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Influences on Physicians' Participation in Coordinated Ambulatory Cardiology Care: A Mixed-Methods Study

Patrick Hennrich1, Regine Bölter1, Michel Wensing1

  • 1Heidelberg University Hospital, Department of General Practice and Health Services Research, Im Neuenheimer Feld, Heidelberg, DE.

International Journal of Integrated Care
|December 7, 2020
PubMed

Insights

Physicians joined a cardiology care program primarily for financial incentives, not for its healthcare improvement goals. Further research is needed to understand the impact of this motivation gap on program outcomes.

Area of Science:

  • Health Services Research
  • Ambulatory Care
  • Cardiology

Background:

  • A managed care program for coordinated ambulatory cardiology care was established in Southern Germany in 2009.
  • The program is a voluntary contract between health insurers and ambulatory medical specialists.
  • It aims to provide guideline-oriented, efficient healthcare through general practitioners and specialists.

Purpose of the Study:

  • To identify factors associated with physicians' participation in the managed care program.
  • To examine the relationship between physicians' motivations for participation and the program's aims.

Main Methods:

  • A mixed-methods study combining semi-structured interviews and structured questionnaires.
  • Interviews were conducted with 21 participating and 11 non-participating specialists.
  • Questionnaires were sent to all eligible specialists, with 75 participating and 21 non-participating physicians responding.

Main Results:

  • Financial benefits were the primary driver for physician participation.
  • Other motivations included seeking alternatives to regular care, diagnostic opportunities, and peer recommendations.
  • Reasons for non-participation included structural barriers, financial investments, and concerns about professional autonomy.

Conclusions:

  • Physician participation in the cardiology managed care program was predominantly motivated by financial gains.
  • This financial motivation appears largely disconnected from the program's intended healthcare improvement objectives.
  • The impact of this divergence on the program's effectiveness requires further investigation.
Abstract

Keywords:
ambulatory carecardiologycoordinationintegrated careparticipationselective contract

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