将全科医生家庭访视任务委托给合格的执业助理：对一个门诊医疗中心的经济效果评估。
Delegation of GP-home visits to qualified practice assistants: assessment of economic effects in an ambulatory healthcare centre.
机构信息
Institute for Community Medicine, University of Greifswald, 17487 Greifswald, Germany.
出版信息
BMC Health Serv Res. 2010 Jun 8;10:155. doi: 10.1186/1472-6963-10-155.
BACKGROUND
Against the background of a decreasing number of general practitioners (GPs) in rural regions in Germany, the AGnES-concept (AGnES = GP-supporting, community-based, e-health-assisted, systemic intervention) supports the delegation of regular GP-home visits to qualified practice assistants. The concept was implemented and evaluated in different model projects in Germany. To explore the economic effects of this concept, the development of the number of home visits in an ambulatory healthcare centre was analysed and compared with the number of home visits in the surrounding county.
METHODS
Information about GP-home visits was derived from reimbursement data of the ambulatory healthcare centre and a statutory health insurance. Information about home visits conducted by AGnES-practice assistants was collected from the project documentation over a time period of 12 consecutive quarter years, four quarter years before the beginning of the project and 8 quarter years while the project was implemented, considering background temporal trends on the population level in the study region.
RESULTS
Within the ambulatory healthcare centre, the home visits by the GPs significantly decreased, especially the number of medically urgent home visits. However, the overall rate of home visits (conducted by the GPs and the AGnES-practice assistants together) did not change significantly after implementation of the AGnES-concept. In the surrounding county, the home visit rates of the GPs were continuous; the temporal patterns were approximately equal for both usual and urgent home visits.
CONCLUSION
The results of the analyses show that the support by AGnES-practice assistants led to a decrease of GP-home visits rather than an induction of additional home visits by the AGnES-practice assistants. The most extended effect is related to the medically urgent home visits rather than to the usual home visits.
背景
在德国农村地区全科医生（GP）数量减少的背景下，AGnES 概念（AGnES = 支持全科医生、基于社区、电子健康辅助、系统干预）支持将常规 GP 家访委托给合格的执业助理。该概念已在德国的不同示范项目中实施和评估。为了探索该概念的经济效应，分析了一个门诊医疗中心的家访数量的发展，并将其与周边县的家访数量进行了比较。
方法
门诊医疗中心和法定健康保险的报销数据中获取 GP 家访的信息。AGnES 执业助理进行的家访信息从项目文件中收集，时间跨度为连续 12 个季度，项目开始前 4 个季度和项目实施期间的 8 个季度，同时考虑研究区域人口水平的背景时间趋势。
结果
在门诊医疗中心，GP 的家访明显减少，特别是医疗紧急家访的数量。然而，在实施 AGnES 概念后，GP 家访的总体率（由 GP 和 AGnES 执业助理共同进行）并没有显著变化。在周边县，GP 的家访率连续；通常和紧急家访的时间模式大致相同。
结论
分析结果表明，AGnES 执业助理的支持导致 GP 家访减少，而不是诱导 AGnES 执业助理进行额外的家访。最广泛的影响与医疗紧急家访有关，而不是与常规家访有关。
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