Public–Private Partnership: Participants’ Experiences of the Web-Based Registration-and-Management System for Patients with Hypertension and Diabetes Mellitus
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Data Collection
2.4. Data Analysis
2.5. Data Analysis Study Validity and Rigor
2.6. Ethical Considerations
3. Results
3.1. Participation Motivation
Participation due to Expectations as Part of a National Pilot Project
“If my medical center receives support for treatments and medications by participating in the hypertension-and-diabetes-mellitus registration-and-management system, it is good”.
“A monthly payment of KRW 1,500 might seem little, but an older patient needs to continue treatment, so I participated in this project”.
“As a physician who operates a medical center, because the government supports medical costs once per month, patients come more frequently instead of coming to the medical center once per two months, and more patients, as well as treatment cases, were expected by participating in this project”.
“Although I was not sure what it was, it was a project initiated by the government and supported by the KMA, so I participated in it”.
“I participated in this project because I was afraid that my patients would go to different medical centers to receive the treatment fee and drug expenses if I did not participate”.
3.2. Participants’ Experiences
3.2.1. Patient-Care Perspective
- Increase in the number of patients’ visits to medical centers:
“Actually, because of the hypertension-and-diabetes-mellitus registration-and-management system, the number of patients increased. Especially, more patients aged 65 years or older have been coming to see me. Supporting the medical cost for one visit per month seems very effective”.
“After participating in the hypertension-and-diabetes-mellitus registration-and-management system, the number of patients visiting my medical center increased a lot. When I asked them to come to see me once per month, they willingly came to see me and did not have any burden because the government paid KRW 1,500, which covered the cost”.
- Drug-administration-compliance improvement:
“Because of the increased number of regular visits to the medical center, medication compliance improved as well”.
- Maintenance of treatment continuity:
“Treatment is maintained because patients continually come to the medical center once per month, although it seems obvious. Anyway, for me, the benefit is in treating patients continually”.
- Improvements in blood-pressure and blood-glucose control:
“As the number of visits to the medical center increased, and medication compliance improved, patients tended to have more interest in their own blood pressure and blood glucose, thereby improving their control over them”.
- Improved mutual relationships with patients:
“Because the medical center does not require patients to pay for their visits, they listen better. They come to the medical center regularly to receive support from the hypertension-and-diabetes-mellitus registration-and-management system, so our relationship with patients improves”.
“The best thing about participating in the hypertension-and-diabetes-mellitus registration-and-management system is that patients do not complain about having a regular visit once per month. In the past, it often caused issues with my patients. Regular visits and treatment are important for chronic diseases, but patients misunderstood that they were for money”.
- Increases in patients’ interest in diseases:
“Yesterday, one patient told me he attended an education session held by the hypertension-and-diabetes-mellitus registration-and-management center. I certainly felt that patients were interested in their diseases and tried to manage them because of the hypertension-and-diabetes-mellitus registration-and-management system”.
“When an older patient, who received education from the hypertension-and-diabetes-mellitus registration-and-management center, asked about his hemoglobin A1C level, I was amazed. It means they are more interested in their own diseases because of the hypertension-and-diabetes-mellitus registration-and-management system”.
3.2.2. Primary-Medical-Center-Operation Perspective
- The burden of excessive administrative work:
“At my medical center, nurses input information into the hypertension and diabetes-mellitus registration-and-management system. In addition, nurses recommend that patients participate in the hypertension-and-diabetes mellitus registration-and-management system and give them information. The workload of nursing staff increased.”.
“If a nurse does not enter accurate information into the hypertension-and-diabetes mellitus registration and management system, a problem occurs in the treatment. Thus, while seeing patients, I directly enter information into the hypertension and diabetes mellitus registration and management system and explain the project”.
“I, a physician, enter information myself into the hypertension and diabetes mellitus registration and management system. Because this system is not linked to the treatment chart system, it requires much work. Also, nursing assistants quit their jobs very frequently, so it is very tedious and burdensome to teach new nursing assistants how to manage the hypertension-and-diabetes-mellitus registration-and-management system. Therefore, I do it myself even if it means I have to go to work on my day off”.
