International Journal of Integrated Care最新文献

Introduction: There is a need to improve public health interventions to promote youth social and emotional development in close collaboration with schools, families and local communities. A close intersectoral collaboration between the regional public health, schools and school boards was established to co-construct and implement "Positive Intervention (PI)" in the Eastern Townships region (Quebec, Canada). This paper describes its implementation according to the "Integrated Community Care (ICC)" framework.

Description: PI is a collaborative and personalized intervention leaning toward an integrated community social care model. In fact, PI relies on the close proximity between Public Health and their educational counterpart as well as their individual temporality. However, PI offered mainly social services and its relationships with Primary Care services was not yet a priority.

Discussion: The results show that it is possible to develop and implement an intervention promoting positive mental health in children, with and for local organisations. The level of integration between schools and Public Health services achieved after only 6 months of implementation is encouraging.

Conclusion: More research is needed to thoroughly document the implementation, social validity, and effects of such an intervention by taking in the point of view of all stakeholders.

Introduction: Reducing hospital use is often viewed as a possible positive consequence of introducing integrated care (IC). We investigated the impact of an IC programme in North East Hampshire and Farnham (NEHF), in southern England, on hospital utilisation among older adults over a 55 months period.

Method: We used a Generalised Synthetic Control design to investigate the effect of implementing IC in NEHF between 2015 and 2020. For a range of hospital use outcomes, we estimated the trajectory that each would have followed in the absence of IC and compared it with the actual trajectory to estimate the potential impact of IC.

Results: Three years into the programme, emergency admission rates started reducing in NEHF relative to its synthetic control, particularly those resulting in overnight hospital stays. By year 5 of the study overall emergency admission rates were 9.8% lower (95% confidence interval: -17.2% to -0.6%). We found no sustained difference in rates of emergency department (ED) visits, and average length of hospital stay was significantly higher from year 2.

Conclusion: An IC programme in NEHF led to lower than estimated emergency admission rates; however, the interpretation of the impact of IC on admissions is complicated as lower rates did not appear until three years into the programme and the reliability of the synthetic control weakens over a long time horizon. There was no sustained change in ED visit rates.

Introduction: Delivery of end-of-life care for severe chronic obstructive pulmonary disease (COPD) has been hampered by an unpredictable disease trajectory and poor integration of health care and social services.

Objective: To critically explore the perspectives, values, and experiences of stakeholders in COPD end-of-life healthcare services in a large district in Aotearoa New Zealand.

Design: Focus groups analysed utilising critical theory and Actor-Network Theory.

Methods: Stakeholders in end-of-life COPD healthcare services were purposively sampled from a large healthcare network in Canterbury, Aotearoa New Zealand to participate in seven focus groups (bereaved carers, community-based health professionals, non-Māori, non-Pacific patients, and support people (two groups), Māori patients, supporters and health professionals, Pacific patients, support people and health professionals, and hospital-based health professionals). Participants discussed end-of-life care services for people with COPD. Transcripts were coded utilising descriptive and structural coding to develop themes related to provision of quality care. Participants were positioned as experts. We considered how the themes arising supported and disrupted the healthcare network for end-of-life COPD.

Results: Five themes related to quality of care for end-of-life COPD were identified: compassion, competence, community, commitment, and collaboration. The absence of any of these five themes required for quality care led to power imbalances within healthcare systems. Power inequities created disconnection among stakeholders which then disrupted commitment, community, and collaboration. A dysfunctional healthcare network impeded compassion between stakeholders and did not support their competence, leading to lower quality care. All five themes were identified as essential to delivery of high-quality end-of-life care in COPD.

Conclusion: Stakeholders' perspectives of end-of-life care for COPD identified of core features of a health system network that enabled or impeded the actions of stakeholders and allocation of resources to provide quality care.

Introduction: Integration of HIV and non-communicable disease (NCD) services is proposed to increase efficiency and coverage of NCD care in sub-Saharan Africa.

Description: Between October 2018 to January 2020 in Tanzania and Uganda, working in partnership with health services, we introduced an integrated chronic care model for people with HIV, diabetes and hypertension. In this model, patients were able to access care from a single point of care, as opposed to the standard of siloed care from vertical clinics. When the study ended, routine clinical services adopted the integrated model. In this article, we discuss how the model transitioned post hand-over in Uganda and draw lessons to inform future scale-up.

Discussion: The findings suggest potential for successful uptake of integrated chronic care by routine clinical services in sub-Saharan Africa. This approach may appeal to health care service providers and policy makers when they can quantify benefits that accrue from it, such as optimal utilization of health resources. For patients, integrated care may not appeal to all patients due to HIV-related stigma. Key considerations include good communication with patients, strong leadership, maintaining patient confidentiality and incorporating patient needs to facilitate successful uptake.

Conclusion: Evidence on the benefits of integrated care remains limited. More robust evidence will be essential to guide scale-up beyond research sites.

People with lived experience of health and social care, including family carers, should be at the heart of integrated care policy and practice. One of the challenges to achieving such co-production is insufficient clarity and limited understanding of the different roles that people with lived experience are asked or choose to undertake. Following research and workshops, four roles have been identified - community builder, improvement expert, disruptor/advocate, and citizen leader. Recognising the distinct contribution and demands of these roles will enable appropriate support and development for people with lived experience and the professionals and managers with whom they collaborate.

