Comprehensive Evaluation of Hypertension Management at the Primary Level in Slovenia: Lessons for the Future

Črt Zavrnik, Valentina Katka Prevolnik Rupel, Nataša Stojnić, Majda Mori Lukančič, Miriam Cerar, Zalika Klemenc-Ketiš, Antonija Poplas Susič

Keywords: hypertension, integrated care, scale-up, primary care

Despite the subsequent tendency to focus on patient-centered integrated care of hypertension at the primary level in Slovenia, many patients with this disease are still treated suboptimally. There is an urgent need to gain a comprehensive overview of the current implementation of integrated care in order to improve it for the future.

Research questions:
The aim of this study is to analyse the weaknesses and strengths of the current hypertension management strategy at the primary level in Slovenia – the implementation of integrated care, the costs and the perspective of the stakeholders of what to scale up.

Three substudies were conducted. (1) The Integrated Care Package (ICP) Grid questionnaire assessed the current implementation of integrated care (identification, treatment, health education, self-management support, structured collaboration and care organization). (2) The qualitative study of 15 focus groups and 23 semi-structured interviews with stakeholders at the micro, meso and macro levels identified facilitators and barriers to scaling integrated care. (3) Hypertension costs (direct from medical records and out-of-pocket from the survey) were evaluated in a sample of 287 patients.

Implementation of integrated care using ICP Grid showed that the elements of self-management and structured collaboration were weakly implemented. Stakeholders identified the organization of primary health care as a facilitator; on the other hand, true teamwork and patient-centered care were constrained by hierarchy and a very heavily skewed medical approach. The total per capita cost of hypertension management was €269.00 per year, of which 22.8% was out-of-pocket costs.

This study allows the formulation of a new roadmap for future (self-)management of hypertension at primary level in Slovenia. The implementation of some new interventions such as patient empowerment and their self-treatment, laic educators and the use of mHealth represent a possible solution to the above challenges.

Points for discussion:
Which interventions can facilitate patient-centered care for hypertension at the primary level?

How can we address the overburden on health workers?