Schillen Philip, Dehnen Alessia, In der Schmitten Jürgen, Kersting Christine, Mortsiefer Achim, Hemming Bernd, Heistermann Peter, Neumann Anja, Dehnen Dorothea
Institut für Allgemeinmedizin, Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland.
Institut für Allgemeinmedizin, Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2023 Dec;182-183:44-52. doi: 10.1016/j.zefq.2023.07.006. Epub 2023 Sep 27.
In the coming decades, demographic change will dramatically increase health care needs, especially for general practitioners (GPs). However, there is a shortage of young primary care physicians, with signs of (impending) underuse already becoming apparent in rural and structurally weak areas. Innovative care concepts are needed to counteract this development and ensure the future of primary care. In addition to medical assistants (MFA), academically trained physician assistants (PAs) could be considered for more demanding delegation tasks and be involved in direct patient care under the responsibility of a physician in the practice team. In England, the Netherlands and the USA, PAs have been a part of the health care systems for many years.
After preliminary interviews with PA experts and primary care researchers and practitioners (n=29), four expert interviews (n=4) with GPs and PAs were performed in a case analysis in order to elicit experiences with PAs in family practice. Based on this, three focus groups were conducted with GPs and practice staff (n=15) to discuss the extent, the need and the willingness to delegate physician services to PAs, as well as existing barriers. After transcription, analyses were performed using qualitative content analysis according to Mayring.
The participants acknowledged the potential to reduce physician workloads and showed a high willingness to delegate tasks. Practical examples suggest that a clearly defined delegation of medical tasks to PAs, e.g. participation in infection consultations, is possible after only a few weeks working in family practices. Thus, the cooperation between GPs, PAs and medical assistants can be successful. Uncertainties exist regarding the legal possibilities and limits of delegation as well as the current and future financial reimbursement of PAs.
The legal and financial framework for the utilization of PAs in ambulatory care should be reliably clarified as well as transparently communicated so that the considerable potentials of delegating tasks to academically trained staff, e.g. PAs, especially in the GP sector, can be exploited in the future.
Participation of PAs in the GP team could be key to overcoming the often threatening or already existing under-provision of medical care in structurally weak regions.
在未来几十年里，人口结构变化将极大地增加医疗保健需求，尤其是对全科医生（GPs）的需求。然而，年轻的初级保健医生短缺，在农村和结构薄弱地区，（即将出现的）医疗服务利用不足的迹象已经很明显。需要创新的护理理念来应对这一发展趋势，并确保初级保健的未来。除了医疗助理（MFA）之外，经过学术培训的医师助理（PAs）可以承担更复杂的委托任务，并在执业团队中医师的指导下参与直接的患者护理工作。在英国、荷兰和美国，医师助理已经在医疗保健系统中存在多年。
1）与医疗助理相比，医师助理在初级保健实践中进行任务委托的潜力/可能性有哪些？2）要使医师助理定期融入初级保健实践，需要哪些结构要求？
在对医师助理专家以及初级保健研究人员和从业者进行初步访谈（n = 29）之后，通过案例分析对全科医生和医师助理进行了四次专家访谈（n = 4），以获取家庭医疗中与医师助理合作的经验。在此基础上，与全科医生和执业人员进行了三个焦点小组讨论（n = 15），以讨论将医师服务委托给医师助理的程度、需求和意愿，以及现存的障碍。转录之后，根据迈林的方法进行定性内容分析。
参与者认可减轻医生工作量的潜力，并表现出很高的任务委托意愿。实际例子表明，在家庭医疗工作几周后，就可以将明确界定的医疗任务委托给医师助理，例如参与感染会诊。因此，全科医生、医师助理和医疗助理之间的合作可以取得成功。在任务委托的法律可能性和限制以及医师助理当前和未来的财务报销方面存在不确定性。
应可靠地阐明并透明地传达门诊护理中使用医师助理的法律和财务框架，以便未来能够挖掘将任务委托给经过学术培训的人员（如医师助理）的巨大潜力，特别是在全科医生领域。
医师助理参与全科医生团队可能是克服结构薄弱地区经常面临的或已经存在的医疗服务供应不足问题的关键。
