Barriers to, and facilitators in, introducing integrated diabetes care in Ireland: a qualitative study of views in general practice

Abstract

ObjectiveTo examine the barriers to, and facilitators in, improving diabetes management from the general practice perspective, in advance of the implementation of an integrated model of care in Ireland.DesignQualitative using semistructured interviews.SettingPrimary care in the Republic of Ireland.ParticipantsPurposive sample of 29 general practitioners (GPs) and two practice nurses.MethodsData were analysed using a framework approach.ResultsThe main barriers and facilitators occurred at the level of the health system but had a ripple effect at an organisational, professional and patient level. The lack of targeted remuneration for diabetes management in the Irish health system created apathy in general practice and was perceived to be indicative of the lack of value placed on chronic disease management in the health system. There were ‘pockets of interest’ among GPs motivated by ‘vocational’ incentives such as a sense of professional duty; however, this was not sufficient to drive widespread improvement. The hospital service was seen as an essential support for primary care management, although some participants referred to emerging tension between settings. The lack of coordination at the primary–secondary interface resulted in avoidable duplication and an ‘in the meantime’ period of uncertainty around when patients would be called or recalled by specialist services. Facilitators included the availability of nursing support and serendipitous access to services. The lack of resources in the community was considered to be at odds with policy to shift routine management to general practice, which is fast reaching saturation.ConclusionsAt present, intrinsic motivation is driving the improvement of diabetes care in Ireland. This will not be sufficient to implement the proposed reform including a national model of integrated care. Policymakers need to assess and prepare for the disparate levels of interest and infrastructure in primary care in Ireland to support this change.

‘It sounds like a great idea but…’: a qualitative study of GPs’ attitudes towards the development of a national diabetes register

“…The topic guide focused on five key issues: how diabetes care was delivered in the practice; challenges to managing diabetes effectively and efficiently; ‘wish list’ for diabetes care in Ireland; changes in care provision at local and national level; and attitudes to the development of national diabetes register. This paper focuses on the themes which emerged in relation to the last two topics; the results of discussions on the other topics are published elsewhere 8. Prompts included the advantages of a regionally versus nationally coordinated register, desirable content and format including key indicators, necessary conditions for implementation and barriers to change.…”

“…Little is known about engagement in quality improvement within the Irish health system as initiatives are often ‘sporadic and individually driven’ 7. Efforts to improve the quality of diabetes care in particular are frequently confined to pockets of interested individuals 8. Qualitative research allows us to explore attitudes while also identifying the beliefs, perceptions and social norms that shape them 9.…”

A Social-Ecological Approach to Determine Barriers of DMSM Practice For Patients with Type 2 Diabetes Mellitus: A literature review

“…A study confirmed that the main barriers at health care system level including, lack remuneration for diabetes management, lack coordination between setting and deficiency access the services. This lack of remuneration could lead to stunt in practice development and low a sense of apathy among healthcare providers (54) Other issues in the healthcare system level related to the integration between setting and professionals as a resource. This condition leads to a sense of ambiguity around the patients' care pathway and waiting times for the patients in the healthcare services (54).…”

Validation of the care providers version of the Rainbow Model of Integrated Care-Measurement Tool in Chinese primary care systems

“…Only a few research reports assessed integrated care from the perspective of healthcare professionals [14][15][16]. Stephenson et al, performed a rapid review of all quantitative surveys and qualitative research studies to assess healthcare professionals' experiences with integrated care [14].…”