title: Social organization of self-management support of persons with diabetes: a health systems comparison.
abstract: OBJECTIVE
  Identify important organizational elements for providing self-management support (SMS).
  
  
  METHODS
  Semi-structured qualitative interviews conducted in two healthcare systems.
  
  
  METHODS
  Kaiser Permanente Northern California and the Danish Health Care System.
  
  
  METHODS
  36 managers and healthcare professionals in the two healthcare systems.
  
  
  METHODS
  Elements important to providing self-management support to persons with diabetes.
  
  
  RESULTS
  Healthcare professionals' provision of SMS was influenced by healthcare system organization and their perceptions of SMS, the capability and responsibility of healthcare systems, and their roles in the healthcare organization. Enabling factors for providing SMS included: strong leadership; aligned incentives; use of an integrated health information technology (HIT) system; multidisciplinary healthcare provider teams; ongoing training for healthcare professionals; outreach; and quality goals. Barriers to providing SMS included lack of collaboration between providers and skeptical attitudes towards prevention and outreach.
  
  
  CONCLUSIONS
  Implementation of SMS can be improved by an understanding of the elements that enhance its provision: (1) initiatives seeking to improve collaboration and integration between providers; (2) implementation of an integrated HIT system; and (3) ongoing training of healthcare professionals.
authors: Steno Health Promotion Center, Steno Diabetes Center, Gentofte, Denmark. mlsz@steno.dk
authors: Michaela
authors: M
authors: Schiøtz
authors: Anne
authors: A
authors: Frølich
authors: Allan
authors: A
authors: Krasnik
authors: Warren
authors: W
authors: Taylor
authors: John
authors: J
authors: Hsu
mesh_terms: D001291:Attitude of Health Personnel; D002140:California; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003718:Denmark; D003920:Diabetes Mellitus / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D012648:Self Care / Q000379:methods*; D012944:Social Support