International Journal of Integrated Care最新文献

Introduction: Childhood adversity is associated with poor physical and mental health outcomes across the lifespan. Integration of health and social care may provide a solution to childhood adversity through practices of better detection and response. There is growing interest in the creation of child and family hubs that integrate health and social care but little literature that describes the development process.

Description: We aimed to evaluate and describe the implementation of a co-designed health and social care child and family hub in Victoria, Australia. Rapid ethnographic methodology was used to iterate the hub components. Practitioners and researchers co-created solutions to barriers identified during implementation.

Discussion: There were five key learnings: (i) Practice change takes time and intensive coaching, (ii) Lived experience is a powerful motivator for practice change, (iii) Integration of services requires more than co-location to break down silos, (iv) Reflective practice is a key driver of practice change, and (v) Using real time data enabled rapid implementation change and directly informed the development of solutions.

Conclusions: Maintaining and developing practice change during implementation requires time and access to a broad range of data to enable iteration and the development of solutions.

Introduction: The 'Scale-Up diaBetes and hYpertension care' (SCUBY) project provides evidence on scaling-up integrated care (IC) in Cambodia, Slovenia, and Belgium. This paper examines macro-level barriers and facilitators to scaling up IC in these settings.

Methods: We used a multi-case study design, with each country being a case. Document review, focus groups, and stakeholder interviews were conducted. The WHO health system building blocks guided the thematic analysis. We then visualised and examined the interlinkages between barriers in each country.

Results: Common challenges to scaling up IC across the three health systems relate to: governance and leadership; health workforce; inadequate health financing system; and fragmented health information systems. In Cambodia, access to non-communicable disease (NCD) services and medicine are important issues. IC scale-up is facilitated by its strong governance and public health service model in Slovenia but health workforce shortages risk progress. In Belgium, the fragmented governance system and predominant fee-for-service provider payment are important barriers. A common response to health workforce and workload challenges was task shifting: to primary care nurses in Belgium, peer supporters in Slovenia, and community health workers in Cambodia.

Conclusions: Examining differences and similarities between barriers in each health system stimulated reciprocal learning. Interactions between health system barriers in specific contexts require further attention to move complex health systems forward.

Introduction: Complex health interventions (CHIs) are common in (public) health and social care practice and policy. A process evaluation (PE) is an essential part of designing and testing CHIs and questions what is implemented, the mechanisms of change, and how context affects implementation. The scale-up of CHIs is challenging and heterogeneous, making the accompanying PE unique to the nature of the inquiry.

Methods: We conducted a scoping review to describe the current practice of conducting PEs alongside or following the scale-up of CHI. Eight primary data sources were searched and data extracted on study characteristics, intervention characteristics, methods used in relation to the PE, and stakeholders included.

Results: We reviewed 10,538 records and included 56 studies. Seven common thematic areas emerged in which CHIs were being scaled-up. The use of scale-up specific frameworks was rare, and common outcomes of the process evaluation focussed on barriers and facilitators in relation to the context; often obtained "once-off" using qualitative and quantitative data sources. Scale-up strategies reported were: supporting increased coverage, comprehensiveness, and institutionalisation; often simultaneously.

Conclusion: Variations in the conduct of process evaluations during the scale-up phase of complex health interventions may reflect differences in context, conceptual challenges, the multi-dimensional nature of scale-up, and the point of engagement with the health care system (e.g., community-level). Ideally, a process evaluation is a recurrent continuous process, leveraging a systems-driven understanding and triangulation of qualitative and quantitative data, that takes place alongside the scale-up project to inform real-world adaptations of scale-up strategies and (untoward) mechanisms of impact when applicable.

Introduction: As in other countries worldwide, Diabetes mellitus type 2 (T2D) and hypertension (HTN) prevalence is increasing in Cambodia. The country is examining models to scale-up integrated T2D and HTN care. However, costs of integrated care in this setting are not yet well-understood. Thus, we modelled the cost of an "Ideal Minimum Integrated Care" (IMIC) package (detection, diagnosis, treatment + health education, self-management and follow-up) for T2D and HTN in Cambodia.

