20.500.12556/DKUM-91103 Scaling-up an integrated care for patients with non-communicable diseases an analysis of healthcare barriers and facilitators in Slovenia and Belgium Nadgradnja celostne oskrbe pacientov s kroničnimi nenalezljivimi boleznimi analiza spodbujevalcev in ovir v Sloveniji in Belgiji Introduction: Although the concept of integrated care for non-communicable diseases was introduced at the primary level to move from disease-centered to patient-centered care, it has only been partially implemented in European countries. The aim of this study was to identify and compare identified facilitators and barriers to scale-up this concept between Slovenia and Belgium. Methods: This was a qualitative study. Fifteen focus groups and fifty-one semi-structured interviews were conducted with stakeholders at the micro, meso and macro levels. In addition, data from two previously published studies were used for the analysis. Data collection and analysis was initially conducted at country level. Finally, the data was evaluated by a cross-country team to assess similarities and differences between countries. Results: Four topics were identified in the study: patient-centered care, teamwork, coordination of care and task delegation. Despite the different contexts, true teamwork and patient-centered care are limited in both countries by hierarchies and a very heavily skewed medical approach. The organization of primary healthcare in Slovenia probably facilitates the coordination of care, which is not the case in Belgium. The financing and organization of primary practices in Belgium was identified as a barrier to the implementation of task delegation between health professionals. Conclusions: This study allowed formulating some important concepts for future healthcare for non-communicable diseases at the level of primary healthcare. The results could provide useful insights for other countries with similar health systems. Uvod: Celostna oskrba kroničnih nenalezljivih bolezni je koncept, ki v bolezen usmerjeno oskrbo nadomešča z oskrbo, usmerjeno na pacienta. Kljub obstoju učinkovitega modela takšne obravnave pa je bil slednji v evropskih državah doslej uveden le delno. Namen te študije je prepoznati in primerjati spodbujevalce in ovire za nadgradnjo celostne oskrbe v Sloveniji in Belgiji. Metode: V sklopu te kvalitativne študije je bilo izvedenih 15 fokusnih skupin in 51 intervjujev z odločevalci na mikro-, mezo- in makroravni. Poleg tega so bili v analizo vključeni tudi podatki iz dveh predhodno objavljenih študij. Zbiranje podatkov in analiza sta bila sprva izvedena v vsaki državi ločeno, nato pa je mednarodna ekipa raziskovalcev primerjala podatke ter opredelila razlike in podobnosti med državama. Rezultati: V raziskavi so bile izpostavljene štiri teme: na pacienta usmerjena oskrba, timsko delo, koordinacija oskrbe ter prenos zadolžitev med zdravstvenimi delavci. Odločevalci obeh držav so izpostavili, da vzpostavljena močna hierarhija in strog medicinski pristop k obravnavi pacientov s kronično boleznijo predstavlja bistveno oviro za uresničitev resničnega timskega dela in na pacienta usmerjene oskrbe. V nasprotju z Belgijo organizacija primarnega zdravstvenega varstva v Sloveniji najverjetneje spodbuja koordinacijo oskrbe. V Belgiji pa sta bila kot bistvena ovira za prenos zadolžitev med zdravstvenimi delavci izpostavljena način financiranja in organizacija primarnih ambulant. Zaključki: Ta študija predstavlja nekaj za prihodnost pomembnih načel obravnave kroničnih nenalezljivih bolezni na primarni zdravstveni ravni. Rezultati lahko predstavljajo uporabna spoznanja za druge države s podobnim zdravstvenim sistemom. scale-up noncommunicable diseases patientcentered care primary healthcare integrated healthcare nadgradnja kronične nenalezljive bolezni na pacienta usmerjena oskrba primarno zdravstveno varstvo celostna oskrba true false true Zavod LRS za zdravstveno varstvo, Republiški zdravstveni center, Univerzitetni zavod za zdravstveno in socialno varstvo, Inštitut za varovanje zdravja Republike Slovenije, Nacionalni inštitut za javno zdravje Angleški jezik Slovenski jezik Znanstveno delo 2024-10-22 12:44:35 2024-10-22 12:58:15 2024-10-23 03:29:56 0000-00-00 00:00:00 2021 0 0 Str. 158-166 št. 3 Letn. 60 2021 0000-00-00 Zaloznikova Objavljeno NiDoloceno 2020-12-23 2021-05-28 2021-06-28 614 71483907 10.2478/sjph-2021-0023 0351-0026 Zavrnik-2021-SCALING-UP_AN_INTEGRATED_CARE_FOR.pdf Zavrnik-2021-SCALING-UP_AN_INTEGRATED_CARE_FOR.pdf 1 DFB73F864B74286161F71298010356E6 dfa559a0300279ffc41bb79ce50be2cb700a688ac475ac9d061ce9cfb17d6b92 686c2c62-9064-11ef-9244-00155d000105 https://dk.um.si/Dokument.php?lang=slv&id=186750 https://doi.org/10.2478/sjph-2021-0023 0 a3383172-9062-11ef-9244-00155d000105 https://dk.um.si/Dokument.php?lang=slv&id=186747 Medicinska fakulteta 0 0 0