Still Cause for Hope? Insights into Family Practice in Two Rural Areas in Northrhine-Westfalia
DOI: 10.3238/zfa.2012.0037-0042german translation / full article
Introduction: In some rural, structurally weak areas in Germany, primary medical care is in peril. Fewer family practitioners have to care for a relative constant number of patients (shortage of future family physicians, demographic change). Aim of this qualitative study is to discern the concrete situation of medical care and daily practice from the perspective of the involved actors in two rural areas of Northrhine-Westfalia. Solutions for the securing of family practices which so far have not yet been discussed should be identified on the basis of sound knowledge of the local conditions.
Material and Methods: Data about the situation of primary care were gathered by structured telephone interviews with the family practitioners. After that the perspective of professions involved in the health care of the population was examined by qualitative interviews. 14 interviews with 16 interviewees were conducted, including five of the seven family practitioners in the region.
Results: Family practitioners in both regions see the future safeguard for family practice in peril, if there is nothing done against the actual developments in health care politics. They criticise insufficient and uncertain financing and growing bureaucratic and administrative tasks. Strongly criticised is the growing restriction of the scope in family practice, which is a form of deprofessionalisation. The interviews show a feeling of lacking acknowledgement from the health care system and society. Family medicine itself is nevertheless highly valued by the family practitioners. Especially the intensive doctor-patient-relationship in family practice in rural areas is a source for professional contentment.
Conclusion: Varying context factors prove to be important for the family practice of the patients even within regionally restricted areas. We identified the professional self-conception that has to change according to new forms of cooperation as well as the necessity to develop a culture of dialog that aims for patient-centred and decentral primary care.