Pub Date : 2024-04-26eCollection Date: 2024-04-01DOI: 10.5334/ijic.7530
Pilar Hilarión, Anna Vila, Joan C Contel, Sebastià J Santaeugènia, Jordi Amblàs-Novellas, Rosa Suñol, Conxita Barbeta, Aina Plaza, Emili Vela
Introduction: This study aimed to assess the implementation of integrated social and health home care services (HCS) offered by the Government of Catalonia, and to identify the main barriers and facilitators of integrated HCS.
Methods: Analysis of the degree of implementation of integrated social and health HCS perceived by social care services (SCS) and primary health care centers (PHCs) between December 2020 and June 2021 in two phases. First, the perception of integration by social workers within SCS and PHCs was assessed using a screening questionnaire. Then, SCS in counties with the highest integration scores received a customized questionnaire for an in-depth assessment.
Results: A total of 105 (100%) SCS and 94 (25%) PHCs answered the screening questionnaire, and 48 (45.7%) SCS received a customized questionnaire. The most frequent barrier identified was the lack of shared protocols, with the most frequent facilitator being the recognition of the importance of integrated HCS.
Conclusions: Our study showed that the degree of implementation of integrated health and social HCS offered by the Government of Catalonia was perceived as low. The identified barriers and facilitators can be used to facilitate such implementation. Further studies should include professionals other than social workers in PHC assessments.
{"title":"Integrated Health and Social Home Care Services in Catalonia: Professionals' Perception of its Implementation, Barriers, and Facilitators.","authors":"Pilar Hilarión, Anna Vila, Joan C Contel, Sebastià J Santaeugènia, Jordi Amblàs-Novellas, Rosa Suñol, Conxita Barbeta, Aina Plaza, Emili Vela","doi":"10.5334/ijic.7530","DOIUrl":"https://doi.org/10.5334/ijic.7530","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to assess the implementation of integrated social and health home care services (HCS) offered by the Government of Catalonia, and to identify the main barriers and facilitators of integrated HCS.</p><p><strong>Methods: </strong>Analysis of the degree of implementation of integrated social and health HCS perceived by social care services (SCS) and primary health care centers (PHCs) between December 2020 and June 2021 in two phases. First, the perception of integration by social workers within SCS and PHCs was assessed using a screening questionnaire. Then, SCS in counties with the highest integration scores received a customized questionnaire for an in-depth assessment.</p><p><strong>Results: </strong>A total of 105 (100%) SCS and 94 (25%) PHCs answered the screening questionnaire, and 48 (45.7%) SCS received a customized questionnaire. The most frequent barrier identified was the lack of shared protocols, with the most frequent facilitator being the recognition of the importance of integrated HCS.</p><p><strong>Conclusions: </strong>Our study showed that the degree of implementation of integrated health and social HCS offered by the Government of Catalonia was perceived as low. The identified barriers and facilitators can be used to facilitate such implementation. Further studies should include professionals other than social workers in PHC assessments.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11049598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osama Hafiz, Xuejun Yin, Shiying Sun, Jingsong Yang, Hueiming Liu
Introduction: The World Health Organisation (WHO) accepted the Integrated People-centred Health Services (IPCHS) framework in 2016 as an essential component for achieving universal health coverage in fragmented health systems. We aimed to examine the empirical applications of the WHO IPCHS framework to guide its use in strengthening health-service research. Methods: Academic databases and the IPCHS website were searched for relevant articles published between 2016 and July 2023. Two reviewers independently screened and extracted data on the study design, setting, IPCHS framework components, and facilitators and barriers to implementing the IPCHS strategies. Descriptive and content analyses were conducted. Results: Six studies were identified using the IPCHS framework. Studies have examined a combination of the five IPCHS strategies. All studies reported building strong primary care-based systems and coordinating care for individuals. Continued relationships and trust, co-production of health programmes, diversity of health care team, and technology were major facilitators, while low health literacy, lack of primary setting capacity and healthcare workforce were principal barriers to IPCHS implementation. Conclusion: This scoping review offers an overview of IPCHS strategies employed in healthcare research. Generally, the IPCHS framework remains underutilised in primary research. These results offer guidance for future research to support effective healthcare delivery.
