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International Archives of Occupational and Environmental Health

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Open Access 01-11-2017 | Original Article

Optimizing cooperation between general practitioners, occupational health and rehabilitation physicians in Germany: a qualitative study

Authors: Jan Stratil, Monika A. Rieger, Susanne Voelter-Mahlknecht

Published in: International Archives of Occupational and Environmental Health | Issue 8/2017

Abstract

Purpose

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.

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.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).

Conclusions

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.

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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 CrossRef

Beach J, Watt D (2003) General practitioners and occupational health professionals. BMJ 327:302–303. doi:10.1136/bmj.327.7410.302 CrossRef

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 53:254–255CrossRef

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 53:249–253CrossRef

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 CrossRef

Buijs P, van Amstel R, van Dijk F (1999) Dutch occupational physicians and general practitioners wish to improve cooperation. Occup Environ Med 56:709–713CrossRef

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 CrossRef

Campbell M, Fitzpatrick R, Haines A et al (2000) Framework for design and evaluation of complex interventions to improve health. BMJ 321:694–696CrossRef

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 CrossRef

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 43:515–525CrossRef

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 CrossRef

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 CrossRef

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 CrossRef

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 CrossRef

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 CrossRef

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 CrossRef

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 32:257–269CrossRef

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 CrossRef

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 CrossRef

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 CrossRef

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:e31CrossRef

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 CrossRef

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 CrossRef

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 CrossRef

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 CrossRef

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 CrossRef

Vroeijenstijn-Nguyen X, Brenner R (2007) Contact between occupational health physicians and rehabilitation physicians—todays reality for a better future? Tijdschr Bedr Verzek 2:59–62CrossRef

Title: Optimizing cooperation between general practitioners, occupational health and rehabilitation physicians in Germany: a qualitative study
Authors: Jan Stratil
Monika A. Rieger
Susanne Voelter-Mahlknecht
Publication date: 01-11-2017
Publisher: Springer Berlin Heidelberg
Published in: International Archives of Occupational and Environmental Health / Issue 8/2017
Print ISSN: 0340-0131
Electronic ISSN: 1432-1246
DOI: https://doi.org/10.1007/s00420-017-1239-6

At a glance: The STEP trials

Springer Medicine

Optimizing cooperation between general practitioners, occupational health and rehabilitation physicians in Germany: a qualitative study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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