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RESEARCH ARTICLE
EUROPEAN JOURNAL OF GENERAL PRACTICE
2024, VOL. 30, NO. 1, 2413123
Task shifting to improve practice eciency: A survey among general
practitioners in non-urban Baden-Wuerttemberg, Germany
Heiner Averbecka , Jasmin Raedlera, Raenhha Dhamib, Simon Schwillc and Joachim E. Fischera
aCenter for Preventive Medicine and Digital Health (CPD), Division of General Medicine, Heidelberg University Medical Faculty Mannheim,
Mannheim, Germany; bDivision of Prevention of Cardiovascular and Metabolic diseases, Heidelberg University Medical Faculty Mannheim,
Center for Preventive Medicine and Digital Health (CPD), Mannheim, Germany; cDepartment for General Practice and Health Services
Research, University Hospital Heidelberg, Heidelberg, Germany
KEY MESSAGES
• The majority of participants, especially young GPs, hold positive motives and beliefs about task shifting in
general practice.
• The GP-centred care programme, as an alternative to the regular remuneration system, influences motives and
beliefs towards task shifting.
• Legal adjustments seem warranted, as GPs support task shifting in the more extensive form of substitution,
currently prohibited by law.
ABSTRACT
Background: Germany is challenged by an increasing shortage in general practice services,
especially in non-urban areas. Task shifting from general practitioners (GPs) to other health
professionals may improve practice efficiency to address this mismatch.
Objectives: Exploring GPs’ motives and beliefs towards task shifting in non-urban Germany and
identifying potential factors influencing these.
Methods: The cross-sectional survey was disseminated by mail in three waves between July 2021
and August 2022 among all GPs in non-urban Baden-Wuerttemberg, Germany. It included items
on demographics and practice characteristics as well as 15 Likert-scale items addressing motives
and beliefs towards task shifting, based on the Theoretical Domain Framework. Likert-scale items
were analysed descriptively, influencing factors on motives and beliefs were identified using
multiple linear regression.
Results: Response rate was 24.2% (281/1162), with respondents comparable in age and gender
to all GPs in Baden-Wuerttemberg. GPs’ motives and beliefs towards task shifting are positive
overall. The majority expects task shifting to reduce their workload (87.9%) and increase practice
efficiency (74.7%). They are open to shift additional tasks to other professionals (69.1%), even in
the currently prohibited form of substitution (51.2%). Motives and beliefs were significantly more
positive among younger GPs and those participating in the GP-centred care programme.
Conclusion: This study describes GPs’ motives and beliefs towards task shifting in non-urban
Germany. Identifying younger GPs and those participating in the GP-centred care programme as
particularly endorsing may help design future interventions aiming to improve efficiency in
general practice in non-urban Germany.
Abbreviations: GPs: General practitioners; MA: Medical assistant; TDF: Theoretical Domains
Framework; SD: Standard deviation.
Introduction
General practice is challenged by the rise of chronic
diseases in an ageing population [1,2] as most health
needs are treated in general practice [3,4]. In Germany,
this is especially true in non-urban areas, where the
relative amount of older people is higher [5] and gen-
eral practitioners (GPs) spend more time performing
home visits [6,7], resulting in a higher time exposure
per patient compared to urban areas [8]. Concurrently,
GPs are replaced at an insufficient rate, resulting in an
© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
CONTACT Heiner Averbeck heiner.averbeck@medma.uni-heidelberg.de Heidelberg University Medical Faculty Mannheim, Center for Preventive
Medicine and Digital Health (CPD), Division of General Medicine, Röntgenstraße 7, DE-68167 Mannheim.
Supplemental data for this article is available online at https://doi.org/10.1080/13814788.2024.2413123.
https://doi.org/10.1080/13814788.2024.2413123
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which
permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been
published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
ARTICLE HISTORY
Received 8 December
2023
Revised 22 September
2024
Accepted 1 October 2024
KEYWORDS
General practice; primary
health care; delivery of
health care; task shifting;
delegation
2 H. AVERBECK ETAL.
ageing GP workforce, foreshadowing an imminent
shortage in GP services [9,10]. One option to address
this mismatch might be to improve efficiency in gen-
eral practice. Recent reviews have shown that
team-based approaches may improve efficiency and
be beneficial for patients [11–13]; however, the amount
to which these insights are transferable to the specific
setting of German general practice is unclear.
