Integration Strategies in the Implementation of a Cardiology Chronic Care Clinic in a Primary Care Setting: A Qualitative Study

Abstract

Introduction: A Cardiology Integrated Chronic Care (ICC) clinic was established at a polyclinic through collaboration between a tertiary hospital and a polyclinic. This novel model in Singapore prompted a study exploring explore how stakeholders conceptualise and operationalise integration when implementing the clinic in primary care, aiming to understand if common cardiology conditions can be anchored in primary care. Methods: Nine semi-structured interviews were conducted with a cardiologist, intervention’s director, family physician, polyclinic head, coordinators and advanced practice nurse. Twelve documents —including implementation monitoring reports, steering committee reports and meeting minutes — were analysed using Singer and colleagues’ conceptual model of integration types. Results: Co-located consultation rooms, direct access investigations and remote consultations between healthcare providers promoted structural integration. Interpersonal integration was fostered through teamwork. Functional integration was accomplished via comprehensive care management protocols and training. Low patient numbers reduced polyclinic revenue but positively impacted care efficiency. Provider satisfaction remained high, with participants gaining knowledge and confidence in managing cases. Conclusion: The clinic demonstrated operational integration but may lack a broader healthcare system perspective. For sustainable larger-scale evolution, economic and policy scrutiny is needed focusing on operational feasibility and outcomes, given low patient volume constraints affecting financial viability and scalability potential.