Gisbert Miralles Jana, Heintze Christoph, Dini Lorena
Institut für Allgemeinmedizin, Charité, Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Deutschland.
Institut für Allgemeinmedizin, Charité, Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2020 Nov;156-157:50-58. doi: 10.1016/j.zefq.2020.07.010. Epub 2020 Sep 17.
The delegation of traditional GP tasks to qualified medical assistants (MFA) includes several modalities based on extended qualification curricula known as "Nicht-ärztliche Praxisassistentin" (NäPa) [non-physician practice assistant], also known as the "Entlastende Versorgungsassistentin" (EVA) and the "Versorgungsassistentin in der Hausarztpraxis" (VERAH and VERAH Plus) [professional healthcare assistants in the family practice]. Delegation to MFA has gained importance in recent years due to an increasing workload of general practitioners in Germany.
This article examines the characteristics of general practitioners (GPs) currently delegating activities to MFAs with and without extended qualification based on the three mentioned modalities (EVA, VERAH and VERAH Plus). In addition, we explore whether the delegated activities are delivered in the office, at the patient's home or in the nursing home and how GPs perceived the potential of future delegation.
Between April and August 2016, we conducted an anonymous postal survey of a representative randomized sample of general practitioners in North Rhine-Westphalia (n = 2,404). The questionnaire contained questions about practice staff, setting for delivery of the delegated activity as well as the perceived added values of and barriers to delegation. We compare characteristics of GPs delegating to MFA with extended qualification to those delegating to standard qualified MFA.
The response rate was 32 % (n = 762). Almost one third of the respondents (n = 239) delegated tasks to MFAs with extended qualification. These GPs are more likely to be younger and male and less likely to be working alone in individual practice. They delegate more activities to be delivered in all settings than GPs employing MFAs without extended qualification.
GPs benefit from delegating to MFA with extended qualification as shown by the associated added values and setting of deployment for delivery of tasks. Delegation to non-medical staff should be considered by more GPs as a means of supporting healthcare delivery. In addition to legal changes, further procedures are needed to encourage GPs to get more actively involved with the issue of delegation and consider to further develop the competence of their staff and deploy them accordingly.
将传统全科医生的任务委托给合格的医疗助理（MFA）有多种模式，这些模式基于被称为“非医师实践助理”（NäPa）的扩展资格课程，也被称为“减负护理助理”（EVA）以及“家庭医生诊所护理助理”（VERAH和VERAH Plus）[家庭医疗中的专业护理助理]。近年来，由于德国全科医生工作量不断增加，将任务委托给医疗助理变得愈发重要。
本文基于上述三种模式（EVA、VERAH和VERAH Plus），研究目前将活动委托给具有和不具有扩展资格的医疗助理的全科医生（GP）的特征。此外，我们探讨委托的活动是在诊所、患者家中还是养老院进行，以及全科医生如何看待未来委托的潜力。
2016年4月至8月期间，我们对北莱茵 - 威斯特法伦州具有代表性的随机抽取的全科医生样本（n = 2404）进行了匿名邮寄调查。问卷包含有关执业人员、委托活动开展地点以及委托的附加值和障碍等问题。我们比较了将任务委托给具有扩展资格的医疗助理的全科医生与委托给标准资格医疗助理的全科医生的特征。
回复率为32%（n = 762）。近三分之一的受访者（n = 239）将任务委托给了具有扩展资格的医疗助理。这些全科医生更可能较年轻且为男性，单独个体执业的可能性较小。与雇佣没有扩展资格的医疗助理的全科医生相比，他们在所有环境中委托开展的活动更多。
如相关附加值和任务开展的部署环境所示，全科医生通过将任务委托给具有扩展资格的医疗助理而受益。更多的全科医生应考虑将任务委托给非医务人员作为支持医疗服务的一种方式。除了法律变革外，还需要进一步的程序来鼓励全科医生更积极地参与委托问题，并考虑进一步发展其工作人员的能力并相应地进行部署。
