Does Not Correspond to Everyday Reality
Enhanced primary care (GP-centered health care; hausarztzentrierte Versorgung, HzV) is intended to strengthen the role of GPs and improve the quality of health care. However, the risk of „measuring“ medical quality is that „quality“ degenerates into a competition to complete predetermined quality indicators.
One result of the study: the number of GP consultations “rose sharply” (+47.4%), while that of the specialist consultations rose by 4.1% (1). Why do we have an average of 18 GP visits per year in Germany while Scandinavian countries only have four? Is the increased number of GP consultations in the HzV perhaps the result of bonus systems (such as for check-up appointments or appointments within the scope of a disease management program)? With respect to the specialist consultations: one goal of the HzV is to restrict the specialist consultations to those absolutely necessary. Thus, the argument put forward by the authors that the increase in specialist consultations suggests “more intensive and better coordinated care” is not comprehensible. Patients often „would like“ a referral to a specialist without a compelling reason.
A further statement from the study: „A stronger effect was observed in the rate of patients with 5 and more drugs prescribed by GPs.“ The problems of polypharmacy in older adults, with its risks, adverse drug events, and side effects, are well known.
Further criticisms of the work include the financing of the study by the statutory health insurance AOK PLUS (neutrality?). The matching of intervention group and control group patients is questionable. The propensity score can only be adjusted for known and actually measured patient characteristics. The characteristic „morbidity index“ is critical because of known up-coding of ICD-10 diagnoses. Studies do not necessarily reflect the everyday reality for GPs. Especially for older multimorbid patients, the limits of measurable, evidence-based, guideline-oriented medicine are quickly reached. In these cases, it is mainly about time, attention, and quality-of-life for patients—which must be provided despite the current situation, in which retiring GPs are barely able to find successors for their practices.
Dr. med. Robert Hector
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Freytag A, Biermann J, Ochs A, Lux G, Lehmann T, Ziegler J, Schulz S, Wensing M, Wasem J, Gensichen J: The Impact of GP-centered healthcare—a case-control study based on insurance claims data. Dtsch Arztebl Int 2016; 113: 791–8 VOLLTEXT|