GPs In Rural Areas Research Articles

Tackling the reasons for GP shortage: The workload of GPs in rural and urban areas in Austria. A cross-sectional study within the framework of QUALICOPC

Background: In the near future Austria like many other European countries will face a shortage of GPs, especially in rural regions. The interest of young doctors to work in this profession is decreasing steadily. According to the literature, working in rural areas is often associated with a higher number of working hours and a higher number of patients, especially in singlehanded practices. It was the aim of this analysis to assess the workload of rural and urban GPs in Austria and to illustrate the infrastructure for their profession. Additionally, factors influencing the workload were analyzed and compared. Methods: The data collection took place between October 2011 and May 2012 within the context of the European QUALICOPC-study by using a standardized GP questionnaire with 60 questions. Via email and personal contacts, a stratified sample of 3.050 general practitioners was invited to participate in the study. Statistical analyses included descriptive statistics and tests as well as correlations. Results: Data from 174 out of 184 returned GP questionnaires could be used. Their analysis shows that GPs in rural areas spent (excluding additional jobs) 5.1 hours per week more on direct patient care (33.6 h vs. 38.7 h; p = 0.010), 3.1 hours more on administrative issues (7.6 h vs. 10.7 h; p = 0.026), and had more than twice as much on-call duties (10.2 vs. 22.7; p < 0.001) within three months than their colleagues from urban areas. The average consultation length is similar in both groups with approx. 9 min per patient as well as the high self-rated workload-feeling. The number of patients, of home visits and of patient contacts is directly proportional to the weekly working hours. 91.7% of the urban and 87.6% of the rural offices were single-handed. Discussion: There is a significant difference between the workload of Austrian GPs in rural and in urban areas. In order to raise the attractiveness of primary care practice in rural areas and the interest of young doctors to work there, substantial changes in both working conditions and organizational structure for primary care services appear to be necessary; possibilities include shared duties in group practices consisting of primary health care teams, incentives, and adequate under- and postgraduate education and training. Key messages: There is a significant and alarming difference between the workload of Austrian GPs in rural and in urban areas. Substantial changes in both working conditions and organizational structure for primary care services appear to be necessary in Austria.

Retention of general practitioners in rural Nepal: A qualitative study

To explore the key issues that influence GP retention in rural areas of Nepal. A qualitative study using triangulation of data from one postal questionnaire, one hand-delivered questionnaire with semistructured interview and focus group discussions. Data from a small community survey from 13 rural districts also included. Sixty-two Nepali GPs, 25 doctors in General Practice training programs, 11 individuals involved in policy development and rural health care. The key issues identified by this study as critical to the retention of Nepali GPs in rural areas were: * Career/promotion prospects * Status/recognition * Financial incentives * Working conditions * Education for children * Continuing medical education * Political stability and security. The strongest theme was that of career development. This must be addressed by the Government of Nepal if there is to be any hope of improving retention of GPs in rural areas. GPs need to have a clear career ladder, with recognition of the value of service in rural areas. There is, however, no one single answer to the complex interacting factors that impact on GP retention in rural Nepal. A multifaceted, holistic response is necessary. From the level of community awareness, a career structure and financial remuneration to adequately set up hospitals, functional teams, family support, continuing professional development and a secure working environment - each area must be addressed for the whole to function.

Health needs in rural areas and the efficacy and cost‐effectiveness of doctors and nurses

Because of a lack of GPs in rural areas of Greece it is mandatory for junior doctors to offer medical service in those areas for a year. The aim of this study is to determine the possibility of replacement of internships with nurses and to suggest the most cost-effective way of covering health needs in remote areas. Regional survey. Patients of primary care offices in two remote areas of Crete, Greece within a year. Comparative analysis of the level of preventive medicine (estimated by questionnaires) and health needs in the two areas. The reasons for visiting medical offices, references rates, percentages of glucose and blood pressure regulation are also studied. Prescription of drugs for chronic diseases and blood pressure counting were the main reasons for office visits (2868/4594). Respiratory track infections (364/4594) follow. Apart from the high percentages of uncontrolled patients with blood pressure (34%) and diabetes mellitus (14%) there is a high percentage of ignorance or wrong opinions concerning preventive medicine, for example only 63% knew the value of a pap test. More than two-thirds of "medical" visits in rural areas were for acts that nurses could easily do. The easy access to a junior doctor did not promote preventive medicine. Replacement of junior doctors with properly trained nurses cooperating with GPs responsible for greater regions would be more cost-effective than junior doctors improving health in rural areas. Legislation should change, mainly with regard to repeat prescriptions, in order to reduce house visits.

