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The OP who suggested this had such an arrangement with her employer, which led to her being involved in the occupational reintegration of her patients in nearly all instances. Some OPs suggested O.
By using this tool, RPs could clearly communicate their assessment on which tasks patients were no longer able to perform. According to some OPs, OPs needed to increase their visibility in order to improve their integration into the rehabilitation process and to build up professional and personal relationships with RPs.
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The concept of joint educational programs was supported in both professional groups. Some OPs also suggested E. Some OPs proposed that they E. RPs stated that data privacy regulations currently prohibit the use of email in rehabilitation clinics, but that this could be solved through the introduction of proper encryption software.
The participants in our study proposed suggestions on how problems in the rehabilitation process and barriers to cooperation between OPs, GPs, and RPs could be overcome. These suggestions referred to 1 regulation, 2 financing, 3 organizational procedures, 4 education and information, and 5 promotion of cooperation. While some of the suggestions are rooted in problems specific to the German health care system, including some suggestions regarding financing or organizational procedures, and may be limited to the German setting or health care systems similar to the German approach, such as Austria or Switzerland.
Recommendations specific to the German health care system include suggestions regarding shortening the rehabilitation report or the use of a standardized communication format in which RPs would communicate the results of their assessment by checking boxes with predefined terms relating to occupational tasks.
Two German pilot projects tested similar interventions to improve the communication between stakeholders and found a positive effect. However, both studies were assessed as prone to a high risk of bias Kuehn et al. While such tools may be specifically useful for the German rehabilitation system, the barrier of timely transmission of relevant findings and the translation of findings from one specific setting or expert group to another is well known in health services research.
It is therefore likely that similar solutions may be useful in the rehabilitation systems in other countries. Although not specifically focused on rehabilitation, the international literature supports structured formats and technology solutions as well as standardized language in order to improve availability, completeness, timeliness, and quality of discharge information from hospitals to out-patient health care providers Kripalani et al.
While the suggested interventions regarding finances were identified in a qualitative study on the general cooperation of German OPs and GPs Mosshammer et al. Although financial incentives to improve cooperation between protagonists in the health care system may pose a solution, a Cochrane review with a focus on the quality of care provided by primary care physicians found that there is insufficient evidence regarding the effectiveness or non-effectiveness of financial incentives Scott et al. The proposal of introducing or strengthening evaluation and feedback mechanisms is supported by a Cochrane review by Ivers et al.
The review assessed the concept that healthcare professionals may be prompted to modify their practice when given performance feedback showing that their clinical practice is inconsistent with a desirable target. This review found moderate evidence that audit and feedback can lead to small but potentially important improvements in professional practice. However, none of the studies included in this review looked explicitly at the topic of this study, and a transferability of the results to the specific circumstances addressed in this study has yet to be assed Ivers et al.
Some participants stated that OPs needed to better explain their role, function, and the concept of professional confidentiality to their patients. The need for such clarification is supported by two German publications which indicated that the position and function of the OP often was not clear to employees and employers Glomm ; Dzuck et al.
A qualitative study from the Netherlands concluded that patients viewed the cooperation between OPs and curative physicians from a strategic perspective in which their own interests were the key decisive factors Plomp et al. If patients could be convinced that OPs were working in their interest, they could be more supportive of interdisciplinary collaboration. A number of studies i. Buijs et al. Our participants suggested introducing joint continuing medical education programs to strengthen and facilitate interdisciplinary communication and to build interdisciplinary relationships.
Similar proposals have also been made in German qualitative studies on interfaces in the rehabilitation process Pohontsch and Deck and cooperation between GPs and OPs in general Mosshammer et al. Nauta et al. In another Dutch study, a training program did not lead to an increased collaboration between GPs and OPs on lower back pain Faber et al. A Cochrane review of the international literature on interprofessional education programs found weak evidence that such programs can have slightly positive effects on cooperation between physicians and other health professionals Reeves et al.
However, the transferability of the results on collaboration between physicians of different disciplines is unclear. An interest in joint professional training programs was voiced in two surveys by a majority of OPs and RPs from Belgium, Austria, and the Netherlands Vroeijenstijn-Nguyen and Brenner ; Rijkenberg By contrast, in a qualitative study from Germany a majority of GPs rejected the proposal of joint quality circles with OPs Mosshammer et al.
In a study conducted within the same research project as this study, we assess the role of intergroup dynamics in general as well as the role of negative or stereotypical group perceptions in particular as a barrier to cooperation, based on the Social Identity Approach by Tajfel and Turner , Based on this theoretical approach, the study identified numerous divergent perceptions i.
Both, divergent and negative perceptions are linked to barriers to cooperation. Based on this theory-driven assessment, we propose solutions for resolving conflicts in intergroup dynamics building on approaches, which themselves are based on or are linked to the Social identity approach, i. Some of the suggestions proposed by participants seem to indicate a heterogeneous level of knowledge regarding rehabilitation services.
