Implementation determinants of an integrated care initiative for socioeconomically vulnerable groups

Abstract Background Integrated care initiatives for socioeconomically vulnerable groups can deliver personalised care, improve health outcomes, and foster greater equity within the healthcare system. However, incorporating these initiatives into standard care remains rare. Insight into implementation determinants and selecting strategies for further implementation and upscaling is therefore needed. Methods We conducted a case study on an integrated care initiative for citizens with prediabetes in the form of group consultations. We used a qualitative design guided by the Consolidated Framework for Implementation Research (CFIR) and the Rainbow Model of Integrated Care. Semi-structured interviews and a focus group were conducted with participants, including professionals, policy makers, and experts by experience. We used Framework analysis to identify implementation determinants and matched implementation strategies to a selection of barriers using CFIR's Expert Recommendations of Implementation Research matching tool. Results We conducted 28 interviews and one focus group (n = 16). Key barriers included insufficient involvement of citizens, which could be overcome by involving patients/consumers and family members. We also identified a lack of embedding in formal structures and fragmentated funding as barriers. These could be addressed through formal commitments, alternative payment schemes, and resource-sharing agreements. Key facilitators were the widespread enthusiasm for the concept of group consultations, a sense of urgency for change, and the adaptability of the initiative to the local context. Conclusions Citizen involvement in designing an integrated care initiative is a key determinant of implementation when targeting socioeconomically vulnerable groups. Despite broad support for integrated care, its implementation is hindered by organisational and system-level barriers related to fragmentation of healthcare and social support. Key messages • Citizen involvement is key to improve implementation of integrated care initiatives for socioeconomically vulnerable groups. • Solutions are needed to overcome implementation barriers caused by fragmentation of healthcare and social support systems.