Care Models for Psychosocial Problems in Primary Care

A survey on awareness and health policy assessment

Social problems relevant to health, such as loneliness, financial problems and problems at work, are common topics addressed in primary care (1). Yet, primary care physicians (PCPs) have only limited time to attend to these problems during consultation hours. However, various care models exist that are designed to integrate medical and non-medical services in primary care. Some of these have already been implemented internationally or tested in pilot projects in Germany. The four most important models are social prescribing (2), in-practice social work services (“arztpraxisinterne Sozialberatung”), health kiosks, and integrated primary care centers (Box). The aim of our study was to determine the level of awareness and health policy assessment of these four care models by PCPs practicing in Germany

Box

Care Models for Psychosocial Problems in Primary Care

Methods

We conducted a survey among PCPs in Germany. A random sample of 10 000 PCPs (drawn by the National Association of Statutory Health Insurance Physicians [KBV, Kassenärztliche Bundesvereinigung] from the German Federal Medical Register [Bundesarztregister]) was invited by mail on 10 October 2023 (reminder on 13 November 2023) to participate in the survey via a web form. The questionnaire asked about awareness of the models (“I have already heard or read something about the concept [. . .] .”) and then explained the models. The survey participants (SPs) were asked to rank the models according to which should, in their opinion, be preferably implemented on a broad scale in Germany. In addition, the form included questions about personal details and the PCP practice. The statistical software package R (version 4.0.2) was used for data analysis. The analysis was primarily descriptive. The representativeness of the SPs was assessed by comparing KV region (KV, Association of Statutory Health Insurance Physicians) as well as gender with the KBV sample, using the chi-square test. The survey was approved by the Ethics Committee of Charité – Universitätsmedizin Berlin (EA2/154/23). In addition, the survey was registered in the German Clinical Trials Register (DRKS, Deutsches Register Klinischer Studien) (DRKS-ID: DRKS00032585) and a protocol was published prospectively (3).

Results

Sample

At least one letter could be delivered to 9833 PCPs; of these, 1474 responded and 1439 (response rate 14.6%) agreed to participate. 603 (45.8%) of the SPs were female, 702 male, 13 diverse or with other gender entry. The mean age of the SPs was 53.0 (standard deviation [SD], 9.9) years. The SPs were evenly distributed across practices in rural communities, small towns, medium-sized towns, and large cities. The distribution of the SPs did not differ from the distribution of the contacted PCPs with regard to KV region (χ²[240] = 255, p = 0.24) and gender (χ²[6] = 8, p = 0.24).

Awareness of the care models

293 (20.7%) of the SPs had heard of social prescribing, 314 (23.2%) of the SPs were aware of in-practice social work services, 928 (68.8%) of health kiosks, and 576 (42.8%) of integrated primary care centers. 309 SPs (23.0%) were not aware of any of the four care models and 134 SPs (10.0%) were familiar with all four care models.

Ranking

When the models were ranked according to which one should preferably be implemented in Germany, social prescribing and in-practice social work services were rated highest, health kiosks slightly lower, and integrated primary care centers lowest (Table).

Table

Ranking of the various care models which should preferably be implemented on a broad scale in Germany (rank 1 should best be implemented)

Discussion

The results of our study show a low level of awareness of integrated care models among PCPs practicing in Germany. Social Prescribing and in-practice social work services were ranked the highest and the health kiosk the lowest.

One strength of our survey is the nationwide random sample with an acceptable response rate; however, the possibility of selection bias cannot be ruled out. Yet several characteristics, such as the distribution of the SPs across the regional Associations of Statutory Health Insurance Physicians and gender, match the distribution in the sample. Since the HÄPPI model (4) was only presented after our study had already been designed and initiated, it could not be taken into account in the survey. But we asked for the views of the SPs on the more far-reaching concept of integrated primary care centers.

The results of our survey show that such care models are not widely known. Even the health kiosk, which has attracted significant media and policy attention, is unknown to more than 30% of PCPs practicing in Germany. Despite the fact that the other care models are being discussed scientifically, they are not known to the majority of PCPs. At the same time, awareness of these service offerings is higher among PCPs compared to the general population where the level of awareness of primary care centers is 25% compared to 43% among PCPs, and of health kiosks 16% compared to 69% among PCPs (5).

Notably, PCPs favor low-threshold models, such as social prescribing and in-practice social work services, which are integrated in the primary care practice, for implementation in the healthcare system. In our survey, the majority of PCPs reject the health kiosk model, which represents an external service. This is in contrast to the efforts of the German Federal Ministry of Health (BMG, Bundesministerium für Gesundheit) to implement the concept on a nationwide scale.

The low level of awareness of the care models underlines the need to involve PCPs in Germany more actively in the further development of the healthcare system in the future. It seems that, despite the involvement of specialist societies and professional associations, the discussions from a healthcare science and policy perspective have so far failed to reach the PCPs practicing in Germany in their entirety. From the PCPs’ point of view, the implementation of service offerings which can be integrated in the PCP practice should be given priority.

Wolfram J. Herrmann, Hendrik Napierala

Conflict of interest statement
WJH and HN are members of the Social Prescribing Competence Network and the Social Health working group of the German Society of General Practice/Family Medicine (DEGAM, Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin). In addition, WJH is Vice Chair of the WONCA Europe Special Interest Group Social Prescribing and Community Orientation.

Manuscript received on 3 February 2024; revised version accepted on 23 May 2024

Translated from the original German by Ralf Thoene, M.D.

Cite this as:
Herrmann WJ, Napierala H: Care models for psychosocial problems in primary care—a survey on awareness and health policy assessment. Dtsch Arztebl Int 2024; 121: 748–9. DOI: 10.3238/arztebl.m2024.0116

References

1. Zimmermann T, Mews C, Kloppe T, et al.: [Social problems in primary health care—prevalence, responses, course of action, and the need for support from a general practitioners’ point of view]. Z Evid Fortbild Qual Gesundhwes 2018; 131–132: 81–9.

2. Napierala H, Krüger K, Kuschick D, Heintze C, Herrmann WJ, Holzinger F: Social prescribing: systematic review of the effectiveness of psychosocial community referral interventions in primary care. Int J Integr Care 2022; 22: 11

3. Napierala H, Herrmann WJ: Supplementary material: health kiosk, social prescribing, integrated primary care centres—the GP perspective on concepts for the care of people with non-medical health-related social problems (1_0). Zenodo 2023. doi.org/10.5281/zenodo.8375384

4. Hausärztinnen- und Hausärzteverband: HÄPPI Hausärztliches Primärversorgungszentrum – Patientenversorgung Interprofessionell. www.haev.de/fileadmin/user_upload/News_Dateien/2023/2023_11_07_HAEPPI_Konzeptpapier_lang.pdf (last accessed on 29 April 2024).

5. Bosch Health Campus: Baden-Württemberg – Gesundheitsstandort! Oder Dauerbaustelle der Gesundheitspolitik? www.bosch-health-campus.de/sites/default/files/documents/2023-11/102_23-10-24_BHC_Neustart%21_Forsa_Ergebnisbericht_WEB.pdf (last accessed on 29 April 2024).