Effectiveness of a delegated primary care model in rural areas: design and methodology of a longitudinal observational study
Abstract Background The shortage of general practitioners (GPs) in Germany, particularly in rural areas, is a pressing issue that requires innovative and sustainable solutions. One promising approach is the integration of trained medical assistants to support GPs by handling specific tasks, thus enh...
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2025-04-01
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| Online Access: | https://doi.org/10.1186/s12913-025-12742-5 |
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| author | Julia Bräuer Romina Lörzing Eckhard Nagel Martin Emmert Reiner Hofmann |
| author_facet | Julia Bräuer Romina Lörzing Eckhard Nagel Martin Emmert Reiner Hofmann |
| author_sort | Julia Bräuer |
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| description | Abstract Background The shortage of general practitioners (GPs) in Germany, particularly in rural areas, is a pressing issue that requires innovative and sustainable solutions. One promising approach is the integration of trained medical assistants to support GPs by handling specific tasks, thus enhancing the efficiency of healthcare delivery. Delegated home visits can be carried out by healthcare professionals (HPs) with a well-defined range of tasks. Methods This quasi-experimental, non-randomised longitudinal observational study runs from January 2023 to June 2025. The study participants are patients cared for by participating GPs, selected based on defined inclusion criteria, who receive regularly delegated home visits. Health-related quality of life (HRQoL) and satisfaction is assessed at three data collection points (t0 as baseline before starting the intervention, t1 after the first testing and data collection phase, and t2 after the second data collection phase). For assessing the HRQoL, we use the Short-Form-Health Survey (SF-12), and satisfaction is being measured using the patient satisfaction questionnaire ZUF-8. These parameters, as well as the continuously collected parameters (kilometers driven, travel and setup time), are analysed statistically (descriptive statistics, paired t test, Wilcoxon test, ANOVA). At t1 and t2, focus group interviews are conducted with the assistants on their satisfaction. They allow to identify the potential for concept improvement by qualitative content analysis. Discussion The “VERSORGT am ORT” (VaO, engl. “PROVIDED on SITE”) project aims to optimise healthcare by using scarce resources in a more efficient way, maintaining patient-professional trust, and extending delegation. It seeks to implement care plans with minimal location changes and generate real-world evidence. Due to geographical and policy limitations, the study will have comparatively few participants and will use a repeated measures design instead of a control group to assess patient HRQoL and satisfaction over time. Changes in HRQoL cannot be directly linked to the new care model due to unclear causalities. Mergenthal et al. reported that 59% of GPs in rural areas delegate home visits to healthcare professionals, saving time. The VaO project aims to further relieve GPs, increasing efficiency without compromising care quality. Trial registration DRKS00033915 – Registration Date 19/03/2024. |
| format | Article |
| id | doaj-art-172a4e8d25fb42b8bc7f5c5bc3eb819b |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
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| series | BMC Health Services Research |
| spelling | doaj-art-172a4e8d25fb42b8bc7f5c5bc3eb819b2025-08-20T03:46:08ZengBMCBMC Health Services Research1472-69632025-04-012511810.1186/s12913-025-12742-5Effectiveness of a delegated primary care model in rural areas: design and methodology of a longitudinal observational studyJulia Bräuer0Romina Lörzing1Eckhard Nagel2Martin Emmert3Reiner Hofmann4Institute for Management in Medicine and Health Sciences, Project Office of the Medical Campus Upper Franconia, University of BayreuthInstitute for Management in Medicine and Health Sciences, Project Office of the Medical Campus Upper Franconia, University of BayreuthInstitute for Management in Medicine and Health Sciences, University of BayreuthHealthcare Management and Health Services Research, University of BayreuthInstitute for Management in Medicine and Health Sciences, Project Office of the Medical Campus Upper Franconia, University of BayreuthAbstract Background The shortage of general practitioners (GPs) in Germany, particularly in rural areas, is a pressing issue that requires innovative and sustainable solutions. One promising approach is the integration of trained medical assistants to support GPs by handling specific tasks, thus enhancing the efficiency of healthcare delivery. Delegated home visits can be carried out by healthcare professionals (HPs) with a well-defined range of tasks. Methods This quasi-experimental, non-randomised longitudinal observational study runs from January 2023 to June 2025. The study participants are patients cared for by participating GPs, selected based on defined inclusion criteria, who receive regularly delegated home visits. Health-related quality of life (HRQoL) and satisfaction is assessed at three data collection points (t0 as baseline before starting the intervention, t1 after the first testing and data collection phase, and t2 after the second data collection phase). For assessing the HRQoL, we use the Short-Form-Health Survey (SF-12), and satisfaction is being measured using the patient satisfaction questionnaire ZUF-8. These parameters, as well as the continuously collected parameters (kilometers driven, travel and setup time), are analysed statistically (descriptive statistics, paired t test, Wilcoxon test, ANOVA). At t1 and t2, focus group interviews are conducted with the assistants on their satisfaction. They allow to identify the potential for concept improvement by qualitative content analysis. Discussion The “VERSORGT am ORT” (VaO, engl. “PROVIDED on SITE”) project aims to optimise healthcare by using scarce resources in a more efficient way, maintaining patient-professional trust, and extending delegation. It seeks to implement care plans with minimal location changes and generate real-world evidence. Due to geographical and policy limitations, the study will have comparatively few participants and will use a repeated measures design instead of a control group to assess patient HRQoL and satisfaction over time. Changes in HRQoL cannot be directly linked to the new care model due to unclear causalities. Mergenthal et al. reported that 59% of GPs in rural areas delegate home visits to healthcare professionals, saving time. The VaO project aims to further relieve GPs, increasing efficiency without compromising care quality. Trial registration DRKS00033915 – Registration Date 19/03/2024.https://doi.org/10.1186/s12913-025-12742-5DelegationEffectivenessGeneral practitionersHealthcare professionalsHome visitsPrimary care |
| spellingShingle | Julia Bräuer Romina Lörzing Eckhard Nagel Martin Emmert Reiner Hofmann Effectiveness of a delegated primary care model in rural areas: design and methodology of a longitudinal observational study BMC Health Services Research Delegation Effectiveness General practitioners Healthcare professionals Home visits Primary care |
| title | Effectiveness of a delegated primary care model in rural areas: design and methodology of a longitudinal observational study |
| title_full | Effectiveness of a delegated primary care model in rural areas: design and methodology of a longitudinal observational study |
| title_fullStr | Effectiveness of a delegated primary care model in rural areas: design and methodology of a longitudinal observational study |
| title_full_unstemmed | Effectiveness of a delegated primary care model in rural areas: design and methodology of a longitudinal observational study |
| title_short | Effectiveness of a delegated primary care model in rural areas: design and methodology of a longitudinal observational study |
| title_sort | effectiveness of a delegated primary care model in rural areas design and methodology of a longitudinal observational study |
| topic | Delegation Effectiveness General practitioners Healthcare professionals Home visits Primary care |
| url | https://doi.org/10.1186/s12913-025-12742-5 |
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