Zavrnik Črt, Danhieux Katrien, Monarres Miriam Hurtado, Stojnić Nataša, Lukančič Majda Mori, Martens Monika, Klemenc-Ketiš Zalika, Wouters Edwin, van Olmen Josefien, Poplas-Susič Antonija
Community Health Centre Ljubljana, Primary Healthcare Research and Development Institute, Metelkova 9, 1000 Ljubljana, Slovenia.
Institute of Tropical Medicine Antwerp, Antwerp Belgium.
Zdr Varst. 2021 Jun 28;60(3):158-166. doi: 10.2478/sjph-2021-0023. eCollection 2021 Sep.
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.
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.
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.
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.
尽管非传染性疾病综合照护的概念已在初级层面提出，旨在从以疾病为中心的照护转向以患者为中心的照护，但在欧洲国家仅得到部分实施。本研究的目的是识别并比较斯洛文尼亚和比利时在扩大这一概念方面已确定的促进因素和障碍。
这是一项定性研究。对微观、中观和宏观层面的利益相关者进行了15个焦点小组讨论和51次半结构化访谈。此外，两项先前发表的研究数据也用于分析。数据收集和分析最初在国家层面进行。最后，由一个跨国团队对数据进行评估，以评估各国之间的异同。
研究确定了四个主题：以患者为中心的照护、团队合作、照护协调和任务委托。尽管背景不同，但在这两个国家，真正的团队合作和以患者为中心的照护都受到层级制度和严重偏向医学的方法的限制。斯洛文尼亚的初级医疗保健组织可能有助于照护协调，而比利时则不然。比利时初级医疗实践的融资和组织被确定为卫生专业人员之间实施任务委托的障碍。
本研究为初级医疗保健层面未来的非传染性疾病医疗保健提出了一些重要概念。研究结果可为其他具有类似卫生系统的国家提供有用的见解。
