Towards Integrated Care for the Elderly: Exploring the Acceptability of Telemonitoring for Hypertension and Type 2 Diabetes Management.

Introduction: Telemonitoring has been proposed as an effective method to support integrated care for older people with hypertension and type 2 diabetes. This paper examines acceptability of telemontioring, its role in supporting integrated care, and identifies scale-up barriers. Methods: A concurrent triangulation mixed-methods study, including in-depth interviews (n = 29) and quantitative acceptability tool (n = 55) was conducted among individuals who underwent a 12-month telemonitoring routine. The research was guided by the Theoretical Framework of Acceptability. Interviews were analysed using template content analysis (TCA). Results: TCA identified seven domains of acceptability, with twenty-one subthemes influencing it positively or negatively. In the quantitative survey, acceptability was high across all seven domains with an overall score of 4.4 out of 5. Urban regions showed higher acceptability than rural regions (4.5 vs. 4.3), with rural participants perceiving initial training and participation effort as significantly more burdensome than their urban counterparts. Discussion: Patients described several instances where telemonitoring supported self-management, education, treatment, and identification elements of the integrated care package. However, there were barriers that may limit its further scale-up. Conclusion: For further scale-up, it is important to screen patients for monitoring eligibility, adapt telemonitoring devices to elderly needs, combine telemonitoring with health education, involve family members, and establish follow-up programmes.

Assessing the reliability and validity of the Slovenian version of the Appraisal of Diabetes Scale (ADS-S) in type 2 diabetes patients.

Managing type 2 diabetes (T2D) effectively is a considerable challenge. The Appraisal of Diabetes Scale (ADS) has proven valuable in understanding how individuals perceive and cope with their condition. This study aimed to evaluate the psychometric properties of the Slovenian version of ADS (ADS-S). We recruited a sample of 400 adult individuals with T2D from three primary healthcare centers in Slovenia, ensuring an average of 57 cases per individual item. The psychometric evaluation included internal consistency, test-retest reliability, construct validity, and discriminant validity. Confirmatory factor analysis (CFA) was additionally performed to evaluate the fit of one- and two-factor models. After excluding incomplete questionnaires, 389 individuals participated, averaging 72.0±7.5 years, with 196 men and 193 women. ADS-S exhibited acceptable internal consistency (Cronbach's α = 0.70) and strong test-retest reliability (interclass correlation = 0.88, p <0.001). Criterion validity was established through significant correlations between ADS-S score and EQ-5D utility score (r = -0.34, p <0.001), EQ-VAS score (r = -0.38, p <0.001), and HbA1c >7.5% (r = 0.22, p = 0.019). Discriminant validity assessment found no significant correlation between ADS-S score and age, but a significant correlation with female gender (r = 0.17, p = 0.001). CFA results supported a two-factor structure (psychological impact of diabetes and sense of self-control) over a one-factor structure, as indicated by model fit indicators. ADS-S stands as a valid and reliable tool for assessing psychological impact and self-control in Slovenian T2D patients. Future research should explore adding items for capturing secondary appraisal of diabetes and studying the influence of female gender on ADS scores.

Development of a Qualitative Data Analysis Codebook for Arterial Hypertension and Type-2-Diabetes Integrated Care Evaluation.

Introduction: Non-communicable diseases, such as arterial hypertension (HTN) and type-2 diabetes (T2D), pose a global public health problem. Integrated care with focus on person-centred principles aims to enhance healthcare quality and access. Previous qualitative research has identified facilitators and barriers for scaling-up integrated care, however the lack of standardized terms and measures hinder cross-country comparisons. This paper addresses these gaps by presenting a generic codebook for qualitative research on integrated care implementation for HTN and T2D. Description: The codebook serves as a tool for deductive or deductive-inductive qualitative analysis, organizing concepts and themes from qualitative data. It consists of nine first level and 39 second level themes. First level codes cover core issues; and second level codes provide detailed insights into facilitators and barriers. Discussion: This codebook is more widely applicable than previously developed tools because it includes a broader scope of stakeholders across micro, meso, and macro levels, and the themes being derived from highly diverse health systems across high- and low-income countries. Conclusion: The codebook is a useful tool for implementation research on integrated care for HTN and T2D at global scale. It facilitates cross-country learning, contributing to improved implementation, scale-up and outcomes.

