Regional Variation in the Primary Medical Care of Northern Germany

Universitätsklinikum Hamburg-Eppendorf1,022 enrolled

Overview

The study explores the variation in the patient populations and describes regional differences regarding the reasons for consultations in the primary medical care in Germany. The data collection will be stratified by rural and urban areas as well as environs. The data set will include a large variety of data about physicians, patients and health care utilization.

Inappropriate supply and the increasing demand on the health care system have been of concern for health policy in Germany for the last 15 years. Concerning primary care, this especially relates to an undersupply of rural GPs (general practitioners). But there also seem to be other relevant regional differences, e.g. a lower number of house calls in larger cities, a greater number of psychiatric (co-)morbidities in the cities, a greater spectrum of services offered by rural doctors, and a difference in accessing primary and secondary care between the rural and the urban areas. Despite these results, differences between rural and urban areas have not been studied extensively in Germany. Therefore this study aims to explore regional variation of patient populations and their reasons for accessing primary care. The study is based on standardized interviews with 240 GPs and approximately 1.200 patients in Northern Germany. Questionnaires are based on a preliminary qualitative study and were pretested. The GP's questionnaire comprises characteristics of the GP and the practice, patient types, reasons for consultation and services offered. The patient's questionnaire includes sociodemographic data and past medical history, quality of life, access to the GP, specialists and hospitals, perceived social support, health behaviour and the reasons for their consultations. Data will be analysed by descriptive statistics and different regression modelling strategies adjusted for possible confounders and the GP-induced cluster structure.

Study Type

OBSERVATIONAL

Enrollment

1,022

Conditions

Any Condition Treated in Primary Care

Interventions

Primary medical careOTHER

All study participants receive primary care as usual in the respective region

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * having consulted the practice within the last 3 months and * being patient of the practice since at least 36 months (i.e. at least one consultation before 36 or more months) Exclusion Criteria: * no capacity to consent (e.g. because of dementia) * insufficient German language skills to conduct interview * not able to participate in the interviews (e.g. because of deafness or major depression)

Locations (1)

Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf

Hamburg, Germany

Outcomes

Primary Outcomes

Reasons for consultation and utilized services in the GP practice

Short form of the German version of the International Classification of Primary Care (ICPC) with 38 different services (e.g. vaccinations, patient education or referrals) and 100 consultation reasons (e.g. disorders of the upper gastrointestinal tract) in 17 subject areas (e.g. digestive system).

Time frame: 3 months

Secondary Outcomes

Patient population in the GP practice

List of 27 patient types regarding their health care utilization behaviour

Time frame: 3 months

Health care utilization

Frequency of accessing GPs, specialists, general hospitals and rehab hospitals

Time frame: 3 months

Data from ClinicalTrials.gov

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