General Practitioners In Rural Areas Research Articles

Changes in the levels of marker molecules salivary α-amylase and cortisol as a stress response to everyday activities of general practitioners in rural areas of the Republic of Bulgaria.

Stress is a phenomenon accompanying everyday life. Various reactions of the body are activated during stress, including activation of the hypothalamo-pituitary-adrenal endocrine axis and the autonomous nervous system. Their activity could be assessed by the measurement of biological stress marker molecules - salivary α-amylase and cortisol - on one side and heart rate, and blood pressure monitoring, on the other. The aim of the present study is to determine whether the daily professional routines cause stress development among general practitioners (GPs) who work in rural, distant areas in the territory of the Republic of Bulgaria. One hundred and twenty-eight GPs were asked to answer a questionnaire to assess their health conditions, habits, priority objectives and interests, as well as their moral and ethical relationships with the patients. On this basis 40 participants were selected and outlined for the present survey (n=40, mean age 55.92±8.8). Four salivary samples were collected from each participant during 1 week: two on Monday (one in the morning and one after work) and two on Friday, by the same mechanism. The salivary samples collection was followed by measurement of blood pressure and pulse. This non-invasive survey was based on an ELISA method for quantitative determination of the marker molecules in saliva. The blood pressure and pulse were measured by blood pressure monitor. The levels of the salivary α-amylase were significantly higher at the end of the working day, especially on Friday (142.28±23.34 U/mL, p=0.018), but not between the beginning and the end of the week. The normal cortisol awakening response, characterized by a peak in the levels of cortisol after wake-up, followed by a slow decrease during the day, was detected only at the beginning of the week. The data show a significant impairment of this regularity at the end of the week. Moreover, the levels of cortisol, measured for the morning samples, show a decrease at the end of the week (25.73±10.51 ng/mL) in comparison to the beginning of the week (30.1±10.84, p=0.033). The analyses on the effect of smoking (p=0.002) and alcohol consumption (p=0.036) on stress development show a significant increase in the levels of the salivary α-amylase, but not on the levels of salivary cortisol. The changes in the blood pressure indicate stress development at the end of the week (p=0.04), while the pulse showed changes within a day rather than during the week. The values of the pulse were higher at the end of the day. The professional lives of the GPs who work in distant and rural places are associated with stress development. Different habits from the daily routine, such as alcohol consumption, smoking and physical activity, could be considered as modulators of stress development.

How do the working lives of general practitioners in rural areas compare with elsewhere in Scotland? Cross-sectional analysis of the Scottish School of Primary Care Survey.

The shortage of GPs in Scotland is concerning, particularly in rural areas. There are many reasons why GPs are leaving general practice; however, satisfaction with working life is an important predictor of GP retention. The aim of this study was to compare the working lives and intentions to reduce work participation of rural GPs and GPs working elsewhere in Scotland. Quantitative analysis of responses from a nationally representative survey of GPs in Scotland. GPs were classified as 'non-rural' or 'rural' and these groups were compared using univariate and multivariate statistical analysis on four domains of working lives (job satisfaction, job stressors and positive and negative job attributes) and four intentions to reduce work participation (reducing working hours, working abroad, leaving direct patient care and leaving medical work entirely). There were significant differences in characteristics between rural and non-rural GPs. After controlling for these differences, GP age and gender, rural GPs reported higher job satisfaction, lower job stressors, higher positive job attributes, and lower negative job attributes than GPs elsewhere. A significant interaction between gender and rurality was found for job satisfaction, indicating that it was rural female GPs who were more satisfied. Rural GPs were, however, more likely to intend to work abroad and leave medical work entirely within 5 years than other GPs. These findings corroborate research from around the world and have serious implications for the future care of patients in rural areas. Further research is urgently required to understand the drivers of these findings.

