Bortz Martin, Schübel Jeannine, Pochert Maik, Bergmann Antje, Voigt Karen
Bereich Allgemeinmedizin, Medizinische Fakultät Carl Gustav Carus, Dresden.
Gesundheitswesen. 2021 Feb;83(2):95-102. doi: 10.1055/a-1130-6266. Epub 2020 Apr 23.
In the context of demographic changes and the shortage of family physicians in the primary care sector in Germany, the delegability of home visits to health care assistants is discussed. There is little information on the extent of home visits delegated. The aim of this article is to examine differences in the socio-demographic and organizational profile of delegating vs. non-delegating family doctors in Saxony and to describe the level of qualification of health care assistants.
This cross-sectional study is part of a series of epidemiological studies in the federal state of Saxony, Germany. All family doctors in Saxony were contacted in 2014 (n=2677), of whom 11,2% participated. In a period of 12 months, family practices documented home visits within a randomly assigned week. Socio-demographic characteristics of the family practice and the level of qualification of health care assistants were surveyed.
A total of 274 family practices participated; 52,9% of all participating family doctors declared their willingness to delegate home visits, but only 8,5% of home visits were made by health care assistants. There were non-significant trends between the willingness to delegate and self-employment vs. being employed (92,4 vs. 84,6%, p=0,06), establishment in a single vs. shared practice (35,2 vs. 31,4%, p=0,09) and higher patient numbers per 3 months (x̄+= 1183,08 vs. 1092,16, p=0,07). The 224 health care assistants that participated in the study were mostly trained in nursing (39,7%) or as medical assistants (50,8%). The vast majority of the health care assistants (82,5%) had no further training or additional qualification; 19,6% completed further training that qualified them to have home visits formally delegated to them.
Among family doctors in Saxony there is a reported high willingness to delegate, which is not implemented sufficiently in practice. Delegation is based on personal confidence in health care assistants without formal qualification. Qualified delegation ensures high standards in patient care and this potential is not used in Saxony, particularly in rural areas with imminent shortages of medical care. More education about the opportunities of qualified delegation seems necessary.
在德国人口结构变化以及基层医疗领域家庭医生短缺的背景下，家庭访视工作委托给医护助理的可行性正在被讨论。关于委托家庭访视的范围，目前几乎没有相关信息。本文旨在研究德国萨克森州委托家庭访视与不委托家庭访视的家庭医生在社会人口统计学和组织概况方面的差异，并描述医护助理的资质水平。
这项横断面研究是德国萨克森州一系列流行病学研究的一部分。2014年联系了萨克森州的所有家庭医生（n = 2677），其中11.2%参与了研究。在12个月的时间里，家庭诊所记录了随机分配周内的家庭访视情况。调查了家庭诊所的社会人口统计学特征以及医护助理的资质水平。
共有274个家庭诊所参与；所有参与研究的家庭医生中有52.9%表示愿意委托家庭访视，但只有8.5%的家庭访视是由医护助理进行的。在委托意愿与个体经营或受雇之间（92.4%对84.6%，p = 0.06）、单诊所或联合诊所的设立情况（35.2%对31.4%，p = 0.09）以及每3个月更高的患者数量（x̄ += 1183.08对1092.16，p = 0.07）之间存在不显著的趋势。参与研究的224名医护助理大多接受过护理培训（39.7%）或医学助理培训（50.8%）。绝大多数医护助理（82.5%）没有接受过进一步培训或获得额外资质；19.6%完成了进一步培训，使他们有资格正式接受家庭访视委托。
据报道，萨克森州的家庭医生中有很高的委托意愿，但在实践中并未得到充分落实。委托是基于对没有正式资质的医护助理的个人信任。合格的委托能确保患者护理达到高标准，而在萨克森州，尤其是在医疗护理即将短缺的农村地区，这种潜力并未得到利用。似乎有必要开展更多关于合格委托机会的教育。
