International Journal of Integrated Care最新文献

Introduction: Patients with multiple autoimmune diseases lack continuity of care due to increasing specialisation and siloed practice in healthcare. Despite improvements in quality, this organisation has led to fragmented patient pathways, as related diseases are treated separately. Limited research has investigated approaches to integrate care for patients with co-occurrent Inflammatory Joint Disease and Inflammatory Bowel Disease, with minimal emphasis on the patient perspective. The aim was to describe the Rheumatology-Gastroenterology Clinic (ReGa), characterise its population, and investigate patient experiences.

Description: A Danish outpatient clinic combining rheumatology and gastroenterology.

Results: During the study period, 54 patients attended the ReGa clinic. Prior to integration, these patients had an average of 29.6 outpatient visits. With most working-age patients, this frequent attendance poses individual and societal challenges. Based on Haggerty et al.'s definition of continuity of care, relational elements emerged as particularly important for patients but not independent of informational and management factors.

Conclusion: The integrated approach was experienced to improve continuity of care for patients with multiple autoimmune diseases. The findings highlight the potential to bridge healthcare gaps and address challenges arising from organisational structures shaped by specialisation and compartmentalisation of knowledge. This approach may also benefit other patient groups with comorbid conditions.

Current insights into how to personalise supportive care for patients with immune-mediated inflammatory disorders (IMIDs) remain limited. Enhancing supportive care can significantly improve patients' quality of life and overall healthcare. The Subjective Health Experience (SHE) model offers a practical framework for segmenting patients based on disease acceptance and control, potentially guiding tailored supportive care. This qualitative study had two aims: explore patient characteristics (behaviours, questions, and needs) within each SHE Segment; and determine required supportive care per Segment by identifying the what (specific types of supportive healthcare) and the how (approach of healthcare delivery). Group discussions and individual interviews were conducted with 19 healthcare professionals in rheumatology, gastroenterology, and dermatology, and 18 patients diagnosed with rheumatoid arthritis/spondyloarthritis, Crohn's disease/ulcerative colitis, or psoriasis/hidradenitis suppurativa. Findings revealed consistent patterns across IMIDs regarding healthcare needs. Patients emphasised the importance of attention and acknowledgement, while healthcare professionals focused on structure and planning. Detailed Segment descriptions supported development of a structured framework aligning supportive care types and delivery approaches with each SHE Segment. Overall, these results support the SHE framework as a guidance for coordinating supportive care across conditions, professionals, and care levels, enhancing its operational use in IMID care to improve personalisation and continuity.

Background: Complex interventions are frequently used at different levels in healthcare. The main aim of this paper is to describe a method for conducting a feasibility study in preparation of an evaluation study for a complex intervention by substantiating several essential methodological choices. These choices are (A) establishing the most appropriate outcomes and instruments to measure them, including comprehensibility of questionnaires for study participants, (B) exploring the distribution and size of these outcomes in the patient target population and (C) quantifying key assumptions for the sample size calculation. We describe this method through the example of our feasibility study on a person-centered and integrated care (PC-IC) approach for multimorbidity and chronic conditions in general practice.

Methods: In 2021 we conducted a feasibility study in 7 general practices in three regions in the Netherlands. These practices replaced their standard disease management programs for diabetes mellitus type 2, cardiovascular disease, chronic obstructive pulmonary disease, and asthma with the PC-IC approach. Systematically selected questionnaires were administered to eligible patients at baseline and at 6 months, and comprehensibility of the questionnaires was assessed. We defined a composite outcome by comparing different scenarios for combining the questionnaire scores.

Results: The method for thoroughly designing an evaluation study for a complex healthcare intervention consisted of several steps. First, the measurement instruments for the feasibility study were chosen after a structured literature search, consulting experts, checking the questionnaires for comprehensibility by patients, and a consensus meeting with the project team. Next, the questionnaires were applied in the study target population for a period of 6 months. The results were then analysed to explore the distribution and size of these outcomes. Subsequently we assessed the most appropriate outcomes, which led to the creation of a composite outcome in our example. The final step was performing a sample size calculation based on the results of the feasibility study.

Conclusions: Using the described method, we conducted a feasibility study to prepare the evaluation of a complex intervention in Dutch general practice. Our paper is useful for other researchers preparing evaluation studies on complex interventions.

Introduction: Socially disadvantaged and marginalised groups experience significant barriers to accessing healthcare compounded by the complexity and lack of integration between health services. Social housing residents face persisting health inequities linked to poverty, stigma and chronic conditions. International evidence suggests tailored, community-based initiatives can advance health and equity by building capacity, trust and engagement, notably through peer-based roles. However, there is little detailed literature on the mechanisms that support successful implementation and impacts across both community and health systems.

Description: The paper describes the implementation and evaluation of a community-driven and co-designed peer-to-peer health education program in social housing communities in Australia. We use a mixed-methods, realist-informed methodology to assess the program's effectiveness and identify success factors at individual, program and organisational levels.

Discussion: An important lesson is that a strength-based and community-led model is effective in areas of entrenched disadvantage and can have greater reach than other health promotion approaches. The program's flexibility, holistic remit, and focus on sharing power and trust-building were crucial for its success.

Conclusion: Peer and community-based initiatives are becoming an increasingly important component of integrated care programs. Valuing the process as well as the outcomes and providing long-term timeframes and ongoing resources are critical to sustain change.

Introduction: This study explores the challenges faced by healthcare professionals in providing integrated care for individuals living with co-occurring schizophrenia and type 2 diabetes in Denmark. Despite the increased complexity of managing both conditions, little research has focused on healthcare professionals experiences and the organizational challenges involved in delivering integrated care.

