Initial assessment of the urgency of treatment requests in the GP practice - a qualitative study on the perspective of medical assistants

Background

Patients often turn to their GP practice first when seeking treatment of any kind. The initial assessment of the urgency of these concerns is usually made by medical assistants (MFA). They play a central role in prioritising treatment requests and managing patients in GP care. Despite this important function, there has been insufficient scientific research into how the initial assessment is carried out in GP practices, which strategies and concepts are used and what role structured initial assessment systems play in everyday practice.

Aims

The aim of the study is to explore existing processes for the initial assessment of the urgency of treatment requests in GP practices from the perspective of medical assistants. The aim is to describe internal practice procedures and identify everyday challenges, influencing factors and opportunities for improvement. The exploration and analysis of current care practice can contribute to the long-term development of a safe and prompt initial assessment in GP practices.

Methods

The EiDiHa study is a monocentric, explorative cross-sectional study. Guideline-based interviews were conducted with ten medical assistants from general practitioner practices in statutory health care. The interviews were analysed using qualitative content analysis according to Kuckartz and Rädiker.

Duration

From June 2026

Contact persons:

• Tomke Jürgens (doctoral student in human medicine):
• Dr Imke Aits, M.Sc. PH:

BackgroundAgainst the backdrop of demographic change, the German healthcare system is confronted with an increasing need for care with limited human resources, making the coordination of inpatient and outpatient care increasingly important. Inadequate planning or coordination of discharge can lead to interruptions in care, medication errors, delayed rehabilitation, increased stress for relatives and avoidable readmissions to hospital. After being discharged from hospital, patients usually turn to their GP for further medical care, but they are often only able to communicate with other medical service providers involved to a limited extent. However, inadequate communication with the GPs providing further treatment jeopardises patient safety and continuity of care. Difficulties in the intersectoral transition are primarily digital hurdles in the form of incompatible systems for data management between hospitals and practices, the lack of nationwide establishment of an electronic patient record, incomplete medication plans and insufficient interprofessional communication between outpatient follow-up providers.

ObjectiveThe aim of the EMIS-HA study is to record the discharge management of regional hospitals in north-west Germany from the perspective of general practitioners providing further treatment, focussing on the perception and satisfaction of respondents with regard to structural and procedural aspects of discharge management and the quality of intersectoral communication. In addition, differences between urban and rural clinics as well as strengths and weaknesses of current practice and potential starting points for health policy interventions are to be evaluated.

MethodologyThis is a monocentric, qualitative, explorative observational study in which interviews are conducted with thirteen general practitioners practising in north-west Germany. The evaluation is carried out after transcription with the qualitative data analysis software MAXQDA.

DurationFrom April 2026

Contact persons:

• Amrei Küpker (student of human medicine);
• Dr Imke Aits, M.Sc. PH;

Targeted early detection of atrial fibrillation in the GP practice

Background
Atrial fibrillation (AFib) is a very common cardiac arrhythmia that often occurs repeatedly for short periods of time as paroxysmal AFib. Even very short-term AF increases the risk of an ischaemic stroke. Paroxysmal AF often remains undetected or is only discovered by chance. However, if AF is recognised in time, oral anticoagulation can significantly reduce the risk of stroke. There is insufficient evidence for an optimal screening approach for AF. AF screening requires an approach that pre-selects patients at increased risk and optimises the duration and frequency of ECG monitoring. It is known that the prevalence increases with age and high blood pressure.

Objectives
The "Target-AF" project aims to improve GP care for older people with an increased risk of stroke through evidence-based, systematic early detection of AF. To this end, the effectiveness of a structured screening intervention in patients at high risk of AF and approaches to risk stratification in GP practices in Germany are being investigated.

Methods
Target-AF is a multicentre, open-label, two-arm (intervention vs. control, 1:1) randomised controlled trial (RCT). Patients from GP practices aged 70 years or older with known hypertension, no prior diagnosis of AF and no anticoagulation are eligible for participation in the study. Up to 1000 participants will be recruited in 72 GP practices of FoPraNet Nord. In each of the six regions, 12 practices will recruit 13-14 patients each. All participants first receive a 24-hour Holter ECG to rule out an existing AF and to check for frequent supraventricular extrasystoles, a potential risk marker. A blood sample will be taken to measure biomarkers that may predict AF (NTproBNP, CDT, TSH and creatinine). Participants will be randomised 1:1 to receive either usual care at the discretion of the treating physician (control group) or an intervention with 7-day ECG monitoring at study enrolment, 3, 12, 24 and 36 months or until detection of atrial fibrillation >30 seconds (intervention group). All patients will be surveyed on their quality of life, health status, cardiovascular and bleeding events and healthcare utilisation at study enrolment and after 3, 12, 24 and 36 months. The primary endpoint is the detection of AF (>30 sec) within 36 months. The secondary objective is to assess the predictive value of biomarkers and supraventricular extrasystoles both individually and in combination.

