International Journal of Integrated Care最新文献

This thesis explored the issue of coordination in the Belgian mental health sector, focusing on "network coordinators" introduced through public policies setting up local networks to counter fragmentation. Using a qualitative and ethnographic methodology, the author examined the work of these new professionals from four perspectives: instruments, practices, knowledge and experience. Describing the contours of a promising but unachievable mandate, this thesis explained the disillusionment that they experience. Finally, it took a critical look at these coordination initiatives by showing the rareness of the "successful coordinator" and highlighting the limits of the network model as it is currently conceived.

Introduction: Integrated care is crucial in delivering coherent and coordinated support to families with multiple and complex problems. Reorienting care organisations towards integrated care is a complex organisational change process. It requires both structural and behavioural adjustments. To learn about effective practice, it is useful to study implementation between contexts.

Description: This mixed methods case study provides a comparison over time of five regional teams simultaneously implementing an integrated care delivery mode. Group interviews identified whether and how different elements in the change approach helped or hindered the change progress.

Discussion: We describe and discuss how the teams were guided and supported in learning to make the behavioural switches associated with their new integrated mode of operation.

Conclusion: Our support-interventions appeared to be largely successful in fostering four pre-defined integrated care behaviours. This research took place during the Covid-19 pandemic, which was challenging but also brought unexpected benefits.

Introduction: Integrated care poses a significant challenge for healthcare policies in Japan as evaluation of hospital discharge services is limited. This study aimed to elucidate the effects of discharge services for elderly acute-care patients on preventing rehospitalisation.

Methods: A retrospective cohort study was conducted using national health data from Kita Ward, Tokyo. Survival analysis was performed with a Cox proportional hazards model, with readmission hazard ratios (HRs) as the primary endpoint. Subgroup analysis examined interactions between each discharge service category (dummy variable) and readmission.

Results: The study encompassed 6,681 subjects. The Cox model adjusted for age, gender, and complications revealed increased readmission events in the discharge service group (HR = 2.92, 95% CI 2.60-3.27). Subgroup analysis by age and length of hospital stay identified a preventive effect in the 85-year-old group (HR = 0.68, 95% CI 0.49-0.93) and 15-21-day length of stay group (HR = 0.73, 95% CI 0.53-1.01), suggesting that discharge services may inadvertently lower barriers to readmission due to healthcare system influences.

Conclusion: While discharge services may elevate readmission demand, they appear to have a preventive effect for individuals aged 85 and over or with an average length of stay of 15-21 days.

Introduction: Addressing challenges due to demographic changes and the quest for improved value in healthcare requires an extended integrated approach to care that fosters collaboration between all stakeholders, especially within collaboration supporting cognitively impaired patients. The aim is to review existing studies on interventions to improve communication and collaboration between such patients, their caregivers and healthcare staff.

Methods: Following PRISMA guidelines, we systematically searched electronic databases Medline (OVID), CINAHL (Ebsco), and Web of Science (Clarivate) for peer-reviewed literature [2010-2020] focusing on intervention studies. Papers were excluded if not assessing the impact of interventions or only presenting a study protocol.

Results: Twelve studies explored diverse approaches to social support, all with the aim of improving communication and collaboration among stakeholders, and identified three intervention types: supporting empowerment, promoting collaborative disease management, and coping, and enhancing communication and relationships.

Discussion: The interventions employed various approaches and assessed a range of outcomes, demonstrating the benefits of enhancing communication and collaboration among stakeholders. Yet only a few studies included the full triad of partners in care.

Conclusion: There is still much to be done to achieve the extended integration of care services and support that will benefit from patient and caregiver involvement.

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.