From shared care to disease management: key-influencing factors

BACKGROUND: In order to improve the quality of care of chronically ill patients the traditional boundaries between primary and secondary care are questioned. To demolish these boundaries so-called ‘shared care’ projects have been initiated in which different ways of substitution of care are applied. When these projects end, disease management may offer a solution to expand the achieved co-operation between primary and secondary care. OBJECTIVE: Answering the question: What key factors influence the development and implementation of shared care projects from a management perspective and how are they linked? THEORY: The theoretical framework is based on the concept of the learning organisation. DESIGN: Reference point is a multiple case study that finally becomes a single case study. Data are collected by means of triangulation. The studied cases concern two interrelated Dutch shared care projects for type 2 diabetic patients, that in the end proceed as one disease management project. RESULTS: In these cases the predominant key-influencing factors appear to be the project management, commitment and local context, respectively. The factor project management directly links the latter two, albeit managing both appear prerequisites to its success. In practice this implies managing the factors' interdependency by the application of change strategies and tactics in a committed and skilful way. CONCLUSION: Project management, as the most important and active key factor, is advised to cope with the interrelationships of the influencing factors in a gradually more fundamental way by using strategies and tactics that enable learning processes. Then small-scale shared care projects may change into a disease management network at a large scale, which may yield the future blueprint to proceed

Nurse-led shared care diabetes projects:lessons from the nurses' viewpoint

This paper explores the experiences of four nurse practitioners specialised in diabetes care, in the development and implementation of two Dutch nurse-led shared care projects to improve quality of care. The focus is on the impeding factors involved. The nurses' views are compared to those of the 38 participating physicians by using instruments of qualitative research. Both nurses and physicians consider the way shared care delivery has been structured as the most impeding factor, particularly downward substitution of care from doctor to nurse. In the end, lessons are drawn for nurses, doctors and managers, to solve the assessed impediments to shared care