Table 4 Actors and mechanisms required to implement a national strategy to increase PHC role in diabetes management
Spain | Slovakia | |
|---|---|---|
Policy dialogue, situation analysis, planning | - Actors: MoH (central and ACs), providers and patient groups (advisors) MoEc approves budget and extra funds to support ACs - Regional MoH: adapts policy/plan to ACs | - Actors: MoH, HICs, health care provider representatives, HCSA |
Implementation PHC Financing | - Regional MoH: inclusion of activities for diabetes management in providers’ contracts, incentives (P4P) or non-financial incentives, provider/practice objectives, accessibility to PHC and availability of equipment for diagnosis/management at PHC level, skill-mix or multidisciplinary practices, integrated electronic records - Central MoH: earmarked funds to implement strategy (if necessary) | - HICs: inclusion of activities for diabetes management in providers’ contracts, payment alignment (P4P or FFS), provider/practice objectives, availability of equipment for diagnosis/management at PHC level - SGRs: accessibility of diagnosis and management services, ensures minimum access via facilities ownership (mostly hospitals) |
Implementation PHC Regulation | - Regional MoH: supervises competences and monitors achievement of management objectives (pre-specified and aligned to MoH guidelines) - MoH: provides clinical guidelines, supervises implementation is aligned with national strategy - MoE: provides license - Professional organisations (SEMFyC and regional branches) collaborate with MoH for guidelines development | - HCSA: supervises MoH, HICs, SGRs, providers - Medical chambers: regulate competences provide license (membership not compulsory) - SGRs: provide permits to HICs, providers and facilities - MoH: provides clinical guidelines, develops quality indicators - HICs: regulate diabetes management, measure quality indicators |
Resistance/challenge | - PHC postgraduate training curriculum’s adaptation to enhanced scope of practice (MoH, MoE and professional associations) - Providers’ inclusion in policy dialogue and planning alignment of payments/incentives across health services, and development of care pathways could enhance coordination of diabetes management and acceptance of PHC role - Budget constraints and competitions for public funds may limit access to diagnostic services in PHC services - Uneven implementation of national strategy in ACs: central support and additional earmarked funds could aid - Budget miscalculation for implementation and maintenance of strategy may lead to unsustainable/temporary reforms - Untargeted conditions (diseases not covered under specific disease programme) may be neglected – supportive guidelines, comprehensive PHC physicians training and continuous education may be helpful | - PHC postgraduate training curriculum’s adaptation to enhanced scope of practice (MoH, MoE and Medical Chambers) - HICs should incentivise group practices - Secondary/inpatient care may resist gatekeeping – inclusive policy dialogue and payments/incentives alignment across health services may dissipate resistance - Population resistance due to reduction of freedom of choice – population trust for the services through raising awareness campaign may dissipate resistance - Distribution of providers, diagnostic and therapeutic services for diabetes management may vary across country - Patients/civil society representation – inclusion may improve population awareness/acceptance of PHC - Untargeted conditions (diseases not covered under specific disease programme) may be neglected – supportive guidelines, comprehensive PHC physicians training and continuous education may be helpful |
Sector-wide approach opportunities | - Public health programmes to tackle risk factors and encourage healthy lifestyle – inclusion in policy dialogue and planning - Cross-sectorial collaboration (Health in All policies) – food, transport | - Public health programmes to tackle risk factors and encourage healthy lifestyle – inclusion in policy dialogue and planning - Cross-sectorial collaboration (Health in All policies) – food, transport |