EXPLORING GENERAL PRACTITIONER WORK IN UPPER AUSTRIA: A PILOT 
RETROSPECTIVE OBSERVATIONAL STUDY ACROSS THIRTY PRACTICES
Erika ZELKO 1   , Thomas PEINBAUER 1   , Lisa VOGGENBERGER 1*   , Fabian BEKELAER 1   ,  
Julia PANTOGLOU 1   , Denise STÜBL 1   , Erwin REBHANDL 1 
1 Institute of General Practice, Johannes Kepler University Linz, Altenberger Str. 69, 4040 Linz, Austria
Received: Jul 11, 2024
Accepted: Oct 04, 2024
Original scientific article
*Correspondence: lisa.voggenberger@jku.at
10.2478/sjph-2025-0007 Zdr Varst. 2025;64(1):49-58
49
ANALIZA DEJAVNOSTI SPLOŠNIH ZDRAVNIKOV V ZGORNJI AVSTRIJI: PILOTNA 
RETROSPEKTIVNA OPAZOVALNA ŠTUDIJA V TRIDESETIH AMBULANTAH
© National Institute of Public Health, Slovenia. 
Zelko E, Peinbauer T, Voggenberger L, Bekelaer F, Pantoglou J, Stübl D, Rebhandl E. Exploring general practitioner work in Upper Austria: A pilot retrospective observational study 
across thirty practices. Zdr Varst. 2025;64(1):49-58. doi: 10.2478/Sjph-2025-0007.
ABSTRACT
Keywords: 
Primary healthcare, 
general/family medicine
Upper Austria
Organisational 
type of practice
Scope of activities
IZVLEČEK
Ključne besede: 
primarna zdravstvena 
oskrba
splošna/družinska 
medicina
Zgornja Avstrija
organizacijske oblike
storitve
kodiranje
Introduction: This study investigates the differences in patient care across various organisational forms of 
general practitioners (GPs) in Upper Austria.
Methods: Data was collected from GPs across Upper Austria, examining patient demographics, prescription 
patterns, staff employment, services offered and the proximity of practices to hospitals. The variability in 
recording patient visit reasons was also analysed.
Results: Of the 30 participating GPs (Response Rate 5.1%), 17 worked in single practices, 7 in group practices, 
and 6 in PHC units. In our sample, single practices tend to prescribe more medications for chronic conditions. 
Group practices and PHC centres are more prevalent in areas with larger populations, offer online appointment 
bookings more frequently and employ more staff. The study also highlights variability in documenting patient 
visit reasons, emphasising the need for standardised documentation practices.  The most common reasons for 
the patient to contact their GP, based on ICPC-2 categories, were general and non-specific, respiratory and 
locomotor problems, and the most common chronic diseases seen in the practice are cardiovascular, endocrine 
diseases and locomotor system problems. The most common therapeutic procedures were counselling and 
prescription of medication.
Conclusion: Our study, the first of its kind, reveals significant insights into the variability and adaptability of 
general medicine outpatient practices in Upper Austria, highlighting the need for improved diagnosis coding at 
the primary care level.
Uvod: Raziskava se osredotoča na razlike v oskrbi bolnikov pri različnih organizacijskih oblikah dela splošnih 
oziroma družinskih zdravnikov (GP) v Zgornji Avstriji.
Metode: Podatke so prispevali splošni zdravniki iz Zgornje Avstrije, pri čemer so nas zanimale predvsem naslednje 
informacije: demografska struktura bolnikov, najpogostejši razlogi za obiske, predpisovanje zdravil, kadrovska 
zasedba v ambulantah, storitve, ki jih zdravniki opravljajo v svojih ambulantah, ter lokacija ambulante glede na 
bližino bolnišnice.
