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Abstract Background Long-term reinforcement in the role of primary care and improvement the healthcare system as a whole requires the involvement of GPs in clinical research processes. However, many clinical studies fail due to failure to achieve sample population targets amongst GPs and their patients. This issue has been identified and discussed, but effective strategies to overcome it are still lacking. One of the reasons is that the positions, requirements, and experiences of GPs on participating in clinical research have hardly been examined up to now. Methods The years 2021 and 2022 saw three quantitative and qualitative surveys amongst GPs in Germany with the aim of shedding light on the attitudes, experiences, and potential issues regarding the involvement of primary care in clinical research projects and participation in cluster-randomised controlled trials (cRCTs) in a general sense. This overview summarises and abstracts conclusions gained from the exploratory series of studies and compares the results with the current research situation. From here, this contribution will then develop an approach towards optimising the integration of GPs into clinical research. Results Most of the GPs asked associated clinical research with opportunities and potential such as closing gaps in healthcare, using evidence-based instruments, optimising diagnostic and therapeutic management, and reinforcement of multiprofessional healthcare. Even so, many GPs unsure as to how far primary care in particular would stand to benefit from studies of this type in the long term. Respondents were also divided on willingness to participate in clinical research. GPs having already participated in Innovation Fund projects generally saw a benefit regarding intervention and cost–benefit relationship. However, some also reported major hurdles and stress factors such as excessive documentation and enrolment requirements, greater interference in practice routines, and sometimes poor integration into project processes such as in communication and opportunities to play an active role in the project. Conclusions Results from the studies presented provide indications as to how GPs perceive clinical research projects and cRCTs as a whole and from their existing project experience, and on the requirements that studies would have to meet for GPs to be willing to participate. In particular, making sure that clinical studies fully conform with GPs would play a major role; this especially applies to freedom to make medical decisions, limitation of documentation obligations, interference in regular practice routine, greater involvement in research planning, and long-term reinforcement in the role of primary care. Clinical research projects and cRCTs should be planned, designed, and communicated for clear and visible relevance to everyday primary care.

Abstract Background Since 2020, physicians in Germany have the possibility of prescribing approved digital health applications (DHAs) with the costs covered by the health system – a step that was unique in the world at that time and still is. So far, there have been hardly any studies that shed light on the possible applications of DHAs in the context of primary care and take stock of the benefits and potential for optimization. In 2022, a quantitative survey was carried out. The aim was to determine what attitudes, experiences and expectations GPs have with regard to the use of DHAs, under what conditions they are willing to integrate them into health care, and what experience they have already gained. Methods The focus was on a large-scale survey of GPs. Between spring and summer 2022, all 18,914 GPs in the federal states of Baden-Württemberg, Hesse, Lower Saxony, Rhineland-Palatinate and Saarland were invited to an online survey. 5,868 questionnaires were included in the evaluation (response rate: 31%). A t-test on independent samples was used to determine significant differences between two groups. Results 68% of those surveyed are positive about DHAs and consider them to be reliable (69%) and safe (63%) applications that can generate efficiency benefits for the doctor-patient relationship. 24% trust themselves to competently advise patients on DHAs. 14% have already prescribed DHAs, 13% plan to do so. 85% of doctors with DHA experience rate the prescribed applications as (very) useful. Observed health care effects relate primarily to the improvement in compliance (94%), mobility (93%), and education (93%), as well as weight reduction (83%). Among other things, a further optimization of usability (59%), systematic further training of doctors on DHAs (53%) and the expansion of gamification elements (49%) are suggested. GPs lack well-founded information with regard to DHAs (52%). Conclusion For GPs, DHAs can be effective tools to encourage patients in their personal responsibility, compliance and motivation to behave in a health-conscious manner and to strengthen prevention in the primary care setting. Where DHAs have been used in a practical context so far, widespread positive health care effects are noticeable. Most respondents do not dare to give patients competent advice on available applications. Comprehensive training courses that provide information about the framework conditions, strategies and advantages of using DHAs appear to be important. There is also a need for more well-founded sources of information and research for doctors to select suitable applications in a targeted manner. GPs see significant added value in DHAs compared to conventional health apps. In order for DHAs to be effectively implemented in primary care, it is important to better inform GPs about the legal basis and possible applications as well as to address their concerns.

