Regional Variation in the Primary Medical Care of Northern Germany

Study Overview
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Brief Summary
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The study explores the variation in the patient populations and describes regional differences regarding the reasons for consultations in the primary medical care in Germany. The data collection will be stratified by rural and urban areas as well as environs. The data set will include a large variety of data about physicians, patients and health care utilization.

Detailed Description
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Inappropriate supply and the increasing demand on the health care system have been of concern for health policy in Germany for the last 15 years. Concerning primary care, this especially relates to an undersupply of rural GPs (general practitioners). But there also seem to be other relevant regional differences, e.g. a lower number of house calls in larger cities, a greater number of psychiatric (co-)morbidities in the cities, a greater spectrum of services offered by rural doctors, and a difference in accessing primary and secondary care between the rural and the urban areas. Despite these results, differences between rural and urban areas have not been studied extensively in Germany. Therefore this study aims to explore regional variation of patient populations and their reasons for accessing primary care. The study is based on standardized interviews with 240 GPs and approximately 1.200 patients in Northern Germany. Questionnaires are based on a preliminary qualitative study and were pretested. The GP's questionnaire comprises characteristics of the GP and the practice, patient types, reasons for consultation and services offered. The patient's questionnaire includes sociodemographic data and past medical history, quality of life, access to the GP, specialists and hospitals, perceived social support, health behaviour and the reasons for their consultations. Data will be analysed by descriptive statistics and different regression modelling strategies adjusted for possible confounders and the GP-induced cluster structure.

Official Title
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Regional Variation of Patient Population and Reasons for Consultation in the Primary Medical Care of Northern Germany

Conditions
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Any Condition Treated in Primary Care

Intervention / Treatment
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* Other: Primary medical care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: having consulted the practice within the last 3 months and being patient of the practice since at least 36 months (i.e. at least one consultation before 36 or more months) Exclusion Criteria: no capacity to consent (e.g. because of dementia) insufficient German language skills to conduct interview not able to participate in the interviews (e.g. because of deafness or major depression)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Primary medical care in rural areas<br>People living in districts, where less than 50% of the population live in cities with more than 20,000 residents and the population density outside of the cities is below 100 people per km². Excluding people living in cities with a population of at least 100,000 residents. | Other: Primary medical care<br>* All study participants receive primary care as usual in the respective region<br>|
| Primary medical care in region environs<br>People living in districts, where 50% or more of the population live in cities with more than 20,000 residents and/or population density outside of the cities is above 100 people per km². Excluding people living in cities with a population of at least 100,000 residents. | Other: Primary medical care<br>* All study participants receive primary care as usual in the respective region<br>|
| Primary medical care in in urban areas<br>People living in cities with a population of at least 100,000 residents. | Other: Primary medical care<br>* All study participants receive primary care as usual in the respective region<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Reasons for consultation and utilized services in the GP practice | Short form of the German version of the International Classification of Primary Care (ICPC) with 38 different services (e.g. vaccinations, patient education or referrals) and 100 consultation reasons (e.g. disorders of the upper gastrointestinal tract) in 17 subject areas (e.g. digestive system). | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient population in the GP practice | List of 27 patient types regarding their health care utilization behaviour | 3 months | 
| Health care utilization | Frequency of accessing GPs, specialists, general hospitals and rehab hospitals | 3 months |