“Well, it’s very doctor-related” – Interprofessional communication and collaboration between general practitioners and nurses: a qualitative study in Southern Germany

“Well, it’s very doctor-related” – Interprofessional communication and collaboration between general practitioners and nurses: a qualitative study in Southern Germany | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article “Well, it’s very doctor-related” – Interprofessional communication and collaboration between general practitioners and nurses: a qualitative study in Southern Germany Kim Nordmann, Stefanie Sauter, Marie-Christin Redlich, Patricia Möbius-Lerch, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4458661/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 May, 2025 Read the published version in BMC Health Services Research → Version 1 posted 10 You are reading this latest preprint version Abstract Background: The demographic transition in Germany is leading to an increase in the number of people needing care or nursing services in their own homes. Interprofessional communication and collaboration among healthcare professions providing outpatient care is paramount to ensure effective and high-quality patient-centred care. However, interprofessional communication and collaboration comes with complex prerequisites and rarely works smoothly. Thus, it is necessary to assess the current status quo. Therefore, the aim is to characterize communication patterns, factors influencing interprofessional communication and collaboration and expectations towards communication and collaboration between home-care nursing services and general practitioner practices in Germany. Methods: Semi-structured interviews with healthcare professionals in general practitioners’ practices and nurses working in home-care nursing services were conducted in southern Germany. The interviews were analysed using inductive thematic content analysis. Results: Current communication occurs via fax, telephone or personal contact for various purposes, including the emission or rectification of medical orders and exchanging information about change in a patient’s condition. Key factors influencing interprofessional communication are organizational (e.g., lack of direct communication), profession-related (e.g., hierarchy) and individual (e.g., capacity to provide care). Interprofessional collaboration is scarce. Nurses and general practitioners expect uncomplicated, efficient and quick communication and collaboration through set channels. Conclusions: Current interaction patterns are deficient and require political, structural and educational changes to establish well-functioning collaboration in the ambulant sector that facilitates patient-centred care. Educational and political reforms should comprise expanding interprofessional education in curricula and the introduction of clear and secure communication channels. ambulatory setting outpatient care home care Germany nursing physician primary care Figures Figure 1 Background Most countries worldwide are experiencing demographic transition – the number of, for example, European citizens aged 65 or over is expected to rise by 41% in the coming three decades [ 1 , 2 ]. For 2050, it is estimated that 22–27% of the German population will be older than 67 years as opposed to 20% in 2021 [ 3 ]. This in turn is associated with increased demand of healthcare services, as multimorbidity rises with age [ 4 ]. Due to the desire of many elderly people to be cared for in their own home, an increase of 42% in the number of persons using professional home-care nursing services is projected until 2050 [ 5 ]. In Germany, ambulant health and nursing care services are provided by a multitude of professionals, such as general practitioners (GPs) and medical specialists, pharmacists, nurses and physiotherapists, all of whom work separately and in accordance with the different pillars of the healthcare system, as mainly defined in the Social Code Books V and XI [ 6 ]. GPs are generally self-employed and cater to the medical needs of the population living in the vicinity of their practice. They employ medical assistants at their practice who are responsible for organizing GP practice procedures (such as documentation and billing for services) and patient flow, including appointment-making and other communication. Medical assistants are the first point of contact at the GP practice, including home-care nursing services and patients [ 7 ]. Home-care nursing services are heterogeneous in their organization, ranging from small local services to larger companies with branches all over Germany. They provide in-home care services, such as nursing diagnosis and interventions, counselling, body-related care measures, administration of medicines and assistance with household management [ 8 ]. While patients have free choice of healthcare provider and home-care nursing service, nursing services must generally first be prescribed in order to access service provision and reimbursement [ 6 ]. As multimorbid patients receive care from these different healthcare provider, interprofessional communication and collaboration among diverse healthcare professions in the ambulatory setting are needed to ensure effective and high-quality patient-centred care [ 9 – 11 ]. For the purpose of this paper, we define interprofessional communication as the “ability to translate information openly, accurately and in a timely manner” between professions [ 12 ] and interprofessional collaboration as “different health and social care professions meeting regularly to negotiate and agree on how to solve complex care problems or deliver services” [ 13 ]. Communication is thus a key element of collaboration and forms the basis for trusting interprofessional relationships [ 14 ]. Interprofessional communication and collaboration might, however, be hampered by the fragmented organizational and financial structure of the German healthcare system which reimburses inadequately for interprofessional coordination and communication activities [ 6 , 15 ]. Especially in home-care, interprofessional collaboration is challenging [ 11 ]. Challenges to interprofessional communication and collaboration and effective patient care might further be exacerbated by i) a shortage of approximately 3,300 GPs, aggravated by the retirement of GPs with few young GPs to replace them, who then work less hours and conduct fewer home visits [ 16 – 19 ] and ii) a lack of at least 35,000 skilled nurses [ 20 ], resulting in the need to recruit foreign staff. With this study, we want to contribute to the body of knowledge relating to the current challenges to interprofessional communication and collaboration between home-care nursing services and GP practices in Germany, as perceived by the healthcare professionals. The aim of this paper is to characterize communication patterns, the factors positively or adversely influencing interprofessional communication and collaboration, and the expectations towards communication and collaboration between home-care nursing services and GP practices in Germany. Methods Participant recruitment and data collection We conducted a qualitative study in a region in southern Germany, which is reported upon in this paper in adherence with the Consolidated Criteria for Reporting Qualitative Research (COREQ) to ensure quality [ 21 ]. Semi-structured interviews were conducted with 1) healthcare professionals in GP practices and 2) nurses working in home-care nursing services. The interview guide was developed systematically according to Helfferich [ 22 ] by collecting questions, verifying them against the aim of the study, and subsequently sorting and summarizing them. The interview guide was tested with two nurses and a general practitioner and validated through discussion in an interdisciplinary scientific team. The final interview guide (see Supplementary material 1) was devised along the themes: 1. current communication patterns between GPs and home-care nursing services (questions informed by previous empirical knowledge [ 23 ]) and 2) the introduction of sociotechnical information and communication technologies, above all, in the current context of the mandatory implementation of the telematics infrastructure in Germany. Besides open-ended questions, participants were asked to rate the quality of communication between GP practices and home-care nursing services from 1 (best) to 6 (worst) to open the discussion about the current quality of communication and provide factors influencing their judgement. We anticipated 30–45 minutes duration for each interview; the actual mean duration was 35 minutes (from the range 17–72 minutes). In total, 55 general practitioner and 32 home-care nursing services in the target region were contacted via post in early March 2023 and three weeks later received an email and a telephone invitation. To boost GP participation in the study, we expanded the target region in June 2023 via purposive sampling through 46 email and telephone invitations. At this stage of data collection, analysis had not yet started. Eligible participants needed to be above the age of 18 years, willing to provide written informed consent, to belong to one of the professional groups: general practitioners, medical assistants, nurses (including those serving as nursing service manager), or trained nursing assistants and be currently working in a GP practice or a home-care nursing facility in a specific region in southern Germany. We included these professional groups as they are the key population involved in communication and collaboration between home-care nursing services and GP practices. Interviews were conducted by trained investigators with a background in qualitative research (KN, SS, FF, MS, MCR, PML) from April to July 2023 at either the participants’ workplace, the interviewer’s office, or via a videoconference tool (Zoom Video Communications, Inc.), according to the participant’s choice. Of the researchers, four were female and two were male. They had a diverse background ranging from medicine to nursing, including public and global health and sociology. In most interviews, two researchers were present: one leading the interview and one note-taker. No other person was present in the room during the interviews. The researchers explained the study goals prior to the interviews. Following the interviews, participants responded to a socio-demographic questionnaire. The researchers took field notes during the interview, which they subsequently discussed. We conducted in total 16 interviews with all contacted healthcare providers willing to participate. Of those interviews, one involved two participants from the same home-care nursing service due to time constraints of the participants. Towards the final interviews, no new themes arose and we concluded that data saturation was reached. Data analysis Interviews were audio recorded, transcribed and pseudonymized. The quotes presented within this manuscript include information on the profession (General Practitioner: GP; (deputy) home-care nursing service manager: NM), the sex (Male: M; Female: F) and the age of the participant in years. No repeat interviews were carried out and we did not send transcripts or findings to participants to comment on or correct. Interview transcripts were stored on a password-protected computer, accessible only to the research team, to protect the privacy and confidentiality of the participants. Thematic content analysis according to Braun and Clark [ 24 ] was used to identify the main themes and subthemes inductively. KN and MS coded one interview with a GP independently; FF and MCR one with a nurse. The results were compared and synthesized to develop a preliminary coding framework. KN then coded the remaining interviews using MAXQDA version 2022 (VERBI Software GmbH), a qualitative data analysis software. Coding was reviewed by a second researcher (MCR) and differences settled between the researchers. The codes were then classified into profession-related and organizational