{"title":"Examining the Use and Application of the WHO Integrated People-Centred Health Services Framework in Research Globally – a Systematic Scoping Review","authors":"Osama Hafiz, Xuejun Yin, Shiying Sun, Jingsong Yang, Hueiming Liu","doi":"10.5334/ijic.7754","DOIUrl":"https://doi.org/10.5334/ijic.7754","url":null,"abstract":"Introduction: The World Health Organisation (WHO) accepted the Integrated People-centred Health Services (IPCHS) framework in 2016 as an essential component for achieving universal health coverage in fragmented health systems. We aimed to examine the empirical applications of the WHO IPCHS framework to guide its use in strengthening health-service research.\u0000Methods: Academic databases and the IPCHS website were searched for relevant articles published between 2016 and July 2023. Two reviewers independently screened and extracted data on the study design, setting, IPCHS framework components, and facilitators and barriers to implementing the IPCHS strategies. Descriptive and content analyses were conducted.\u0000Results: Six studies were identified using the IPCHS framework. Studies have examined a combination of the five IPCHS strategies. All studies reported building strong primary care-based systems and coordinating care for individuals. Continued relationships and trust, co-production of health programmes, diversity of health care team, and technology were major facilitators, while low health literacy, lack of primary setting capacity and healthcare workforce were principal barriers to IPCHS implementation.\u0000Conclusion: This scoping review offers an overview of IPCHS strategies employed in healthcare research. Generally, the IPCHS framework remains underutilised in primary research. These results offer guidance for future research to support effective healthcare delivery.","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140654199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alezandra Torres-Castaño, L. Perestelo-Pérez, D. Koatz, Vanesa Ramos-García, A. González-González, A. Toledo-Chávarri, C. Bermejo-Caja, Himar González-Pacheco, Analia Abt-Sack, V. Pacheco-Huergo, C. Orrego
Background: The incorporation of shared decision making (SDM) is a central part of empowerment processes, as it facilitates greater activation on the part of patients, increasing the likelihood of them gaining control over their healthcare and developing skills to solve their health problems. Despite these benefits, there are still difficulties in the implementation of SDM among healthcare professionals due to internal and external factors related to the context and health systems. Aim: To explore primary care professionals (PCPs)’ perceptions of the SDM model, based on their preconceptions and experience in clinical practice. Methods: A framework analysis was conducted on qualitative data derived from a virtual community practice forum, within a cluster-randomized clinical trial developed in the e-MPODERA project. Results: The most important points in the opinions of the PCPs were: exploring the patients’ values, preferences and expectations, providing them with and checking their understanding of up-to-date and evidence-based health information. The analysis revealed three themes: determinants of the implementation process of SDM, lack of consistency and dilemmas and benefits of PCP active listening, motivation and positive expectations of SDM. Discussion: In our initial analysis, we examined the connections between the categories of the TDC model and its application in the primary care context. The categories related to the model reflect the theoretical understanding of professionals, while those related to perceptions of its application and use show certain discrepancies. These discrepancies could indicate a lack of understanding of the model and its real-world implications or insufficient commitment on the part of professionals or the organization to ensure its effective implementation. Conclusions: Specific targeted training that addresses knowledge, attitudes and practice may resolve the aforementioned findings.
