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[关于克服联邦养老基金和法定医疗保险在医疗康复方面接口问题的建议]

[Recommendations for overcoming interface problems in medical rehabilitation of federal pension funds and statutory health insurance].

作者信息

Pohontsch N, Träder J-M, Scherer M, Deck R

机构信息

Institut für Sozialmedizin, Universität zu Lübeck.

出版信息

Rehabilitation (Stuttg). 2013 Oct;52(5):322-8. doi: 10.1055/s-0032-1330005. Epub 2013 Jun 7.

Abstract

OBJECTIVE

Interface problems in medical rehabilitation are a consequence of problems with communication and cooperation, lack of information and transparency. Different stakeholders are trying to solve these problems since many years or decades respectively. Following a series of deficit-oriented studies we tried to develop recommendations for possible solutions of important interface problems together with affected people based on a qualitative analysis of main problem areas.

METHOD

10 separate group discussions with rehabilitation patients, general practitioners and specialists in private practices, representatives of the federal pension fund and statutory health insurance as well as clinicians from rehabilitation clinics and 3 mixed group discussions (all before mentioned groups excluding rehabilitation patients) were conducted. These group discussions served to prepare a semidiurnal final conference. All meetings were recorded and content analyzed or summarized in protocols respectively.

RESULTS

Results are recommendations on strategies to reduce interface problems in medical rehabilitation. Those are: development of a rehabilitation-information-website for insurees and general practitioners and specialists in private practices; changes in forms, applications, notifications; advanced training for general practitioners and specialists in private practices und support in detecting rehabilitation need.

CONCLUSION

Due to divided structures of care provision and increasing specialization, overcoming interface problems is one of the main challenges in the provision of medical rehabilitation. It can be met if different stakeholder approach each other without prejudices, share instead of demarcate competencies and are willing to strike new paths. Our recommendations represent the first step to reaching this goal.

摘要

目的

医疗康复中的衔接问题是沟通与合作存在问题、信息缺乏及透明度不足的结果。多年来或数十年来,不同利益相关者一直在尝试解决这些问题。在进行了一系列以缺陷为导向的研究之后,我们基于对主要问题领域的定性分析,试图与受影响者共同制定针对重要衔接问题可能解决方案的建议。

方法

与康复患者、私人执业的全科医生和专科医生、联邦养老基金和法定医疗保险的代表以及康复诊所的临床医生进行了10次分组讨论,还进行了3次混合组讨论(上述所有组,但不包括康复患者)。这些分组讨论旨在筹备一场为期半天的最终会议。所有会议均进行了记录,并分别对内容进行了分析或在会议纪要中进行了总结。

结果

结果是关于减少医疗康复中衔接问题策略的建议。这些建议包括:为被保险人以及私人执业的全科医生和专科医生开发一个康复信息网站;改变表格、申请、通知;为私人执业的全科医生和专科医生提供进阶培训,并在发现康复需求方面提供支持。

结论

由于医疗服务结构分散且专业化程度不断提高,克服衔接问题是提供医疗康复的主要挑战之一。如果不同利益相关者能够不带偏见地相互接触、共享而非划分职责,并愿意开辟新途径,那么这一挑战是可以应对的。我们的建议是实现这一目标的第一步。

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