In contrast to other European countries (e.g. Spain
or the United Kingdom), most GPs work in solo prac-
tices comprising one or two GPs [14]. Medical tasks are
performed by GPs or to a lesser extent by medical
assistants (MAs) as the only other established profes-
sion [15] (German: Medizinische Fachangestellte).
Attempts to introduce additional professions such as
physician assistants remain limited to individual proj-
ects and are not common yet [16,17]. Thus, team-based
approaches in German general practice remain limited
to task shifting from GPs to MAs.
To promote task shifting, two major training pro-
grammes for MAs, ‘Healthcare assistants in general
practice’ (German abbreviation: VerAH) and ‘Non-physician
practice assistant’ (NaePA), have been implemented [18].
However, both programmes are not ubiquitously
adopted [19] and MA responsibilities remain narrower
compared to international examples (e.g. the United
Kingdom or Denmark) [20,21].
This is partly due to legal restrictions. Specifically,
task shifting is limited to performing tasks delegated
by GPs. Therein, GPs remain responsible for any task
performed and are obligated to ensure adequate qual-
ification of MAs. Although performed in other coun-
tries, the more extensive form of substitution, where
MAs perform tasks without supervision or outside the
organisational structure of general practice, is prohib-
ited by law. Currently, although task shifting has been
shown to improve practice efficiency [22–25], GPs feel
insecure about legal specifications [19,26,27] and per-
ceive remuneration for tasks shifted to MAs as increas-
ingly complicated [19].
This complexity has been addressed by implementa-
tion of the GP-centred care programme (German: hau-
sarztzentrierte Versorgung). Opposed to the regular
remuneration system, where remuneration is organised
in small capitation fees accompanied by numerous fees
for service, remuneration in the GP-centred care pro-
gramme is delivered mainly in capitation fees. Although
being voluntary for both patients and GPs, patients for-
feit their right to consult any physician at any time and
are obligated to consult their GP first. Thereby, it aims
to improve care coordination by introducing a gate-
keeping role, as in Belgium or the United Kingdom
[14,28]. Patients profit from improved care coordination
and consequent health benefits [29,30], while GPs profit
from less bureaucratic remuneration. Finally, the pro-
gramme specifically promotes task shifting by financially
incentivising training programmes for MAs and simplify-
ing remuneration of tasks shifted to MAs. Still, the
resulting effect on task shifting remains unknown.
To expand task shifting in general practice, a
behaviour change of decision-makers is necessary. As
most practices are owned and operated by GPs, they
decide who performs which task in their practice,
making them the primary decision-makers in their
practices. Thus, it seems natural to focus on GPs’
motives and beliefs using behaviour change theory.
Previous studies established a high ‘willingness to
delegate’ among GPs [19,24,31–33] and facilitators
such as a reduced workload [24,34] or barriers such as
lacking financial incentives [24] or legal concerns [19].
However, underlying motives and beliefs [32] as well
as reasons for the gap between ‘willingness to dele-
gate’ and actual involvement of MAs [31] remain
vague. Specifically, findings indicating women [24,35],
young GPs [24,26,35] or GPs working in group prac-
tices [26,35] being more willing to delegate were not
replicated in more recent studies [31]. Furthermore, no
studies focused on non-urban areas, where motives
and beliefs might differ, due to organisational specifics
such as the higher number of home visits or lower
accessibility of secondary care [6,7]. Ultimately,
although some factors influencing delegation have
been identified, underlying motives and beliefs remain
elusive, leaving tangible ways to expand task shifting
in German general practice undetermined.
Objectives
Therefore, this study aims to explore GPs’ motives and
beliefs towards task shifting to MAs, to increase prac-
tice efficiency in non-urban general practice in
Germany and to identify factors influencing these
motives and beliefs.
Methods
Setting
Study design is a cross-sectional survey among all GPs
currently active in non-urban areas in the state of
Baden-Wuerttemberg, Germany. Baden-Wuerttemberg
was selected as a convenience sample resulting from
the conducting institute’s connections in the state.
The federal Office for Building and Regional
Planning provides two county-level definitions of
Non-Urbanity (population density and population
EUROPEAN JOURNAL OF GENERAL PRACTICE 3
reachable in a pre-defined travel time) [36]. 12 of the
44 counties in Baden-Wuerttemberg met one or both
definitions. GPs working in either of the 12 counties
represented our target sample. GPs were defined as all
physicians currently active in general practice, as
defined by German law (general internal medicine,
general practice and paediatrics). As challenges such
as the management of chronic diseases may impact
paediatrics differently, we excluded paediatrics from
our target sample.
