Implementing diabetes self-management support in a new organizational context: experiences within Dutch care groups
Keywords:Accountable care organizations, bundled payment, chronic care model, clinical commissioning groups, diabetes, person-centered care, self-management
AbstractRationale, aims and objectives: Self-management support (SMS) is a crucial element in the treatment of diabetes and a key component of person-centered care. Widely introduced disease management programs are assumed to improve SMS. Hence, new organizations, such as care groups and accountable care organizations, are introduced to implement disease management programs successfully. This study aims to explore the status of SMS within Dutch care groups and to identify professionals’ preferences and barriers regarding SMS within this new organizational context.Methods: A sequential explanatory mixed method design was used. SMS is quantitatively assessed with the Assessment of Chronic Illness Care and subsequently used to explore SMS experiences, preferences and barriers during the interviews. Grol’s implementation framework was used to categorize barriers for improvement.Results: The level of SMS differed between and within care groups, but was on average basic to reasonably good. At least about half of the interviewees (range 56-100% per SMS element) preferred to improve SMS. Experienced barriers to improve SMS could be related to the organizational level (mainly time and inadequate IT), the professional and patient (mainly motivation and routines), economical and financial arrangements (uncertainty and ambiguity) and SMS elements itself (mainly limited insight in effectiveness).Conclusions: Care groups have not fully implemented SMS and most interviewees prefer improvement. Experienced barriers to improve SMS support, concerning IT, professionals’ and patients’ motivation and short-term of financial arrangements, still need to be encountered within this new organizational context. This could partly be facilitated by more insight in the question: how could SMS be effective for whom?
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