Schmidt Felicitas Maria, Wildner Manfred
Medizinische Fakultät, Ludwig-Maximilians-Universität München.
Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, LGL, Oberschleißheim.
Gesundheitswesen. 2019 Jul;81(7):e133-e140. doi: 10.1055/a-0725-8193. Epub 2018 Oct 24.
In response to the increased use of emergency rooms, the increasing cost pressure on hospitals and the growing difficulty of filling emergency services in structurally weaker areas, the introduction of central practices (Portalpraxen) has been decided at federal level. Several Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen (KVen)) have already started to transform the medical on-call service before this legislative change and are now at different stages of the reform process. At many hospitals there are already so-called standby duty clinics (BDP). For the assessment of the current reform status as the basis for the Hospital Structure Act and the Nursing Reform Act, the present study aims to provide an overview of the organizational forms of the on-call medical service in the respective districts of the Associations of Statutory Health Insurance Physicians.
All 17 KV districts were contacted by telephone and/or in writing in order to conduct a semi-structured interview along 3 dimensions: the general organizational structure, the personnel (above all physicians) and the supply mandate. KV Brandenburg, KV Hamburg and KV Nordrhein (subsidiary Gesundheitsmanagementgesellschaft mbH) completed the questionnaire.
In the districts of Hesse, Schleswig-Holstein, Thuringia and Westphalia-Lippe, at the time of the 2017 survey, the out-of-hour service was exclusively organised in emergency service practices. Baden-Wuerttemberg, Lower Saxony, North Rhine, Rhineland-Palatinate and Saarland have extensively introduced emergency service practices. However, the traditional service remains present in some regions. There are huge organisational differences between metropolitan and rural areas reflecting various challenges: Bavaria, Brandenburg and Mecklenburg-Western Pomerania only established emergency service practices in major cities due to economic considerations.
Emergency service practices provide a way to address the challenges of physician shortage and patient control. With their flexibility regarding the organization, they are adaptable to regional differences and are already playing a major role in assuring out-of-hour medical service in Germany.
为应对急诊室使用量增加、医院成本压力不断加大以及结构薄弱地区急诊服务人员配备难度日益增大的情况，联邦层面已决定引入集中诊疗模式（Portalpraxen）。在这项立法变革之前，一些法定医疗保险医师协会（Kassenärztliche Vereinigungen (KVen)）就已开始对医疗值班服务进行改革，目前处于改革进程的不同阶段。许多医院已经设有所谓的待命值班诊所（BDP）。为评估当前作为《医院结构法》和《护理改革法》基础的改革现状，本研究旨在概述法定医疗保险医师协会各地区值班医疗服务的组织形式。
通过电话和/或书面形式联系了所有17个KV地区，以便沿着三个维度进行半结构化访谈：总体组织结构、人员（主要是医生）和服务任务。勃兰登堡KV、汉堡KV和北莱茵KV（下属健康管理公司mbH）完成了问卷。
在黑森州、石勒苏益格 - 荷尔斯泰因州、图林根州和威斯特法伦 - 利珀地区，在2017年调查时，非工作时间服务仅在急诊服务诊所组织。巴登 - 符腾堡州、下萨克森州、北莱茵州、莱茵兰 - 普法尔茨州和萨尔兰州已广泛引入急诊服务诊所。然而，传统服务在一些地区仍然存在。大城市和农村地区存在巨大的组织差异，反映出各种挑战：由于经济考虑，巴伐利亚州、勃兰登堡州和梅克伦堡 - 前波美拉尼亚州仅在主要城市设立了急诊服务诊所。
急诊服务诊所为应对医生短缺和患者管理挑战提供了一种方式。它们在组织方面具有灵活性，能够适应地区差异，并且已经在德国非工作时间医疗服务保障中发挥着重要作用。