Relevance of the expected results
The project will provide data on effect sizes and implementation parameters that will serve as the basis for the design of a future, statistically significant randomised controlled trial on stroke prevention through targeted screening for atrial fibrillation.

Funding
The project is funded by the German Federal Ministry of Research, Technology and Space (BMFTR) (funding reference 01GK2502A). The project duration is 60 months (01.05.2026 to 31.04.2031).

Project leader

• Prof Dr Eva Hummers and Dr Eva Maria Noack, Institute of General Medicine, University Medicine Göttingen

Project partners

• Prof Dr Martin Scherer, Institute and Polyclinic of General Medicine, University Medical Center Hamburg-Eppendorf
• Prof Dr Nils Schneider, Institute of General Practice and Palliative Medicine, Hannover Medical School
• Prof Dr Michael Freitag, Division of General Medicine, Department of Health Services Research, University of Oldenburg
• Prof Dr Jean-François Chenot, Department of General Medicine, Institute of Community Medicine, University Medicine Greifswald
• Prof Dr Ralf Jendyk, Institute of General Medicine, Rostock University Medical Centre
• Prof Dr Rolf Wachter, Clinic and Polyclinic for Cardiology, University of Leipzig
• Priv.-Doz. Sara Yasemin Nußbeck, Central Biobank, University Medical Centre Göttingen
• Prof Dr Christian Thies, School of Computing Science, Reutlingen University of Applied Sciences
• Prof Dr Markus Bleckwenn, Institute of General Medicine, University of Leipzig
• Prof Dr Tim Friede, Institute for Medical Statistics, University Medical Center Göttingen

Contact person

• Dr Imke Aits M.Sc:
  

Guideline-compliant care for patients with depression in GP practices: Multicentre, cluster-randomised intervention using an online self-help tool

Background
Depression is one of the most common mental illnesses worldwide. The individual risk of illness and the population-related burden of disease are high and increasing, especially for people of working age.

GPs play a central role in the care of people with depression. However, guideline-compliant diagnosis and treatment is often inadequately implemented in primary care.

Objectives
The aim of the SCOPE-D project is to improve primary care for patients with depression in Germany by 1) promoting the implementation of the National Care Guideline for Unipolar Depression and 2) strengthening psychosomatic primary care by integrating the online self-help tool deprexis®.

Methods
SCOPE-D is a multi-centre, cluster-randomised intervention study at six locations under the umbrella of the supra-regional research practice network FoPraNet-Nord. By means of interviews with GPs, analyses of routine data and questionnaire surveys of patients, changes in care routines and the effectiveness of the online self-help tool deprexis® in the context of psychosomatic primary care are to be investigated.
Relevance of the expected.

Results
The results are of great practical importance, as they are intended to sustainably promote professional expertise, research competence and the implementation of guideline-based depression care in GP practices. They can contribute to the evidence-based further development of clinical guidelines and curricula for psychosomatic primary care, in particular through the systematic integration of digital self-help tools.

Funding
The project is funded by the Federal Ministry of Research, Technology and Space (BMFTR) (funding reference 01GK2505A). The project duration is 42 months (01.04.2026 to 30.09.2029).

Consortium management

• Prof Dr Nils Schneider and PD Dr Kambiz Afshar, Institute of General Medicine and Palliative Medicine, Hannover Medical School

Consortium partners

• Prof Dr Martin Scherer, Institute and Polyclinic of General Medicine, University Medical Center Hamburg-Eppendorf
• Prof Dr Eva Hummers, Institute of General Medicine, University Medical Centre Göttingen
• Prof Dr Michael Freitag, Division of General Medicine in the Department of Health Services Research, University of Oldenburg
• Prof Dr Jean-François Chenot, Department of General Medicine, University Medicine Greifswald
• Prof Dr Ralf Jendyk, Institute of General Medicine, Rostock University Medical Centre
• Prof Dr Christian Krauth, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School
• Prof Dr Antonia Zapf, Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf

Co-operation partner

• Prof Dr Christian Thies, School of Computing Science, Reutlingen University of Applied Sciences

Contact persons

Nina Willerscheidt M.Sc.:
Dr Imke Aits M.Sc : imke.aits@uol.de

CARE - Comprehensive Assessmentof RenalHealth for Everyone

Improving primary care for chronic kidney disease - a study on the implementation of the CKD guideline

Chronic kidney disease (CKD) affects 8-10 million people in Germany and is mainly treated by GPs. The CARE project is investigating how GP care for people with chronic kidney disease not requiring renal replacement therapy can be improved.