Rezultati: Od 30 sodelujočih zdravnikov (odzivnost 5,1-odstotna) jih 17 dela v samostojnih praksah, 7 v skupinskih 
praksah in 6 v zdravstvenih centrih (PHC). Zdravniki v samostojnih praksah so predpisovali več zdravil za kronične 
bolezni. Skupinske prakse in PHC so pogostejši na območjih z večjim številom prebivalcev, pogosteje omogočajo 
spletno naročanje in zaposlujejo več osebja. Študija prav tako izpostavlja raznolikost pri dokumentiranju razlogov 
za obiske bolnikov, kar poudarja potrebo po standardizaciji dokumentacije. Glede na ICPC-2 kodirni sistem, so 
najpogostejši razlogi, zaradi katerih pacienti obiščejo svojega družinskega zdravnika sledeči: splošne in nespecifične 
težave, težave z dihalnim sistemom ter gibalne težave. Najpogostejša kronična obolenja, ki jih zdravniki 
obravnavajo v praksi, so bolezni srca in ožilja, endokrine bolezni ter težave z gibalnim sistemom. Najpogostejši 
terapevtski postopki pa so svetovanje in predpisovanje zdravil.
Zaključek: Naša študija, prva te vrste v Zgornji Avstriji, omogoča vpogled v raznolikost delovanja in organizacije 
splošnih ambulant v tej regiji. Prav tako izpostavlja potrebo po izboljšanju kodiranja diagnoz na primarni ravni 
zdravstvene oskrbe.
1 INTRODUCTION
Since the Alma-Ata Declaration of 1978, the World Health 
Organization (WHO) has emphasized the pivotal role 
of Primary Health Care (PHC) and family medicine in 
delivering effective population health care, and numerous 
definitions of family medicine and primary healthcare 
have emerged (1-3). 
Despite these recognised values, PHC globally faces 
significant challenges, such as increasing workloads and 
the intricate interplay between physician satisfaction 
and patient outcomes (4). Evaluations of different health 
systems reveal a complex landscape: countries like Norway 
and Austria struggle with recruiting general practitioners 
(GPs), while the UK faces a growing retention crisis, 
threatening the core values of family medicine across 
many EU countries (5-11). 
Research further underscores the factors influencing GP 
practice choices. According to Gisler et al. (8), the three 
most important criteria are work environment, location 
and workload. Harris et al. (12) also point to the issue of 
loneliness in GP work environments as a critical problem 
that requires attention. These themes – workload, patient 
outcomes, job satisfaction and burnout – highlight the 
pressing need for targeted interventions to support and 
strengthen the healthcare workforce. Addressing the 
workload of GPs and improving access to primary care, 
especially close to patients’ homes, remains a global 
challenge (13-15).
Efforts to address these challenges will likely involve 
demand management strategies and increased 
interprofessional collaboration (13, 14, 16). Canadian 
researchers, for instance, have identified difficulties in 
implementing team-based approaches at the primary care 
level, including overcoming traditional professional role 
divisions and managing the barriers and facilitators to 
effective teamwork (17). These issues are also pertinent 
to the Austrian health system, which is both complex and 
fragmented in its organizational and financial structure, 
as well as relatively costly (15).
In response to these challenges, digitalisation and the use 
of artificial intelligence in patient care have been proposed 
as potential solutions to reduce GP workloads. However, 
some studies suggest that current digital solutions may 
have increased rather than alleviated the workload of 
healthcare workers (14, 18). One common conclusion 
across numerous studies is that patient safety and quality 
of care are negatively affected by high workloads (18-20). 
Another critical concern is the low interest among young 
physicians in fields characterised by high workloads, 
burnout and the pressures of working in single-handed 
practices (8, 12, 21).
10.2478/sjph-2025-0007 Zdr Varst. 2025;64(1):49-58
50
Austria faces similar challenges in its primary care system. 
Most GPs work in single-handed practices, hospitals, or 
group practices, including PHC units. They can either enter 
into contracts with social insurance organizations, work 
independently as private practitioners, or be employed 
within medical practices. In Upper Austria, which had a 
population of 1,522,825 in 2023, there are 2,307 active 
GPs (as of 03 July 2024, Upper Austrian Medical Chamber). 
