International Journal of Integrated Care最新文献

Background: Persons with knee osteoarthritis suffer from a prevalent chronic condition requiring comprehensive treatment approaches. To effectively cater to their needs, healthcare professionals must adopt an integrated health perspective and collaborate across disciplines. This study aimed to understand the viewpoints of patients and healthcare professionals and identify factors influencing collaborative care for persons with knee osteoarthritis.

Methods: Semi-structured interviews were conducted with knee osteoarthritis persons and healthcare professionals involved in their care. Data analysis involved identifying common themes, patterns, and discrepancies among stakeholders. Interviews were coded using NVivo, and inductive analysis was employed to determine themes.

Results: Nine healthcare professionals from various disciplines and eight patients with knee osteoarthritis participated. Five main themes emerged: diagnostics, communication, training conditions, integrated health perspective, and Perceived collaboration and support from healthcare professionals. Persons with knee osteoarthritis sought comprehensive diagnoses and expressed satisfaction. Healthcare professionals faced barriers like limited integrated health perspective and time constraints, stressing the need for interdisciplinary training and collaboration.

Conclusion: Implementing an integrated healthcare vision is crucial for personalized care in chronic conditions like knee osteoarthritis. Continuous training and curriculum integration for healthcare professionals are necessary to prioritize integrated health perspectives and collaboration, thus better meeting the diverse needs of persons.

Introduction: Many older individuals face complex health and social care issues that require an integrated care approach. However, current health and social care services are often fragmented in terms of financing, organisation, and delivery, and therefore do not fit the needs of older individuals. Reablement is an innovative integrated approach that aims to 'help individuals to help themselves' by providing goal-oriented, person-centred care. An interdisciplinary team works intensively with individuals towards their goals, while considering their capabilities and contextual factors.

Description: The aim of this study was to assess the feasibility of a Dutch reablement programme in terms of acceptability, implementation, practicality, adaptation, integration, and limited efficacy. Using qualitative methods, six clients, three informal caregivers, eight care professionals, and one programme director were interviewed, complemented by data from electronic care files. Findings indicated positive stakeholder experiences.

Discussion: Despite positive experiences, three key challenges emerged: 1) behaviour change; 2) in- and external interprofessional collaboration; and 3) enrolment. The study underscores the complexity of implementing and integrating reablement in community care.

Conclusion: Our findings offer critical insights that could guide future efforts to implement reablement programmes more effectively.

Introduction: Worldwide, exposure to sexual violence has widespread consequences for survivors' health and for their communities. There is still insufficient understanding of how to design support and care services for survivors in a multiorganizational context. This study aims to map and explore support and care for survivors of sexual violence from a multiorganizational perspective in Sweden, to identify and understand common improvement areas.

Method: This study was conducted within a larger project called Survive which aims to improve support and care for survivors of sexual violence in Jönköping County in Sweden. This case study integrates qualitative data from interviews (n = 34) and an electronic survey (n = 95) with participants from eight organizations that provide support and care to survivors of sexual violence. Qualitative data was analysed using thematic analysis. The quantitative data from the electronic survey was evaluated to map the 'organizations' involvement in support and care provision by using descriptive statistics.

Results: The findings encompass four themes to improve support and care: 1) Systematic approaches to identifying exposure to sexual violence; 2) A need to improve the integration of existing supportive resources; 3) Need for an interlinked process for trauma therapy and long-term support; 4) The potential of developing capacity, competence and teamwork in trauma care.

Conclusion: It is essential to improve support and care for survivors of sexual violence by developing systematic approaches for identification of sexual violence, interlinked support and care processes as well as improved access and competence in trauma care.

Introduction: The scope of integrated care has evolved and broadened the past decades from specialist pathways to incorporate a more holistic approach. To identify such trends in evidence and knowledge, we analysed published papers in the International Journal of Integrated Care over a 10-year period.

Methods: From an initial set of 5.075 IJIC papers (2012-2022), 508 articles were selected after excluding several categories such as poster and conference abstracts. As no existing theoretical framework seemed to fit our study aim, we chose to focus specifically on two important areas in integrated care that are known for development; impact measurement and co-production in research.

Results: There was an overall growth of published papers in the journal. The papers predominantly feature contributions from Western regions, including Europe, the Western Pacific and the Americas. Results regarding impact measurement showed no clear overarching pattern over time. Engaging the target population as co-producers in the studies is still low (<5%).

Conclusions: Although the number of papers increased pointing towards more attention for integrated care, we could not identify any significant growth or advancement in the two crucial areas of co-production and impact measurement in integrated care research. These gaps need to be addressed accordingly in both practice and research.

Introduction: Integrated care has been adopted as a guiding principle to reduce fragmentation and to make health systems more person-centred. Successful integration requires care services and processes that include primary care, specialist care, and acute services. To promote learning and development in the field, flexible and adaptable empirically derived frameworks for different contexts, conditions and settings are required.

Description: The Western Sydney Local Health District (WSLHD) inTouch Program is a systems approach to reconceptualising service delivery, focusing on integrating systems components, platforms for service delivery and coordinating care planning for improved care delivery. The inTouch Program key features and core elements, and three care pathways are presented, demonstrating the adaptability for different population cohorts.