Background: It is currently the most cost-effective management model to have multiple professionals from relevant institutions collaborate so as to provide integrated chronic disease management services. The "classified, color-coded, hierarchical and regionalized" chronic disease management model in Youxi County, Fujian Province is a typical case in China. However, related research is limited. This paper aims to analyze the practice measures and lessons learned in Youxi County, focusing on the professional integration of service providers.

Methods: From January to March 2021, interviews with 15 key informants in Youxi County were conducted to collect qualitative data, which was analyzed by the thematic framework method as well as the policy data, using the professional integration dimension in the evaluation framework of the integrated healthcare system.

Results: A series of measures were taken, such as improving the professional division and collaboration mechanism, establishing the incentive and restraint mechanism geared toward chronic disease management, formulating norms and standards of chronic disease management for patients with different color labels, and promoting the compatibility of inter-professional value and culture under the governmental institutional supply and the organizational support of the tight county healthcare alliance in Youxi County, to prompt professionals of different levels and types to collaborate in order to provide integrated chronic disease management services. However, some problems remained, such as limited capacity of primary health care, the relatively narrow range and weak effect of the incentive and restraint mechanism, inadequate implementation of the norms and standards, and so forth.

Conclusions: Our findings provide reference for other regions in China and other low- and middle-income countries in exploring the integrated chronic disease management model. Long-term follow-up surveys and mixed research designs are required in the future to enrich relevant evidence.

Introduction: As the world population ages, health and social care professionals are increasingly confronted with patients with chronic long-term conditions and multimorbidity, requiring an extensive assessment and integrated care management strategy. The aim of this paper was to systematically collect and assess evidence of interprofessional education and training strategies for Comprehensive Geriatric Assessment (CGA) to build a competent health workforce.

Methods: A systematic review was conducted according to PRISMA guidelines and the databases Medline, CINAHL, Cochrane and Embase were searched for studies illustrating effectiveness of educational interventions for teaching and training CGA in an interprofessional context.

Results: Based on 21 identified studies, a great variability and heterogeneity in duration, setting and design of the interventions was identified. Promising results were found in the domains analysed, ranging from knowledge and skills; practices and behaviour; patient health outcomes; attitudes and perceptions to collaboration and quality of care.

Discussion: Education and training of transversal skills within a continuous learning approach is key to equip the health care workforce for successful CGA performance in an interprofessional environment.

Conclusion: Further research in this field is recommended to strengthen the evidence-base towards development of a resilient and integrated health care workforce for an ageing population.

Introduction: As the number of children and young people (CYP) presenting to Emergency Departments (ED) with acute mental health (MH) presentations has been steadily increasing over the years and further accelerated by the pandemic, there is an urgent need to develop and evaluate innovative solutions to respond to this growing challenge.

Description: The evaluation of the Safeguards Teams Program (STP) aims to ascertain the impact, implementation and economic analysis of this acute rapid response recovery-focused, trauma-informed assessment and brief intervention for CYP (aged 0-17 years) presenting in acute MH crisis and their families/caregivers.The STP will support consumers (patients) and their families/caregivers to navigate the complex and often fragmented child and adolescent MH services (CAMHS) landscape, thereby avoiding unnecessary ED presentations or hospitalisations, and facilitating comprehensive assessment and appropriate care pathways for those who present in crisis.

Discussion: The STP is expected to provide CYP in MH crisis and their support networks with early access to evidence-based specialist care at the right place and time.

Conclusion: Implementation of the STP will assist with identifying and addressing gaps in acute care for CYP and provide the necessary evidence for service redesign in collaboration with consumers, service providers and other stakeholders.

Background: Cooperation is a core feature of integrated healthcare systems and an important link in their value-creating mechanism. The premise is that providers who cooperate can promote more efficient use of health services while improving health outcomes. We studied the performance of an integrated healthcare system in improving regional cooperation.

Methods: Using claims data and social network analysis, we constructed the professional network from 2004 to 2017. Cooperation was studied by analyzing the evolution of network properties at network and physician practice (node) level. The impact of the integrated system was studied with a dynamic panel model that compared practices that participated in the integrated system versus nonparticipants.

Results: The regional network evolved favourably towards cooperation. Network density increased 1.4% on average per year, while mean distance decreased 0.78%. At the same time, practices participating in the integrated system became more cooperative compared to other practices in the region: Degree (1.64e-03, p = 0.07), eigenvector (3.27e-03, p = 0.06) and betweenness (4.56e-03, p < 0.001) centrality increased more for participating practices.

Discussion: Findings can be explained by the holistic approach to patients' care needs and coordination efforts of integrated healthcare. The paper provides a valuable design for performance assessment of professional cooperation.

Highlights: Using claims data and social network analysis, we identify a regional cooperation network and conduct a panel analysis to measure the impact of an integrated care initiative on enhancing professional cooperation.Physician practices participating in the integrated system became more cooperative and improved their influence in the regional network more than non-participating practices.Integrated healthcare systems effectively incentivize cooperation through a holistic approach to patient care needs and coordination efforts.