Objectives To investigate opinions' convergences and divergences of diabetic patients and health-care professionals on diabetes care and the development of a regional diabetes programme.Background Development and implementation of a regional diabetes programme.

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BackgroundChronic disease management has been implemented for some time in several countries to tackle the increasing burden of chronic diseases. While Switzerland faces the same challenge, such initiatives have only emerged recently in this country. The aim of this study is to assess their feasibility, in terms of barriers, facilitators and incentives to participation.MethodsTo meet our aim, we used qualitative methods involving the collection of opinions of various healthcare stakeholders, by means of 5 focus groups and 33 individual interviews. All the data were recorded and transcribed verbatim. Thematic analysis was then performed and five levels were determined to categorize the data: political, financial, organisational/ structural, professionals and patients.ResultsOur results show that, at each level, stakeholders share common opinions towards the feasibility of chronic disease management in Switzerland. They mainly mention barriers linked to the federalist political organization as well as to financing such programs. They also envision difficulties to motivate both patients and healthcare professionals to participate. Nevertheless, their favourable attitudes towards chronic disease management as well as the fact that they are convinced that Switzerland possesses all the resources (financial, structural and human) to develop such programs constitute important facilitators. The implementation of quality and financial incentives could also foster the participation of the actors.ConclusionsEven if healthcare stakeholders do not have the same role and interest regarding chronic diseases, they express similar opinions on the development of chronic disease management in Switzerland. Their overall positive attitude shows that it could be further implemented if political, financial and organisational barriers are overcome and if incentives are found to face the scepticism and non-motivation of some stakeholders.

In about one-third of vignette cases, inflammatory bowel disease treatment propositions made by practicing gastroenterologists diverged from expert recommendations. Practicing gastroenterologists may experience difficulty in applying recommendations in daily practice.

PurposeTo explore the needs and expectations of diabetic patients and healthcare professionals in the canton of Vaud.ContextDevelopment and implementation of a diabetes cantonal program.MethodsWe conducted one focus group (FG) with diabetic patients and one with healthcare professionals (general practitioners, diabetologists, pharmacists, home healthcare managers, podologists) in each of the four health regions of the canton (n=8 FG). FGs were audio-taped and transcribed verbatim, and content analysis performed.Results and conclusionPerceived quality of diabetes care varies, depending on participants and regions considered. Participants describe a lack of collaboration and communication between professionals, problems linked to self-management education, and a lack of information on diabetes for the general population.They propose to improve the quality of care by strengthening existing structures, by developing centralization of care and information, and by reinforcing teamwork and self-management education. They also suggest implementing information and prevention campaigns for the general population.Diabetics and healthcare professionals express the need to develop a cantonal program at a local level and adapted to patients’ needs. For patients, such a program would represent an opportunity to have access to comprehensive care. For healthcare professionals, it would favor the development of teamwork and of local networks.Participants point out similar problems and solutions, even if not similarly expressed. These results should help the development and implementation of a program adapted to the patients’ and professionals’ needs.