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Schrimpf A, Scheiwe E, Bleckwenn M. Insights from end-of-career general practitioners on changing working conditions and generational differences: considerations for future strategies. BMC PRIMARY CARE 2024; 25:171. [PMID: 38762452 PMCID: PMC11102275 DOI: 10.1186/s12875-024-02419-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
The landscape of general practice has experienced notable transformations in recent decades, profoundly influencing the working conditions of general practitioners (GPs). This study aimed to examine the most salient changes affecting GPs' daily practices. Through semi-structured qualitative interviews with 15 end-of-career GPs, the study explored how these changes affected work organization, equipment, working hours, work-life balance, job satisfaction, training, patient relationships, and reputation. The interviews revealed that these changes were perceived as barriers, opportunities, or a complex interplay of both for general practice. While the interviewed GPs valued technological advancements and reported positive developments in working conditions, challenges included a gradual reduction in the range of tasks, growing administrative burdens, and less practical training for young physicians. Other changes, such as new doctor-patient dynamics, the transition from single to group practice, and differing professional expectations of the younger generation, were seen as both challenging and strengthening for general practice. By combining these factors and trade-offs observed by end-of-career GPs in our study over the past few decades with general societal changes, we provide ideas for the design of future framework conditions in general practice that might enhance the attractiveness of the profession. These insights offer key considerations that can guide future strategies for general practice and medical education.
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Affiliation(s)
- Anne Schrimpf
- Institute for General Practice, Faculty of Medicine, Leipzig University, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.
| | - Elisabeth Scheiwe
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Markus Bleckwenn
- Institute for General Practice, Faculty of Medicine, Leipzig University, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
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Osmanski-Zenk K, Klinder A, Pingsmann A, Lohmann CH, Bail HJ, Kladny B, Mittelmeier W. Institutional Surgical Setting and Volume Effects of Certified Arthroplasty Centers in Germany: Evaluation of the Quality of Care in a 5-Year Comparison. Healthcare (Basel) 2024; 12:904. [PMID: 38727461 PMCID: PMC11083652 DOI: 10.3390/healthcare12090904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
To improve arthroplasty care quality, the EndoCert initiative focuses on structural, processual, and surgeon-related quality assurance. The aim of this study was to assess the impact of a surgeon's case load in certified centers on quality of care, distinguished by different types of surgeons. Data from the annual reports of EndoCert certified centers for the years 2017 to 2021 were analyzed. The study revealed reduced numbers of cases, while the number of surgeons remained constant. Since 2020, the decrease in the average case load per surgeons has become more pronounced. There were also differences between senior (sECrs) and EndoCert-registered surgeons (ECrs). Before the 2020 pandemic, over half of surgeons exceeded minimum annual case requirements, while, afterwards, this number declined, especially for the ECrs. Affiliated surgeons, who are also sECrs or ECrs, performed predominantly lower numbers of arthroplasties. However, a higher percentage of affiliated surgeons in a center correlated with faster surgeries and lower mortality rates. High numbers of arthroplasties per center or surgeon were not necessarily associated with better quality indicators, especially in the knee. While the comprehensive quality standards may offset volume effects, EndoCert should reconsider minimum volume regulations based on surgeon, but also on each joint.
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Affiliation(s)
- Katrin Osmanski-Zenk
- Orthopedic Clinic and Policlinic, University Rostock Medical Center, 18057 Rostock, Germany
| | - Annett Klinder
- Orthopedic Clinic and Policlinic, University Rostock Medical Center, 18057 Rostock, Germany
| | - Andreas Pingsmann
- Professional Association for Orthopaedics and Trauma Surgery, Biberburg Orthopaedic Associates, 14089 Berlin, Germany
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke-University, 39120 Magdeburg, Germany
| | - Hermann Josef Bail
- Department of Orthopedics and Traumatology, Paracelsus Medical University, 90471 Nuremberg, Germany
| | - Bernd Kladny
- Fachklinik Herzogenaurach, D-91074 Herzogenaurach, Germany
| | - Wolfram Mittelmeier
- Orthopedic Clinic and Policlinic, University Rostock Medical Center, 18057 Rostock, Germany
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Stuckenschneider T, Schmidt L, Speckmann EM, Koschate J, Zieschang T. Recruiting patients for falls prevention in the emergency department - worth the challenge. BMC Geriatr 2023; 23:880. [PMID: 38129767 PMCID: PMC10740331 DOI: 10.1186/s12877-023-04607-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Severe falls escalate the risk of future falls and functional decline as indicated by recent global guidelines. To establish effective falls prevention, individuals at highest risk must be thoroughly studied and, therefore, successfully recruited. OBJECTIVE Recruiting from an emergency department (ED) may mitigate common selection biases, such as overrepresentation of individuals with a higher social status and healthier lifestyle. However, this approach presents unique challenges due to ED-specific conditions. Hence, we present the successes and challenges of an ED-based recruitment for an observational study. METHODS The SeFallED study targets older adults aged ≥60 years, who present to either of two hospitals in Oldenburg after a fall without subsequent admission. A study nurse addressed individuals in the EDs. Subsequently, potential participants were contacted by phone to arrange a home visit for obtaining written consent. Data of participants were compared with total admissions during the recruitment period to determine recruitment rate and compare patients' characteristics. RESULTS Over 1.500 individuals met the inclusion criteria. Of these, 288 participants were successfully recruited. Most patients presented to the ED outside of the study team's working hours, and some opted not to participate (main reason: too unwell (40%)). Compared to working hours, a participant was recruited every 14 h. Comparing characteristics, a trend towards better health and younger age was observed. CONCLUSION ED-based recruitment offers the opportunity to include more diverse individuals in falls prevention. To achieve adequate sample sizes, flexibility in working days and hours of the research team are obligatory. TRIAL REGISTRATION DRKS00025949.