{"title":"Healthcare Professionals’ Perceptions about the Implementation of Shared Decision-Making in Primary Care: A Qualitative Study from a Virtual Community of Practice","authors":"Alezandra Torres-Castaño, L. Perestelo-Pérez, D. Koatz, Vanesa Ramos-García, A. González-González, A. Toledo-Chávarri, C. Bermejo-Caja, Himar González-Pacheco, Analia Abt-Sack, V. Pacheco-Huergo, C. Orrego","doi":"10.5334/ijic.6554","DOIUrl":"https://doi.org/10.5334/ijic.6554","url":null,"abstract":"Background: The incorporation of shared decision making (SDM) is a central part of empowerment processes, as it facilitates greater activation on the part of patients, increasing the likelihood of them gaining control over their healthcare and developing skills to solve their health problems. Despite these benefits, there are still difficulties in the implementation of SDM among healthcare professionals due to internal and external factors related to the context and health systems. Aim: To explore primary care professionals (PCPs)’ perceptions of the SDM model, based on their preconceptions and experience in clinical practice. Methods: A framework analysis was conducted on qualitative data derived from a virtual community practice forum, within a cluster-randomized clinical trial developed in the e-MPODERA project. Results: The most important points in the opinions of the PCPs were: exploring the patients’ values, preferences and expectations, providing them with and checking their understanding of up-to-date and evidence-based health information. The analysis revealed three themes: determinants of the implementation process of SDM, lack of consistency and dilemmas and benefits of PCP active listening, motivation and positive expectations of SDM. Discussion: In our initial analysis, we examined the connections between the categories of the TDC model and its application in the primary care context. The categories related to the model reflect the theoretical understanding of professionals, while those related to perceptions of its application and use show certain discrepancies. These discrepancies could indicate a lack of understanding of the model and its real-world implications or insufficient commitment on the part of professionals or the organization to ensure its effective implementation. Conclusions: Specific targeted training that addresses knowledge, attitudes and practice may resolve the aforementioned findings.","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140695249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Varatharasan, Debbie Chiodo, Mary Hanna, Joanna Henderson
Introduction: Mental health and substance use services for youth in Canada continue to be fragmented. In response, Integrated Youth Services (IYS) has been proposed to address gaps in youth mental health services that can lead to improved youth outcomes. Youth Wellness Hubs Ontario (YWHO) was launched in 2017 as Ontario’s IYS Network for youth ages 12–25, prioritizing continuous improvement through evaluation. Description: At the end of the first three years of the YWHO initiative, an evaluation was carried out to identify the barriers and facilitators to the initial implementation of YWHO and service delivery modifications resulting from the COVID-19 pandemic across ten sites. Reporting on these is the focus of this article. Key informant interviews were conducted in early 2021 with Network Leads from all ten initial YWHO sites. Reflexive thematic analysis was used to analyze all interview data. Discussion: Facilitators to the implementation of the YWHO model included diversified funding models, YWHO Provincial Office implementation supports, clear hub processes, robust community partnerships, organizational support and dedicated staff. Common barriers included certain challenges related to staffing and finances, implementation of the shared data collection platform, implementation of measurement-based care, partnerships, integrated service delivery, and branding and communications. Conclusion: Implementation of IYS is highly collaborative and quite complex. As interest in such models increase, so does the need for knowledge related to optimal implementation. Learnings have informed developments and improvements made to the YWHO model. Insights will also inform how stakeholders support youth in their communities in designing and implementing services that improve youth mental health and overall well-being.
{"title":"Lessons Learned from the Implementation of Youth Wellness Hubs Ontario, an Integrated Youth Services Network: Perspectives from Network Leads","authors":"N. Varatharasan, Debbie Chiodo, Mary Hanna, Joanna Henderson","doi":"10.5334/ijic.7605","DOIUrl":"https://doi.org/10.5334/ijic.7605","url":null,"abstract":"Introduction: Mental health and substance use services for youth in Canada continue to be fragmented. In response, Integrated Youth Services (IYS) has been proposed to address gaps in youth mental health services that can lead to improved youth outcomes. Youth Wellness Hubs Ontario (YWHO) was launched in 2017 as Ontario’s IYS Network for youth ages 12–25, prioritizing continuous improvement through evaluation. Description: At the end of the first three years of the YWHO initiative, an evaluation was carried out to identify the barriers and facilitators to the initial implementation of YWHO and service delivery modifications resulting from the COVID-19 pandemic across ten sites. Reporting on these is the focus of this article. Key informant interviews were conducted in early 2021 with Network Leads from all ten initial YWHO sites. Reflexive thematic analysis was used to analyze all interview data. Discussion: Facilitators to the implementation of the YWHO model included diversified funding models, YWHO Provincial Office implementation supports, clear hub processes, robust community partnerships, organizational support and dedicated staff. Common barriers included certain challenges related to staffing and finances, implementation of the shared data collection platform, implementation of measurement-based care, partnerships, integrated service delivery, and branding and communications. Conclusion: Implementation of IYS is highly collaborative and quite complex. As interest in such models increase, so does the need for knowledge related to optimal implementation. Learnings have informed developments and improvements made to the YWHO model. Insights will also inform how stakeholders support youth in their communities in designing and implementing services that improve youth mental health and overall well-being.","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140718821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-09eCollection Date: 2024-04-01DOI: 10.5334/ijic.7581
Indira Coenen, Elyne De Baetselier, Veerle Foulon, Tinne Dilles
Introduction: Although there is evidence that interprofessional, person-centred, integrated care is important for optimising pharmaceutical care of older people with polypharmacy, this way of working is often not implemented in practice. The aim of this study was to identify common characteristics of successful interprofessional initiatives and factors influencing their implementation, in order to close this know-do gap.