Of these, 49% (1,124 GPs) work in single-handed practices, 
11% (248 GPs) in group practices, including PHC units, and 
40% are employed in hospitals. Additionally, 30% (692) 
of all extramural GPs in Upper Austria work as contract 
physicians, with 57% being male and 43% female (22).
GPs with social insurance contracts in Austria are 
reimbursed through a combination of capitation and 
fee-for-service payments. Billing occurs quarterly, 
with compensation based on a per capita flat rate for 
enrolled patients, as well as specific service items, 
such as counselling. Currently, there are 666 family 
physicians in Upper Austria practising privately, without 
a health insurance contract (as of September 2024). In 
2026, Austria will introduce speciality training in family 
medicine, a move that has been supported by both GPs 
and policymakers (23, 24, 15).
Given these systemic complexities and the ongoing 
challenges faced by practising physicians, it is essential 
to thoroughly examine the current state of the healthcare 
system. Before introducing new technologies or 
implementing best practices, a clear understanding of the 
existing workloads and challenges is necessary. Therefore, 
the aim of our study was to assess the scope of activities 
of GPs in Upper Austria.
2 METHODS
2.1 Study design
In this observational cross-sectional pilot study, we invited 
587 GPs in Upper Austria to participate. Data collection 
occurred between April and November 2023 (Figure 1).
2.2 Participants
2.2.3 General practitioners
We invited GPs in Upper Austria contracted with the health 
insurance company (Österreichische Gesundheitskasse; 
ÖGK) to participate in the study. GPs without a health 
insurance contract were initially not invited to participate 
due to typically shorter operating hours, fewer patient 
contacts per week, and longer individual appointment 
durations, which could have hindered the achievement of 
comparable data across the various practice types.
10.2478/sjph-2025-0007 Zdr Varst. 2025;64(1):49-58
51
Timeline of the study.Figure 1. 
Inclusion and exclusion criteria.
Inclusion criteria Exclusion criteria
Table 1.
GPs working in 
single practices
GPs working in 
group practices
GPs working in PHC (Primary 
Health Care) units
GPs with a valid contract 
with the national health 
insurance system
GPs working primarily 
in hospitals
GPs working in social or 
institutional settings 
GPs without a health 
insurance contract
2.2.4 Patient contacts
We invited each participating GP to record data from 100 
consecutive patient interactions during the second week 
of October 2022, covering in-person, phone and video 
consultations, both in the practice and during home visits 
within regular practice hours.
2.3 Data collection
Email invitations to participate in the study were originally 
sent out to GPs using the database provided by the 
Medical Association (Ärztekammer) of Upper Austria (587 
email addresses and phone numbers). Research students 
also contacted all 587 GPs by phone to offer assistance 
with data collection at their practices.
2.3.1 Instructions for participating physicians 
Physicians received a detailed write-up explaining the 
study’s purpose, objectives, procedure, and data collection 
methods. A video tutorial guided them on collection of 
study data, with researchers available by phone or email 
for support. Research students were also available to 
physically assist with data collection in practices. All 
physician interactions with patients, relatives and medical 
staff were counted as contacts, whether in-person or 
for health services such as prescriptions or referrals. 
Emergency consultations during regular practice hours 
were also documented.
2.3.2 Questionnaires 
With the permission of Slovenian researchers, we 
translated and adapted their questionnaire (25) into 
German using the forward and backward translation 
method and validated it through cognitive debriefing 
methodology. The questionnaire used for data collection 
included basic patient data, visit type and purpose, 
diagnostic procedures, referrals to clinical specialists, 
diagnoses observed, interventions performed, sick 
leave status and follow-up appointments. Additionally, a 
separate questionnaire on practice characteristics and 
participating GP demographics was completed at the 
study’s start. 
2.3.3 Ethical approval
The Ethics Committee of the Medical Faculty at Johannes 
Kepler University Linz confirmed that ethical approval was 
not necessary for the study.