Unity or diversity? Recent developments in the organization of out of hours general medical services in Scotland

The objective of this paper is to describe variations in the different models of out of hours general medical services and identify explanations for variation and the possible influence on patient satisfaction and service costs. A cross-sectional survey of all models of out of hours care was undertaken, including co-operatives, deputizing services, practice rotas and rural general practitioners doing their own cover. Fifteen sites were chosen representing 10 models of care, for more detailed case study; 65 semistructured interviews with key informants were conducted within the case study sites. A postal patient satisfaction questionnaire and an economic analysis were also carried out. Out of hours organizations have developed in response to a complex mix of the population served, geography, resources available and political expediency, leading to considerable structural heterogeneity, even within co-operatives. There was little evidence of formal integration with other services. Only the largest co-operatives showed any evidence of utilizing guidelines/protocols or of providing formal staff training. There were clear differences in the structure of out of hours care in urban and rural areas. Increasing the use of centralized call handling and triage will not address the needs of rural GPs, who would still be required to be available for work. Neither patient satisfaction nor costs varied by model of service provision. The English out of hours review has outlined an integrated model of service provision with consistent standards within an accountability framework. It would appear that only the largest organizations will be in a position to address these standards and that they are likely to be inappropriate to the needs of GPs in rural areas.

Unity or diversity? Recent developments in the organization of out of hours general medical services in Scotland

The objective of this paper is to describe variations in the different models of out of hours general medical services and identify explanations for variation and the possible influence on patient satisfaction and service costs. A cross-sectional survey of all models of out of hours care was undertaken, including co-operatives, deputizing services, practice rotas and rural general practitioners doing their own cover. Fifteen sites were chosen representing 10 models of care, for more detailed case study; 65 semistructured interviews with key informants were conducted within the case study sites. A postal patient satisfaction questionnaire and an economic analysis were also carried out. Out of hours organizations have developed in response to a complex mix of the population served, geography, resources available and political expediency, leading to considerable structural heterogeneity, even within co-operatives. There was little evidence of formal integration with other services. Only the largest co-operatives showed any evidence of utilizing guidelines/protocols or of providing formal staff training. There were clear differences in the structure of out of hours care in urban and rural areas. Increasing the use of centralized call handling and triage will not address the needs of rural GPs, who would still be required to be available for work. Neither patient satisfaction nor costs varied bymodel of service provision. The English out of hours reviewhas outlined an integrated model of service provision with consistent standards within an accountability framework. It would appear that only the largest organizations will be in a position to address these standards and that they are likely to be inappropriate to the needs of GPs in rural areas.

Out-of-hours service in rural areas: An observational study of accessibility, attitudes and quality standards among general practitioners in Iceland

Objectives - To examine the access, workload, duties, commitments and quality standards of primary care physicians (GPs) resulting from out-of-hours service. Setting - All GPs (n=96) in rural Iceland. Main outcome measures - Answers to a postal survey. Results - The participation rate was 80%. The GPs estimated that in 97% of the cases they could be contacted within 5 minutes in an emergency. Under usual circumstances (weather conditions) and within a distance of 10 km, 70% of them could reach the patient within 30 minutes of receiving the call. In severe weather conditions, 50% of the GPs in smaller districts (650-6000 inhabitants) estimated that it could take up to 5 hours or more to reach the patient (which could happen once a year). In the least populated districts, 84% of the GPs had to be on call 14 days or more per month. Serious emergencies (involving special training such as cardiac resuscitation or tracheal intubation) were relatively rare, and GPs expressed the necessity for regular refresher courses in such fields. Conclusions - Modern telecommunication networks guarantee good access to out-of-hours service. The workload and on-call duties are great and do not comply with European Union (EU) recommendations regarding minimal rest time. If GPs in rural areas are to be expected to provide frontline health care, including in severe emergency situations, regular training courses are needed.