Description: We visualised a package - IMIC - of effective interventions for T2D and HTN inspired by SCUBY-ICP and PEN. WHO NCD and HEART Costing Tools were adapted to estimate annual total IMIC intervention cost per health centre, cost per case and cost per capita.

Discussion: Cost of the IMIC provides information on costs to aid decision-making on implementation. The Excel-based costing tool is easy to accomplish and can be replicated to provide more accurate results by using more precise actual input data, once these are available in the country.

Conclusion: The projected costs of IMIC for T2D and HTN in Cambodia provides evidence to informed decision-making of relevant actors in implementing scale-up of IMIC for T2D and HTN. The model can be used in countries with similar context to calculate costs of integrated care.

Introduction: Youths with mental health problems are often not identified in primary healthcare, which may prevent or delay appropriate support. In the Netherlands, a Consultation and Advise expert team (CandA team) was implemented to support general practitioners (GPs), youth professionals and youths with mental health problems. This study investigates the team's scope, activities, stakeholders' and users' experiences.

Method: Interviews and focus groups with policymakers, healthcare professionals, parents and youths were analysed using ATLAS.ti. Demographics and mental health problems of 706 youths (0-18 years) consulting the CandA team, type of healthcare providers consulting the team, and type of care provided by the team (2015-2017) were analysed, using descriptive statistics and Chi-square tests.

Results: Youths consulted the CandA team for 'other behavioural/psychological complaints' (41%); irritable/angry behaviour (14%); anxious/nervous behaviour (10%); overactivity (8%); feeling down/depressed (6%). CandA team services were used by GPs, youth counsellors, and youth physicians/nurses. Most stakeholders were positive about the team's services.

Conclusion: The CandA team seems an adequate form of integrated assessment and support for youth mental health problems in the community. The team's composition, expertise and positioning are success factors. Cooperation with schools could be improved. Quantitative evaluation is needed to investigate effects of the team and adequacy of referrals.

Background: Limitations of traditional structures and approaches to further enhance patient safety, satisfaction, and systemic sustainability in healthcare, are becoming increasingly visible. Embedding reflexivity is a proposed strategy to promote progress. We aimed to explore the potential of creating reflexive spaces for promoting integration and client-centeredness in maternity care specifically.

Methods: In this participatory action research (PAR), two multidisciplinary and multiorganizational groups of maternity care professionals and clients (n = 28) from two Dutch regions, participated in 'reflexive dialogues'. Cases were discussed from a Safety-II perspective. In total, 22 meetings took place from 2020-2022, mostly online. Additionally, 23 participants were interviewed. Data were audio-recorded, transcribed, and thematically analyzed.

Findings: Participants were generally positive about the reflexive dialogues and Safety-II approach. They felt both safe and challenged to critically reflect on their own and each other's care practices. Exchanging perspectives, experiences, and approaches fostered trust, well-being, and repertoire, and through this, resilience.

Conclusions: By structurally stimulating, facilitating, and embedding Safety-II guided reflexive dialogues between professionals and clients from multiple organizations and disciplines, healthcare leaders could promote resilience and reinforce the transformation towards integrated, relation-centered maternity care.

Introduction: People with multimorbidity can experience fragmented healthcare and burden of treatment and the evidence-base for integrated care in multimorbidity is weak. The aim of this study was to develop a model for integrated care for patients with multimorbidity: The Primary Organization and Relations-Team (PORT).

Description: The PORT prototype was formed using a co-production approach including workshops with healthcare professionals from hospital, general practice and municipalities, and interviews with patients with multimorbidity. The qualitative data were analyzed with systematic text condensation. During the co-production phase, 38 persons were interviewed or participated in workshops. Four themes emerged as central for integrated care for patients with multimorbidity: Information sharing, decision making across sectors, healthcare fragmentation, and patient-centeredness. A prototype aimed at these themes was developed and included continuous information sharing and case management by a joint specialty clinic, a total healthcare plan, and systematic needs assessment.

Discussion: The results and PORT prototype were developed through a comprehensive co-production process and the results and model may be transferred to other healthcare systems that are divided into sectors.