Abstract Background Counselling and management of overweight and obesity are tasks for which general practitioners possess favourable qualifications. Based on a long-term doctor-patient relationship, GPs have various options for actions to deal with overweight problems. To date, however, there is only little evidence on the experiences which people with obesity have made with the primary physician model and the care needs and wishes they actually address to their GPs. This study investigated what experiences people with obesity have had with GP care and what care needs and wishes they communicated to their GPs. The results will be used to derive starting points for optimising the primary healthcare setting. Methods A total of 32 individuals affected by obesity were recruited over 24 online health forums. With them, we conducted qualitative interviews in the time between April and October 2022. Results The respondents considered the primary care physician to be the central contact person when they sought advice and support with weight problems. The advice of the GP was associated with an increased willingness to deal with reducing one’s own weight. Despite this positive perception, widespread drawbacks existed from the perspective of the respondents: (1) incidental or late discovery of obesity, (2) absence of continuous weight counselling, (3) no agreement on specific weight reduction goals, (4) no referrals to help and support services, (5) insensitive discussion. Only some of the respondents who have recently been able to reduce their weight sustainably attributed their success primarily to the support they received from their GP. Conclusion GPs should be encouraged to address obesity consistently and promptly. In addition, concrete recommendations and realistic goals for weight loss should be formulated. Continuous and motivating discussions are crucial in this regard. A focus on nutrition and exercise counselling in the GP’s office should also be encouraged. GPs should be strengthened in their role as mediators by integrating their patients into a network of further assistance as needed. The development of care structures for obesity management should be promoted.

The shortage of general practitioners (GPs) and the fact that country doctors’ practices are vanishing—a situation that is currently taking a turn for the worse in some regions of Germany—are issues that have been dealt with in the media as a topic of specific discussion for some time now. In the process, news coverage is dominated by certain depiction patterns, referred to as frames, which are shaped in terms of textual and visual impact. The present explorative study addresses the questions of which media depiction and interpretation patterns (frames) are encountered on the shortage of general practitioners in news coverage in the Federal Republic of Germany and how general practitioners, the circumstances, and the benefits of their care are presented in this context. In the course of a search via the Lexis Nexis database, a total of 655 news items were found or selected that mainly deal with the shortage of general practitioners (period from 1 January 2017 to 31 December 2022). Furthermore, the media libraries of the two public television broadcasters ARD and ZDF were specifically searched for documentaries on the shortage of general practitioners for the said period. A qualitative content analysis was subsequently performed, in which characteristic reporting patterns on the topic under consideration were identified based on frame-defining categories. Five frames could be identified that outline the shortage of general practitioners in different ways. The first three frames present the dominant image of GPs as highly stressed, aged, or frustrated primary care providers who attempt to keep their practice going for as long as possible despite their increasing stress levels. The other frames portray the phenomenon of the shortage of GPs, in particular, as a side effect of demographic and structural changes, discuss the (diminishing) appeal of the profession of a general practitioner, or discuss the issue of remote areas that no longer have access to a GP practice and now receive ‘alternative solutions’. The frames identified reflect societal views and anxieties regarding the consequences of a progressive shortage of GPs, which have been spurred on by the media. They reflect the significance of the GP as a trustworthy and competent primary care provider who is not readily replaceable, neither in his/her role as a guide in the healthcare system nor with regard to his social function.

