Information exchange networks for chronic diseases in primary care practices in Germany: a cross-sectional study

Abstract

Background: Coordination of care requires information exchange between health workers. The structure of their information exchange networks may influence the quality and efficiency of healthcare delivery. The aim of this study was to explore and classify information exchange networks in primary care for patients with chronic diseases in Germany.

Methods: A cross-sectional study was carried out between 2019 and 2021. As part of a larger project on coordination of care, this study focused on information exchange in practice teams regarding patients with type 2 diabetes (DM), coronary heart disease (CHD) and chronic heart failure (CHF). Social network analysis was applied to determine the number of connections, density and centralization for each of the health conditions for each of the practices. On the basis of the descriptive findings, we developed typologies of information exchange networks in primary care practices.

Results: We included 153 health workers from 40 practices, of which 25 practices were included in the social network analysis. Four types of information exchange structures were identified for the three chronic diseases: highly connected networks with low hierarchy, medium connected networks with medium hierarchy, medium connected networks with low hierarchy and lowly connected networks. Highly connected networks with low hierarchy were identified most frequently (18 networks for DM, 17 for CHD and 14 for CHF). Of the three chronic conditions, information sharing about patients with DM involved the most team members. Information exchange outside the family practice took place mainly with nurses and pharmacists.

Conclusions: This study identified four types of information exchange structures, which provides a practical tool for management and improvement in primary care. Some practices had few information transfer connections and could hardly be considered a network.

Trial registration: We registered the study prospectively on 7 November 2019 at the German Clinical Trials Register (DRKS, www.drks.de ) under ID no. DRKS00019219.

Keywords: Chronic diseases; General practice; Information exchange networks; Social network analysis.

Fig. 1

Information exchange networks for CHD and CHF. P physician, PA practice assistant, P NA: non-response physician, PA NA: non-response practice assistant. The circles marked “P” indicate physicians, those marked “PA” indicate practice assistants and the lines between them indicate information change once per week