Programs to encourage working as a general practitioner in rural areas: why do medical students not want to participate? A cross-sectional study

BackgroundIn many countries, not enough students are interested to work as general practitioners in rural areas. To solve this problem, several, sometimes partly extracurricular, programs have been developed. Most of these programs are based on continuity, which means that students stay in a rural region for an extended period of time, by completing clerkships. Although the effects of these programs are positive, it is often difficult to motivate students to participate. The purpose of the present study is to get insight into the reasons why students choose not to participate in these programs.MethodsWe carried out a questionnaire study among medical students in the clinical phase of the Technical University of Munich in Germany. First, we asked the students whether they actively informed themselves about the program which aims to reduce the shortage of general practitioners in rural areas in Bavaria. Furthermore, the questionnaire focused on the reasons for not participating in this program.ResultsBased on the answers of 442 students from study years 3–6, the most frequently chosen reason for not participating in the program is “identification with another discipline” with 61.0%, directly followed by “not willing to commit long-term” (56.1%). In third place is “personal connections to another region” with 30.5%. In the open comments, we find the same reasons: many students do not want to commit to a certain direction too early. In addition, students indicate that the number of regions where this program is offered is too limited for them.ConclusionsOffering programs to prepare and motivate students for work as general practitioners in rural areas can contribute to increasing the pool of future general practitioners. To encourage students to participate in such a program, it is important to consider the motives of students. Many students who might be interested in general practice do not choose to take part in such a program because they do not want to commit to a particular specialty or region at an early stage. It is important to take these insights into account when designing and implementing these programs.

How do the working lives of general practitioners in rural areas compare with elsewhere in Scotland? Cross-sectional analysis of the Scottish School of Primary Care National GP Survey.

Like many countries around the world, Scotland faces a shortage of general practitioners (GPs) due to both recruitment and retention issues. Such workforce shortages are of particular concern in rural areas. There are many reasons why GPs are leaving general practice; however, satisfaction with working life is an important predictor of GP retention. It is important, therefore, to understand working life satisfaction of rural GPs. The purpose of this study was to compare the working lives and intentions to reduce work participation of rural GPs and GPs working elsewhere in Scotland. This study was a quantitative analysis of survey data from the Scottish School of Primary Care national working lives survey. GPs were classified as working in 'non-rural' or 'rural' practices based on the Scottish Government's rural binary classification system, and were compared using univariate and multivariate statistical analysis on four domains of working lives: job satisfaction, job stressors, positive and negative job attributes, and four intentions to reduce work participation: reducing working hours, working abroad, leaving direct patient care and leaving medical work entirely. A total of 2465 GPs returned the survey, giving a response rate of 56%. Three-hundred and forty seven GPs who returned the survey worked in practices in rural areas (14.1%). Rural GPs were more likely to do out-of-hours work (p<0.001), to have worked in their practice for fewer years (p=0.014), to work in single-GP partnerships (p<0.001), and to work in practices with smaller list sizes (p<0.001), than GPs in non-rural settings. Compared with GPs elsewhere, rural GPs reported higher mean job satisfaction (5.23 v 5.39, respectively; p<0.005), lower mean job stressors (3.58 v 3.29; p<0.001) and lower mean negative job attributes (4.08 vs 3.78; p<0.001). These differences remained highly significant after controlling for potential confounders (age, gender and the differences in work practices shown above). In regression analysis, a significant interaction was found between gender and rurality for job satisfaction (p=0.008), which indicated that rural female GPs' higher job satisfaction mainly accounted for rural GPs' increased job satisfaction. No significant interaction was found between gender and rurality for the other domains of working lives. Compared with GPs elsewhere, however, rural GPs were more likely to intend to work abroad (mean 1.39 v 1.55; p=0.013) and leave medical work entirely within 5 years (mean 2.15 v 2.36; p=0.039). These intentions remained significant after controlling for potential confounders. No significant interaction was found between gender and rurality for variables for intentions to reduce work participation. Rural GPs in Scotland are more satisfied with their working lives than GPs working elsewhere in Scotland, which is mainly due to higher job satisfaction in female GPs in rural areas. Despite this, rural GPs as a whole have a higher intention to leave their job in the next 5 years than their non-rural counterparts. Although some of these differences are small, they may signal serious implications for the future care of patients in rural areas and require further research to understand the drivers of this.

Differences in Billing Patterns Between GPs and Pediatricians Using Early Diagnostics in Children and Adolescents as an Example: Analysis of Nationwide Data from Statutory Health Insurance Physicians

