AGnES – Supporting General Practitioners With Qualified Medical Practice Personnel – Model Project Evaluation Regarding Quality and Acceptance: Support for General Practitioners Is Uncertain

by Dr. rer. med. Neeltje van den Berg, Dipl.-Psych. Claudia Meinke, Dipl.-Kffr. Romy Heymann, Dipl.-Pharm. Thomas Fiß, Dipl.-Pflegewirtin Eileen Suckert, Christian Pöller MSc, Dipl.-Pflegew. Adina Dreier, Dipl.-Pflegew. Hagen Rogalski, Dipl.-Ing. Thomas Karopka, Prof. Dr. rer. cur. Roman Oppermann, Prof. Dr. med. Wolfgang Hoffmann MPH in volume 1–2/2009

The number and available consultation time of general practitioners is a critical resource in our healthcare system. As much as support provided by AGnES may seem the obvious answer, the valid evaluation of such complex interventions is required in order to use funding from the social security insurers in a targeted fashion. Empirical data of general practitioner support from the AGnES intervention are lacking: summary estimates of participating doctors and model extrapolations of the "capacity" of an AGnES qualified medical practice worker of 500 hours/year do not show how much calculated "home visiting time" the doctor really has available to treat additional patients. Owing to a study design without a control group and published doctors' working hours as they relate to individual patients —as are customary in the international literature—the real amount of support that this means for doctors remains uncertain (1).

This lack is not likely to be amended by the analyses of secondary data promised in the chapter on limitations, since data from Association of Statutory Health Insurance Physicians' financial statements about planned home visits do not include the duration of the visits and no further descriptions of the medical care iniput except for car mileage rates. Similarly, a valid classification of the treatment needs of home visit patients in primary care by using ICD-10 codes will not succeed because these codes are not process oriented.

The authors of the Cochrane review "Substitution of doctors by nurses in primary care" summarize their results as follows: "Doctors' workload may remain unchanged either because nurses are deployed to meet previously unmet need or because nurses generate demand for care where previously there was none" (3).

It is questionable to what extent a lack of general practitioners and the stipulated support of GPs by AGnES were used as an argument in engineering a change to para 87 SGB V, to further political interests: namely, the introduction of new and less costly healthcare positions into primary care delivered by GPs, at the cost of deprofessionalization of the work of GPs.
DOI: 10.3238/arztebl.2009.0357


Prof. Dr. med. Thomas Lichte
Prof. Dr. med. Markus Herrmann MPH M.A.

Dr. med. Andreas Klement
Institut für Allgemeinmedizin
Martin-Luther-Universität Halle-Wittenberg
06112 Halle/Saale, Germany
[e-mail]

References

1. Kinnersley P, Anderson E, Parry K et al.: Randomised controlled trial of nurse practitioner versus general practitioner care for patients requesting "same day" consultations in primary care. BMJ 2000; 320: 1043–8.

2. Wockenfuß R, Herrmann K, Claußnitzer M, Sandholzer H: Diagnoseklassifikation in der Allgemeinpraxis. Notfall & Hausarztmedizin 2008; 34(12): 586–90.

3. Laurant M, Reeves D, Hermens R, Braspenning J, Grol R, Sibbald B: Substitution of doctors by nurses in primary care. Cochrane Database Syst Rev 2005; (2): CD001271

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