Implementation of Integrated Primary Care for Patients with Diabetes and Hypertension: A Case from Slovenia.

INTRODUCTION: Research on models of integrated health care for hypertension and diabetes is one of the priority issues in the world. There is a lack of knowledge about how integrated care is implemented in practice. Our study assessed its implementation in six areas: identification of patients, treatment, health education, self-management support, structured collaboration and organisation of care. METHODS: This was a mixed methods study based on a triangulation method using quantitative and qualitative data. It took place in different types of primary health care organisations, in one urban and two rural regions of Slovenia. The main instrument for data collection was the Integrated Care Package (ICP) Grid, assessed through four methods: 1) a document analysis (of a current health policy and available protocols; 2) observation of the infrastructure of health centres, organisation of work, patient flow, interaction of patients with health professionals; 3) interview with key informants and 4) review of medical documentation of selected patients. RESULTS: The implementation of the integrated care in Slovenia was assessed with the overall ICP score of 3.7 points (out of 5 possible points). The element Identification was almost fully implemented, while the element Self-management support was weakly implemented. DISCUSSION: The implementation of the integrated care of patients with diabetes and/or hypertension in Slovenian primary health care organisations achieved high levels of implementation. However, some week points were identified. CONCLUSION: Integrated care of the chronic patients in Slovenia is already provided at high levels, but the area of self-management support could be improved.

Implementation of a Savvy Mobile ECG Sensor for Heart Rhythm Disorder Screening at the Primary Healthcare Level: An Observational Prospective Study.

INTRODUCTION: The Jozef Stefan Institute developed a personal portable electrocardiogram (ECG) sensor Savvy that works with a smartphone, and this was used in our study. This study aimed to analyze the usefulness of telecardiology at the primary healthcare level using an ECG personal sensor. METHODS: We included 400 patients with a history of suspected rhythm disturbance who visited their family physician at the Healthcare Center Ljubljana and Healthcare Center Murska Sobota from October 2016 to January 2018. RESULTS: The study found that there was no statistically significant difference between the test and control groups in the number of present rhythm disorders and actions taken to treat patients with either observation or administration of a new drug. However, in the test group, there were significantly fewer patients being referred to a cardiologist than in the control group (p < 0.001). DISCUSSION: The use of an ECG sensor helps family physicians to distinguish between patients who need to be referred to a cardiologist and those who can be treated by them. This method is useful for both physicians and patients because it shortens the time taken to start treatment, can be used during pandemics such as COVID-19, and reduces unnecessary cost.

Successful Implementation of Integrated Care in Slovenian Primary Care.

For the purpose of celebrating the 40th anniversary of Alma Ata declaration, the WHO published a successful model of integrated patient care being performed in Slovenia. After two years, the WHO experts evaluated the success in practise during a visit to the Slovenian primary care environment. This report showed that Slovenia was a notable exception regarding developing effective primary care systems. The country has an impressive primary care which performs very well.

Transition from a traditional to a comprehensive quality assurance system in Slovenian family medicine practices.

In Slovenia, quality of care at the primary healthcare level is formally a priority, but the legislation to ensure quality in this area is proceeding very slowly. The first steps towards a systematic quality control system in Slovenian family medicine were implemented with the initiation of an ongoing project of renewed family medicine practices in 2011 and the introduction of quality indicators. In 2017, an initiative by the Ministry of Health and the Department of Family Medicine at the Faculty of Medicine, the University of Ljubljana, aimed to develop a new approach to quality assurance and an improvement. It comprises four main parts: the family medicine practice team, a quality control group, a quality control office and the Ministry of Health. In this plan, quality is controlled and improved at the micro, mezzo and macro levels. The described system for quality assurance and improvement is still waiting to be implemented in practice, as there is a lack of human and financial resources.