Despite a 13.1% increase in the number of pediatricians between 2011 - 2020, the capacity of pediatric care has largely stagnated. This is due to increasing flexibility in working hours and a declining willingness of doctors to establish practices. In addition, there is an imbalance in the distribution of pediatric medical care capacities. While metropolitan areas are often characterized by oversupply, there is an increasing shortage of pediatricians, especially in rural areas. As a result, general practitioners in rural areas are increasingly taking over part of pediatric care. We quantify this compensation effect using the example of examinations of general health and normal child development (U1-U9). Basis of the analysis was the Doctors' Fee Scale within the Statutory Health Insurance Scheme (Einheitlicher Bewertungsmaßstab, EBM) from 2015 (4th quarter). Nationwide data from the National Association of Statutory Health Insurance Physicians (KBV) for general practitioners and pediatricians from 2015 was evaluated. In the first step, the EBM was used to determine the potential overlap of services between the two groups of doctors. The actual compensation between the groups was quantified using general health and normal child development as an example. In section 1.7.1 (early detection of diseases in children) of the EBM, there is a list of 16 options for services that can be billed (fee schedule positions, GOP) by general practitioners and pediatricians. This particularly includes child examinations U1 to U9. The analysis of the national data of the KBV for the early detection of diseases in children showed significant differences between rural and urban regions in the billing procedure. Nationwide, general practitioners billed 6.6% of the services in the area of early detection of diseases in children in 2015. In rural regions this share was 23% compared to 3.6% in urban regions. The analysis of the nationwide data showed that the proportion of services billed by general practitioners was higher in rural regions than in urban regions. The EBM allows billing of services by both general practitioners and pediatricians, especially in the area of general GOP across all medical groups. The national billing data of the KBV shows that general practitioners in rural regions bill more services from the corresponding sections than in urban regions.

Diagnostic and Therapeutic Challenges of a Slipped Capital Femoral Epiphysis in a Low and Middle Income Country: A Case Report and Literature Review

Background:Slipped Capital Femoral Epiphysis (SCFE) is an incapacitating orthopedic disease, particularly affecting older children and adolescents and caused by the sliding of the proximal femoral epiphysis on the metaphysis. SCFE has a clinical polymorphism, compounded with a certain diagnostic variability among health practitioners and the relatively high cost of its surgical management contribute to the diagnostic delay observed in most developed countries as well as developing ones. Herein, we report the case of SCFE in an adolescent Cameroonian, with emphasis on its diagnostic and therapeutic challenges in Low and Middle-Income Countries (LMICs), in a bit to improve on timely recognition and management by clinicians in these settings.Case Presentation:A 10-year-old girl has presented with unilateral right thigh pain of more than one year duration associated with a limping gait and no fever. Before the referral to our health facility, she consulted several general practitioners in rural areas and pediatricians in the city with no definite diagnosis. On the basis of the clinical and the imaging studies, the diagnosis of stable right SCFE with moderate displacement was made. Under general anesthesia, the patient underwent open reduction and internal fixation with three pins under c-arm fluoroscopy. Clinical and radiological follow-up till one year after surgical intervention were satisfactory. The pins were removed after one year of fixation confirming a good bone fusion in plain x-ray. Her clinical examination and radiological follow-up three years after removal of the pins were satisfactory.Conclusion:The case report illustrates that SCFE often a missed diagnosis in LMICs. This is worrisome because delayed diagnosis may lead to long-term complications such as avascular necrosis and early degenerative joint disease. Although the above case was missed by several clinicians and finally diagnose late, the present case highlights the need for a high index of clinical suspicion in order to timely diagnose and timely manage SCFE to avert potential long-term physical disabilities and psychological trauma in children.

Has the diffusion of primary care teams in France improved attraction and retention of general practitioners in rural areas?

Many countries, including France, are facing the old and persistent problem of geographical inequalities of their health human resources, in particular general practitioners (GPs). This situation leads, among other things, to underserved areas, which could result in a lower level of primary health care accessibility. Since the mid-2000s in France, several policies were implemented to provide financial as well as other incentives to support the development of multi-professional group practices, Primary Care Teams (PCTs), in order to attract and retain GPs in underserved areas. This study aims to measure the impact of PCTs settlement on the evolution of GP density in rural areas. To this end, we compare the evolution of GP density between rural areas with PCTs and similar rural areas without PCTs, before (2004–2008) and after (2008–2012) the development of PCTs facilities. The results show that PCTs are mainly located in underserved areas and suggest that they could attract and retain GPs there. Those results should be of interest to countries facing relatively similar geographical inequalities issues and that are also experimenting with multi-professional group practices.

