Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 152 No. 5152 (2022)

Role distribution and collaboration between specialists and rural general practitioners in long-term chronic care: a qualitative study in Switzerland

  • Rebecca Tomaschek
  • Armin Gemperli
  • Michael Baumberger
  • Isabelle Debecker
  • Christoph Merlo
  • Anke Scheel- Sailer
  • Christian Studer
  • Stefan Essig
DOI
https://doi.org/10.57187/smw.2022.40015
Cite this as:
Swiss Med Wkly. 2022;152:40015
Published
20.12.2022

Summary

INTRODUCTION: This study explores general practitioners’ (GPs’) and medical specialists’ perceptions of role distribution and collaboration in the care of patients with chronic conditions, exemplified by spinal cord injury.

METHODS: Semi-structured interviews with GPs and medical specialists caring for individuals with spinal cord injury in Switzerland. The physicians we interviewed were recruited as part of an intervention study. We used a hybrid framework of inductive and deductive coding to analyse the qualitative data.

RESULTS: Six GPs and six medical specialists agreed to be interviewed. GPs and specialists perceived the role of specialists similarly, namely as an expert and support role for GPs in the case of specialised questions. Specialists’ expectations of GP services and what GPs provide differed. Specialists saw the GPs’ role as complementary to their own responsibilities, namely as the first contact for patients and gatekeepers to specialised services. GPs saw themselves as care managers and guides with a holistic view of patients, connecting several healthcare professionals. GPs were looking for relations and recognition by getting to know specialists better. Specialists viewed collaboration as somewhat distant and focused on processes and patient pathways. Challenges in collaboration were related to unclear roles and responsibilities in patient care.

CONCLUSION: The expectations for role distribution and responsibilities differ among physicians. Different goals of GPs and specialists for collaboration may jeopardise shared care models. The role distribution should be aligned according to patients’ holistic needs to improve collaboration and provide appropriate patient care.