factors, based on by Nieuwboer’s et al. [ 10 ] conceptualization who identified factors hindering doctor-nurse communication in an ambulatory setting through a qualitative study. We expanded the factors by a third one, titled ‘individual factors’, and summarized codes pertaining to current communication patterns under one theme as well. The analysis was conducted in German. For the purpose of this publication, quotes were translated from German into English and double-checked by the research team (original and translated version can be found in Supplementary material 2). Ethics This study was approved in November 2022 by the Gemeinsame Ethikkommission der Hochschulen Bayerns (Joint Ethics Committee of the Bavarian Universities of Applied Sciences) under the number GEHBa-202211-V-084. The participants provided written informed consent prior to data collection and did not receive any compensation for their participation. Results Starting with the sociodemographic characteristics of the study participants, we present current communication patterns and factors that influence interprofessional communication and collaboration grouped into organizational, profession-related and individual factors. This is followed by an overview of the factors and expectations towards interprofessional communication and collaboration. Sociodemographic characteristics We interviewed six GPs and one medical assistant working in a GP practice, as well as nine (deputy) home-care nursing service managers and one nurse employed at home-care nursing services (Table 1 ). Of the 17 participants, three were women employed in a GP practice and six were women working in home-care nursing services. The participants from GP practices had been working for an average of 6.50 (± 4.86) years at their current practice which provided care to 1,250 (± 298) patients per quarter on average, of which about 15% received home-care nursing services. The GP practices were largely similar in their structure, with one self-employed GP employing several medical assistants. In contrast, ambulant nursing care facilities varied from small, familiar facilities with 12 employees and 55 clients to big enterprises with specialized IT departments, employing 120 people and caring for 500 clients. Table 1 Characteristics of study participants and their facilities Participants from GP practices (n = 7) Participants from home-care nursing services (n = 10) Total (n = 17) Mean age (± SD) [years] 42.14 ± 8.87 44.60 ± 12.22 43.59 ± 11.04 Sex Female 3 6 9 Male 4 4 8 Profession GP 6 0 6 Medical assistant 1 0 1 NM 0 9 9 Nurse 0 1 1 Average years in current position (± SD) 6.50 ± 4.86 7.00 ± 5.45 6.79 ± 5.22 Average number of patients/clients (± SD) 1250 ± 298 152 ± 138 NA Average number of patients receiving care from home-care nursing services (± SD) 196 ± 140 NA NA GP: General practitioner, NA: Not applicable, NM: (deputy) Home-care nursing service manager, SD: Standard deviation Current communication patterns Way of communication All GPs and nurses communicated primarily using traditional methods such as fax machines and telephones, while digital means such as email were infrequently used. Occasionally, and especially in urgent cases, nurses might physically visit the GP practice. “Many things can be done by phone or by fax. So, if we can't reach the doctors by phone, then we try to reach them by fax. Email, it's really rather rare that you can reach the doctors by email. [...] And quite often it is also the case that if we have no other chance of getting through, then we drive to the doctors, but that is the last solution.” (NM, F, 60) Reasons for communication The reasons for communication reported on both sides were to i) issue medical orders for e.g., medication and ii) discuss a patient’s condition, such as the necessity of a home visit. “If the home-care nursing service runs out of medication, or if a visit is requested, or if wound care is needed, they send us an electronic fax.” (GP, M, 51) Contact person when communicating All nurses typically communicated with the medical assistant and only in urgent cases directly with the GP. GPs reached out to the ambulant nursing care facility only in case of follow-up questions. GPs evaluated the quality of contact, using a Likert scale ranging from 1 (best) to 6 (worst), at a level of 2–3. Conversely, nurses perceived the quality less favourably, assigning a 3–4. “I would say 98 percent of the time, it is enough for us to correspond with the medical assistants. Sometimes the medical assistants then say they have to consult with the doctor and then they call us back.” (NM, F, 60) Factors influencing interprofessional communication and collaboration Organizational factors Organizational factors negatively impacting interprofessional communication and collaboration included fragmentation of the setting, lack of direct and intersectoral communication, scarce personal contact and high workload. Fragmentation of the setting Home-care nursing services catered for patients attended to by different GPs, while GPs took care of patients from various home-care nursing services. All GPs working in rural areas reported that their patients were served by fewer home-care nursing services compared to GPs in urban areas. The fact that documentation and information systems were not shared impeded automated transfer of information. “Above all, we have the problem that, because we supply customers in the entire [Name of a region], we do not say: ‘Okay, we have 50% of the customers at one GP’, but we have all GPs from [Name of a place] to [Name of a place].” (NM, F, 29) Lack of direct intersectoral communication When the necessity for direct communication arose, most GPs reported difficulties in reaching the appropriate person in the home-care nursing services. Likewise, most nurses criticized the accessibility of the GP, emphasizing short opening hours and the absence of a dedicated communication channel for GP-nurse interaction as nurses relied on the same telephone number as patients, being in direct “competition with sick people” (NM, M, 47) and needing to wait in the loop. Some GPs and nurses alike further criticized the deficient intersectoral communication, such as between specialists and GPs or between acute care facilities and home-care nursing services. “And then it is often not clear to me who is really my contact person [from the home-care nursing service].” (GP, F, 38) “Communication is the classic way: telephone. This is becoming more and more difficult because, of course, in the practices the telephones are probably running hot and glowing.” (NM, M, 45) Scarce personal contact Even though nurses and GPs valued personal contact, which was thought to foster a productive work climate, opportunities for such interactions were limited mainly due to time constraints. GPs in rural areas reported more instances of personal contact than their urban counterparts. “I find this personal contact, even if they [nurses] then come to me personally in the practice, for example, very important and very good.” (GP, M, 40) High workload Time constraints were thought to arise due to a high and rising workload perceived by most nurses and GPs alike, which negatively influenced the quality and efficiency of patient care and collaboration. Many GPs additionally perceived nurses as overburdened with documentation responsibilities and staff shortages. “The practices, the medical assistants, they just give me the strong impression that they have such a run-up and such a run-in that they simply can't cope with the work anymore. And that is very noticeable.” (NM, M, 30) Profession-related factors Profession-related factors impeding efficient interprofessional communication and collaboration encompassed hierarchy, responsibilities and rights, as well as education. Hierarchy Both GPs and nurses used words like “them” and “us” in their communication about one another, drawing a strong demarcation line between the professional groups. According to many nurses, the hierarchical thinking of GPs and medical assistants hindered effective collaboration – even though they reported that this was slowly changing. As some nurses perceived themselves as the “eye and ear” of the patient, they demanded to be treated as an equal partner by GPs. While some GPs were more open to propositions from nurses, they stressed that the patients’ treatment was ultimately their decision, and most GPs perceived themselves as having the authority to issue directives to nurses. “Ultimately, the decision comes from my side, what is then prescribed.” (GP, M, 40) “In my experience it always depends on the hierarchical thinking of the physicians how well or how badly what works.” (NM, F, 42) Responsibilities Some GPs perceived nurses as not wanting to carry responsibility, thus shifting it towards the GPs and overloading them with tasks. Most nurses, on the other hand, perceived the need to monitor the GPs’ work and criticized the current system of medical orders as they depended on issuing correct medical orders for reimbursement. “I feel like it's often more like, well, I sent a fax, then the doctor can take care of it.” (GP, M, 51) “Things get lost. They [the GPs] have a medication plan from half a year ago again. They haven't entered the data for people yet. I can understand all that, given the stress and the throughput that they have in the doctors' offices. But you always have to keep a close eye on things.” (NM, M, 47) Rights A lack of right to access patients’ data further impeded the work of some nurses as they sometimes did not receive information about a patient whom they were jointly treating with the GP, due to data protection issues. “The [doctors] are not really allowed to give me any information. As I said, I have some doctors who do it because they know that we are there every day. But there are doctors who don't say anything.” (NM, F, 31) Education Both professions criticized the lack of knowledge of the other profession, claiming that it hampered their interprofessional collaboration. Some nurses, for example, highlighted that GPs’ lack of knowledge in practice management had a negative impact on the working climate and efficiency of their practice, while many GPs, on the other hand, mentioned the lack of knowledge concerning patient care and lack of experience on the part of nurses as hindering factors. “The problem is that many doctors have never learned how to manage staff. And a lot stands and falls with the ladies or the medical assistants […]. If there is a good atmosphere, then you go into the practice, you notice that immediately, the practice is running, it is also well organized.” (NM, F, 42) “In outpatient care, I sometimes have calls where I don't really / where you can tell they [nurses] are just overwhelmed by the situation, but they can’t really assess what the problem is from a nursing point of view.” (GP, F, 38) Individual factors Individual factors hampering efficient interprofessional communication and collaboration included the capacity to provide and the perspective on care, initiative to initiate change and the effective use of language. Capacity to provide care Most GPs and nurses noted differences in the quality of care provided by different GP practices and home-care nursing services. Many nurses, for example, highlighted frequent instances where they received incorrect medical orders, which they subsequently needed to rectify in a time-consuming process. “And there are striking differences in care services. That simply has to be said.” (GP, M, 52) “Because in the last two quarterly prescriptions in the last quarters that we requested, there were so many errors that we had to request at least 50 percent of the prescriptions again.” (NM, F, 60). Perspective on care collaboration Most nurses emphasized that the quality of collaboration was significantly influenced by individuals, i.e., the medical assistant or the GP, and the overall organization of the GP practice. While in some GP practices they received the necessary information or medical order promptly, delays