Abstract
Introduction: Diabetes and hypertension are two of the four most common non-communicable diseases that cause death, especially in the elderly. The key to reducing premature mortality and morbidity leis in early detection and timely treatment of diseases in primary health care. Integration of many aspects of medical care is important to achieve good health outcomes. Our study includes an analysis of the different aspects of integrated care in Slovenia and the opinion of health care users and providers on the mentioned diseases.
Methods: Data collection took place in 15 focus groups, 8 with health care teams and 7 with patients. A total of 48 health care professionals and 42 patients were involved. The main topics discussed were opinions about the current implementation of integrated care for people with diabetes and hypertension, with a particular focus on the barriers and facilitators to scaling up. Texts were transcribed verbatim and analysed using NVivo software. A coding tree with 12 main themes and 52 first-level subthemes was used.
Results: The results show that the current system of integrated care provides good accessibility and defined diagnostic screening with integrated preventive examinations. Collaboration within the team is good, with the involvement of registered and community nurses being a particular advantage. Participants felt that patients do not take their illness seriously. Patients pointed out that access to medication and equipment, some of which they have to pay for themselves, is a barrier. They would like to see more self-management, education about type 2 diabetes and a healthy lifestyle, and more awareness through various media. They point to the overload of medical staff and too much administrative work, leaving less time for quality patient care. Participants see opportunities in networking with the local community and also see good added value in peer support, as they benefit from their own experiences.
Conclusions: Both the healthcare team and patients identified accessibility, screening, electronic referrals and prescriptions as facilitators, while overburden and impersonal attitudes, work organisation, unavailability and cost of medicines and equipment, lack of information and patient empowerment were highlighted as barriers.
Implications for applicability/transferability and sustainability: According to our findings, we can improve integrated care and adapt it to the needs of patients. The results of the situation analysis have led us to launch two pilot projects in which patients are empowered to take more responsibility for their own health while we provide them with professional support.