Methods: A qualitative, explorative design with in-depth semi-structured interviews was used. Flemish primary healthcare professionals (HCPs) and patients aged over 75, involved in successful initiatives of interprofessional pharmaceutical care for older people with polypharmacy, were included. Inductive analysis was conducted to identify main topics.
Results: Fifteen HCPs and four patients, involved in nine interprofessional initiatives, were interviewed. In all initiatives the HCPs had interprofessional consultations about older people with polypharmacy. The interaction between the characteristics of the initiatives and the context had an important impact on the implementation. These context factors were positioned under the micro-, meso- and macro context. Implementation strategies, actions to enhance the initiatives' adoption, corresponded with three themes: communication and influence, coordination by different stakeholders, and (dis)incentives.
Conclusion: The identification of these success factors might inspire HCPs, providers of interprofessional education and policymakers to facilitate interprofessional pharmaceutical care.
{"title":"Implementation of Interprofessional Pharmaceutical Care Initiatives: Lessons Learned from Successful Bottom-Up Initiatives in Primary Care.","authors":"Indira Coenen, Elyne De Baetselier, Veerle Foulon, Tinne Dilles","doi":"10.5334/ijic.7581","DOIUrl":"https://doi.org/10.5334/ijic.7581","url":null,"abstract":"<p><strong>Introduction: </strong>Although there is evidence that interprofessional, person-centred, integrated care is important for optimising pharmaceutical care of older people with polypharmacy, this way of working is often not implemented in practice. The aim of this study was to identify common characteristics of successful interprofessional initiatives and factors influencing their implementation, in order to close this know-do gap.</p><p><strong>Methods: </strong>A qualitative, explorative design with in-depth semi-structured interviews was used. Flemish primary healthcare professionals (HCPs) and patients aged over 75, involved in successful initiatives of interprofessional pharmaceutical care for older people with polypharmacy, were included. Inductive analysis was conducted to identify main topics.</p><p><strong>Results: </strong>Fifteen HCPs and four patients, involved in nine interprofessional initiatives, were interviewed. In all initiatives the HCPs had interprofessional consultations about older people with polypharmacy. The interaction between the characteristics of the initiatives and the context had an important impact on the implementation. These context factors were positioned under the micro-, meso- and macro context. Implementation strategies, actions to enhance the initiatives' adoption, corresponded with three themes: communication and influence, coordination by different stakeholders, and (dis)incentives.</p><p><strong>Conclusion: </strong>The identification of these success factors might inspire HCPs, providers of interprofessional education and policymakers to facilitate interprofessional pharmaceutical care.</p>","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11012220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cathrine Bell, C. W. Appel, Anders Prior, Anne Frølich, A. Pedersen, P. Vedsted
Introduction: Patients with multimorbidity attend multiple outpatient clinics. We assessed the effects on hospital use of scheduling several outpatient appointments to same-day visits in a multidisciplinary outpatient pathway (MOP). Methods: This study used a quasi-experimental design. Eligible patients had multimorbidity, were aged ≥18 years and attended ≥2 outpatient clinics in five different specialties. Patients were identified through forthcoming appointments from August 2018 to March 2020 and divided into intervention group (alignment of appointments) and comparison group (no alignment). We used patient questionnaires and paired analyses to study care integration and treatment burden. Using negative binomial regression, we estimated healthcare utilisation as incidence rates ratios (IRRs) at one year before and one year after baseline for both groups and compared IRR ratios (IRRRs). Results: Intervention patients had a 19% reduction in hospital visits (IRRR: 0.81, 95% CI: 0.70–0.96) and a 17% reduction in blood samples (IRRR: 0.83, 0.73–0.96) compared to comparison patients. No effects were found for care integration, treatment burden, outpatient contacts, terminated outpatient trajectories, hospital admissions, days of admission or GP contacts. Conclusion: The MOP seemed to reduce the number of hospital visits and blood samples. These results should be further investigated in studies exploring the coordination of outpatient care for multimorbidity. Research question: Can an intervention of coordinating outpatient appointments to same-day visits combined with a multidisciplinary conference influence the utilisation of healthcare services and the patient-assessed integration of healthcare services and treatment burden among patients with multimorbidity?