- Satisfaction with project participation
“Actually, this project helps me to operate the medical center and maintain my practice. Since the opening of the medical center, the medical cost has been covered for patients who were happy about it. Also, I was very satisfied as well”.
“Because of the hypertension-and-diabetes-mellitus registration-and-management system, the treatment cost and the complex test fees have been supported, so I think South Korea is a good country. In addition, older people keep thanking me, although I did not pay for them, so I feel good”.
“In my opinion, the best thing about the hypertension-and-diabetes-mellitus registration-and=management center was the education on hemoglobin A1C. It takes much time to explain this test alone. Because patient education is performed regularly by the hypertension-and-diabetes-mellitus registration-and-management system, I am very happy about it”.
“Of course, I would recommend this project to my colleagues or perform it in other regions because patients receive great benefits”.
3.3. Suggestions
3.3.1. The Necessity of Strengthening the Systematic Education Project
- The importance of measuring blood pressure and blood glucose at home:
“Many patients respond too sensitively regarding their blood-pressure or blood-glucose levels. Informing them on how to measure them at home would be helpful”.
“Especially, older patients with diabetes mellitus want everything to be cared for at the medical center. However, it is not possible. Please inform them of the importance and accurate method of self-measuring blood glucose”.
- The necessity of regular tests:
“There are still patients who consider testing very negatively, although not many of them nowadays. Nobody wants to argue with them. So, I hope that the hypertension-and-diabetes-mellitus registration-and-management center will inform them of which tests are needed and why”.
- The importance of continual treatment:
“Some patients tend not to come to the medical center anymore or stop taking medications alone if they feel their health is improving. It is sad that they come back to the medical center if their health deteriorates. Please emphasize this point. It is essential not to stop treatment”.
- The necessity of vaccination for patients with chronic diseases:
“Sometimes, patients agree to receive vaccination against pneumonia for free but do not agree if they need to pay for it. They believe we recommend it for money. So, if the hypertension-and-diabetes-mellitus registration-and-management center educates them, such patients will receive vaccinations more willingly”.
“Because immunity is low in patients with chronic diseases, vaccination is essential, but patients are often ignorant of it. Thus, the importance of vaccination must be educated”.
- Education on complications of chronic diseases:
“Education on complications of patients with hypertension and diabetes mellitus is necessary if they are controlled”.
“For those who do not understand complications well, specific symptoms and risks must be educated repeatedly”.
- Diet for hypertension and diabetes mellitus:
“Especially older people want to know what to eat and what to avoid eating specifically. Such education will give practical help”.
“Vague education will make patients eat whatever they want. So, please use a picture of a table setting or other food pictures for education”.
- Diet for older people:
“Diets might be different for older people. Because of their tooth condition or blood-glucose levels, there is a limitation. So, there must be specific education on diet”.
- Easy home exercises:
“It would be great to receive training from a personal trainer in a gym, but educational materials for home exercises would be helpful”.
“Everybody knows doing exercises is a good thing, but older people usually do not do exercises. If they are taught what to do step by step, in detail, they can easily follow them at home”.
3.3.2. Continual Maintenance and Broad Application of the Project
“The biggest challenge was the continuity of the hypertension and diabetes mellitus registration and management system. The web-based hypertension and diabetes mellitus registration and management system was perceived as an unstable pilot project”.
“Nationwide, there are not many regions where this project is performed. I do not understand why this good project has been expanded to other towns in the city or other regions in the country. It provides patients with education, complication tests, and free tests. Also, it even educates and manages the medical centers”.
“A policy is needed to increase the enrollment rate of not only people aged 65 years or older but also those aged between 30 and 64 years”.
3.3.3. System Improvement
- Improvement of the testing system:
“When seeing patients, sometimes testing for a cholesterol level is all I need. However, the testing system of the hypertension-and-diabetes-mellitus registration-and-management system only allows the performance of a set of grouped tests. If needed, it would be better if it were possible to perform only a cholesterol test”.
- Simplification of the input system:
“The biggest problem is that there is a lot of administrative work. The medical insurance request system, disease management system, and hypertension and diabetes mellitus registration and management system are operated separately, so we must enter information into each system. Thus, there is a great burden of entering information into the hypertension-and-diabetes-mellitus registration-and-management system. I feel sorry for nurses as well. Simplification of administrative work and unification of systems are needed”.
