Optimizing cooperation between general practitioners, occupational health and rehabilitation physicians in Germany: a qualitative study
Tóm tắt
To achieve successful medical rehabilitation and timely return to work, general practitioners, occupational health and rehabilitation physicians need to cooperate effectively. This cooperation, however, can be hampered by organizational, interpersonal, and structural barriers. In this article, we present and discuss suggestions proposed by physicians and patients on how these barriers can be overcome. We conducted eight qualitative focus group discussions with general practitioners (GPs), occupational health physicians (OPs), rehabilitation physicians (RPs) and rehabilitation patients, which we analyzed with qualitative content analysis methods. Room for improvement exists with regard to (1) regulation (e.g. formalized role and obligatory input of occupational physicians), (2) finance (e.g. financial incentives for physicians based on the quality of the application), (3) technology (e.g. communication by email), (4) organizational procedures (e.g. provision of workplace descriptions to RPs on a routine basis), (5) education and information (e.g. joint educational programs, measures to improve the image of OPs), and (6) promotion of cooperation (e.g. between OPs and GPs in regards to the application process). Many suggestions are practical and could be implemented into the daily routine of physicians, while others demand multi-level, multi-stakeholder approaches. Our findings are supported by numerous international studies (especially from Western Europe). Future quantitative research could assess the relative weight of these findings. Feasibility and effectiveness of the proposed suggestions should be tested in controlled interventional studies.
Tài liệu tham khảo
Arora VM, Manjarrez E, Dressler DD, Basaviah P, Halasyamani L, Kripalani S (2009) Hospitalist handoffs: a systematic review and task force recommendations. J Hosp Med 4(7):433–440. doi:10.1002/jhm.573
Beach J, Watt D (2003) General practitioners and occupational health professionals. BMJ 327:302–303. doi:10.1136/bmj.327.7410.302
Beaumont D (2003a) Rehabilitation and retention in the workplace—the interaction between general practitioners and occupational health professionals: a consensus statement. Occup Med Oxf Engl 53:254–255
Beaumont D (2003b) The interaction between general practitioners and occupational health professionals in relation to rehabilitation for work: a Delphi study. Occup Med Oxf Engl 53:249–253
Behrens J (2000) The realization of the mandate of rehabilitation physicians to include the occupational health physician. DRV-Schriften 20:244–246
Bethge M (2016) Effects of graded return-to-work: a propensity-score-matched analysis. Scand J Work Environ Health 42(4):273–279. doi:10.5271/sjweh.3562
Buijs P, van Amstel R, van Dijk F (1999) Dutch occupational physicians and general practitioners wish to improve cooperation. Occup Environ Med 56:709–713
Buijs PC, Weel ANH, Nauta NP et al (2009) Teaching general practitioners and occupational physicians to cooperate: joint training to provide better care for European workers. Eur J Gen Pract 15:125–127. doi:10.3109/13814780903378517
Campbell M, Fitzpatrick R, Haines A et al (2000) Framework for design and evaluation of complex interventions to improve health. BMJ 321:694–696
Carroll C, Rick J, Pilgrim H et al (2010) Workplace involvement improves return to work rates among employees with back pain on long-term sick leave: a systematic review of the effectiveness and cost-effectiveness of interventions. Disabil Rehabil 32:607–621. doi:10.3109/09638280903186301
Dasinger LK, Krause N, Thompson PJ et al (2001) Doctor proactive communication, return-to-work recommendation, and duration of disability after a workers’ compensation low back injury. J Occup Environ Med Am Coll Occup Environ Med 43:515–525
Dzuck M, Haufe E, Scheuch K et al (2002) What expectations do employers, employees and labour representatives have of occupational health physicians? In: Nowak D, Praml G (eds) Perspectives of clinical occupational and environmental medicine. Rindt Druck, Fulda, pp 299–302
Edlund C, Dahlgren L (2002) The physician’s role in the vocational rehabilitation process. Disabil Rehabil 24:727–733. doi:10.1080/09638280210124310
Faber E, Bierma-Zeinstra SMA, Burdorf A et al (2005) In a controlled trial training general practitioners and occupational physicians to collaborate did not influence sickleave of patients with low back pain. J Clin Epidemiol 58:75–82. doi:10.1016/j.jclinepi.2004.04.015
