>> With the personal union of Prof. Dr. med. Thomas Kühlein as director of the General Medical Institute of the UK Erlangen and at the same time as head of the associated MVZ Eckental, is the first time in Germany that a rural medical care center is under the direction of a general medical university institution. With a team of specialists, doctors in further training and medical assistants, around 2,000 patients receive primary care every quarter at the MVZ Eckental. This is reflected on the complementary, university side in the fact that the research work carried out here is primarily intended to answer the question of how well patients and citizens are cared for by family doctors and which determinants contribute to high-quality patient care. “We want to show where there is too little and also where there is too much medicine,” says research coordinator Dr. Susann Hueber, who sees the task of health services research as “creating knowledge and understanding of the benefits of diagnostic and therapeutic measures for the individual patient, but also for society.” The science of health services research offers the methodological possibilities for this, to systematically pursue these questions and to be able to show what is ultimately really needed and used from all innovations.
The focus of the work is the topic of oversupply, whereby undersupply and oversupply are not mutually exclusive, but either exist parallel to each other or are even mutually dependent. Useless or insufficiently useful medicine should be identified in order to reduce it and thus enable the establishment of adequate basic care.
The Erlangen Institute has already taken the first steps to approach this topic in an interdisciplinary manner in the research network PRO PRICARE (Preventing Overdiagnosis in Primary Care, funded by the BMBF from 2017 to 2020). From 2023, it will be involved in research projects on the use of monitoring measures for chronic diseases (Project ChroMo) and on the development of guidelines for dealing with thyroid nodules (Project LeiSE). Hueber says: “Our work is intended to contribute to understanding which diagnostic and therapeutic interventions bring patients more risks than benefits.” On the one hand, this protects the patients themselves, but also protects the financial and human resources of the healthcare system and society and thus make an important contribution towards a sustainable healthcare system.
As an academic institution, the General Medical Institute not only has expertise in the care of
research, but also in university didactics. The guiding principle for this is strong primary medicine, which aims at transparent, cost-effective and patient-oriented medicine and represents an attractive field of work. The entire team, consisting of doctors, psychologists, sociologists, health scientists as well as study and team assistants, is responsible for the research and teaching tasks. And this takes the form of strong, interdisciplinary collaboration: within projects, across projects and also in student teaching. Particularly noteworthy is the combination of university research and primary care patient care at the MVZ Eckental. According to Hueber, this enables “the early implementation of innovations in primary medicine and in this combination is exemplary for Germany”.
The guiding principle of this approach to care research is the explicit involvement of everyone involved in care in order to, in Hueber's words, “practice health care research 'from practice - for practice'”.
The foundation of research is a close exchange not only with our own MVZ, but also with other general practitioners' practices. Since 2020, the institute has been significantly involved in the development and implementation of the Bavarian research network for general medicine, or BayFoNet for short. BayFoNet is one of six primary care research practice networks in Germany and is supported by the university locations in Würzburg, Munich (TU and LMU) and Erlangen. “The aim should be to build a sustainable infrastructure that makes it possible to carry out clinical studies and studies on health services research in general medical practice,” explains Hueber. The Erlangen healthcare researchers also want to make a contribution to overcoming social and health challenges: the effects of the corona pandemic on general practice (Pricov project), the burden on those in need of care and their relatives (BaCoM project) and the recording of vaccination side effects (CoVaKo ).
Hueber: “And from January 2023 we will also be part of a project to develop adaptation measures for general and specialist medical care to the effects of climate change” (AdaptNet project).
Since the institute was founded and established in 2013, we can look back on successful acquisition of third-party funding, with around one million euros per year. This meant that the number of employees in research, teaching and administration was expanded from initially two to 21. “We see this as clear evidence of a strengthening of academic general medicine, the importance of good primary care and the relevance of health services research,” says Susann Hueber, who was there almost from the start. What brought Susann Hueber to Erlangen is easy to explain: first her training as a nurse, then her studies. And then she just stayed, because for her Erlangen is “a wonderful, livable and lovable city”, located in Franconia, surrounded by cities like Nuremberg and Fürth and the nearby nature in Franconian Switzerland. Erlangen also has a large university, the Friedrich-Alexander University, which offers good networking and exchange opportunities with other academic disciplines for research work. <<

The interview was conducted by MVF editor-in-chief Peter Stegmaier.

