Integrating Diabetes Services: opportunities to build cultural bridges

Objective: To identify barriers to integrated care for diabetes services at the District Health Board/Primary Health Organisation interface, along with possible solutions to these barriers. Design: Qualitative and interpretive using semistructured interviews and a modified Delphi technique to collect data. A general inductive approach was used for data analysis. Setting: Fourteen participants were recruited from one of the three Auckland, New Zealand district health boards (DHBs) and three of the primary health organisations (PHOs) located within the DHB district. Results: The main barriers to integration identified were a lack of collaborative skills in the workforce, a lack of resources and a lack of time for stakeholders to integrate care. Study participants from each of the major professional subcultures (medicine, nursing and management) identified different barriers to integration and this divergence of views was identified as a further barrier to integration. Conclusions: The research identified three possible solutions. The first was the creation of a work space to allow clinical staff from different sectors to build cultural bridges. The second was for funders to identify ways of being perceived by all stakeholders as adding value to the integration process and the third was the development of a funding environment supportive of integration.