Home visit delegation in primary care: acceptability to general practitioners in the state of Mecklenburg-Western Pomerania, Germany

Abstract

Background: Shortages and maldistribution of primary care physicians (PCPs) are affecting many countries today, including in Germany. As has been suggested, the ensuing problems might be alleviated by delegating some medical tasks to physicians' assistants (PAs). This was tried in three regions of the German state of Mecklenburg-Western Pomerania under a pilot project entitled AGnES (Arztentlastende gemeindenahe E-Health-gestützte Systemische Intervention, i.e., a community-based, e-health-assisted, systemic intervention to reduce physicians' workloads). We conducted a survey of all practicing PCPs in the state to assess their overall attitude toward the delegation of home visit tasks, and to determine what they would prefer as the job description and type of employment contract for a PA who would be hired to assist them.

Methods: All PCPs practicing in Mecklenburg-Western Pomerania were asked in a quantitative survey about their willingness to delegate home visits, their perceived barriers to and benefits of home visit delegation to a qualified assistant, the skills they would require of a PA who would be hired to carry out home visits, and their preferred type of employment contract for the PA.

Results: 47% of the PCPs (515/1096) responded to the survey. 46% of the respondents were already informally delegating home visit tasks to qualified PAs. Female PCPs were more likely to do so (odds ratio [OR] 1.70), as were PCPs practicing in rural areas (OR 1.63) and those working in individual practice (OR 1.94). Most PCPs were in favor of delegating home visits to qualified PAs (77%). Main advantages were seen in reducing physicians' workloads (70%) and in increasing their job satisfaction (48%). 34% of PCPs said they would not cover the cost of training PAs.

Conclusion: Acceptance of home visit delegation among PCPs in the state of Mecklenburg-Western Pomerania is high, mainly among the younger physicians. Perceived barriers and benefits of delegation of home visits to qualified PAs should be taken into account in the design of future health-care reforms, so that practice in rural areas can be made more attractive for the incoming generation of PCPs.

Figure 1

Benefits of home visit delegation to an AGnES nurse. Modified from (27). AGnES, Arztentlastende gemeindenahe E-Health-gestützte Systemische Intervention (a community-based, e-health-assisted systemic support for primary care)

Figure 2

Barriers to home visit delegation to an AGnES nurse. Modified from (27). AGnES, Arztentlastende gemeindenahe E-Health-gestützte Systemische Intervention (a community-based, e-health-assisted systemic support for primary care)

Figure 3

Preferred profile of qualified medical practice assistants undertaking home visits, organizational skills. DMP, disease management program. Modified from (27)

Figure 4

Preferred profile of qualified medical practice assistants undertaking home visits, preventive skills. Modified from (27)