Research on models of integrated health care for hypertension and diabetes is one of the priority issues in the world. There is a lack of knowledge about how integrated care is implemented in practice. Our study assessed its implementation in six areas: identification of patients, treatment, health education, self-management support, structured collaboration and organisation of care. This was a mixed methods study based on a triangulation method using quantitative and qualitative data. It took place in different types of primary health care organisations, in one urban and two rural regions of Slovenia. The main instrument for data collection was the Integrated Care Package (ICP) Grid, assessed through four methods: 1) a document analysis (of a current health policy and available protocols; 2) observation of the infrastructure of health centres, organisation of work, patient flow, interaction of patients with health professionals; 3) interview with key informants and 4) review of medical documentation of selected patients. The implementation of the integrated care in Slovenia was assessed with the overall ICP score of 3.7 points (out of 5 possible points). The element Identification was almost fully implemented, while the element Self-management support was weakly implemented. The implementation of the integrated care of patients with diabetes and/or hypertension in Slovenian primary health care organisations achieved high levels of implementation. However, some week points were identified. Integrated care of the chronic patients in Slovenia is already provided at high levels, but the area of self-management support could be improved.

Background: As the population ages, the prevalence of chronic diseases such as arterial hypertension (AH) and type 2 diabetes (T2D) is increasing, posing challenges for effective management in primary care settings. Although mobile health (mHealth) home telemonitoring offers promising support, evidence regarding its clinical impact on older patients is limited. Objective: The objective of this paper was to evaluate the impact of 12-month telemonitoring on clinical outcomes in older individuals with AH and T2D compared to standard care in a primary care setting. Methods: In a multicenter, open-label, randomized controlled trial, individuals aged 65 years and older with AH and T2D were randomly assigned in a 1:1 ratio to either a telemonitoring group or a standard care group. The telemonitoring group received mHealth support in addition to standard care. Over 12 months, participants measured blood pressure (BP) twice weekly with 2 consecutive readings each morning and evening, using the second reading as valid. Blood glucose (BG) was measured monthly, both fasting and 90 minutes after meals. Abnormal results triggered a 7-day BP or 1-day BG profile or a teleconsultation with a general practitioner. Meanwhile, the control group received routine care based on integrated care protocols at community health centers. Primary outcomes were the differences between groups in the change in systolic blood pressure (SBP) and HbA_1c levels at 12 months after inclusion from baseline. Secondary outcomes included changes in diastolic blood pressure, fasting BG, lipid profile, body mass index, appraisal of diabetes, and behavioral risk factors. Results: Initially, 128 patients were enrolled, with 117 (91.4%) completing the 12-month follow-up. The mean age was 71.3 (SD 4.7) years, with a mean SBP of 136.7 (SD 14.1) mmHg and mean HbA_1c of 7.2% (SD 1.0%). There were no significant sociodemographic or clinical differences between groups at baseline. At 12 months, the telemonitoring group experienced significant reductions in SBP (−9.7 mmHg, 95% CI −12.6 to −6.8; P<.001) and HbA_1c (−0.5%, 95% CI −0.8 to −0.3; P<.001), whereas the control group exhibited nonsignificant changes in SBP (−2.8 mmHg, 95% CI −5.9 to 0.2; P=.07) and HbA_1c (0%, 95% CI −0.3 to 1.9; P=.75). The difference between groups at 12 months was significant for both SBP (−6.9 mmHg, 95% CI −11 to −2.7; P=.001) and HbA_1c (−0.5%, 95% CI −0.8 to −0.2; P=.002), with no significant differences observed in secondary outcomes. Conclusions: Telemonitoring effectively improves AH and T2D control in older people but has no impact on other cardiovascular risk factors and diabetes-related quality of life. Future research should explore combining educational and behavioral interventions with telemonitoring to enhance overall health outcomes. However, complex interventions may pose challenges for the elderly, suggesting the need for careful patient selection to ensure that benefits outweigh potential burdens.

Introduction: Telemonitoring has been proposed as an effective method to support integrated care for older people with hypertension and type 2 diabetes. This paper examines acceptability of telemontioring, its role in supporting integrated care, and identifies scale-up barriers. Methods: A concurrent triangulation mixed-methods study, including in-depth interviews (n = 29) and quantitative acceptability tool (n = 55) was conducted among individuals who underwent a 12-month telemonitoring routine. The research was guided by the Theoretical Framework of Acceptability. Interviews were analysed using template content analysis (TCA). Results: TCA identified seven domains of acceptability, with twenty-one subthemes influencing it positively or negatively. In the quantitative survey, acceptability was high across all seven domains with an overall score of 4.4 out of 5. Urban regions showed higher acceptability than rural regions (4.5 vs. 4.3), with rural participants perceiving initial training and participation effort as significantly more burdensome than their urban counterparts. Discussion: Patients described several instances where telemonitoring supported self-management, education, treatment, and identification elements of the integrated care package. However, there were barriers that may limit its further scale-up. Conclusion: For further scale-up, it is important to screen patients for monitoring eligibility, adapt telemonitoring devices to elderly needs, combine telemonitoring with health education, involve family members, and establish follow-up programmes.

