German GPs' willingness to expand roles of physician assistants: a regional survey of perceptions and informal practices influencing uptake of health reforms in primary health care

Dini, Lorena; Sarganas, Giselle; Boostrom, Eugene; Ogawa, Sumiko; Heintze, Christoph; Braun, Vittoria

doi:10.1093/fampra/cmr127

Cited by 29 publications

(45 citation statements)

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“…Our response rate is comparable or better to other studies conducted in Germany or the Netherlands [12,31]. Compared to the GP population of a rural area of Germany, the Berlin source population has a similar age distribution and fairly similar distribution of individual and group practices [42,43]. Similarly, a study that investigated GPs’ willingness to delegate primary prevention tasks to physician assistants found that GPs consider lifestyle counseling as part of their task.…”

Section: Discussionsupporting

confidence: 75%

Primary prevention in general practice – views of German general practitioners: a mixed-methods study

et al. 2014

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BackgroundPolicy efforts focus on a reorientation of health care systems towards primary prevention. To guide such efforts, we analyzed the role of primary prevention in general practice and general practitioners’ (GPs) attitudes toward primary prevention.MethodsMixed-method study including a cross-sectional survey of all community-based GPs and focus groups in a sample of GPs who collaborated with the Institute of General Practice in Berlin, Germany in 2011. Of 1168 GPs 474 returned the mail survey. Fifteen GPs participated in focus group discussions. Survey and interview guidelines were developed and tested to assess and discuss beliefs, attitudes, and practices regarding primary prevention.ResultsMost respondents considered primary prevention within their realm of responsibility (70%). Primary prevention, especially physical activity, healthy eating, and smoking cessation, was part of the GPs’ health care recommendations if they thought it was indicated. Still a quarter of survey respondents discussed reduction of alcohol consumption with their patients infrequently even when they thought it was indicated. Similarly 18% claimed that they discuss smoking cessation only sometimes. The focus groups revealed that GPs were concerned about the detrimental effects an uninvited health behavior suggestion could have on patients and were hesitant to take on the role of “health policing”. GPs saw primary prevention as the responsibility of multiple actors in a network of societal and municipal institutions.ConclusionsThe mixed-method study showed that primary prevention approaches such as lifestyle counseling is not well established in primary care. GPs used a selective approach to offer preventive advice based upon indication. GPs had a strong sense that a universal prevention approach carried the potential to destroy a good patient-physician relationship. Other approaches to public health may be warranted such as a multisectoral approach to population health. This type of restructuring of the health care sector may benefit patients who are unable to afford specific prevention programmes and who have competing demands that hinder their ability to focus on behavior change.

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Section: Discussionsupporting

confidence: 75%

Primary prevention in general practice – views of German general practitioners: a mixed-methods study

et al. 2014

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“…12 The issue of task shifting from GP to practice assistant or advanced nurse practitioner is the subject of current debate in many countries. [13][14][15] Our analysis of the monthly prevalence in relation to the setting in which care was provided showed the high number of people who had received medical care at home: in the previous month, more than 14% of the population had received a home visit from a doctor. This is not a new observation, as several studies have already highlighted this characteristic of the Belgian health care system: each Belgian person on average receives 1.6 home visits per year, the majority of which are conducted by GPs, compared to 2.7 consultations in the doctor's office and 2.1 consultations in a specialist clinic.…”

Section: Discussionmentioning

confidence: 99%

The ecology of health care in a Belgian area

Duchesnes

Vögeli

et al. 2014

Acta Clinica Belgica

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Introduction: Focusing on the monthly prevalence of health problems and recourse to different levels of care of the population is an interesting approach to demonstrate the respective roles of different levels of health care. In the present study, the ecology of health care was studied in the region of Liè ge, Belgium. Method: A survey questioning people about their health problems was conducted in 2009 in two communes of the province of Liè ge. For each health problem, 'health care' was defined as contact with any qualified care provider. For each consultation, three elements were recorded: the profession of the health care provider; the place where the care was provided and the kind of health care received. Results: A total of 537 people were interviewed. The monthly prevalence of people who experienced a health problem during the previous month was 85.1%. The monthly prevalence of people who turned to a health care provider at least once during the month was 62.2%. The proportion of people turning to doctors, primarily local doctors, for a simple consultation was important (49.2%). Discussion: Our results are highly comparable with those of other studies. Recourse to a doctor is high (49%), which probably reflects the broad accessibility of health care in Belgium and maybe its overuse. Additional questions on the current and future organisation of the Belgian health care system are debated.

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“…Moreover, a study of Dini et al showed that 48% of general practitioners in Germany inclined to delegate home visit tasks to their practice assistants. The main disadvantage here was the related costs for training of the practice assistants, while the ability to save time was named as the main advantage [23]. To realise task substitution in Germany there are for example the so called ‘AGnES-model projects’ in different federal states, which transfer medical duties and house visits to qualified practice assistants.…”

Section: Discussionmentioning

confidence: 99%

Practice assistants in primary care in Germany – associations with organizational attributes on job satisfaction

et al. 2013

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BackgroundJob satisfaction and organizational attributes in primary care teams are important issues as they affect clinical outcomes and the quality of health care provided. As practice assistants are an integral part of these teams it is important to gain insight into their views on job satisfaction and organizational attributes. The aim of this study was to evaluate the job satisfaction of practice assistants and the organizational attributes within their general practices in Germany and to explore the existence of possible associations.MethodsThis observational study was based on a job satisfaction survey and measurement of organizational attributes in general practices in the German federal state of Baden-Wuerttemberg. Job satisfaction was measured with the 10-item ‘Warr-Cook-Wall job satisfaction scale’. Organizational attributes were evaluated with the 21-items ‘survey of organizational attributes for primary care’ (SOAPC). Linear regression analyses were performed in which each of SOAPC scales and the overall score of SOAPC was treated as outcome variables.Results586 practice assistants out of 794 respondents (73.8%) from 234 general practices completed the questionnaire. Practice assistants were mostly satisfied with their colleagues and least of all satisfied with their income and recognition for their work. The regression analysis showed that ‘freedom of working method’ and ‘recognition of work’, the employment status of practice assistants and the mode of practice were almost always significantly associated with each subscale and overall score of SOAPC.ConclusionsJob satisfaction is highly associated with different aspects of organizational attributes for primary care (‘communication’, ‘decision-making’ and ‘stress’). Consequently, improved job satisfaction could lead to a better-organized primary care team. This implication should be investigated directly in further intervention studies with a special focus on improving the recognition for work and income.

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German GPs' willingness to expand roles of physician assistants: a regional survey of perceptions and informal practices influencing uptake of health reforms in primary health care

Abstract: The increasing proportion of women in family medicine might favor task shifting in General Practice.

Cited by 29 publications

References 28 publications

Primary prevention in general practice – views of German general practitioners: a mixed-methods study

Primary prevention in general practice – views of German general practitioners: a mixed-methods study

The ecology of health care in a Belgian area

Practice assistants in primary care in Germany – associations with organizational attributes on job satisfaction

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