AGnES: supporting general practitioners with qualified medical practice personnel: model project evaluation regarding quality and acceptance.
BACKGROUND
The German AGnES (community-based, e-health-assisted systemic support for primary care) project allows general practitioners (GPs) to delegate certain elements of medical care, including house calls, to qualified AGnES employees and thereby provide primary care to a larger number of patients. AGnES projects of various types have been carried out in a number of German federal states from 2005 onward. In this article, an evaluation of the AGnES projects to date is presented.


METHODS
Patient data (age, sex, diagnoses, level of care, mobility, etc.) and each of the specific activities carried out in the AGnES framework were documented with standardized computer-based instruments. The GPs, AGnES employees, and patients also underwent standardized interviews. The acceptance of the AGnES project, competence of the AGnES employees, and quality of medical care within the projects were evaluated. The participating GPs themselves assessed the quality of medical care.


RESULTS
By July 8, 2008, 8386 house calls on a total of 1486 patients had been made within the framework of the AGnES projects. The evaluation revealed a high degree of acceptance of the project among the participating GPs, AGnES employees, and patients. The GPs considered the quality of medical care within the AGnES project to be good for the vast majority of patients.


CONCLUSIONS
Structural redundancy is avoided by directly placing the AGnES employees in the general practitioners' practices. Based on the results of the AGnES projects, the law in Germany has now been amended to enable implementation of the AGnES project in the regular health care system from January 2009 onward. The next steps to be taken are the establishment of adequate reimbursement within the catalog of the statutory health insurance scheme and a detailed definition of the required qualifications.
van den Berg
Neeltje
N
Institut für Community Medicine, Ernst-Moritz- Arndt-Universität Greifswald, Germany.
Meinke
Claudia
C
Heymann
Romy
R
Fiss
Thomas
T
Suckert
Eileen
E
Pöller
Christian
C
Dreier
Adina
A
Hoffmann
Wolfgang
W
Rogalski
Hagen
H
Oppermann
Roman
R
Karopka
Thomas
T
D003695:Delivery of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D006291:Health Policy / Q000639:trends*; D006792:House Calls / Q000706:statistics & numerical data*; D009313:National Health Programs / Q000706:statistics & numerical data*; D010821:Physicians, Family / Q000592:standards / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care