[On the state of intersectoral treatment in otolaryngology in Germany - Results of a survey].

Background: The German Healthcare System is currently subject of significant structural changes. Due to politic influences it is obvious that more and more even complex diagnostic and therapeutic procedures will be performed in an office setting or as day treatments. This is due to the high rate of hospital treatments in Germany compared to other OECD countries. A revision of the healthcare system will include both, ambulatory and hospital treatments, which will only be possible with some new structures for this "intersectoral" treatment. Currently there are no data available on the status, possibilities and structure of the "intersectoral" treatment in ENT in Germany.

Methods: To get an overview on the possibilities for an "intersectoral" treatment in ENT in Germany a survey was conducted. Each chariman of an ENT clinic/Department and all ENT specialists in private practice were contacted and got a questionnaire. The evaluation was performed differently for chairmen of an ENT department, ENT specialists in private practice without and with a ward for inpatients in hospitals.

Results: 4,548 questionnaires were mailed. Out of them 493 were filled and came back (10.8%). The return rate in the group of ENT Department chairmen was with 52.9% even higher. "Intersectoral" for physicians in hospitals means that they are usually working with a personal authorization by the local Association of Statutory Health Insurance Physicians, ENT specialists in private practice usually with a ward for inpatient authorization in a hospital. Appropriate structures for an intersectoral organization of patients´s treatment are currently missing. Both, ENT Department chairmen and ENT specialists in private practice declared the current remuneration system for ambulatory and day surgery as completely inaedequate and is urgently to be revised. Beside this, ENT Department chairmen declared problems with the emergency care of patients with complications operated on outside the hospital, problems with the continuing education of residents and with information transfer. They request that hospital specialists should be allowed to work in the contractual medical care of outpatients without a restriction. ENT specialists in private practice mentioned positively the good cooperation possibilities with hospital physicians, knowledge sharing, and wide ranges of indications in the ENT Departments. Negative points could be possible worse information sharing when there is no distinct contact person in the ENT Departments, a possible competitive situation between ENT Departments and specialists in private practice, and sometimes long waiting times for the patients.

Discussion: The German health care system is currently facing a radical reform with the overcoming of traditional rigid and inflexible sectors in outpatient care and inpatient hospital care. To achieve this, the intersectoral patient treatment should play the key role. "Intersectoral" means that the whole process of patient care from diagnosis to therapy is closely interlinked and can also be managed by the same physicians, no matter whether they are working as spcialists in an ENT-Department in a hospital or in private practice. However, currently there are no appropriate structures available to achieve this goal. Beside creating structural conditions for intersectoral treatment the current remuneration system for outpatient procedures and dayclinic treatments must be renewed in a way to cover all the costs. Further conditions are the development of good cooperation models between ENT Departments and specialists in private practice, and the possibility for hospital ENT physicians to work in the contractual medical care of outpatients without a restriction. Intersectoral patient care must take the quality management, the continuing education of residents and the patient safety under consideration.