2.4 Statistical analysis
Data analysis utilised SPSS (Version 28) and MedCalc 
Software Ltd. Descriptive statistics summarised the data, 
while the chi-square test of independence examined 
associations between categorical variables and practice 
types. The Kruskal-Wallis test compared differences 
among practice types due to small sample sizes and non-
normal distribution. The significance level was α=0.05, 
with only valid cases included.
3 RESULTS
The study was conducted in 30 GP practices in Upper 
Austria, with a response rate of 5.1%. The GPs were 
distributed as follows: 17 in single practices, 7 in group 
practices, and 6 in PHC units. The mean age of GPs was 
53.7 years (SD 9.8), ranging from 26 to 68 years. There was 
no significant age difference between GPs from different 
practice types (p=0.297; Table 2).
The demographic profile showed 73.3% male GPs, 19.4% 
female, and 6.4% non-binary/unspecified. Most practices 
were in rural areas (77.4%), with some in urban (12.9%) 
and suburban (9.7%) areas. Patient catchment areas, as 
reported by the GPs themselves, varied: 16.1% reported 
their patients originate from areas with populations above 
10,000, 45.2% from areas with populations of 3,000-10,000 
and 38.7% from areas with populations below 3,000. Most 
practices were within a 30-minute (45.2%) or 15-minute 
10.2478/sjph-2025-0007 Zdr Varst. 2025;64(1):49-58
52
Organizational structure of the practice and age of the GP.
Patients‘ age according to organizational structure of the practice.
N
Single practice PHC unit dfGroup practice KW HTotal p
Mean AgeMaximum Age KW HMinimum Age SDMedian Age df p
Table 2.
Table 3.
Single practice
Group practice
PHC unit
Total
n
Minimum Age
Maximum Age
Mean Age
Median Age
SD
17
7
6
30
409
0
99
51.2
54
24.3
322
1
94
49.4
51
20.8
2414
1
94
50.4
54
23.1
2.2031145
0
99
50.4
53
22.9
0.332
53.7
46.3
45.5
50.3
68
55
59
68
2.42839
32
26
26
9.8
9.8
11.9
10.6
51
48
48
49
2 0.297
(41.9%) drive of a hospital. The regions predominantly had 
three or more GPs (93.5%). The most commonly employed 
professionals were practice assistants (93.5%) and 
registered nurses (64.5%). Additional services included 
teaching practices (71.0%) and nursing home care (64.5%). 
Pharmacies were present in just under 50% of practices, 
with other services (acupuncture, social prescribing, 
chiropractic, complementary medicine) in 35.5%. There 
were significant associations between certain activities 
(pharmacies, teaching practices) and practice type, with 
pharmacies more common in group practices (p=0.002) 
and teaching practices more common in PHC units 
(p=0.049). All practices offered telephone contact; 29.0% 
had websites, 35.3% offered scheduling an appointment 
online, 83.9% had an email contact, and 16.1% offered 
video consultations. Websites with appointment booking 
were more common in group practices and PHC units 
(p=0.041).
3.1 Patient contacts
The study included 1,145 patient contacts with the largest 
proportions from group (36.2%) and single practices 
(35.7%). PHC units accounted for 28.1%. While the goal was 
for each GP to register 100 consecutive patient contacts, 
the actual number of contacts varied due to incomplete 
data entry from some practices, leading to a total of 
1,145 patient contacts instead of the expected 3,000. 
Patient age did not vary significantly across practice types 
(p=0.332; see Table 3).
The most common reasons for patients to contact their 
GPs, based on ICPC-2 categories, were general and 
non-specific (27.3%), respiratory (25.0%) and locomotor 
(12.4%) medical issues (Table 4). The chi-square test of 
independence showed a statistically significant result 
10.2478/sjph-2025-0007 Zdr Varst. 2025;64(1):49-58
53
Reason for doctor’s visit based on ICPC-2 categories.
n
Single practice 
Organisational structure of practice
Group practice PHC unit Total
nn n df% % χ2 or LR% % p
Table 4.