Conclusion: Integrated multimorbidity care may be met through continuous information sharing, case management by a joint specialty clinic, a total healthcare plan, and systematic needs assessment.

Background: How have we progressed and where are the gaps of integrated care in Singapore? Social-health care provision in the context of an ageing population is critical in the city-state's management of the unprecedented demand as the proportion of seniors with multiple complex medical needs have almost doubled in the past decade.

Objective: This study measures the maturity level of Singapore's integrated care, identifies key gaps and discusses their implications using the SCIROCCO Exchange tool, an online self-assessment tool consisting of the 12 dimensions necessary for the provision of integrated care.

Methods: A three-step mixed method Delphi study was used to derive expert consensus. Participants across the social-healthcare sector as well as representatives from all three public healthcare delivery networks with at least five years of experience were included. Participants rated each of the twelve dimensions of the SCIROCCO Exchange tool on a six-point ordinal scale and provided justifications for each rating. Criteria from the RAND UCLA appropriateness method and thematic analysis were adopted for the analysis.

Results: All participants completed the study. The study found five dimensions in the "Initial" maturity level and five dimensions in the "Progressing" maturity level. There were two dimensions which were "Uncertain" because of split responses, possibly due to their differing vantage points and conceptualisations of integrated care. The overall medians were plotted on a spider diagram. The absence of a systematic approach for integrated care was the most common subtheme across all dimensions. This is foundational for integrated care as this would enable stakeholders across health and social care to identify with a common goal.

Implications: The findings emphasise the imperative to reshape social-health care delivery by focusing on foundational dimensions (such as structure, governance and citizen empowerment) to enable progress in other dimensions. Following the conclusion of this study, Singapore initiated a primary care reform with the launch of Healthier SG in July 2023. Future research may wish to explore the impact of Healthier SG on maturity of integrated care in Singapore.

Introduction: This study explored the Osona palliative care system, recognized internationally for its good results in managing the chronic patient. The literature notices a gap of models that evaluate integration in healthcare systems. This study assesses the degree of integration of the Osona palliative care system, as well it implements a model that evaluates integration.

Methods: This research used a qualitative methodology, involving a case study design with three study phases. The first phase involved reviewing primary sources, followed by conducting interviews. The final phase entailed comparing the findings with a theoretical model to analyse and validate the results.

Results: The study found the integrative elements that the Osona system includes such as: multidisciplinary teams, leadership and a palliative care system that is cost-efficient. It also found aspects to improve including collaboration, continuity of care, early patient identification and lack of funding.

Discussion: Our findings suggest that the Osona system has made significant progress toward integration, even though it continues the path of ongoing development in integrated care.

Conclusion: This research found that the Osona palliative care system includes many integrating aspects such as multidisciplinary teams, leadership and the system's cost-efficiency. Nevertheless, some aspects need changes such as continuity of care, collaboration, enhanced early patient identification and increase funding. Furthermore, this study provides an example of how to assess integration in a system.

Introduction: Integrated care programs that prioritize comprehensive service delivery for behavioural health and medical conditions have the potential to improve patient outcomes. Few programs, however, use data-driven methods to guide program evaluation and implementation, limiting their effectiveness, as well as the scope of findings in the research literature.

Purpose: To address these gaps, we describe an innovative and rigorous evaluative research framework: the Rutgers Integrated Care Evaluation (RICE) Research Framework, designed to be tailorable across conditions and care settings.

Method: The RICE Research Framework is guided by two core concepts: (1) an approach built on engaging as equal partners and (2) data source triangulation. For the former, the approach relies on multiple teams (Project, Clinical Site, Evaluation, and Consumer) working in collaboration. While teams have specific roles, all teams engage frequently as equal partners to facilitate performance and advance research deliverables. For the latter, we provide a template with recommended primary and secondary data sources with areas of focus, applicable methods, and samples. These sources, when used in combination, can guide implementation, advance replicability, develop/refine health care programs, and foster dissemination of scientific findings.

Conclusions: We recommend clinicians and scientists implement the RICE Research Framework to enhance their integrated care programs.