Skip to main content
Have a personal or library account? Click to login
Integration Strategies in the Implementation of a Cardiology Chronic Care Clinic in a Primary Care Setting: A Qualitative Study Cover

Integration Strategies in the Implementation of a Cardiology Chronic Care Clinic in a Primary Care Setting: A Qualitative Study

Open Access
|Sep 2026

References

  1. Pega F, Náfrádi B, Momen NC, et al. Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000–2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environ Int. 2021;154:106595. DOI: 10.1016/j.envint.2021.106595
  2. RB S, Xiaoyin Y, Philimon G, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet Lond Engl. 2015;386. https://pubmed-ncbi-nlm-nih-gov.libproxy1.nus.edu.sg/25960110/ (accessed 19 October 2023).
  3. Powell-Cope GM, Luther S, Neugaard B, et al. Provider-perceived barriers and facilitators for ischaemic heart disease (IHD) guideline adherence. J Eval Clin Pract. 2004;10:227239. DOI: 10.1111/j.1365-2753.2003.00450.x
  4. Deshmukh A, Iglesias M, Khanna R, et al. Healthcare utilization and costs associated with a diagnosis of incident atrial fibrillation. Heart Rhythm O2. 2022;3:577586. DOI: 10.1016/j.hroo.2022.07.010
  5. Gerhard, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC – PubMed. Eur Heart J. 2021;42:373498. DOI: 10.1093/eurheartj/ehaa612
  6. Singer SJ, Kerrissey M, Friedberg M, et al. A comprehensive theory of integration. Med Care Res Rev MCRR. 2020;77:196207. DOI: 10.1177/1077558718767000
  7. Barceló A, Epping-Jordan J, Orduñez P, et al. Innovative care for chronic conditions: Organizing and delivering high quality care for chronic noncommunicable diseases in the Americas. PAHO/WHO | Pan American Health Organization; 2013. https://www.paho.org/en/documents/innovative-care-chronic-conditions-organizing-and-delivering-high-quality-care-chronic (accessed 19 October 2023).
  8. Rush KL, Burton L, Schaab K, et al. The impact of nurse-led atrial fibrillation clinics on patient and healthcare outcomes: a systematic mixed studies review. Eur J Cardiovasc Nurs. 2019;18:526533. DOI: 10.1177/1474515119845198
  9. Matchar DB. Do anticoagulation management services improve care? Implications of the Managing Anticoagulation Services Trial. Card Electrophysiol Rev. 2003;7:379381. DOI: 10.1023/B:CEPR.0000023144.60821.d1
  10. Bazemore A, Petterson S, Peterson LE, et al. Higher primary care physician continuity is associated with lower costs and hospitalizations. Ann Fam Med. 2018;16:492497. DOI: 10.1370/afm.2308
  11. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83:457502. DOI: 10.1111/j.1468-0009.2005.00409.x
  12. Foo CD, Surendran S, Tam CH, et al. Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore: a qualitative study. BMJ Open. 2021;11:e046010. DOI: 10.1136/bmjopen-2020-046010
  13. Surendran S, Foo CD, Tam CH, et al. The missed opportunity of patient-centered medical homes to thrive in an Asian context. Int J Environ Res Public Health. 2021;18:1817. DOI: 10.3390/ijerph18041817
  14. Woo BFY, Tam WWS, Rangpa T, et al. A nurse-led integrated chronic care e-enhanced atrial fibrillation (NICE-AF) clinic in the community: A preliminary evaluation. Int J Environ Res Public Health. 2022;19:4467. DOI: 10.3390/ijerph19084467
  15. Hu PL, Tan CY-L, Nguyen NHL, et al. Integrated care teams in primary care improve clinical outcomes and care processes in patients with non-communicable diseases. Singapore Med J. 2023;64:423429. DOI: 10.11622/smedj.2022067
  16. Tan KB, Earn Lee C. Integration of primary care with hospital services for sustainable universal health coverage in Singapore. Health Syst Reform. 2019;5:1823. DOI: 10.1080/23288604.2018.1543830
  17. Jafar TH, Tan NC, Shirore RM, et al. Integration of a multicomponent intervention for hypertension into primary healthcare services in Singapore-A cluster randomized controlled trial. PLoS Med. 2022;19:e1004026. DOI: 10.1371/journal.pmed.1004026
  18. MOH | Primary Healthcare Services, https://www.moh.gov.sg/home/our-healthcare-system/healthcare-services-and-facilities/primary-healthcare-services (accessed 1 December 2023).
  19. Bhat A, Khanna S, Chen HHL, et al. Integrated care in atrial fibrillation: A road map to the future. Circ Cardiovasc Qual Outcomes. 2021;14:e007411. DOI: 10.1161/CIRCOUTCOMES.120.007411
  20. Surendran S, Foo CD, Matchar DB, et al. Developing integration among stakeholders in the primary care networks of Singapore: a qualitative study. BMC Health Serv Res. 2022;22:782. DOI: 10.1186/s12913-022-08165-1
