gms | German Medical Science

Background: Traditionally, clinical practice guidelines assist practitioners' and patients' decisions about appropriate health care for specific clinical circumstances, whereas coordination of care receives less attention. In 1998, the Dutch College of General Practitioners (NHG) started to develop interdisciplinary agreements complementary to the practice guidelines.

Objectives: To achieve consensus among general practitioners and medical specialists about referral criteria and care transition in areas covered by evidence-based practice guidelines.

Methods: Topics were selected based on mutual need among NHG and relevant national specialist societies to improve care coordination. For each topic, a balanced working group was composed with equal numbers of general practitioners and medical specialists.

Results: In total 12 collaboration agreements were produced, including topics such as asthma in children (1998), subfertility (1998), rheumatoid arthritis (2002), dyspepsia (2003), chronic renal damage (2009), and diabetes mellitus (2012). These were formally endorsed by both NHG and the specialist society involved. A barrier was that the previously produced underlying guideline could not be modified based on recent research findings or changing opinions.

Discussion: Cooperative efforts of all relevant parties led to collaboration agreements based on the best available practice and supported by all relevant professional groups. Integrating development of collaboration agreements and guidelines could overcome problems due to rapid changes in the field.

Implications for guideline developers/users: Organization and coordination of care should be concomitantly addressed in guidelines to improve quality of care on topics that need strong involvement of both primary and secondary care physicians.