[Emerging structures in wound care : Counselling on and prescription of medicinal products in nursing homes].

BACKGROUND-
OBJECTIVE: In 2015 almost 2.9 million people in Germany received nursing care insurance benefits. More than 27% of those in need of long-term care lived in inpatient care facilities. Of the residents 6% included in the examination by the Medical Services of the Leading Association of Healthcare Insurances (MDS) had chronic wounds or bedsores requiring treatment. The aim of the study was to gain insights into care decisions and the research question was: what is the process of wound care in nursing homes?
METHODS: The study used a qualitative design. Based on four inpatient nursing facilities of different ownership, the data were collected with 19 guideline-based interviews, the average duration being 62 min. All interviews were transcribed and analyzed using the qualitative MAXQDA 18 software.
RESULTS: The exclusively resident-related rule processes with the known interface problems pose challenges for general practitioners and nursing homes and reach their limits. They promote the emergence of additional players, so-called homecare companies, which are not provided for in the German healthcare system and thus also not in the remuneration system. In new care structures, homecare companies are taking over the wound care process almost completely. They are financed through prescription business, i.e. through discounts granted by drug manufacturers.
CONCLUSION: For nursing homes and general practitioners, homecare companies offer a welcome opportunity to meet the complex requirements of the care process while simultaneously saving their own resources. The financing of services from manufacturer discounts gives rise to fears that products with a higher cost margin will be preferentially used, thus counteracting the economic viability requirement for services provided by statutory healthcare insurance.