Why a successful task substitution in glaucoma care could not be transferred from a hospital setting to a primary care setting: a qualitative study

Implementation Science

Niek S Klazinga²  Marc A Koopmanschap⁴  Esther van Sprundel³  Hans G Lemij¹  Thomas Plochg²  Kim M Holtzer-Goor⁴ 

[1] Glaucoma service, The Rotterdam Eye Hospital, Rotterdam, the Netherlands;Academic Medical Center (AMC), University of Amsterdam, Amsterdam, the Netherlands;Glaucoma Research Unit, The Netherlands and Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands;Institute for Health Policy and Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands

关键词: Quality of health care;    Access to health care;    Diffusion of innovation;   

Others  :  813813
DOI  :  10.1186/1748-5908-8-14

 received in 2012-07-23, accepted in 2013-01-23,  发布年份 2013

【 摘 要 】

Background

Healthcare systems are challenged by a demand that exceeds available resources. One policy to meet this challenge is task substitution-transferring tasks to other professions and settings. Our study aimed to explore stakeholders’ perceived feasibility of transferring hospital-based monitoring of stable glaucoma patients to primary care optometrists.

Methods

A case study was undertaken in the Rotterdam Eye Hospital (REH) using semi-structured interviews and document reviews. They were inductively analysed using three implementation related theoretical perspectives: sociological theories on professionalism, management theories, and applied political analysis.

Results

Currently it is not feasible to use primary care optometrists as substitutes for optometrists and ophthalmic technicians working in a hospital-based glaucoma follow-up unit (GFU). Respondents’ narratives revealed that: the glaucoma specialists’ sense of urgency for task substitution outside the hospital diminished after establishing a GFU that satisfied their professionalization needs; the return on investments were unclear; and reluctant key stakeholders with strong power positions blocked implementation. The window of opportunity that existed for task substitution in person and setting in 1999 closed with the institutionalization of the GFU.

Conclusions

Transferring the monitoring of stable glaucoma patients to primary care optometrists in Rotterdam did not seem feasible. The main reasons were the lack of agreement on professional boundaries and work domains, the institutionalization of the GFU in the REH, and the absence of an appropriate reimbursement system. Policy makers considering substituting tasks to other professionals should carefully think about the implementation process, especially in a two-step implementation process (substitution in person and in setting) such as this case. Involving the substituting professionals early on to ensure all stakeholders see the change as a normal step in the professionalization of the substituting professionals is essential, as is implementing the task substitution within the window of opportunity.

【 授权许可】

   
2013 Holtzer-Goor et al.; licensee BioMed Central Ltd.

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