To identify members of the target population, we
used a database provided by commercial marketing
agencies targeting physicians. After removal of dou-
blets and invalid address sets (e.g. not currently active
as a GP), 1,162 of 1,383 initially acquired address sets
were identified as eligible, representing our study sam-
ple. According to data from the Association of Statutory
Health Insurance Physicians, which registers all cur-
rently active physicians, approximately 1,250 GPs
should qualify as eligible, indicating some non-inclusion
of the study population. No public data specific to our
sample were available to further check for representa-
tiveness of the study population (e.g. gender).
Survey
The survey was self-designed, as no validated survey
assessing this topic exists. The Theoretical Domain
Framework (TDF) was applied as the theoretical basis,
as it is designed to explore factors influencing behaviour
change and is well established in health services
research. It comprises 14 domains potentially influenc-
ing behaviour change, 9 of which were represented in
the survey in 15 five-point Likert-scale items (1 =
Strongly disagree, 2 = Disagree, 3 = Neither agree nor
disagree, 4 = Agree, 5 = Strongly agree; Table 3). The
items were designed using validated question stems
[37] and pretested, as reported in detail in the study
protocol [38].
The final survey (Supplement 1) included items
addressing demographics, practice characteristics (e.g.
participation in the GP-centred care programme) and
15 Likert-scale items addressing motives and beliefs
towards task shifting to MAs.
Survey administration
We administered the survey by standard mail. Mailings
included a personalised cover letter describing the
purpose of the study, the survey, a response form, a
free return envelope and a second envelope without
identifier to contain the completed survey, ensuring
respondents’ anonymity.
The survey was administered in three waves in July
and August 2021 and August 2022. The third wave, ini-
tially planned for September 2021, was postponed due
to the COVID-19 vaccine booster campaign starting in
September 2021. We expected response rates to drop
significantly, because of the growing workload. Thus, in
consultation with associated GPs, we identified summer
2022 as most suitable to administer the final wave.
Analysis
Survey responses were scanned, digitally converted
and uploaded into a database. Unreadable answers
were censored. All data were checked for plausibility
before analysis (e.g. identical responses across all
items), incomplete survey data were included in the
analysis if applicable, with missing items reported.
We performed descriptive data analysis without
adjusting for potential statistical errors or non-
representativeness and did not perform sensitivity
analyses. Practice type was dichotomised into solo
practice and group practice, disregarding further dis-
crimination between medical care centre, group prac-
tice and joint practice. No other modification of items
was performed.
Analysis to identify influencing factors on motives
and beliefs was performed using a multiple linear
regression model between demographics, practice
characteristics and TDF items. Data analysis for multi-
ple linear regression was conducted in R version 4.2.3.
Ethics approval and consent to participate
The study has been approved by the Ethics Committee
II of Heidelberg University, Mannheim Medical Faculty
in April 2021 (Approval no. 2021–530). Consent for
participation in the survey was assumed when the sur-
vey was returned.
Results
Respondent characteristics
Of 1,162 surveys, 281 were returned, resulting in a
response rate of 24.2%. Respondents’ characteristics
are reported in Table 1.
Motives and beliefs towards delegation
Table 2 shows GPs’ responses to Likert-scale items
addressing motives and beliefs towards delegation. The
majority of respondents aim to reach the highest effi-
ciency possible in their practices (mean = 4.08, SD =
4 H. AVERBECK ETAL.
0.94) and delegation comes to mind when thinking
about ways to achieve this goal (mean = 4.14, SD =
0.91). They feel able to implement changes to processes
in their practices (mean = 4.06, SD = 0.85) and expect
delegation to reduce their personal workload (mean =
4.27, SD = 0.83) and increase efficiency in their practice
(mean = 3.98, SD = 0.92). Further, most do not fear an
impairment of patient treatment when delegating tasks
to MAs (mean = 2.30, SD = 1.00). Ultimately, the major-
ity of GPs are open to delegate additional tasks to MAs
in the future (mean = 3.70, SD = 1.19) and, to a lesser
extent, most GPs are open to shifting tasks to MAs in
the form of substitution (mean = 3.32, SD = 1.19).
