In recent years ‘shared care’ has been a popular topic in the Danish health services,especially in relation to chronic diseases. Shared care aims at creating coherent treatmentof the patient through close collaboration and shared responsibilities across sectorialboundaries. In practice this vision is not always carried out. We have undertaken acomparative analysis of the circumstances for and the results of the implementationprocess of two database registration systems for diabetes patients; examples of ITsupportedshared care.The system in Roskilde was developed using a bottom-up methodology, which impliesthat the development process was initiated on a small budget by the end users. Inopposition to Roskilde, the system on Funen arose from a top-down development withfinancial support from the pharmaceutical industry. The two opposite developmentstrategies have resulted in two functionally and structurally different systems. In spite ofthis the consequence of the implementation process in both counties is the same: thesecondary sector has adopted the system but the primary sector is more scepticaltowards using it.In this master thesis we are exploring the circumstances as to why it is so difficult toimplement IT-supported shared care in the primary health sector. To examine this weprimarily focus on three problem areas:• The two sectors are different in structure and culture, which has a big influenceon their requirements and conditions.• The general practitioners are difficult to represent as a united group andtherefore difficult to involve in the development process. Also the decisionmakers have no managerial power over the practitioners and therefore can’tmake overall decisions for both sectors. A result of this has been that the focus ofthe development process was primarily on the secondary sector.• Maybe the treatment of diabetes is not suitable for IT-supported shared care.Diabetes only accounts for approx. 5 % of the consultations for a generalpractitioner. In our case study the general practitioners did not express any needfor shared care in relation to diabetes treatment. This make the concept of sharedcare in relation to diabetes treatment seem irrelevant to general practitioners.The points mentioned above are some of the primary causes to why the process ofimplementing IT-supported shared care is so difficult.
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