Regional Variation in the Primary Medical Care of Northern Germany (AVFN)

Regional Variation of Patient Population and Reasons for Consultation in the Primary Medical Care of Northern Germany

The study explores the variation in the patient populations and describes regional differences regarding the reasons for consultations in the primary medical care in Germany. The data collection will be stratified by rural and urban areas as well as environs. The data set will include a large variety of data about physicians, patients and health care utilization.

Study Overview

• Status: Completed
• Conditions: Any Condition Treated in Primary Care
• Intervention / Treatment: Other: Primary medical care

Detailed Description

Inappropriate supply and the increasing demand on the health care system have been of concern for health policy in Germany for the last 15 years. Concerning primary care, this especially relates to an undersupply of rural GPs (general practitioners). But there also seem to be other relevant regional differences, e.g. a lower number of house calls in larger cities, a greater number of psychiatric (co-)morbidities in the cities, a greater spectrum of services offered by rural doctors, and a difference in accessing primary and secondary care between the rural and the urban areas. Despite these results, differences between rural and urban areas have not been studied extensively in Germany. Therefore this study aims to explore regional variation of patient populations and their reasons for accessing primary care.

The study is based on standardized interviews with 240 GPs and approximately 1.200 patients in Northern Germany. Questionnaires are based on a preliminary qualitative study and were pretested. The GP's questionnaire comprises characteristics of the GP and the practice, patient types, reasons for consultation and services offered. The patient's questionnaire includes sociodemographic data and past medical history, quality of life, access to the GP, specialists and hospitals, perceived social support, health behaviour and the reasons for their consultations. Data will be analysed by descriptive statistics and different regression modelling strategies adjusted for possible confounders and the GP-induced cluster structure.

• Study Type: Observational
• Enrollment (Actual): 1022

Contacts and Locations

Study Locations

• Germany
  • Hamburg, Germany, 20246
    • Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

The study is located in Northern Germany. We included all districts and cities ("Landkreise" and "Kreisfreie Städte") which have at least 20% of their area within a maximum linear distance of 100kms from our study centre in Hamburg. We assigned all districts and cities to three region types: "urban area", "environs" and "rural area". In each region type 80 GPs will be recruited and stratified by district. The prospected sample size in each district unit corresponds to its population size in relation to the total population in the respective region type. In each GP practice 15 patients will be selected at random (using random number tables) and invited to participate in the study. From our experience with similar studies we anticipate a response rate of 33%.

Description

Inclusion Criteria:

• having consulted the practice within the last 3 months and
• being patient of the practice since at least 36 months (i.e. at least one consultation before 36 or more months)

Exclusion Criteria:

• no capacity to consent (e.g. because of dementia)
• insufficient German language skills to conduct interview
• not able to participate in the interviews (e.g. because of deafness or major depression)

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Primary medical care in rural areas; People living in districts, where less than 50% of the population live in cities with more than 20,000 residents and the population density outside of the cities is below 100 people per km². Excluding people living in cities with a population of at least 100,000 residents.	Other: Primary medical care; All study participants receive primary care as usual in the respective region
Primary medical care in region environs; People living in districts, where 50% or more of the population live in cities with more than 20,000 residents and/or population density outside of the cities is above 100 people per km². Excluding people living in cities with a population of at least 100,000 residents.	Other: Primary medical care; All study participants receive primary care as usual in the respective region
Primary medical care in in urban areas; People living in cities with a population of at least 100,000 residents.	Other: Primary medical care; All study participants receive primary care as usual in the respective region

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reasons for consultation and utilized services in the GP practice	Short form of the German version of the International Classification of Primary Care (ICPC) with 38 different services (e.g. vaccinations, patient education or referrals) and 100 consultation reasons (e.g. disorders of the upper gastrointestinal tract) in 17 subject areas (e.g. digestive system).	3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient population in the GP practice	List of 27 patient types regarding their health care utilization behaviour	3 months
Health care utilization	Frequency of accessing GPs, specialists, general hospitals and rehab hospitals	3 months

Collaborators and Investigators

• Sponsor: Universitätsklinikum Hamburg-Eppendorf
• Investigators: Principal Investigator: Martin Scherer, Prof. Dr., Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf

Publications and helpful links

General Publications

• Hansen H, Schafer I, Pohontsch NJ, Kazek A, Hardt H, Luhmann D, Scherer M. Regional differences in the patient population of general practices in northern Germany: results of a mixed-methods study. BMJ Open. 2020 Nov 27;10(11):e041762. doi: 10.1136/bmjopen-2020-041762.
• Hansen H, Schafer I, Porzelt S, Kazek A, Luhmann D, Scherer M. 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. BMC Fam Pract. 2020 Jun 17;21(1):110. doi: 10.1186/s12875-020-01180-3.
• Schafer I, Hansen H, Ruppel T, Luhmann D, Wagner HO, Kazek A, Scherer M. Regional differences in reasons for consultation and general practitioners' spectrum of services in northern Germany - results of a cross-sectional observational study. BMC Fam Pract. 2020 Jan 31;21(1):22. doi: 10.1186/s12875-020-1093-6.
• Schafer I, Hansen H, Pohontsch N, Bole L, Wagner HO, Fuhr M, Luhmann D, Scherer M. Regional variation of patient behaviour and reasons for consultation in the general practice of Northern Germany: protocol for an observational study. BMJ Open. 2016 Jun 29;6(6):e010738. doi: 10.1136/bmjopen-2015-010738.

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2015
• Primary Completion (Actual): May 1, 2017
• Study Completion (Actual): July 1, 2017

Study Registration Dates

• First Submitted: September 2, 2015
• First Submitted That Met QC Criteria: September 21, 2015
• First Posted (Estimate): September 24, 2015

Study Record Updates

• Last Update Posted (Actual): August 3, 2017
• Last Update Submitted That Met QC Criteria: August 2, 2017
• Last Verified: August 1, 2017

More Information

Terms related to this study

• Other Study ID Numbers: KVHH-KVSH-2015/1