[State-certified Health Professionals Supported by Telemedicine in the On-call Service of Community Doctors]

Regional Associations of Statutory Health Insurance Physicians in Germany are obliged to provide around-the-clock non-emergency care. This includes out-of-hours care, weekends, and public holidays. Due to a growing shortage of specialised doctors in private practice - especially in more rural area - this well-established system might be about to collapse. A possible solution could lie in training medical personnel to work under telemedical supervision.

The Association of Statutory Health Insurance Physicians of Lower Saxony, Klinikum Oldenburg AöR, and Johanniter-Unfall-Hilfe (JUH) Germany developed a pilot scheme in which specially-trained paramedics provided out-of-hours non-emergency medical services. Supervision was ensured by telemedical backup. Descriptive statistics were used to analyse the data.

The majority of cases occurred in urban areas in the afternoon or at night. Most problems could be resolved by providing patient counselling. The majority of patients presented with unspecific symptoms. Telemedical support by a medical doctor was only required in 2.1 % of cases. In Germany, treatment by paramedics is widely accepted. In 63.5 % of cases patients could remain in an ambulatory setting.

Our study showed that non-emergency out-of-hours service can be competently delivered by paramedics under telemedical supervision. However, the expansion of high-speed wireless internet access is crucial for ensuring nationwide telemedical support. More research is needed to find out whether the described pilot scheme can be rolled out or even expanded in more rural areas of Germany.