Community orientation of general practitioners in 34 countries

General practitioners (GPs) are frontline health workers. They should be sensitive to the health needs of the community in addition to caring for patients that visit their practice. Due to changes in demography, epidemiology, ecology and healthcare policy, a community orientation becomes more important. Our research question is: to what extent does community orientation of GPs vary between countries and GPs and how can this variation be explained? We use cross-sectional survey data from the QUALICOPC study, conducted among over 7000 GPs in 34 countries. Community orientation was measured through a scale constructed from three survey questions on whether GPs would take action when confronted with: repeated accidents in an industrial setting, frequent respiratory problems in patients living near a certain industry, and repeated cases of food poisoning in the local community. Independent variables are at healthcare system level and GP or practice level. Data were analysed using linear multilevel regression analysis. Community orientation varies between GPs and countries. Community orientation is more frequent in healthcare systems with a list system, among self-employed GPs, those using medical records to make overviews, and those more active in prevention and multidisciplinary cooperation. GPs in rural areas and areas with more people from ethnic minorities are more community oriented. Based on the variation between countries and GPs, we would like to raise awareness and underline the importance of multidisciplinary cooperation.

Rural and Remote General Practitioners’ Perceptions of Psychologists

ObjectiveAs the first professional contact for most Australians with mental health concerns, general practitioners (GPs) are often considered the “gateway” to accessing psychologists. Understanding GPs’ views of psychologists is therefore of great importance to the profession. GPs serve a particularly important role in mental health in rural and remote areas given the lack of other services; however there has been limited research investigating the relationship between psychologists and GPs in rural areas. This study aimed to investigate rural GPs’ perceptions of rural psychologists.MethodSemi‐structured qualitative telephone and in‐person interviews were conducted with 13 GPs working in rural and remote South Australia. Data were analysed thematically.ResultsThree main themes were identified: Psychologists are useful/helpful; working with psychologists can be challenging; and psychologists are not well understood. Rural GPs held mostly positive views about psychologists and their value in providing professional support and reducing GP workloads. However, GPs’ understanding of psychologists’ training and expertise varied considerably, with most reporting gaps in their knowledge. Challenges included limited access to psychologists and communication barriers. Communication was considered to be enhanced by co‐locating psychology services within the GP practice, which was also considered to be a valuable educational opportunity for GPs.ConclusionWhile rural GPs held largely positive views of psychologists, they may require further support in understanding what psychologists can offer and promoting psychology to their patients. Results may assist in improving communication between rural psychologists and GPs and inform strategies to improve rural GPs’ understanding of psychologists’ skills and training.

Participation in medical activities beyond standard consultations by Swiss general practitioners: a cross-sectional study

BackgroundFew data exist to support the observation that general practitioners (GPs) occupy many important positions in our communities or to characterize which GPs devote more of their time to such activities. We sought to characterize community-based complementary medical activities performed by GPs in the canton Vaud, Switzerland.MethodsAll GPs in a region were invited to participate in a cross-sectional study (n = 600) examining engagement in complementary activities beyond standard ambulatory consultations. Categories included teaching, care giving in specific structures, roles as medical experts or company doctors, community care giving, and others completed by the GP. GPs were asked the number of hours devoted monthly to each activity and whether or not they are remunerated for this work.ResultsOne hundred and sixty-eight GPs responded (28%), with 149 (92%) reporting that they were engaged in at least one activity beyond their in-office consultations, including 117 (72%) in community care-giving (ex: care for addictions or refugees). Altogether, GPs spend on average 5.8 h a week on these activities. One-hundred and twenty-three GPs (82%) were remunerated for at least one of their complementary engagements. Predictors of participation in a larger number of complementary activities were working in a rural area (IRR 1.29, 95% CI 1.05 to 1.57) and having a higher weekly workload (IRR 1.01 for each additional hour, 95% CI 1.01 to 1.02).ConclusionThe vast majority of GPs engage in activities beyond their standard clinic tasks and they are typically reimbursed. GPs in rural areas and those who work more hours per week are more likely to engage in complementary activities.

Continuing education for general practitioners working in rural practice: a review of the literature

BackgroundStudies demonstrate that the CME/CPD (continuing medical education/continuing professional development) needs of rural general practitioners (GPs) are unique. Little research has focused specifically on the effectiveness of CME/CPD programmes for rural practice.AimsTo review the literature on CME/CPD for GPs in rural areas, focussing on studies which examined impact on doctor performance or patient outcomes.MethodsA search of peer-reviewed English language literature and relevant grey literature was conducted: identified literature was reviewed.ResultsNineteen articles met the pre-specified inclusion criteria. Educational delivery approaches examined include regional CME/CPD small-group learning programmes, workshops and distance learning. Most articles report on participant experience or satisfaction while doctor performance and patient outcomes are seldom reported. Distance learning programmes found it difficult to recruit or engage doctors, two out of six studies found improvements in self-reported knowledge or performance, while none reported measurable changes in doctor performance/patient care.