were common in others. Notably, one nurse recounted an experience where a medical assistant explicitly said that she was not their “first priority”. GPs lamented not receiving complete and timely information from nurses, hindering their ability to engage in meaningful patient care. However, some nurses stated that before contacting the GP, they evaluated the need for GP contact thoroughly and tried to be accommodating in their contact. One nurse, for example, recounted requesting medical orders early and sending return postage to cover this. “Well, it’s very doctor-related. So, there are practices where you work very well together, where you also get it very quickly, even without much fuss. And there are practices where every request has to be discussed.” (NM, F, 29) “Of course, it is sometimes annoying, yes, when certain things that are medically important are brought to our attention much too late.” (GP, M, 52) Initiative to change Regarding the initiative to change current communication and collaboration patterns, most nurses waited for GPs, who saw themselves as the initiators of improvement. However, some GPs stated that they would not initiate changes in communication patterns with others due to time constraints. “We haven't started the attempt [to improve communication methods with GPs] again. Because, as I said, I think that the GP practices must decide and have ideas as to what facilitation there is for this from their side or for ideas as to what would be useful.” (NM, F, 60) Use of language An additional factor influencing interprofessional communication and collaboration was the perceived insufficient language fluency of some nurses, which led to misunderstandings. “That the [nurses] are very often not proficient in German and then communication is more difficult as a result.” (GP, M, 51) Overview and expectations The organizational, profession-related and individual factors influencing interprofessional communication between GPs and home-care nursing services are summarized in Fig. 1 . To improve interprofessional collaboration, nurses wished for uncomplicated, efficient and quick communication, using set channels specifically for nurse-GP communication, such as a fax line or a face-to-face meeting. GPs and nurses alike desired a prioritization of patients’ well-being. “In the ideal situation, the information simply arrives correctly. Back and forth, a simple, direct communication. The information gets there. It stays there. Yes, successful communication, as in all areas, that nothing gets lost, that everything arrives.” (NM, M, 47) “After all, it's not about our work, it's always about the result for the customer.” (NM, M, 45) Discussion Currently, home-care nursing facilities and GP practices communicate mainly via fax or telephone. Occasionally, nurses would personally visit the GP clinic. The communication serves various purposes, including issuing or rectifying medical orders, the necessity for home visits or wound treatment and sharing information about a change in a patient’s condition. This study identified several key factors that influence interprofessional communication and collaboration: 1) Organizational factors encompassing the fragmentation and the lack of direct communication and personal contact with others, 2) profession-related factors (e.g., hierarchy and responsibilities) and 3) individual factors involving personal attributes, such as the capacity to provide and the perspective on care amongst others. While our findings highlight challenges of nurse-GP communication and collaboration in the German outpatient care, these are not unique to the German setting: Our results are consistent with a number of studies that describe the same routes (fax, telephone and mail) and reasons for communication [ 11 , 25 – 28 ]. Organizational factors influencing communication and collaboration, such as fragmentation of ambulant and specialist care with no shared information system [ 6 , 10 , 29 ], lack of direct communication and personal contact [ 10 , 30 , 31 ], as well as the high workload [ 29 , 32 ] have been identified in recent studies. The results of our study confirm further findings of previous studies, identifying profession-related factors such as hierarchy [ 10 , 30 – 34 ], responsibilities and rights [ 28 , 34 ] and education [ 28 , 33 ] as impacting interprofessional communication and collaboration. Our results are in line with other studies identifying factors on an individual level, such as the capacity to provide care [ 30 , 31 ], the perspective on care and initiative to change [ 34 ] and use of language [ 31 ]. Whilst most factors were identified in various papers, our study provides a comprehensive overview of the factors influencing GP-nurse communication and collaboration in the care for outpatients. It also considers unique aspects of the current situation in Germany, including the heavy reliance on fax machines and the fragmentation of the ambulant sector [ 6 , 11 ]. Even though each factor has been presented under a specific category, they should not be seen as independent from one another. Nurses currently assume a mediating position between healthcare providers and patients or their relatives, e.g., as a support in coping with the illness or need for care [ 35 ]. They perceive themselves as the “ear and eye of the patient” and wish to be recognized as an “equal partner” in communication and collaboration with GPs to jointly achieve the best possible patient care (profession-related). However, due to the prevailing framework conditions, time constraints and organization of collaboration (organizational level), home-care nursing services are, for example, reliant on prescriptions from GPs and thus de facto dependent on them. Furthermore, even though there is a change in GPs’ mindset and some nowadays ask for nurses’ feedback, “hierarchical thinking” still prevails in many GPs (profession-related), which negatively impacts communication and collaboration. A change in a specific category might lead to changes on other levels, in the same way as a change in perception of the nursing role might impact factors on all levels. Several studies have shown that understanding each other’s roles, professional identities and clarity about the responsibilities of each profession can significantly improve GP-nurse collaboration and communication in the ambulant setting [ 36 – 38 ]. Implications and recommendations According to the definitions provided in the introduction, the current interaction pattern between GPs and nurses cannot be classified as collaboration, because negotiation processes are scarce. Rather, it is purely information exchange in the sense of communication, although timeliness and efficiency should be increased. In order to improve nurse-GP communication and implement effective collaboration, on an organizational level, clear communication channels need to be established, which might be facilitated by the mandatory implementation of the telematics infrastructure in Germany [ 39 ]. Further policy recommendations include, amongst others, an adequate reimbursement of times dedicated to interprofessional communication and collaboration. This would incentivize individuals’ motivation to cooperate, enhancing interprofessional relationships and aiding the development of a mutual understanding of approaches, language and goals [ 40 ]. The establishment of ‘formal team meetings’ would further allow for a structured care coordination, sufficient time to discuss cases and exchange views on organizational issues [ 37 , 41 ]. On an individual level, the development of a ‘common language’ might further be guided through structured communication tools and frameworks, such as the American Medical Director Association’s “Protocols for Physician Notification” or ISBAR (Introduction, Situation, Background, Assessment, and Recommendation) [ 31 , 42 ]. To facilitate long-term changes, interprofessional education should be incorporated in curricula of each healthcare profession, jointly with an ongoing on the job training [ 28 , 36 ]. This intervention can promote trust, a shared understanding of objectives and counteract prevailing stereotypes [ 10 , 36 ]. Another long-term change might further be the establishment of dedicated case management professionals who are responsible for structuring interprofessional teams caring for chronic patients [ 43 , 44 ]. This goes along with further concepts of professionalisation within nursing care which are debated in the context of digitalization [ 45 ] but is also already visible in the differentiation of job profiles in nursing such as community health nursing or advanced nursing practice. Limitations The findings of this study contribute to the limited body of knowledge in interprofessional communication and collaboration between GPs and nurses in the ambulatory setting. It is worth noting that since no financial incentives were provided for participating in these interviews, those with a stronger interest in interprofessional exchange were more likely to do so, potentially leading to an under-representation of individuals with less interest in such exchange. As medical assistants are the first point of contact at the GP practice for home-care nurses and with only one medical assistant participating, we might have missed valuable viewpoints concerning the communication and collaboration between home-care nursing services and GP practices. Furthermore, the study was conducted in a specific region in Germany, and it therefore might not be possible to generalize the results. Conclusions Interprofessional communication and collaboration between home-care nursing facilities and GP practices are influenced by factors on an organizational and individual level, as well as profession-related factors. Current interaction patterns are deficient and require changes on political, structural and educational levels to establish well-functioning collaboration in the ambulant sector that facilitates patient-centred care. The results of this study highlight the need to improve nurse-GP communication and to implement effective collaboration. Based on the factors identified as influencing nurse-GP interaction, educational and political reforms should be established. These may comprise 1) establishing and reinforcing interprofessional education in medical and nursing curricula and 2) defining professional roles and responsibilities to tackle individual and profession-related factors. As for organizational factors, there is a need for political reforms, such as introducing clear and secure communication channels. Abbreviations COREQ Consolidated Criteria for Reporting Qualitative Research GP General practitioner NM Nursing service manager Declarations Ethics approval and consent to participate This study was approved in November 2022 by the Joint Ethics Committee of the Bavarian Universities of Applied Sciences (Gemeinsame Ethikkommission der Hochschulen Bayerns) under the number GEHBa-202211-V-084. The participants provided written informed consent prior to data collection and did not receive any compensation for their participation. The study was conducted in accordance with the Declaration of Helsinki. Consent for application Not applicable. Availability of data and materials Data is available upon reasonable request from the corresponding author. Competing interests FF serves as Associate Editor at BMC Health Services Research. All other authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ contributions FF, MS, MCR and SS conceptualized the study. KN, SS, MCR, PML, MS and FF contributed to data collection. KN, MCR, MS and FF analyzed the data. KN drafted the manuscript; SS, MCR, MS and FF revised the draft critically and provided important intellectual content. All authors read and approved the final manuscript. 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(2024) Interprofessional collaboration in the home care setting: perspectives of people receiving home care, relatives, nurses, general practitioners, and therapists—results of a qualitative analysis. BMC Primary Care 25: 79. Hoonakker PLT, Carayon P, Walker JM, Brown RL, Cartmill RS. The effects of Computerized Provider Order Entry implementation on communication in Intensive Care Units. Int J Med Inform. 