Factors Influencing the Access to and Utilization of Medical Rehabilitation Services Recommended after Care Assessment - Results of Qualitative Interviews with Professionals Involved in the Decision Process

Abstract

In Germany, persons in need of care can receive a rehabilitation recommendation from the medical service of the health insurance companies. Approximately half of these recommendations lead to applications and every fourth recommendation to actual utilisation of medical rehabilitation. Little is known about the supporting factors for and barriers to this special access to medical rehabilitation for persons in need of care. To explore the influencing factors - both personal and procedural - from the perspectives of involved professionals. Interviews regarding on the access to medical rehabilitation were conducted with expert raters from the medical service of the German statutory health insurance system and with employees in long-term care and in health insurance. For data analysis systematic text condensation was used. Based on 53 interviews with 56 involved professionals, individual- and process-related influencing factors were identified. In addition to sociodemographic, health-related, personal and financial characteristics, rehabilitation-related attitudes and a strong attachment to the home environment seem to be particularly relevant. Furthermore, service-related (e. g. expectations and wishes) and process-related (e. g. care structures) characteristics also seem to have an impact. The importance of social support from relatives was emphasized. The results point to potential supporting factors and barriers in the access to rehabilitation by means of care assessment. They should be considered for possible improvements of the assessment and approval procedures as well as the necessary early and sufficient councelling of the concerned persons and their relatives.