  21. Woo BFY, Zhou W, Lim TW, et al. Practice patterns and role perception of advanced practice nurses: A nationwide cross-sectional study. J Nurs Manag. 2019;27:9921004. DOI: 10.1111/jonm.12759
  22. Poulsen RM, Pii KH, Bültmann U, et al. Developing Normative Integration among Professionals in an Intersectoral Collaboration: A Multi-Method Investigation of an Integrated Intervention for People on Sick Leave Due to Common Mental Disorders. Int J Integr Care. 2019;19:4. DOI: 10.5334/ijic.4694
  23. Goodwin N. Taking integrated care forward: the need for shared values. Int J Integr Care. 2013;13:e026. DOI: 10.5334/ijic.1180
  24. Valentijn PP, Schepman SM, Opheij W, et al. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care. 2013;13:e010. DOI: 10.5334/ijic.886
  25. NVivo. Lumivero. https://lumivero.com/products/nvivo/ (accessed 19 October 2023).
  26. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77101. DOI: 10.1191/1478088706qp063oa
  27. Guest G, Bunce A, Johnson L. How many interviews are enough?: An experiment with data saturation and variability. Field Methods. 2006;18:5982. DOI: 10.1177/1525822X05279903
  28. Lincoln YS, Cuba EG. Naturalistic inquiry. 1st edn. California: SAGE Publications Inc; 1985. https://us.sagepub.com/en-us/nam/naturalistic-inquiry/book842 (accessed 19 October 2023).
  29. Goldblatt H, Karnieli-Miller O, Neumann M. Sharing qualitative research findings with participants: study experiences of methodological and ethical dilemmas. Patient Educ Couns. 2011;82:389395. DOI: 10.1016/j.pec.2010.12.016
  30. Naccarella L, Raggatt M, Redley B. The influence of spatial design on team communication in hospital emergency departments. HERD. 2019;12:100115. DOI: 10.1177/1937586718800481
  31. Hua Y, Becker F, Wurmser T, et al. Effects of nursing unit spatial layout on nursing team communication patterns, quality of care, and patient safety. HERD. 2012;6:838. DOI: 10.1177/193758671200600102
  32. Foo CD, Yan JY, Chan ASL, et al. Identifying key themes of care coordination for patients with chronic conditions in Singapore: A scoping review. Healthcare. 2023;11:1546. DOI: 10.3390/healthcare11111546
  33. Maier CB, Aiken LH. Task shifting from physicians to nurses in primary care in 39 countries: a cross-country comparative study. Eur J Public Health. 2016;26:927934. DOI: 10.1093/eurpub/ckw098
  34. Vaseghi F, Yarmohammadian MH, Raeisi A. Interprofessional collaboration competencies in the health system: A systematic review. Iran J Nurs Midwifery Res. 2022;27:496504. DOI: 10.4103/ijnmr.ijnmr_476_21
  35. Kluge E-HW. Resource allocation in healthcare: Implications of models of medicine as a Profession. Medscape Gen Med. 2007;9:57.
  36. Falces C, Andrea R, Heras M, et al. Integration between cardiology and primary care: impact on clinical practice. Rev Esp Cardiol. 2011;64:564571. DOI: 10.1016/j.recesp.2011.02.021
  37. Freixa-Pamias R, Gràcia PB, Rodríguez Latre ML, et al. Impact of an integral assistance model between primary care and cardiology on the management of patients with ischemic heart disease or atrial fibrillation. J Comp Eff Res. 2019;8:103111. DOI: 10.2217/cer-2018-0088
  38. Vester MPM, de Grooth GJ, Bonten TN, et al. Implementation of an integrated care model between general practitioner and cardiologist: The support consultation cardiology. J Integr Care. 2019;27:305315. DOI: 10.1108/JICA-04-2019-0012
  39. Comín-Colet J, Verdú-Rotellar JM, Vela E, et al. Efficacy of an integrated hospital-primary care program for heart failure: a population-based analysis of 56,742 patients. Rev Esp Cardiol. 2014;67:283293. DOI: 10.1016/j.recesp.2013.12.007
  40. Alaujan BS, Zamzami BA, Ababtain HA, et al. Integrating Preventive Cardiology in Primary Care: the Role of Nurses, Pharmacists, Health Records, and Emergency Services. Int J Health Sci. 2021;5:10491066. DOI: 10.53730/ijhs.v5nS1.15060
  41. Machado AM, Leite F, Pereira MG. Integrated Care in Atrial Fibrillation: A Multidisciplinary Approach to Improve Clinical Outcomes and Quality of Life. Healthcare. 2025;13:325. DOI: 10.3390/healthcare13030325
  42. Bowen G. Document analysis as a qualitative research method. Qual Res J. 2009;9:2740. DOI: 10.3316/QRJ0902027
DOI: https://doi.org/10.5334/ijic.10197 | Journal eISSN: 1568-4156
Language: English
Page range: 13 - 13
Submitted on: Sep 15, 2025
Accepted on: Aug 25, 2026
Published on: Sep 3, 2026
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services

© 2026 Shilpa Surendran, Rakhi Vashishtha, Brigitte Fong Yeong Woo, Ash Yusi Zhang, David Bruce Matchar, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.