Heart Failure Outcomes in Primary Care: The Role of Primary Care Practice Assistants (VERAH) in German General Practice
Kateryna Karimova, Anastasiya Glushan, Justyna Weronika Wünstel, Renate Klaaßen-Mielke, Catriona FriedmacherBackground
Germany’s GP‐centred care (GPCC) model aims to strengthen coordinated primary care and incorporates delegated case management delivered by Primary Care Practice Assistants (VERAH). While previous studies have demonstrated beneficial effects for patients with heart failure, the additional long‐term impact of multidisciplinary primary care incorporating VERAH support compared with GPCC alone remains unclear.
Methods
We conducted a retrospective cohort study using German statutory health insurance claims data from 2011 to 2022. Patients with heart failure were identified using validated ICD‐10 codes from inpatient and outpatient care records and assigned to three groups: usual care, GPCC and GP‐centred care with extended multidisciplinary team involvement (GPCC‐Plus). GPCC‐Plus was defined as a study‐specific category based on predefined VERAH‐related service codes and lump‐sum payments documented in AOK Baden‐Württemberg claims data. Outcomes included all‐cause hospitalisation, ambulatory care‐sensitive condition (ACSC) hospitalisations and all‐cause mortality. Multivariable regression models were adjusted for sociodemographic factors, comorbidities and healthcare utilisation, with time‐varying covariates included where applicable. Direct comparisons between GPCC and GPCC‐Plus were performed, and longitudinal trends were assessed over the 12‐year observation period.
Results
Both GPCC models were associated with reduced hospitalisations compared with usual care, with consistently stronger effects observed in GPCC‐Plus practices involving multidisciplinary team care including Primary Care Practice Assistants (VERAH). GPCC‐Plus demonstrated the lowest odds of all‐cause hospitalisation and mortality across the study period. ACSC hospitalisations showed modest declines in both GPCC groups. Longitudinal analyses indicated sustained benefits over time, with more pronounced and consistent improvements in the GPCC‐Plus group.
Conclusions
A coordinated, integrated, multidisciplinary primary care programme including delegated case management by Primary Care Practice Assistants (VERAH) is associated with sustained long‐term reductions in hospitalisations and mortality among patients with heart failure over 12 years. These findings suggest that integrating structured nonphysician workforce roles may enhance the effectiveness of GPCC beyond GP coordination alone.
Implications for Nursing Management
Structured delegated case management and multidisciplinary teamwork can support continuity of care for patients with heart failure. Clear roles and communication pathways facilitate the integration of nursing and practice‐based care into GPCC.