Abstract
BackgroundAmong other factors, the patients’ consultation reasons and GPs’ spectrum of services determine the process and outcome of the medical treatment. So far, however, there has been little information on differences in reasons for consultation and GPs’ services between urban and rural areas. Our study’s goal was thus to investigate these factors in relation to the regional location of GPs’ practices.MethodsWe conducted a cross-sectional observational study based on standardised GP interviews in a quota sampling design. All counties and independent cities within a radius of 120 km around Hamburg were divided into three regional categories (urban area, environs, rural area) and stratified proportionally to the population size. Differences in the number of reasons for consultation and services were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the German federal states and administrative districts. Differences in individual consultation reasons and services were identified by logistic regression via stepwise forward and backward selection.ResultsPrimary care practices in 34 of the 37 selected administrative districts (91.9%) were represented in the dataset. In total, 211 GPs were personally interviewed. On average, GPs saw 344 patients per month with a slightly higher number of patients in rural areas. They reported 59.1 ± 15.4 different reasons for consultation and 30.3 ± 3.9 different services. There was no statistically significant regional variation in the number of different consultation reasons, but there was a broader service spectrum by rural GPs (ß = − 1.42; 95% confidence interval − 2.75/− 0.08; p = 0.038) which was statistically explained by a higher level of medical training. Additionally, there were differences in the frequency of individual consultation reasons and services between rural and urban areas.ConclusionGPs in rural areas performed more frequently services usually provided by medical specialists in urban areas. This might be caused by a low availability of specialists in rural areas. The association between medical training and service spectrum might imply that GPs compensate the specific needs of their patients by completing advanced medical training before or after setting up a medical practice.Trial registrationThe study was registered in ClinicalTrials.gov (NCT02558322).
Highlights
Among other factors, the patients’ consultation reasons and General practitioner (GP)’ spectrum of services determine the process and outcome of the medical treatment
12% of GPs in urban areas, 13% of GPs in the environs, and 25% of GPs in rural areas had to be recruited from other stratification groups of the respective regional category than originally planned
GPs from rural areas performed a larger number of different services than GPs from urban areas
Summary
The patients’ consultation reasons and GPs’ spectrum of services determine the process and outcome of the medical treatment. In Germany, for example, GPs are mostly self-employed in independent small businesses. They can work individually in private practices (individual practice) or together with other physicians – either in private practices where each physician submits his own claims (group practice) or in private practices where the claims of all physicians are combined and submitted as one bill (joint practice). In the statutory health insurance system, which includes approximately 90% of the German population, about 95% of the services are determined by the Federal Joint Committee. The remainder of the services can be defined individually by the statutory health insurance companies based on strict legal requirements [1]
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