Description: Using a qualitative exploratory design, the study involved semi-structured interviews with four healthcare professionals, 17 field observations of outpatient consultations, and one focus group interview, conducted between August 2020 and February 2021. Ricoeur's interpretive philosophy was used for data analysis, focusing on the healthcare practices and challenges identified by healthcare professionals.

Discussion: Three key themes emerged: (1) Specialization leads to lack of knowledge and fragmented care, (2) The need for guiding in a complex healthcare system, and (3) The missing link - a lack of overview of healthcare services. These challenges impact integrated care delivery, as discussed in the context of Denmark's healthcare system and international evidence.

Conclusion: The study highlights the need for a more integrated, holistic approach to care, including improved collaboration between specialized and general healthcare professionals, better care coordination, and policy improvements. Further research is needed to identify effective strategies for overcoming these barriers and to create more integrated care pathways for patients with complex conditions.

Background: This study aimed to develop consensus on the core elements of the Community Specialist Teams for Older People (CST OP) service model.

Methods: This study utilised a modified Delphi approach. World Café Focus Groups (n = 97) were facilitated to develop and refine statements which were included in a Real-Time Delphi survey.

Results: Four key themes were produced from the World Café Focus Groups data: Fundamentals of service design, Access and transitions of care, Team Functions and Quality improvement. Themes produced informed the CST OP Real-Time Delphi survey, which was completed by 77 participants, representing a response rate of 78%.

Conclusion: The modified Delphi approach has resulted in the refinement and agreement of a set of core CST OP statements that outline the key components of the CST OP service model which will guide future implementation and delivery of the CST OP model of care, ensuring consistency in the design and implementation of the CST OP model.

While the benefits of mentorship programs are well established, their effective design, implementation, and sustainability remain complex and challenging. This perspective paper contributes to the mentorship literature by presenting key lessons learned from the implementation of a mentorship program in the emerging field of integrated health and social care. We suggest that prioritizing thoughtful mentor-mentee matching, promoting flexible and adaptable mentoring meeting formats, offering clear guidance for structured mentoring meetings, and acknowledging the reciprocal value of mentoring relationships can inform strategic approaches to strengthening mentorship programs in integrated care and beyond.

Background: Cancer survival rates vary significantly between low and high-income areas. By leveraging community assets, healthcare inequities may be addressed. Nationally, Macmillan Cancer Support (Macmillan) (a national cancer charity) is working with local Voluntary and Community Sector (VCS) organisations to improve cancer care.In Plymouth, where cancer mortality is above average, Macmillan has partnered with the Zebra Collective (Zebra) (a community cooperative), Age UK Plymouth (a local charity), The Wolseley Trust (Social Prescribing team), and General Practice (GP) surgeries. In Spring 2024, the Plymouth Cancer Champions' Project (PCCP) launched to address these inequities through community-led approaches via peer-to-peer community engagement and volunteer recruitment.

Approach: This Integrated Care Case is a practice-based account of how through an embedded ethnographic action research approach, a small community cooperative (Zebra) is influencing its' local low-income community's understanding of and engagement with cancer care services from an asset-based community development approach.

Findings: The PCCP prioritises involving individuals with lived experience, including those from lower socio-economic status backgrounds, minoritised ethnic groups, and cancer-affected backgrounds, in leadership roles. This collaborative, community-driven approach fosters inclusivity, empowerment, and engagement, and a deep contextual understanding of the community context including barriers and strengths. Through an innovative asset-based community development approach, the deficit narrative is countered- enabling people-led change, influence and learning within cancer care inequity and integrated care.

Background: Integration of voluntary and statutory mental health services may address gaps in mental health care. The Community Mental Health Framework for Adults and Older Adults 2019 provided impetus for integration within England. It was unknown how, why, or under what circumstances integration would occur.

Methods: A realist evaluation of Framework implementation in Somerset was undertaken. The extent of change, and how, why and under what circumstances change occurred were evaluated. Embedded researchers collected observational and interview data, and reviewed internal records. Realist qualitative analysis created and tested a programme theory exploring the extent, cause, and impact of change.

Results: Services worked together to create an integrated mental health service using a cultural change model: new language prompted new ways of thinking and working. Programme theory testing demonstrated good extent of change. Voluntary sector integration helped address treatment gaps: all service users were offered a service. Mechanisms of change included: new language, relationship building, flexible working, and valuing voluntary sector services. Contextual factors affecting the extent of change included: balances of power, rigidity of statutory services, and trusting management.

Conclusions: Integrating services using a culture change model addresses gaps in mental health care. Optimal implementation requires addressing contextual barriers.

Introduction: Despite ongoing efforts to integrate health and social services, achieving integration in front-line practice remains challenging. This study explored collaboration in a multidisciplinary development group aimed at improving collaboration in one co-located health and social services centre in Helsinki, Finland. Drawing on the notion of knowledge practices as means for solving complex issues, the study analysed how collaboration and co-development are enacted within the group.

Description: Observational data collected from 11 development workshops were analysed using an abductive approach. The analysis identified three modes of collaboration: 1) one-sided knowledge sharing, 2) collaborative knowledge sharing, and 3) collaborative knowledge creation.

Discussion: Shared concepts and a new multidisciplinary service process supported collaborative modes for working, while some facilitation practices seemed to hinder them. The findings revealed a gap between the ideal of bottom-up development and the organisational conditions influencing it. A clear mandate and purposeful facilitation are critical to achieving the intended goals of such development initiatives.

Conclusion: Stronger theoretical foundations and explicit theories of change could enhance development efforts. This study identified theoretical concepts that illuminate collaboration as a contextually shaped set of social practices. These insights can contribute to the design and facilitation of practice-based development efforts.