Population Preferences for the Care of Family Members in the Same Primary Care Practice

Results of a Representative Population Survey

A patient’s family plays a role in every medical contact, even if family members are not physically present. Primary care (PC) medicine is characterized by the fact that several family members can be cared for—over the long-term, with continuity, and independently of their respective symptoms—in the same PC practice (1). This has several advantages, such as offering a deeper understanding about the biological and psychosocial relationships as well as about any stresses caused by family events, which are particularly important for providing longitudinal support to families and their individual members (2).

To date, however, there is no representative data on whether people in Germany actually wish to have their family members cared for in the same PC practice, or whether they feel that the traditional PC practices that accompany a family over generations are outdated. Based on a representative population survey, this work therefore addresses the following questions: How high is the preference of the population living in Germany for having several or all family members cared for in the same PC practice? Are the sociodemographic characteristics, net household income, urban/rural setting, migrant background, and/or household size independently associated with this preference?

Methods

A representative population study (trial registry number: DRKS00017157) (3) that was carried out in August/September 2020 included a question about the preference for the care of family members in the same PC practice (n = 2 017 respondents, aged 14–96). This ongoing study collects data through face-to-face interviews. The respondents were selected using a combination of stratified, multi-stage random sampling and quota sampling (details at www.osf.io/s2wxc/). A detailed analysis plan of the current study was published before the evaluation (www.osf.io/yq3xm/).

Preferences were measured with the following question: “Primary care physicians care for the entire population, individuals as well as families. If it were up to you, how would you like to choose your primary care practice?”

The answer options were:

• (1) I would like several or all members of my family to be cared for in the same primary care practice.
• (2) I would like the members of my family to be cared for in different primary care practices.
• (3) I have no preference about whether my family members are cared for in the same or in different primary care practices.

Connections between personal characteristics and this preference (dichotomized: answer option 1 = in the same practice versus 2–3 = in different practices/not important) were explored using multivariable logistic regression. Prevalence data were weighted for the total population (weighted n = 2 000). The care of children/adolescents in PC practices was not explicitly addressed.

Results

While 45.6% of the population would like to have several/all family members be cared for in the same PC practice, 45.3% stated that they had no preferences about whether or not their family members received care in the same or different PC practices. Only 6.5% explicitly wished for their family members to be cared for in different PC practices (2.5% did not specify). The preference for the care of several/all family members in the same practice was not significantly correlated with an urban or rural setting, gender, or a migrant background of the respondents. A higher monthly net household income per capita was associated with a lower probability of having a preference to have several/all family members receive care in the same PC practice, independent of the other personal characteristics mentioned. On the other hand, people from larger households as well as people who are married or in a registered partnership were more likely to prefer this type of care than unmarried people (e.g., single, divorced, or widowed) (Table).

Table

Relationship between personal characteristics and the preference for the care of family members in the same primary care practice

Discussion

With its representative sample, this study provides the first insight into the preferences of the population in Germany for the care of family members in the same PC practice. There is a high desire for several/all family members to be cared for in the same PC practice, regardless of whether they live in urban/rural areas or have a migrant background. Based on this preference, we can assume that, given the freedom to choose a physician, a large part of the population would choose to have the care of their family members in the same PC practice. The preference for care in the same PC practice by people from lower-income households and from larger households may indicate an increased need for care in families that are socio-economically disadvantaged and/or families with children. While the preference for care in a single PC practice by people in larger households as well as by people who are married or in a registered partnership could be due to organizational reasons, it still enables the care of the family in the narrower sense of family medicine.

As only one member of each household was interviewed, no statement can be made about the preferences of the other family members. Additionally, not all potential influencing factors on the preferences could be recorded (such as the presence of a chronic illness or home care). Data were collected during the COVID-19 pandemic, with its additional burdens on families; this may have increased the preference for receiving care in a single PC practice.

Conclusion

By providing the care of several family members at the same time in the same practice, PC medicine has a greater potential than other care structures to provide the care of the population that spans generations and takes into account the social context (4). Almost half of the population expressed a preference for the care of family members in the same PC practice—in other words, an explicit desire to have a central medical contact point for their families. This represents a high proportion of patients who are cared for in PC practices, even if increasing mobility and different living locations of family members can preclude receiving care from the same PC practice. However, implementing this potential for PC medicine depends on having conducive framework conditions, such as:

• Networking at the community/district levels, also with structural simplifications in addition to the collective agreement (4);
• Incentivizing an attitude of accountability by teams in the practices through pay metrics for longer talks or family conferences;
• Offering appropriate remuneration for all participating professions for interdisciplinary case conferences to coordinate medical care (5);
• Providing low-threshold, spatially and temporally suitable offers of visiting hours for families.

Vera Kalitzkus, Stefan Wilm, Daniel Kotz, Sabrina Kastaun

Institute of General Practice, Center for Health and Society, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (Kalitzkus, Wilm), [e-mail]

Institute of General Practice, Center for Health and Society, Addiction Research and Clinical Epidemiology Unit, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (Kotz, Kastaun)

Institute of General Practice, Research Focus on Patient–Physician Communiciation, Centre for Health and Society, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (Kastaun)

Conflict of interest statement:
The authors declare that no conflict of interest exists.

Manuscript received on 3 August 2021, revised version accepted on 22 October 2021.

Translated from the original German by Veronica A. Raker, PhD.

Cite this as: Kalitzkus V, Wilm S, Kotz D, Kastaun S: Population preferences for the care of family members in the same primary care practice—results of a representative population survey. Dtsch Arztebl Int 2021; 118: 844–5. DOI: 10.3238/arztebl.m2021.0367

References

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2. Kalitzkus V, Wilm S: Familie in der Medizin – Familienmedizin. In: Wonneberger A, Weidtmann K (eds.): Familienwissenschaft. Grundlagen und Überblick. Heidelberg, Springer: 2017; 417–50

3. Kastaun S, Brown J, Brose LS, et al.: Study protocol of the German Study on Tobacco Use (DEBRA): a national household survey of smoking behaviour and cessation. BMC Public Health 2017; 17: 378

4. Wilm S: Accountable care: Eine Perspektive für das deutsche Gesundheitswesen? In: Baas J (ed.): Perspektive Gesundheit 2030. Berlin, MWV: 2021; 251–8.

5. DEGAM – Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin: DEGAM-Zukunftspositionen. Allgemeinmedizin – spezialisiert auf den ganzen Menschen. Frankfurt am Main, 2012. www.degam.de/files/Inhalte/Degam-Inhalte/Ueber_uns/Positionspapiere/DEGAM_Zukunftspositionen.pdf (last accessed on 25 June 2021).