Authors:

Abstract

Introduction:  Despite the subsequent tendency to focus on patient-centered integrated care of type 2 diabetes at the primary level in Slovenia, many patients with this disease are still treated sub optimally. There is an urgent need to gain a comprehensive overview of the current management strategy of this disease in order to improve it for the future – the implementation of integrated care, the costs and the perspective of the stakeholders of what to scale-up.

Methods: Three sub studies were conducted. (1) The Integrated Care Package (ICP) Grid questionnaire assessed the current implementation of integrated care (identification, treatment, health education, self-management support, structured collaboration and care organization). (2) The qualitative study of 15 focus groups and 23 semi-structured interviews with stakeholders at the micro (patients and health providers), meso (organisations) and macro (national) levels identified facilitators and barriers to scaling integrated care. (3) Type 2 diabetes costs (direct from medical records and out-of-pocket from the survey) and health-related quality of life (ADS survey) were evaluated in a sample of 132 patients.

Results:  Implementation of integrated care using ICP Grid showed that the elements of self-management and structured collaboration were weakly implemented. Stakeholders identified the organization of primary health care as a facilitator; on the other hand, true teamwork and patient-centered care were constrained by hierarchy and a very heavily skewed medical approach. The average total per capita cost of type 2 diabetes management was €601.80 per year, of which 17.4% was out-of-pocket costs. The health-related quality of life assessment using ADS survey was averagely scored 2.03 on a scale from 1 to 5 (lower number is better quality of life).

Conclusions: This study allows the formulation of a new roadmap for future (self-)management of type 2 diabetes at primary level in Slovenia. The implementation of some new interventions such as patient empowerment and their self-treatment, peer support and the use of mHealth represent a possible solution to the above challenges.

Implications For Applicability/Transferability, Sustainability, And Limitations: The research presented on various aspects of the management of type 2 diabetes provides a useful tool for the holistic assessment of this disease. Due to its universal design, it is easily transferable to other chronic diseases as well as to other countries with different context and can therefore facilitate cross-country studies.