International Journal of Integrated Care最新文献

Introduction: While the World Health Organization (WHO) advocates organizing maternity care and preventive child healthcare (PCHC) as people-centred, integrated healthcare services, globally these services are often established separately, causing discontinuity of care. Our aim is to synthesize the evidence concerning what impacts parents' experience of continuity of care, and how to promote it.

Methods: Qualitative systematic review. Embase, Medline, Web of Science, Cochrane, CINAHL and Google Scholar were searched for studies on parents' perspectives on integrated care. Helpful practices and issues regarding continuity of care were identified.

Results: We found that parents valued easily accessible, tailored, family-centred care that is a display of interprofessional collaboration and is geared towards supporting and empowering parents.

Discussion: Study strengths are its qualitative nature, allowing for in-depth patient views and experiences, and the multidisciplinary research team, which ensured a multidimensional view of the issue.

Conclusion: Ideally, (a) parents enter the postnatal period well-prepared, and well-informed about self-care, PCHC and possible postnatal carepathways, (b) number of caretransfers is limited, (c) by overlapping maternity care and PCHC, parents are provided with an opportunity to maintain meaningful relationships with their care providers, and (d) information is consistent, family-centred, and tailored.

Introduction: Multimorbid patients have been growing, leading to an exponential increase in healthcare costs and patterns of resource utilization. Despite the heightened interest toward integrated care programs as a response to the complex need of multimorbid patients, economic evaluations of these programs remain scarce. This work investigated the economic evaluations of service interventions targeting multimorbid patients, to identify the characteristics of these programs and the methods applied to their evaluation.

Methods: We conducted a scoping review of papers published between 2010 and 2021 on PubMed, Science Direct, EconLit and Web Of Science. The search strategy was built around three keyword blocks: service interventions, multimorbidity, economic evaluations. We selected economic evaluations of service interventions delivered through multiple care settings and targeting patients with 2+ chronic conditions.

Results: Twenty-five articles were included. Interventions were categorized as organizational-type versus patient-oriented. The selected studies often targeted patients with one chronic disease, associated with a mental disorder, like depression or anxiety. Included studies were mostly cost-utility analyses conducted with the healthcare perspective.

Discussions and conclusions: This work confirmed that economic evaluations of service interventions for multimorbid patients are limited in number. This could suggest that decision-making regarding the delivery of healthcare services for multimorbid patients may not always be based on a solid evidence base. More economic analyses are needed to inform evidence-based coverage decision-making.

Integrated care demands a workforce that is confident, capable and compassionate. This is dependent on a willingness to work inter-professionally and understand the roles, standards and values of other professional groups. However, there are few examples of integrated care initiatives within higher education that aim to build the knowledge and skills required to support effective integrated, people-centred care. While satisfying, working in the helping professions is emotionally challenging and for students' these challenges are often underestimated. Some students struggle through their studies with many failing to complete and others drop out in the early years of their careers. Understanding what supports students to thrive in their professional roles is essential to retention of a highly skilled integrated workforce. To address this challenge, this paper outlines a conceptual framework designed to promote a pedagogical environment focused on creating the conditions for integrated working. The framework is based on the "student lifecycle", from starting to see the benefits of a career in the helping professions, developing a sense of belonging through to thriving and succeeding as future practitioners. It outlines how students are supported to develop emotional resilience, inter-professional empathy and reflexivity to help them stay and stay well in their careers.

Introduction: Peer support workers-people with a significant lived and living experience of a social or health condition-use their experiential knowledge and obtain training to help and care for others. They are integrated in different clinical settings, including those for people experiencing homelessness. Most research on peer support implementation in homelessness has not considered the timing of the implementation, particularly in periods of crisis.

Description: During the COVID-19 pandemic crisis, a participatory research project examined the integration of a peer support worker in a primary and community care clinic that serves people experiencing homelessness in Montreal (Canada). This article presents a narrative case study analysis of the specific data on implementation derived from this project.

Results: Three main learning points are of interest regarding implementation: 1) crises can precipitate challenges but also particular opportunities for the implementation of peer support initiatives in homelessness; 2) even during a crisis, certain key steps cannot be skipped when the goal is a successful implementation; and 3) research can be an external asset for clinical teams as they struggle to deliver care during periods of crisis.

Conclusion: Peer support initiatives in homelessness can be implemented in the Canadian context during periods of crisis-for example, the COVID-19 pandemic-for health and social care services. Moreover, the concept of crisis itself can be reexamined by clinical and research teams worldwide as potentially enabling the implementation of novel initiatives.

Introduction: China's rapidly aging population and rise in chronic diseases put immense strain on the country's healthcare system. To address these challenges, Yuhuan People's Hospital established County-level Integrated Health Organization (CIHO) as part of the Healthy China 2030 initiative.

Description: Based on the Kaiser Permanente (KP) model, the CIHO takes a multi-disciplinary, collaborative approach to deliver integrated care. It brings together various medical specialties, collaborates with community organizations and companies, and implements reforms in information technology and payment models. Through these efforts, the CIHO has significantly improved healthcare delivery in Yuhuan county.

Discussion: Population segmentation relies on data integration and segmentation tools to identify targeted healthcare needs. The allocation and collaboration of health workforce for residents with different health conditions are suggested to be dynamically designed according to both internal and external factors. Corresponding payment mechanism is also an important factor that needs to be taken into consideration.

Conclusion: The CIHO's success has provided a model for integrated, efficient healthcare that could be replicated in other regions of China and offer insights for rural areas in other countries facing similar demographic and epidemiological pressures.

