Regional and patient-related factors influencing the willingness to use general practitioners as coordinators of the treatment in northern Germany - results of a cross-sectional observational study

Abstract

Background: In most countries, the general practitioner (GP) is the first point of contact in the healthcare system and coordinator of healthcare. However, in Germany it is possible to consult an outpatient specialist even without referral. Coordination by a GP might thus reduce health expenditures and inequalities in the healthcare system. The study describes the patients' willingness/commitment to use the GP as coordinator of healthcare and identifies regional and patient-related factors associated with the aforementioned commitment to the GP. Methods: Cross-sectional observational study using a standardised telephone patient survey in northern Germany. All counties and independent cities within a radius of 120 km around Hamburg were divided into three regional categories (urban areas, environs, rural areas) and stratified proportionally to the population size. Patients who had consulted the GP within the previous three months, and had been patients of the practice for at least three years were randomly selected from medical records of primary care practices in these districts and recruited for the study. Multivariate linear regression models adjusted for random effects at the level of federal states, administrative districts and practices were used as statistical analysis methods. Results: Eight hundred eleven patients (25.1%) from 186 practices and 34 administrative districts were interviewed. The patient commitment to a GP attained an average of 20 out of 24 possible points. Significant differences were found by sex (male vs. female: + 1.14 points, p < 0.001), morbidity (+ 0.10 per disease, p = 0.043), education (high vs. low: − 1.74, p < 0.001), logarithmised household net adjusted disposable income (− 0.93 per step on the logarithmic scale, p = 0.004), regional category (urban areas: − 0.85, p = 0.022; environs: − 0.80, p = 0.045) and healthcare utilisation (each GP contact: + 0.30, p < 0.001; each contact to a medical specialist: − 0.75, p = 0.018). Professional situation and age were not significantly associated with the GP commitment.

Is subjectively perceived treatment urgency of patients in emergency departments associated with self-reported health literacy and the willingness to use the GP as coordinator of treatment? Results from the multicentre, cross-sectional, observational study PiNo Bund

“…Lower scores indicate that the patient prefers to move independently in the healthcare system. 11 The F-HaBi also contains an item regarding if the patient has a regular GP.…”

“…In this campaign, it should be considered that GP commitment is associated with different sociodemographic data. 11 The media campaign could, therefore, include targeted interventions for groups with low GP commitment like women or patients from regions with higher urban density, 11 which could receive specific information about why they in particular would profit from GP coordination.…”

“…According to this concept, the commitment to a GP is strong if patients (1) consult their GP first in all healthcare issues, (2) let their GP to coordinate all of their healthcare issues and (3) have a high amount of trust to their GP. 11 Among other factors, a higher willingness to use the GP as coordinator of treatment is associated with male sex, a lower socioeconomic status and a higher number of chronic diseases. 11 The commitment to a GP has to be distinguished from 'health literacy', which describes the ability of an individual to access and understand health information in order to take decisions concerning healthcare, disease prevention and health promotion.…”

“…11 Among other factors, a higher willingness to use the GP as coordinator of treatment is associated with male sex, a lower socioeconomic status and a higher number of chronic diseases. 11 The commitment to a GP has to be distinguished from 'health literacy', which describes the ability of an individual to access and understand health information in order to take decisions concerning healthcare, disease prevention and health promotion. 12 The aim of this study was to analyse if subjectively perceived treatment urgency of patients in emergency departments is associated with their self-reported health literacy and their willingness to use the GP as coordinator of treatment.…”

Regional differences in the patient population of general practices in northern Germany: results of a mixed-methods study

“…In addition, urban GPs often just act as a providers of medical services 8 and their patients have a lower commitment. 44 Further research is needed to explore these differences particularly related to the entire German territory.…”