Experiences of Doctors and Patients in the implementation of Indonesia’s diabetes management model, Prolanis

Problem

Indonesia have been implementing a nationwide diabetes management model through the newly established universal health coverage scheme since 2014. The model has similarities with the Chronic Care Model that originated in the United States. It consists of monthly consultations, medication dispensing, laboratory checks, with an optional addition of group exercise and education classes. There are three distinct types of primary care practices in Indonesia implementing this model (government-run community health centre, private primary care clinic, individual doctor practice). No study to date has assessed how Prolanis is being implemented across the different types of primary care. We aimed to explore the experiences of primary care doctors and patients in the implementation of Prolanis. Specifically to address the questions: 1) How is Prolanis implemented in different primary care settings?; 2) What are the factors influencing the implementation of Prolanis?; 3) What are the perceived effects of implementing Prolanis in diabetes care provision?

Approach

A qualitative approach used in-depth interviews to explore the experiences of doctors and patients in the implementation of Prolanis. We carried out a purposive sampling on the basis of maximum variation to include doctors and patients from the three types of primary care and from both urban and rural settings. Themes and sub-themes were identified from interview transcripts using a thematic approach in order to answer the research questions.

Findings

A total of 36 participants were interviewed for this study, 18 doctors and 18 patients. An overlap of themes was found from the doctor and patient interviews, resulting in four main themes influencing the implementation of Prolanis for all participants: contextual factors, system factors, process factors, and outcome factors. Prolanis was found to be implemented differently across types of primary care. One example was whether patient group sessions were provided. The decision to run group sessions was influenced by the setting of the practice, the social nature of their patient group, and the available human resources. Having group sessions was highly regarded as an effective approach to achieve good clinical outcomes in diabetes management with Prolanis, with both patients and doctors expressing its effectiveness in the actual increase of diabetes self-management.

Consequences

The relatively short period of Prolanis implementation (5 years) may be reflected in the different approaches to Prolanis implementation, with practices still finding their way to implement the model according to their circumstances (e.g. size, urban/rural). The highly appreciated group sessions should be considered across all primary care types as they have been viewed as an effective approach to management. Improvements are still needed to effectively implement Prolanis nationally and the findings from this study will provide recommendations on how best to achieve optimum diabetes self-management provision in primary care in Indonesia.