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Table 3 Overview of barriers and facilitators to the implementation of integrated care per IM level

From: Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups: a case study

IM level Barriers Facilitators
Innovation • Disease-specific care management • Performance monitoring via the care chain information system
• Insufficient integration between the various patient databases
Individual professional • Decreased earnings • Increased earnings
• Too many innovations • GP support
• Resistance by GPs  
Patient • Patients’ insufficient medical and policy-making expertise • Increased focus on self-management
Social context • Resistance by GP assistants due to perceived competition • Innovators in primary and secondary care
  • Tradition of transmural cooperation
Organisational context • Lack of qualified PNs • Care group management and support
• Too much care provided by PNs • PNs and DNSs acting as integrators
Economic and political context • The negative role of some health insurers • Financial incentives for care innovations
• Yearly changes in insurance policies • Health insurer cooperation
• The funding system incentivising the provision of care exactly as described in the care protocols • Financial pressure in the health sector
  • Financial incentives for guideline adherence