| Main theme | Barriers (b) and facilitators (f) | Policy adjustments in Blue Care | Preconditions |
|---|
| I Arrangements |
Signed covenant Blue Care-shows mutual trust between all stakeholders (f) Potential lack of long-term commitment (b) Willingness of stakeholders to redesign structure of health care in region (f)
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Creation of a business model Arrangement of a special tariff for Primary Care Plus Organisation of legal agreements with Dutch Care Authority
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– Put effort in mutual trust between stakeholders – Designate an integrator – Pursue a common goal (substitution) – Arrange legal agreements
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| II IT-systems |
Referral organisation TIPP was not able to make appointments in hospital information system (b) Appointment application of referral organisation TIPP was not available in general practitioner practices (b) Hospital and general practitioner information systems were not linked with each other (b)
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Possibility for referral organisation to make appointments directly in the agenda system of the medical specialties +3. Creation of a Primary Care Plus application in which all stakeholders (general practitioners, medical specialists, TIPP) have access
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| III Participation and involvement of all care providers | Assistants of general practitioners were not informed about Primary Care Plus and did not know how to support medical specialists working in their practice (b) |
Organisation of information sessions for all care providers Development of an internet forum, where all information about the project is available
| – Make sure all stakeholders are informed about the ins and outs of the intervention and their responsibilities, e.g. through information sessions |
| IV Profile of medical specialist |
General practitioners only accepted advice from medical specialists who had considerable experience in their working field (b/f) Medical specialists had different coping styles with Primary Care Plus and the paradigm shift in health care (b/f)
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+ 2. Determination of a profile for the medical specialist in Primary Care Plus: Senior Generalist Medical specialist should share the conviction of the necessity of substitution
| – Qualifications for an appropriate profile of an eligible medical specialist who will be working in Primary Care Plus |
| V Referral pattern |
The adherence area of this feasibility study was too small resulting in too few referrals for efficient consultation time in Primary Care Plus (b) General practitioners from referral practices feared referring their patients to intervention practices (b) General practitioners from intervention practices experienced a relatively low threshold when referring to Primary Care Plus (b/f) General practitioners experienced difficulties in whether or not to refer a patient to the hospital or Primary Care Plus (b)
| 1. +2. +3. Opening independent Primary Care Plus centre(s)
4. Various proposed solutions:
Medical specialists giving feedback to general practitioners about the referrals Discussion in multidisciplinary teams about the referrals Referral according to the default principlea Referral according to the International Classification of Primary Care coding system
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– Make sure that consultation time will be efficiently planned (e.g. by centralising Primary Care Plus) – Make sure that general practitioners are able to deliberate with medical specialists about referral uncertainties
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| VI Communication between general practitioner and medical specialist |
Advice letter from medical specialist arrived too late at general practitioners office (b) ‘Out of sight, out of mind’ – fewer referrals from referral practices compared to intervention practices (b) Deliberation was experienced as very valuable and crucial to continue Primary Care Plus (f)
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Track and trace system/application +3. Various opportunities to deliberate: E-mail, telephone, walk-in consultation hours for general practitioners (and their patients), video conference and joint consultations
| – Arrange various possibilities for general practitioners to deliberate with medical specialists |
| VII Arrangements regarding diagnostic procedures |
Uncertainty about the responsibility for requesting diagnostics (b) Different diagnostic facilities for specialists available in general practitioner practices (b) Not enough diagnostic tools available in Primary Care Plus depending on the medical specialty (b) No access to diagnostic results if diagnostic tests were being performed in organisations other than the academic hospital (b)
| 2. Opening Primary Care Plus centres where diagnostic tools are available |
– Create a diagnostics protocol, in which responsibilities are defined – The cooperating laboratory/organisation where diagnostics are performed should be defined – Consider which medical specialties are eligible for Primary Care Plus – To avoid double diagnostic requests, medical specialists should have access to previous diagnostic results, also from organisations other than the hospital
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