A General and non-specific
B Blood, blood-forming 
organs, immune system
D Digestive system
F Eye
H Ear
K Cardiovascular System
L Locomotor
N Neurology System
P Mental Health
R Respiratory
S Dermatology
T Endocrine, metabolic, 
nutritional
U Urology
W Pregnancy, childbirth, 
family planning 
X Gynaecology
Y Andrology
Z Social problems
Total
121
6 
24
2
10
29
46
9
11
95
25
17 
6
0 
3
3
2
409
55
2 
19
5
4
15
51
14
11
98
17
17 
7
2 
2
1
2
322
137
7 
29
2
9
19
45
12
16
93
13
17 
10
0 
1
2
2
414
313
15 
72
9
23
63
142
35
38
286
55
51 
23
2 
6
6
6
1145
3229.6
1.5 
5.9
0.5
2.4
7.1
11.2
2.2
2.7
23.2
6.1
4.2 
1.5
0.0 
0.7
0.7
0.5
100.0
17.1
0.6 
5.9
1.6
1.2
4.7
15.8
4.3
3.4
30.4
5.3
5.3 
2.2
0.6 
0.6
0.3
0.6
100.0
55,18933.1
1.7 
7.0
0.5
2.2
4.6
10.9
2.9
3.9
22.5
3.1
4.1 
2.4
0.0 
0.2
0.5
0.5
100.0
27.3
1.3 
6.3
0.8
2.0
5.5
12.4
3.1
3.3
25.0
4.8
4.5 
2.0
0.2 
0.5
0.5
0.5
100.0
0.007
(p=0.007), indicating an association between the type 
of medical practice and reason for the contact. The 
most common reasons in single practices were general 
and non-specific (29.6%), followed by respiratory (23.2%) 
and locomotor (11.2%) medical issues. Similar to single 
practices, in group practices general and non-specific 
issues (33.1%) were the most common reason for the 
patient to contact the GP, followed by respiratory (22.5%) 
and locomotor (10.9%) medical issues. On the other hand, 
the most common reason in PHC units were respiratory 
(30.4%), followed by general and non-specific (17.1%) 
medical issues and locomotor system problems (15.8%).
Table 5 presents the prevalence of chronic diseases among 
patients across various types of medical practices. A 
chi-square test of independence with the most common 
diseases (n>100) revealed a significant association with 
the type of practice (p<0.001). The most common chronic 
diseases seen in single practices included cardiovascular 
system-related issues (42.5%), followed by endocrine, 
metabolic, nutritional disorders (33.5%) and locomotor 
system problems (33.3%). In group practices, chronic 
conditions (no illness) (32.4%) and endocrine, metabolic 
and nutritional disorders (33.1%) were the most prevalent 
among patients, followed by cardiovascular system-
related diseases (28.7%). The PHC units most commonly 
dealt with endocrine, metabolic and nutritional disorders 
(34.5%), cardiovascular system-related diseases (30.1%) 
and locomotor system diseases (25.8%).
10.2478/sjph-2025-0007 Zdr Varst. 2025;64(1):49-58
54
Chronic diseases and conditions.
Multiple responses possible, frequency and percentage of selected categories are shown. 
** Results of chi-square test for 8 most often selected categories (n>100).
n
Single practice 
(n=409)
Organisational structure of practice
Group practice 
(n=414)
PHCunit 
(n=322)
Total 
(n=1223)
nn n df% % χ2 or LR% % p
Table 5.
