Table 2.
Barriers to primary and secondary care collaboration in PSS/FD care.
| Points (Number of individual votes) |
|||||
|---|---|---|---|---|---|
| Ranking | Total | GPs | Medical Specialists | Barriers | Determinants |
| 01 | 144 (40) | 54 (15) | 68 (19) | Different expectations between patients, GP and specialist | Interactional |
| 02 | 110 (34) | 36 (10) | 52 (17) | Lack of clarity with responsibility of care when multiple professionals are involved | Organisational |
| 03 | 107 (31) | 27 (8) | 54 (16) | No shared language between primary and secondary care professionals | Systemic |
| 04 | 76 (23) | 36 (10) | 36 (10) | Time pressure - too little time for collaboration | Organisational |
| 05 | 60 (16) | 19 (6) | 32 (8) | Insufficient or too much information in referral letter | Interactional |
| 06 | 42 (13) | 13 (3) | 26 (8) | No unified protocol and associated tools across levels of care | Organisational |
| 07 | 39 (14) | 5 (3) | 32 (10) | Too leading or unclear question in the referral letter | Interactional |
| 08 | 38 (16) | 18 (7) | 17 (7) | Lack of a generalistic doctor with an overview of the whole care trajectory | Organisational |
| 09 | 25 (10) | 7 (4) | 18 (6) | Anxiety of the professional over missed diagnoses | Systemic |
| 10 | 21 (11) | 11 (6) | 9 (4) | Insufficient knowledge about treatment options across services | Organisational |
| 10 | 21 (10) | 2 (1) | 14 (8) | Stigma and negative loadings associated with terms used around functional/medically unexplained symptoms | Systemic |
| 12 | 17 (5) | 5 (2) | 12 (3) | Discomfort in dealing with uncertainty by doctors, patients and society | Systemic |
| 13 | 16 (5) | 11 (3) | 5 (2) | Difficulties in utilising the preferred means of communication | Organisational |
| 14 | 12 (7) | 1 (1) | 8 (5) | Insufficient treatment capacity in either level of care | Organisational |
| 15 | 11 (7) | 3 (3) | 3 (2) | Lack of continuity of care across different services and levels of care | Organisational |
| 15 | 11 (6) | 0 (0) | 11 (6) | IT-systems not communicating | Organisational |
| 17 | 10 (5) | 2 (1) | 8 (4) | The need for a diagnosis to receive sickness benefits | Systemic |
| 18 | 6 (2) | 3 (1) | 3 (1) | Access to referral letter by patients may restrict what information GPs provide because of presumed negative reactions by patients | Systemic |
| 19 | 5 (2) | 2 (1) | 3 (1) | Referral as a means of exchange or based on patient’s wish instead of for a medical reason | Interactional |
| 19 | 5 (2) | 0 (0) | 5 (2) | Referrals to wrong places or unclear where to refer to due to lack of specialised outpatient facilities | Organisational |
| 21 | 4 (1) | 0 (0) | 4 (1) | Lack of communication across the different levels of care | Organisational |
| 22 | 0 (0) | 0 (0) | 0 (0) | Lack of mutual trust because GP and specialist do not know each other personally | Interactional |
FD: Functional disorders; GP: General practitioner; IT: Information technology; PSS: Persistent somatic symptoms.