References

  1. D’Amour D, Goulet L, Labadie JF, Martín-Rodriguez LS, Pineault R. A model and typology of collaboration between professionals in healthcare organizations. BMC Health Serv Res. 2008 Sep;8(1):188. https://doi.org/10.1186/1472-6963-8-188 DOI: https://doi.org/10.1186/1472-6963-8-188
  2. Koch G, Wakefield BJ, Wakefield DS. Barriers and facilitators to managing multiple chronic conditions: a systematic literature review. West J Nurs Res. 2015 Apr;37(4):498–516. https://doi.org/10.1177/0193945914549058 DOI: https://doi.org/10.1177/0193945914549058
  3. Tandjung R, Rosemann T, Badertscher N. Gaps in continuity of care at the interface between primary care and specialized care: general practitioners’ experiences and expectations. Int J Gen Med. 2011;4:773–8. https://doi.org/10.2147/IJGM.S25338 DOI: https://doi.org/10.2147/IJGM.S25338
  4. Aller MB, Vargas I, Coderch J, Vázquez ML. Doctors’ opinion on the contribution of coordination mechanisms to improving clinical coordination between primary and outpatient secondary care in the Catalan national health system. BMC Health Serv Res. 2017 Dec;17(1):842. https://doi.org/10.1186/s12913-017-2690-5 DOI: https://doi.org/10.1186/s12913-017-2690-5
  5. Sampson R, Barbour R, Wilson P. The relationship between GPs and hospital consultants and the implications for patient care: a qualitative study. BMC Fam Pract. 2016 Apr;17(1):45. https://doi.org/10.1186/s12875-016-0442-y DOI: https://doi.org/10.1186/s12875-016-0442-y
  6. Scherpbier-de Haan ND, Vervoort GM, van Weel C, Braspenning JC, Mulder J, Wetzels JF, et al. Effect of shared care on blood pressure in patients with chronic kidney disease: a cluster randomised controlled trial. Br J Gen Pract. 2013 Dec;63(617):e798–806. https://doi.org/10.3399/bjgp13X675386 DOI: https://doi.org/10.3399/bjgp13X675386
  7. Brinkhof MW, Al-Khodairy A, Eriks-Hoogland I, Fekete C, Hinrichs T, Hund-Georgiadis M, et al.; SwiSCI Study Group. Health conditions in people with spinal cord injury: contemporary evidence from a population-based community survey in Switzerland. J Rehabil Med. 2016 Feb;48(2):197–209. https://doi.org/10.2340/16501977-2039 DOI: https://doi.org/10.2340/16501977-2039
  8. Gross-Hemmi MH, Gemperli A, Fekete C, Brach M, Schwegler U, Stucki G. Methodology and study population of the second Swiss national community survey of functioning after spinal cord injury. Spinal Cord. 2021 Apr;59(4):363–72. https://doi.org/10.1038/s41393-020-00584-3 DOI: https://doi.org/10.1038/s41393-020-00584-3
  9. Lundström U, Wahman K, Seiger Å, Gray DB, Isaksson G, Lilja M. Participation in activities and secondary health complications among persons aging with traumatic spinal cord injury. Spinal Cord. 2017 Apr;55(4):367–72. https://doi.org/10.1038/sc.2016.153 DOI: https://doi.org/10.1038/sc.2016.153
  10. Ronca E, Scheel-Sailer A, Koch HG, Essig S, Brach M, Munzel N, et al. Satisfaction with access and quality of healthcare services for people with spinal cord injury living in the community. J Spinal Cord Med. 2018:1–11. DOI: https://doi.org/10.1080/10790268.2018.1486623
  11. Ho CH. Primary care for persons with spinal cord injury - not a novel idea but still under-developed. J Spinal Cord Med. 2016 Sep;39(5):500–3. https://doi.org/10.1080/10790268.2016.1182696 DOI: https://doi.org/10.1080/10790268.2016.1182696
  12. Chamberlain JD, Ronca E, Brinkhof MW. Estimating the incidence of traumatic spinal cord injuries in Switzerland: using administrative data to identify potential coverage error in a cohort study. Swiss Med Wkly. 2017 May;147:w14430. DOI: https://doi.org/10.4414/smw.2017.14430
  13. Hagen EM, Grimstad KE, Bovim L, Gronning M. Patients with traumatic spinal cord injuries and their satisfaction with their general practitioner. Spinal Cord. 2012 Jul;50(7):527–32. https://doi.org/10.1038/sc.2011.187 DOI: https://doi.org/10.1038/sc.2011.187
