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Rodríguez C, Contandriopoulos AP, Larouche D. Implementation evaluation of an integrated healthcare delivery initiative for diabetic patients. Healthc Policy. 2006;1(3):99-120
Rodríguez, C., Contandriopoulos, A. P., & Larouche, D. (2006). Implementation evaluation of an integrated healthcare delivery initiative for diabetic patients. Healthcare policy = Politiques de sante, 1(3), 99-120.
Rodríguez, Charo, et al. "Implementation evaluation of an integrated healthcare delivery initiative for diabetic patients." Healthcare policy = Politiques de sante vol. 1,3 (2006): 99-120.
Rodríguez C, Contandriopoulos AP, Larouche D. Implementation evaluation of an integrated healthcare delivery initiative for diabetic patients. Healthc Policy. 2006 Mar;1(3):99-120. PMID: 19305674; PMCID: PMC2585338.
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Healthc Policy. 2006 Mar;1(3):99-120.

Implementation evaluation of an integrated healthcare delivery initiative for diabetic patients.

Healthcare policy = Politiques de sante

Charo Rodríguez, André-Pierre Contandriopoulos, Danielle Larouche

Affiliations

  1. Area of Health Services and Policy Research, Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC. [email protected]

PMID: 19305674 PMCID: PMC2585338

Abstract

The aim of this in-depth, longitudinal, qualitative case study was to understand and explain the dynamics of implementing a pilot project to deliver integrated healthcare for type 2 diabetic patients. Data gathering included in-depth, face-to-face interviews with family physicians, nurses and other healthcare providers, managers and policy makers (n = 25) at various points during the research period, and focus groups (n = 3) with patients. These data were complemented by onsite observations of numerous committee meetings, and analysis of project documentation. Benson's (1975) political economy perspective provided a valuable conceptual framework for tracking the complex dynamics of implementing service integration. Manipulative strategies (continuing medical education, new information technology) did not engage physicians. Of the cooperative strategies attempted (disease management, patient education, community mobilization), only patient education appears to have succeeded: patients acknowledged that project educational activities enabled them to improve self-management of their disease. However, the project's emphasis on patient education effectively increased nurses' bargaining power within the healthcare team, to the detriment of the focus on integrated care. Integrating care is a laborious process that takes time to reach fruition. This one-year pilot project was insufficient for mobilizing health professionals away from fragmented practices toward integrated ones. New resources mostly allowed them to maintain or increase their power positions within the network of care providers. Nevertheless, this initiative raised physicians' awareness and appreciation of the care that other health professionals provided to their patients.

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