Entwicklung der Prävalenz von Notfällen sowie der Alters- und Geschlechtsstruktur der Notfall-Patienten in Deutschland und England im Zeitverlauf

The goal of working in primary care is to treat common health problems that exceed self-care abilities. The general practitioner is mostly the first contact for patients to the health care system and as a so-called „gatekeeper“ the ticket for further care in specialized centers. However, the patient clientele and also the symptom constellations are very variable and do theoretically cover all imaginable clinical conditions. Thus, even life-threatening health conditions can first lead to a visit of the family practitioner due to a less pronounced symptomatology. Based on the fact that possible misunderstandings of these situations could have fatal consequences for the patient, working in primary care does have a very important position in the health care system. This fact raises the question of how high the burden of life-threatening emergencies for general practitioners is and whether the frequency of these situations has changed over the years. The aim of this work is to cover a wide range of different diseases and to investigate these health conditions regarding the age structure and gender distribution. Therefore, Germany and England are compared as two industrial nations. In total, 460 general practitioner practices with a total of 586 physicians in Germany and 62 general practitioner practices with a total of 553 physicians in England are considered in this work. The data in this work refer to the IMS-Disease-Analyzer® database. As one of the largest European patient databases, it includes information from Germany and England. Not just patient data, such as gender, age, diagnoses and therapies, are recorded but also general information of the respective physician (age, sex, specialization). Through a broad observation period, both cross-sectional and longitudinal studies are possible. High representativeness is achieved through ongoing review, correction and supplementation. The patient-related data is registered from the admission into the health system until the discharge, without deletion taking place. Hence, a complete evaluation is made possible. For this reason, the IMS-Disease-Analyzer® is recommended as the basis of this work. It can be determined that the number of cases increased in partly considerably in the observation period from 2008 to 2017. So, emergencies represent a not insignificant role in general medical practices. In Germany, an average of 46.8 of the reported emergencies per general practitioner occurred in 2008, compared to 57.5 cases in 2017. In England, there are 32.4 emergency cases per one family doctor practice in 2017, compared to 30.3 in 2008. In terms of percentage, older patients dominate in the health sectors of cardiovascular and cerebrovascular diseases as well as in the diagnosis of acute pulmonary embolism. With abdominal diseases and the diagnoses „shock“ and „collapse“, there is a preponderance of under forty years old patients. Regarding the gender distribution there are no major differences between Germany and England. The distribution varies slightly, the tendency is the same in the considered diseases. Since there is no comparable study which consolidates the described diagnoses, the burden of emergencies in general has so far only been evaluated to a limited extent. In further studies, it would be important to clarify if and in which dimensions the general practitioner visit causes a delay in the treatment process and how the further procedure of these emergencies is. Besides, it would be important to analyze to what extent the outcome of the patients is influenced.