title: German GPs' willingness to expand roles of physician assistants: a regional survey of perceptions and informal practices influencing uptake of health reforms in primary health care.
abstract: BACKGROUND
  Many countries with shortages in health personnel are introducing task shifting in primary health care. GPs' attitudes and practices strongly affect task shifting and the expansion of the roles of physician assistants (PAs).
  
  
  OBJECTIVE
  To assess, in a German state with shortages of health personnel, the overall willingness of GPs to delegate home visit tasks to PAs and to elicit their perceptions of barriers to and benefits of such delegation and the current practice of informal delegation.
  
  
  METHODS
  Postal self-administered anonymous survey of all practicing GPs in the rural state of Mecklenburg-Vorpommern. Main outcomes were GPs' willingness to delegate in home visit tasks to a properly trained PA, perceived barriers to and benefits of home visit delegation and current practice of informal delegation. Using multinomial logistic regression, associations were identified among outcome variables, and characteristics of the GPs and of their practices.
  
  
  RESULTS
  Response rate was 47%. Responders (500) were comparable to all GPs in the state (1096); 48% of practitioners are willing to delegate home visits tasks to PAs. The main barrier to delegation was the related costs of PAs' training (34%), and the main benefit that it 'saves the GP's time' (67%). The 46% of practitioners who are informally delegating home visit tasks were significantly more likely be younger [odds ratio (OR) and 95% confidence interval (CI)] [OR = 0.96 (0.93-0.99)] and female [OR = 1.70 (1.12-2.58)].
  
  
  CONCLUSIONS
  The increasing proportion of women in family medicine might favor task shifting in General Practice.
authors.affiliation: Institute of General Practice and Family Medicine, Berlin, Germany. lorena.dini@charite.de
authors.forename: Lorena
authors.initials: L
authors.lastname: Dini
authors.forename: Giselle
authors.initials: G
authors.lastname: Sarganas
authors.forename: Eugene
authors.initials: E
authors.lastname: Boostrom
authors.forename: Sumiko
authors.initials: S
authors.lastname: Ogawa
authors.forename: Christoph
authors.initials: C
authors.lastname: Heintze
authors.forename: Vittoria
authors.initials: V
authors.lastname: Braun
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D058006:General Practice / Q000458:organization & administration*; D058005:General Practitioners / Q000523:psychology*; D005858:Germany; D018166:Health Care Reform; D019538:Health Care Surveys; D006792:House Calls; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D032024:Personnel Delegation; D010823:Physician Assistants; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration; D024382:Professional Role; D019035:Rural Health Services / Q000458:organization & administration; D011795:Surveys and Questionnaires; D000078329:Workforce