Augustin Jobst, Trialonis-Suthakharan Nirohshah, Nowossadeck Enno
Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Deutschland.
Fachgebiet Soziale Determinanten der Gesundheit, Abt. für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut (RKI), Berlin, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2025 Sep 4. doi: 10.1007/s00103-025-04119-0.
Various public health measures are being implemented to ensure healthcare provision in rural and structurally vulnerable regions. However, the actual effect of these measures has not yet been fully clarified. This narrative review aims to identify relevant measures and compile existing evaluation results on their effectiveness.As part of a literature and document analysis, Google Scholar was used to search specific websites and databases of self-governing bodies in the healthcare sector (e.g. associations of statutory health insurance physicians and ministries) as well as relevant German journals. The results reveal a variety of conceptual approaches and practical measures designed to ensure healthcare provision. These are implemented as individual measures (e.g. "Rollende Arztpraxis") or complex bundles of measures (e.g. "Digitales Dorf"). Measures to improve the context, such as promoting the establishment of practices through the provision of affordable building land, and new organisational structures, such as doctor networks, are frequently employed, but their impact is often limited. Due to their relatively simple implementation, telemedicine measures are particularly important and are predominantly rated as having a positive effect.In principle, the evaluation of measures should be intensified further, with greater attention being paid to the methods and criteria used to evaluate their effectiveness. An accompanying evaluation should also ensure that successfully evaluated measures are not discontinued at the end of the project, but transferred to standard care if they are effective. Due to regional and local conditions, region-specific solutions should also be sought to optimise care.
目前正在实施各种公共卫生措施，以确保农村和结构脆弱地区的医疗服务提供。然而，这些措施的实际效果尚未完全明确。本叙述性综述旨在确定相关措施，并汇总有关其有效性的现有评估结果。作为文献和文件分析的一部分，利用谷歌学术搜索了医疗保健部门自治机构的特定网站和数据库（如法定医疗保险医生协会和各部委）以及相关的德国期刊。结果显示了旨在确保医疗服务提供的各种概念方法和实际措施。这些措施作为个别措施（如“巡回医疗诊所”）或复杂的措施组合（如“数字村庄”）实施。改善环境的措施，如通过提供价格合理的建筑用地来促进诊所的设立，以及新的组织结构，如医生网络，经常被采用，但其影响往往有限。由于实施相对简单，远程医疗措施尤为重要，且大多被评为具有积极效果。原则上，应进一步加强对措施的评估，更加关注用于评估其有效性的方法和标准。同时进行的评估还应确保，成功评估的措施在项目结束时不会停止，而是在有效时转为标准护理。由于区域和当地条件，还应寻求针对特定区域的解决方案，以优化医疗服务。