For example statements of GPs suggesting an unawareness of existing evaluation schemes or the financing of consolidative post-rehabilitation programs or of one RP admitting to be unaware of the role of OPs in the rehabilitation system. While not explicitly stated by participants, overcoming a lacking knowledge on processes in the rehabilitation system could pose a possible solution. A systematic assessment of informational needs offers a promising field for future research. Our study has several strengths.
We were able to achieve high levels of heterogeneity in our sample of interviewees, e. Moreover, we included patients as main stakeholders. They made only few suggestions in regards to improving the cooperation, and mostly discussed barriers to cooperation and problems they had experienced during their treatment. As most suggestions proposed by the physicians focused on problems experienced by patients as well, we believe the suggestions to work in their interest.
A limitation of the study is that the composition of our focus groups deviated from the composition specified in our protocol Voelter-Mahlknecht et al. We believe the perception of different roles of OPs is still represented in our sample, as some OPs had worked as employees of occupational service providers and as staff doctors in the past. As a strong heterogeneity of rehabilitation clinics in regards to OP—RP-cooperation has been indicated by some studies, we cannot exclude the possibility of a bias in the RPs and rehabilitants perception due to unwanted group effects.
As participants were aware that the interviews were conducted by occupational health experts, biased responses due to social desirability are possible, but we believe this risk can be considered low due to the richness of our data and the critical statement made in the discussions.
We conducted FGDs with homogenous professional groups in order to have participants discuss less constrained and to allow them talk more freely about negative or possibly prejudicial attitudes regarding the other medical specialists or patients. As numerous critical statements were made by participants about other groups of participants, we consider the FGDs with heterogeneous participants of a homogenous professional group to be successful. Inter-professional discussion took place within the validation workshop held in January where OPs and GPs participated. We will consider conducting FGDs with mixed professional groups based on the finding of this study, if new resources can be acquired.
In this study, we present suggestions to overcome problems and improve collaboration at the interprofessional interfaces of the rehabilitation process in Germany which in part may be transferred to other countries, too. This study builds on an earlier publication that has outlined possible obstacles to cooperation in terms of organizational, interpersonal, and structural barriers.
We suggest that stakeholders focus on organizational procedures, education and information interventions, and on the promotion of cooperation, as these interventions may be implemented by the stakeholders themselves in their everyday working routine. Changing aspects of finance and regulation may be more effective although more complicated to establish and therefore more suitable as long term solutions.
Based on the literature, the qualitative study on barriers to cooperation and the results of this qualitative study on possible solutions, we believe a key aspect lies in changing the perception of and knowledge about the role and function of OPs in general and in the rehabilitation process in particular. Moreover, we would like to thank Dipl. Martina Michaelis and Christine Preiser for her assistance in developing the interview guide, Dr. Rainer Kaluscha for supporting the recruiting process, Peter von Philipsborn for language checks and Lisa Peterson for translation services and language check.
Skip to main content Skip to sections. Advertisement Hide. Download PDF. Optimizing cooperation between general practitioners, occupational health and rehabilitation physicians in Germany: a qualitative study. Open Access. First Online: 05 July Purpose To achieve successful medical rehabilitation and timely return to work, general practitioners, occupational health and rehabilitation physicians need to cooperate effectively. Methods 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.
Results Room for improvement exists with regard to 1 regulation e. Conclusions Many suggestions are practical and could be implemented into the daily routine of physicians, while others demand multi-level, multi-stakeholder approaches.
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Background Occupational health physicians OPs , general practitioners GPs , and rehabilitation physicians RPs fulfill different functions in the rehabilitation process, which need to be connected and coordinated effectively to achieve successful medical and occupational rehabilitation in employees. The overall aim of this research project was to identify barriers to and ways to improve the cooperation between RPs, OPs, and GPs in the rehabilitation process in Germany Voelter-Mahlknecht et al.
The first part of the qualitative study focused on the assessment of the cooperation as well as the identification of barriers and determinants for good cooperation and communication Stratil et al. The present, second part focuses on possible solutions as reported by the four groups of stakeholders.
In particular, we aim to answer the following questions: 1. We used a purposive sampling technique aiming for maximal structural variation in the composition of our sample in order to represent the heterogeneity of the stakeholder involved in the process we aimed for Palinkas et al. RPs and patients were recruited through cooperation with the rehabilitation clinics Treatment Center Federsee Therapiezentrum Federsee in Bad Buchau specializing in orthopedics, oncology and rheumatology and the Huettenbuehl clinic of the Rehabilitation Center Bad Duerrheim Reha-Zentrum Bad Duerrheim, Klinik Huettenbuehl in Bad Duerrheim specializing in psychosomatic and mental health via contact persons.
We assigned the suggestions proposed by our four groups of stakeholders in six categories: O organizational, T technology, F finance, R regulation, E educational and information, and P promotion of cooperation. Conflict of interest The authors declare that they have no conflict of interest. J Hosp Med 4 7 — More than half of these exhibitors are manufacturers; followed by dealers, service providers, institutions, associations or self-help groups.
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