Implementation Barriers and Facilitators of an Integrated Care Initiative Targeting Socioeconomically Vulnerable Groups

Introduction: The incorporation of integrated care initiatives for socioeconomically vulnerable groups into standard care is rare. Insight into implementation barriers and facilitators to select strategies for further implementation and upscaling are therefore needed.

Description: This study evaluated the implementation of an integrated care initiative adopting interprofessional collaborative practice of patient-centred care for citizens with prediabetes in the form of group consultations.

Results: Key barriers included insufficient involvement of citizens in the design of the group consultations, which could be overcome by involving patients/consumers and family members in the design of the group consultations. Additionally, we identified a lack of embedding in the current healthcare and social support systems and fragmented financing systems as barriers. By developing a formal implementation blueprint, obtaining formal commitments, using other payment schemes, and developing resource sharing agreements, these barriers could be addressed. Finally, inadequate evaluation was identified as a barrier. This could be improved by capturing and sharing local knowledge and developing and organising a quality monitoring system. Key facilitators were the widespread enthusiasm for the concept of group consultations, a sense of urgency for change, and the adaptability of the initiative to the local context.

Conclusion: Meaningful citizen involvement in the design of an integrated care initiative, such as group consultations, is a key determinant of implementation when targeting socioeconomically vulnerable groups. Although there is broad support for interprofessional collaborative practice, the organisational and governance structures required for their sustainable implementation remain underdeveloped.