Regional Influences on Home Visits - Is Care in Rural Areas Secured in the Long Term?

Abstract

Demographic change and urbanisation are proceeding at a rapid pace in Germany. Although the need for care is increasing due to a growing older and multimorbid generation, the number of home visits by general practitioners has been declining since years. Previous studies have shown that the workload for general practitioners is increasing, especially in rural areas. Research question What kind of structural practice characteristics are associated with the frequency of GP home visits? What influence do regional characteristics of GP practices have? In a study of family doctors̓ practices in Saxony, 4286 home visits were documented by questionnaires from 303 participating practices over a period of one year. Each practice surveyed the home visits within a randomly assigned week. In addition to the characteristics of the home visits, information about the practice, such as regional location, home visit organization and patient numbers was also collected. The frequency of home visits was based on information provided by the doctors surveyed. Subsequently, the data based on the postal code were supplemented with structural information from the State Statistical Office and data from the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung-KV). The data were first analysed regarding bivariate associations. Significantly associated variables were finally tested in a multivariate regression model. According to their own statements, the interviewed general practitioners carried out an average of 14.5 (SD 9.5) home visits per week, which included the care of 32.0 (SD 30.0) nursing home patients. The number of home visits correlated significantly negatively with the number of inhabitants and significantly positively with the average age of the region. In the multivariate analysis, the age of the doctor was found to be the largest predictor of the number of home visits per week, with younger doctors making significantly fewer home visits. The number of home visits per week continues to decline compared to preliminary studies. In the regression model, the great influence of the doctor̓s age on the number of home visits is striking. While regional-structural characteristics fade into the background, a changed attitude towards home visits must be assumed, with telemedicine and delegation coming to the fore.