Hussein Mohsen, Kregar Velikonja Nevenka, Erjavec Karmen
University of Novo mesto, SI.
Artros, Ljubljana, SI.
Int J Integr Care. 2023 Apr 6;23(2):4. doi: 10.5334/ijic.6995. eCollection 2023 Apr-Jun.
Integrated clinical pathways should provide the best and most efficient treatment. As no study on barriers to inter-organisational collaboration has investigated the barriers to unimplemented integrated clinical care in a country with less efficiently organised health system, the study aimed to identify these barriers in the preoperative management of patients with hip or knee osteoarthritis in Slovenia.
A cross-sectional study was conducted using multiple methods, including a quantitative survey with participants involved in target patient groups, and in-depth interviews with involved key actors at micro, meso and macro levels in Slovenia.
Respondents predominantly expressed a lack of inter-organisational collaboration. The exposed barriers are individualistic culture, the level of development of the health system, financing, administration, and regulatory frame at the macro level, shortage of staff at the meso level, and the lack of technological standards, trust, communication, and perception of pressures at the micro level.
In addition to the barriers identified in previous studies, our study shows that individualistic culture and the level of development of the health system at the macro level, manifested as a pressure on health professionals and other actors at the micro level, are important barriers to inter-organisational collaboration.
综合临床路径应提供最佳且最有效的治疗。由于尚无关于组织间协作障碍的研究调查过在卫生系统组织效率较低的国家中未实施的综合临床护理的障碍，本研究旨在确定斯洛文尼亚髋或膝骨关节炎患者术前管理中的这些障碍。
采用多种方法进行横断面研究，包括对目标患者群体的参与者进行定量调查，以及对斯洛文尼亚微观、中观和宏观层面的相关关键行为者进行深入访谈。
受访者主要表示缺乏组织间协作。所揭示的障碍包括个人主义文化、卫生系统的发展水平、宏观层面的融资、管理和监管框架、中观层面的人员短缺，以及微观层面缺乏技术标准、信任、沟通和对压力的认知。
除了先前研究中确定的障碍外，我们的研究表明，个人主义文化和宏观层面卫生系统的发展水平，表现为对微观层面卫生专业人员和其他行为者的压力，是组织间协作的重要障碍。
