Abstract
BackgroundHigh continuity of care has a positive impact on health outcomes, but insight into the mechanisms underlying this impact is limited. Information continuity, on which our study focuses, is especially important when relational continuity is not given, which is often the case at hospital admission or hospital discharge. The aim of this study is to provide insight into the information flows between general practices and hospitals in Germany, and to identify factors associated with these flows of information.MethodsThis is a qualitative interview study in a purposeful sample of staff from hospitals and general practices (general practitioners, care assistants in general practice, hospital management, hospital physicians, and nursing staff). Interviews were conducted via telephone or face-to-face using a self-developed semi-structured interview guide. Stepwise systematic content analysis was used to structure collected material into themes and sub-themes that related to the study aim. Data was analysed by two researchers in several cycles, alternating between inductive and deductive approaches.ResultsA total of 49 interviews were conducted. Duration of the interviews varies between 21 and 78 min (mean duration 43 min). Across all groups, more than two thirds of participants were female (n = 34, 69%). The analysis highlighted six interdependent main themes regarding factors that affect information flows between hospitals and general practices: organisational, legal, financial, patient factors, individual characteristics, and emotional & social factors. The latter theme emerged as particularly rich and was therefore divided into four subthemes: appreciation and understanding of the respective other, (intrinsic) motivation, socialisation, and relationships. Organised meetings and events were mentioned as strategies to address emotional and social factors.ConclusionsDigitalisation can facilitate information flows between care providers. However, knowing each other and good personal relations remain important for effective collaboration. Cooperation between all stakeholders is needed to aim to achieve continuity of care.Trial registration: DRKS00015183 on DRKS/ Universal Trial Number (UTN): U1111-1218–0992. Date of registration 23/08/2018.
Highlights
High continuity of care has a positive impact on health outcomes, but insight into the mechanisms underlying this impact is limited
Our study focuses on one aspect of information continuity across care sectors: the transfer of information that has been accumulated in general practice to hospital, usually in paper-based or digitally recorded formats [9]
The groups are not mutually exclusive, the assignment to the groups was based on the individual’s role in VESPEERA
Summary
High continuity of care has a positive impact on health outcomes, but insight into the mechanisms underlying this impact is limited. Definitions of the concept in the literature differ and the distinction from related concepts can be difficult [8]. In their widely used definition, Haggerty et al [7] define continuity of care by referring to three core dimensions: relational continuity, informational continuity, and management continuity. Relational continuity refers to a longitudinal and trusting relationship between a patient and one or more health care providers, which is considered to be a core element of primary care. The experience of continuity of care might be described differently by patients and health care providers [7]
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