Effect of the delegation of GP-home visits on the development of the number of patients in an ambulatory healthcare centre in Germany.
Effect of the delegation of GP-home visits on the development of the number of patients in an ambulatory healthcare centre in Germany.
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DOI：
10.1186/1472-6963-12-355
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发表时间：
2012-10-10
影响因子：
2.8
通讯作者：
Hoffmann W
中科院分区：
文献类型：
--
作者：
van den Berg N;Heymann R;Meinke C;Baumeister SE;Flessa S;Hoffmann W
AGnES概念（AGnES：全科医生支持、社区为基础、电子保健辅助、系统性干预），以支持供应不足地区的全科医生。该项目的目的是将全科医生家访委托给合格的AGnES实践助理，以增加可以为其提供医疗护理的病人人数。本文重点介绍的影响，委托GP家访的总人数治疗的患者。首先，计算通过将家访委托给AGnES实践助理治疗的额外患者的理论数量。其次，分析了参与GP实践的患者数量的实际变化。患者数量理论增长的计算基于项目数据，数据由国家健康保险医师协会提供，或来自文献。该项目的背景是勃兰登堡联邦州农村县Oberspreewald-Lausitz的一个流动医疗中心，该中心雇用了6名全科医生，其中4名参与了AGnES项目。对参与GP实践的患者数量变化的分析是基于实践的报销数据。计算出的AGnES实践助理的平均能力为每年1 376.5次家访。全科医生平均每年进行1200次家访。由于紧急医疗原因的家访不能委托，我们在分析中只包括AGnES实践助理的一半能力（相当于每周工作20小时）。考虑计算模型中的所有参数，每年可节省360.1 GP工时。这些GP小时可用于治疗170名额外患者/季度年。在四个参与的GP实践中，患者数量在项目期间平均增加了133例患者/季度，相当于理论上可能的患者数量的78%。经验研究结果的潜力，以增加病人的数量在GP的做法，通过授权的任务接近的理论计算。计算值和真实的值之间的差异可能是由于患者的年龄和死亡率分布的差异。结果表明，基于实践助理的支持系统可以缓解农村地区GP短缺的后果。
The AGnES-concept (AGnES: GP-supporting, community-based, e-health-assisted, systemic intervention) was developed to support general practitioners (GPs) in undersupplied regions. The project aims to delegate GP-home visits to qualified AGnES-practice assistants, to increase the number of patients for whom medical care can be provided. This paper focuses on the effect of delegating GP-home visits on the total number of patients treated. First, the theoretical number of additional patients treated by delegating home visits to AGnES-practice assistants was calculated. Second, actual changes in the number of patients in participating GP-practices were analyzed. The calculation of the theoretical increase in the number of patients was based on project data, data which were provided by the Association of Statutory Health Insurance Physicians, or which came from the literature. Setting of the project was an ambulatory healthcare centre in the rural county Oberspreewald-Lausitz in the Federal State of Brandenburg, which employed six GPs, four of which participated in the AGnES project. The analysis of changes in the number of patients in the participating GP-practices was based on the practices’ reimbursement data. The calculated mean capacity of AGnES-practice assistants was 1376.5 home visits/year. GPs perform on average 1200 home visits/year. Since home visits with an urgent medical reason cannot be delegated, we included only half the capacity of the AGnES-practice assistants in the analysis (corresponding to a 20 hour-work week). Considering all parameters in the calculation model, 360.1 GP-working hours/year can be saved. These GP-hours could be used to treat 170 additional patients/quarter year. In the four participating GP-practices the number of patients increased on average by 133 patients/quarter year during the project period, which corresponds to 78% of the theoretically possible number of patients. The empirical findings on the potential to increase the number of patients in GP-practices through delegation of tasks come close to the theoretical calculations. Differences between the calculated and the real values may be due to differences in the age and mortality distribution of the patients. The results indicate that a support system based on practice assistants can alleviate the consequences of GP-shortages in rural areas.
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影响因子：
2.9
作者：
Rosemann, Thomas;Joest, Katharina;Szecsenyi, Joachim
通讯作者：
Szecsenyi, Joachim
影响因子：
3.8
作者：
Dreier, Adina;Rogalski, Hagen;Hoffmann, Wolfgang
通讯作者：
Hoffmann, Wolfgang
影响因子：
2.9
作者：
Theile G;Kruschinski C;Buck M;Müller CA;Hummers-Pradier E
通讯作者：
Hummers-Pradier E
影响因子：
7.7
作者：
Van den Berg, Neeltje;Meinke, Claudia;Hoffmann, Wolfgang
通讯作者：
Hoffmann, Wolfgang
影响因子：
1.1
作者：
Snijder, E. A.;Kersting, M.;Junius-Walker, U.
通讯作者：
Junius-Walker, U.