2013;82(5):e107–17. Witti MH, Zottmann JM, Wershofen B, Thistlethwaite JE, Fischer F, Fischer MR. FINCA – a conceptual framework to improve interprofessional collaboration in health education and care. Front Med. 2023;10:1213300. Karam M, Brault I, Van Durme T, Macq J. Comparing interprofessional and interorganizational collaboration in healthcare: A systematic review of the qualitative research. Int J Nurs Stud. 2018;79:70–83. Erdmann J., Götz K. Kooperation zwischen Hausärzt*innen und ambulanten Pflegediensten — eine qualitative Studie [Cooperation Between Family Physicians and Outpatient Nursing Services – a Qualitative Study]. Zeitschrift für Allgemeinmedizin. 2022;98(5):184–9. Ärztezeitung. Freie Arztsitze – Fast 3300 Hausarztstellen sind unbesetzt [Doctor vacancies – Almost 3300 GP positions are unfilled]. 2020. www.aerztezeitung.de/Politik/Fast-3300-Hausarztstellen-sind-unbesetzt-413131.html. Accessed 27 February 2024. Blum M. Ärztestatistik: Mehr Köpfe, nicht mehr Arztstunden [Medical doctor statistic: more heads, not more hours]. Dtsch Ärztebl. 2021;118(15):A-762 / B-641. Hilberg T. Durchschnittsalter der Niedergelassenen steigt weiter an [Average age of outpatient clinicians is rising]. 2023. Dtsch Ärztebl. 31 May 2023. https://www.aerzteblatt.de/nachrichten/143592/Durchschnittsalter-der-Niedergelassenen-steigt-weiter-an#:~:text=Mai%202023&text=Berlin%20%E2%80%93%20Das%20Durchschnittsalter%20der%20niedergelassenen,Versorgung%20in%20Deutschland%20(Zi). Accessed 19 October 2023. Trusch B, Heintze C, Petelos E, Dini L. Collaboration amongst general practitioners and gynaecologists working in primary health care in Germany: a cross-sectional study. Prim Health Care Res Dev. 2021;22: e42. Ärztezeitung. Bericht: Deutschland fehlen mindestens 35.000 Pflege-Fachkräfte [Report: Germany lacks at least 35,000 nursing staff]. 2021. https://www.aerztezeitung.de/Politik/Bericht-Deutschland-fehlen-mindestens-35000-Pflege-Fachkraefte-424867.html. Accessed 27 February 2024. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57. Helfferich C. Leitfaden- und Experteninterviews. In: Baur N, Blasius J, editors. Handbuch Methoden der empirischen Sozialforschung. Wiesbaden: Springer; 2014. p. 559–74. Peltonen J, Leino-Kilpi H, Heikkilä H, Rautava P, Tuomela K, Siekkinen M, Sulosaari V, Stolt M. Instruments measuring interprofessional collaboration in healthcare – a scoping review. J Interprof Care. 2019;34(2):147–61. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3:77–101. Hughes CA, Allen P, Bentley M. eReferrals: Why are we still faxing?. Australian Journal of General Practice. 2018;47(1–2):51–6. Johnson C, Pylypchuk Y. Use of Certified Health IT and Methods to Enable Interoperability by U.S. Non-Federal Acute Care Hospitals, 2019. ONC Data Brief 54, 1–20; 2021. Lyngstad M, Melby L, Grimsmo A, Hellesø R. Toward Increased Patient Safety? Electronic Communication of Medication Information Between Nurses in Home Health Care and General Practitioners. Home Health Care Management & Practice. 2013;25:203–11. Zimansky M, Ceylan B, Klukas E, Hamacher M, van de sand H, Gustaevel M, Wiegelmann S, Hämel K. Interprofessionelle Zusammenarbeit von Hausärzt_innen und Pflegefachpersonen in der Primärversorgung: Eine qualitative Studie [Interprofessional collaboration of general practitioners and nurses in primary care: A qualitative study]. Pflege. 2024;37(1):11 –8. Weiss J, Hof B, Burkhalter H. Interprofessionelle Zusammenarbeit zwischen diplomierten Pflegefachpersonen der ambulanten Pflege und Hausärzt_innen: Eine qualitative Studie [Interprofessional cooperation between registered community nurses and general practitioner: A qualitative study]. Pflege. 2023;36(5):296–305. Nieuwboer MS, van der sande R, Maassen ITHM, Olde Rikkert MGM, Perry M, van der Marck M. Communication between Dutch community nurses and general practitioners lacks structure: An explorative mixed methods study. Eur J Gen Pract. 2020;26(1):86–94. Tjia J Mazor KM, Field T, Meterko V, Spenard A, Gurwitz JH. Nurse-physician communication in the long-term care setting: perceived barriers and impact on patient safety. J Patient Saf. 2009;5(3):145–52. Rudberg I, Olsson A, Thunborg C, Salzmann-Erikson M. Interprofessional communication in a psychiatric outpatient unit – an ethnographic study. BMC Nurs. 2023;22:286. Foronda C, MacWilliams B, McArthur E. Interprofessional communication in healthcare: An integrative review. Nurse Educ Pract. 2016;19:36–40. van Der Gulden R, Scherpbier-de Haan ND, Greijn CM, Looman N, Tromp F, Dielissen PW. Interprofessional education and collaboration between general practitioner trainees and practice nurses in providing chronic care; a qualitative study. BMC Med Educ. 2020;20:290. Mayrhofer L, Mrak L, Kobleder A, Kohler M. Die Rolle von Pflegefachpersonen in der onkologischen Rehabilitation: Ein Scoping Review [The role of nurses in oncology rehabilitation: A scoping review]. Pflege. 2021;34(4):203–11. Behrend R, Maaz A, Sepke M, Peters H. Interprofessionelle Teams in der Versorgung. In: Jacobs K, Kuhlmey A, Greß S, Klauber J, Schwinger A, editors. Pflege-Report 2019 – Mehr Personal in der Langzeitpflege – aber woher?. Berlin, Heidelberg: Springer p. 201–9. Hämel K, Vössing C. The collaboration of general practitioners and nurses in primary care: A comparative analysis of concepts and practices in Slovenia and Spain. Prim Health Care Res Dev. 2017;18(5):492–506. McInnes S, Peters K, Bonney A, Halcomb E. An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice. J Adv Nurs. 2015;71(9):1973–85. gematik GmbH. An arena for digital health. Telematics Infrastructure 2.0 white paper for a federally networked healthcare system. Berlin: gematik GmbH; 2021. Carron T, Domeisen Bendetti F, Fringer A, Fierz K, Peytremann-Bridevaux I. Integrated care models in Swiss primary care: An embedded multiple case study. J Eval Clin Pract. 2023;29(6):1025–38. McInnes S, Peters K, Bonney A, Halcomb E. Understanding collaboration in general practice: a qualitative study. Fam Pract. 2017;34(5):621–6. Curtis K, Tzannes A, Rudge T. How to talk to doctors – a guide for effective communication. Int Nurs Rev. 2011;58(1):13–20. Hudon C, Bisson M, Chouinard M-C, et al. Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada. BMC Health Serv Res. 2023; 23:377. Schirin Gessl A, Flörl A, Schulc E. Demand for community-based case management in Austria – a qualitative analysis. BMC Nurs. 2022;21:5. Aigner J, Fischer F. Pflegekompetenzgesetz – Gehen vor Enthusiasmus die Potentiale der Digitalisierung auf dem Weg verloren? [Nursing Competence Act - Is the potential of digitalisation being lost in the enthusiasm?]. Gesundheitswesen. 2024;86(4):260–2. Additional Declarations Competing interest reported. FF serves as Associate Editor at BMC Health Services Research. All other authors declare that they have no competing interests. Supplementary Files Supplementarymaterial1.pdf Supplementary material Supplementary material 1: Interview guide Supplementarymaterial2.pdf Supplementary material 2: Quotes from the interviews and their translation Cite Share Download PDF Status: Published Journal Publication published 03 May, 2025 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 04 Jul, 2024 Reviews received at journal 02 Jul, 2024 Reviews received at journal 21 Jun, 2024 Reviewers agreed at journal 07 Jun, 2024 Reviewers agreed at journal 06 Jun, 2024 Reviewers invited by journal 29 May, 2024 Editor invited by journal 24 May, 2024 Submission checks completed at journal 23 May, 2024 Editor assigned by journal 23 May, 2024 First submitted to journal 22 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4458661","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":310037026,"identity":"e6c00c09-12c4-4812-b72b-3a338d959948","order_by":0,"name":"Kim Nordmann","email":"","orcid":"","institution":"Bavarian Research Center for Digital Health and Social Care","correspondingAuthor":false,"prefix":"","firstName":"Kim","middleName":"","lastName":"Nordmann","suffix":""},{"id":310037027,"identity":"ccb15d64-b698-44e0-9d88-e42ffb83719f","order_by":1,"name":"Stefanie Sauter","email":"","orcid":"","institution":"Bavarian Research Center for Digital Health and Social Care","correspondingAuthor":false,"prefix":"","firstName":"Stefanie","middleName":"","lastName":"Sauter","suffix":""},{"id":310037028,"identity":"b007d0ac-d1e8-4e4f-bdc9-1fce5182396e","order_by":2,"name":"Marie-Christin Redlich","email":"","orcid":"","institution":"Bavarian Research Center for Digital Health and Social Care","correspondingAuthor":false,"prefix":"","firstName":"Marie-Christin","middleName":"","lastName":"Redlich","suffix":""},{"id":310037029,"identity":"7d5a98bd-6af8-4669-9dcd-7dc166d856f3","order_by":3,"name":"Patricia Möbius-Lerch","email":"","orcid":"","institution":"Bavarian Research Center for Digital Health and Social Care","correspondingAuthor":false,"prefix":"","firstName":"Patricia","middleName":"","lastName":"Möbius-Lerch","suffix":""},{"id":310037030,"identity":"29a193c6-29fe-4f33-b45d-c3adf2b95764","order_by":4,"name":"Michael Schaller","email":"","orcid":"","institution":"Bavarian Research Center for Digital Health and Social 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Care","correspondingAuthor":true,"prefix":"","firstName":"Florian","middleName":"","lastName":"Fischer","suffix":""}],"badges":[],"createdAt":"2024-05-22 06:36:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4458661/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4458661/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-025-12819-1","type":"published","date":"2025-05-03T15:57:17+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57953572,"identity":"63413fb8-700c-42fb-8779-455d94d0ca41","added_by":"auto","created_at":"2024-06-07 23:05:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":79244,"visible":true,"origin":"","legend":"\u003cp\u003eOrganizational, profession-related and individual factors influencing interprofessional communication between GPs and home-care nursing services\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4458661/v1/5e9571222c565c3c2abb922a.png"},{"id":81988196,"identity":"7be89480-6d8f-458a-af20-bf80e9fb01f0","added_by":"auto","created_at":"2025-05-05 16:08:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":858596,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4458661/v1/37d4bc87-8290-4305-858e-5c8304fefe57.pdf"},{"id":57952655,"identity":"76d5e3d7-fe77-4dba-915e-ad9b7145ce78","added_by":"auto","created_at":"2024-06-07 22:57:43","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":136012,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSupplementary material 1: Interview guide\u003c/p\u003e","description":"","filename":"Supplementarymaterial1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4458661/v1/43a888dd9150a29e454d0be7.pdf"},{"id":57952657,"identity":"9f5e6284-8cbd-4d95-92c8-657ef0b3bc4c","added_by":"auto","created_at":"2024-06-07 22:57:43","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":117816,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary material 2: Quotes from the interviews and their translation\u003c/p\u003e","description":"","filename":"Supplementarymaterial2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4458661/v1/14082068aa7d37c6fb3e35c5.pdf"}],"financialInterests":"Competing interest reported. FF serves as Associate Editor at BMC Health Services Research. All other authors declare that they have no competing interests.","formattedTitle":"“Well, it’s very doctor-related” – Interprofessional communication and collaboration between general practitioners and nurses: a qualitative study in Southern Germany","fulltext":[{"header":"Background","content":"\u003cp\u003eMost countries worldwide are experiencing demographic transition – the number of, for example, European citizens aged 65 or