title: [Involvement of doctors' assistants in primary care for patients with long-term conditions. General practitioners' (GPs) perception of barriers and opportunities--a qualitative study].
abstract: OBJECTIVE
  Care for patients with multiple and chronic diseases is an increasing challenge. The particular demands of chronically ill patients increase the complexity of primary care. Involvement of doctors' assistants is discussed as part of comprehensive frameworks for structured care like the Chronic Care Model (CCM). The aim of this qualitative study was to reveal perceived barriers and opportunities among German general practitioners (GPs) according to the involvement of their assistants in patient care.
  
  
  METHODS
  14 GPs were interviewed. The documents were evaluated analytically according to their content.
  
  
  RESULTS
  Most GPs have a positive point of view with regard to the integration of their assistants. They claim a task-oriented training for the assistants as a precondition. Their working experience, an established patient-assistant relationship and the preparedness to take own responsibility in patient care are stated as supporting factors for the involvement of doctors' assistants in patient care. Main barrier seems to be a lack of time for additional work of their employees.
  
  
  CONCLUSIONS
  There is a need for task-oriented training, in order to professionalize practice teams. Remarkably, this new approach to chronic care is already integrated into routine care. However, it seems to suit only for some distinct diseases, selected patients and a limited number of doctors' assistants. As part of further professionalization an evaluation of a new job profile for doctors' assistants should be discussed.
authors.affiliation: Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Germany. regine.boelter@med.uni-heidelberg.de
authors.forename: Regine
authors.initials: R
authors.lastname: Bölter
authors.forename: Dominik
authors.initials: D
authors.lastname: Ose
authors.forename: Katja
authors.initials: K
authors.lastname: Götz
authors.forename: Antje
authors.initials: A
authors.lastname: Miksch
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
authors.forename: Tobias
authors.initials: T
authors.lastname: Freund
mesh_terms: D001291:Attitude of Health Personnel; D005194:Family Practice; D058005:General Practitioners; D006801:Humans; D010823:Physician Assistants; D011320:Primary Health Care