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Affiliation(s)
- Tim Stuckenschneider
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Ammerländer Heerstraße 114-118, Lower Saxony, 26129, Oldenburg, Germany.
| | - Laura Schmidt
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Ammerländer Heerstraße 114-118, Lower Saxony, 26129, Oldenburg, Germany
| | - Elisa-Marie Speckmann
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Ammerländer Heerstraße 114-118, Lower Saxony, 26129, Oldenburg, Germany
| | - Jessica Koschate
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Ammerländer Heerstraße 114-118, Lower Saxony, 26129, Oldenburg, Germany
| | - Tania Zieschang
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Ammerländer Heerstraße 114-118, Lower Saxony, 26129, Oldenburg, Germany
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Umgelter A, Faust M, Wenske S, Umgelter K, Schmid RM, Walter G. Do patients referred to emergency departments after being assessed in primary care differ from other ED patients? Retrospective analysis of a random sample from two German metropolitan EDs. Int J Emerg Med 2023; 16:64. [PMID: 37752441 PMCID: PMC10523768 DOI: 10.1186/s12245-023-00542-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND To assess differences between patients referred to emergency departments by a primary care physician (PCP) and those presenting directly and the impact of referral on the likelihood of admission. DESIGN OF STUDY Retrospective cohort study. SETTING EDs of two nonacademic general hospitals in a German metropolitan region. PARTICIPANTS Random sample of 1500 patients out of 80,845 presentations during the year 2019. RESULTS Age was 55.8 ± 22.9 years, and 51.4% was female. A total of 34.7% presented by emergency medical services (EMS), and 47.7% were walk-ins. One-hundred seventy-four (11.9%) patients were referred by PCPs. Referrals were older (62.4 ± 20.1 vs 55.0 ± 23.1 years, p < .001) and had a higher Charlson Comorbidity Index (CCI) (3 (1-5) vs 2 (0-4); p < .001). Referrals received more ultrasound examinations independently from their admission status (27.6% vs 15.7%; p < .001) and more CT and laboratory investigations. There were no differences in sex, Manchester Triage System (MTS) category, or pain-scale values. Referrals presented by EMS less often (9.2% vs 38.5%; p < .001). Admission rates were 62.6% in referrals and 37.1% in non-referrals (p < .001). Referral (OR 3.976 95% CI: 2.595-6.091), parenteral medication in ED (OR 2.674 (1.976-3.619)), higher MTS category (1.725 (1.421-2.093)), transport by EMS (1.623 (1.212-2.172)), abnormal vital parameters (1.367 (0.953-1.960)), higher CCI (1.268 (1.196-1.344)), and trauma (1.268 (1.196-1.344)) were positively associated with admission in multivariable analysis, whereas ultrasound in ED (0.450 (0.308-0.658)) and being a nursing home resident (0.444 (0.270-0.728)) were negatively associated. CONCLUSION Referred patients were more often admitted. They received more laboratory investigations, ultrasound examinations, and computed tomographies. Difficult decisions regarding the necessity of admission requiring typical resources of EDs may be a reason for PCP referrals.
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Affiliation(s)
- Andreas Umgelter
- II. Medizinische Klinik, Klinikum Rechts Der Isar der Technischen Universität München, Munich, Germany.
- Zentrale Notfallversorgung, Vivantes Humboldt Klinikum, 13509, Berlin, Germany.
