DÄ internationalArchive20/2009AGnES – Supporting General Practitioners With Qualified Medical Practice Personnel – Model Project Evaluation Regarding Quality and Acceptance: In reply
LNSLNS Klement et al rightly comment that for the reasons given, secondary data cannot replace a control group in the study, neither with regard to extent/volume nor with regard to quality (1). However, reimbursement data from general practices and data from Associations of Statutory Health Insurance Physicians and health insurers (as long as they're provided by the respective colleagues and institutions) can provide relevant insights, for example with regard to the practices' productivity (number of patients on the practice list, number of home visits), numbers of hospital admissions, inpatient days, and the prescription of care services delivered at home.

The authors draw attention to studies of so called "nurse practitioners" (NP), which have been conducted in several European countries. Compared with AGnES, who are closely tied to the general practitioner, NP have considerably extended competences and do not work on the basis of delegation but autonomously, in the sense of a substitution of doctors' services. The evidence that exists for NP therefore does not extend to the AGnES projects in Germany.

The problems that have led to the concept of the AGnES projects and the change to para 87 section 2b SGB is real, not only in the new German states (2). The AGnES concept aims to achieve a high quality of care for patients at home, even in regions where underprovision of medical care is impending or already reality, through ensuring intense and specific qualifications for the AGnES staff and their ties with general practices (3). This undertaking comes at a price—the economic analysis that was conducted in parallel in all model projects has shown that substantial cost savings are not to be expected as a result of AGnES. Attempts to implement a cheaper "AGnES light" solution by lowering the qualification and/or quality standards would endanger our patients' safety and are therefore unacceptable. DOI: 10.3238/arztebl.2009.0358


Prof. Dr. med. Wolfgang Hoffmann MPH
Dr. rer. med. Neeltje van den Berg
Institut für Community Medicine
Abt. Versorgungsepidemiologie und Community Health
Klinikum der Ernst-Moritz-Arndt Universität Greifswald, AöR
Ellernholzstr. 1/2
17487 Greifswald, Germany
wolfgang.hoffmann@uni-greifswald.de


Conflict of interest statement
The authors of both the letter and of the reply declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Hoffmann W, Bobrowski C, Fendrich K: Sekundärdatenanalyse in der Versorgungsepidemiologie – Potenzial und Limitationen. Bundesgesundheitsbl-Gesundheitsforsch-Gesundheitsschutz 2008; 51: 1193–201. MEDLINE
2.
Siewert U, Fendrich K, Hoffmann W: Analyse und Prognose der ambulanten Versorgungssituation sowie von Patientenzahlen in Mecklenburg-Vorpommern bis zum Jahr 2020. Abschlussbericht „Versorgungsepidemiologische Auswirkungen des demografischen Wandels in Mecklenburg-Vorpommern – Bereiche Ambulante Versorgung und Epidemiologie“. Institut für Community Medicine, Ernst-Moritz-Arndt-Universität Greifswald, 2008.
3.
van den Berg N, Dreier A, Rogalski H, Oppermann RF, Hoffmann W: Das AGnES Curriculum – Evidenzbasierte Qualifizierungsinhalte und Praxiskompetenzen aus den AGnES-Modellprojekten (2005–2008) für die Durchführung ärztlich angeordneter Hilfeleistungen in der Häuslichkeit der Patienten nach § 87 Abs. 2b SGB V. Schriftenreihe der Hochschule Neubrandenburg, Reihe G, Band 7. Neubrandenburg 2009.
4.
van den Berg N, Meinke C, Heymann R et al.: AGnES: Supporting General Practitioners with qualified medical practice personnel—model project evaluation regarding quality and acceptance [AGnES: Hausarztunterstützung durch qualifizierte Praxismitarbeiter – Evaluation der Modellprojekte: Qualität und Akzeptanz]. Dtsch Arztebl Int 2009; 106(1–2): 3–9. VOLLTEXT
1. Hoffmann W, Bobrowski C, Fendrich K: Sekundärdatenanalyse in der Versorgungsepidemiologie – Potenzial und Limitationen. Bundesgesundheitsbl-Gesundheitsforsch-Gesundheitsschutz 2008; 51: 1193–201. MEDLINE
2. Siewert U, Fendrich K, Hoffmann W: Analyse und Prognose der ambulanten Versorgungssituation sowie von Patientenzahlen in Mecklenburg-Vorpommern bis zum Jahr 2020. Abschlussbericht „Versorgungsepidemiologische Auswirkungen des demografischen Wandels in Mecklenburg-Vorpommern – Bereiche Ambulante Versorgung und Epidemiologie“. Institut für Community Medicine, Ernst-Moritz-Arndt-Universität Greifswald, 2008.
3. van den Berg N, Dreier A, Rogalski H, Oppermann RF, Hoffmann W: Das AGnES Curriculum – Evidenzbasierte Qualifizierungsinhalte und Praxiskompetenzen aus den AGnES-Modellprojekten (2005–2008) für die Durchführung ärztlich angeordneter Hilfeleistungen in der Häuslichkeit der Patienten nach § 87 Abs. 2b SGB V. Schriftenreihe der Hochschule Neubrandenburg, Reihe G, Band 7. Neubrandenburg 2009.
4. van den Berg N, Meinke C, Heymann R et al.: AGnES: Supporting General Practitioners with qualified medical practice personnel—model project evaluation regarding quality and acceptance [AGnES: Hausarztunterstützung durch qualifizierte Praxismitarbeiter – Evaluation der Modellprojekte: Qualität und Akzeptanz]. Dtsch Arztebl Int 2009; 106(1–2): 3–9. VOLLTEXT