Community Care Points—Awareness Levels and Utilization

Community care points have, since 2008, been established within the framework of the Long-term Care Further Development Act (PfWG, Pflege-Weiterentwicklungsgesetz) to provide regional contact points for counseling on a wide range of aspects related to care and social needs. The responsibilities of community care points comprise, among others, providing information and advice on the utilization of social benefits and assistance services as well as coordinating the care of patients and their relatives close to their homes. The community care points are potentially responsible for more than four million persons in need of care and their relatives (1); however, there are hardly any data on how well known the counseling facilities are among the population. The aim of this study was to determine, for the first time in Germany, the level of awareness of community care points and to identify person groups with information deficits and impaired access conditions.

Methods

The results are based on data of the 2021 insured survey conducted by the National Association of Statutory Health Insurance Physicians (KBV, Kassenärztliche Bundesvereinigung) (N = 6193). The telephone survey of randomly selected insured persons carried out from 29 March to 26 April 2021 is representative of the adult German-speaking residential population with regard to age, gender and formal education (2) (table 1). Statistical analyses were performed by means of multiple logistic regressions. For the analyses, the statistical software package R (version 4.0.2) was used.

Table 1. Insured survey on awareness levels and utilization of community care points – weighted sample *¹.

		Awareness level *2		Utilization *3		Total
		N	%	N	%	N
Age (years)	18–44	635	28.3	94	4.4	2133
	45–64	1032	45.0	313	13.7	2292
	65+	1017	58.1	297	17.0	1749
Gender	Male	1104	36.9	221	7.4	2990
	Female	1548	48.6	483	15.2	3184
Educational attainment	Low	1858	46.9	542	13.7	3960
	High	717	35.0	148	7.2	2047
Town/rural (number of residents)	Rural (<5000)	747	46.8	240	15.0	1597
	Town (5000– 99 999)	1070	43.9	259	10.6	2437
	City (≥ 100 000)	612	40.3	134	8.8	1520
Citizenship	German	2553	44.1	688	11.9	5785
	Other	97	25.6	16	4.2	378
Employment	Full-time	826	34.5	175	7.3	2394
	Part-time	403	43.0	116	12.4	938
	Retirement pension	1112	57.4	338	17.4	1938
	Other	275	34.2	66	8.2	804
Chronic disease	Yes	1411	49.2	433	15.1	2868
	No	1225	37.5	262	8.0	3263
Subjective health	Excellent/very good/good	2097	41.5	507	10.0	5052
	Not so good/poor	544	49.5	194	17.7	1099
Number of GP visits (in 12 months)	None	768	36.1	182	8.6	2126
	1 to 5 times	1501	45.2	384	11.6	3322
	more than 6x	364	52.7	135	19.5	691

*¹ Weighting based on the Microcensus on gender, age and educational attainment (2). Deviations from the weighted N (6174) are attributable to missing values.

*² Question: “Have you ever heard of such a community care point?“ (no/yes)

*³ Question: “And have you ever sought advice or assistance from a community care point?“ (no/yes)

Results

Awareness of community care points

Approximately 42% of the respondents had heard of community care points. Awareness of community care points was associated with the age of the respondents. Older respondents (≥ 65 years) were more frequently informed about community care points compared to the reference age group (45–64 years), younger respondents, by contrast, less often (table 2). Respondents with multiple general practitioner (GP) visits (more than six visits during the last twelve months) were more frequently aware of community care points, respondents with no GP visits less frequently. Women had heard of community care points more often than men, and respondents from rural communities (<5000 inhabitants) more often than urban residents. Respondents with a high level of formal education were less likely to have knowledge about community care points compared to respondents with a low level of formal education, as were respondents without German citizenship compared to German respondents.

Table 2. Multiple logistic regression models on awareness levels and utilization of community care points.