0 Chronic conditions 
(No Illness) **
A General and non-specific
B Blood, blood-forming 
organs, immune system
D Digestive system**
F Eye
H Ear
K Cardiovascular System**
L Locomotor System**
N Neurology**
P Mental Health**
R Respiratory System**
S Skin
T Endocrine, metabolic, 
nutritional**
U Urology
W Pregnancy, childbirth, 
family planning 
X Gynaecology
Y Andrology
Z Social problem
92 
28
33 
93
14
11
174
136
45
71
46
35
137 
24
0 
4
21
0
78 
20
14 
36
12
12
97
83
31
58
35
32
111 
19
4 
13
19
1
134 
10
21 
48
6
9
119
88
45
72
26
18
137 
20
2 
10
17
1
304 
58
68 
177
32
32
390
307
121
201
107
85
385 
63
6 
27
57
2
1422.5 
6.8
8.1 
22.7
3.4
2.7
42.5
33.3
11.0
17.4
11.2
8.6
33.5 
5.9
0.0 
1.0
5.1
0.0
24.2 
6.2
4.3 
11.2
3.7
3.7
30.1
25.8
9.6
18.0
10.9
9.9
34.5 
5.9
1.2 
4.0
5.9
0.3
41,78132.4 
2.4
5.1 
11.6
1.4
2.2
28.7
21.3
10.9
17.4
6.3
4.3
33.1 
4.8
0.5 
2.4
4.1
0.2
26.6 
5.1
5.9 
15.5
2.8
2.8
34.1
26.8
10.6
17.6
9.3
7.4
33.6 
5.5
0.5 
2.4
5.0
0.2
<0.001
The most common therapeutic procedures were 
counselling (86.4%) and prescription of medicines (51.3%; 
Table 6). Counselling was the most commonly used 
therapeutic procedure across all practice types, with no 
significant difference among them (p=0.126). There are 
differences in medication prescription in group practices 
(50.5%) and PHC units (43.8%); they exhibited lower 
rates compared to single practices (57.9%) and showed 
a significance (p=0.001). Group practices (5.3%) showed 
significantly (p<0.001) higher utilisation of injections 
compared to other practice types. Moreover, single 
practices (6.1%) and group practices (4.1%) had higher 
rates of vaccination administration compared to PHC units 
(p<0.001). PHC units provide significantly more (p<0.001) 
other therapeutic procedures.
The number of referrals was quite low, most patients 
were referred to physiotherapy 3.3% (n=40) and to other 
specialists 9.9% (n=121), most commonly to specialists for 
radiology (46 patients), dermatology (21 patients) and 
internal medicine (21 patients).
The most commonly prescribed long-term medications were 
antihypertensives 26.8%, psychopharmacological 15.8%, 
statins 13.1% and dietary supplements 13.1%, followed 
by anticoagulants 12.2% (Table 7). Significantly higher 
prescription rates were found in single practices compared 
to group practices and PHC units for the prescription 
of antihypertensives (p<0.001), ointments (p=0.002), 
intestinal medication (p<0.001), psychopharmacological 
drugs (p=0.029), anticoagulants (p=0.018) and chronic 
antibiotics (p=0.031), with the results of the chi-square 
test of independence being significant (p<0.05). Only 
biological medicines were more often prescribed in group 
practices (p=0.002).
10.2478/sjph-2025-0007 Zdr Varst. 2025;64(1):49-58
55
Therapeutic procedures performed.
Prescription of chronic medication. 
Multiple responses possible, frequency and percentage of selected answers are shown.
*Other: Throat swabs and other tests, removal of foreign bodies and cerumen, physical therapy, conversational therapy, administrative, 
other non-categorised.
a0 cells (0.0%) have an expected count less than 5.
Multiple responses possible, frequency and percentage of selected answers are shown.
n
n
Single practice 
(n=409)
Single practice 
(n=409)
Organisational structure of practice
Organisational structure of practice
Group practice 
(n=414)
Group practice 
(n=414)
PHCunit 
(n=322)
PHCunit 
(n=322)
Total
(n=1145)
Total
(n=1145)
n
n
n
n
n
n
df
df
%
%
%
%
χ2 or LR
χ2 or LR
%
%
%
%
p
p
Table 6.
Table 7.