Dr. med. Lisette Warkentin, doctor and research assistant
>> Why do you work at the General Medical Institute of the UK Erlangen?
After almost three years of clinical and practical training, I moved from the hospital to the institute. I was interested in further questioning our supply structures and working to improve these structures. I am now working part-time in a family doctor's practice again and am experiencing care from both the perspective of direct patient care and from a research perspective. This results in a very varied, exciting and versatile everyday working life.

In your opinion, what characterizes health care research at the General Medical Institute of the UK Erlangen?
Our team is characterized by heterogeneity both in terms of professional backgrounds and personal characteristics. This results in valuable additions to the development of ideas, the preparation of applications and the implementation of the project. Everyone can contribute their skills and develop further. The institute is also characterized by the main topic “Protection against oversupply”. In view of finite human, financial and ecological resources, I consider this topic to be highly topical and particularly relevant in order to ensure effective and satisfactory patient care.

What topics and questions are you currently working on?
In some cases, problems and challenges in medical care differ depending on which sector you work in. One of our current studies deals with this topic. We are investigating whether there is awareness of these sector-dependent challenges. Using health insurance data, a wide variety of questions about care under real conditions can be answered and thus supplement findings from controlled studies. For example, we examined the safety and effectiveness of oral anticoagulants.

What would you personally like to achieve with health services research?
With health services research, I would like to contribute to effective patient care. In the optimal scenario, the resources of our healthcare system should be used in such a way that diagnostic and therapeutic measures are only used where they have a demonstrable benefit for patients. This
also means that patients are protected from interventions that have no benefit or may even be associated with harm. To this end, it is important to raise awareness of the issue of oversupply among both patients and doctors. <<

Dr. PH Maria Sebastião, research assistant
>> Why do you work at the General Medical Institute of the UK Erlangen?
For me, after completing my doctorate, Erlangen represented the ideal combination of a liveable city and a well-developed research infrastructure. The institute offers a broad team with methodological and content-related expertise, while at the same time there is a connection to the general practitioner's practice via the affiliated MVZ. I see this as an ideal prerequisite for the development of project ideas and the implementation of practical research projects that have a long-term impact. In addition, new research ideas are promoted here and participation is made possible by our own working groups. In addition, I also have the opportunity to work in teaching alongside research and am happy to inspire students about general medicine.

In your opinion, what sets the General Medical Institute of the UK Erlangen apart?
The institute is proof that many cooks don't always spoil the broth. General practitioners, psychologists, sociologists and health scientists work together here. The research projects are as diverse as the team is - always with the common question of how oversupply can be avoided. Because oversupply is highly relevant not only for individual patients, but also for the healthcare system and society. But I also appreciate the culture of discussion here at the institute; thinking about other projects is a given for everyone. This exchange is incredibly invigorating and always provides a fresh perspective on problems.
What topics and questions are you currently working on?
The focus of my research is patient orientation in healthcare. I prefer to immerse myself in the perspectives of patients using qualitative methods. Because of my speech therapy background, I am also interested in how interprofessional collaboration can improve patient care. This is what I do, among other things: in the Health Coordination Office with the question of how patient guides can support patients and relieve the burden on family doctors. But the topic of Covid-19 is currently an integral part of primary care research and is part of my research projects “Bavarian Ambulatory Covid-19 Monitor” (BaCoM) and “Corona Vaccine Consortium” (CoVaKo), a study on vaccination side effects.

What would you personally like to achieve with health services research?
I would like to contribute to improving patient care. This requires good, practical research projects. For me, patients are seen as experts for their own health and their experiences in the healthcare system, without whose involvement no meaningful research is possible. <<