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Category | Frequency (%) | |
---|---|---|
Age groups of the medical-center directors | 30 s | 6 (8.4) |
40 s | 25 (35.2) | |
50 s | 22 (31.0) | |
≥60 s | 18 (25.4) | |
Specialization | Internal medicine | 37 (52.1) |
Family medicine | 18 (25.4) | |
Surgery | 3 (4.2) | |
Others | 13 (18.3) | |
Duration of medical-center operation | <5 years | 21 (29.6) |
5–9 years | 8 (11.3) | |
≥10 years | 42 (59.1) | |
Participation period in the hypertension-and-diabetes-mellitus project | 0.5–1 year | 6 (8.4) |
1 year ≤ x > 3 years | 12 (16.9) | |
3 years ≤ x > 5 years | 11 (15.5) | |
≥5 years | 42 (59.2) | |
The average number of patients with hypertension per day | ≤9 patients | 29 (40.8) |
10–19 patients | 23 (32.4) | |
20–29 patients | 12 (16.9) | |
≥30 patients | 7 (9.9) | |
The average number of patients with diabetes mellitus per day | ≤9 patients | 34 (47.9) |
10–19 patients | 24 (33.8) | |
20–29 patients | 7 (9.8) | |
≥30 patients | 6 (8.5) | |
The average number of patients with hypertension and diabetes mellitus per day | ≤9 patients | 30 (42.2) |
10–19 patients | 23 (32.4) | |
20–29 patients | 8 (11.3) | |
≥30 patients | 10 (14.1) | |
The occupations of the respondents | Physicians | 43 (60.6) |
Nurses/Nursing assistants | 21 (29.6) | |
Others | 7 (9.8) |
Category | Subcategory | Themes |
---|---|---|
Participation motivation | Participation due to expectations, as part of a national pilot project | Patient-centered project Support from the Korean Medical Association (KMA) The expectation of an increase in the number of treatments Prevention of loss of patients to other hospitals |
Participation experiences | Patient-care perspective | Increase in the number of patients’ visits to medical centers Drug-administration-compliance improvement Maintenance of treatment continuity Improvement in blood pressure and blood-glucose control Improved mutual relationships with patients Increase in patients’ interest in diseases |
Primary-medical-center-operation perspective | The burden of excessive administrative work Satisfaction with project participation | |
Suggestions | The necessity of strengthening systematic education | Importance of measuring blood pressure and blood glucose at home The necessity of regular tests Importance of continual treatment The necessity of vaccination for patients with chronic diseases Education on complications of chronic diseases Diet for hypertension and diabetes mellitus Diet for older people Easy home exercises |
Continued maintenance and broad application of the project | Securing continuous possibilities Expanding regions of project implementation Expanding age groups of participants | |
System improvement | Improvement of the test system Simplification of the input system |
Recommended Training Topics |
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Lee, S.; Song, N.; Kim, S. Public–Private Partnership: Participants’ Experiences of the Web-Based Registration-and-Management System for Patients with Hypertension and Diabetes Mellitus. Healthcare 2023, 11, 1297. https://doi.org/10.3390/healthcare11091297
Lee S, Song N, Kim S. Public–Private Partnership: Participants’ Experiences of the Web-Based Registration-and-Management System for Patients with Hypertension and Diabetes Mellitus. Healthcare. 2023; 11(9):1297. https://doi.org/10.3390/healthcare11091297
Chicago/Turabian StyleLee, Seonah, Nanyoung Song, and Suhyun Kim. 2023. "Public–Private Partnership: Participants’ Experiences of the Web-Based Registration-and-Management System for Patients with Hypertension and Diabetes Mellitus" Healthcare 11, no. 9: 1297. https://doi.org/10.3390/healthcare11091297
APA StyleLee, S., Song, N., & Kim, S. (2023). Public–Private Partnership: Participants’ Experiences of the Web-Based Registration-and-Management System for Patients with Hypertension and Diabetes Mellitus. Healthcare, 11(9), 1297. https://doi.org/10.3390/healthcare11091297