Abstract Background General practice offers good conditions to detect and provide care for dementia-related diseases. Nonetheless, the effectiveness of dementia care in general practice is repeatedly criticised. To date, few studies have attempted to form a comprehensive picture of the status quo of dementia care in general practice that focuses on GP perspectives of experience and action. The aim of this study was to identify potential strengths and weaknesses of GP-based dementia care, by means of combined consideration of relevant care and treatment dimensions (construct of ‘dementia sensitivity’). Methods Through an online poll, a total of 4,511 GPs who are active as treatment providers in Baden-Württemberg, Hesse, Rhineland-Palatinate and Saarland were surveyed between September 2022 and January 2023. In addition to the descriptive analysis, a T-test with independent samples was used to identify significant differences between two groups (interval-scaled or metric variables). Pearson’s chi-squared test (χ2) was used to analyze the percentage values. Two levels of significance were tested for (mean difference at p

Abstract Background By providing both assistance and support, GPs can play a central role for family caregivers. By catering to the needs of caregivers, they are capable of stabilising in-home care settings over the long term. The aim of the present study is to provide a status quo analysis of how GPs assess their options for supporting individuals providing care, as well as the focal points set by their practice, and their estimation of obstacles and challenges encountered in day-to-day practice. Method An online questionnaire was used to survey a total of 5112 GPs in North Rhine-Westphalia between April and November 2022 (response quota: 46%). A heterogeneous random sample was obtained (58% male, 42% female; average age: 57; 50% medium-sized town/city practice, 50% rural/small town practice). To determine significant differences between two groups, a t-test was used with independent random samples. Answers to free-form questions were analysed using a subsequent coding based on a qualitative content analysis. Findings A total of 70% of respondents have frequent contact with family caregivers. Some 79% consider GPs to be well-suited to the role of primary contact point for caregivers and coordinating care. GP-carer support relationships typically arise as a result of caregivers approaching GPs (90%). Topics frequently addressed involve a worsening of the care situation (77%) and changes in the care needed (86%); consultations in the initial phase of the care situation are less common (44%). While respondents perceive a complex constellation of needs on the part of family caregivers, differences in priorities are observable between GPs in urban and rural environments (involvement of consultant/support network versus proactive and psychosocial assistance). GPs experience a wide range of challenges in providing assistance to caregivers, including the timely organisation of appropriate relief programmes (87%), referring caregivers to suitable help services (80%) or the early identification of informal caregivers (60%). Discussion In order to strengthen the GP role, the practice team should talk to caregivers as early as possible, and refer them to suitable help and support programmes. To achieve effective support for successful care, it is important to cater equally to the needs of the persons giving and receiving care as part of the caregiver-care receiver-GP triad.

Abstract Mass media portrayal of old age plays a great role in social perceptions of aging. However, there are hardly any empirical findings on the effects on recipients or to what extent this can change attitudes, especially amongst older people. Three types of media portrayals of old age in German news magazines were determined and used as stimulus material. In 2020, 910 participants (from 60 years) were confronted with different age frames in the course of a quasi-experimental survey. In order to substantiate the results, in 2022, 36 focused interviews were conducted with older people each of whom was presented with an age frame. This article links the central findings of both studies, with a focus on the qualitative study. The survey results showed that presenting a negative age frame led to an improvement in the self-image of old age whereas the public image of old age deteriorated significantly. After presenting a positive frame, the public image improved greatly while the self-image decreased. The interviews confirm these results. Type of reaction upon reception of the negative age frame varied between approval and clear signs of consternation. However, interviewees did not relate with the older people portrayed with personal aging often felt to be at odds with the portrayal of age shown. The positive frame was first received with pleasure and curiosity. Even so, interviewees became unsettled about how ‘modern’ aging is portrayed, some of them showing insecurity that they could not fulfil the characteristics and requirements of ‘modern’ aging. Media portrayal of age seems not to have the effects on older people as might be expected. Negative effects appear such as media portrayal making older recipients aware of their own age by presenting age in an exaggeratedly positive light in the “best agers” frame. In view of these results, the theory of social comparison processes may be used by which the media provides recipients with standards of comparison.

