International Journal of Integrated Care最新文献

Introduction: Integrated care for families provides tailored, coordinated support across various life domains. It relies on partnerships between families, professionals, organisations, and policymakers, navigating diverse perspectives, cultures, and structures. These differences make partnerships complex and not a given. While much is known about partnerships, the dynamics between stakeholders in practice remains underexplored. Therefore, this study examines the dynamics of partnerships in the organisation and development of integrated care initiatives, identifying important aspects, facilitators and barriers.

Method: This qualitative study explored partnership by following five integrated care teams over two years, through interviews (n = 54), observations of clinical case discussions (n = 40) and four learning sessions, incorporating perspectives of families, professionals, managers and local policymakers on partnership.

Results: Four aspects of partnership were identified: shared vision among stakeholders; roles and responsibilities; monitoring and evaluation; and funding. Facilitators included inclusive participation, transparent communication, and flexible approaches. Barriers were conflicting interests, undefined roles and leadership, and fragmented systems that may hinder collaboration.

Conclusion/discussion: Balancing relational and organisational aspects of integrated care is complex yet essential to provide person-centred care. Continuous stakeholder involvement, along with evaluation and reflection, is crucial for fostering shared learning and ensuring the development and sustainability of partnerships within these initiatives.

Background: Since the onset of the COVID-19 pandemic, the number of Remote Care Management (RCM) programs in Ontario has increased; however, many have not been objectively evaluated based on their structure and performance.

Objective: This study demonstrates how the core structure of the RCM model, developed by the Connected Care Halton Ontario Health Team (CCHOHT) with Halton Healthcare Services and Ontario Health atHome, aligns with the RCM recommendations and evaluation tool from the Ontario Ministry of Health (OMH). The focus is specifically on the CCHOHT's RCM program for chronic diseases.

Method: This study presents the CCHOHT's RCM model to demonstrate the degree to which it is consistent with the recommendations for developing RCM programs forwarded by the OMH. It also evaluates the CCHOHT's current chronic diseases RCM program using the OMH's RCM evaluation taxonomy tool and an amended version of this tool proposed by the authors. The taxonomy is based on four foundational criteria: technology, touch, integration and equity.

Results: The CCHOHT's chronic diseases RCM program meets the OMH's four RCM taxonomy criteria. The program is a digital solution that remotely manages patients, provides follow-up communication, and escalates critical cases through a more patient-centred, connected clinical pathway of services and care partners.

Conclusion: The CCHOHT's RCM model and its chronic diseases RCM program are built on intersecting principles of RCM and integrated care as articulated by the OMH. The adaptable nature of the RCM model allows it to be extended to other clinical conditions.

Introduction: The Northern Patient Watch (NPW) program aimed to reduce hospital resource use by providing proactive support through peer health navigators working alongside health professionals. This study assessed the impact of NPW on hospital admissions, bed-days, emergency department presentations, and outpatient non-attendance rates, compared to propensity score-matched controls.

Research method: A propensity score matching design compared NPW enrolees with controls over 3-, 6-, and 12-month follow-up periods. Hospital resource utilisation was the primary outcome, with secondary outcomes including outpatient appointment non-attendance rates. Statistical methods addressed both normally and non-normally distributed variables.

Results: NPW enrolees used fewer hospital bed-days at all time points compared to matched controls, with the greatest effect at 12 months (median 2.00 [CI 0.00, 8.00] vs. 4.00 [CI 1.00, 14.00]). Admissions were significantly lower at all time points, halving at 12 months (median 1.00 [CI 0.00, 4.00] vs. 2.00 [CI 1.00, 4.00]). Emergency presentations were lower in the NPW group but not statistically significant. Outpatient non-attendance rates were significantly reduced (12 months: 44.8% vs. 55.6%), showing improved healthcare engagement.

Conclusion: The NPW programme reduced admissions, bed-days, and outpatient non-attendance, suggesting peer health navigators supported by health professionals improve resource use and patient engagement.

Introduction: Why do integrated care programmes succeed in some settings but not others, even when national leadership and funding are aligned? This persistent question shaped our examination of the New Zealand Falls and Fracture Prevention Programme (FFPP), a complex, cross-sector initiative targeting older adults. We applied and extended the Context and Capabilities for Integrating Care (CCIC) framework to explore how organisational and inter-organisational factors contributed to variation in implementation and outcomes.

Method: We conducted a qualitative comparative case study of four large districts with differences in FFPP implementation including 28 semi-structured interviews. Thematic analysis was primarily deductive, using the CCIC framework, but remained open to emergent, context-specific themes.

Results: We identified 43 organisational and implementation factors, of which five had a particularly important effect on FFPP implementation and outcomes: a well-structured governance team, collaborative leadership, engagement with primary care and private organisations, positive prior collaboration experience, and applying a population-based approach. We modified the CCIC framework to more fully reflect our observations by adding prior collaboration experience and a life-cycle approach (from pre-engagement to establishment).

Conclusion: The CCIC framework captured most key organisational dynamics but was enhanced by incorporating temporal and historical dimensions of collaboration.

Singapore's Healthier SG initiative represents a pivotal step toward integrated, preventive, and community-based care for an ageing population. While considerable attention has been given to integrating medical and social care, the role of logistics, ranging from service scheduling to last-mile delivery of health and mobility aids, remains under-addressed in policy implementation. Drawing on my experience as a logistics and health systems researcher, this paper posits that logistics and supply chain systems form a "third pillar" of care integration, particularly for ageing in place. Using Singapore's transition to Healthier SG as a case, I reflect on implementation gaps, system design flaws, and promising innovations.

