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