AbstractBackground Securing primary care is an important issue for health policy. Given a threatened shortage of GPs in Germany, there are discussions about what actions to take to guarantee primary care.Objectives The aim was to obtain opinions of German GPs towards (a) the status quo and development of primary care, (b) favoured actions to secure it and (c) assessment of the actions taken.Methods In 2021 and 2022, 96 semi-structured interviews (criterion sampling) amongst GPs were conducted in all German federal states (41 face-to-face, 32 by telephone, 23 via telecommunication application). The data was analysed according to qualitative content analysis. Additionally, a short questionnaire recorded the problem of GP shortage.Results Many interviewees fear a veritable shortage of GPs in the future. They identify structural problems linked to the health care system. The interviewees suggested creating a primary care physician system or upgrading the GP position. They proposed greater support of interests about general practice in education and training, a restructuring of curricula and admissions criteria in higher medical education and reforming GP training. Building up multi-professional outpatient care centres and strengthening task shifting are valuable. The interviewees have observed progress in ensuring primary care but see a need for further action.Conclusion The study has shown that GPs, from their perspective and experience, make specific suggestions to ensure primary care in the long term. Consequently, it is advisable to consider their points of view when planning, implementing and adjusting steps to strengthen primary care.

AbstractBackground Since 2020, physicians in Germany can prescribe approved digital health applications (DHAs) with the costs covered by the health system. There has so far been a lack of studies on attitudes and experiences amongst GPs in using DHAs.Objectives The aim was to elucidate the experiences and observations of GPs that have used DHAs in health care and to examine the conditions necessary for DHAs to gain a foothold in primary care according to the GPs.Methods In 2022, 96 qualitative semi-standardised interviews were conducted with German GPs with experience in prescribing DHAs. The GPs were all organised in digitalisation-oriented physicians’ associations. Fifty-four interviews were carried out in person and 42 by phone. The data were analysed according to qualitative content analysis.Results Unlike health apps, the interviewees saw DHAs as reliable tools for enhancing the relationship between GPs and their patients. They saw the DHAs they had been prescribing as useful and reported various benefits, including improvements in compliance, mobility, information for patients and weight reduction. The physicians also saw room for further improvement (usability, gamification, training, information sources). Interviewees saw the inclusion of DHAs in evidence-based guidelines as a major step forward.Conclusion The interviewees rated DHAs favourably regarding healthcare potential and as safer and more reliable than conventional health apps. Many saw benefits to healthcare from using such applications. From the interviewees’ point of view, DHAs can be integrated more effectively into patient care.

Abstract Background Hardly any area of application for health apps is seen to be as promising as health and lifestyle support in type 2 diabetes mellitus. Research has emphasised the benefits of such mHealth apps for disease prevention, monitoring, and management, but there is still a lack of empirical data on the role that health apps play in actual type 2 diabetes care. The aim of the present study was to gain an overview of the attitudes and experiences of physicians specialising in diabetes with regard to the benefits of health apps for type 2 diabetes prevention and management. Methods An online survey was conducted amongst all 1746 physicians at practices specialised in diabetes in Germany between September 2021 and April 2022. A total of 538 (31%) of the physicians contacted participated in the survey. In addition, qualitative interviews were conducted with 16 randomly selected resident diabetes specialists. None of the interviewees took part in the quantitative survey. Results Resident diabetes specialists saw a clear benefit in type 2 diabetes-related health apps, primarily citing improvements in empowerment (73%), motivation (75%), and compliance (71%). Respondents rated self-monitoring for risk factors (88%), lifestyle-supporting (86%), and everyday routine features (82%) as especially beneficial. Physicians mainly in urban practice environments were open to apps and their use in patient care despite their potential benefit. Respondents expressed reservations and doubts on app user-friendliness in some patient groups (66%), privacy in existing apps (57%), and the legal conditions of using apps in patient care (80%). Of those surveyed, 39% felt capable of advising patients on diabetes-related apps. Most of the physicians that had already used apps in patient care saw positive effects in increased compliance (74%), earlier detection of or reduction in complications (60%), weight reduction (48%), and decreased HbA1c levels (37%). Conclusions Resident diabetes specialists saw a real-life benefit with added value from health apps for managing type 2 diabetes. Despite the favourable role that health apps may play in disease prevention and management, many physicians expressed reservations regarding usability, transparency, security, and privacy in such apps. These concerns should be addressed more intensively towards bringing about ideal conditions for integrating health apps successfully in diabetes care. This includes uniform standards governing quality, privacy, and legal conditions as binding as possible with regard to apps and their use in a clinical setting.

