Piloting integrated health networks to improve type 2 diabetes care in Andorra

Primary care nurse-physician teams were introduced to lead new diabetes health networks, with the aim of connecting providers across sectors and strengthening primary care gatekeeping; collaboration with stakeholders in the early design stages of the initiative encouraged multistakeholder buy-in from the outset; updated evidence-based care pathways published in a guidebook helped streamline and standardize care; extensive patient education and coaching on self-management skills enabled patients to engage in their own care; pragmatic intermediary solutions were found to address pressing challenges; for example, implementing paper medical records carried by the patient to counter poor communication between providers in the absence of an electronic information system.

Strengthening diabetes service delivery at the primary care level in Iceland

Following grassroots efforts to increase the role of primary care providers in managing patients with diabetes, formal clinical guidelines to support diabetes care delivery at the primary level were published in 2009. The delivery of diabetes-related care in primary settings is increasing as a result; knowledge gained through experiences working abroad provided inspiration for the initiative and fostered local innovation; informal discussions among providers had sufficient power to initially motivate and direct change; incorporating trainings for providers into the formal education system helped to establish a new standard of care and ensured sustainability of knowledge.

Designing a national diabetes plan for Slovenia

The Ministry of Health convened a working group to develop a national diabetes strategy. After several years of deliberation among working-group members, the finalized National Diabetes Strategy was approved by the government in 2010; an active patient association supported patient engagement and involvement throughout the initiative’s planning and implementation process; meaningful stakeholder engagement across professions and institutions helped develop a common vision for the initiative; building trust between stakeholders took time, but was necessary to allow functional teamwork and effective plan development; oversight from the Ministry of Health fostered important linkages across activities, ensuring that changes to service delivery under the initiative aligned with and complemented other parallel reforms.

Integrated Diabetes Care: A Multidisciplinary Approach

Integrated care is an approach that seeks to improve the quality of care for people with diabetes by ensuring that services are well coordinated around their needs. Healthcare professionals, people with diabetes and the system must be aligned to support improvement both in the delivery of care and in achieving better outcomes for people with diabetes.

Project INTEGRATE: Lessons for Policy, Management and Implementation of Integrated Care in Europe

Project INTEGRATE aims to gain valuable insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term chronic conditions.

This project has already examined four case studies of best practices of integrated care in Europe, in the areas of COPD, Mental Health, Geriatric Conditions and Diabetes, that have had a proven impact in terms of improving patient experiences, generating better care outcomes and providing cost-effectiveness. The key aim of this part of the research was to define what constitutes good quality integrated care provision, and how integrated care systems can most effectively be built. In Phase 2 of the research, the project considered the cross-cutting themes process design, service delivery, skill mix, patient involvement, financial flows, regulatory conditions, and enabling information technologies in order to create connectivity, alignment and collaboration ...

Patient-Centred Care for Patients With Diabetes and HIV at a Public Tertiary Hospital in South Africa: An Ethnographic Study

Healthcare systems across the globe are adopting patient-centred care (PCC) approach to empower patients in taking charge of their illnesses and improve the quality of care. Although models of patient?centredness vary, respecting the needs and preferences of individuals receiving care is important. South Africa has implemented an integrated chronic disease management (ICDM) which has PCC component. The ICDM aims to empower chronic care patients to play an active role in disease management process, whilst simultaneously intervening at a community/ population and health service level. However, chronic care is still fragmented due to systemic challenges that have hindered the practice of PCC. In this article, we explore provider perspectives on PCC for patients with comorbid type 2 diabetes and HIV at a public tertiary hospital in urban South Africa.

Integrating Care for Diabetes and Hypertension with HIV Care in Sub-Saharan Africa: A Scoping Review

 Although HIV continues to have a high prevalence among adults in sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCD) such as diabetes and hypertension is increasing rapidly. There is an urgent need to expand the capacity of healthcare systems in SSA to provide NCD services and scale up existing chronic care management pathways. A scoping review mapped extant policy and evidence based literature on the feasibility of integrating NCD care with HIV in the region.

Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: A qualitative methods study

Abstract

Primary health care: health systems, communities and the planet

The effect of integrated health care in patients with hypertension and diabetes: a systematic review and meta-analysis

A growing number of studies show that integrated health care provides comprehensive and continuous care to patients with hypertension or diabetes. However, there is still no consensus about the effect of integrated health care on patients with hypertension or diabetes. The objective of this study was to verify the effectiveness of integrated health care for patients with hypertension or diabetes by using a systematic review and meta-analysis.

Adoption and Initial Implementation of a National Integrated Care Programme for Diabetes: A Realist Evaluation

The implementation of models of integrated care for chronic conditions is not well understood. We conducted a realist evaluation to determine how and why the implementation of the National Diabetes Programme in Ireland worked (or not). This study showed that, locally important contexts facilitating implementation included staff experience of delivering diabetes care, capacity, and familiarity with the intended purpose of new clinical posts. The extent to which integrated care was adopted and implemented depended on judgements made by professionals working in these contexts; specifically, judging the relative advantage of the programme and whether to engage in negotiations to legitimize their new roles in diabetes care.

“After all, we are all sick”: multi-stakeholder understanding of stigma associated with integrated management of HIV, diabetes and hypertension at selected government clinics in Uganda

Integrated care is increasingly used to manage chronic conditions. In Uganda, the integration of HIV, diabetes and hypertension care has been piloted, to leverage the advantages of well facilitated and established HIV health care provision structures. This qualitative study aimed to explore HIV stigma dynamics whilst investigating multi-stakeholder perceptions and experiences of providing and receiving integrated management of HIV, diabetes and hypertension at selected government clinics in Central Uganda. 

Implementing integrated care clinics for HIV-infection, diabetes and hypertension in Uganda (INTE-AFRICA): process evaluation of a cluster randomised controlled trial

Sub-Saharan Africa is experiencing a dual burden of chronic human immunodeficiency virus and non-communicable diseases. A pragmatic parallel arm cluster randomised trial (INTE-AFRICA) scaled up ‘one-stop’ integrated care clinics for HIV-infection, diabetes and hypertension at selected facilities in Uganda. These clinics operated integrated health education and concurrent management of HIV, hypertension and diabetes. A process evaluation (PE) aimed to explore the experiences, attitudes and practices of a wide variety of stakeholders during implementation and to develop an understanding of the impact of broader structural and contextual factors on the process of service integration.

Developing an integrated model of care for vulnerable populations living with non-communicable diseases in Lebanon: an online theory of change workshop

The Syrian crisis, followed by a financial crisis, port explosion, and COVID-19, have put enormous strain on Lebanon’s health system. Syrian refugees and the vulnerable host population have a high burden of Non-communicable Diseases (NCD) morbidity and unmet mental health, psychosocial and rehabilitation needs. The International Committee of the Red Cross (ICRC) recently introduced integrated NCD services within its package of primary care in Lebanon, which includes NCD primary health care, rehabilitation, and mental health and psychosocial support services. We aimed to identify relevant outcomes for people living with NCDs from refugee and host communities in northern Lebanon, as well as to define the processes needed to achieve them through an integrated model of care. Given the complexity of the health system in which the interventions are delivered, and the limited practical guidance on integration, we considered systems thinking to be the most appropriate methodological approach.