Roadmap improves RHO relationship with family physician

To make the cooperation between GPs and social domain more efficient, first the relationship between GPs and regional GP organizations (RHO) must improve. Danique Hesselink comes up with a roadmap.

A growing number of patients come to the family doctor with physical complaints for which no obvious medical cause can be found. Many of these patients are struggling with social problems such as debt, loneliness or poverty. Because these problems often fit better within the social domain, the GP regularly comes under pressure to help these patients anyway. This not only increases the workload, but leads to inefficiencies in care.

Gatekeeper of care

As the gatekeeper of care, the general practitioner has an important role in the coordination of patients to care professionals outside primary care. But they suffer from a lack of time and organizational power. The regional GP organization (RHO) does have this organizational power and is there to relieve the GP. The RHO can play an important supporting and facilitating role for the general practitioners. But the relationship between the RHO and the GPs is not always that good. There is a lack of clear preconditions, support and trust.

Collaboration with RHOs

Danique Hesselink, clinical informaticist at Medrie, investigated as part of the Clinical Informatics course at TU/e how to improve the collaboration between GPs and RHOs, in order to optimize the cooperation between GPs and the social domain and better help vulnerable patients.

In her research, Hesselink uses the Rainbow Model of Integrated Care, developed by her academic supervisor Pim Valentijn. This model focuses on the needs of the patient. Based on the needs of a group of patients, or population, different forms of clinical, professional and organizational collaboration can be initiated. This study is concerned with patients with social problems. These are victims of the uncoordinated collaboration between healthcare and social domain.

Accessibility

Family physicians are the "saviors" of these patients because of their easy accessibility. Hesselink sees those getting frustrated. "This demand for care measures a lot of time and money because of the lack of a good referral and collaboration mechanism to the social domain."

In turn, the RHOs are trying to be the "savior" of the GPs. But the GPs do not see these regional organizations that way. Clear frameworks and direction are lacking, and there is a lack of trust. Hesselink: "GPs feel that the RHO does not need to get involved in something that is not GP medicine."

Roadmap for better collaboration

How can the relationship between general practitioners and RHOs be improved? Based on her findings, Hesselink developed a practical roadmap. This roadmap describes how the regional GP organization can shape cooperation. The motto "of, for and by GPs" is leading.

1. Awareness and needs assessment

"Start with the patient," Hesselink advises. "Which patients are involved and what needs do they have? What do these patients suffer from and why do they visit the general practitioner? What expectations do they have of the general practitioner?" In addition, she recommends looking at the GP himself. "What is the problem for the GP in terms of delivering care to the patient at the center? For example, what does the family physician need to organize to meet the patient's expectations? Is the GP the right person to meet these expectations?" Finally, it is good to also map out the system. "Think about laws and regulations you have to deal with and policy notes that underlie the issue."

After each phase, it is important to mirror and collect a go or no go, according to Hesselink. "After the first phase, it's about recognizing the problem, the urgency of the problem and then formulating a mission for the RHO."

2. Explore and discover

The second phase is exploration. Here the RHO, together with a number of GPs or practice support workers, will explore how the cooperation can be shaped." Hesselink: "You start working out the necessary preconditions and make a regional plan. In doing so, first outline the wishes of the professionals and then outline what the support from the RHO can look like."

Even after this phase, it is important to mirror and collect a go/no go. This can be done by reviewing the created plan and the established preconditions with the constituency. "Make adjustments where necessary and test again. Ask collectively for agreement and document it."

3. The discovery phase

In this phase, the RHO and GPs will see if the preconditions they have jointly drawn up are usable in practice. "In doing so, monitor as RHO the wishes and needs of the GP and keep examining whether the role of the organization is still in line," Hesselink recommends. "Adjust if necessary. Nothing is set in stone. The focus is on the common interest: the patient must receive the right care and the collaboration must make this possible."

Future-proof

Improving collaboration between GP care and the social domain is a complex challenge, but a necessary one to future-proof care. A better relationship between the RHO and GPs is a primary goal in this regard. The role of the RHO is crucial here: it must not only facilitate, but also continuously check whether the cooperation is in line with the expectations of the GPs. Only in this way can cross-domain cooperation become a success, Hesselink concludes.

Her roadmap provides a structured approach for this. "By starting with the patient's needs and organizing cooperation step by step, the workload for family physicians can be reduced and patients get the care they need."