Interprofessional collaboration in primary care in Germany – collective irresponsibility, one-way-street or colourful bouquet of services? A qualitative study with stakeholders from various professions

BACKGROUND: Interprofessional collaboration (IPC) in outpatient care can improve patient outcomes and satisfaction, health prevention and economics. German primary care (PC) is challenged by an ongoing demand for health care professionals to extend services. PC in Germany is regularly provided by general practitioners and medical assistants. Models on how to establish interprofessional primary care (IPPC) are scarce. OBJECTIVES: Aim of the study was to explore stakeholders' suggestions on IPC in German PC to support development of an IPPC model. METHODS: Professionals from various nation-wide institutions and associations with professional backgrounds in general practice, medical assistance, nursing, physician assistance, social work and specialist medicine as well as from health insurance and law, were recruited. Semi-structured interviews were performed. Deductively identified main categories included strategies for implementing IPC on system-level, organisational-level, team-level and individual-level and were coded in sub-categories inductively. RESULTS: On system-level professionals predominantly named accountability, funding and remuneration. On organisational level documentation systems, the necessity of coordination and the availability of qualified personnel were discussed. On team-level interviewees focussed on the necessity of a mutual understanding of roles and responsibilities, clear and collaborative distribution of tasks and team leadership as well as patient integration and health literacy support. On individual-level the acceptance of new roles and professions was pointed out. CONCLUSION: To establish IPPC in Germany, remuneration and accountability need to be addressed. Models of IPPC need to integrate suggestions explored, a step-by-step approach for general practitioners to enable change-management and longitudinal support to promote adapted leadership and sustainable implementation.