Safety culture describes leader and staff interactions, attitudes, routines, awareness, and practices within an organisation. With this study, we aimed to determine the psychometric properties of the Slovenian-language version of the Safety Attitudes Questionnaire (SAQ) – Short Form in primary health care settings. This was a cross-sectional study in the largest primary health care in Slovenia. We invited all employees with a leadership role to participate in the study (N = 211). We used the Slovenian-language version of the SAQ – Short Form. There were 154 participants in the final sample (73.0% response rate), of which 136 (88.3%) were women. The mean age of the sample was 46.2 ± 10.0 years. Exploratory factor analysis put forward six factors: 1) Perceptions of Management; 2) Stress recognition; 3) Teamwork Climate; 4) Communication; 5) Safety Climate; 6) Working Conditions and Satisfaction. This model explained 61.7% of the variance of the safety culture in the primary health care setting. The reliability of the whole scale and of the six factors, assessed using Cronbach’s alpha, was all above 0.78. The results of our study suggests that the Slovenian-language version of the SAQ – Short Form with six factors could be a reliable and valid tool for measuring the safety culture in the primary health care workers with leadership role In Slovenia. The Slovenian version differed from the original SAQ – Short Form and the majority of other translated versions. Also, the data was from one health centre only and therefore we cannot draw strong conclusions on its external validity.

Introduction Integrated care interventions for type 2 diabetes (T2D) and hypertension (HT) are effective, yet challenges exist with regard to their implementation and scale-up. The ‘SCale-Up diaBetes and hYpertension care’ (SCUBY) Project aims to facilitate the scale-up of integrated care for T2D and HT through the co-creation and implementation of contextualised scale-up roadmaps in Belgium, Cambodia and Slovenia. We hereby describe the plan for the process and scale-up evaluation of the SCUBY Project. The specific goals of the process and scale-up evaluation are to (1) analyse how, and to what extent, the roadmap has been implemented, (2) assess how the differing contexts can influence the implementation process of the scale-up strategies and (3) assess the progress of the scale-up. Methods and analysis A comprehensive framework was developed to include process and scale-up evaluation embedded in implementation science theory. Key implementation outcomes include acceptability, feasibility, relevance, adaptation, adoption and cost of roadmap activities. A diverse range of predominantly qualitative tools—including a policy dialogue reporting form, a stakeholder follow-up interview and survey, project diaries and policy mapping—were developed to assess how stakeholders perceive the scale-up implementation process and adaptations to the roadmap. The role of context is considered relevant, and barriers and facilitators to scale-up will be continuously assessed. Ethics and dissemination Ethical approval has been obtained from the Institutional Review Board (ref. 1323/19) at the Institute of Tropical Medicine (Antwerp, Belgium). The SCUBY Project presents a comprehensive framework to guide the process and scale-up evaluation of complex interventions in different health systems. We describe how implementation outcomes, mechanisms of impact and scale-up outcomes can be a basis to monitor adaptations through a co-creation process and to guide other scale-up interventions making use of knowledge translation and co-creation activities.

Introduction: The Jozef Stefan Institute developed a personal portable electrocardiogram (ECG) sensor Savvy that works with a smartphone, and this was used in our study. This study aimed to analyze the usefulness of telecardiology at the primary healthcare level using an ECG personal sensor. Methods: We included 400 patients with a history of suspected rhythm disturbance who visited their family physician at the Healthcare Center Ljubljana and Healthcare Center Murska Sobota from October 2016 to January 2018. Results: The study found that there was no statistically significant difference between the test and control groups in the number of present rhythm disorders and actions taken to treat patients with either observation or administration of a new drug. However, in the test group, there were significantly fewer patients being referred to a cardiologist than in the control group (p < 0.001). Discussion: The use of an ECG sensor helps family physicians to distinguish between patients who need to be referred to a cardiologist and those who can be treated by them. This method is useful for both physicians and patients because it shortens the time taken to start treatment, can be used during pandemics such as COVID-19, and reduces unnecessary cost.