Inuencing factors on motives and beliefs towards
delegation
Table 3 shows results of the multiple linear regression
model correlating demographics and practice charac-
teristics with TDF items. The model included N = 224
surveys, due to missing values in N = 57 responses. A
more detailed table is provided in supplement 2.
We identified GPs’ age, average working hours,
practice type and participation in the GP-centred care
programme as influencing factors on GPs’ motives and
beliefs. Older GPs described themselves significantly
less often as being able to implement changes in their
practices, less likely to aim for the highest efficiency
possible and delegation comes to mind less often
when thinking about increasing practice efficiency.
Participation in the GP-centred care programme sig-
nificantly influences motives and beliefs towards dele-
gation. Participants identify as first to implement new
models in health care or practice organisation and del-
egation comes to mind more often as an option to
increase practice efficiency. They are more open to
delegate additional tasks to their personnel and subse-
quently intend to do so in the future. Fittingly, partic-
ipants’ beliefs about consequences are more positive.
They expect a reduced workload and increased prac-
tice efficiency, without expecting an impaired patient
treatment. Finally, participants are more open to trans-
fer tasks in the form of substitution.
Discussion
Summary
We explored GPs’ motives and beliefs towards task shift-
ing to MAs to increase practice efficiency in non-urban
GP in Germany. Motives and beliefs were positive, indi-
cating fertile ground to advance team-based care and,
more specifically, task shifting in the future.
For the first time, participation in the GP-centred
care programme was identified as major influencing
factor. To a lesser extent, we confirmed previously
identified factors such as age, working hours and prac-
tice type to influence GPs’ motives and beliefs, whereas,
opposed to previous findings, gender and employ-
ment status did not.
Comparison with existing literature
Young GPs having more positive beliefs about delega-
tion has been shown before [23,39,40], although more
recent studies did not find similar associations [31].
This seems unintuitive, as experience in delegation fos-
ters positive beliefs [26] and younger, thus less experi-
enced, GPs still show more positive beliefs than older,
more experienced GPs. Although lacking an explana-
tion, this raises hopes for more team-based care in the
future, especially as the reduced workload and
improved time management is strongly agreed upon
once more [19,24–26,31,41].
Most significantly, we identified participation in the
GP-centred care programme as a major influencing
factor on motives and beliefs. Although being hinted
at before [40], for the first time we describe its influ-
ence in detail. Although training of and delegating to
MAs is financially incentivised, participants did not
expect delegation to be financially worthwhile more
often, hinting towards other specifications of the pro-
gramme being responsible for its influence. Possibly,
the programme addressing previously identified barri-
ers, such as increasing bureaucracy and unclear legal
conditions [19] when delegating to Mas, or benefits
not addressed in this study, such as increased work
satisfaction [26] or improved patient care, may encour-
age more positive motives and beliefs in participants.
Table 1. Respondents’ characteristics.
nMean SD
Age 280 56.8 9.8
1
Working Hours per week 255 47.5 12.0
Missing 26
Gender n %
Male 169 60.6
Female 110 39.4
Non-binary 0 0.0
Missing 2
Employment Status n %
Self-employed 250 90.6
Employed 26 9.4
Missing 5
Practice Type n %
Solo practice 131 49.4
Group practice 134 50.6
Missing 16
GP-centred care n %
Participant 192 71.1
Non-participant 78 29.9
Missing 11
EUROPEAN JOURNAL OF GENERAL PRACTICE 5
Table 2. General practitioners’ motives and beliefs towards task shifting.
