Abstract
BackgroundIn 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.MethodsA 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.ResultsThe 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.ConclusionsWorkload 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).
Highlights
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
In Germany, where primary care is not offered by communities, home visits of family practitioners (FP) remain the common method of ensuring low-threshold health care access for immobilized patients [1]
The growing urbanization boom is attracting young people with better transport, social and cultural infrastructure to urban areas while decreasing the attractiveness of rural regions [9, 12]. Both developing challenges are important for the workload of home visits, as the decreasing numbers of FP will increase the workload of the remaining FP in rural regions, which will be faced with a rising numbers of time-consuming home visits, as studies show that elderly people utilize more home visits, especially over 75 years [1, 2, 4, 6, 9, 10]
Summary
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. In Germany, where primary care is not offered by communities, home visits of family practitioners (FP) remain the common method of ensuring low-threshold health care access for immobilized patients [1] This is relevant for the growing group of elderly living in single households in rural areas [2]. In the last few decades, declines in home visits by physicians have been reported in most industrialized countries, e.g. Germany, United Kingdom, Netherlands or Australia [4,5,6] In this context, it is important to review two developing challenges to ensure the future access of primary care for homebound patients. Both developing challenges are important for the workload of home visits, as the decreasing numbers of FP will increase the workload of the remaining FP in rural regions, which will be faced with a rising numbers of time-consuming home visits, as studies show that elderly people utilize more home visits, especially over 75 years [1, 2, 4, 6, 9, 10]
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