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