{"title":"The Effect of Coordinating the Outpatient Treatment across Medical Specialities for Patients With Multimorbidity","authors":"Cathrine Bell, C. W. Appel, Anders Prior, Anne Frølich, A. Pedersen, P. Vedsted","doi":"10.5334/ijic.7535","DOIUrl":"https://doi.org/10.5334/ijic.7535","url":null,"abstract":"Introduction: Patients with multimorbidity attend multiple outpatient clinics. We assessed the effects on hospital use of scheduling several outpatient appointments to same-day visits in a multidisciplinary outpatient pathway (MOP). Methods: This study used a quasi-experimental design. Eligible patients had multimorbidity, were aged ≥18 years and attended ≥2 outpatient clinics in five different specialties. Patients were identified through forthcoming appointments from August 2018 to March 2020 and divided into intervention group (alignment of appointments) and comparison group (no alignment). We used patient questionnaires and paired analyses to study care integration and treatment burden. Using negative binomial regression, we estimated healthcare utilisation as incidence rates ratios (IRRs) at one year before and one year after baseline for both groups and compared IRR ratios (IRRRs). Results: Intervention patients had a 19% reduction in hospital visits (IRRR: 0.81, 95% CI: 0.70–0.96) and a 17% reduction in blood samples (IRRR: 0.83, 0.73–0.96) compared to comparison patients. No effects were found for care integration, treatment burden, outpatient contacts, terminated outpatient trajectories, hospital admissions, days of admission or GP contacts. Conclusion: The MOP seemed to reduce the number of hospital visits and blood samples. These results should be further investigated in studies exploring the coordination of outpatient care for multimorbidity. Research question: Can an intervention of coordinating outpatient appointments to same-day visits combined with a multidisciplinary conference influence the utilisation of healthcare services and the patient-assessed integration of healthcare services and treatment burden among patients with multimorbidity?","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140722220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wei Ting Chen, Sing Yong Lim, Shermaine How, W. Tan, Ian Yi Onn Leong
The population in Singapore is ageing, adding pressure to community care as the health and social needs of its residents increase. This has accelerated the pace at which Regional Health Systems adopt and deliver its population health strategies from early prevention, chronic disease management, crisis care to end-of-life care. To this end, the Central Health Integrated Care Network (ICN) began its journey to develop Communities of Care (CoCs) with other health and social care partners to meet the needs of residents in the Central Zone of Singapore. This paper describes the processes and steps taken by Central Health ICN to build partnerships with other agencies and organisations to build place-based models of care in the local neighbourhoods. The faciliating factors and the barriers faced in the implementation of CoCs were described to allow sharing of such learnings on large scale change. Strategies in overcoming some of the challenges were also presented to demonstrate the iterative processes required in building integrated place-based models of care to meet the needs of the residents in different communities.
