Abstract
BackgroundIn most countries, the general practitioner (GP) is the first point of contact in the healthcare system and coordinator of healthcare. However, in Germany it is possible to consult an outpatient specialist even without referral. Coordination by a GP might thus reduce health expenditures and inequalities in the healthcare system. The study describes the patients’ willingness/commitment to use the GP as coordinator of healthcare and identifies regional and patient-related factors associated with the aforementioned commitment to the GP.MethodsCross-sectional observational study using a standardised telephone patient survey in northern Germany. All counties and independent cities within a radius of 120 km around Hamburg were divided into three regional categories (urban areas, environs, rural areas) and stratified proportionally to the population size. Patients who had consulted the GP within the previous three months, and had been patients of the practice for at least three years were randomly selected from medical records of primary care practices in these districts and recruited for the study. Multivariate linear regression models adjusted for random effects at the level of federal states, administrative districts and practices were used as statistical analysis methods.ResultsEight hundred eleven patients (25.1%) from 186 practices and 34 administrative districts were interviewed. The patient commitment to a GP attained an average of 20 out of 24 possible points. Significant differences were found by sex (male vs. female: + 1.14 points, p < 0.001), morbidity (+ 0.10 per disease, p = 0.043), education (high vs. low: − 1.74, p < 0.001), logarithmised household net adjusted disposable income (− 0.93 per step on the logarithmic scale, p = 0.004), regional category (urban areas: − 0.85, p = 0.022; environs: − 0.80, p = 0.045) and healthcare utilisation (each GP contact: + 0.30, p < 0.001; each contact to a medical specialist: − 0.75, p = 0.018). Professional situation and age were not significantly associated with the GP commitment.ConclusionOn average, the patients’ commitment to their GP was relatively strong, but there were large differences between patient groups. An increase in the patient commitment to the GP could be achieved through better patient information and targeted interventions, e.g. to women or patients from regions of higher urban density.Trial registrationThe study was registered in ClinicalTrials.gov (NCT02558322).
Highlights
In most countries, the general practitioner (GP) is the first point of contact in the healthcare system and coordinator of healthcare
In most countries, healthcare is organised as a primary care system which usually means the general practitioner is the first medical contact point in the healthcare system coordinating patients’ healthcare across sectors [1–3]
No patients could be recruited from 65 GPs due to time-related or organisational reasons
Summary
The general practitioner (GP) is the first point of contact in the healthcare system and coordinator of healthcare. Healthcare is organised as a primary care system which usually means the general practitioner is the first medical contact point in the healthcare system coordinating patients’ healthcare across sectors [1–3]. This role of general medicine is referred to as gatekeeping. The general practitioner is often the first contact point for a sick person and the specialist group of general practitioners is among the most frequently consulted groups of physicians in Germany [1, 8]. A strong commitment to a GP exists if 1) patients have a GP whom they prefer to consult first in all healthcare issues, 2) if patients understand their GP to be a central and competent coordinator of all their healthcare issues and 3) if there is a relationship of trust between patients and GP
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