Background There is currently no cure for dementia but general practitioners (GPs) have therapeutic options available to counteract the progression of mild cognitive impairment, including drug and non-drug treatment. So far, few studies have investigated treatment strategies preferred by GPs.Objectives This study aimed to gain an overview of GPs’ attitudes towards influencing the progression of dementia, their involvement regarding dementia prevention and perceived effective approaches. It also elucidated the challenges experienced by GPs and desired optimisation measures towards reinforcing secondary prevention.Methods Between June 2020 and March 2021, 64 semi-standardised interviews amongst GPs were conducted in all federal states of Germany. Thirty interviews were carried out in person and 34 by phone. The data were analysed according to qualitative content analysis.Results Many interviewees see great importance in secondary dementia prevention and believe they could make an effective contribution, some of them using non-drug approaches. GPs play a role in guiding patients and relatives towards support services. Some doctors consider drug treatment as the only option towards influencing the progression of dementia, showing low expectations on self-efficacy. Interdisciplinary collaboration is a frequent challenge, which often conflicts with a coherent treatment strategy.Conclusion Many GPs feel confident about influencing the progression of dementia and believe they can intervene effectively, using various (non-drug) treatment measures and referrals to support services. GPs perceive challenges, including obstacles in interdisciplinary collaboration and negative impacts after drug administration. To improve the conditions for GP intervention, it depends on expanding interdisciplinary collaboration and care strategies.

Abstract Background General Practitioners are considered to be well placed to monitor home-care settings and to respond specifically to family caregivers. To do this, they must be sensitive to the needs and expectations of caregivers. In order to determine the current status of GP care in terms of the support given to family caregivers, a series of studies were conducted to gather the perspectives of both caregivers and GPs. The results are used to derive starting points as to which measures would be sensible and useful to strengthen support offered to family caregivers in the primary care setting. Methods Between 2020 and 2021, three sub-studies were conducted: a) an online survey of 612 family caregivers; b) qualitative interviews with 37 family caregivers; c) an online survey of 3556 GPs. Results Family caregivers see GPs as a highly skilled and trustworthy central point of contact; there are many different reasons for consulting them on the subject of care. In the perception of caregivers, particular weaknesses in GP support are the absence of signposting to advisory and assistance services and, in many cases, the failure to involve family caregivers in good time. At the same time, GPs do not always have sufficient attention to the physical and psychological needs of family caregivers. The doctors interviewed consider the GP practice to be well suited to being a primary point of contact for caregivers, but recognise that various challenges exist. These relate, among other things, to the timely organisation of appropriate respite services, targeted referral to support services or the early identification of informal caregivers. Conclusions GP practices can play a central role in supporting family caregivers. Caregivers should be approached by the practice team at an early stage and consistently signposted to help and support services. In order to support care settings successfully, it is important to consider the triadic constellation of needs, wishes and stresses of both the caregiver and the care recipient. More training and greater involvement of practice staff in the support and identification of caregivers seems advisable.

