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Table 3 Barriers of the integrated care interventions by Implementation Model levels

From: Context, mechanisms and outcomes of integrated care for diabetes mellitus type 2: a systematic review

Ref. Innovation Individual Professional Patient Social Context Organisational Context Economic & Political Context
[39]a - Delayed software installation    - Competing staff priorities   
[40]a - No useful outcome data     - Workflow changes  
[44] - Wireless Internet   - Using self-management tools - Committed staff - Location of computer in practice - Funding
- Software updates   - Staff priorities - Uncertain programme sustainability
[32]    - Unwillingness to consult experts   - Too broad referral indication  
[41]a       
[45] - Unavailability of wireless Internet      - High costs
[42]     - Difficult local context   
[54] - Lack of IT system - Unwillingness to share care - Unwillingness to consult experts - Suboptimal leadership - Information provision - Restricting legal regulations
- Perceived inexpertise - Lack of motivation/compliance/knowledge - Rivalry - Communication
- Lack of (educational) structure
[37]   - Low engagement     
- High attrition rate
[26]   - High attrition rate     
[33]       
[50]    - Lack of prompting - Culture/behavioural changes - Location of computer in practice setting  
- Time constraints
- Unavailability of technology
- Personal factors affecting IT use
[55]   - Resistance to messaging - Unawareness of system features    
[25]   - Reluctance to discharge patients - Reluctance to be discharged    
[48]   - Understanding/implementing diabetes education   - Safety issues (neighbourhoods, patients) - Provider training  
- Staff turnover
- Large caseloads
- Using tools - Wide geographical area
[27]       
[34] - Lack of IT support   - Language and literacy problems - Lack of leadership support - Time constraints  
- Manual data entry - Limited staff capacity
- High staff turnover
[28]    - Medically and socially complicated patients   - Limited staff capacity  
[29] - Long consultations - Reluctance to use IT   - Culturally diverse setting   
- Translating materials
- Use of interpreters
[30] - Registry building (multiple data sources, inconsistent formatting) - Unwillingness to share data   - Changing culture - Changing the workflow and culture of the practice - Funding concerns
- Implementing/teaching change model - Uncertain programme sustainability
[51] - Accommodating self-management tools at home   - Inexperience with self-management tools    
[43]       
[35]       
[38] - Lack of registry   - Lack of self-motivation   - Space limitations  
- Difficulties in building a registry   - Time constraints
[31] - Lack of integrated approach to information management      
[52]   - Difficult computer use - Difficult computer use    
[56]   - Psychosocial barriers   - Competing staff priorities   
- Lack of openness to innovation
[53] - Intervention complexity - Fear of losing patients - Lack of patient self-motivation   - Implementing workflow changes - Income concerns
- Funding concerns
- Lack of diabetes-specific expertise - Administrative burden - Uncertain programme sustainability
- Isolated work
- Lack of staff
[46]       
[49] - Intervention complexity      
[36] - Implementation of registry   - Economically complicated patients   - Implementing workflow changes  
- Unanticipated staff changes
[47]       
  1. aindicates articles with lower methodological quality. Empty cells indicate that no barriers were mentioned in the category
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