Out-of-Hours Primary Care in Germany: General Practitioners' Views on the Current Situation

Objective: The aim of this study was to explore views, experiences und perspectives of German GPs related to current out-of-hours service provision covering both urban and rural settings. Methods: In the context of the international project EurOOHnet (European Research Network for Out-of-Hours Primary Health Care) the German members (of EurOOHnet) developed a questionnaire about organisational structures, infrastructure requirements and the procedures of information flow between regular care and out-of-hours care in 2011. This questionnaire was adopted in every participating country. A comprehensive postal questionnaire was sent to 410 feneral practice cooperatives in Germany. Qualitative content analysis and an inductive reasoning process, supported by the use of Atlas.ti, were used to identify key themes from responses to open-ended questions in the survey. Results were grouped into 3 overarching categories and each of these were grouped into 3 sub-categories. Results: The questionnaire response rate was 44 % (181/410). The analysis identified organisational issues (e.g., financing) and infrastructure barriers (e.g., lack of motivated GPs for out-of-hours care) as key themes. Significantly, different priorities between rural and urban GPs were identified. In particular, rural GPs highlighted shortages of GPs and distance between the GP practice and patients' residence as concerning factors impacting on out-of-hours care. Conclusions: Based on reported views from survey respondents, urban and rural primary care service needs vary significantly and, therefore, different solutions are needed to improve out-of-hours primary care and optimise service quality.