A qualitative study on health professionals’ views on changes towards integrated care in the Basque Health Service

Abstract

Introduction: The public Basque Health System is undergoing a transformation process towards more integrated care. A cornerstone of this process was the creation of 13 integrated healthcare organizations (IHOs), starting in 2010. As part of a wider evaluation, a qualitative study on the views of frontline health professionals on changes experienced in relation to the integration process was conducted. Methods: A dialogical approach based on individual interviews and focus groups was used. Interviews with 19 key informants allowed identifying organisational and health professional’s characteristics which could potentially influence a health professionals’ “integration experience”. These findings influenced the composition of the four focus groups which took place in October and November 2018. Trying to cover the maximum array of professional profiles, participants in the focus groups were selected based on a theoretical sampling strategy. According to it, participating professionals’ profile heterogeneity was based upon several features: field of practice (primary care/hospital care), professional discipline (doctors/nurses), gender, years of practice, medical specialty (cardiology, endocrinology, internal medicine, pneumology …), community versus biomedical approach, liaison responsibilities, IHO size … Four focus groups were organised as follows: one group of primary care level professionals, two groups of hospital level professionals and one mixed group with both primary and hospital care level professionals. The integration model followed in the public Basque Health Service explicitly aims at integrated care for patients and is based on three main change levers: culture and values, governance, and development of a population health approach. The focus group discussions gathered views and perceptions on changes in these three potential levers as well as on the perceived impact, to date, of the integration process on patients’ care. All four group discussions were digitally recorded and transcribed verbatim. A thematic analysis was conducted. Results: Frontline health professionals in the focus groups mentioned several elements related to the management model: the development of electronic information and communication tools (such as the shared electronic clinical record, electronic prescription and consultations…), new coordination professional roles, the role of emergencies and hospitalisation at home services, and the increased development of shared care pathways between primary and hospital care professionals. Regarding changes in the organisational structure, the perceived benefits and disadvantages of the creation of the IHOs were also explored. As regards interprofessional collaboration, participants reported improved communication between primary and hospital care professionals as well as increased efforts by managers to facilitate opportunities to meet. Views on the leadership role of primary care professionals in the delivery of integrated care were also gathered. A key area identified regarding the development of a population health approach was the necessary cooperation and collaboration between social care and health care professionals and organisations. A generalised view among health professionals in the focus groups is that changes introduced with the integration process are benefiting patients, particularly chronic patients.

Keywords

• integration
• health professionals
• qualitative
• focus groups
• experience