{"title":"Communities of Care Approach: Developing a Place-based Model of Care and Building Partnerships in the Communities in Central Singapore","authors":"Wei Ting Chen, Sing Yong Lim, Shermaine How, W. Tan, Ian Yi Onn Leong","doi":"10.5334/ijic.7727","DOIUrl":"https://doi.org/10.5334/ijic.7727","url":null,"abstract":"The population in Singapore is ageing, adding pressure to community care as the health and social needs of its residents increase. This has accelerated the pace at which Regional Health Systems adopt and deliver its population health strategies from early prevention, chronic disease management, crisis care to end-of-life care. To this end, the Central Health Integrated Care Network (ICN) began its journey to develop Communities of Care (CoCs) with other health and social care partners to meet the needs of residents in the Central Zone of Singapore. This paper describes the processes and steps taken by Central Health ICN to build partnerships with other agencies and organisations to build place-based models of care in the local neighbourhoods. The faciliating factors and the barriers faced in the implementation of CoCs were described to allow sharing of such learnings on large scale change. Strategies in overcoming some of the challenges were also presented to demonstrate the iterative processes required in building integrated place-based models of care to meet the needs of the residents in different communities.","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140722242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lieke Reinhoudt-den Boer, R. Huijsman, J. V. Van Wijngaarden
Background: Integrated care is enhanced by integration on system, organizational, professional, and clinical levels including functional and normative integration. Many studies have been done on functional integration on these different levels, less studies focus on how normative integration takes place. In this study, we focus on the question: what differences in frames of refence must be addressed to establish consensus on appropriate care for People with Multiple Problems? Methods: A mixed-method Delphi study was carried out in which professionals and managers regularly involved in care for people with multiple problems (PWMPs) worked towards consensus on appropriate care delivery through the assessment of 15 vignettes representing real trajectories of PWMPs. Results: No consensus on appropriate care delivery was reached on any of the 15 vignettes. Five differences in perspective explained the dissensus: 1) an individual versus a systemic perspective on the client; 2) a focus on self-expressed needs of clients or professionally assessed (normative) needs; 3) client-directed or caregiver-directed care; 4) client as victim of circumstances or responsible for circumstances; 5) a focus on barriers or opportunities. Conclusions: In general, panelists agreed that care for PWMPs should be integrated. However, the further integrated care was to be operationalized in practice the greater the dissensus between panelists emerged. To understand how these differences in perspectives may be overcome to provide care for PWMPs normative integration needs to be studied during actual processes of care delivery.
{"title":"Identifying Differences in Frames of Reference That Are Hard to Reconcile During the Process of Normative Integration to Deliver Care for People with Multiple Problems: A Mixed-Method Delphi Study in the Netherlands","authors":"Lieke Reinhoudt-den Boer, R. Huijsman, J. V. Van Wijngaarden","doi":"10.5334/ijic.7583","DOIUrl":"https://doi.org/10.5334/ijic.7583","url":null,"abstract":"Background: Integrated care is enhanced by integration on system, organizational, professional, and clinical levels including functional and normative integration. Many studies have been done on functional integration on these different levels, less studies focus on how normative integration takes place. In this study, we focus on the question: what differences in frames of refence must be addressed to establish consensus on appropriate care for People with Multiple Problems? Methods: A mixed-method Delphi study was carried out in which professionals and managers regularly involved in care for people with multiple problems (PWMPs) worked towards consensus on appropriate care delivery through the assessment of 15 vignettes representing real trajectories of PWMPs. Results: No consensus on appropriate care delivery was reached on any of the 15 vignettes. Five differences in perspective explained the dissensus: 1) an individual versus a systemic perspective on the client; 2) a focus on self-expressed needs of clients or professionally assessed (normative) needs; 3) client-directed or caregiver-directed care; 4) client as victim of circumstances or responsible for circumstances; 5) a focus on barriers or opportunities. Conclusions: In general, panelists agreed that care for PWMPs should be integrated. However, the further integrated care was to be operationalized in practice the greater the dissensus between panelists emerged. To understand how these differences in perspectives may be overcome to provide care for PWMPs normative integration needs to be studied during actual processes of care delivery.","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140745928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Z. Otty, Sarah Larkins, Rebecca Evans, Amy Brown, S.S. Sabesan
Introduction: Development and implementation of the Townsville Lung Cancer Referral Pathway [TLCRP] aims to reduce delays and improve referral patterns of people with suspected lung cancer in north Queensland, Australia. Reported in this paper is the experiences and perspectives of general practitioners [GPs] and specialists of the TLCRP. Methods: This was a descriptive qualitative study nested within a larger project evaluating TLCRP, utilising a broader implementation science framework. In-depth, semi-structured interviews with GPs and specialists were conducted. An iterative, inductive thematic analysis of interview transcripts was used to derive key codes, then grouped into themes regarding participant experiences and perceptions. Results: Data analysis identified two major themes and several sub-themes. The major themes were variation in the uptake of TLCRP and enhancing coordinated care and communication. Discussion: Several enablers and barriers to implementing TLCRP were identified. Barriers to adaptation of TLCRP included lack of clinical time, resistance to changing referral patterns, lack of familiarity or experience with HealthPathways and technology issues. Conclusion: Emerging themes from this study may be used to reduce the barriers and improve uptake of TLCRP and other health care pathways in the local health service and may have wider relevance in other settings.