Introduction: Interprofessional collaboration (IPC) has been proven effective for COPD patients, however an overview on how to develop and sustain IPC in primary care is lacking. The objective of this review was to identify preconditions for IPC in primary care COPD management. Secondary objectives were to study if the identified preconditions differed from those found in the general primary care setting and secondary and tertiary COPD setting.

Methodology: Three separate searches were executed in four databases for publications reporting preconditions for IPC. The identified preconditions were categorised into the domains of the Rainbow Model for Integrated Care (RMIC).

Results: The first search revealed 32 preconditions and covered all RMIC domains. In the second search, 12 additional preconditions were found, with 90% of preconditions overlapping with the first search. The third search revealed only one study and no extra preconditions were identified.

Conclusion: Many preconditions need to be considered when developing IPC for COPD in primary care. However, these are not setting or disease specific. This makes it possible to develop IPC in primary care for multiple chronic conditions and using knowledge gained from other healthcare settings.

Introduction: The demand for person-centred integrated care (PC-IC) requires health services focused on patients' individual needs. Strengthening primary care is crucial in promoting PC-IC. Goal-oriented care (GOC) prioritizes patient goals and fosters interprofessional team-based care, optimizing PC-IC. GOC requires healthcare providers to shift from problem- to goal-oriented practices. However, how providers change their daily practice to align care with what matters most to patients remains unclear.

Aim: This qualitative study explores how primary care providers (PCPs) experience behaviour change when implementing GOC in daily work after an interprofessional GOC-training.

Method: Six months post-training, focus groups with PCPs were organized. A theoretical thematic analysis was conducted using the Capability, Opportunity, Motivation, and Behaviour (COM-B) model.

Results: Twenty-two PCPs participated in five focus groups. Motivational factors catalysed behaviour change towards GOC, including developing awareness on care actions through reflective practice. PCPs identified capabilities such as asking person-centred questions, maintaining a broad knowledge and enhancing their advocacy for patients. Opportunities stressed team support, care continuity, and reflexivity-promoting workplaces as vital for enabling behavioural change in GOC.

Conclusion: Reflective practice is vital for aligning PCPs' behaviour with GOC. Involvement of all colleagues and dedicated time for reflection promote team alignment and consistency in achieving patients' personal goals.

Background: 'Person-centred integrated care' (PCIC) emerged in literature, policy and practice to meet the increasing care needs of an older population living longer with increased levels of chronic illness, multimorbidity and at enhanced risk of care fragmentation. Most evaluations of PCIC have been service-centred, rather than person-centred, and there is a lack of research on the effects of integrated care on patients, especially older people.

Methods: This integrative review explored evidence regarding older people's PCIC experiences, synthesising empirical literature from five databases: Medline, PsycInfo, CINAHL, Embase and Web of Science.

Results: Findings included: i) definitions and components of integrated care and conceptualisations of person-centredness in the context of integrated care; ii) older people's positive PCIC experiences featured: coordination; continuity and relational care; involvement in care, including effective communication and information about care; and holistic care; iii) integrated care optimises care when successfully delivered, however, older people's experiences were mixed; and iv) barriers included a lack of integrated care frameworks developed from patients' perspectives, poor communication and information and staff shortages and turnover leading to discontinuity, limited time for meaningful interactions and follow-up care.

Conclusion: While PCIC optimises care experiences, its evaluation is challenged by multiple conceptualisations and lack of engagement with service users.

Hospital-at-Home (HaH) delivers hospital-level treatment in the home, whether people's own dwelling or a care home. Its intention is to replicate medical interventions available in hospitals in familiar and less distressing surroundings for older people and better coordinate care around the needs of the individuals and their unpaid carers. This study set out to hear directly from those most closely involved, older people themselves, the unpaid carers who support them, and the professionals delivering the service. Drawing on forty-three in-depth interviews, the research highlights both advantages and tensions within the model. Many participants described HaH as respectful, personal, and more attentive than hospital care. Carers welcomed the speed and attentiveness of the service but often found their responsibilities increased, sometimes to a challenging degree. Professionals valued the opportunity to work in a more person-centred way while also pointing to practical obstacles around risk, resources, and coordination with wider services.

Introduction: The transition from hospital to home is a critical clinical juncture marked by significant risks. Third Sector Organizations (TSOs) are well-positioned to support these transitions through volunteer-based programs. Given the increasing complexity of patient needs and the push for reduced hospital lengths of stay, the integration of community resources into transitional care becomes vital.

Objective: Study objectives were i) to identify where TSOs are engaged in supporting post-hospital transitions, ii) to document the characteristics of transitional care models delivered by TSOs, and iii) to characterize the clients participating in these volunteer-supported programs.

Methods and results: Forty-eight articles that reported on a community-based program delivered by a third-sector organization supporting adults transitioning from hospital to home were included. Study results suggest that TSOs can fill critical gaps in transitional care by leveraging local knowledge and providing personalized, practical, and psychosocial support. TSOs leveraged volunteers to offer personalized, community-based support that addressed both practical and psychosocial needs during care transitions; however, significant variability in program structure and limited evaluation data hindered the assessment of effectiveness and transferability. All programs were time-limited, engaged volunteers in service delivery, and provided home-based and community-based services.

Conclusions: This review highlights the importance of integrating volunteers and TSOs into health systems to develop a more comprehensive approach to transitional care. However, the scalability of volunteer and third-sector-facilitated programs may be challenged by a lack of consistency in programs and reporting, which can undermine transferability and evidence-based practice.