Abstract
BACKGROUND: Previous studies have identified inequities in the diagnostic and therapeutic procedures used with community-dwelling people living with dementia (PlwDs) or people living with mild cognitive impairment (PlwMCIs) depending on the urban vs. rural location of their residence. Whether those differences in health care and health services utilization still exist for people residing in shared-housing arrangements (SHAs) remains unclear at this point. METHODS: In a prospective, multicenter, mixed-methods, cluster-randomized controlled trial, the "DemWG study," 341 PlwDs or PlwMCIs living in a total of 97 SHAs across Germany were recruited. 31 of the participating SHAs were rural (133 participants), 66 were urban (208 participants). As a secondary analysis we evaluated health care data (e.g. vaccinations, medication), utilization of inpatient/outpatient medical services, non-pharmacological therapies according to the German Remedies Directive, provision of health and medical aids and structural data of the SHAs. Variables were assessed at baseline by trained staff from the SHAs using validated instruments (e.g. FIMA - questionnaire for health-related resource use in an elderly population). Descriptive and inferential statistical methods were applied. P-values were corrected with the Benjamini-Hochberg procedure. RESULTS: The majority of the assessed health care data did not show significant differences between urban and rural SHA inhabitants. After the p-values were corrected, only two variables remained different: inhabitants of rural SHAs were prescribed a significantly larger number of total drugs, while urban inhabitants had significantly more appointments with neurologists/psychiatrists in the last 6 months. There were no significant differences in the use of all other type of inpatient/outpatient services, non-pharmacological therapies, use of health and medical aids. Also, the structural data of the SHAs like staffing did not significantly differ between urban and rural place of living. DISCUSSION: While it seems that most inequities in the care of PlwDs/PlwMCIs living in SHAs between rural and urban areas have been overcome, there is still the one crucial difference in this non-representative sample of SHAs: the contact with neurologic/psychiatric specialists who offer elaborated diagnostic procedures is less frequent in rural areas. TRIAL REGISTRATION: ISRCTN89825211 (Registered prospectively, 16 July 2019).