Facilitators and barriers in general practitioners’ choice to work in primary care units in Austria: a qualitative study

 

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Abstract

Background Recent reforms in Austria have focused on establishing team-based care within multiprofessional primary care units, to enhance amongst others, the work attractiveness of general practice. Nearly 75% of qualified general practitioners are not working as contracted physicians with the social health insurance. This study aims to explore the facilitators of and barriers to non-contracted general practitioners to work in a primary care unit.

Methods We conducted twelve semi-structured, problem-centered interviews among purposively sampled non-contracted general practitioners. To extract categories of facilitators and barriers for working in a primary care unit, transcribed interviews were inductively coded using qualitative content analysis. Subcategories were grouped into factors (facilitators and barriers) of thematic criteria and mapped on the macro-, meso-, micro-, and individual levels.

Results We identified 41 categories, including 21 facilitators and 20 barriers. Most facilitators were located at the micro-level, while most barriers were located at the macro-level. Teamwork and associated conditions made primary care units attractive as workplaces and corresponded with individual demands. In contrast, system factors tended to reduce the attractiveness of working as a general practitioner.

Conclusions Multifaceted efforts are needed to address relevant factors at all of the levels mentioned above. These need to be carried out and consistently communicated by all stakeholders. Efforts to strengthen the holistic approach in primary care, like modern remuneration and patient steering mechanisms, are essential. Financial support, consulting services as well as training on entrepreneurship, management, leadership, and team-based care may help to reduce the risk and burden of founding and running a primary care unit.

Zusammenfassung

Hintergrund Rezente Reformmaßnahmen in Österreich zielen darauf ab die team-basierte Versorgung in multiprofessionellen Primärversorgungseinheiten zu etablieren. Diese sollen unter anderem die Attraktivität der hausärztlichen Tätigkeit steigern. Fast 75% der Allgemeinmediziner in Österreich arbeiten nicht als Kassenhausärzte. Das Ziel dieser Studie ist es unter Allgemeinmediziner:innen ohne Kassenvertrag die fördernden und hemmenden Faktoren zu erheben, die für eine Tätigkeit in einer Primärversorgungseinheit zu tragen kommen.

Methoden Wir führten 12 semistrukturierte, problem-zentriert Interviews unter gezielt ausgewählten Allgemeinmedizinern ohne Kassenvertrag durch. Die Interviews wurden transkribiert und induktiv kodiert unter Verwendung der qualitativen Inhaltsanalyse. Gefundene Unterkategorien wurden zu thematischen Kategorien zusammengefasst und in weiterer Folge der Makro-, Meso-, Mikro- oder Individualebene zugeordnet.

Ergebnisse Wir identifizierten 41 Faktoren, 21 davon förderlich und 20 hemmend. Die meisten förderlichen Faktoren waren der Mikroebene zuordenbar, während die meisten hemmenden Faktoren auf der Makroebene liegen. Teamarbeit und damit verbundene Aspekte lassen Primärversorgungseinheiten als einen attraktiven Arbeitsplatz erscheinen und entsprechen den individuellen Ansprüchen. Dem hingegen reduzieren Systemfaktoren die Attraktivität der hausärztlichen Tätigkeit.

Schlussfolgerungen Es braucht vielfältige Bemühungen, um die relevanten Faktoren auf allen Ebenen zu adressieren. Diese müssen von allen Stakeholdern mitgetragen und einheitlich kommuniziert werden. Maßnahmen, um den holistischen Ansatz der Primärversorgung zu stärken, sind zentral. Dazu gehören moderne Honorierungsmodelle und Steuerungsmechanismen. Finanzielle Unterstützung, Beratungsangebote sowie Fortbildungen in den Bereichen Unternehmertum, Management, Führung und teambasierte Versorgung können dazu beitragen, das Risiko und die Last bei der Gründung und dem Betrieb einer Primärversorgungseinheit zu reduzieren.

Publication History

Article published online:
12 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag
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