Facilitators and barriers of implementing the WHO ICOPE care model in Nepal: A clinical perspective.

Introduction: The Integrated Care for Older People (ICOPE) care model is being actively implemented worldwide, including in low-resource countries like Nepal. We aimed to conduct a survey to understand the major barriers and facilitators of implementing ICOPE in Nepal from a clinical perspective. Methods: A survey questionnaire was developed to assess the barriers and facilitators of implementing ICOPE at the micro, meso, and macro levels and the recommended four steps of ICOPE. Relevant suggestions for improving ICOPE were also collected from the implementors. Results: Among the 11 (ICOPE implementors) respondents, four were geriatricians and seven were non-geriatric clinicians. Lack of suitable infrastructure, shortage of trained workforce, comparatively low priority for geriatric health and geriatrics, lack of national guidelines and funding were considered the major barriers for implementing ICOPE in Nepal. Major facilitators for implementing ICOPE in Nepal were motivated healthcare workers, continuous support from the WHO, and government ICOPE training programs. Lack of a systematic referral framework with no provision of electronic health records and a dedicated team were considered as major barriers in completing the recommended four steps of ICOPE. The respondents thought the ICOPE application was feasible in Nepal, which could also serve as a tool to share health records digitally. Additionally, localisation of the ICOPE pathway was suggested. Conclusion: The ICOPE care pathway was considered quite feasible in Nepal by the implementors, although more work is needed to remove the current barriers and embed ICOPE in the existing healthcare system.