Interprofessional Collaboration between General Physicians and Emergency Department Teams in Belgium: A Qualitative Study

Abstract

This study aimed to assess interprofessional collaboration between general physicians and emergency departments in the French speaking regions of Belgium. Eight group interviews were conducted both in rural and urban areas, including in Brussels.Findings showed that the relational components of collaboration, which are highly valued by individuals involved, comprise mutual acquaintanceship and trust, shared power and objectives. The organizational components of collaboration included out-of-hours services, role clarification, leadership and overall environment. Communication and patient’s role were also found to be key elements in enhancing or hindering collaboration across these two levels of care.Relationships between general physicians and emergency departments’ teams were tightly linked to organizational factors and the general macro-environment. Health system regulation did not appear to play a significant role in promoting collaboration between actors. A better role clarification is needed in order to foster multidisciplinary team coordination for a more efficient patient management. Finally, economic power and private practice impeded interprofessional collaboration between the care teams.In conclusion, many challenges need to be addressed for achievement of a better collaboration and more efficient integration. Not only should integration policies aim at reinforcing the role of general physicians as gatekeepers, also they should target patients’ awareness and empowerment.

Patients’ perceptions of continuity of care across primary care level and emergency departments in Belgium: cross-sectional survey

“…Particularly, they were more likely to believe that, if necessary, their PCP informs the emergency physician of their arrival to the ED. Indeed, PCPs prefer to use this direct approach because it allows a direct interaction and case discussion between healthcare providers5 and helps to reduce waiting time for the elderly in the ED. At the same time, older people are shown to express greater satisfaction with the care received and have more realistic expectations 20.…”

“…First, ED activities in Brussels are three times more elevated than those in rural areas. In a previous study, actors from both levels of care have identified this workload as a major factor hindering communication and coordination between them 5. It has long been recognised that increasing access to general practitioners would decrease use of emergency services27–29 and that stronger primary care (in terms of accessibility, comprehensiveness and continuity) would lead to improved population health and lower healthcare service use 30.…”

“…Thus, PCPs hold the economic power as they are the ‘patient providers’. Consequently, collaboration suffers; emergency physicians consider PCPs to exert their monopoly through the privileged relationship with patients 5. This suggests that patients having more trust and satisfaction with their PCPs than in the ED may be symptomatic of this poor coordination between the two levels of care.…”

“…In Belgium, the limitations of communication tools between EDs and primary care level have led to 75.7% of primary care physicians (PCPs) and 85.7% of emergency physicians in Wallonia to be dissatisfied with communication between their two levels of care 4. Referral letters written by PCPs are of variable quality and occasionally lack essential information4; EDs’ written reports are sometimes sent to PCPs only months later, with some reports even sent to inaccurate addresses 5. Furthermore, shared patient records are underused, mainly because many physicians are untrained in using these systems or because of the additional administrative tasks required for enrolling patients and keeping their data updated on the platform 5.…”

“…Referral letters written by PCPs are of variable quality and occasionally lack essential information4; EDs’ written reports are sometimes sent to PCPs only months later, with some reports even sent to inaccurate addresses 5. Furthermore, shared patient records are underused, mainly because many physicians are untrained in using these systems or because of the additional administrative tasks required for enrolling patients and keeping their data updated on the platform 5. These factors raise a significant challenge in terms of informational continuity for patients between the emergency physician and their PCP.…”