Discussion: The inTouch Program, and each pathway, embodies an ongoing, dynamic response to patient priorities. Informed by bottom-up stakeholder input from staff, consumers, and care providers, each pathway fosters interorganisational collaboration by facilitating coproduction of care across primary, aged, and community care sectors, as well as hospitals. The analysis derives an inTouch Integrated Care Framework consisting of six core elements, four strategy and governance enablers, and operational components required for practical implementation and sustainability of pathways. Together they operationalise and link diverse health and social care organisations into a living continuum of care.

Conclusion: Accounting for nuances in organisational and care settings, is the difference between success and failure for integrated care. The exploration of the inTouch program and three pathways has detailed how to deliver care for different patient cohorts across health and social care settings. The three care pathways demonstrate the viability and necessity to pursue collaboration, cooperation and care navigation, whilst tailoring services to specific contexts and stakeholder needs. inTouch program aims to ensure safe, high quality patient care is delivered across health and social settings, prioritising the patient needs.

Effective care integration requires the right information, at the right time, with care and support delivered in the right environment. Patient-reported outcome measures [PROMs] offer a mechanism to support collaborative integrated care to help people understand their conditions better, live well, and remain independent. Through the lens of the delivery of integrated care in England, we consider the opportunities and challenges associated with the use of PROMs across health and care.

Introduction: We built Cascades of Care (CoC) for hypertension in Belgium, Slovenia and Cambodia, and assessed CoC stratifications across patients' gender and socioeconomic status. Differences between the CoCs were studied by looking at the level of implementation of the integrated care package and other health system characteristics.

Methods: A mixed methods design: Age-standardized gender-specific hypertension cascades were built from survey and register data and logistic regression analyses were performed. Focus group discussions with experts were used to interpret these results.

Results: In Belgium, the largest gap is between 'prevalence' and 'diagnosis'. In Cambodia, a large drop -especially among men- is found at the beginning and the end of the cascade. In Slovenia, only a limited number of patients is tested and linked to care, but once registered, attrition is quite low. Poor financial situation was a significant determinant of drop-out across the countries but at different stages of the CoC, and especially in Cambodia large gender differences were observed with women being better retained throughout the CoC.

Discussion and conclusion: Despite contextual differences between the countries and difficulties in comparability of the cascades, lessons can be learnt from each country's strengths and weaknesses to improve quality of integrated hypertension care.

Introduction: Social prescribing (SP) involves person-centred integration of non-clinical supports into care, which is critical for addressing mental health and psychosocial needs and enhancing wellbeing. This systematic review evaluated the impact of SP referral pathways on mental health, wellbeing, and psychosocial outcomes.

Methods: Four databases (Medline, Embase, PsycINFO and Scopus) were searched for empirical studies of referral pathways to community-based SP interventions targeting mental health, psychosocial factors and/or wellbeing. Data from studies published from January 2010 to April 2024 were extracted; referral pathways, interventions, and their resultant outcomes were synthesised and tabulated.

Results: Across the 30 included studies, 27 SP interventions and two main referral pathways were identified, involving providers across health, community, social, and voluntary care sectors. Quantitative outcomes (n = 21, 70%) most frequently measured were wellbeing, anxiety, depression and quality of life. Findings were mixed, and widely varying methodological approaches limited study comparability. Qualitative outcomes (n = 16, 53%) were mostly associated with social interactions (e.g., increased sense of belonging) and self-concepts and feelings (e.g., increased sense of purpose).

Discussion and conclusion: Research on SP referral pathways supporting mental health, wellbeing and psychosocial outcomes is proliferating, but high heterogeneity in the evidence base limits conclusive inferences about effectiveness. Standardised quantitative measurement of core outcomes, supplemented by rigorous qualitative designs, will enhance capacity to demonstrate the value of an SP approach to integrated care for mental and psychosocial health and wellbeing.

Introduction: Top-level managers in municipal social care administration play a central role in ensuring high-quality care through coordination within and between organisations. However, there is limited understanding of the specific tasks and responsibilities they undertake in this regard. Therefore, this study aimed to explore municipal top-level managers' perspectives on fostering safe and integrated care for older adults with complex care needs living at home.

Methods: Thirteen top-level managers in municipal social care administration were interviewed. Interview data were analysed thematically.

Results: One theme 'Leading through trust and empowerment, and encouraging collaborations within and between organisations to foster safe and integrated care' and five subthemes were identified: 'Creating conditions for seamless care by minimising cross-organisational barriers', 'Using the mandated role when navigating the bigger picture', 'Empowering middle managers and nursing staff', 'Fostering trust in working towards a common goal' and 'Leveraging successful partnerships across organisations'.

Conclusion: Top-level managers see themselves as parts of a larger system that requires them to collaborate with others. Empowering middle managers and nursing staff to thrive in their roles, through leadership based on trust, promotes a unified effort toward the common goal of safe and integrated care for older adults with complex care needs.