Изучение мнения сельского населения об организации и качестве медицинской помощи, оказываемой участковыми врачами

In order to develop a system of measures to improve the quality and availability of outpatient care for rural population in 20162017. a study was conducted on the basis of polyclinics 3 CRH Republic of Dagestan. A survey of 817 patients served by district doctors was conducted. The advantages of the work of General practitioners in rural areas compared with local therapists. The answers of patients on the reasons for which they consider activity of General practitioners effective are rather indicative: there is no need to address to different doctors (47,5%); the number of referrals to specialists decreased (24.4%); the number of laboratory tests decreased (20.2%). With the introduction of General practice medical care has become more accessible (48%), more qualified (36.2%) and more volume (32.4%). On the basis of the materials of the research recommendations and proposals on optimization of outpatient care for rural population were developed.

How general practitioners perceive and assess self-care in patients with multiple chronic conditions: a qualitative study

BackgroundIt is not known how general practitioners (GPs) perceive the concept of self-care and how they assess self-care ability in patients with multiple chronic conditions. As a part of the strategy to improve the care of people living with chronic conditions, disease management programs in Denmark require GPs and other health care workers to assess and support patients’ self-care ability. The aim of the present study was to explore GPs’ perceptions and assessment of self-care ability in patients with multiple chronic conditions who have difficulty following a given treatment.MethodsA qualitative study conducted through in-depth, semi-structured interviews with a purposive sample of 12 GPs in rural areas of Denmark with economically disadvantaged populations. The interviews involved 36 complex patient cases selected by the GPs themselves. Our analysis followed the principles of systematic text condensation.ResultsMost GPs in our study had a health-related perception of self-care, but some had a broader perception encompassing the situational context of the patient’s life. The GPs’ assessments of patients’ self-care ability were based on information from the ongoing and often long-term relationships with the patients. GPs identified four major factors that influenced patients’ self-care ability, which accumulated and fluctuated over time: multimorbidity, cognitive resources, material resources, and the patients’ social contexts.ConclusionsThe GPs in this study had dual perceptions of self-care, related to both the chronic health conditions and to the broader situational contexts of their patients’ lives. GPs’ assessments of self-care ability depended largely on their experiences from the doctor-patient relationship, and they emphasized that the factors affecting self-care ability were highly dynamic over the patient’s lifetime. However, these findings might be resisted by the Danish disease management programs, which tend to have a static and more narrow, health-related view of patient self-care. The Danish programs require GPs to assess self-care ability upfront at the beginning of treatment and do not consider whether a relationship with the patient is established. If GPs’ perceptions and assessments of self-care ability are not included in chronic disease management models, there is a risk that they vill be insufficiently implemented in general practice.

Factors facilitating the establishment of integrated and patient-centered community health centers in rural Germany