Counselling
Drug Prescription
Injection
Infiltration
Infusion
Vaccination
Manual Therapy
Minor Surgery
Acute wound care
Chronic wound care
Other*
Antibiotics
Analgesics
Antihypertensives
Gastrointestinal
Statins
Hormones
Psychopharmacological
Anticoagulants
Pulmonary 
Antidiabetic
Ointments
Nutritional supplements
Biological medicines
Anti-rheumatic drugs
342
237
3
3
10
25
3
2
10
5
6
5
44
137
68
55
46
78
65
19
36
18
66
4
23
284
141
2
3
6
2
3
2
5
2
22
0
29
60
23
37
26
52
32
11
18
6
42
4
8
363
209
22
4
14
17
3
1
7
2
13
1
27
110
29
58
44
51
43
20
33
3
42
18
17
989
587
27
10
30
44
9
5
22
9
41
6
100
307
120
150
116
181
140
50
87
27
150
26
48
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
83.6
57.9
0.7
0.7
2.4
6.1
0.7
0.5
2.4
1.2
1.5
1.2
10.8
33.5
16.6
13.4
11.2
19.1
15.9
4.6
8.8
4.4
16.1
1.0
5.6
88.2
43.8
0.6
0.9
1.9
0.6
0.9
0.6
1.6
0.6
6.8
0.0
9.0
18.6
7.1
11.5
8.1
16.1
9.9
3.4
5.6
1.9
13.0
1.2
2.5
4.151a
14.613a
24.618a
0.150
1.713a
14.824a
0.118
0.680
0.944a
1.540
15.386a
6.955
4.674
20.300
25.618
1.077
2.167
7.087
7.999
0.986
2.776
12.553
6.490
12.663
4.432
87.7
50.5
5.3
1.0
3.4
4.1
0.7
0.2
1.7
0.5
3.1
0.2
6.5
26.6
7.0
14.0
10.6
12.3
10.4
4.8
8.0
0.7
10.1
4.3
4.1
86.4
51.3
2.4
0.9
2.6
3.8
0.8
0.4
1.9
0.8
3.6
0.5
8.7
26.8
10.5
13.1
10.1
15.8
12.2
4.4
7.6
2.4
13.1
2.3
4.2
0.126
0.001
<0.001
0.928
0.425
0.001
0.943
0.7122
0.624
0.463
<0.001
0.031
0.097
<0.001
<0.001
0.584
0.338
0.029
0.018
0.611
0.250
0.002
0.039
0.002
0.109
4 DISCUSSION
Our research highlights differences in patient care across 
various GP organizational forms in Upper Austria. Single 
practices tend to prescribe more medications for chronic 
conditions. Group practices and PHC centres are more 
common in areas with larger populations, offer online 
appointment booking and employ more staff. Most 
practices are within a 15–30-minute drive from the nearest 
hospital, offer a wide range of services and frequently refer 
patients for radiological examinations. With a referral rate 
to other specialists of 9.9%, this is a rather low referral 
rate compared to other countries (26). Since specialist 
access in Austria does not always require GP referrals, 
referral data should be interpreted cautiously. Recording 
formats for patient visit reasons varied, thus complicating 
data interpretation. Legal coding requirements apply 
only to PHC units, possibly leading to inconsistent data 
entry. The provisions of the EU General Data Protection 
Regulation (GDPR) came into effect in 2018, which 
entails new obligations for general practitioners including 
in the mode of communication with patients (27). 
Common reasons for patient visits include non-specific 
issues, respiratory problems, musculoskeletal issues, 
cardiovascular conditions and dermatological concerns, 
consistent with findings from other studies (25, 28). 
Counselling, which accounts for 86.4% of cases, is the most 
frequently used and reimbursed therapeutic procedure. 
This high percentage likely reflects the fact that GPs in 
Austria routinely include counselling as part of standard 
medical consultations, with potential contributions from 
coding inaccuracies. The age and gender of doctors 
in our sample align with data from the Upper Austria 
Medical Chamber (22). Therapeutic procedures depend 
on insurance-covered services, influenced by annual 
negotiations between the medical association and social 
insurance companies. Similar financial procedures are 
noted by other authors (29-31). Differences in medication 
prescriptions can be partially explained by the older age 
structure of patients in single practices. According to the 
insurance company (32), the most frequently prescribed 
medications at the primary level are antidepressants, 
lipid-lowering agents and non-insulin antidiabetics. In 
our sample, regarding patient contacts in the second 
week of October of 2022, the most frequently prescribed 
medications were antihypertensives, psychotropic drugs 
and lipid-lowering agents. At the 2012 WONCA conference, 
Kleinbichler and colleagues presented an analysis of 9,674 
patient consultations from three Austrian GP practices. 
