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

ABSTRACT: Objectives: The aim of our study was to explore patient types in general practitioner (GP) practices and to quantify the regional differences of the frequencies of these patient types in northern Germany.

Design and setting: We conducted a mixed-methods study based on focus groups and standardised interviews with GPs. All counties and independent cities within a radius of 120?km around Hamburg were assigned one of three regional categories (urban areas, environs, rural areas). The focus groups were analysed using qualitative content analysis. Relative frequencies of consultations by patient types and differences between the regions were calculated. Logistic regression analyses were used to identify differences among regions.

Participants: Nine focus groups with 65 GPs (67.7% male). From the 280 initially recruited GPs 211 (65.4% male) could be personally interviewed.

Results: Four themes with 27 patient types were derived from the focus groups: patients classified by morbidity, sociodemographic characteristics, special care needs and patient behaviour. Five patient characteristics were significantly more prevalent in urban areas than rural areas: patients with migration background and culturally different disease concepts (OR 1.23; 95%?CI 1.06 to 1.42), privately insured patients (OR 1.17; 95%?CI 1.05 to 1.31), educationally disadvantaged patients with low health literacy (OR 1.11; 95%?CI 1.04 to 1.19), patients with psychiatric disorders (OR 1.07; 95%?CI 1.02 to 1.12) and senior citizens living on their own without caregivers (OR 1.05; 95%?CI 1.05 to 1.31). Three patient types were significantly less prevalent in urban areas: minors accompanied by their parents (OR 0.71; 95%?CI 0.61 to 0.83), patients with poor therapy adherence (OR 0.87, 95%?CI 0.80 to 0.95) and patients with dementia (OR 0.90; 95%?CI 0.82 to 0.99).

Conclusions: GPs could compensate the specific needs of their patients with medical training aligned with the requirements of their region. Urban GPs need skills treating patients with psychiatric, social and cultural problems, rural GPs regarding the care for children or noncompliant patients.

Trial registration number: NCT02558322.

SUBMITTER: Hansen H

PROVIDER: S-EPMC7703430 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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

Hansen Heike H Schäfer Ingmar I Pohontsch Nadine Janis NJ Kazek Agata A Hardt Hanna H Lühmann Dagmar D Scherer Martin M

BMJ open 20201127 11

<h4>Objectives</h4>The aim of our study was to explore patient types in general practitioner (GP) practices and to quantify the regional differences of the frequencies of these patient types in northern Germany.<h4>Design and setting</h4>We conducted a mixed-methods study based on focus groups and standardised interviews with GPs. All counties and independent cities within a radius of 120 km around Hamburg were assigned one of three regional categories (urban areas, environs, rural areas). The f ...[more]

PMID: 33247029

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Project description: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. CONCLUSION:On average, the patients' commitment to their GP was relatively strong, but there were large differences between patient groups. An increase in the patient commitment to the GP could be achieved through better patient information and targeted interventions, e.g. to women or patients from regions of higher urban density. TRIAL REGISTRATION:The study was registered in ClinicalTrials.gov (NCT02558322).

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Project description:BackgroundDutch standard diabetes care is generally protocol-driven. However, considering that general practices wish to tailor diabetes care to individual patients and encourage self-management, particularly in light of current COVID-19 related constraints, protocols and other barriers may hinder implementation. The impact of dispensing with protocol and implementation of self-management interventions on patient monitoring and experiences are not known. This study aims to evaluate tailoring of care by understanding experiences of well-organised practices 1) when dispensing with protocol; 2) determining the key conditions for successful implementation of self-management interventions; and furthermore exploring patients' experiences regarding dispensing with protocol and self-management interventions.Methodsin this mixed-methods prospective study, practices (n = 49) were invited to participate if they met protocol-related quality targets, and their adult patients with well-controlled type 2 diabetes were invited if they had received protocol-based diabetes care for a minimum of 1 year. For practices, study participation consisted of the opportunity to deliver protocol-free diabetes care, with selection and implementation of self-management interventions. For patients, study participation provided exposure to protocol-free diabetes care and self-management interventions. Qualitative outcomes (practices: 5 focus groups, 2 individual interviews) included experiences of dispensing with protocol and the implementation process of self-management interventions, operationalised as implementation fidelity. Quantitative outcomes (patients: routine registry data, surveys) consisted of diabetes monitoring completeness, satisfaction, wellbeing and health status at baseline and follow-up (24 months).ResultsQualitative: In participating practices (n = 4), dispensing with protocol encouraged reflection on tailored care and selection of various self-management interventions A focus on patient preferences, team collaboration and intervention feasibility was associated with high implementation fidelity Quantitative: In patients (n = 126), likelihood of complete monitoring decreased significantly after two years (OR 0.2 (95% CI 0.1-0.5), p < 0.001) Satisfaction decreased slightly (- 1.6 (95% CI -2.6;-0.6), p = 0.001) Non-significant declines were found in wellbeing (- 1.3 (95% CI -5.4; 2.9), p = 0.55) and health status (- 3.0 (95% CI -7.1; 1.2), p = 0.16).ConclusionsTo tailor diabetes care to individual patients within well-organised practices, we recommend dispensing with protocol while maintaining one structural annual monitoring consultation, combined with the well-supported implementation of feasible self-management interventions. Interventions should be selected and delivered with the involvement of patients and should involve population preferences and solid team collaborations.

Project description:BackgroundPatients are increasingly able to access their laboratory test results via patient portals. However, merely providing access does not guarantee comprehension. Patients could experience confusion when reviewing their test results.ObjectiveThe aim of this study is to examine the challenges and needs of patients when comprehending laboratory test results.MethodsWe conducted a web-based survey with 203 participants and a set of semistructured interviews with 13 participants. We assessed patients' perceived challenges and needs (both informational and technological needs) when they attempted to comprehend test results, factors associated with patients' perceptions, and strategies for improving the design of patient portals to communicate laboratory test results more effectively. Descriptive and correlation analysis and thematic analysis were used to analyze the survey and interview data, respectively.ResultsPatients face a variety of challenges and confusion when reviewing laboratory test results. To better comprehend laboratory results, patients need different types of information, which are grouped into 2 categories-generic information (eg, reference range) and personalized or contextual information (eg, treatment options, prognosis, what to do or ask next). We also found that several intrinsic factors (eg, laboratory result normality, health literacy, and technology proficiency) significantly impact people's perceptions of using portals to view and interpret laboratory results. The desired enhancements of patient portals include providing timely explanations and educational resources (eg, a health encyclopedia), increasing usability and accessibility, and incorporating artificial intelligence-based technology to provide personalized recommendations.ConclusionsPatients face significant challenges in interpreting the meaning of laboratory test results. Designers and developers of patient portals should employ user-centered approaches to improve the design of patient portals to present information in a more meaningful way.

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

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

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