| | - Markus Faust
- II. Medizinische Klinik, Klinikum Rechts Der Isar der Technischen Universität München, Munich, Germany
- Zentrale Notfallversorgung, Vivantes Humboldt Klinikum, 13509, Berlin, Germany
| | - Slatomir Wenske
- Zentrale Notfallversorgung, Vivantes Humboldt Klinikum, 13509, Berlin, Germany
| | - Katrin Umgelter
- Klinik Für Interdisziplinäre Intensivmedizin, Vivantes Humboldt Klinikum, Berlin, Germany
| | - Roland M Schmid
- II. Medizinische Klinik, Klinikum Rechts Der Isar der Technischen Universität München, Munich, Germany
| | - Georg Walter
- Zentrale Notfallversorgung, Vivantes Klinikum Spandau, Berlin, Germany
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Althammer A, Trentzsch H, Prückner S, Gehring C, Hoffmann F. [Pediatric emergency patients in the emergency departments of a German metropolitan region : A retrospective cross-sectional study over a one-year period]. Med Klin Intensivmed Notfmed 2023:10.1007/s00063-023-01064-1. [PMID: 37702784 DOI: 10.1007/s00063-023-01064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/11/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND To date, no detailed analysis of pediatric emergencies treated in emergency departments (ED) exists. However, in the context of capacity planning and upcoming emergency care reform in Germany, these data are urgently needed. METHODS Retrospective, multicenter cross-sectional study for the period 01 July 2013 to 01 June 2014 of pediatric cases in emergency departments in Munich. RESULTS A total of 103,830 cases were analyzed (age: 6.9 ± 5.4 years, boys/girls 55%/45%). A total of 85.9% of cases were treated as outpatients, 12.4% (9.6 per 100,000 children) were admitted to normal and 1.7% (1.0 per 100,000 children) to intensive care. However, the real bed requirements exceeded these guideline numbers, with an absolute requirement of 4.9 ICU beds and 35.1 normal ward beds per day. Load peaks were seen on Wednesday and Friday afternoons and on weekends. Every 8th patient who presented to an ED as a self-referral was treated as an inpatient. CONCLUSION Capacity planning for inpatient emergency care of pediatric patients requires planning for more beds than can be expected on a population basis. The availability of panel physician care influences patient volume in the EDs. Initial medical assessment tools for treatment need and urgency are needed to distribute patients. The pediatric emergency centers planned as part of the current reform of emergency care must be adequately staffed and financed in order to be able to handle-in close cooperation with statutory health insurance-accredited medical care-the expected demand for care.
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Affiliation(s)
- Alexander Althammer
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der LMU München, Schillerstr. 53, 80336, München, Deutschland
- Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Heiko Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der LMU München, Schillerstr. 53, 80336, München, Deutschland
| | - Stephan Prückner
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der LMU München, Schillerstr. 53, 80336, München, Deutschland
| | - Christian Gehring
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der LMU München, Schillerstr. 53, 80336, München, Deutschland
| | - Florian Hoffmann
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, LMU Klinikum München, Kinderintensiv- und Notfallmedizin, Lindwurmstr. 4, 80337, München, Deutschland.
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Bessert* B, Oltrogge-Abiry* JH, Peters PS, Schmalstieg-Bahr K, Bobardt-Hartshorn JS, Janis Pohontsch N, Bracht S, Mayer-Runge U, Scherer M. Synergism of an Urgent Care Walk-in Clinic With an Emergency Department. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:491-498. [PMID: 37378594 PMCID: PMC10511010 DOI: 10.3238/arztebl.m2023.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 12/16/2022] [Accepted: 05/11/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND The overutilization of hospital emergency departments by low-urgency patients is seen as a growing problem in health-care delivery, and a variety of solutions are under discussion. We studied the change in utilization of a hospital emergency department (ED) by low-urgency patients after an urgent care walk-in clinic (WIC) was opened in the immediate vicinity. METHODS A prospective, single-center pre-post comparative study was carried out at the University Medical Center Hamburg-Eppendorf (UKE). The ED patient collective consisted of adult walk-in patients who presented to the ED between 4 pm and midnight. The "pre" period consisted of August and September 2019, and the "post" period was from November 2019 (after the opening of the WIC) to January 2020. RESULTS The study patients consisted of 4765 ED walk-in patients and 1201 WIC patients. 956 (80.5%) of the WIC patients had been referred onward to the WIC after initially presenting to the ED; from this group, 790 patients (82.6%) received definitive care in the WIC. The number of outpatients treated in the ED fell by 37.3% (95% confidence interval [30.9; 43.8]), from 851.5 to 536.7 per month. The most marked decreases were in the areas of dermatology (from 62.5 to 14.3 patients per month), neurology (45.5 to 25), ophthalmology (115 to 64.7), and trauma surgery (211 to 128.7). No decrease was seen in urology, psychiatry, or gynecology. For patients presenting without any referral document, the mean length of stay fell by a mean of 17.6 [7.4; 27.8] minutes from its "pre" value of 172.3 minutes. The rate of patients who left during treatment fell from 76.5 to 28.3 patients per month (p < 0.001). CONCLUSION A GP-led urgent care walk-in clinic next door to an interdisciplinary hospital emergency department is a resource-saving treatment option for walk-in patients who present to the emergency department. Most of the patients referred from the ED to the WIC were able to receive definitive care there.
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Affiliation(s)
- Bastian Bessert*
- *These authors share first authorship
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Jan Hendrik Oltrogge-Abiry*
- *These authors share first authorship
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Penelope-Sophie Peters
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | | | | | - Nadine Janis Pohontsch
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Svea Bracht
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Ulrich Mayer-Runge
- Interdiscplinary Central Emergency Department, University Medical Center Hamburg-Eppendorf, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Germany
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