Item n Mean SD
1. Strongly
disagree 2. Disagree
3. Neither
agree nor
disagree 4. Agree
5. Strongly
agree
4.1 I work in a region where there is currently a shortage in primary care supply. 281 3.96 ±1.17 2.5% 14.6% 11.4% 27.4% 44.1%
4.2 I am one of the rst to implement new models in health care or practice organisation. 277 2.99 ±1.21 13.4% 22.4% 27.8% 25.3% 11.2%
4.3 I am able to implement changes to the processes in my practice. 281 4.06 ±0.85 0.4% 7.5% 8.9% 52.7% 30.6%
4.4 I am well-informed about the possibilities of delegation. 281 3.84 ±0.94 1.1% 10.3% 16.7% 47.7% 24.2%
4.5 When I think about eciency in my practice, the use of delegation plays a role. 279 4.14 ±0.91 0.7% 7.9% 7.2% 45.2% 39.1%
4.6 My goal for this practice is to achieve the highest eciency possible. 280 4.08 ±0.94 0.7% 7.5% 13.2% 40.0% 38.6%
4.7 I will delegate as many tasks as possible to my non-physician medical sta in the future. 279 3.73 ±1.08 1.8% 15.4% 18.6% 36.6% 27.6%
I think that an increase in delegation of medical tasks to non-physician medical sta in my practice…
4.8 … increases patient satisfaction. 281 3.19 ±1.05 3.6% 26.7% 28.1% 31.0% 10.7%
4.9 … impairs the treatment of my patients. 280 2.30 ±1.00 25.0% 33.6% 29.3% 10.7% 1.4%
4.10 … reduces my workload. 281 4.27 ±0.83 0.4% 5.3% 6.4% 43.1% 44.8%
4.11 … increases eciency in my practice. 281 3.98 ±0.92 0.7% 7.1% 17.4% 42.7% 32.0%
4.12 … is nancially worthwhile for my practice. 279 3.52 ±1.04 2.2% 15.4% 30.8% 31.5% 20.1%
4.13 I am open to delegating additional medical activities to my practice personnel. 278 3.70 ±1.10 4.7% 12.9% 12.6% 47.1% 22.7%
4.14 I am open to delegating additional medical activities to my practice personnel if they
obtained additional training.
277 3.87 ±1.03 3.2% 9.7% 12.3% 46.6% 28.2%
4.15 I am open to transferring medical tasks to my practice personnel in the sense of
substitution.
277 3.32 ±1.19 7.3% 21.1% 20.4% 34.5% 16.7%
N = 281
6 H. AVERBECK ETAL.
Table 3. Factors inuencing general practitioners’ motives and beliefs towards task shifting.
Gender Age Workload Employment status Practice-type GP-centred care
Male (Ref.)
Female/
diverse (years) (hours/week)
Self-employed
(Ref.)
Employee
Solo practice
(Ref.)
Group practice
Non-participant
(Ref.)
Participant
4.1 I work in a region
where there is
currently a
shortage in
primary care
supply.
Estimate −0.14 −0.01 0.02 0.11 0.04 0.39
4.2 I am one of the rst
to implement new
models in health
care or practice
organisation.
Estimate 0.25 −0.01 0.02** 0.32 0.44* 0.91***
4.3 I am able to
implement
changes to the
processes in my
practice.
Estimate −0.05 −0.02*** 0.01 −0.23 0.45*** 0.16
4.4 I am well-informed
about the
possibilities of
delegation.
Estimate 0.08 −0.01 0.01 −0.05 0.22 0.30
4.5 When I think about
eciency in my
practice, the use
of delegation
plays a role.
Estimate −0.08 −0.02** 0.01 0.08 0.04 0.67***
4.6 My goal for this
practice is to
achieve the
highest eciency
possible.
Estimate −0.28 −0.02* 0.01 0.08 0.12 0.30
4.7 I will delegate as
many tasks as
possible to my
non-physician
medical sta in
the future.
Estimate 0.04 −0.02 0.01 −0.15 0.04 0.41*
I think that an increase in delegation of medical tasks to non-physician medical sta in my practice…
4.8 … increases patient
satisfaction.
Estimate −0.18 −0.02 0.01 0.37 −0.01 0.35
4.9 … impairs the
treatment of my
patients.
Estimate 0.00 0.01 0.00 −0.06 −0.03 −0.35*
4.10 … reduces my
workload.
Estimate 0.07 −0.02*** 0.00 −0.03 −0.11 0.29*
4.11 … increases
eciency in my
practice.
Estimate 0.04 −0.03*** 0.01 0.01 0.00 0.41**
4.12 … is nancially
worthwhile for my
practice.
Estimate −0.12 −0.03*** 0.00 0.20 −0.15 0.25
4.13 I am open to
delegating
additional medical
activities to my
practice personnel.
Estimate −0.20 −0.02 0.01 −0.06 0.06 0.84***
4.14 I am open to
delegating
additional medical
activities to my
practice personnel,
if they obtained
additional training.
Estimate 0.27 −0.02* 0.01 0.09 0.09 0.68***
4.15 I am open to
transferring
medical tasks to
my practice
personnel in the
sense of
substitution.
Estimate 0.08 −0.01 0.01 0.24 0.03 0.78***
N = 224; * p < 0.05; ** p < 0.01; *** p < 0.001.