  14. Zanini C, Lustenberger N, Essig S, Gemperli A, Brach M, Stucki G, et al. Outpatient and community care for preventing pressure injuries in spinal cord injury. A qualitative study of service users’ and providers’ experience. Spinal Cord. 2020 Aug;58(8):882–91. https://doi.org/10.1038/s41393-020-0444-4 DOI: https://doi.org/10.1038/s41393-020-0444-4
  15. Touhami D, Brach M, Essig S, Ronca E, Debecker I, Eriks-Hoogland I, et al. First contact of care for persons with spinal cord injury: a general practitioner or a spinal cord injury specialist? BMC Fam Pract. 2021 Oct;22(1):195. https://doi.org/10.1186/s12875-021-01547-0 DOI: https://doi.org/10.1186/s12875-021-01547-0
  16. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International journal for quality in health care : journal of the International Society for Quality in Health Care. 2007;19(6):349-57. DOI: https://doi.org/10.1093/intqhc/mzm042
  17. Tomaschek R, Touhami D, Essig S, Gemperli A. Shared responsibility between general practitioners and highly specialized physicians in chronic spinal cord injury: study protocol for a nationwide pragmatic nonrandomized interventional study. Contemp Clin Trials Commun. 2021 Nov;24:100873. https://doi.org/10.1016/j.conctc.2021.100873 DOI: https://doi.org/10.1016/j.conctc.2021.100873
  18. Ronca E, Scheel-Sailer A, Koch HG, Gemperli A; SwiSCI Study Group. Health care utilization in persons with spinal cord injury: part 2-determinants, geographic variation and comparison with the general population. Spinal Cord. 2017 Sep;55(9):828–33. https://doi.org/10.1038/sc.2017.38 DOI: https://doi.org/10.1038/sc.2017.38
  19. Fereday J, Muir-Cochrane E. Demonstrating Rigor Using Thematic Analysis: A Hybrid Approach of Inductive and Deductive Coding and Theme Development. Int J Qual Methods. 2006;5(1):80–92. https://doi.org/10.1177/160940690600500107 DOI: https://doi.org/10.1177/160940690600500107
  20. Diamantidis CJ, Powe NR, Jaar BG, Greer RC, Troll MU, Boulware LE. Primary care-specialist collaboration in the care of patients with chronic kidney disease. Clin J Am Soc Nephrol. 2011 Feb;6(2):334–43. https://doi.org/10.2215/CJN.06240710 DOI: https://doi.org/10.2215/CJN.06240710
  21. Forrest CB. A typology of specialists’ clinical roles. Arch Intern Med. 2009 Jun;169(11):1062–8. https://doi.org/10.1001/archinternmed.2009.114 DOI: https://doi.org/10.1001/archinternmed.2009.114
  22. Stålhammar J, Holmberg L, Svärdsudd K, Tibblin G; Jan Stålhammar, Lars Holmberg, Kurt. Written communication from specialists to general practitioners in cancer care. What are the expectations and how are they met? Scand J Prim Health Care. 1998 Sep;16(3):154–9. https://doi.org/10.1080/028134398750003106 DOI: https://doi.org/10.1080/028134398750003106
  23. Schweizerische Akademie der Medizinischen Wissenschaften (SAMW). Charta 2.0 Interprofessionelle Zusammenarbeit im Gesundheitswesen. 2020.
  24. Schmitz C, Atzeni G, Berchtold P. Challenges in interprofessionalism in Swiss health care: the practice of successful interprofessional collaboration as experienced by professionals. Swiss Med Wkly. 2017 Oct;147:w14525. DOI: https://doi.org/10.4414/smw.2017.14525
  25. Haddara W, Lingard L. Are we all on the same page? A discourse analysis of interprofessional collaboration. Acad Med. 2013 Oct;88(10):1509–15. https://doi.org/10.1097/ACM.0b013e3182a31893 DOI: https://doi.org/10.1097/ACM.0b013e3182a31893
  26. Berendsen AJ, Benneker WH, Schuling J, Rijkers-Koorn N, Slaets JP, Meyboom-de Jong B. Collaboration with general practitioners: preferences of medical specialists—a qualitative study. BMC Health Serv Res. 2006 Dec;6(1):155. https://doi.org/10.1186/1472-6963-6-155 DOI: https://doi.org/10.1186/1472-6963-6-155
  27. Adams SG, Pitts J, Wynne J, Yawn BP, Diamond EJ, Lee S, et al. Effect of a primary care continuing education program on clinical practice of chronic obstructive pulmonary disease: translating theory into practice. Mayo Clin Proc. 2012 Sep;87(9):862–70. https://doi.org/10.1016/j.mayocp.2012.02.028 DOI: https://doi.org/10.1016/j.mayocp.2012.02.028
