Integrated care pathways—A strategy towards better care coordination in municipalities? A qualitative study

Abstract

Introduction One of the main strategies in the Coordination Reform in Norway is implementing integrated care pathways. Most studies on integrated care pathways are conducted in hospital settings or across the hospital–primary care continuum. There are few studies on how such pathways are experienced in primary care. We have conducted a formative evaluation in a primary care setting. The research questions are “What assessments and understanding of integrated care pathways exist in primary care?” “To what extent do integrated care pathways appear as a suitable strategy to handle care coordination challenges from a primary care point of view?” Methods A total of 72 qualitative interviews with chief municipal executives and healthcare management from 36 municipalities in one county of Norway were conducted. Results Even though integrated care pathways were promoted as a strategy to accommodate the intentions of the Coordination Reform, the concept is perceived as diffuse and ambiguous among informants in our study. Only one of four municipalities reported use of integrated care pathways. Discussion Our empirical findings show that municipal management is skeptical and negatively minded to disease-specific integrated care pathways. However, they are positive towards patient-centered care pathways which are flexible, adaptable to individual needs and local conditions. We found that there is no golden strategy for handling challenges in care coordination in primary care. On the contrary, what our informants find as “appropriate” strategies vary and change, but the complexity in problem solving could never be reduced to enforce standardized diagnose-specific integrated care pathways.