They identified arterial hypertension as the most common 
reason for patient contact with a physician, which also 
aligns with our findings (33).
4.1 Limitations
Our study provides valuable insights into the situation of 
family medicine in Upper Austria, but it is important to 
note that the results are not representative of the entire 
country. While the findings offer an understanding of 
the current organizational structures and patient care 
practices in the region, they cannot be generalised to 
all of Austria. The non-random sampling method and the 
focus on GPs with insurance contracts further limit the 
representativeness of the results.
Although our data may not be generalisable, they can 
serve as a valuable resource for strengthening primary 
care in Austria. 
5 CONCLUSION
Our study, the first of its kind, offers valuable insights into 
the operations of family medicine outpatient practices in 
Upper Austria. The data indicates significant variability 
in the structure and functioning of these practices. The 
variation in organizational structures, services offered, 
staffing and diagnosis coding, underscores the complexity 
and adaptability of outpatient care. Our findings offer 
important insights into the work of GPs amidst evolving 
changes in general medicine in Austria, particularly with 
the introduction of a specialisation in family medicine. 
We view organizational variability as a strength of 
Austrian general medicine, as it offers greater flexibility, 
enables better adaptation to local population needs, and 
promotes cost efficiency (e.g., a PHC centre may not be 
economically viable in areas with smaller populations). 
However, the lack of standardised diagnosis coding 
remains a limitation, hindering accurate comparisons 
with international best practices. We plan to do a follow-
up study with a larger number of participating GPs to 
observe trends and changes over time. This future study 
will provide a more comprehensive understanding of the 
evolution of general practice, including the development 
of group practices and PHC centres, which involve more 
healthcare professionals and emphasise holistic, team-
based care and interprofessional collaboration.
10.2478/sjph-2025-0007 Zdr Varst. 2025;64(1):49-58
56
ACKNOWLEDGEMENT
We would like to extend our sincere gratitude to all 
the contributors who supported the completion of this 
manuscript. Special thanks to the student employees who 
assisted with contacting practices and data collection: 
Laura Eggers, Laura Koch, Astrid Kathrein, Markus Mader, 
Miles Walker.
We are also deeply appreciative of the (anonymous) 
general practitioners in Upper Austria who participated in 
this pilot study. Your cooperation and willingness to share 
your practice data made this research possible.
CONFLICT OF INTEREST
The authors declare no conflicts of interest related to this 
study.
FUNDING
This research received no specific grant from any funding 
agency in the public, commercial, or not-for-profit sectors.
ETHICAL APPROVAL
This study has been granted an exemption from requiring 
ethics approval by the Ethics Committee of the Medical 
Faculty of the Johannes Kepler University Linz, Austria, 
via email on the 26 January 2022 from Eva Vormündl to 
Erika Zelko.
AVAILABILITY OF DATA AND MATERIALS
The datasets generated and analysed during the current 
study are available from the corresponding author upon 
reasonable request.
LLM STATEMENT
During the preparation of this article the authors used the 
GPT-4 language model to test and fine-tune the article’s 
wording. After using this model, the authors reviewed and 
edited the content as needed and take full responsibility 
for the content of the publication.
10.2478/sjph-2025-0007 Zdr Varst. 2025;64(1):49-58
57
ORCID  
Erika Zelko: 
https://orcid.org/0000-0002-2730-9118
Thomas Peinbauer: 
https://orcid.org/0009-0006-6274-3979
Lisa Voggenberger: 
https://orcid.org/0000-0001-8992-5840
Fabian Bekelaer: 
https://orcid.org/0009-0009-7015-4658
Julia Pantoglou: 
https://orcid.org/0000-0002-9772-6961
Denise Stübl: 
https://orcid.org/0009-0006-2647-4345
Erwin Rebhandl: 
https://orcid.org/0009-0005-2851-1974
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