Bold values signify the most relevant signicance values.
EUROPEAN JOURNAL OF GENERAL PRACTICE 7
Finally, we confirmed the openness of GPs to trans-
fer tasks in the form of substitution [35], particularly in
young GPs and participants of the GP-centred care
programme. Although currently prohibited by law,
international examples suggest that this may help fur-
ther advancing efficiency in GP [11], warranting recon-
sideration of this policy.
Strengths and limitations
Several caveats must be considered. First, the
response rate, although comparable to previous
works in similar settings [26,31,40,42], and address
data not obtained from registers might lead to selec-
tion or non-coverage bias. As no registry data identi-
fying only GPs working in rural areas in
Baden-Wuerttemberg were available (e.g. registry of
the Association of Statutory Health Insurance
Physicians), address data were acquired using com-
mercial sources. These data did not include demo-
graphics, leaving us unable to test representativeness
of our sample. However, aggregate data by the
Association of Statutory Health Insurance Physicians
suggest similar gender (female/male/diverse
46%/54%/0%) and age distribution (mean 55.4 years)
[43,44] between our sample and all GPs working in
Baden-Wuerttemberg, indicating representativeness
to some extent. Still, factors such as the socioeco-
nomic status of the population treated in each prac-
tice were not addressed in this study, potentially
leaving other influencing factors on GPs’ motives and
beliefs obscure.
Second, the application of the survey was spread
over a longer period, as the third wave was postponed
past the COVID-19 booster campaign. The huge num-
ber of vaccinations and the strain put on general prac-
tice during the booster campaign might have
influenced responses. Due to the study design, we
could not test for differences between waves, leaving
its influence unclear.
Although survey items have not been psychometri-
cally tested before conducting the study, we see the
theory-guided approach as a strength. Thus, despite
not all TDF domains being operationalised in the sur-
vey, this study provides valuable insights and raises
questions for future research.
Finally, this study focuses solely on GPs, leaving the
perspectives of MAs, patients and other stakeholders
undetermined. Clearly, these must be considered when
making organisational changes in general practice.
Although previous research shone some light on this
topic [32,45–50], further research focusing on these
perspectives is necessary.
Implications for research and practice
Reasons for the influence of the GP-centred care pro-
gramme remain unclear. Specifically, as we did not find
financial incentives particularly relevant to participants,
other specifications may foster positive motives and
beliefs. Future research should focus on identifying spe-
cifics of the programme influencing task shifting, e.g.
organisation rather than amount of remuneration, to
help transfer its benefits into other healthcare systems.
Furthermore, liberating legal restrictions, e.g. the per-
mission of task shifting in the form of substitution,
might help increasing efficiency in general practice,
although undesired effects, such as the risk of lower
remuneration for tasks substituted, must be considered.
Conclusion
Most GPs are willing to expand task shifting in
non-urban general practice. This study provides a
deeper understanding of underlying motives and
beliefs and identifies younger GPs and those partici-
pating in the GP-centred care programme as particu-
larly endorsing. This may inform future initiatives
aiming to increase efficiency in general practice, ulti-
mately mitigating the increasing shortage in GP ser-
vices. For now, concepts on how to expand task
shifting and ultimately advance team-based care in
general practice need to be further explored and clar-
ification of reimbursement as well as reconsideration
of legal restrictions is necessary.
Notes
We use the term ‘general practice’ as translation for the
term commonly used in Germany: ‘hausaerztliche
Versorgung’. Other translations for the German term
may include ‘family medicine’ or ‘primary care’, depend-
ing on the specific roles assumed by physicians in dif-
ferent healthcare systems.
Author contributions
HA (Principal Investigator) conceptualised the study as part
of his dissertational project. JF advised on the study design.
JR, RD and HA performed data analysis. HA, SS and JF con-
ducted data interpretation. HA produced the rst draft of
the manuscript, which was revised by JR, SS and JF. All
authors reviewed and approved the nal version of the
manuscript.
Disclosure statement
No potential conict of interest was reported by the
author(s).
8 H. AVERBECK ETAL.
Funding
This research received no specic grant from any funding
agency in the public, commercial, or not-for-prot sectors.
ORCID
Heiner Averbeck http://orcid.org/0000-0001-5925-7837
Simon Schwill http://orcid.org/0000-0002-0954-2194
Data Availability statement
The data sets used and/or analysed during the current study
are available from the corresponding author upon reason-
able request.
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