Cooperation between general practitioners, occupational health physicians, and rehabilitation physicians in Germany: what are barriers to cooperation and how can these be overcome? A qualitative study

Introduction: Rehabilitation measures for patients in the working age primarily aim at maintaining employability, restoring fitness for work and timely return to work. General practitioners (GPs), occupational health physicians (OPs), and rehabilitation physicians (RPs) fulfill different functions in the rehabilitation process, which need to be interlinked effectively to achieve a successful medical and occupational rehabilitation. In Germany, this cooperation at the interfaces is regarded as often working suboptimal. On this background, this qualitative study had two main aims: the first was to record the experiences and attitudes of OPs, RPs and GPs, as well as of rehabilitation patients, to indicate barriers to and obstacles in the cooperation and communication between medical professionals at the intersection of workplace and rehabilitation institutions. The second aim of the publication was to identify, present and discuss suggestions proposed by physicians and patients on how these barriers and obstacles can be overcome and thereby how communication and cooperation between the medical protagonists may be improved. A special focus of the study was a supposed exclusion of OPs from the rehabilitation process, as reported in the literature. Methods and analysis: As previous literature reviews have shown, insufficient data on the experiences and attitudes of the stakeholders are available. Therefore, an exploratory qualitative approach was chosen. In total, 8 Focus Group Discussions with occupational physicians, rehabilitation physicians, general practitioners and rehabilitation patients (2 Focus Groups with 4–10 interviewees per category) were conducted. Qualitative content analysis was used to analyze the data. Results: A number of barriers to and obstacles in cooperation and communication were reported by the participants, including: (1) organizational (e.g. missing contact details, low reachability, schedule restrictions), (2) interpersonal (e.g. rehabilitants level of trust in OPs, low perceived need to cooperate with OPs, low motivation to cooperate), and (3) structural barriers (e.g. data privacy regulations, regulations concerning rehabilitation reports). In regards to these barriers, options for improvement were identified and characterized by the author in the following categories: (1) regulatory interventions (e.g. formalized role and obligatory input of occupational physicians), (2) financial interventions (e.g. financial incentives for physicians based on the quality of the application), (3) technological interventions (e.g. communication by E-Mail), (4) changes in organizational procedures (e.g. provision of workplace descriptions to RPs on a routine basis), (5) educational and informational interventions (e.g. joint educational programs, measures to improve the image of OPs), and (6) the promotion of cooperation (e.g. between OPs and GPs in regards to the application process). Ethics and dissemination: The research was undertaken with the approval of the ethics committee of the medical faculty and university hospital of Tübingen. The study participants’ gave their written consent prior to participating in the interviews. As set out in the study protocol, the results were published in international, peer-reviewed medical journals. Conclusion: The data on barriers as well as on options for improvements presented in this study are in line with studies and expert opinions from Germany and other countries in Western Europe. While some of the proposed solutions could be implemented by the participants themselves by changing behavior and practice in the everyday routine, a multi-level stakeholder approach might be necessary for implementing others. The evidence for the proposed suggestion is limited and mostly based on studies not conducted in the context of the German health care setting. Future quantitative research is needed to assess the relative weight of the findings and controlled interventional studies are necessary to assess feasibility and effectiveness of the proposed suggestions