Introduction: A common problem in Germany is the recruitment of young general practitioners in rural areas. In principle, the physician self-government is responsible for securing outpatient care. Confronted with demographic change and preferences of a younger medical work-force, in recent years also communities and local governments get involved in the planning process. This is also reflected in recent healthcare reforms, where local planning commissions, which formerly comprised only payer and provider representatives, now also include community stakeholders. Regional Health Conferences are another political tool to adapt care needs to local structures. However, the role of local “players” is very variable and its effects are unclear.The community of Hohenstein is part of a rural governmental district in Southern Germany. Regional and local care providers are already scarce, the problem will increase in foreseeable time as 25 % of general practitioners (GPs) are 60 years and older. Therefore the county government took action.Project description: The county government in cooperation with the community health conference started the initiative “healthy community” with the goal to develop sustainable health-promoting structures in the region. Interested communities can become certified, if an analysis of health-related infrastructure and a SWOT-analysis is performed and a mission statement for the community is formulated. Hohenstein was the first community to be certified in May 2015. Along with this, a working group consisting of citizens and regional multipliers was established.Secondly, the county government along with the health conference and the mayor involved regional physicians and stakeholders from industry and business as well as the Medical Faculty of the University of Tübingen (the _Institute of General Practice and Interprofessional Care_). This cooperation initiated the development of a regional health centre Hohenstein (_GZH_) and therefore established a steering committee.Impact, Highlights: In 2015 from this derived the initiative “friends of GZH”, including local business, university and politics, who jointly provide funds for planning and setting up the infrastructure during the first two years of development. In addition, the community provides for the infrastructure, namely a new building which offers room for a primary care practice team, meeting rooms and additional healthcare providers.As a result, one regional GP has moved his practice into this building in 2015, forming a first nucleus.In order to secure primary care workforce and integrative care structures, a formal cooperation with the Institute of General Practice and Interprofessional Care was established. The healthcare centre (GZH) is the first university-based primary care practice in Baden-Württemberg. This ensures a direct contact of students and residents in training with workplaces in rural areas. At the same time it facilitates development and evaluation of care concepts by securing direct access to providers and data. The goal is to establish the practice as a “laboratory for the provision of primary care in rural areas” with respect to organizational and medical care-concepts.The commitment of the “healthy community” promotes a network of local structures active in healthcare (such as sports clubs, volunteers and tourist related activities). Existing prevention programs will be transparent for the GZH and can be used by its health coaches in the future. Also, the planning of integrated care programs will profit of the working group.Citizens, who are also sensitized by “health community”, will be involved in regular round-tables in order to assess care needs and preferences. In the framework of “Healthy Community Days” different health care providers and citizens can deliver mutual information.Stakeholder interests and political support is secured by the steering committee and the “friends of GZH”, which for instance help to push technical infrastructure like fast internet.The University will ensure continuous evaluation of patient -and provider preferences and their incorporation in concept development. Continuous contacts with international and national research and health-policy will ensure up-to-date planning of care arrangements.Conclusion: The approach to initiate local care structure with regional stakeholders of politics and business, with care providers and academia covers multiple structural problems at the same time.Especially the common interest of local employers, the community and politics in providing a sustainable regional infrastructure drives their commitment to the project. This secures support of initial funding and infrastructure. Planning and evaluation of innovative concepts is secured by the involvement of academia, which in turn cooperates with a network of experienced consultants. This enables the establishment of integrated and innovative care models rather than establishing a conglomerate of single practices without common care concepts. Models are adapted to local needs by continuous involvement of local citizens, patients and providers.

Stressed and overworked? A cross-sectional study of the working situation of urban and rural general practitioners in Austria in the framework of the QUALICOPC project.

AimTo assess the workload of general practitioners (GPs) in Austria, with a focus on identifying the differences between GPs working in urban and rural areas.MethodsWithin the framework of the Quality and Costs of Primary Care in Europe (QUALICOPC) study, data were collected from a stratified sample of GPs using a standardized questionnaire between November 2011 and May 2012. Data analysis included descriptive statistics and regression analysis.ResultsThe analysis included data from 173 GPs. GPs in rural areas reported an average of 49.3 working hours per week, plus 23.7 on-call duties per 3 months and 26.2 out-of-office care services per week. Compared to GPs working in urban areas, even in the fully adjusted regression model, rural GPs had significantly more working hours (B 7.00; P = 0.002) and on-call duties (B 18.91; P < 0.001). 65.8% of all GPs perceived their level of stress as high and 84.6% felt they were required to do unnecessary administrative work.ConclusionOur findings show a high workload among Austrian GPs, particularly those working in rural areas. Since physicians show a diminishing interest to work as GPs, there is an imperative to improve this situation.

Health services research in general practice--a Bavarian perspective

The aim of this review is to provide an overview about health services research in Bavarian primary care. The academic development of general practice and the associated health services research is described within this narrative -review. Health services research is a heterogeneous field which might be best described for primary care as "research along the last mile of the health care System". Various elements are evolving in Bavarian primary care research, like investigation of diagnostic issues, impact of psychosomatic co-morbidity on patient management and maintenance of medical services in rural areas. Strategies to analyse and interpret routine data are established in cooperation with the Bavarian Association of Statutory Health Insurance Physicians (KVB) which alleviates understanding of health care in Bavaria. The development of health services research in primary care is accompanied by the evolution of general practice as an academic discipline. Health services research should be strengthened to improve understanding and management of health care resource use. The presence of oversupply in large attractive cities combined with a shortage of physicians in rural areas is a specific challenge for health care planning in Bavaria. This is of importance for medical care of the ageing population; and needs to be addressed with reference to the shortage of general practitioners in rural areas.

