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. 2019 Jan 4;20(1):3.
doi: 10.1186/s12875-018-0891-6.

The workload for home visits by German family practitioners: an analysis of regional variation in a cross-sectional study

Maik Pochert  1 , Karen Voigt  2 , Martin Bortz  2 , Alessa Sattler  2 , Jeannine Schübel  2 , Antje Bergmann  2
Affiliations

The workload for home visits by German family practitioners: an analysis of regional variation in a cross-sectional study

Maik Pochert et al. BMC Fam Pract. .

Abstract

Background: In Germany, home visits account for a considerable workload for many family practitioners, substantial rural-urban disparities are assumable with regards to home visit frequency and duration. Considering the ongoing demographic change and a rural-urban migration a significant regional difference in the provision of care is assumable. There is a lack of reliable data on the current provision of home visits and how their organisational procedures can be ensured in the future. The aim of this study was to describe and assess the average workload of family practitioners during home visits and compare their rural-urban variations.

Methods: A cross-sectional study over a period of 12 months was conducted in Saxony as part of the fifth project of the Saxon Epidemiologic Studies in General Practice (SESAM-5). Over a 1-week period, family practitioners documented every home visit and answered questionnaires about sociodemographic, organisational and clinical characteristics. According to common categorizations in empirical studies four regional groups (rural, semi-rural, semi-urban, urban) were analysed and compared by non-parametric tests: Kruskal-Wallis followed by Dunn's, Jonckheere-Terpstra and Mann-Whitney-U. Multinomial logistic regression analyses were carried out using a collection of plausible predictors to assess influences for a high frequency and a long duration of home visits.

Results: The sample included 3673 home visits conducted by 253 family practitioners. On average, 14.5 home visits were carried out per week with an average duration of almost 28 min. After comparing regional areas, the number and total duration per home visit showed significant differences between the regions: 8.2 h (rural), 7 h (semi-rural), 6.6 h (semi-urban) and 5 h (urban). The regression analyses found that a high frequency of home visits was most likely accomplished in rural regions and a long duration was most likely performed in private homes.

Conclusions: Workload of home visits is strongly associated with the regional location of the practice, leading to rural-urban disparities. Strategies to reduce regional disparities to ensure the future provision of care in the German and comparable health care systems should be discussed, e.g. by financial incentives (short-term), exploiting the potential of delegation (medium-term) and discussing the implementation of substitution (long-term).

Keywords: Cross-sectional study; Family practitioners; Home visits; Homebound patients; Rural-urban; Workload.

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Conflict of interest statement

Ethics approval and consent to participate

A positive ethic vote was confirmed by the ethics committee of the Technical University of Dresden (EK 350092013) and adheres to the Declaration of Helsinki. Written consent was obtained from every participant (FP, assistant physicians, medical assistants). According to the national guideline § 15 Medical Association’s professional code of conduct of Saxony (Berufsordnung für Ärzte in Sachsen) a patient consent was not required because patient data were documented anonymously.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of the SESAM-5
See this image and copyright information in PMC

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