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首页> 外文期刊>BMC Family Practice >Regional variations of perceived problems in ambulatory care from the perspective of general practitioners and their patients - an exploratory focus group study in urban and rural regions of northern Germany
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Regional variations of perceived problems in ambulatory care from the perspective of general practitioners and their patients - an exploratory focus group study in urban and rural regions of northern Germany

机译：通用从业者及其患者视角下的外国护理中存在的区域变化 - 德国城乡地区的探索性重点小组研究

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Background Patients from rural and urban regions should have equitable access to health care. In Germany, the physician-patient-ratio and the supply of medical services vary greatly between urban and rural areas. The aim of our study was to explore the regional variations of the perceived health care problems in ambulatory care from the perspective of affected professionals and laypersons i.e. general practitioners and their patients. Methods We conducted 27 focus groups with general practitioners ( n =?65) and patients ( n =?145) from urban areas, environs and rural areas in northern Germany. Discussions were facilitated by two researchers using a semi-structured guideline. The transcripts were content analyzed using deductive and inductive categories. Results General practitioners and patients reported problems due to demographic change and patient behaviour, through structural inequalities and the ambulatory reimbursement system as well as with specialist care and inpatient care. A high physician density, associated with high competition between general practitioners, a high fluctuation of patients and a low status of general practitioners were the main problems reported in urban areas. In contrast, participants from rural areas reported an insufficient physician density, a lack of young recruits in primary care and a resulting increased workload as problematic. All regions are concerned with subjectively inadequate general practitioners’ budgets, insufficiently compensated consultations and problems in the cooperation with specialists and inpatient care institutions. Most problems were mentioned by GPs and patients alike, but some (e.g. high competition rates in urban regions and problems with inpatient care) were only mentioned by GPs. Conclusions While many problems arise in urban regions as well as in rural regions, our results support the notion that there is an urgent need for action in rural areas. Possible measures include the support of telemedicine, delegation of medical services and reoccupation of vacant practices. The attractiveness of working in rural areas for general practitioners, specialists and clinicians must be increased by consolidating and expanding rural infrastructure (e.g. child care and cultural life). The above mentioned results also indicate that the ambulatory reimbursement system should be examined regarding the reported inequalities. Measures to further enhance the cooperation between general practitioners, specialists and inpatient care should be taken to solve supra-regionally reported problems. Problems showing regional variations indicate the need for measures to balance these variations between the regions. This is the first German study to analyze subjective views of the stakeholders concerned on regionally variating problems in ambulatory care. Further studies are needed to quantify the extent of the identified problems and differences. A corresponding survey is currently under way.
机译：农村和城市地区的背景患者应公平地获得医疗保健。在德国，城乡之间的医生 - 患者率和医疗服务的供应在很大程度上变化。我们的研究目的是从受影响的专业人士和拉德斯顿的角度来探讨守护者护理中的感知医疗保健问题的区域变化。一般从业者及其患者。方法采用德国北部北部城区，周边地区，患者（n =Δ65）和患者（n = -_145）进行了27个重点小组。两个研究人员使用半结构化指南促进了讨论。通过演绎和归纳类别分析了转录物的内容。结果全科医生和患者报告了人口变化和患者行为，通过结构不平等和静态护理系统以及专业护理和住院护理。与一般从业者之间的高竞争相关，高度竞争，患者的高波动和一般从业人员的低竞争相关的医生密度是城市地区报告的主要问题。相比之下，农村地区的参与者报告了医生密度不足，缺乏初级保健的年轻新兵，并导致工作量增加。所有地区都涉及主观不足的通用从业者预算，与专家和住院护理机构合作不足赔偿和问题。 GPS和患者的大多数问题都提到，但有些问题（例如，城市地区的高竞争率和住院护理的问题）仅被GPS提及。结论，虽然城市地区以及农村地区出现了许多问题，但我们的业绩支持了迫切需要在农村地区采取行动的概念。可能的措施包括远程医疗，医疗服务代表团的支持和空置惯例的再次支持。必须通过巩固和扩大农村基础设施（例如儿童保育和文化生活）来增加在农村地区工作的普通科学家，专家和临床医生的吸引力。上述结果还表明，应审查关于报告的不平等的守护报恢复系统。应采取进一步加强普通科学者，专家和住院护理之间的合作的措施，以解决超大区域报告的问题。显示区域变异的问题表明需要措施来平衡地区之间的这些变化。这是第一项德国研究，分析有关利益相关者的主观性意见，这些涉及有关的利益攸关方的看法在等级变异问题中。需要进一步的研究来量化所发现的问题和差异的程度。目前正在进行相应的调查。

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