Franche R-L, Cullen K, Clarke J et al (2005) Workplace-based return-to-work interventions: a systematic review of the quantitative literature. J Occup Rehabil 15:607–631. doi:10.1007/s10926-005-8038-8
Friesen MN, Yassi A, Cooper J (2001) Return-to-work: the importance of human interactions and organizational structures. Work (Read, Mass) 17:11–22
Glomm D (2001) Health management in the company—new demands on the occupational physician’s activities. Arbeitsmed Sozialmed Umweltmed 36(2):86–88
Hesselink G et al (2012) Improving patient handovers from hospital to primary care: a systematic review. Ann Intern Med 157(6):417–428. doi:10.7326/0003-4819-157-6-201209180-00006
Ivers N, Jamtvedt G, Flottorp S et al (2012) Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 6:CD000259. doi:10.1002/14651858.CD000259.pub3
Jankowiak S, Kaluscha R, Krischak G (2013) The involvement of occupational health physicians in the rehabilitation process: an evaluation of discharge reports using computational linguistics. DRV-Schriften 98:203–204
Kattel S, Manning DM, Erwin PJ, Wood H, Kashiwagi DT, Murad MH (2016) Information transfer at hospital discharge: a systematic review. J Patient Saf. doi:10.1097/pts.0000000000000248
Kripalani S, Jackson AT, Schnipper JL, Coleman EA (2007a) Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med 2(5):314–323. doi:10.1002/jhm.228
Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW (2007b) Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA 297(8):831–841. doi:10.1001/jama.297.8.831
Kuehn W, Knuelle E, Schian H (2008) Effects of an intensified cooperation between company physicians and rehabilitation physicians (in-depth analysis, long-time observation). DRV-Schriften 77:276–278
Luedemann A (2006) Communication and communication structure between occupational health physicians and rehabilitation clinics. Dissertation, Medical Faculty, University Luebeck
MacEachen E, Clarke J, Franche R-L et al (2006) Systematic review of the qualitative literature on return to work after injury. Scand J Work Environ Health 32:257–269
Manecke I, Spallek M, Rebe T et al (2008) The pilot project “JobReha”—background and practice report. Arbeitsmedizin Sozialmedizin Umweltmed 43:36–40
Mayring P (2014) Qualitative content analysis: theoretical foundation, basic procedures and software solution. Klagenfurt, Austria
Mosshammer D, Manske I, Grutschkowski P, Rieger MA (2011) The interface between general practice and occupational medicine. Arbeitsmed Sozialmed Umweltmed 43:301–307
Mosshammer D, Natanzon I, Manske I et al (2012) Deficiencies and barriers of the cooperation between German general practitioners and occupational health physicians? A qualitative content analysis of focus groups. Z Für Evidenz Fortbild Qual Im Gesundheitswesen 106:639–648. doi:10.1016/j.zefq.2011.09.027
Mosshammer D, Natanzon I, Manske I et al (2014) Cooperation between general practitioners and occupational health physicians in Germany: how can it be optimised? A qualitative study. Int Arch Occup Environ Health 87:137–146. doi:10.1007/s00420-013-0845-1
Mosshammer D, Michaelis M, Mehne J et al (2016) General practitioners’ and occupational health physicians’ views on their cooperation: a cross-sectional postal survey. Int Arch Occup Environ Health 89:449–459. doi:10.1007/s00420-015-1084-4
Mueller WD, Knufinke R, Smolenski UC et al (2009) Interlinking of medical rehabilitation and vocational reintegration for employees of a mining company suffering from lower back pain—implementation of an optimized rehabilitation concept. DRV-Schriften 83:171–172
Mueller E, Mehrer L, Faust T et al (2013) Occupation-linked care of patients with musculoskeletal disorders: results of a survey among general practitioners, orthopedists, occupational health physicians and within rehabilitation. DRV-Schriften 101:146–147
Nauta AP, von Grumbkow J (2001) Factors predicting trust between GPs and OPs. Int J Integr Care 1:e31
Nauta N, Weel A, Overzier P, von Grumbkow J (2006) The effects of a joint vocational training programme for general practitioner and occupational health trainees. Med Educ 40:980–986. doi:10.1111/j.1365-2929.2006.02564.x
Palinkas LA, Horwitz SM, Green CA et al (2015) Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health 42:533–544. doi:10.1007/s10488-013-0528-y
