Lösungsansätze gegen den Allgemeinarztmangel auf dem Land – Ergebnisse einer Online-Befragung unter Ärzten in Weiterbildung

Steinhäuser, Jost; Annan, Nancy; Roos, Marco; Szecsenyi, J; Joos, Stefanie

doi:10.1055/s-0031-1272576

Cited by 42 publications

(47 citation statements)

References 7 publications

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“…The impression of young doctors as to what is rural from a health care delivery point of view might therefore be vague and influenced rather by subjective factors or just perceptions [18,26]. Common false perceptions about GPs working in rural group practices in Germany include e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Common false perceptions about GPs working in rural group practices in Germany include e.g. that working in rural areas means more working hours and that there is less access to specialists [16,18,27]. …”

Section: Discussionmentioning

confidence: 99%

“…However, as the dimensions of rurality and the distances to the closest place of medical care between Canada and Germany were so extreme, a different existing instrument better applicable to the German setting was needed. In addition, from previous studies, we knew that young General Practice trainees are willing to drive up to 30 minutes to their place of work and that factors attracting them to work in a rural area were mainly related to the infrastructure of the locality [18]. Furthermore, from a health care delivery point of view, working with colleagues, minimal on-call duties and a hospital nearby have been shown to be important factors [18].…”

Section: Introductionmentioning

confidence: 99%

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Rural area in a European country from a health care point of view: an adaption of the Rural Ranking Scale

Steinhaeuser

Otto

Goetz

et al. 2014

BMC Health Serv Res

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BackgroundIn many countries, rural areas are facing a shortage of general practitioners (GPs). Appropriate strategies to address this challenge are needed. From a health care delivery point of view, the term rural area is often poorly defined. However rural areas have to be adequately defined to ensure specific strategies are tailored to these environments. The aims of this study were to translate the New Zealand 6-item Rural Ranking Scale (RRS), to culturally adapt it and to implement it to identify rural areas from a health care delivery perspective. Therefore we aimed to validate the RRS by defining cut-off scores for urban, semi-rural and rural areas in Germany.MethodsAfter receiving permission, two researchers independently translated the RRS. In a consensus meeting, four items were identified that had to be culturally adapted. The modified RRS-Germany (mRRS-G) was sent to 724 GPs located in urban, semi-rural and rural areas to validate the “rurality” scoring system for conditions in Germany.ResultsFour items, “travelling time to next major hospital”, “on-call duty”, “regular peripheral clinic” and “on-call for major traumas” had to be adapted due to differences in the health care system. The survey had a response rate of 33.7%. A factor analysis showed a three dimensional structure of the mRRS-G scale with a poor internal consistency. Nevertheless, the three items regarding “on-call duty”, “next major hospital” and “most distant boundary covered by your practice” were identified as significant predictors for rurality. The adapted cut-off point for rurality in Germany was 16. From this study’s participants, 9 met the RRS cut-off point for rurality (a score of 35 or more).ConclusionCompared with New Zealand rurality scores based on this tool, German scores are far less rural from a health care delivery point of view. We consider that the construct of rurality has more aspects than those assessed by the mRRS-G. Nevertheless, rural areas from a health care delivery viewpoint can be effectively defined using mRRS-G and therefore it can support tailored strategies against GPs shortage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Rural area in a European country from a health care point of view: an adaption of the Rural Ranking Scale

Steinhaeuser

Otto

Goetz

et al. 2014

BMC Health Serv Res

View full text Add to dashboard Cite

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“…Moreover a nationwide survey with trainees in family medicine revealed a general willingness to work in a rural general practice: Meeting their identified influencing factors “family friendly surrounding, the rural village itself and cooperation with colleagues”, 77% could envision going rural. Furthermore, a positive tendency towards working as an employee in group practices can be observed [39]. In this respect studies performed in the United Kingdom and Switzerland add international accordance concerning the positive career path general practice can offer in terms of employment, working atmosphere and work-life balance [40, 41].…”

Section: Discussionmentioning

confidence: 99%

Mobility concepts and access to health care in a rural district in Germany: a mixed methods approach

