Programme no. 527-OP
Public Health
Collaboration between general practice and municipalities on the referral of patients with chronic diseases to patient education and rehabilitation programs in the municipalities
Julie Høgsgaard Andersen*1, Marius Brostrøm Kousgaard2, Thorkil Thorsen3
1The Research Unit for General Practice,Department of Public Health, University of Copenhagen,Copenhagen,Denmark, 2The Research Unit for General Practice,Department of Public Health, University of Copenhagen,Copenhagen,Denmark, 3The Research Unit for General Practice,Department of Public Health, University of Copenhagen,Copenhagen,Denmark
* = Presenting author
Objectives: To investigate what factors influence whether or not GPs recommend patients with chronic disease to attend patient education and rehabilitation programs in the municipalities?
Background: Structural reforms in the Danish public sector have delegated increased responsibility for health care to the municipalities. In response, the municipalities have established a range of new education and rehabilitation programs for patients with chronic diseases. General Practitioners (GPs) are expected to play an important role in recruiting patients for these programs. However studies have shown that many patients are not informed about the programs, and that it is difficult for the municipalities to get information about the programs across to the GPs and make them refer their patients.

Results: The main reason for not referring patients to patient rehabilitation and education programs in the municipalities was lack of knowledge about the content and quality of the programs. This was especially pronounced with regard to Learn how to live with a chronic disease. Other important reasons for not referring were forgetfulness and a busy schedule that did not always allow for prolonged talks about rehabilitation, as well as patients’ lack of motivation. Positive stories from patients who had participated in a program and experience with working with the municipalities influenced referral rates positively.The GPs differed with respect to how they preferred to receive information about the programs in the municipalities.

Material/Methods: We focused on two types of patient education and rehabilitation programs:
  1. Disease specific rehabilitation programs for type-2-diabetes and COPD.
  2. A generic program called Learn how to live with a chronic disease which is based on the Stanford Model, where patients teach patients how to live a good life with a chronic disease.

The data collection process consisted of two main parts: 1) A qualitative case study of collaborative relations in four municipalities involving interviews with 25 GPs and 13 representatives from the municipalities as well as observations at meetings in relevant cooperation committees. 2) A questionnaire study among a representative sample of GPs, inquiring into their knowledge about, attitudes towards and experiences with referring patients with chronic diseases to patient education and rehabilitation programs in the municipalities.

Conclusion: Many GPs felt they knew too little about the rehabilitation and education programs in the municipalities. The municipalities should make use of several different information strategies in order to reach the GPs.
Points for discussion: What could the municipalities do to increase the referral rates?