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

机译：德国家庭医生的家访工作量：一项横断面研究中的区域差异分析

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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. 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. 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. 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).
机译：在德国，家访对许多家庭从业者来说是相当大的工作量，在家访频率和持续时间方面，可以推测出城乡之间的巨大差异。考虑到正在进行的人口变化和从农村向城市的移民，在提供医疗服务方面可能存在地区差异。缺乏关于当前家庭访问提供的可靠数据，以及未来如何确保其组织程序的可靠数据。这项研究的目的是描述和评估家庭医生在家庭访问期间的平均工作量，并比较其城乡差异。萨克森州进行了为期12个月的横断面研究，这是撒克逊人流行病学一般实践研究（SESAM-5）第五个项目的一部分。在1周的时间内，家庭医生记录了每次家访，并回答了有关社会人口统计学，组织和临床特征的问卷。根据经验研究中的常见分类，通过非参数检验对四个区域组（农村，半农村，半城市，城市）进行了分析和比较：Kruskal-Wallis，然后是Dunn，Jonckheere-Terpstra和Mann-Whitney-U。使用一系列合理的预测变量进行了多项逻辑回归分析，以评估高频率和长时间的家庭访问的影响。样本包括253位家庭医生进行的3673次家访。平均每周进行14.5次家访，平均持续时间将近28分钟。比较区域区域后，每次家访的次数和总持续时间显示出区域之间的显着差异：8.2？h（农村），7？h（半农村），6.6？h（半城市）和5？h（城市） ）。回归分析发现，在农村地区，家庭访问的频率最高，而在私人家庭中，访问时间的频率最高。上门拜访的工作量与这种做法的区域位置密切相关，导致城乡差距。应当讨论减少区域差异的策略，以确保将来在德国和类似的医疗体系中提供医疗服务，例如通过财务激励措施（短期），开发授权的潜力（中期）并讨论替代的实施（长期）。

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