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[Supporting Medical Care for Children and Adolescents in General Practice: A Mixed-Methods Evaluation of the
Magdalena Rohr1,2, Maja Pawellek1,2, Mara König1,2
1Klinik und Poliklinik für Kinder- und Jugendmedizin der Universität Regensburg, KinderUniKlinik Ostbayern (KUNO), Klinik St Hedwig, Regensburg, Germany.
Background:
Medical care for children and adolescents is unequally distributed across regions; specialist services are particularly scarce in rural areas. In the model project 'KUNOLand', postgraduate trainees in child and adolescent medicine rotate for six months from the hospital to two general practices in a rural district of Eastern Bavaria in Germany to strengthen local care. This study aims to provide a formative and summative evaluation regarding feasibility, acceptance, and effectiveness.
Methods:
The mechanisms of action of the model project were specified using a logic model. During the evaluation period (April 2022 to March 2025), the following data were collected: semi-structured interviews with stakeholders, documentation of hospital contacts, routine practice data, and an online survey among parents. Quantitative data were analyzed descriptively; qualitative data were analyzed using computer-assisted content analysis following Kuckartz (2012).
Results:
The concept outlined in the model project is feasible under certain conditions: for example, through the continuous involvement of medical practices, the provision of protected time for assistant physicians by the hospital for the pilot project, and the structured integration of rotation into specialist training. Postgraduate trainees clinical work could be successfully integrated into daily practice. Communication with the hospital occurred mainly by phone (median: 2.5 contacts/month); the data-protection-compliant telemedicine app was rarely used. Treatment numbers increased significantly, especially among younger children, and the range of services expanded. Parents reported high satisfaction, and additional physician visits could often be avoided. Trainees and practice staff reported substantial competency gains. The project attracted new pediatric patients and strengthened regional care.
Conclusions:
The model project demonstrates that structured integration of postgraduate trainees in child and adolescent medicine into general practices in rural areas can strengthen both care and training. The findings suggest good transferability to similar regions. By enhancing training, the project can make an effective contribution to recruiting future pediatricians.
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