O'Neill Kate, Riordan Fiona, Racine Emmy, Tracey Marsha, Papoutsi Chrysanthi, Kearney Patricia M, McHugh Sheena M
School of Public Health, University College Cork, Cork, IE.
Eli Lilly and Company, Cork, IE.
Int J Integr Care. 2022 Jul 14;22(3):3. doi: 10.5334/ijic.5815. eCollection 2022 Jul-Sep.
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).
Documentary analysis and qualitative interviews with a purposive sample of national stakeholders (n = 19), were used to develop an initial theory on expected programme delivery. We refined this theory using semi-structured interviews (n = 38) with professionals from different clinical disciplines involved in programme implementation.
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.
Our results highlight the need for adequate preparatory work to raise awareness of and support new roles to implement integrated care, clarification on the core components of new care models, and the development of local service infrastructures to support integrated care.
慢性病综合护理模式的实施情况尚未得到充分理解。我们进行了一项现实主义评价，以确定爱尔兰国家糖尿病计划的实施方式及成效（或未取得成效的原因）。
通过对国家利益相关者的目标样本（n = 19）进行文献分析和定性访谈，来构建关于预期项目实施的初步理论。我们利用对参与项目实施的不同临床学科专业人员进行的半结构化访谈（n = 38）对该理论进行了完善。
促进实施的当地重要背景因素包括提供糖尿病护理的工作人员经验、能力以及对新临床岗位预期目的的熟悉程度。综合护理的采用和实施程度取决于在这些背景下工作的专业人员所做出的判断；具体而言，判断该项目的相对优势以及是否参与谈判以使他们在糖尿病护理中的新角色合法化。
我们的结果凸显了开展充分准备工作的必要性，以提高对实施综合护理新角色的认识并提供支持，明确新护理模式的核心组成部分，以及发展当地服务基础设施以支持综合护理。
