Table 4 Agreement with measures towards securing primary care
| Â | Â | Rotated component matrix | Â | ||
|---|---|---|---|---|---|
Question: Selected measures are listed below. How effective you think each measure would be in securing primary care in the long term? (N = 5,164; response categories very effective and somewhat effective taken together) | Overall agreement | Comp. 1 (variance clarif.: 39.7%) | Comp. 2 (variance clarif.: 15.6%) | Comp. 3 (variance clarif.: 11.6%) | Urban vs. rural physicians |
A primary care system with general practitioners as the first point of contact for patients while avoiding simultaneous appointments with specialists without prior referral | 88% | .521 | .069 | .775 | 84%/92% |
Routine establishment of complementary longitudinal programmes alongside Medicine courses communicating interest, insights, and skills needed in general practice | 78% | -.006 | .488 | .54 | 79%/77% |
Substantial reduction in general cost pressure for general practitioners | 69% | .65 | .45 | .134 | 66%/72% |
Shift away from classical medical practices towards outpatient (primary) care centres with the aim of expanding primary care; examples include polyclinics or health centres near hospitals or in urban areas towards fostering multi-professional cooperation and other more flexible working models | 62% | .866 | .144 | .026 | 64%/60% |
Substantial increase in the proportion of primary care in continuing medical education (such as an increase to a third) | 59% | .411 | -.009 | .402 | 57%/61% |
An authoritative primary care service catalogue as a clear guide to what can be expected from a GP towards preventing primary care overload, such as by ensuring sufficient qualifications and a set number of working hours | 58% | .715 | .485 | .040 | 55%/61% |
Fundamental general medical training reforms (including shortening and flexibilisation, more focus on key competencies in primary care) | 55% | .793 | -.035 | .239 | 55%/55% |
Medical study course and curriculum restructuring (improvement with more specific and relevant preparation for a future career in outpatient clinics and medical practices) | 54% | .31 | .401 | .753 | 58%/51% |
Major changes to the enrolment criteria for medical study courses (broader and more intensive inclusion of factors such as personality and curriculum details) | 51% | .159 | .797 | .359 | 51%/51% |
Fundamental improvement in general practitioner pay (such as pegging it to at least specialist level) | 49% | .101 | .618 | .223 | 45%/52% |
Delegation and increased use of non-medical health professions and extension to their sphere of responsibility | 45% | .869 | .029 | .163 | 31%/58%* |
A substantial increase in study places for Human Medicine | 42% | .827 | .007 | .281 | 33%/50%* |
Effective recruitment of medical personnel (more effort on incentives and rewards such as in municipalities with subsidies and bonuses for establishment in a rural area, for example) | 39% | .852 | .155 | .074 | 32%/46%* |
Consistent establishment of a rural primary care quota across Germany (clearly regulated in each federal state, with on-top quotas as required) | 36% | .282 | .674 | -.339 | 24%/48%* |
(More effective) demand planning with distribution aimed towards regional effectiveness | 34% | .84 | .199 | .081 | 34%/34% |
Increased and more standardised use of digitalisation and telemedicine (including video consultations as well as health app prescriptions for patient self-management) | 29% | .368 | .079 | .403 | 41%/17%* |
Quotas for access to specialist training | 25% | .326 | .762 | -.352 | 25%/25% |
Provide career changers from other disciplinary backgrounds with more access and authorisation to work as a general practitioners | 22% | .777 | .252 | -.388 | 23%/21% |