The pioneer model of physician assistants or nurses combined with technology supervised by physicians could be a solution for patient-centered care in rural areas.
Heidelberg, 30 August 2023: Bringing primary care in rural regions closer to patients through the use of physician assistants (PAs) or nurses and smart technology. The startup Lillian Care is doing pioneering work with its approach. Successful trailblazing in terms of viability, digital support for treatment pathways and patient acceptance, as the field study conducted in the German state of North Rhine-Westphalia has now shown. Lillian Care could thus contribute to solving one of the major healthcare problems in times of demographic change: medical under-provision in structurally weak regions.
Long distances, long waiting times, stressed medical assistants and overworked physicians are part of the reality of primary healthcare in rural areas. Previous attempts by municipalities, health insurers and aging GPs to counteract the shrinking number of practices in rural areas have all failed or only worked in isolated cases. But time is pressing. Already today, more than 4,100 medical practices in Germany are unoccupied, and according to a study by the Robert Bosch Foundation, this figure is expected to rise to more than 11,000 by 2035. As a result, almost 40 percent of German districts will be threatened or affected by a lack of medical care.
Triad of Nurses/Physician Assistants – Technology – Physicians
Lillian Care has developed a medical practice concept based on interprofessional task sharing and modern technologies, in order to operate local practices for primary care in cooperation with municipalities and health insurers – irrespective of the place of residence of the attending physicians. The focus is on the role of PAs and nurses, who are given more treatment responsibility and their own latitude in accordance with their training. Physician (telemedical) supervision within the framework of approved medical delegation will ensure the provision of medical treatment. In addition to hybrid care, medical consultation hours are also offered on site. Treatment is preceded and accompanied with the help of a binding patient app, which has an important guiding function. Lillian Care will provide the on-site physicians with practice rooms, infrastructure, technology and a qualified team.
Successful mastering from minor cases to complex treatments
In the recently completed field test, the hybrid treatment pathways including the technical setup were tested and important data was collected for the final development of the app for patient management and intelligent appointment scheduling. The results show that the hybrid care is well accepted and, above all, ensures the medical quality of treatment from minor cases to complex treatments.
„The successful field test is an important milestone for Lillian Care. It is the first building block for our nationwide network of healthcare facilities that we are implementing together with the municipalities,“ says Linus Drop, CEO and Co-Founder of Lillian Care, confidently.
„Our focus was on the practicability of the prescribed treatment paths and, of course, on the acceptance of this new setting by our patients. Both met our expectations,“ summarizes family doctor Wolfgang Gerlach-Reinholz. According to this, the treatment time per case was approx. 10 — 15 minutes plus a further 5 minutes for supervision. During the test period, there were also isolated warning signs that indicated a potentially dangerous condition at an early stage. In the case of these so-called red flags, diagnosis and treatment were completed with the immediate and direct involvement of the physician. All patients were subsequently reviewed by the team as part of a supervision process. The patients gave consistently positive feedback on the form of treatment, which was initially unfamiliar to them.
Innovative service concept for weak infrastructure areas
Dr. Bernadette Klapper, Federal Managing Director of the German Association of Nursing Professions (Deutscher Berufsverband für Pflegeberufe e.V.), and a member of the Lillian Care expert advisory board, also sees promise in the overall concept: „If we succeed in making better use of the potential of PAs and nurses for outpatient care, this is a key to restoring primary healthcare in under-provided regions and opening up avenues for improved care.“ In addition, the model holds positive incentives for the professional development of the nursing profession and frees it from administrative restrictions.
Advantages through New Work and digitalization
In countries such as Finland or Canada, this type of care has been common practice for decades. „The interprofessional collaboration between physicians and nurses or PAs, supported by the sensible use of technology, is the key to the targeted use of resources to provide patient-centered care close to home,“ says Dr. Florian Fuhrmann, Chief Technology Officer and Co-Founder, summarizing the Lillian model. „We are very excited about the high level of interest in working at one of our practices to pioneer primary healthcare.“
At Lillian Care, physicians are salaried employees. The company takes on tasks such as billing, practice marketing, IT and personnel management; in doing so, it also bears the risk in the areas of real estate, investment, personnel, and enables the physicians to earn above-average salaries.
About Lillian Care:
Lillian Care brings together the growing challenges in medically under-provided regions with the special requirements of modern healthcare professionals. The company was founded by Linus Drop, Dr. Florian Fuhrmann and Markus Liesmann. With their many years of experience in various areas of German and international healthcare, they aim to make primary healthcare an attractive, modern and patient-oriented professional field again and thus reach regions that have long been struggling for medical assistance.
An advisory board of experts led by Ulrich Weigeldt, Honorary Chairman of the German Family Physicians Association, Dr. Bernadette Klapper and Prof. Dr. Volker Amelung, and Bjoern von Siemens as lead investor are supporting the founding team in the challenge of saving rural areas from medical desertification.
The name Lillian Care is inspired by Lillian Wald, who is considered to be the founder of American community care. Not only did she work tirelessly as a nurse in the poor neighborhoods of New York City, but she also founded a nurse organization. Her goal was to provide equal health care to all. With her hands-on, problem-solving nature, she had a major impact on the development of public health.
