gms | German Medical Science

Background: General practitioners (GPs) are the first point of contact for a large number of patients with heterogenous diseases in very short timeframes. Due to the outpatientization of German health care, the importance of efficient GP care will continue to increase in the future. Hence, research and practice need more knowledge about unmet efficiency potentials to both compensate the increasing workload in GP practices and maintain the medical quality.

Objective: This study aimed to explore the ecosystem and pain points of German GP care to identify optimization potentials.

Methods: In this exploratory qualitative study, we interviewed 19 GP care experts from Germany: ten GPs, four medical GP assistants, one lobbyist for medical GP assistants, and four GP practice managers. Based on a predetermined sampling plan, quota sampling was applied to recruit our target group. The semi-structured online interviews were conducted between September and December 2022. Data were analyzed deductively and inductively using Kuckartz’s content analysis technique. The COREQ-Checklist guided the development of the study design, the data analysis, and the presentation of the results.

Results: By analyzing the interview transcripts, we coded 1.474 text segments, which we then further structured into 25 sub-categories, and finally into four main categories: relevant players in GP care, relevant processes in GP practices, process optimization potentials, and process digitalization ideas. Firstly, we structured the relevant players in GP care into five sub-categories: patients and caregivers, GP practice staff, external patient-close players (e.g., outpatient peers, hospitals, or physiotherapists), external patient-distant players (e.g., supplier, service provider, or payer), and legislator. Secondly, relevant processes in GP practices include medical processes (e.g., therapeutic or diagnostic procedures), administrative patient-close processes (e.g., appointment management or issuing prescriptions), and administrative patient-distant processes (e.g., medical billing or accounting). Thirdly, process optimization potentials include, e.g., communication-related processes, data processing, data sharing, documentation, or medical billing. Fourthly, process digitalization ideas include, e.g., practice management software, voice recognition, decision support system, artificial intelligence, cloud computing, or applications of the telematics infrastructure.

Implication for research and healthcare practice: Our study highlights that perceived process optimization potentials and digitalization ideas are as heterogeneous as the organizational structures of GP practices. Notably, the organizational form of the practice (e.g., single practice, medical service association, or medical care center), and the number of employees seem to substantially affect the attitudes of GP care experts. Furthermore, GPs differ regarding their operational profiles. While some focus on medical care and delegate all possible administrative tasks to their employees, others take on most tasks on their own. What most GP care experts have in common is that they crave relief from administrative tasks and, particularly, optimization of communication-related processes. User-centered digital health solutions may be promising and time-saving solutions to both reduce the burden on GP practice staff and maintain or even increase the quality of care.

Funding: Other funding; Project name: Ecosystem-Based Mixed Methods Study to Identify Opportunities for Digitally Enabled Care in Outpatient Health Care Delivery Settings (EMIDOC); Industry Funding