Abstract Background Most people with dementia (PwD) are cared for at home, with general practitioners (GPs) playing a key part in the treatment. However, primary dementia care suffers from a number of shortcomings: Often, diagnoses are made too late and therapies by GPs do not follow the guidelines. In cases of acute crises, PwD are too often admitted to hospital with adverse effects on the further course of the disease. The aim of this study is to implement and evaluate a new GP-based, complex dementia care model, DemStepCare. DemStepCare aims to ensure demand-oriented, stepped care for PwD and their caregivers. Methods/design In a cluster randomized controlled trial, the care of PwD receiving a complex intervention, where the GP is supported by a multi-professional team, is compared to (slightly expanded) usual care. GPs are clustered by GP practice, with 120 GP practices participating in total. GP practices are randomized to an intervention or a control group. 800 PwD are to be included per group. Recruitment takes place in Rhineland-Palatinate, Germany. In addition, a second control group with at least 800 PwD will be formed using aggregated routine data from German health insurance companies. The intervention comprises the training of GPs, case management including repeated risk assessment of the patients’ care situation, the demand-oriented service of an outpatient clinic, an electronic case record, external medication analyses and a link to regional support services. The primary aims of the intervention are to positively influence the quality of life for PwD, to reduce the caregivers’ burden, and to reduce the days spent in hospital. Secondary endpoints address medication adequacy and GPs’ attitudes and sensitivity towards dementia, among others. Discussion The GP-based dementia care model DemStepCare is intended to combine a number of promising interventions to provide a complex, stepped intervention that follows the individual needs of PwD and their caregivers. Its effectiveness and feasibility will be assessed in a formative and a summative evaluation. Trial registration German Register of Clinical Trials (Deutsches Register Klinischer Studien, DRKS), DRKS00023560 . Registered 13 November 2020 - Retrospectively registered. HTML&TRIAL_ID=DRKS00023560.

Abstract Background Family caregivers are often the first line of support for people requiring care; although they may personally stand to benefit, these activities substantially increase the risk of physical and emotional stress. General practitioners (GPs) may provide important support and stabilisation, but need to adjust to the needs and expectations of this group in order to do so. The aim of the study was to compare the needs of family caregivers from GPs to the support they actually experience. Additional aims included determining the main factors affecting satisfaction amongst family caregivers with support from GPs. The results were used to develop possible approaches towards optimisation within the purview of general medical practice. Methods Between January and July 2020, 612 people supporting or caring for a family member responded to an online survey posted in seventeen internet forums focused on family caregivers. In addition to the descriptive analysis, a t-test with independent samples was used to identify significant differences between two groups. We also used binary logistic regression analysis to identify indications of potentially influential factors regarding the experienced support from GPs. Results Around three out of every four respondents (72%) consulted GPs in care matters. The respondents gave positive responses on their GP’s knowledge of the care situation (71%), approachability in various issues connecting with care and service towards the caregiver (82%). GPs’ efforts in meeting the needs and requirements of the care recipient were also rated positively (82%). Weaknesses in support from GPs mainly involved the lack of information on advice and assistance services (55%) as well as frequently not identifying or involving caregivers as such soon enough (42%). Results from regression analysis show that the last two aspects play a major role in subjective satisfaction amongst family caregivers with support from GPs. Conclusions We recommend that GPs undergo further training to reinforce awareness that the care triad of needs, requirements and stresses amongst family caregivers also plays a vital role in care outcomes. With this in mind, general practice staff should adopt a pre-emptive strategy towards approaching family members about potential issues and informing them about existing assistance and support services.

Background Obesity poses severe challenges for the health care system. GPs are in an advantageous position to contribute to preventing obesity by diagnosing patients and initiating treatment. Sporadic studies have shown that attitudes towards obesity management in primary care can have a major influence on treating patients successfully. Objectives The study focuses on attitudes and behavioural patterns towards obesity patients, willingness to provide care, approaches and strategies, and the challenges experienced. Methods After developing the interview guides based on a literature review, 36 GPs in North Rhine-Westphalia and Saarland, Germany, were interviewed between November 2019 and March 2020. Using qualitative typing according to Kluge, different prototypes of GPs were formed. The dimensions of the interview guides were used for deriving the prototypes. Results GPs were categorised into four types depending on how they saw themselves and their role in treating patients. The first type (the resigned) was conspicuous through its negative attitude towards obesity management and a lack of willingness to provide care. The second type (the instructors) emphasised the value of active exercise, diet and health promotion, while the third type (the motivators) saw psychosocial support and motivation as a key element in helping patients. In contrast, type four (the educators) focussed primarily on early prevention through patient education. Conclusion Depending on which (proto-)type a patient visits, different focuses and strategies are pursued for obesity management and doctor–patient communication. This results in different perspectives and chances of success about therapeutic measures.