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It is somewhat striking to see this disparity of numbers of specialised physicians in developed countries.
A lack of specialised physicians especially exists in poorer, more rural and remote areas as described for Australia [48] and similar findings were postulated even across the U.K. [8].
Involvement of specialised physicians in DN would likely help to improve rates of antidementia drug treatment.
In the study region, specialised physicians have poorer information systems than primary care physicians and, consequently, data are less available.
It involved shifting tasks from; doctors, specialised physicians to non-physician clinicians, non-physician clinicians to nurses/midwives, and Nurses/midwives to nursing assistants.
Several studies have shown that RA patients cared for by physicians experienced in the management of their disease, thus primarily rheumatologists, have better outcomes than those followed by less specialised physicians.
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All patients had received various types of physiotherapy including massage, heat, transcutaneous nerve stimulation and exercises, but had not been treated by a specialised physician before entering the study.
These include the following activities: using guidelines, having joint medical policy, using electronic communication, using electronic patient records, using specialised support (physician assistants), using week schedules and year planning, having internal rules and finally, having a formal leader.
About 80% of staff classified as "highly specialised" were physicians, whereas the majority of "specialised and unspecialised employees" were nurses (including head nurses), therapists, and laboratory and radiology technicians.
Although the practice varies considerably among countries, long-term work disability assessments are usually performed by specialised social insurance physicians [ 1, 4].
Consequently we feel that a discussion about specialised nursing home physicians, similar to positions already established in the Netherlands [ 25], should be conducted more intensely and more open-mindedly than it is currently in Germany.
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