{"title":"Clinicians’ Experiences and Perspectives about a New Lung Cancer Referral Pathway in a Regional Health Service","authors":"Z. Otty, Sarah Larkins, Rebecca Evans, Amy Brown, S.S. Sabesan","doi":"10.5334/ijic.7627","DOIUrl":"https://doi.org/10.5334/ijic.7627","url":null,"abstract":"Introduction: Development and implementation of the Townsville Lung Cancer Referral Pathway [TLCRP] aims to reduce delays and improve referral patterns of people with suspected lung cancer in north Queensland, Australia. Reported in this paper is the experiences and perspectives of general practitioners [GPs] and specialists of the TLCRP. Methods: This was a descriptive qualitative study nested within a larger project evaluating TLCRP, utilising a broader implementation science framework. In-depth, semi-structured interviews with GPs and specialists were conducted. An iterative, inductive thematic analysis of interview transcripts was used to derive key codes, then grouped into themes regarding participant experiences and perceptions. Results: Data analysis identified two major themes and several sub-themes. The major themes were variation in the uptake of TLCRP and enhancing coordinated care and communication. Discussion: Several enablers and barriers to implementing TLCRP were identified. Barriers to adaptation of TLCRP included lack of clinical time, resistance to changing referral patterns, lack of familiarity or experience with HealthPathways and technology issues. Conclusion: Emerging themes from this study may be used to reduce the barriers and improve uptake of TLCRP and other health care pathways in the local health service and may have wider relevance in other settings.","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140745175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Poor outcomes following the transition from hospital back to community living are common, especially for older adults with complex health and social care needs. Some health care systems now have multiple interprofessional teams (in hospital and community) to support care transitions. These teams will need to be well coordinated to improve care transition outcomes. Methods: We conducted a scoping review to identify and map peer-reviewed literature on how interprofessional teams are working together to support older adults transitioning from hospital back to the community. We used the six-stage framework developed by Levac and colleagues (2010). Procedures were guided by the Joanna Briggs Institute scoping review guidelines. Results: Our structured search and screening process resulted in 70 articles, published between 2000 and 2022, from 14 counties. Within these articles, 26 programs were described that used interprofessional teams in both the hospital and community. Discussion: The qualitative articles suggested that effective teamwork is very important for promoting care transition quality, but the quantitative research did not report on team-related outcomes. Quantitative research has described, but not evaluated, strategies for promoting interprofessional collaboration. Conclusion: Future research should focus on evaluating processes used to promote effective interprofessional teamwork in care transition interventions.
{"title":"Interprofessional Teams Supporting Care Transitions from Hospital to Community: A Scoping Review","authors":"Cara Brown, B. Tittlemier, K. Tiwari, Hal Loewen","doi":"10.5334/ijic.7623","DOIUrl":"https://doi.org/10.5334/ijic.7623","url":null,"abstract":"Introduction: Poor outcomes following the transition from hospital back to community living are common, especially for older adults with complex health and social care needs. Some health care systems now have multiple interprofessional teams (in hospital and community) to support care transitions. These teams will need to be well coordinated to improve care transition outcomes. Methods: We conducted a scoping review to identify and map peer-reviewed literature on how interprofessional teams are working together to support older adults transitioning from hospital back to the community. We used the six-stage framework developed by Levac and colleagues (2010). Procedures were guided by the Joanna Briggs Institute scoping review guidelines. Results: Our structured search and screening process resulted in 70 articles, published between 2000 and 2022, from 14 counties. Within these articles, 26 programs were described that used interprofessional teams in both the hospital and community. Discussion: The qualitative articles suggested that effective teamwork is very important for promoting care transition quality, but the quantitative research did not report on team-related outcomes. Quantitative research has described, but not evaluated, strategies for promoting interprofessional collaboration. Conclusion: Future research should focus on evaluating processes used to promote effective interprofessional teamwork in care transition interventions.","PeriodicalId":14049,"journal":{"name":"International Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140754070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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