Klingenberg Anja, Broge Björn, Herholz Harald, Szecsenyi Joachim, Ose Dominik
Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen (AQUA-Institut) Göttingen, Göttingen, Germany.
Med Klin (Munich). 2010 Feb;105(2):89-95. doi: 10.1007/s00063-010-1012-8. Epub 2010 Feb 20.
In 2004, German statutory health care funds were given the possibility to offer their insured a special general practitioner-( GP-)centered health care contract (HZV), since 2007 they are obliged to do so. The aim of these contracts is to strengthen the role of the GP as a coordinator in the health care system. Until now, the evidence regarding the GPs' view on these contracts is poor. A written survey was conducted in Hesse in order to learn how the participating GPs evaluate the regional HZV.
In Apri 2008, a questionnaire was developed, tested and mailed to 2,815 GPs who were participating in the GP-centered health care contract at that time. All analyses where conducted with SPSS (version 15.0).
A total of 686 questionnaires were returned (response rate 24.4%). Altogether, the GPs' feedback ranged from great approval to clear disapproval of the contract. However, 70.0% of the survey's participants evaluated the HZV in general to be positive, 60.1% felt it strengthens their role as a GP. Quality circles on good prescribing and GP-specific education, obligatory parts of the HZV, were evaluated to be especially positive (70.3% and 69.4%, respectively). Positive effects were also seen concerning coordination of care (53.3%) and cooperation with patients (36.3%). Improvements concerning cooperation with specialists and hospitals were reported less often (24.9% and 13.0%, respectively). Workload because of additional administration for the HZV was criticized.
In future, special GP-centered health care contracts should focus on improvement of cooperation between GPs and other caregivers. Workload for additional administration should be reduced.
2004年,德国法定医疗保健基金开始有机会为其参保人提供一种以全科医生(GP)为中心的特殊医疗保健合同(HZV),自2007年起则必须提供。这些合同的目的是加强全科医生在医疗保健系统中作为协调者的作用。到目前为止,关于全科医生对这些合同看法的证据还很匮乏。在黑森州进行了一项书面调查,以了解参与调查的全科医生对地区性HZV的评价。
2008年4月,设计了一份问卷,进行测试后邮寄给当时参与以全科医生为中心的医疗保健合同的2815名全科医生。所有分析均使用SPSS(版本15.0)进行。
共收回686份问卷(回复率24.4%)。总体而言,全科医生的反馈从对合同的高度认可到明确反对不等。然而,70.0%的调查参与者总体上对HZV给予了积极评价,60.1%的人认为它加强了他们作为全科医生的作用。HZV的强制性部分,即关于合理用药和针对全科医生的特定教育的质量圈,得到了特别积极的评价(分别为70.3%和69.4%)。在医疗协调(53.3%)和与患者合作(36.3%)方面也看到了积极效果。关于与专科医生和医院合作的改善情况的报告较少(分别为24.9%和13.0%)。因HZV额外行政工作导致的工作量受到了批评。
未来,以全科医生为中心的特殊医疗保健合同应注重改善全科医生与其他医护人员之间的合作。应减少额外行政工作的工作量。