BackgroundMedical overuse is a topic of growing interest in health care systems and especially in primary care. It comprises both over investigation and overtreatment. Quaternary prevention strategies aim at protecting patients from unnecessary or harmful medicine. The objective of this study was to gain a deeper understanding of relevant aspects of medical overuse in primary care from the perspective of German general practitioners (GPs). We focused on the scope, consequences and drivers of medical overuse and strategies to reduce it (=quaternary prevention).MethodsWe used the qualitative Grounded Theory approach. Theoretical sampling was carried out to recruit GPs in Bavaria, Germany. We accessed the field of research through GPs with academic affiliation, recommendations by interview partners and personal contacts. They differed in terms of primary care experience, gender, region, work experience abroad, academic affiliation, type of specialist training, practice organisation and position. Qualitative in-depth face-to-face interviews with a semi-structured interview guide were conducted (n = 13). The interviews were audiotaped and transcribed verbatim. Data analysis was carried out using open and axial coding.ResultsGPs defined medical overuse as unnecessary investigations and treatment that lack patient benefit or bear the potential to cause harm. They observed that medical overuse takes place in all three German reimbursement categories: statutory health insurance, private insurance and individual health services (direct payment). GPs criticised the poor acceptance of gate-keeping in German primary care. They referred to a low-threshold referral policy and direct patient access to outpatient secondary care, leading to specialist treatment without clear medical indication. The GPs described various direct drivers of medical overuse within their direct area of influence. They also emphasised indirect drivers related to system or societal processes. The proposed strategies for reducing medical overuse included a well-founded wait-and-see approach, medical education, a trustful doctor-patient relationship, the improvement of primary/health care structures and the involvement of patients and society.ConclusionsGPs are frequently located at the starting point of the diagnostic and treatment process. They have the potential to play a vital role in quaternary prevention. This requires a debate going beyond the medical profession and involving society as a whole.Electronic supplementary materialThe online version of this article (10.1186/s12875-017-0667-4) contains supplementary material, which is available to authorized users.

Background: Due to technological progress and improvements in medical care and health policy the average age of patients in primary care is continuously growing. In equal measure, an increasing proportion of mostly elderly primary care patients presents with multiple coexisting medical conditions. To properly assess the current situation of co-and multimorbidity, valid scientific data based on an appropriate data structure are indispensable. CONTENT (CONTinuous morbidity registration Epidemiologic NeTwork) is an ambitious project in Germany to establish a system for adequate record keeping and analysis in primary care based on episodes of care. An episode is defined as health problem from its first presentation by a patient to a doctor until the completion of the last encounter for it. The study aims to describe co-and multimorbidity as well as health care utilization based on episodes of care for the study population of the first participating general practices.

To assess factors associated with physical activity (PA) in a large sample of primary care patients, 1,250 outpatients from 75 general practices were approached consecutively. Of these, 1,021 (81.7%) returned short forms of the international physical activity questionnaire (IPAQ) and the arthritis impact measurement scale (AIMS2-SF). In addition, the patient health questionnaire (PHQ-9) was used to assess concomitant depression. A stepwise multiple linear regression analysis with the IPAQ score as dependent variable was performed separately for knee and hip patients. The impact of osteoarthritis (OA) on patients with an affected knee (594/58.2%) was more severe, as reflected in higher scores in the "symptom", "lower body", and "affect" scales of the AIMS2-SF (p < 0.01 for all). These patients were also less active than patients with OA to the hip (p = 0.02 for IPAQ score). Main predictors of PA [change in p(F) for all factors < or =0.001] in knee OA patients were physical limitation to the lower limb (R(2) = 0.180), social network (R(2) = 0.121), pain (R(2) = 0.111), body mass index (R(2) = 0.041), and age (R(2) = 0.032). Predictors for OA at the hip (427/41.8%) differed slightly [change in p(F) for all factors < or =0.003): physical limitation to the lower limb (R(2) = 0.162), pain (R(2) = 0.131), PHQ-9 score (R(2) = 0.092), social network (R(2) = 0.078), and disease duration (R(2) = 0.043). Our findings suggest that factors associated with PA differ depending on the localization of the OA. Our results may help to tailor future interventions more appropriately. Further research is needed to determine whether these tailored interventions will result in increased PA.

The findings emphasize the influence of physical as well as psychosocial factors on PA of patients with OA and should help to tailor future interventions more appropriately. Further research is needed to determine if these tailored interventions will result in better compliance and in increased PA.