Open Access Research

Ambulatory health services utilization in patients with dementia - Is there an urban-rural difference?

Daniela Koller1, Marion Eisele2, Hanna Kaduszkiewicz2, Gerhard Schön3, Susanne Steinmann4, Birgitt Wiese4*, Gerd Glaeske1 and Hendrik van den Bussche2

Author Affiliations

1 University of Bremen, Centre for Social Policy Research, Division Health Economics, Health Policy and Outcomes Research, Parkallee 39, 28209 Bremen, Germany

2 Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany

3 Department of Medical Biometry and Epidemiology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany

4 Centre for Biometry, Medical Informatics and Medical Technology, Institute for Biometry, Hannover Medical School, OE 8410, 30625 Hannover, Germany

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International Journal of Health Geographics 2010, 9:59  doi:10.1186/1476-072X-9-59

Published: 17 November 2010



Due to demographic changes and an un-equal distribution of physicians, regional analyses of service utilization of elderly patients are crucial, especially for diseases with an impact like dementia. This paper focuses on dementia patients. The aim of the study is to identify differences in service utilization of incident dementia patients in urban and rural areas.


Basis for the analysis were all insured persons of a German Health Insurance fund (the GEK) aged 65 years and older living in rural and urban areas. We focussed on physician contacts in the outpatient sector during the first year after an incidence diagnosis of dementia. Special attention was given to contacts with primary care physicians and neurologists/psychiatrists. The dementia cohort was analyzed together with a non-dementia control group drawn according to age, gender and amount of physician contacts. Uni- and bivariate as well as multivariate analysis were performed to estimate the influences on service utilization.


Results show that the provision of primary care seems to be equally given in urban and rural areas. For specialists contacts however, rural patients are less likely to consult neurologists or psychiatrists. This trend can already be seen before the incident diagnosis of dementia. All consultations rise in the quarter of the incident dementia diagnosis compared to the control group. The results were also tested in a linear and a logistic regression, showing a higher chance for persons living in urban areas to visit a specialist and an overall higher rate in service utilization for dementia patients.


Because of a probable increase in the number of dementia patients, service provision has to be accessible even in rural areas. Due to this and the fact that demographic change is happening at different paces in different regions, regional variations have to be considered to ensure the future service provision.