Pfaff H, Janßen C, Kowalski C, Brinkmann A (2009) Physicians and companies: joint activities for health. A new concept for an improved health care. Short version of the final report of the project “physicians and companies as cooperation partners (ÄrBeK)”. Bertelsmann Stiftung, Gütersloh
Plomp HN, Wisse A, Anema JKH (2011) Patients on the collaboration between occupational and curative physicians. Ned Tijdschr Geneeskd 155:A3880
Pohontsch N, Deck R (2011) Intersection problems in rehabilitation care. Neurorehabilitation 3:114–119
Reeves S, Perrier L, Goldman J et al (2013) Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev 3:CD002213. doi:10.1002/14651858.CD002213.pub3
Rijkenberg A (2012) The communication between occupational health physicians and specialists in physical medicine and rehabilitation—the situation in two different countries. A thesis submitted for the degree of: “Master in Occupational Health (MOH),” Department of Epidemiology and Social Medicine, University of Antwerp, Belgium
Rijkenberg AM, van Sprundel M, Stassijns G (2013) Collaboration between occupational physicians and other specialists including insurance physicians. Versicherungsmedizin Hrsg Von Verband Lebensversicher-Unternehm EV Verband Priv Krankenversicher EV 65:140–145
Schochat T, Neuner R, Seidel H (2003) A analysis of the definition of the intersection between occupational health physician and medical rehabilitation. Arbeitsmedizin Sozialmedizin Umweltmed 38:124–125
Schupp W (2001) Physician’s management in rehabilitation. Arbeitsmedizin Sozialmedizin Umweltmed 36:175–183
Schwarze M, Spallek M, Korallus C et al (2013) Advantages of the JobReha discharge letter: an instrument for improving the communication interface in occupational rehabilitation. Int Arch Occup Environ Health 86:699–708. doi:10.1007/s00420-012-0805-1
Scott A, Sivey P, Ait Ouakrim D, Willenberg L, Naccarella L, Furler J, Young D (2011) The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database Syst Rev (9):CD008451. doi:10.1002/14651858.CD008451.pub2
Seidel H, Neuner R, Schochat T (2003) Occupational health physician and medical rehabilitation—a survey among occupational health physicians in Baden-Württemberg. Arbeitsmedizin Sozialmedizin Umweltmed 38:228–234
Stratil J, Rieger M, Voelter-Mahlknecht S (2017) Cooperation between general practitioners, occupational health physicians and rehabilitation physicians in Germany: what are problems and barriers to cooperation? A qualitative study. Int Arch Occup Environ Health. doi:10.1007/s00420-017-1210-6
Tajfel H, Turner JC (1979) An integrative theory of intergroup conflict. In: Austin, Worchel (eds) The social psychology of intergroup relations. Brooks/Cole, Monterey, pp 33–47
Tajfel H, Turner JC (1986) The social identity theory of intergroup behaviour. In: Worchel S, Austin WG (eds) Psychology of intergroup relations. Nelson-Hall, Chicago, pp 7–24
Tavs H (2005) Occupational health physician and medical rehabilitation. Betriebsarzt und medizinische Rehabilitation. Dissertation, Medical Faculty, University Ulm
Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19(6):349–357. doi:10.1093/intqhc/mzm042
Valk M, van den Broek-Porius (2007) Cooperation of pulmonologists and occupational health physicians regarding occupational health. Tijdschr Voor Bedr- En Verzek 12:254–258
van Amstel R, Buijs P (2000) Open to improvements—medical specialists on the cooperation with occupational health physicians in the sociomedical supervision (Deel 2). TNO Arbeid, Hoofddorp
van Vilsteren M, van Oostrom SH, de Vet HCW et al (2015) Workplace interventions to prevent work disability in workers on sick leave. Cochrane Database Syst Rev 10:CD006955. doi:10.1002/14651858.CD006955.pub3
Voelter-Mahlknecht S, Rieger MA (2014) Patient care at the interface between rehabilitation and occupational health physicians—a systematic literature review focusing health care organization. Dtsch Med Wochenschr 1946 139:1609–1614. doi:10.1055/s-0034-1370189
Voelter-Mahlknecht S, Stratil J, Kaluscha R et al (2017) The cooperation between occupational physicians, rehabilitation physicians, and general practitioners in Germany: experiences, attitudes and possibilities for improvement from the perspectives of the medical groups and rehabilitation patients—protocol for a qualitative study. BMJ Open 7:e014228. doi:10.1136/bmjopen-2016-014228
Vroeijenstijn-Nguyen X, Brenner R (2007) Contact between occupational health physicians and rehabilitation physicians—todays reality for a better future? Tijdschr Bedr Verzek 2:59–62