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Abstract
Since 2008, a partly generalized payment is applied to the outpatient sector in Germany. Therefore, it is difficult to quantify the exact amount of consultations linked to a paid case (“Abrechnungsfall”). This is due to the fact, that not every single service is paid and documented with date. The result is a lack of information on how the workload of the doctor’s offices is. How new developments, like the 2024 introduced electronic prescription or sick certificates by phone, influence the number of consultations is unclear. For this reason, this piloting study tested, whether this information can be gathered through an on-set data acquisition and how many consultations of doctor’s offices are provided for which reasons.
11 practices in the administrive region of Mittelhessen participated in this study. They shall represent the spectrum of main specializations, location (urban/rural), kind of practice and opening times of the outpatient offices in Germany. All prospective contacts within a working week (5 days) in the middle of the quarter (week 3-10) between 03/20-03/21 were documented. Based on the defined groups of the demand planning guidelines by the “Gemeinsamer Bundesausschuss” the following groups were included: general practitioners (4), general specialized care (6; dermatology, gynecology, neurology, orthopedics/trauma surgeons, pediatrics, urology), and specialized specialized care (1; cardiology). For every consultation, the reason of consult (acute complaint; control of an acute complaint; other control visit/monitoring of a chronic disease in a disease management program or other chronical illnesses, resulting in regular appointments; other reasons, not included in mentioned reasons), the kind of contact (with physician, without physician, only for prescription, sick certificate, others) the sex and the age group of the patient were documented. Furthermore, the offices added information from their routine data, such as number of contacts in the observed and past quarter. After the observed week, the offices transferred information on how many paid cases in the quarter were charged. This enables the calculation of number of contacts linked to one paid case. The collected data was descriptively and inference statistically analyzed with Excel® and SPSS® (version 27), wherefore Chi2-Tests were performed probatorically.
All required data could be collected. Overall, the piloting study documented 3266 office contacts (57% by women, 43% by men) in the particular observed weeks. Referring to individual contact numbers, there was no significant difference between the sexes. On average of the offices, 12% of contacts occurred by minors, 49% by the age group of 18-59, 28% by 60–79-year-olds and 11% by over 79-year-olds. The reasons distributed on acute reasons with 25%, control of an acute reason 15%, other routine controls with 31% and others with 25%. In the mean, 62% of contacts were with a physician, 19% only for a prescription 7% only with non-physician staff (for example for blood drawing, urine control), 2% only for a sick certificate and 10% for other reasons (for example collecting testing results, home visits, consultations through telephone). There were partially explicit differences between different office groups: for instance, 33% of contacts to general care offices were only for a prescription, in comparison to 11% of contacts with specialized care. The number of contacts in the middle of the quarter has been 2,2 (general 2,9; specialized 1,8). On average, patients had 2,0 contacts (general 3,6; specialized 1,1) in the past quarter (including those, who did not have a contact). In projection of a year, this would conclude in 16,9 contacts on average. In the mean, one paid case is linked to 2,3 contacts (general 3,3; specialized 1,7).
This study is delivering hints on the quantity of preventable contacts, for example that 43% of generalized care contacts of patients over 60 are only for a prescription and 40% of the contacts to specialized care are for routine control appointments, where there is low evidence for the frequency. As a piloting study, these results can only be interpreted for generating hypotheses. Because of the little sample size, the statistical value is limited. The demographics of Mittelhessen is comparable to the one Germany itself regarding the age and sex distribution. The portion of office contacts with an actual physician contact differs considerably from other studies. Probable reasons could be the different methods and their bias possibilities and the influence of the covid-19 pandemic. The calculated ratio of contacts to paid cases and the yearly number of contacts lies in between the Arztreport 2008 (2,5 contacts per paid case; 17,7 contacts per year [data of 2007]) and the Arztreport 2022 (1,8 contacts per case; 15,1 days with deducted services [data of 2020]). Therefore, the assessment of this study seems to be appropriate. Key indicators referring to frequency of contacts and kind of contact are the age and the practice group, especially if generalized or specialized. There are first indications of the influence of the location of the practice, which need further research. The kind of contacts, especially “only for prescription”, which cause 19% (33% with generalized care) of the contacts, show the potential of reducing the demand of office services, for example through the 2024 introduced electronic prescription.
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Dates
Created: 2025Issued: 2025-03-13Updated: 2025-03-13
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
Utilization of outpatient health careInanspruchname ambulanter Versorgung
DFG-subjects
Medizinische VersorgungHäufigkeitArztpraxisInanspruchnahme
DDC-Numbers
610
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Pham, Hung Son Christian: Häufigkeit und Gründe ambulanter Arztkontakte - Eine Pilotstudie. : Philipps-Universität Marburg 2025-03-13. DOI: https://doi.org/10.17192/z2025.0149.
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This item has been published with the following license: In Copyright