Table 7 Quotes from HCPs and patients in phase 4—process evaluation of the implementation of the improved and digitalized ‘Support for diabetes’ intervention, based on focus group, N = 6 and interviews N = 4

4.1–Training and preparation

4.1.1

Well of course you have to think for yourself. But it would be nice that after not doing something for two months, there is a written summary of the steps that need to be taken for this project

Nurse practitioner 1

4.2–Appreciation for the intervention

4.2.1

Well for that one man who was so unsatisfied [with the care sector], I know that he also mentioned that this was the first time that he had the opportunity to talk about these things and that is something he really appreciated. For the other man I spoke, I don’t know, it was not an unpleasant conversation. He indicated that he will take his medication from now on, but I have no way of knowing whether he actually will

Nurse practitioner 2

4.3–Practical barriers to implementation

4.3.1

Well, I believed that the overhead in this project was more than the outcome

General practitioner 1

4.3.2

If you sometimes participate in home visits as a part of medication reviews, you often see patients who collected giant piles of medication at home. And you can see the same thing when someone has passed away, or when someone moves. All those people are on repeat dispensing, so they pick up their medication on time but never use it

Pharmacist 1

4.4–Organizational barriers to implementation

4.4.1

We have been working together for quite some years now. By now, we know how to do things and what we can ask of each other. We know each other also outside work, so by now we hardly have to ask one another to get what we want. Therefore, the collaboration protocol is not needed as hard here as it might somewhere else

Pharmacist 1

4.4.2

There were people on the list that I had known for years, and I had given this man a medication dispenser last year, so I mean, how can he even be non-adherent?

Nurse practitioner 3

4.4.3

But I think that might be the difference between a GP and a NP. A NP has a lot of trouble asking about erectile dysfunction in patients with T2DM for example, while that is a very normal question for me

General practitioner 1

4.4.4

I see some of those patients four times a year. So I mean, if patients are truly that dissatisfied with their medication, they can mention it themselves right?

Nurse practitioner 4

4.4.5

But, all of that has to do with how you see yourself. The doctor used to be a police officer, but nowadays I see myself as a coach. I therefore don’t find it intrusive to ask about a patients medication, because if they really don’t want to take it I don’t care. My role as a coach is simply to explain them what the consequences are if they don’t

General practitioner 2

4.4.6

The main role for us is to create time. If I think something is truly important as the owner of this practice, that means I have to prioritize it. So for example if we say this is an important project, then I might leave two full hours a month free in the calenders of my NPs, so they know that that is the time they have to work on this project. I have noticed in the past that that gives more structure, because I cannot expect all my employees to do it by themselves

General practitioner 3