Effectiveness of a delegated primary care model in rural areas: design and methodology of a longitudinal observational study.

BACKGROUND

The shortage of general practitioners (GPs) in Germany, particularly in rural areas, is a pressing issue that requires innovative and sustainable solutions. One promising approach is the integration of trained medical assistants to support GPs by handling specific tasks, thus enhancing the efficiency of healthcare delivery. Delegated home visits can be carried out by healthcare professionals (HPs) with a well-defined range of tasks.

METHODS

This quasi-experimental, non-randomised longitudinal observational study runs from January 2023 to June 2025. The study participants are patients cared for by participating GPs, selected based on defined inclusion criteria, who receive regularly delegated home visits. Health-related quality of life (HRQoL) and satisfaction is assessed at three data collection points (t0 as baseline before starting the intervention, t1 after the first testing and data collection phase, and t2 after the second data collection phase). For assessing the HRQoL, we use the Short-Form-Health Survey (SF-12), and satisfaction is being measured using the patient satisfaction questionnaire ZUF-8. These parameters, as well as the continuously collected parameters (kilometers driven, travel and setup time), are analysed statistically (descriptive statistics, paired t test, Wilcoxon test, ANOVA). At t1 and t2, focus group interviews are conducted with the assistants on their satisfaction. They allow to identify the potential for concept improvement by qualitative content analysis.

DISCUSSION

The "VERSORGT am ORT" (VaO, engl. "PROVIDED on SITE") project aims to optimise healthcare by using scarce resources in a more efficient way, maintaining patient-professional trust, and extending delegation. It seeks to implement care plans with minimal location changes and generate real-world evidence. Due to geographical and policy limitations, the study will have comparatively few participants and will use a repeated measures design instead of a control group to assess patient HRQoL and satisfaction over time. Changes in HRQoL cannot be directly linked to the new care model due to unclear causalities. Mergenthal et al. reported that 59% of GPs in rural areas delegate home visits to healthcare professionals, saving time. The VaO project aims to further relieve GPs, increasing efficiency without compromising care quality.

TRIAL REGISTRATION

DRKS00033915 - Registration Date 19/03/2024.