Identifikation von potenziellem Reha-Bedarf in der Hausarztpraxis: Idee und Wirklichkeit

Abstract

Medical rehabilitation is a basic component in the German health care system. However, several studies have shown only moderate effects by rehabilitation treatment. The effectiveness of medical rehabilitation depends on different factors, like rehabilitation need, access, preparation for rehabilitation treatment, therapy intensity and rehabilitation aftercare. During the past few years the lack of cooperation and communication between cost carriers and general practitioners has been emphasized. Since general practitioners play a central role in the patients' decision for rehabilitation treatment, the aim of the present study was to facilitate the identification of rehabilitation need by general practitioners. The project group integrated different professions. To facilitate assessment of rehabilitation need in patients attending a medical practice, two different approaches were applied: First, a self-administered patient questionnaire was developed, containing different subjective indicators of rehabilitation need (e. g., subjective health, problems in activities and participation as well as daily or occupational stress). Secondly, the project group worked out a short checklist for general practitioners, containing a number of criteria confirming patients' potential need for rehabilitation. Both instruments were tested in nine medical practices with 60 patients presumably in need for medical rehabilitation. The short checklist as well as the patient questionnaire proved to be practicable and economical. Nine of 40 general practitioners participated. Based on the checklist a need for rehabilitation was identified in 85% of their patients. In another 10% of the patients the result was questionable, and in three patients the finding was negative. In the self-assessment of the patients, 98% stated a subjective need of rehabilitation (global rating), only one patient indicated no rehabilitation need. The agreement between physician and patient assessments was only weak (kappa: 0.11, p=0.08). Defining deviation by one category as still indicative of agreement of the two ratings, an agreement of 78% is reached. Both instruments in principle proved to be useful in medical practice. They allow quick and easy assessment of a potential rehabilitation need in everyday practice. Despite these positive results and the supportive function of the checklist, the participation rate among general practitioners was unexpectedly low, possibly mainly due to the additional bureaucracy, a negative image of the rehabilitation system, and the concurrence with DMPs. Poor accessibility of general practitioners regarding questions of medical rehabilitation is well-known from numerous earlier research projects. Satisfying integration of physicians could not be reached, although the approach of needs assessment seems to be promising. Further research should focus on how the urgently required cooperation could be achieved.