over is expected to rise by 41% in the coming three decades [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. For 2050, it is estimated that 22–27% of the German population will be older than 67 years as opposed to 20% in 2021 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This in turn is associated with increased demand of healthcare services, as multimorbidity rises with age [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Due to the desire of many elderly people to be cared for in their own home, an increase of 42% in the number of persons using professional home-care nursing services is projected until 2050 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Germany, ambulant health and nursing care services are provided by a multitude of professionals, such as general practitioners (GPs) and medical specialists, pharmacists, nurses and physiotherapists, all of whom work separately and in accordance with the different pillars of the healthcare system, as mainly defined in the Social Code Books V and XI [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. GPs are generally self-employed and cater to the medical needs of the population living in the vicinity of their practice. They employ medical assistants at their practice who are responsible for organizing GP practice procedures (such as documentation and billing for services) and patient flow, including appointment-making and other communication. Medical assistants are the first point of contact at the GP practice, including home-care nursing services and patients [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Home-care nursing services are heterogeneous in their organization, ranging from small local services to larger companies with branches all over Germany. They provide in-home care services, such as nursing diagnosis and interventions, counselling, body-related care measures, administration of medicines and assistance with household management [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. While patients have free choice of healthcare provider and home-care nursing service, nursing services must generally first be prescribed in order to access service provision and reimbursement [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs multimorbid patients receive care from these different healthcare provider, interprofessional communication and collaboration among diverse healthcare professions in the ambulatory setting are needed to ensure effective and high-quality patient-centred care [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e–\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor the purpose of this paper, we define interprofessional communication as the “ability to translate information openly, accurately and in a timely manner” between professions [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and interprofessional collaboration as “different health and social care professions meeting regularly to negotiate and agree on how to solve complex care problems or deliver services” [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Communication is thus a key element of collaboration and forms the basis for trusting interprofessional relationships [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInterprofessional communication and collaboration might, however, be hampered by the fragmented organizational and financial structure of the German healthcare system which reimburses inadequately for interprofessional coordination and communication activities [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Especially in home-care, interprofessional collaboration is challenging [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Challenges to interprofessional communication and collaboration and effective patient care might further be exacerbated by i) a shortage of approximately 3,300 GPs, aggravated by the retirement of GPs with few young GPs to replace them, who then work less hours and conduct fewer home visits [\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e–\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and ii) a lack of at least 35,000 skilled nurses [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], resulting in the need to recruit foreign staff.\u003c/p\u003e \u003cp\u003eWith this study, we want to contribute to the body of knowledge relating to the current challenges to interprofessional communication and collaboration between home-care nursing services and GP practices in Germany, as perceived by the healthcare professionals. The aim of this paper is to characterize communication patterns, the factors positively or adversely influencing interprofessional communication and collaboration, and the expectations towards communication and collaboration between home-care nursing services and GP practices in Germany.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eParticipant recruitment and data collection\u003c/p\u003e\u003cp\u003eWe conducted a qualitative study in a region in southern Germany, which is reported upon in this paper in adherence with the Consolidated Criteria for Reporting Qualitative Research (COREQ) to ensure quality [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Semi-structured interviews were conducted with 1) healthcare professionals in GP practices and 2) nurses working in home-care nursing services. The interview guide was developed systematically according to Helfferich [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] by collecting questions, verifying them against the aim of the study, and subsequently sorting and summarizing them. The interview guide was tested with two nurses and a general practitioner and validated through discussion in an interdisciplinary scientific team. The final interview guide (see Supplementary material 1) was devised along the themes: 1. current communication patterns between GPs and home-care nursing services (questions informed by previous empirical knowledge [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]) and 2) the introduction of sociotechnical information and communication technologies, above all, in the current context of the mandatory implementation of the telematics infrastructure in Germany. Besides open-ended questions, participants were asked to rate the quality of communication between GP practices and home-care nursing services from 1 (best) to 6 (worst) to open the discussion about the current quality of communication and provide factors influencing their judgement. We anticipated 30–45 minutes duration for each interview; the actual mean duration was 35 minutes (from the range 17–72 minutes). In total, 55 general practitioner and 32 home-care nursing services in the target region were contacted via post in early March 2023 and three weeks later received an email and a telephone invitation. To boost GP participation in the study, we expanded the target region in June 2023 via purposive sampling through 46 email and telephone invitations. At this stage of data collection, analysis had not yet started. Eligible participants needed to be above the age of 18 years, willing to provide written informed consent, to belong to one of the professional groups: general practitioners, medical assistants, nurses (including those serving as nursing service manager), or trained nursing assistants and be currently working in a GP practice or a home-care nursing facility in a specific region in southern Germany. We included these professional groups as they are the key population involved in communication and collaboration between home-care nursing services and GP practices.\u003c/p\u003e\u003cp\u003eInterviews were conducted by trained investigators with a background in qualitative research (KN, SS, FF, MS, MCR, PML) from April to July 2023 at either the participants’ workplace, the interviewer’s office, or via a videoconference tool (Zoom Video Communications, Inc.), according to the participant’s choice. Of the researchers, four were female and two were male. They had a diverse background ranging from medicine to nursing, including public and global health and sociology. In most interviews, two researchers were present: one leading the interview and one note-taker. No other person was present in the room during the interviews. The researchers explained the study goals prior to the interviews. Following the interviews, participants responded to a socio-demographic questionnaire. The researchers took field notes during the interview, which they subsequently discussed. We conducted in total 16 interviews with all contacted healthcare providers willing to participate. Of those interviews, one involved two participants from the same home-care nursing service due to time constraints of the participants. Towards the final interviews, no new themes arose and we concluded that data saturation was reached.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eInterviews were audio recorded, transcribed and pseudonymized. The quotes presented within this manuscript include information on the profession (General Practitioner: GP; (deputy) home-care nursing service manager: NM), the sex (Male: M; Female: F) and the age of the participant in years. No repeat interviews were carried out and we did not send transcripts or findings to participants to comment on or correct. Interview transcripts were stored on a password-protected computer, accessible only to the research team, to protect the privacy and confidentiality of the participants.\u003c/p\u003e\u003cp\u003eThematic content analysis according to Braun and Clark [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] was used to identify the main themes and subthemes inductively. KN and MS coded one interview with a GP independently; FF and MCR one with a nurse. The results were compared and synthesized to develop a preliminary coding framework. KN then coded the remaining interviews using MAXQDA version 2022 (VERBI Software GmbH), a qualitative data analysis software. Coding was reviewed by a second researcher (MCR) and differences settled between the researchers. The codes were then classified into profession-related and organizational factors, based on by Nieuwboer’s et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] conceptualization who identified factors hindering doctor-nurse communication in an ambulatory setting through a qualitative study. We expanded the factors by a third one, titled ‘individual factors’, and summarized codes pertaining to current communication patterns under one theme as well. The analysis was conducted in German. For the purpose of this publication, quotes were translated from German into English and double-checked by the research team (original and translated version can be found in Supplementary material 2).\u003c/p\u003e\u003cp\u003eEthics\u003c/p\u003e\u003cp\u003e This study was approved in November 2022 by the Gemeinsame Ethikkommission der Hochschulen Bayerns (Joint Ethics Committee of the Bavarian Universities of Applied Sciences) under the number GEHBa-202211-V-084. The participants provided written informed consent prior to data collection and did not receive any compensation for their participation.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e Starting with the sociodemographic characteristics of the study participants, we present current communication patterns and factors that influence interprofessional communication and collaboration grouped into organizational, profession-related and individual factors. This is followed by an overview of the factors and expectations towards interprofessional communication and collaboration.