BACKGROUND Among other factors, the patients' consultation reasons and GPs' spectrum of services determine the process and outcome of the medical treatment. So far, however, there has been little information on differences in reasons for consultation and GPs' services between urban and rural areas. Our study's goal was thus to investigate these factors in relation to the regional location of GPs' 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 120 km around Hamburg were divided into three regional categories (urban area, environs, rural area) 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 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 344 patients per month with a slightly higher number of patients in rural areas. They reported 59.1 ± 15.4 different reasons for consultation and 30.3 ± 3.9 different services. There was no statistically significant regional variation in the number of different consultation reasons, but there was a 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 medical training. Additionally, there were differences in the frequency of individual consultation reasons and services between rural and urban areas. CONCLUSION GPs in rural areas performed more frequently services usually provided by medical specialists in urban areas. This might be caused by a low availability of specialists in rural areas. The association between medical training and service spectrum might imply that GPs compensate the specific needs of their patients by completing advanced medical training before or after setting up a medical practice. TRIAL REGISTRATION The study was registered in ClinicalTrials.gov (NCT02558322).

中文翻译：

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在德国北部进行咨询的原因和全科医生的服务范围方面的地区差异-一项横断面观察研究的结果。

背景技术除其他因素外，患者的咨询原因和全科医生的服务范围决定了医疗过程和结果。但是，到目前为止，关于城乡之间的协商原因和全科医生的服务差异的信息很少。因此，我们的研究目标是调查与全科医生实践所在地区有关的这些因素。方法我们基于配额抽样设计中的标准化GP访谈进行了横断面观察研究。汉堡周围120公里半径内的所有县和独立城市均分为三个区域类别（城市地区，环境，农村地区），并与人口规模成比例地分层。在混合模型中通过多元线性回归分析了咨询和服务原因数量上的差异，该混合模型针对德国联邦州和行政区的水平产生了随机影响，并进行了调整。通过逐步向前和向后选择的逻辑回归，确定了个体咨询原因和服务的差异。结果数据集中代表了37个选定行政区中的34个（91.9％）的初级保健实践。总共对211名GP进行了个人访谈。平均而言，全科医生每月有344名患者，而农村地区的患者人数略多。他们报告了59.1±15.4个不同的咨询原因以及30.3±3.9个不同的服务。不同咨询原因的数量在统计上没有明显的地区差异，但是农村全科医生的服务范围更广（ß=-1.42； 95％置信区间-2.75 /-0.08； p = 0.038），这在统计学上可以通过较高水平的医学培训来解释。此外，城乡之间个人咨询原因和服务的频率也存在差异。结论农村地区的全科医生通常由城市地区的医疗专家提供更频繁的服务。这可能是由于农村地区的专家人数较少。医学培训和服务范围之间的关联可能意味着，GP会在建立医学实践之前或之后通过完成高级医学培训来补偿患者的特殊需求。试验注册该研究已在ClinicalTrials.gov（NCT02558322）中进行了注册。