et al. 2018

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BackgroundWestern countries are facing the challenges of an imminent shortage of physicians, especially general practitioners. As a consequence longer travel times to doctors’ practices may arise. This study aimed to investigate the mobility behavior of a rural population in terms of medical consultations.MethodsAn exploratory mixed-methods design was conducted in the Waldshut district of the federal state Baden-Württemberg in Germany. Focus groups and a single telephone-interview with representatives, occupationally affiliated with mobility in the district (e.g. representatives of public transport, nursing-services or the District Office Waldshut), were performed in 2016 and analyzed using Mayring’s structuring content analysis. A questionnaire based on the collected qualitative data was subsequently distributed to a random sample of 1000 adult inhabitants living in the Waldshut district. Quantitative data were analyzed employing descriptive statistics.ResultsQualitatively, four focus groups and one single telephone-interview with a total of 20 participants were performed. Therein the necessity of reaching a nearby general practitioner and the importance of individual motor traffic was emphasized. Novel mobility modes of ride sharing and telemedicine were controversially discussed as future transport and consultation options, respectively.Quantitatively, 277 questionnaires (27.7%) were valid and included in our analysis. Mean age was 51 years (SD = 18.5) and 58% (n = 160) were female. Irrespective of the mode of transport 60% (n = 166) expected to reach their general practitioner within 15 min. Using the possibility of multiple answers 47% (n = 192) stated to use a car in order to reach their general practitioner, public transport was used by 5% (n = 19). Nearly 80% (n = 220) could imagine sharing a car with well-known persons for consultations. Turning to a general practitioner via telemedicine was imaginable for 32% (n = 91).ConclusionsIndividual motor car traffic seems to be an important factor in providing accessibility to rural medical care. As a supplementation, web based ride sharing has economic and structural potential for reaching a doctor’s practice. However, familiarity and trustworthiness need to be guaranteed within this flexible transport mode. Furthermore, telemedicine may be a future approach in order to reduce travel time to a doctor’s practice.

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“…Being a GP in rural areas is associated with many prejudices e.g. low income, 24-hour accessibility and overtime or social control by the rural population [25–27]. When questioning medical students in Germany about their occupational perspectives and expectations the students consider urban areas as attractive places to work, whereas economically underdeveloped rural areas are highly unattractive [28].…”

Section: Introductionmentioning

confidence: 99%

Regional variations of perceived problems in ambulatory care from the perspective of general practitioners and their patients - an exploratory focus group study in urban and rural regions of northern Germany

et al. 2017

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BackgroundPatients from rural and urban regions should have equitable access to health care. In Germany, the physician-patient-ratio and the supply of medical services vary greatly between urban and rural areas. The aim of our study was to explore the regional variations of the perceived health care problems in ambulatory care from the perspective of affected professionals and laypersons i.e. general practitioners and their patients.MethodsWe conducted 27 focus groups with general practitioners (n = 65) and patients (n = 145) from urban areas, environs and rural areas in northern Germany. Discussions were facilitated by two researchers using a semi-structured guideline. The transcripts were content analyzed using deductive and inductive categories.ResultsGeneral practitioners and patients reported problems due to demographic change and patient behaviour, through structural inequalities and the ambulatory reimbursement system as well as with specialist care and inpatient care. A high physician density, associated with high competition between general practitioners, a high fluctuation of patients and a low status of general practitioners were the main problems reported in urban areas. In contrast, participants from rural areas reported an insufficient physician density, a lack of young recruits in primary care and a resulting increased workload as problematic. All regions are concerned with subjectively inadequate general practitioners’ budgets, insufficiently compensated consultations and problems in the cooperation with specialists and inpatient care institutions. Most problems were mentioned by GPs and patients alike, but some (e.g. high competition rates in urban regions and problems with inpatient care) were only mentioned by GPs.ConclusionsWhile many problems arise in urban regions as well as in rural regions, our results support the notion that there is an urgent need for action in rural areas. Possible measures include the support of telemedicine, delegation of medical services and reoccupation of vacant practices. The attractiveness of working in rural areas for general practitioners, specialists and clinicians must be increased by consolidating and expanding rural infrastructure (e.g. child care and cultural life). The above mentioned results also indicate that the ambulatory reimbursement system should be examined regarding the reported inequalities. Measures to further enhance the cooperation between general practitioners, specialists and inpatient care should be taken to solve supra-regionally reported problems. Problems showing regional variations indicate the need for measures to balance these variations between the regions.This is the first German study to analyze subjective views of the stakeholders concerned on regionally variating problems in ambulatory care. Further studies are needed to quantify the extent of the identified problems and differences. A corresponding survey is currently under way.

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Lösungsansätze gegen den Allgemeinarztmangel auf dem Land – Ergebnisse einer Online-Befragung unter Ärzten in Weiterbildung

Abstract: As the basic willingness to set up practice in rural areas is quite high, relevant influencing factors such as family friendly surroundings, out-of-hour services arrangements und working models offering the opportunity to work in group handed practices should be emphasized in recruitment.

Cited by 42 publications

References 7 publications

Rural area in a European country from a health care point of view: an adaption of the Rural Ranking Scale

Rural area in a European country from a health care point of view: an adaption of the Rural Ranking Scale

Mobility concepts and access to health care in a rural district in Germany: a mixed methods approach

Regional variations of perceived problems in ambulatory care from the perspective of general practitioners and their patients - an exploratory focus group study in urban and rural regions of northern Germany

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