  28. Pang J, Grill A, Bhatt M, Woodward GL, Brimble S. Evaluation of a mentorship program to support chronic kidney disease care. Can Fam Physician. 2016 Aug;62(8):e441–7.
  29. Rohrbasser A, Harris J, Mickan S, Tal K, Wong G. Quality circles for quality improvement in primary health care: their origins, spread, effectiveness and lacunae- A scoping review. PLoS One. 2018 Dec;13(12):e0202616. https://doi.org/10.1371/journal.pone.0202616 DOI: https://doi.org/10.1371/journal.pone.0202616
  30. Meyer-Nikolic V, Hersperger M. Q-Monitoring-Resultate schaffen Übersicht [Q-Monitoring-Results provide overview]. Schweiz Arzteztg. 2012;93(27-28):1036–8. DOI: https://doi.org/10.4414/saez.2012.00744
  31. Hummers-Pradier E, Beyer M, Chevallier P, Eilat-Tsanani S, Lionis C, Peremans L, et al. Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 2. Results: Primary care management and community orientation. Eur J Gen Pract. 2010 Mar;16(1):42–50. https://doi.org/10.3109/13814780903563725 DOI: https://doi.org/10.3109/13814780903563725
  32. Smith SM, O’Kelly S, O’Dowd T. GPs’ and pharmacists’ experiences of managing multimorbidity: a ‘Pandora’s box’. Br J Gen Pract. 2010 Jul;60(576):285–94. https://doi.org/10.3399/bjgp10X514756 DOI: https://doi.org/10.3399/bjgp10X514756
  33. Berendsen AJ, Benneker WH, Meyboom-de Jong B, Klazinga NS, Schuling J. Motives and preferences of general practitioners for new collaboration models with medical specialists: a qualitative study. BMC Health Serv Res. 2007 Jan;7(1):4. https://doi.org/10.1186/1472-6963-7-4 DOI: https://doi.org/10.1186/1472-6963-7-4
  34. Farmer J. Connected care in a fragmented world: lessons from rural health care. Br J Gen Pract. 2007 Mar;57(536):225–30.
  35. Kaufmann CF, Balthasar A. Zukünftige ambulante Grundversorgung: Einstellungen und Präferenzen der Bevölkerung (Obsan Bericht 04/2021). Neuchâtel: Schweizerisches Gesundheitsobservatorium; 2021.
  36. Søndergaard E, Willadsen TG, Guassora AD, Vestergaard M, Tomasdottir MO, Borgquist L, et al. Problems and challenges in relation to the treatment of patients with multimorbidity: general practitioners’ views and attitudes. Scand J Prim Health Care. 2015 Jun;33(2):121–6. https://doi.org/10.3109/02813432.2015.1041828 DOI: https://doi.org/10.3109/02813432.2015.1041828
  37. O’Malley AS, Reschovsky JD. Referral and consultation communication between primary care and specialist physicians: finding common ground. Arch Intern Med. 2011 Jan;171(1):56–65. https://doi.org/10.1001/archinternmed.2010.480 DOI: https://doi.org/10.1001/archinternmed.2010.480
  38. Szafran O, Torti JM, Kennett SL, Bell NR. Family physicians’ perspectives on interprofessional teamwork: findings from a qualitative study. J Interprof Care. 2018 Mar;32(2):169–77. https://doi.org/10.1080/13561820.2017.1395828 DOI: https://doi.org/10.1080/13561820.2017.1395828
  39. Hudson CC, Gauvin S, Tabanfar R, Poffenroth AM, Lee JS, O’Riordan AL. Promotion of role clarification in the Health Care Team Challenge. J Interprof Care. 2017 May;31(3):401–3. https://doi.org/10.1080/13561820.2016.1258393 DOI: https://doi.org/10.1080/13561820.2016.1258393
  40. Kim LY, Giannitrapani KF, Huynh AK, Ganz DA, Hamilton AB, Yano EM, et al. What makes team communication effective: a qualitative analysis of interprofessional primary care team members’ perspectives. J Interprof Care. 2019;33(6):836–8. https://doi.org/10.1080/13561820.2019.1577809 DOI: https://doi.org/10.1080/13561820.2019.1577809
  41. Saba GW, Villela TJ, Chen E, Hammer H, Bodenheimer T. The myth of the lone physician: toward a collaborative alternative. Ann Fam Med. 2012;10(2):169–73. https://doi.org/10.1370/afm.1353 DOI: https://doi.org/10.1370/afm.1353

Most read articles by the same author(s)