The focus is on the question of how an individual risk assessment for possible kidney failure can contribute to more guideline-compliant treatment. This is based on kidney function values from blood and urine tests as well as the age and gender of the patients. This data is systematically recorded in participating practices. Some of the practices receive a re-registering student on the treatment.

The aim of the study is to investigate whether this approach improves the quality of care and has a positive effect on the course of the disease, particularly with regard to the progression of kidney disease.

Laufzeit: 01.04.2026-30.09.2030

Financing: Federal Ministry of Research, Technology and Space (BMFTR)

Contact persons:
Marianne Timper M.Sc.:
Dr Imke Aits M.Sc : imke.aits@uol.de

Project partners:
FoPraNet-North

The influence of counselling during health check-ups in general practice on patients' lifestyles

Background

Prevention is an important part of the work of general practitioners. The statutory health examination (health check-up) includes a consultation with the doctor as well as a full-body status assessment. The influence of this counselling is to be investigated as part of this research project.

Aim

The aim of the GUBER study is to investigate the effects of GP counselling on patients' lifestyles:

• Which areas of lifestyle are addressed?
• What influence can general practitioners exert with their counselling?

The present project is a cross-sectional survey with a quantitative study design. With the help of an (online) questionnaire, patients in GP practices are asked about their experiences. The results can be used to draw conclusions about the importance of GP consultations.

Duration: from November 2024

Contact person:

Christian Hübner (doctoral candidate in human medicine):

Dr Imke Aits M.Sc:

Utilisation of urological screening examinations - a qualitative analysis of patients' participation decisions

Background

In Germany, the urological screening examination is offered by the statutory health insurance funds for men aged 45 and over and includes a digital rectal examination of the prostate and rectum, palpation of the inguinal lymph nodes and the external genital organs. The determination of the PSA value (prostate-specific antigen) as part of the screening is a self-payer service. The benefits and harms of the examination are still being debated. Overall, the statutory urological screening examination is only utilised by around a third of men in Germany.

Objective

The low utilisation rate in conjunction with the current debate about urological screening examinations, in particular the determination of the PSA value, gives rise to a closer examination.

The objectives of the research project are

1. To determine the reasons for or against participation in urological screening.
2. to determine other factors that influence the utilisation of urological screening.
3. to analyse different perspectives on urological screening.

This project is a cross-sectional survey with a qualitative study design. Patients, general practitioners and urologists are interviewed using guided interviews.

Duration: from December 2024

Contact person:

Carlotta Martin (student of human medicine): carlotta.marie.martin@uni-oldenburg.de

Dr Imke Aits M.Sc. (PH):

Mental health and its influencing factors in medical studies - a cross-sectional survey of medical students in Oldenburg

Background

Previous research has shown a high prevalence of depressive symptoms among medical students. Depressive disorders are often associated with a significantly reduced quality of life and performance for those affected. As only healthy doctors can provide their patients with the best possible care, the mental health of this professional group should already be taken into account during their studies.

Aim

This project aims to regularly record certain aspects of the mental health of students of human medicine at the University of Oldenburg. Based on the results, existing support programmes can be evaluated and, if necessary, new programmes tailored to the needs of the students can be implemented. The aims are...

1. Regular recording of the frequency of depressive symptoms among Oldenburg medical students
2. Identification of influencing factors in the form of stressors or socio-demographic characteristics
3. Evaluation of existing support services and survey of the need for and desired form of further services

This project is a cross-sectional survey with a quantitative study design. With the help of a developed online questionnaire, the above-mentioned data will be collected from Oldenburg medical students and then analysed descriptively.

Duration: from November 2023

Responsibilities
Jana, Paehl¹, Dr Imke Aits¹

_FacultyVI Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany

Contact person::

Jana Paehl (doctoral candidate in human medicine):

Dr Imke Aits M.Sc. (PH):

Sub-project 2: Diagnosis and treatment of urinary tract infections in Dutch and German primary care centres and their influence on the prevalence of antibiotic-resistant bacteria

Background

Antibiotic resistance is a global public health problem. Infections with resistant bacteria are more difficult to treat and previously treatable infectious diseases can become life-threatening. Worldwide, the treatment options for infectious diseases, including the prescription of antibiotics, differ between countries. There are also striking differences between neighbouring countries such as Germany and the Netherlands, although the causes are still largely unknown.