General practitioner (family physician) workforce in Australia: comparing geographic data from surveys, a mailing list and medicare

BackgroundGood quality spatial data on Family Physicians or General Practitioners (GPs) are key to accurately measuring geographic access to primary health care. The validity of computed associations between health outcomes and measures of GP access such as GP density is contingent on geographical data quality. This is especially true in rural and remote areas, where GPs are often small in number and geographically dispersed. However, there has been limited effort in assessing the quality of nationally comprehensive, geographically explicit, GP datasets in Australia or elsewhere.Our objective is to assess the extent of association or agreement between different spatially explicit nationwide GP workforce datasets in Australia. This is important since disagreement would imply differential relationships with primary healthcare relevant outcomes with different datasets. We also seek to enumerate these associations across categories of rurality or remoteness.MethodWe compute correlations of GP headcounts and workload contributions between four different datasets at two different geographical scales, across varying levels of rurality and remoteness.ResultsThe datasets are in general agreement with each other at two different scales. Small numbers of absolute headcounts, with relatively larger fractions of locum GPs in rural areas cause unstable statistical estimates and divergences between datasets.ConclusionIn the Australian context, many of the available geographic GP workforce datasets may be used for evaluating valid associations with health outcomes. However, caution must be exercised in interpreting associations between GP headcounts or workloads and outcomes in rural and remote areas. The methods used in these analyses may be replicated in other locales with multiple GP or physician datasets.

Ambulatory Care Trends in Germany

Traditionally, Germany has a weak primary care system. In addition, the number of general practitioners (GPs) has declined in the past years. Main challenges are an aging population, disintegration of care, variations in care, an increase in chronic conditions, and a shortage of GPs especially in rural areas. Policy reacted by implementing financial incentives for GPs in rural areas and special GP training programs. Improvements in chronic care aim to better integrate care through Disease Management Programs, the electronic health card, and voluntary primary care schemes. The largest challenge to be addressed is the delegation of physician tasks to physician assistants.

Healthcare-seeking behavior of patients with epileptic seizure disorders attending a tertiary care hospital, Kolkata

Introduction:Neurological diseases are very important causes of prolonged morbidity and disability, leading to profound financial loss. Epilepsy is one of the most important neurological disorders Healthcare seeking by epilepsy patients is quite diverse and unique.Aims and Objectives:The study was conducted among the epilepsy patients, to assess their healthcare-seeking behavior and its determinants.Materials and Methods:Three hundred and fifteen epilepsy patients, selected by systematic random sampling, in the neuromedicine outpatient department of a tertiary care hospital were interviewed with a predesigned, pretested, semi-structured proforma.Results and Conclusion:More than 90% sought healthcare just after the onset of a seizure. The majority opted for allopathic medicine and the causes for not seeking initial care from allopaths were ignorance, faith in another system, constraint of money, and so on. A significant association existed between rural residence and low social status of the patients with initial care seeking from someone other than allopaths. No association was found among sex, type of seizure, educational status of the patients, and care seeking. The mean treatment gap was 2.98 ± 10.49 months and the chief motivators were mostly the family members. Patients for anti epileptic drugs preferred neurologists in urban areas and general practitioners in rural areas. District care model of epilepsy was proposed in the recommendation.

Studienbeihilfe in Sachsen - Eine Erfolgsgeschichte?

The lack of general practitioners in rural areas is a problem for many industrialised countries. There seems to be a promising solution among medical students. This was recognised in Saxony in 2009 and an appropriate sponsoring programme was set up. In this study we have examined the utility, the factors influencing the interest in this sponsorship and its acceptance. Answers to a written questionnaire sent to medical students in Saxony were evaluated with the help of descriptive statistics. 25 of the total of 1 055 students who received the questionnaire stated that they used the sponsorship programme. Positive influencing factors for interest were above all a higher state of knowledge, the students' background, stage of studies and type of financial support. The primary reasons for rejecting the program were, besides fear of being bound by it (74%), the wish for advanced training in a different specialty (54%) and the wish to work in a hospital (33%). By adapting the conditions of the sponsorship programme and by targetted communications, it should be possible to increase its acceptance. Thus, financial compensation for not used sponsoring could induce more advanced students to accept aid. Students from rural districts should be specifically approached since they exhibit a higher affinity for choosing to practice in rural areas. It would also be helpful to focus more on students who finance their studies themselves. In general, it can be assumed that a higher density of information would also lead to a greater interest.