[Physicians' experience with and attitudes to interaction between health care levels]

We have studied physicians' experience with and attitudes to interaction between health care levels, and their opinions on how this can be improved.

Three focus groups were established. They consisted of 15 male and 2 female physicians with 3 months to 28 years of experience. Interviews with the participants were transcribed and qualitatively analysed.

Physicians had different opinions on which characteristics are important to establish a good professional interaction, and their opinions varied according to which health care level they represent. While GPs emphasised confidence, respect, knowledge of each other and accessibility, that is a relational perspective; the local hospital physicians put more emphasis on capacity, i.e. competence, stability and accessibility. Physicians at the central Hospital emphasized capacity and structure, i.e. their own and collaborators' professional interest, accessibility and formalised structures for interactions. A sense of personal knowledge and verbal and written contact was important, but guidelines and treatment plans were also considered to be important for interaction. There was a strong ownership to the individual patient across all three levels, which was an unexpected finding.

Good interaction seems to be a balance between the relational perspective, with emphasis on dialogue, structural arrangements, accessibility and continuity and professional competence. In addition, there is a need to clarify responsibilities for each patient.