title: Technical support and delegation to practice staff - status quo and (possible) future perspectives for primary health care in Germany.
abstract: BACKGROUND
  Primary health care in industrialized countries faces major challenges due to demographic changes, an increasing prevalence of chronic diseases and a shortage of primary care physicians. One approach to counteract these developments might be to reduce primary care physicians' workload supported by the use of health information technology (HIT) and non-physician practice staff. In 2009, the U.S. Commonwealth Fund (CWF) conducted an international survey of primary care physicians which the present secondary descriptive analysis is based on. The aim of this analysis was twofold: First, to explore to what extend German primary care physicians already get support by HIT and non-physician practice staff, and second, to show possible future perspectives.
  
  
  METHODS
  The CWF questionnaire was sent to a representative random sample of 1,500 primary care physicians all over Germany. The data was descriptively analyzed. Group comparisons regarding differences in gender and age groups were made by means of Chi Square Tests for categorical variables. An alpha-level of p < 0.05 was used for statistical significance.
  
  
  RESULTS
  Altogether 715 primary care physicians answered the questionnaire (response rate 49%). Seventy percent of the physicians use electronic medical records. Technical features such as electronic ordering and access to laboratory parameters are mainly used. However, the majority does not routinely use technical functions for drug prescribing, reminder-systems for guideline-based interventions or recall of patients. Six percent of surveyed physicians are able to transfer prescriptions electronically to a pharmacy, 1% use email communication with patients regularly. Seventy-two percent of primary care physicians get support by non-physician practice staff in patient care, mostly in administrative tasks or routine preventive services. One fourth of physicians is supported in telephone calls to the patient or in patient education and counseling.
  
  
  CONCLUSIONS
  Within this sample the majority of primary care physicians get support by HIT and non-physician practice staff in their daily work. However, the potential has not yet been fully used. Supportive technical functions like electronic alarm functions for medication or electronic prescribing should be improved technically and more adapted to physicians' needs. To warrant pro-active health care, recall and reminder systems should get refined to encourage their use. Adequately qualified non-physician practice staff could play a more active role in patient care. Reimbursement should not only be linked to doctors', but also to non-physician practice staff services.
authors.affiliation: Department of General Practice and Health Services Research, University of Heidelberg Hospital, Heidelberg, Germany. elisabeth.urban@med.uni-heidelberg.de
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Urban
authors.forename: Dominik
authors.initials: D
authors.lastname: Ose
authors.forename: Stefanie
authors.initials: S
authors.lastname: Joos
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
authors.forename: Antje
authors.initials: A
authors.lastname: Miksch
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002983:Clinical Competence / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D055695:Electronic Prescribing / Q000592:standards; D005260:Female; D005858:Germany; D063005:Health Information Systems; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D008503:Medical Staff; D011939:Mental Recall; D008875:Middle Aged; D032024:Personnel Delegation; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D010821:Physicians, Family / Q000523:psychology* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D017010:Reminder Systems / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D000078329:Workforce