of children with special needs were strongly associated with increased adverse mental health symptoms and health behaviors in their children. Parents of children with special needs were more likely to be depressed during the COVID-19 pandemic than adults in 2019. We call for additional mental health support to reduce the mental health burden in families with children with special needs.