title: Cooperation between general practitioners, occupational health physicians, and rehabilitation physicians in Germany: what are problems and barriers to cooperation? A qualitative study.
abstract: OBJECTIVE
  General practitioners (GPs), occupational health physicians (OPs), and rehabilitation physicians (RPs) fulfill different functions in the rehabilitation process, which need to be interlinked effectively to achieve a successful medical and occupational rehabilitation. In Germany, this cooperation at the interfaces is often suboptimal. The aim of this study was to identify and discuss perceived barriers to cooperation between GPs, OPs, and RPs.
  
  
  METHODS
  We used a qualitative study design with eight focus group discussions (FGD) with GPs, OPs, RPs, and rehabilitants. Two FGDs per expert group with 4-10 participants were conducted. The transcripts were analyzed using qualitative content analysis.
  
  
  RESULTS
  A number of obstacles to cooperation were reported by the participants, including (1) organizational (e.g., missing contact details, low reachability, schedule restrictions), (2) interpersonal (e.g., rehabilitants level of trust in OPs, low perceived need to cooperate with OPs, low motivation to cooperate), and (3) structural barriers (e.g., data privacy regulations, regulations concerning rehabilitation reports).
  
  
  CONCLUSIONS
  The present data agree with study results from other countries, which addressed interfaces in the rehabilitation process. While some barriers could be overcome by the participants themselves, a multi-level stakeholder approach might be necessary. Future quantitative research is required to assess the relative weight of the findings.
authors.affiliation: Institute for Occupational Medicine, Social Medicine and Health Services Research (Institut fuer Arbeitsmedizin, Sozialmedizin und Versorgungsforschung), University Hospital Tuebingen, Wilhelmstrasse 27, 72074, Tuebingen, Germany.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Stratil
authors.affiliation: Institute for Occupational Medicine, Social Medicine and Health Services Research (Institut fuer Arbeitsmedizin, Sozialmedizin und Versorgungsforschung), University Hospital Tuebingen, Wilhelmstrasse 27, 72074, Tuebingen, Germany.
authors.forename: Monika A
authors.initials: MA
authors.lastname: Rieger
authors.affiliation: Institute for Occupational Medicine, Social Medicine and Health Services Research (Institut fuer Arbeitsmedizin, Sozialmedizin und Versorgungsforschung), University Hospital Tuebingen, Wilhelmstrasse 27, 72074, Tuebingen, Germany. Susanne.Voelter-Mahlknecht@med.uni-tuebingen.de.
authors.forename: Susanne
authors.initials: S
authors.lastname: Völter-Mahlknecht
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D003299:Cooperative Behavior; D005260:Female; D017144:Focus Groups; D058005:General Practitioners / Q000523:psychology*; D005858:Germany; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D054538:Occupational Health Physicians / Q000523:psychology*; D009787:Occupational Medicine; D000072157:Physiatrists / Q000523:psychology*
keywords: Cooperation; General practice; Health services research; Interface; Occupational medicine; Rehabilitation