\u003c/p\u003e \u003cp\u003eSociodemographic characteristics\u003c/p\u003e \u003cp\u003eWe interviewed six GPs and one medical assistant working in a GP practice, as well as nine (deputy) home-care nursing service managers and one nurse employed at home-care nursing services (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Of the 17 participants, three were women employed in a GP practice and six were women working in home-care nursing services. The participants from GP practices had been working for an average of 6.50 (\u0026plusmn;\u0026thinsp;4.86) years at their current practice which provided care to 1,250 (\u0026plusmn;\u0026thinsp;298) patients per quarter on average, of which about 15% received home-care nursing services. The GP practices were largely similar in their structure, with one self-employed GP employing several medical assistants. In contrast, ambulant nursing care facilities varied from small, familiar facilities with 12 employees and 55 clients to big enterprises with specialized IT departments, employing 120 people and caring for 500 clients.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of study participants and their facilities\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipants from GP practices (n\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eParticipants from home-care nursing services (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMean age (\u0026plusmn;\u0026thinsp;SD) [years]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.14\u0026thinsp;\u0026plusmn;\u0026thinsp;8.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.60\u0026thinsp;\u0026plusmn;\u0026thinsp;12.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43.59\u0026thinsp;\u0026plusmn;\u0026thinsp;11.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical assistant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAverage years in current position (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.00\u0026thinsp;\u0026plusmn;\u0026thinsp;5.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.79\u0026thinsp;\u0026plusmn;\u0026thinsp;5.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAverage number of patients/clients (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1250\u0026thinsp;\u0026plusmn;\u0026thinsp;298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e152\u0026thinsp;\u0026plusmn;\u0026thinsp;138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAverage number of patients receiving care from home-care nursing services (\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e196\u0026thinsp;\u0026plusmn;\u0026thinsp;140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eGP: General practitioner, NA: Not applicable, NM: (deputy) Home-care nursing service manager, SD: Standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCurrent communication patterns\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eWay of communication\u003c/h2\u003e \u003cp\u003eAll GPs and nurses communicated primarily using traditional methods such as fax machines and telephones, while digital means such as email were infrequently used. Occasionally, and especially in urgent cases, nurses might physically visit the GP practice.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Many things can be done by phone or by fax. So, if we can't reach the doctors by phone, then we try to reach them by fax. Email, it's really rather rare that you can reach the doctors by email. [...] And quite often it is also the case that if we have no other chance of getting through, then we drive to the doctors, but that is the last solution.\u0026rdquo; (NM, F, 60)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eReasons for communication\u003c/h2\u003e \u003cp\u003eThe reasons for communication reported on both sides were to i) issue medical orders for e.g., medication and ii) discuss a patient\u0026rsquo;s condition, such as the necessity of a home visit.\u003c/p\u003e \u003cp\u003e\u0026ldquo;If the home-care nursing service runs out of medication, or if a visit is requested, or if wound care is needed, they send us an electronic fax.\u0026rdquo; (GP, M, 51)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eContact person when communicating\u003c/h2\u003e \u003cp\u003eAll nurses typically communicated with the medical assistant and only in urgent cases directly with the GP. GPs reached out to the ambulant nursing care facility only in case of follow-up questions. GPs evaluated the quality of contact, using a Likert scale ranging from 1 (best) to 6 (worst), at a level of 2\u0026ndash;3. Conversely, nurses perceived the quality less favourably, assigning a 3\u0026ndash;4.\u003c/p\u003e \u003cp\u003e\u0026ldquo;I would say 98 percent of the time, it is enough for us to correspond with the medical assistants. Sometimes the medical assistants then say they have to consult with the doctor and then they call us back.\u0026rdquo; (NM, F, 60)\u003c/p\u003e \u003cp\u003eFactors influencing interprofessional communication and collaboration\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eOrganizational factors\u003c/h2\u003e \u003cp\u003eOrganizational factors negatively impacting interprofessional communication and collaboration included fragmentation of the setting, lack of direct and intersectoral communication, scarce personal contact and high workload.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFragmentation of the setting\u003c/h2\u003e \u003cp\u003eHome-care nursing services catered for patients attended to by different GPs, while GPs took care of patients from various home-care nursing services. All GPs working in rural areas reported that their patients were served by fewer home-care nursing services compared to GPs in urban areas. The fact that documentation and information systems were not shared impeded automated transfer of information.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Above all, we have the problem that, because we supply customers in the entire [Name of a region], we do not say: \u0026lsquo;Okay, we have 50% of the customers at one GP\u0026rsquo;, but we have all GPs from [Name of a place] to [Name of a place].\u0026rdquo; (NM, F, 29)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eLack of direct intersectoral communication\u003c/h2\u003e \u003cp\u003eWhen the necessity for direct communication arose, most GPs reported difficulties in reaching the appropriate person in the home-care nursing services. Likewise, most nurses criticized the accessibility of the GP, emphasizing short opening hours and the absence of a dedicated communication channel for GP-nurse interaction as nurses relied on the same telephone number as patients, being in direct \u0026ldquo;competition with sick people\u0026rdquo; (NM, M, 47) and needing to wait in the loop. Some GPs and nurses alike further criticized the deficient intersectoral communication, such as between specialists and GPs or between acute care facilities and home-care nursing services.\u003c/p\u003e \u003cp\u003e\u0026ldquo;And then it is often not clear to me who is really my contact person [from the home-care nursing service].\u0026rdquo; (GP, F, 38)\u003c/p\u003e \u003cp\u003e\u0026ldquo;Communication is the classic way: telephone. This is becoming more and more difficult because, of course, in the practices the telephones are probably running hot and glowing.\u0026rdquo; (NM, M, 45)\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eScarce personal contact\u003c/h2\u003e \u003cp\u003eEven though nurses and GPs valued personal contact, which was thought to foster a productive work climate, opportunities for such interactions were limited mainly due to time constraints. GPs in rural areas reported more instances of personal contact than their urban counterparts.\u003c/p\u003e \u003cp\u003e\u0026ldquo;I find this personal contact, even if they [nurses] then come to me personally in the practice, for example, very important and very good.\u0026rdquo; (GP, M, 40)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eHigh workload\u003c/h2\u003e \u003cp\u003eTime constraints were thought to arise due to a high and rising workload perceived by most nurses and GPs alike, which negatively influenced the quality and efficiency of patient care and collaboration. Many GPs additionally perceived nurses as overburdened with documentation responsibilities and staff shortages.\u003c/p\u003e \u003cp\u003e\u0026ldquo;The practices, the medical assistants, they just give me the strong impression that they have such a run-up and such a run-in that they simply can't cope with the work anymore. And that is very noticeable.\u0026rdquo; (NM, M, 30)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eProfession-related factors\u003c/h2\u003e \u003cp\u003eProfession-related factors impeding efficient interprofessional communication and collaboration encompassed hierarchy, responsibilities and rights, as well as education.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eHierarchy\u003c/h2\u003e \u003cp\u003eBoth GPs and nurses used words like \u0026ldquo;them\u0026rdquo; and \u0026ldquo;us\u0026rdquo; in their communication about one another, drawing a strong demarcation line between the professional groups. According to many nurses, the hierarchical thinking of GPs and medical assistants hindered effective collaboration \u0026ndash; even though they reported that this was slowly changing. As some nurses perceived themselves as the \u0026ldquo;eye and ear\u0026rdquo; of the patient, they demanded to be treated as an equal partner by GPs. While some GPs were more open to propositions from nurses, they stressed that the patients\u0026rsquo; treatment was ultimately their decision, and most GPs perceived themselves as having the authority to issue directives to nurses.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Ultimately, the decision comes from my side, what is then prescribed.\u0026rdquo; (GP, M, 40)\u003c/p\u003e \u003cp\u003e\u0026ldquo;In my experience it always depends on the hierarchical thinking of the physicians how well or how badly what works.\u0026rdquo; (NM, F, 42)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eResponsibilities\u003c/h2\u003e \u003cp\u003eSome GPs perceived nurses as not wanting to carry responsibility, thus shifting it towards the GPs and overloading them with tasks. Most nurses, on the other hand, perceived the need to monitor the GPs\u0026rsquo; work and criticized the current system of medical orders as they depended on issuing correct medical orders for reimbursement.\u003c/p\u003e \u003cp\u003e\u0026ldquo;I feel like it's often more like, well, I sent a fax, then the doctor can take care of it.\u0026rdquo; (GP, M, 51)\u003c/p\u003e \u003cp\u003e\u0026ldquo;Things get lost. They [the GPs] have a medication plan from half a year ago again. They haven't entered the data for people yet. I can understand all that, given the stress and the throughput that they have in the doctors' offices. But you always have to keep a close eye on things.\u0026rdquo; (NM, M, 47)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eRights\u003c/h2\u003e \u003cp\u003eA lack of right to access patients\u0026rsquo; data further impeded the work of some nurses as they sometimes did not receive information about a patient whom they were jointly treating with the GP, due to data protection issues.\u003c/p\u003e \u003cp\u003e\u0026ldquo;The [doctors] are not really allowed to give me any information. As I said, I have some doctors who do it because they know that we are there every day. But there are doctors who don't say anything.\u0026rdquo; (NM, F, 31)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eEducation\u003c/h2\u003e \u003cp\u003eBoth professions criticized the lack of knowledge of the other profession, claiming that it hampered their interprofessional collaboration. Some nurses, for example, highlighted that GPs\u0026rsquo; lack of knowledge in practice management had a negative impact on the working climate and efficiency of their practice, while many GPs, on the other hand, mentioned the lack of knowledge concerning patient care and lack of experience on the part of nurses as hindering factors.\u003c/p\u003e \u003cp\u003e\u0026ldquo;The problem is that many doctors have never learned how to manage staff. And a lot stands and falls with the ladies or the medical assistants [\u0026hellip;]. If there is a good atmosphere, then you go into the practice, you notice that immediately, the practice is running, it is also well organized.