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Table 2 Categories of factors associated with information flows

From: The role of personalised professional relations across care sectors in achieving high continuity of care

  Definition Examples of topics identified
Organisational Statements on the extent to which organisational (outpatient, inpatient, cross-sector) factors influence information flows -Information systems in hospitals and general practices are not compatible
-Phone calls mostly from smaller hospitals
-Different timelines in hospitals and general practices impede telephonic reachability (a.m. surgery times in hospitals, p.m. out-of-office hours in general practices)
-Telephone calls disrupt current activities
-In general practices that are well organised, medical assistants work independently and manage information flows
-Skills mix improves communication: case management, medical assistants, physician assistants
Legal Statements about the extent to which legal requirements influence information flows -Data protection (fax requires phone calls for verification of identity, no verification of identity possible via telephone, impedes digital communication, hospitals need patients’ consent for transferring medical information to other care providers)
-Statutory regulations do not apply to patients with private health insurance (e.g. GP does not receive a discharge letter)
Financial Statements on the extent to which financial factors influence information flows -Health care organisations have to implement communication and information technology at their own financial risk
-Communication is not financially compensated
Patient factors Statements about the influence of patient factors on information flows -Communication is more intense in complex cases (e.g. patients with multimorbidity, polypharmacy, geriatric patients, oncological patients) or if misunderstandings are expected to occur
-Communication via telephone is preferred in those cases
Individual characteristics Statements about the extent to which individual characteristics influence information flows -Some physicians are more likely to call than physicians in other hospitals
-Language barriers with foreign staff hinder information exchange
Emotional & social factors
Appreciation and understanding of the respective other Statements about how understanding of the tasks of others and appreciation for their work influences information flows -GPs do not feel appreciated by junior physicians in hospitals, GPs are under the impression that they put all the work on the GP
-VERAHs feel that detailed information at admission is not appreciated by the care providers in hospitals
-Hospital physicians tend to not trusting external diagnostic results
-Communication improves when care providers have worked together for a longer time, as they gain understanding about the others’ working mechanism
-Work shadowing can be an opportunity for developing an understanding for different areas in health care
 (Intrinsic) motivation Statements about what influence (intrinsic) motivation has on information flows -Only few individuals seem to be intrinsically motivated to communicate with other care providers
-Motivation could be improved through positive reinforcement by patients
-A change in paradigm is needed for hospital staff: health care does not end with hospital discharge
 Socialisation Statements about how information flows are influenced by different types of socialisation -Medical students outside of Germany seem to be better trained for information exchange with other health care providers
-Participants experience information flows to be better among geriatricians or oncologists
-Young GPs who have spent time in hospitals seem to be more aware about the information that needs to be passed
-Differences are observed between physicians in big hospitals, small hospitals, or general practices
 Relationships Statements on the extent to which personal relationships and contacts influence information flows and contact establishment -Knowing someone and having met someone positively influences information flows and contact establishment
-Knowing someone especially influences the probability of oral communication
-Care providers know each other from formal and informal meetings, both are used for professional exchange
-Knowing someone seems to be one of the or the most important factor for successful information flows