Regional differences in reasons for consultation and general practitioners’ spectrum of services – Results of a cross-sectional observational study

Background Among other factors, the patients’ consultation reasons and the GPs’ spectrum of services determine process and outcome of the medical treatment. So far, however, there has been little information on differences in reasons for consultations and performed services between urban and rural areas. Thus, the goal of the study was to investigate these factors in relation to the regional location of the GP practices.Methods We conducted a cross-sectional observational study based on standardised GP interviews in a quota sampling design. All counties and independent cities within a radius of 120km around Hamburg were divided in three regional categories (urban, rural, environs) and stratified proportionally to the population size. Differences in the number of reasons for consultation and services were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the German federal states and administrative districts. Differences in individual consultation reasons and services were identified by logistic regression models via stepwise forward and backward selection.Results Primary care practices in 34 of the 37 selected administrative districts (91.9%) were represented in the dataset. In total, 211 GPs were personally interviewed. On average, GPs saw 1,032 patients per quarter (3-month period) with a slightly higher number of patients in rural areas. They reported 59.1 ± 15.4 different reasons for consultations and 30.3 + 3.9 different services. There was no statistically significant regional variation in the number of different consultation reasons, but there was broader service spectrum by rural GPs (ß=-1.42; 95% confidence interval -2.75/-0.08; p=0.038), which was statistically explained by a higher level of postgraduate training. Additionally, there were differences in the frequency of individual consultation reasons and services between rural and urban areas.Conclusions GPs in rural areas spent less time on communicative, preventive, and consultant medicine than GPs in urban areas. In contrast, GPs in rural areas more often performed services that are usually provided by ambulatory specialist care in urban areas. Depending on the analysed item, primary care in the environs was either similar to “urban areas” or to “rural areas”.