Navigating collaboration in complex care: perspectives from general practitioners, hospital specialists, and patients...

Seamless collaboration is key to effective healthcare, yet cross-sector partnerships often struggle due to structural and professional differences. This study aimed to explore the dynamics of cross-sector partnership through the experiences and perspectives of hospital physicians, general practitioners (GPs), and patients managing multiple chronic conditions.

Data were gathered from 41 semi-structured interviews (14 hospital physicians, 10 GPs, and 17 patients with type 2 diabetes and at least one comorbidity). The Interpretive Description methodological approach guided the study, with the concept of Boundary Work providing the theoretical framework for examining how professional roles, boundaries, and collaboration were shaped and navigated across sectors.

Four main themes were identified: (1) Mapping Current Collaboration: Contexts, Patients, and Channels, (2) Perceiving Collaboration: Positive Views and Shortcomings, 3) Expectations and Roles: Imbalanced Responsibilities, and 4) Tackling Collaboration Challenges and Acknowledging Barriers. Informants shared mixed views on cross-sector partnerships. While some reported successful collaboration, hospital physicians anticipated fewer patient referrals from GPs, whereas GPs often felt unsupported and left to handle complex cases alone. Cross-sector collaboration was widely perceived as frustrating and, at times, disappointing, highlighting the need for improvement.

Hospital physicians, GPs, and patients alike advocate for improved cross-sectoral collaboration. Despite strong interest in enhancing cooperation, there is a need for professional consensus on which complex cases require cross-sector involvement. Moreover, clarifying the distribution of responsibilities and addressing the practical dimensions of collaboration and patient engagement are crucial for improving outcomes.