Social organization of self-management support of persons with diabetes: A health systems comparison

摘要

Objective. Identify important organizational elements for providing self-management support (SMS). Design. Semi-structured qualitative interviews conducted in two healthcare systems. Setting. Kaiser Permanente Northern California and the Danish Health Care System. Subjects. 36 managers and healthcare professionals in the two healthcare systems. Main outcome measures. Elements important to providing self-management support to persons with diabetes. Results. Healthcare professionals' provision of SMS was influenced by healthcare system organization and their perceptions of SMS, the capability and responsibility of healthcare systems, and their roles in the healthcare organization. Enabling factors for providing SMS included: strong leadership; aligned incentives; use of an integrated health information technology (HIT) system; multidisciplinary healthcare provider teams; ongoing training for healthcare professionals; outreach; and quality goals. Barriers to providing SMS included lack of collaboration between providers and skeptical attitudes towards prevention and outreach. Conclusions and implications. Implementation of SMS can be improved by an understanding of the elements that enhance its provision: (1) initiatives seeking to improve collaboration and integration between providers; (2) implementation of an integrated HIT system; and (3) ongoing training of healthcare professionals.