		Awareness level  *1	Utilization *2
		OR [95% CI]	OR [95% CI]
Age (years)	18–44	0.53 [0.46; 0.61]	0.36 [0.28; 0.47]
	45–64	Ref.	Ref.
	65+	1.35 [1.07; 1.72]	0.90 [0.65; 1.25]
Gender	Male	Ref.	Ref.
	Female	1.57 [1.39; 1.77]	1.96 [1.62; 2.38]
Educational attainment	Low	Ref.	Ref.
	High	0.83 [0.73; 0.95]	0.82 [0.66; 1.02]
Town/rural	Rural (< 5 000)	1.15 [1.00; 1.31]	1.50 [1.23; 1.83]
	Town (5 000–99 999)	Ref.	Ref.
	City (≥ 100 000)	0.97 [0.84; 1.11]	0.90 [0.71; 1.13]
Citizenship	German	Ref.	Ref.
	Other	0.55 [0.41; 0.74]	0.46 [0.22; 0.83]
Employment	Full-time	Ref.	Ref.
	Part-time	1.12 [0.94; 1.33]	1.19 [0.90; 1.57]
	Retirement pension	1.32 [0.95; 1.56]	1.38 [0.96; 1.95]
	Other	1.13 [0.93; 1.37]	1.12 [0.79; 1.56]
Chronic disease	Yes	1.08 [0.95; 1.22]	1.29 [1.06; 1.56]
	No	Ref.	Ref.
Subjective health	Excellent/very good/good	Ref.	Ref.
	Not so good/poor	0.94 [0.80; 1.10]	1.17 [0.94; 1.46]
Number of GP visits (in 12 months)	None	0.80 [0.71; 0.91]	0.87 [0.71; 1.07]
	1 to 5 times	Ref.	Ref.
	More than 6x	1.30 [1.07; 1.58]	1.41 [1.09; 1.82]

*¹ Question about the dependent variable “awareness level”: “Have you ever heard of such a community care point?“ (no/yes)

*² Question about the dependent variable “utilization”. “And have you ever sought advice or assistance from a community care point?“ (no/yes)

CI, confidence interval; OR, odds ratio; Ref., reference category

Utilization of community care points

There were 11.4% of the respondents who had already used the services of community care points. As expected, the chronically ill were more likely to use community care points. An age effect on the utilization of community care points was only demonstrated for the younger age group in comparison to the reference. More frequent GP visits increase the utilization compared to the reference. Women and rural residents used the services offered more often. Persons without German citizenship did so less frequently.

Discussion

Less than half of the German-speaking population had already heard of community care points; the utilization rate was about 11%. Knowledge of community care points increases with age and frequency of GP visits. Besides the number of GP visits, the degree of utilization also depends on whether the patient has a chronic disease. This suggests that the population is informed about the existence of community care points on specific occasions or finds the services themselves when needed.

Besides age, other sociodemographic differences are noted in the population. The fact that women are more frequently aware of community care points and utilize these more often than men likely reflects gender differences in home care. Women continue to be far more likely to provide care for family members (3) and to receive care themselves (1). Thus, it is imperative to inform (care-giving) men about the available support services.

Respondents with higher educational attainment were less likely to be informed about community care points than respondents with lower educational attainment. Since a low level of educational attainment is frequently associated with less knowledge about the health care system, this finding suggests that information is successfully provided for example by GPs to patients on certain occasions. Reduced knowledge and utilization of community care points among persons without German citizenship could be caused by a lack of integration of persons with migration background into the German health care system. In this context, an integration effort through target-group-oriented provision of information supported by migrant self-organizations would be desirable (4).

Awareness of community care points is also limited among medical professionals, even though they play an important role in the referral of patients to community care points. This emerges from the initial results of a survey among GPs in Berlin conducted as part of a feasibility study of cooperation between community care points and general practitioner practices (5). Cooperation and thus better interconnectedness could help to promote awareness and utilization among the general population, too. The results of this study provide guidance on which segments of the population are to receive special attention.