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Introduction: Adequate communication between care and medical disciplines is an important prerequisite for safe patient care. Studies have shown that personal, social and organizational barriers might hinder communication in hospital care and long term care. Literature in primary care on these topics is scarce, but studies on implementation of collaborative services in primary healthcare indicate that communication is an important prerequisite for collaboration. This study aims to identify factors that facilitate or hinder patient related communication between General Practitioners (GPs) and Community Nurses (CNs), in order to find strategies to improve poor communication, if present. Six mono-disciplinary focus groups (13 GPs, 3 meetings; 18 CNs, 3 meetings) were organized, to create an atmosphere of equality and trust, knowing that hierarchical relationships could hinder open discussions. The interviews were tape-recorded and transcribed ad verbatim. Professionals were invited to discuss topics concerning individual attitudes and experiences, barriers and facilitators, prerequisites and current and future strategies for improvement. ATLAS.ti was used to code transcripts. Results: Despite the fact that GPs and CNs have regular contacts (mostly via telephone, less often in person), poor communication was frequently perceived. Trustful relations appeared to be the most important prerequisite for effective communication. Organizational factors (e.g. lack of shared care plans, no contact in person and lack of time) and professional specific factors (e.g. discipline specific language, perspective, education level and position) influenced development of trustful relationships. Significant suggestions for improvement of communication by both GPs and CNs were made, for example the importance of communication skills training and use of practical communication tools that structure information. Discussions: The results of this study are in line with earlier studies in hospital and long term care settings with regard to miscommunication between doctors and nurses. However, in this primary care study, causes seem to be more divers and disruptive. Medical and nursing professionals are not part of one team, but work from different organizations, with different interests, visions, procedures and methods of working. Conclusions: Different professional and organizational factors might hinder effective patient related communication between GPs and CNs. Inter-professional training programmes should address these factors and should be evaluated for their effect on quality of care. [ABSTRACT FROM AUTHOR]

Introduction: Collaborative primary care is needed to meet the complex needs of individuals with dementia and their informal caregivers. In the Netherlands, shortcomings of current dementia care still exists, including ad hoc based collaboration, lack of feedback on quality to professionals involved, and incomplete implementation of established multidisciplinary guidelines. We developed and implemented DementiaNet, an integrated care approach in primary care that aims to reduce the burden of the disease on individuals, health care services, and society. DementiaNet is network-based care which stimulates collaboration, enhances knowledge and skills and encourages quality improvement cycles. We applied a bottom up and tailor made approach and supported local primary care networks in the Netherlands to implement 5 core processes: network based care, clinical leadership, quality improvement cycles, inter professional practice based training, and communication support tools. A two year leadership support program for network leaders was an important part of the intervention and our study included a one group pre-test-posttest design using Leadership Practice Inventory (LPI-self and LPI-observer; score 30 to 300) to investigate the network leaders performance. Results: Currently, 17 local networks are formed and 22 clinical leaders developed leadership collaborative competencies (2 General Practitioners (GPs), 11 Community Nurses (CNs), 3 Practice Nurses, 4 Dementia care case managers and 2 Occupational Therapists). The networks vary on membership, quality of care and strength of collaboration due to local circumstances. Activities and goals of each networks vary as well, ranging from getting to know each other in person, improving on dementia care knowledge to introducing shared care plans. Poor communication between GPs and CNs, hindered implementation, as well as lacking management's support and poor financial arrangements. The leadership program helped clinical leaders to facilitate network collaboration and stimulate improvement of dementia care as a joint effort. Discussion: Networked care is difficult to accomplish because many complex factors have to be taken into account. Although leadership is often expressed as an important prerequisite for implementing collaborative care models, clinical leaders are not often explicitly supported in executing their leadership role. Conclusion: Results show that clinical practice varies and the DementiaNet approach can lead to quality improvement and stronger collaboration with medical and nursing professionals in leadership roles. Collaborative leadership has to be actively supported and empowered, as professionals are not automatically qualified to execute this leading role in an collaborative network. [ABSTRACT FROM AUTHOR]