\u0026rdquo; (NM, F, 42)\u003c/p\u003e \u003cp\u003e\u0026ldquo;In outpatient care, I sometimes have calls where I don't really / where you can tell they [nurses] are just overwhelmed by the situation, but they can\u0026rsquo;t really assess what the problem is from a nursing point of view.\u0026rdquo; (GP, F, 38)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eIndividual factors\u003c/h2\u003e \u003cp\u003e Individual factors hampering efficient interprofessional communication and collaboration included the capacity to provide and the perspective on care, initiative to initiate change and the effective use of language.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eCapacity to provide care\u003c/h2\u003e \u003cp\u003eMost GPs and nurses noted differences in the quality of care provided by different GP practices and home-care nursing services. Many nurses, for example, highlighted frequent instances where they received incorrect medical orders, which they subsequently needed to rectify in a time-consuming process.\u003c/p\u003e \u003cp\u003e\u0026ldquo;And there are striking differences in care services. That simply has to be said.\u0026rdquo; (GP, M, 52)\u003c/p\u003e \u003cp\u003e\u0026ldquo;Because in the last two quarterly prescriptions in the last quarters that we requested, there were so many errors that we had to request at least 50 percent of the prescriptions again.\u0026rdquo; (NM, F, 60).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003ePerspective on care collaboration\u003c/h2\u003e \u003cp\u003eMost nurses emphasized that the quality of collaboration was significantly influenced by individuals, i.e., the medical assistant or the GP, and the overall organization of the GP practice. While in some GP practices they received the necessary information or medical order promptly, delays were common in others. Notably, one nurse recounted an experience where a medical assistant explicitly said that she was not their \u0026ldquo;first priority\u0026rdquo;. GPs lamented not receiving complete and timely information from nurses, hindering their ability to engage in meaningful patient care. However, some nurses stated that before contacting the GP, they evaluated the need for GP contact thoroughly and tried to be accommodating in their contact. One nurse, for example, recounted requesting medical orders early and sending return postage to cover this.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Well, it\u0026rsquo;s very doctor-related. So, there are practices where you work very well together, where you also get it very quickly, even without much fuss. And there are practices where every request has to be discussed.\u0026rdquo; (NM, F, 29)\u003c/p\u003e \u003cp\u003e\u0026ldquo;Of course, it is sometimes annoying, yes, when certain things that are medically important are brought to our attention much too late.\u0026rdquo; (GP, M, 52)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eInitiative to change\u003c/h2\u003e \u003cp\u003eRegarding the initiative to change current communication and collaboration patterns, most nurses waited for GPs, who saw themselves as the initiators of improvement. However, some GPs stated that they would not initiate changes in communication patterns with others due to time constraints.\u003c/p\u003e \u003cp\u003e\u0026ldquo;We haven't started the attempt [to improve communication methods with GPs] again. Because, as I said, I think that the GP practices must decide and have ideas as to what facilitation there is for this from their side or for ideas as to what would be useful.\u0026rdquo; (NM, F, 60)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eUse of language\u003c/h2\u003e \u003cp\u003eAn additional factor influencing interprofessional communication and collaboration was the perceived insufficient language fluency of some nurses, which led to misunderstandings.\u003c/p\u003e \u003cp\u003e\u0026ldquo;That the [nurses] are very often not proficient in German and then communication is more difficult as a result.\u0026rdquo; (GP, M, 51)\u003c/p\u003e \u003cp\u003eOverview and expectations\u003c/p\u003e \u003cp\u003eThe organizational, profession-related and individual factors influencing interprofessional communication between GPs and home-care nursing services are summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. To improve interprofessional collaboration, nurses wished for uncomplicated, efficient and quick communication, using set channels specifically for nurse-GP communication, such as a fax line or a face-to-face meeting. GPs and nurses alike desired a prioritization of patients\u0026rsquo; well-being.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u0026ldquo;In the ideal situation, the information simply arrives correctly. Back and forth, a simple, direct communication. The information gets there. It stays there. Yes, successful communication, as in all areas, that nothing gets lost, that everything arrives.\u0026rdquo; (NM, M, 47)\u003c/p\u003e \u003cp\u003e\u0026ldquo;After all, it's not about our work, it's always about the result for the customer.\u0026rdquo; (NM, M, 45)\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eCurrently, home-care nursing facilities and GP practices communicate mainly via fax or telephone. Occasionally, nurses would personally visit the GP clinic. The communication serves various purposes, including issuing or rectifying medical orders, the necessity for home visits or wound treatment and sharing information about a change in a patient\u0026rsquo;s condition. This study identified several key factors that influence interprofessional communication and collaboration: 1) Organizational factors encompassing the fragmentation and the lack of direct communication and personal contact with others, 2) profession-related factors (e.g., hierarchy and responsibilities) and 3) individual factors involving personal attributes, such as the capacity to provide and the perspective on care amongst others.\u003c/p\u003e \u003cp\u003eWhile our findings highlight challenges of nurse-GP communication and collaboration in the German outpatient care, these are not unique to the German setting: Our results are consistent with a number of studies that describe the same routes (fax, telephone and mail) and reasons for communication [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Organizational factors influencing communication and collaboration, such as fragmentation of ambulant and specialist care with no shared information system [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], lack of direct communication and personal contact [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], as well as the high workload [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] have been identified in recent studies. The results of our study confirm further findings of previous studies, identifying profession-related factors such as hierarchy [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31 CR32 CR33\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], responsibilities and rights [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and education [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] as impacting interprofessional communication and collaboration. Our results are in line with other studies identifying factors on an individual level, such as the capacity to provide care [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], the perspective on care and initiative to change [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and use of language [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhilst most factors were identified in various papers, our study provides a comprehensive overview of the factors influencing GP-nurse communication and collaboration in the care for outpatients. It also considers unique aspects of the current situation in Germany, including the heavy reliance on fax machines and the fragmentation of the ambulant sector [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEven though each factor has been presented under a specific category, they should not be seen as independent from one another. Nurses currently assume a mediating position between healthcare providers and patients or their relatives, e.g., as a support in coping with the illness or need for care [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. They perceive themselves as the \u0026ldquo;ear and eye of the patient\u0026rdquo; and wish to be recognized as an \u0026ldquo;equal partner\u0026rdquo; in communication and collaboration with GPs to jointly achieve the best possible patient care (profession-related). However, due to the prevailing framework conditions, time constraints and organization of collaboration (organizational level), home-care nursing services are, for example, reliant on prescriptions from GPs and thus de facto dependent on them. Furthermore, even though there is a change in GPs\u0026rsquo; mindset and some nowadays ask for nurses\u0026rsquo; feedback, \u0026ldquo;hierarchical thinking\u0026rdquo; still prevails in many GPs (profession-related), which negatively impacts communication and collaboration. A change in a specific category might lead to changes on other levels, in the same way as a change in perception of the nursing role might impact factors on all levels. Several studies have shown that understanding each other\u0026rsquo;s roles, professional identities and clarity about the responsibilities of each profession can significantly improve GP-nurse collaboration and communication in the ambulant setting [\u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eImplications and recommendations\u003c/p\u003e \u003cp\u003eAccording to the definitions provided in the introduction, the current interaction pattern between GPs and nurses cannot be classified as collaboration, because negotiation processes are scarce. Rather, it is purely information exchange in the sense of communication, although timeliness and efficiency should be increased. In order to improve nurse-GP communication and implement effective collaboration, on an organizational level, clear communication channels need to be established, which might be facilitated by the mandatory implementation of the telematics infrastructure in Germany [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurther policy recommendations include, amongst others, an adequate reimbursement of times dedicated to interprofessional communication and collaboration. This would incentivize individuals\u0026rsquo; motivation to cooperate, enhancing interprofessional relationships and aiding the development of a mutual understanding of approaches, language and goals [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The establishment of \u0026lsquo;formal team meetings\u0026rsquo; would further allow for a structured care coordination, sufficient time to discuss cases and exchange views on organizational issues [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. On an individual level, the development of a \u0026lsquo;common language\u0026rsquo; might further be guided through structured communication tools and frameworks, such as the American Medical Director Association\u0026rsquo;s \u0026ldquo;Protocols for Physician Notification\u0026rdquo; or ISBAR (Introduction, Situation, Background, Assessment, and Recommendation) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. To facilitate long-term changes, interprofessional education should be incorporated in curricula of each healthcare profession, jointly with an ongoing on the job training [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This intervention can promote trust, a shared understanding of objectives and counteract prevailing stereotypes [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Another long-term change might further be the establishment of dedicated case management professionals who are responsible for structuring interprofessional teams caring for chronic patients [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. This goes along with further concepts of professionalisation within nursing care which are debated in the context of digitalization [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] but is also already visible in the differentiation of job profiles in nursing such as community health nursing or advanced nursing practice.