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„There Is Sufficient Work For Everybody“
Neeltje van den Berg
MEDICA.de talked to Neeltje van den Berg, assisting project manager and research assistant at the institute for Community Medicine at the University of Greifswald, about unnecessary competition, useful task sharing and why medical quality does not suffer through AGnES.
MEDICA.de: Miss van den Berg, your project has been in the centre of attention for a while and many people raised concerns that AGnES competes with mobile nursing services or that it may even outstrip doctors. What is your opinion about this?
Neeltje van den Berg: AGnES staff is supposed to give general practitioners a helping hand. Doctors will not give off any of their competence, they only pass on work, it is only a matter of delegating tasks. Besides, staff members do not take over the function of a nurse. If AGnES staff observe the need for nursing they do pass the information on nursing staff.
MEDICA.de: The new assistants are therefore really not in rivalry to nursing staff?
Van den Berg: No, rather on the contrary. During the run of our project it happened in many cases that we provided nursing services with more work because the new assistants observed during their visits many cases that were in need of special care and therefore initiated further steps. I think, there is sufficient work for everybody, we do not additionally have to compete with each other.
MEDICA.de: The AGnES concept meanwhile is part of regular health care provision. Does this mean that we will see mobile doctor's assistants throughout Germany?
Van den Berg: Possibly. Doctors can now balance the service nationwide. However, the intention is that AGnES will only be deployed in regions that suffer from a lack of doctors or that are in danger to do so in the future or in regions with special needs. This decision has to be made by health insurances and the Association of Statutory Health Insurance Physicians.
MEDICA.de: What about qualifying these special assistants?
Van den Berg: That is a very important issue. Based on the results of our project, we developed and evaluated a curriculum of 622 hours of advanced training, all in cooperation with the University of Applied Sciences Neubrandenburg. Topics are being taught on a modular basis since many doctor's assistants and nurses have already done numerous advanced trainings. However, now the service is part of regular health care provision and since then only 200 hours are scheduled for further education. That is why we say: Pay attention!
MEDICA.de: Pay attention? In what way?
Van den Berg: Well, the new staff have to be able to decide on the spot whether it is sufficient to just fulfill the assigned tasks or whether it is necessary that an expert takes a look again at the patient. That is why it is important for the assistants to be trained in an appropriate way. The assistants do everything on location except diagnosing and initializing therapies. Indeed, the delegating general practitioner in the end is always liable for everything the mobile assistants do. Hence, a sufficient qualification is also in the doctor' interest.
MEDICA.de: Can quality of the treatment at the patient's home by these mobile assistants really keep up with a house call made by the general practitioner?
Van den Berg: Definitely. We have evaluated this aspect, subjectively and objectively. We have questioned the doctors whether they think that the treatment by AGnES staff is qualitatively as good as their own treatment. All questioned doctors agreed. We have also observed that blood pressure values improved because of the regular monitoring. Also quality of life increased significantly due to the devotion of the nurses which in turn has positive effects on the patient's health. It has always been our aim that the general care provided by general practitioners with the help of mobile assistants is at least as good as care provided by the general practitioner alone.
MEDICA.de: How can AGnES be improved?
Van den Berg: AGnES has been part of the regular health care provision since 1 April, therefore it is too early to judge the success of the concept properly. It first needs a chance to find its place. But it is necessary to initiate a suitable evaluation straight away. Until now, it has not been decided who is going to undertake the evaluation and what exactly it needs to include. Unfortunately, the accounting codes do not reveal what has been done in terms of treatment on location. It is also not clear yet, whether 17 Euros is enough in terms of payment for such a home visit.
The interview was conducted by Nadine Lormis