Influences on Physicians' Participation in Coordinated Ambulatory Cardiology Care: A Mixed-Methods Study

Introduction: In 2009 a managed care programme for coordinated ambulatory cardiology care was established in Southern Germany. Designed as a voluntary contract between health insurers and ambulatory medical specialists, it aims for a guideline-oriented, efficient health care by general practitioners and medical specialists. In this study, we aimed to identify factors associated with physicians' participation and their relation to the aims of the programme. Methods: A mixed-methods study was designed. We conducted semi-structured interviews with a sample of 21 specialists participating and 11 specialists not participating in the programme. Structured questionnaires were sent to all eligible medical specialists, of whom 75 specialists participating and 21 specialists not participating in the programme responded. Both the interview and questionnaire covered a range of questions on the participation and implementation of the program. Results: Financial benefits were the most frequently named reason to participate. Other prevalent motives were the prospect of an alternative to regular health care, expected diagnostic possibilities and recommendations from peers. Reasons for not participating were mainly structural, such as technical modifications as well as economic investments and fear for one's professional autonomy. Conclusion: Physicians' participation in the programme was mainly financially driven and largely unrelated to its care-related aims. Still, it is unclear if these divergences between motivation to participate and aims of a managed care programme affect its eventual impact, hence further research is required.