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

Background:

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.

Method:

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.

Results:

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.

Conclusions:

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?

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