[The Role of Municipalities in Lower Saxony for Future Physician's Care - A Survey of Mayors and District Administrators]. / Die Rolle von niedersächsischen Kommunen für die zukünftige ärztliche Versorgung ­ Eine Befragung der Bürgermeister und Landräte.

BACKGROUND: Comprehensive outpatient medical care is being increasingly threatened due to the decreasing willingness of physicians to establish their practices in rural areas. Partly, municipalities feel impelled to support doctors setting up their practices with their own resources. The aim of this study was to get the community perspective on the ambulatory care situation and to examine the role and influence of the local authorities. METHODS: The mayors (n=411) and district administrators (n=38) in Lower Saxony received a self-developed written questionnaire in September 2015 (comprehensive survey). RESULTS: The response rate was 72%. Availability of general practitioners was considered as inadequate by 30% of those surveyed and 71% described specialist care as being insufficient. Two-thirds of respondents saw local problems with filling vacant doctors' offices. 42% of mayors and 65% of district administrators said they had already supported outpatient doctors. The most frequent measures carried out so far included financial support, consulting services and the development of cooperation and networks. The majority considered the model of medical care centers being operated under municipal sponsorship to be unsuitable in principle. CONCLUSIONS: Local governments prevalently see problems with filling vacant doctors' offices as well as a need for local support. A significant proportion of municipalities has already implemented various support measures. Community participation in the outpatient care with medical care centers under municipal sponsorship is assessed rather critically.

[Assessing the benefits of digital health solutions in the societal reimbursement context]. / Nutzenbewertung von digitalen Gesundheitsprodukten (Digital Health) im gesellschaftlichen Erstattungskontext.

For a number of reasons, achieving reimbursability for digital health products has so far proven difficult. Demonstrating the benefits of the technology is the main hurdle in this context. The generally accepted evaluation processes, especially parallel group comparisons in randomized controlled trials (RCTs) for (clinical) benefit assessment, are primarily intended to deal with questions of (added) medical benefit. In contrast to drugs or classical medical devices, users of digital health solutions often profit from gaining autonomy, increased awareness and mindfulness, better transparency in the provision of care, and improved comfort, although there are also digital solutions with an interventional character targeting clinical outcomes (e. g. for indications such as anorexia, depression). Commonly accepted methods for evaluating (clinical) benefits primarily rely on medical outcomes, such as morbidity and mortality, but do not adequately consider additional benefits unique to digital health. The challenge is therefore to develop evaluation designs that respect the particularities of digital health without reducing the validity of the evaluations (especially with respect to safety). There is an increasing need for concepts that include both continuous feedback loops for adapting and improving an application while at the same time generate sufficient evidence for complex benefit assessments. This approach may help improve risk benefit ratio assessments of digital health when it comes to implementing digital innovations in healthcare.

Which strategies might improve local primary healthcare in Germany? An explorative study from a local government point of view.

BACKGROUND: Facing rising inequities and poorer accessibility of physicians in rural areas, new healthcare delivery structures are being considered to support local healthcare in German communities. To better understand perspectives on and attitudes towards different supplementary models, we examined attitudes among local politicians in the German federal state of Lower Saxony towards the suitability of supplementary care models. METHODS: As part of a cross-sectional study, we surveyed local politicians in Lower Saxony at the local authority and district levels (n = 449) by mail questionnaire. We asked for an assessment of four potential supplementary healthcare models at the local level: the use of trained medical assistants, patients' buses, mobile physicians' offices, and telemedicine. RESULTS: The response rate was 71.0% for mayors (n = 292) and 81.6% (n = 31) for county administrators. In summary, 72.4% of respondents supported the use of trained medical assistants, 48.9% voted for patients' buses, 22.0% for mobile physicians' offices, and 13.9% for telemedicine. Except for telemedicine, the politicians' approval of the supplementary models in rural areas was higher than in urban areas. The assessment regarding the suitability of each model was not significantly connected with indicators of a positively or negatively assessed local healthcare situation. The analyses showed that the use of trained medical assistants was associated with the positive effects of division of labor and potential to relieve physicians. In contrast, there was skepticism about technical support via telemedicine, mostly due to concerns about its unsuitability for elderly people and the potential lower quality of healthcare delivery. CONCLUSION: Local politicians widely accept the use of trained medical assistants, whereas the applicability of technical solutions such as telemedicine is perceived with skepticism. Therefore, the knowledge gap between evidence for and prejudices against telemedicine needs to be addressed more effectively. Reasons for the assessments of the presented models are more likely traceable to personal views than to assessments of the actual estimated local primary care situation.