Aim

This project aims to investigate differences and similarities in the management, incidence and treatment of infectious diseases in the Ems-Dollard region with a focus on primary care. Particular attention will be paid to urinary tract infections (UTIs) as these are one of the most common infectious diseases in primary care and one of the main reasons for antibiotic prescribing. Specific objectives of the project are:

1. the systematic comparison of primary care systems on both sides of the border, including aspects of infrastructure, guidelines, financing of diagnostics and treatment of patients with urinary tract infections (UTIs),
2. a better understanding of the daily routine and reality of GPs in the treatment of UTIs and
3. the determination of the prevalence of antibiotic-resistant pathogens isolated from UTIs.

The following methods will be used

• Literature research on infrastructure, general healthcare conditions and practice guidelines for the treatment of UTIs
• Interviews with German and Dutch general practitioners to investigate the differences in the diagnosis and treatment of patients with a UTI
• Investigations of patients with symptoms of uncomplicated UTI in the north of the Dutch-German border region to determine and compare the causative pathogens and their resistance patterns
• Comparison of the results with inpatient data of hospitalised patients with urinary tract infections

DurationApril 2021 until October 2024

Funded by: Ministry of Science and Culture of Lower Saxony

Responsibilities

Dr Corinna Glasner¹ ,Prof Dr Michael Freitag²

Members of the project

Prof. Dr Axel Hamprecht², Dr Marco Blanker¹, Prof. Dr Alexander Winter², Dr Bianca Michalik², Dr Henk van der Worp¹, Dr Matthijs Berends1^,3, Dr Joppe van Duijn³, Dr Alewijn Ott³, Dr Imke Aits², Aida Bedri²

_{¹University Medical Center Gronigen, University of Groningen, Groningen, Netherlands
² University Medicine Oldenburg, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
³ Certe Medische Diagnostiek en Advies [Certe Medical Diagnostics and Counselling], Groningen, Netherlands}

Contact person::

Aida Bedri, M.Sc. Epidemiology (Research Associate):

Department of Health Services Research, Division of General Medicine under the direction of Prof Dr Michael Freitag

Development and evaluation of a concept for interprofessional cooperation

for patients with palliative care needs

Background and objectives

The care of people with progressive non-oncological chronic diseases is a challenge in general practice. Affected patients often suffer for years from severe pain, shortness of breath, anxiety or other accompanying symptoms. Specialised outpatient palliative care (SAPV) focuses on controlling these symptoms. In the advanced stages of the disease, patients are often hospitalised, which could potentially have been avoided through early symptom relief and control. Despite the expansion of general outpatient palliative care (AAPV) - supplemented in 2017 by specially qualified and coordinated outpatient palliative medical care (BQKPMV) - case-related consultations between GPs and SAPV are not provided as part of standard care.

The aim of the KOPAL study is to optimise care at the end of life by intensifying outpatient interdisciplinary and interprofessional cooperation, thereby reducing hospital stays, reducing the symptom burden and improving quality of life.

Design and methodology

• Two-arm cluster-randomised, controlled intervention study at four sites in northern Germany.
• Inclusion of 608 patients with a documented confirmed diagnosis of heart failure (NYHA 3-4), COPD (GOLD 3-4, Group D) or dementia (GDS ≥ 4) in 56 GP practices.
• Standardised survey on the health situation at baseline and after 6, 12, 24 and 48 weeks.
• Primary endpoint: total number of hospital admissions during the observation period;
• Secondary endpoints: Current care situation, healthcare costs (economic efficiency), symptom burden, health-related quality of life.
• Final qualitative evaluation of the intervention.

Intervention

Home visit by an SAPV nurse with a structured discussion to prepare for the one-off structured telephone case discussion between the SAPV nurse, SAPV doctor and GP.

Planned utilisation of results

If successful, the KOPAL concept can be an easy-to-implement, low-threshold approach to strengthening academic appointments and interdisciplinary outpatient palliative care.

Funding organisation: Innovation Committee of the G-BA

Duration: June 2019 to May 2022

Partners: UKE Hamburg, University Medical Centre Göttingen, Hannover Medical School, University of Oldenburg

Contact persons in Oldenburg:

Silke Böttcher, M.A. Public Health (Research Associate):