Implementing an Integrated Geriatric Care Model from the Perspective of Family Practitioners
DOI: 10.3238/zfa.2013.0016-0022german translation / full article
Background: Managed care is a strategy used to counteract the disintegration of functions and services in healthcare systems. Despite the demonstrated political will to put such models into practice in Germany, barriers to their implementation could not be surmounted in recent years. One reason for this, which should be considered, is that implementation of these models would require changes in routine practice. The present formative evaluation project examined the feasibility of an integrated geriatric care model from the view of family practitioners.
Methods: Face-to-face interviews and a focus group discussion were conducted at different points during the project with the physicians (N = 34) participating in the integrated care program. All interviews and the focus group discussion were digitally recorded, transcribed and thematically coded using the grounded theory approach.
Results: At the beginning of the project, the surveyed physicians (n = 3) cited their overall burden of work as the reason for their limited participation in the program. In addition, it became apparent that the target enrollment population of elderly insured patients was not sufficiently informed about the program. This problem was also discussed in the focus group (n = 6) one year later. The physicians also claimed that additional assistance was needed with enrolling patients in the program – even though an enrollment nurse position had been created during the project to lighten the burden of work. At the end of the project, the physicians (n = 3) actively participating in the program stressed the need for reminders and exchanges with colleagues to successfully put the model into practice.
Conclusions: Successful implementation of an integrated care model requires that physicians willing to participate in the program and those working in their practice make changes to their routine practice. This could not be achieved during this project through monetary incentives and the support of an enrollment nurse alone. Continuous support of the participating family practitioners provided in the form of academic detailing could contribute to successful model implementation.