Background: Social prescribing link workers support patients to connect with community resources to improve their health and well-being. These roles are prominent in policy, but there is limited evidence on what support is provided by link workers and what factors influence implementation of link worker interventions.

Methods: A convergent, mixed methods process evaluation of an exploratory randomised trial of a one-month general practice-based link worker intervention targeting adults with multimorbidity in deprived areas. Qualitative data from interviews with 25 patients, 10 general practitioners, 10 link workers and eight community resource providers were thematically analysed and integrated with quantitative data to explore implementation, adaptations, context and mediators.

Results: GPs reported recruitment challenges related to complicated research documentation and COVID-19 related workload and restrictions. Despite most components of the intervention being delivered, the intervention was considered too short to support people with complex needs to connect with resources, particularly in the context of COVID-19 restrictions. Timing of the referral, location within general practice and link workers' person-centred approach facilitated the intervention.

Conclusions: For future evaluations, recruitment procedures need to be simplified and integrated into everyday practice. For patients with multimorbidity, a longer intervention is indicated to achieve connection with community resources.

Introduction: The SCUBY project aimed to provide knowledge on the scaling-up of an Integrated Care Package (ICP) for type 2 diabetes and hypertension across three distinct health systems (Cambodia, Slovenia, and Belgium). Here, we analyse the different elements of the country-specific scale-up roadmaps to identify similarities and differences, and share lessons learned.

Methods: Thematic analysis was used to derive crucial roadmap elements from key SCUBY documents (n = 20), including policy briefs, interim reports, research outputs, and consortium meeting notes.

Results: Roadmap elements differed according to priority needs, features of the (health) systems, and partly reflected the position of the SCUBY research team within each country. Common cross-country elements were: task-shifting to patients themselves, nurses and community health workers; strengthening monitoring and evaluation; and creating an enabling environment for ICP implementation.

Discussion: Scale-up of complex interventions requires continuous engagement of multiple stakeholders and contextualization of action plans. The linkage of research teams with key implementation stakeholders and policy makers creates change-teams, allowing advancement from formative research to implementation of roadmap strategies and full scale-up in due time.

Conclusion: The development processes and contents of the roadmaps provided essential and reciprocal learnings. These learnings help shape future policy dialogues and best practices to tackle chronic disease in each participating country.

Background: Higher life expectancy has produced a higher older people porpulation, not necessarily with a consistent quality of life, showing a high rate of vulnerability and dependence. The current social and health crisis situation has highlighted the need to create new integrated models of care that could be translated into social and health policies.

Objective: The present study aims to develop, test, and validate an innovative integrated care model for older people with dependence and at risk of social exclusion and their caregivers.

Methods: The TEC-MED project participants are nine project partners and six associated partners, with geographic coverage from six countries in the Mediterranean basin, Spain, Tunisia, Italy, Lebanon, Egypt, and Greece. Project coordination will take place at three different levels, macro, meso and micro, through six work packages. The pilot phase uses qualitative-quantitative method to assess the impact of the TEC-MED project, it is expected to train 36 Training Agents, six per country, who apply to a total of 28,200 people (mainly elders and their caregivers).

Conclusion: The study proposes a new social integrated care organizational model focused on the integration of social and health care, comprising the governance model; the organization structure and the skills profiles for the caring personnel.

This study documents the experience of implementing an adaptation of the Hospital-at-Home (HaH) model to alleviate the constraints in available hospital beds and manpower amid a surge in infection rates in Singapore during the Omicron and XBB COVID waves, addressing challenges and proposing insights for scalable implementation. HaH substitutes inpatient hospitalizations by leveraging existing community healthcare services and remote healthcare technologies. This HaH adaptation was designed to be activated in during surges and deactivated when bed and manpower demands stabilize, making it less intensive on hospital resources. HaH demonstrated success in facilitating safe early discharge and admission avoidance for high-risk patients, reducing hospital bed utilization without reducing care quality. However, challenges including lack of technological literacy, language barriers, and miscommunications resulting from clerical errors were experienced. Our findings suggest that hospitals with internal resource constraints can make adaptations to leverage existing providers and assets within the community where necessary. We also observed that HaH shifts many aspects of healthcare responsibility to patients and their caregivers, which may be beyond their expected capabilities. Clear communication of expectations and limitations from all parties involved is paramount to upholding the quality of care in HaH.

Introduction: Multimorbidity challenges quality and sustainability of healthcare systems. Care groups were introduced in the Netherlands to promote integration of chronic primary care, but it remains unknown to which degree they facilitate this. This study therefore aims to determine whether Dutch general practices perceive themselves to be capable of delivering integrated chronic care and uncover the role of care groups.

Methods: We performed a survey study amongst 39 care groups and 65 healthcare providers within general practices (GPs and nurse practitioners).

Results: 43% of healthcare providers within general practices are (very) dissatisfied with capabilities for chronic care to patients and 56% do not feel capable of delivering integrated care. Care groups and providers show alignment in their perception of some of the most important facilitators and barriers such as motivation and lack of time, but other factors are valued differently at both levels.

Discussion: Our findings show inability of general practices to deliver integrated chronic care despite a health system that is inherently supportive of care integration and point to a mismatch between barriers and facilitators amongst practices and care groups, resulting in providers partly relying on their motivation in accommodating integrated chronic care.

Conclusion: General practices are not sufficiently supported by care groups and national policies in delivering integrated chronic care. The identified mismatch between policy and practice warrants redesign of support from care groups to align policies with identified barriers and facilitators at the provider level.