\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eThe findings of this study contribute to the limited body of knowledge in interprofessional communication and collaboration between GPs and nurses in the ambulatory setting. It is worth noting that since no financial incentives were provided for participating in these interviews, those with a stronger interest in interprofessional exchange were more likely to do so, potentially leading to an under-representation of individuals with less interest in such exchange. As medical assistants are the first point of contact at the GP practice for home-care nurses and with only one medical assistant participating, we might have missed valuable viewpoints concerning the communication and collaboration between home-care nursing services and GP practices. Furthermore, the study was conducted in a specific region in Germany, and it therefore might not be possible to generalize the results.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eInterprofessional communication and collaboration between home-care nursing facilities and GP practices are influenced by factors on an organizational and individual level, as well as profession-related factors. Current interaction patterns are deficient and require changes on political, structural and educational levels to establish well-functioning collaboration in the ambulant sector that facilitates patient-centred care. The results of this study highlight the need to improve nurse-GP communication and to implement effective collaboration. Based on the factors identified as influencing nurse-GP interaction, educational and political reforms should be established. These may comprise 1) establishing and reinforcing interprofessional education in medical and nursing curricula and 2) defining professional roles and responsibilities to tackle individual and profession-related factors. As for organizational factors, there is a need for political reforms, such as introducing clear and secure communication channels.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCOREQ\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Consolidated Criteria for Reporting Qualitative Research\u003c/p\u003e\n\u003cp\u003eGP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;General practitioner\u003c/p\u003e\n\u003cp\u003eNM \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Nursing service manager\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved in November 2022 by the Joint Ethics Committee of the Bavarian Universities of Applied Sciences (Gemeinsame Ethikkommission der Hochschulen Bayerns) under the number GEHBa-202211-V-084. The participants provided written informed consent prior to data collection and did not receive any compensation for their participation. The study was conducted in accordance with the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for application\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFF serves as Associate Editor at BMC Health Services Research. All other authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors’ contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFF, MS, MCR and SS conceptualized the study. KN, SS, MCR, PML, MS and FF contributed to data collection. KN, MCR, MS and FF analyzed the data. KN drafted the manuscript; SS, MCR, MS and FF revised the draft critically and provided important intellectual content. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the preparation of this work, the authors used ChatGPT 4.0 in order to improve readability and language. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEuropean Commission. Long-Term Care Report: Trends, challenges and opportunities in an ageing society. Luxembourg: Publications Office of the European Union; 2021.\u003c/li\u003e\n\u003cli\u003ePl\u0026ouml;thner M, Schmidt K, de Jong L, Zeidler J, Damm K. Needs and preferences of informal caregivers regarding outpatient care for the elderly: a systematic literature review. BMC Geriatr. 2019;19:82. \u003c/li\u003e\n\u003cli\u003eStatistisches Bundesamt. 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J Patient Saf. 2009;5(3):145\u0026ndash;52.\u003c/li\u003e\n\u003cli\u003eRudberg I, Olsson A, Thunborg C, Salzmann-Erikson M. Interprofessional communication in a psychiatric outpatient unit \u0026ndash; an ethnographic study. BMC Nurs. 2023;22:286.\u003c/li\u003e\n\u003cli\u003eForonda C, MacWilliams B, McArthur E. Interprofessional communication in healthcare: An integrative review. Nurse Educ Pract. 2016;19:36\u0026ndash;40.\u003c/li\u003e\n\u003cli\u003evan Der Gulden R, Scherpbier-de Haan ND, Greijn CM, Looman N, Tromp F, Dielissen PW. Interprofessional education and collaboration between general practitioner trainees and practice nurses in providing chronic care; a qualitative study. BMC Med Educ. 2020;20:290.\u003c/li\u003e\n\u003cli\u003eMayrhofer L, Mrak L, Kobleder A, Kohler M. Die Rolle von Pflegefachpersonen in der onkologischen Rehabilitation: Ein Scoping Review [The role of nurses in oncology rehabilitation: A scoping review]. Pflege. 2021;34(4):203\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eBehrend R, Maaz A, Sepke M, Peters H. Interprofessionelle Teams in der Versorgung. In: Jacobs K, Kuhlmey A, Gre\u0026szlig; S, Klauber J, Schwinger A, editors. Pflege-Report 2019 \u0026ndash; Mehr Personal in der Langzeitpflege \u0026ndash; aber woher?. Berlin, Heidelberg: Springer p. 201\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eH\u0026auml;mel K, V\u0026ouml;ssing C. The collaboration of general practitioners and nurses in primary care: A comparative analysis of concepts and practices in Slovenia and Spain. Prim Health Care Res Dev. 2017;18(5):492\u0026ndash;506.\u003c/li\u003e\n\u003cli\u003eMcInnes S, Peters K, Bonney A, Halcomb E. An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice. J Adv Nurs. 2015;71(9):1973\u0026ndash;85.\u003c/li\u003e\n\u003cli\u003egematik GmbH. An arena for digital health. Telematics Infrastructure 2.0 white paper for a federally networked healthcare system. Berlin: gematik GmbH; 2021. \u003c/li\u003e\n\u003cli\u003eCarron T, Domeisen Bendetti F, Fringer A, Fierz K, Peytremann-Bridevaux I. Integrated care models in Swiss primary care: An embedded multiple case study. J Eval Clin Pract. 2023;29(6):1025\u0026ndash;38.\u003c/li\u003e\n\u003cli\u003eMcInnes S, Peters K, Bonney A, Halcomb E. Understanding collaboration in general practice: a qualitative study. Fam Pract. 2017;34(5):621\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eCurtis K, Tzannes A, Rudge T. How to talk to doctors \u0026ndash; a guide for effective communication. Int Nurs Rev. 2011;58(1):13\u0026ndash;20.\u003c/li\u003e\n\u003cli\u003eHudon C, Bisson M, Chouinard M-C, et al. Implementation analysis of a case management intervention for people with complex care needs in primary care: a multiple case study across Canada. BMC Health Serv Res. 2023; 23:377. \u003c/li\u003e\n\u003cli\u003eSchirin Gessl A, Fl\u0026ouml;rl A, Schulc E. Demand for community-based case management in Austria \u0026ndash; a qualitative analysis. BMC Nurs. 2022;21:5.\u003c/li\u003e\n\u003cli\u003eAigner J, Fischer F. Pflegekompetenzgesetz \u0026ndash; Gehen vor Enthusiasmus die Potentiale der Digitalisierung auf dem Weg verloren? [Nursing Competence Act - Is the potential of digitalisation being lost in the enthusiasm?]. Gesundheitswesen. 2024;86(4):260\u0026ndash;2.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"ambulatory setting, outpatient care, home care, Germany, nursing, physician, primary care","lastPublishedDoi":"10.21203/rs.3.rs-4458661/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4458661/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/em\u003e The demographic transition in Germany is leading to an increase in the number of people needing care or nursing services in their own homes. Interprofessional communication and collaboration among healthcare professions providing outpatient care is paramount to ensure effective and high-quality patient-centred care. However, interprofessional communication and collaboration comes with complex prerequisites and rarely works smoothly. Thus, it is necessary to assess the current status quo.\u003c/p\u003e\n\u003cp\u003eTherefore, the aim is to characterize communication patterns, factors influencing interprofessional communication and collaboration and expectations towards communication and collaboration between home-care nursing services and general practitioner practices in Germany.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/em\u003eSemi-structured interviews with healthcare professionals in general practitioners’ practices and nurses working in home-care nursing services were conducted in southern Germany. The interviews were analysed using inductive thematic content analysis.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults: \u003c/strong\u003e\u003c/em\u003eCurrent communication occurs via fax, telephone or personal contact for various purposes, including the emission or rectification of medical orders and exchanging information about change in a patient’s condition. Key factors influencing interprofessional communication are organizational (e.g., lack of direct communication), profession-related (e.g., hierarchy) and individual (e.g., capacity to provide care). Interprofessional collaboration is scarce. Nurses and general practitioners expect uncomplicated, efficient and quick communication and collaboration through set channels.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003e\u003c/em\u003eCurrent interaction patterns are deficient and require political, structural and educational changes to establish well-functioning collaboration in the ambulant sector that facilitates patient-centred care. Educational and political reforms should comprise expanding interprofessional education in curricula and the introduction of clear and secure communication channels.\u003c/p\u003e","manuscriptTitle":"“Well, it’s very doctor-related” – Interprofessional communication and collaboration between general practitioners and nurses: a qualitative study in Southern Germany","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-07 22:57:38","doi":"10.21203/rs.3.rs-4458661/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-04T08:17:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-02T09:47:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-21T09:36:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"327037286219189469669451904456326460132","date":"2024-06-07T07:59:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230697174316683001503404516252356235870","date":"2024-06-06T12:29:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-29T14:10:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-24T06:13:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-23T06:49:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-23T06:49:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2024-05-22T06:33:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d92938ff-9395-4897-9efd-9b6d8ccca94d","owner":[],"postedDate":"June 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-05T16:06:31+00:00","versionOfRecord":{"articleIdentity":"rs-4458661","link":"https://doi.org/10.1186/s12913-025-12819-1","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2025-05-03 15:57:17","publishedOnDateReadable":"May 3rd, 2025"},"versionCreatedAt":"2024-06-07 22:57:38","video":"","vorDoi":"10.1186/s12913-025-12819-1","vorDoiUrl":"https://doi.org/10.1186/s12913-025-12819-1","workflowStages":[]},"version":"v1","identity":"rs-4458661","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4458661","identity":"rs-4458661","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}