Group consultations for socioeconomically vulnerable cardiometabolic risk groups: from implementation to integration into standard practice

Background: Integrated care initiatives for socioeconomically vulnerable cardiometabolic risk groups can deliver pro-active care, improve health outcomes, and foster greater equity within the healthcare system. However, implementation of these initiatives into standard care is often not achieved. Therefore, insights into implementation determinants are needed to identify opportunities for implementation support. Building on previous results, one of the focus points of this research are stakeholder perspectives on how to pay for group consultations.

 

Approach: We conducted a case study on cross-domain group consultations for citizens with cardiometabolic risk factors. To identify implementation determinants, we used a qualitative design guided by the Consolidated Framework for Implementation Research (CFIR) and the Rainbow Model of Integrated Care. Semi-structured interviews and a focus group were conducted with professionals, policy makers, and people with lived experience. We used Framework analysis to identify implementation determinants and matched implementation strategies to a selection of barriers using CFIR’s Expert Recommendations of Implementation Research matching tool.

 

Because fragmentation of funding has previously been identified as a main cause of discontinuation of cross-domain initiatives, we conducted a follow-up study aiming to identify viable strategies to mitigate this barrier. We therefore employed Q-methodology to systematically identify different perspectives on how to pay for group consultations, to identify widely supported solutions. During October and November 2025, data is being collected, including at least 25 participants.

 

The primary care provider who initiated the group consultations, together with other participating professionals, contributed to data collection, interpretation, and the dissemination of findings to a broader group of stakeholders and the lay audience.

 

Results: We conducted 28 interviews and one focus group (n=16) to identify implementation determinants. Key facilitators were 1) the widespread enthusiasm for the concept of group consultations, 2) a sense of urgency for change, and 3) the adaptability of the initiative to the local context. Key barriers included 1) insufficient involvement of citizens in the design of the group consultations, which can be overcome by involving experts by experience. 2) A lack of embedding in the current healthcare and social support systems, which can be mitigated by obtaining formal commitments. 3) Inadequate evaluation, which could be improved by capturing and sharing local knowledge and developing and organising a quality monitoring system, and 4) fragmentation of funding.

 

Preliminary findings of perspectives on how to pay for group consultations indicate consensus among stakeholders on the importance of trust between providers and payers, structural financing, and cofinancing from the medical and social domains.

 

Implications: Community involvement in designing an integrated care initiative is a key determinant of implementation when targeting socioeconomically vulnerable groups. Despite broad support for embedding integrated care into standard practice, its implementation is hindered by organisational and system-level barriers related to fragmentation of healthcare and social support. [Based on preliminary findings] The development of a payment structure built on trust and securing sustainable funding from both the medical and social domain seem to stimulate implementation of cross-sector initiatives.