International Journal of Integrated Care最新文献

Introduction: In two randomized controlled trials (RCT) we tested the efficacy of a novel integrated vocational rehabilitation and mental healthcare intervention, coined INT, for sickness absentees with common mental disorders. The aim was to improve vocational outcomes compared to Service As Usual (SAU). Contrary to expectations, the delivered intervention caused worse outcomes within some diagnostic groups and some benefits in others. In this phase 4 study, we examined the effectiveness of the intervention in real-world practice.

Method: In this prospective intervention study, we allocated adult sickness absentees with either depression, anxiety, or adjustment disorder to receive INT in a real-world setting in a Danish Municipality. We compared the vocational outcomes of this group to a matched group who received INT as a part of the RCTs, after randomization to the intervention group herein. Primary outcome was return to work at any point within 12 months.

Results: In the real-world group, 151 participants received INT during 2019. From the randomized trials, 302 matched participants who received INT between 2016-2018 were included. On the primary outcome - return to work within 12 months - the real-word group fared worse (48.3 vs 64.6 %, OR 0.54 [95%CI: 0.37-0.79], p = 0.001). Across most other vocational outcomes, a similar pattern of statistically significant poorer outcomes in the real-world group was observed: Lower number of weeks in work and lower proportion in work at 12 months (42.3% vs. 58.3% (p = 0.002)).

Discussion: The real-word group showed significantly worse vocational outcomes. Like in many other studies of complex interventions, implementation was difficult in the original randomized trials and perhaps even more difficult in the less structured real-world setting. Since the intervention was less effective for some groups compared to SAU in the original trial, this negative effect may be even more pronounced in a real-world setting.

Third-sector organizations (TSOs) are recognized for having a unique and essential role in designing and delivering community-centred, sustainable health and well-being services. A World Café workshop at the 2023 International Conference on Integrated Care to explore perspectives on the questions explored the question: How do we characterize the role of the Third Sector in Integrated Care Systems? Are they Partners, Service Providers, Both or Neither? Attendees from Canada, England, Scotland, Wales, Ireland, Belgium, Denmark, and the Netherlands shared perspectives regarding facilitators and barriers to engaging TSOs in integrated care systems, drawing on experiences and practices from their communities and health systems. Building from participant perspectives, we posit that while cross-sectoral alliances between government and voluntary organizations are possible, and this engagement can contribute substantial health-promoting value to society, much work remains to be done. Meaningful collaboration requires attitudinal shifts, new working methods, rebalancing power within the relationships, and sufficient resources to support the collaboration. Creative approaches to facilitating positive engagement of TSOs within integrated care systems can address long-standing barriers and misunderstandings. Sharing and learning through research, evaluations, and networks is essential to achieve integrated care systems based on trust and committed collaboration.

Background: A community psychiatry service is provided from selected primary health care (PHC) clinics in Gauteng, South Africa. This study described the demographic and clinical characteristics of health care users (HCUs), and explored HCUs' experiences of these services in order to shed light on the challenges of integrating psychiatric services into PHC.

Methods: A mixed-methods study was conducted at two PHC clinics, where 384 clinical records were reviewed and 23 HCUs were interviewed. In Clinic-1, community psychiatry services were co-located, while in Clinic-2, these services were physically integrated into the PHC clinic.

Results: HCUs from both clinics were generally female (55%), had not completed secondary level education (65%), and were unemployed (80%). Both clinics struggled with medication stock-outs and had the same number of community psychiatry health care providers. Compared to the co-located clinic, the physically integrated clinic had insufficient consultation rooms (compromising confidentiality), higher caseloads (910 compared to 580), more HCUs with psychotic disorders (61% compared to 44%) and a history of missed medication (58% compared to 40%). In both clinics, overall care coordination was limited, although some nurses coordinated care for HCUs. While organisational integration approaches improved the proximity of mental health services, there were challenges in continuity of care within and across health care sites.

Conclusion: Coordination and continuity of care were constrained in both clinics, regardless of the organisational integration approaches used. As low- and middle-income countries work towards integrating mental health care into PHC, the implementation of organisational integration approaches should consider physical space, caseload, HCU need, and the inclusion of dedicated providers to coordinate care.

Intro: Complex and siloed health and social service systems can be difficult for people to navigate. The fragmented and poorly linked services leads to ineffective communication between care teams, delayed access to services, concerns regarding quality and safety of patient care, as well as patient frustration and disengagement.

Description: Planned Care for Better Health (PCBH) is a community-based care navigation and coordination program for people with complex health and psychosocial needs who are at risk of future hospitalisation. It focuses on early identification and holistic care to remove barriers and improve access to healthcare. By including a persons', family and carers in planning, listening to their needs, supporting the person to achieve their goals, and empowering them to make decisions on their own health, PCBH aims to enhance clients' healthcare experience and reduce preventable hospital utilisation.

Discussion: Building trusting and collaborative relationships with clients, families, carers, and health service providers requires commitment. Acknowledging and addressing psychosocial needs is critical for enhancing health outcomes. Equipping patients with self-management skills and knowledge to navigate and engage support services may generate lasting effects, even post-program enrolment.

Conclusion: PCBH is associated with a notable reduction in unplanned hospitalisations and total bed days. However, reduction in ED presentations is similar between the intervention and comparison cohorts. Future initiatives should focus on a shared vision of integrated care, robust leadership, and participative co-creation with service-level stakeholders. Sustained program establishment, a multidisciplinary care coordinator team, and an early creation of robust evaluation strategy must be considered.

Introduction: This study aimed to assess the effect of integrated palliative care (IPC) on potentially inappropriate end- of-life care and healthcare-costs in the last 30 days of life in the Netherlands.

Methods: Nationwide health-insurance claims data were used to assess potentially inappropriate end-of-life care (≥2 emergency room visits; ≥2 hospital admissions; >14 days hospitalization; chemotherapy; ICU admission; hospital death) and healthcare-costs in all deceased adults in IPC regions pre- and post- implementation and in those receiving IPC compared to a 1:2 matched control group.

Results: In regions providing IPC deceased adults (n = 37,468) received significantly less potentially inappropriate end-of-life care post-implementation compared to pre-implementation (26.5% vs 27.9%; p < 0.05). Deceased adults who received IPC (n = 210) also received significantly less potentially inappropriate end-of-life care compared to a matched control group (14.8% vs 28.3%; p < 0.05). Mean hospital costs significantly decreased for deceased adults who received IPC (€2,817), while mean costs increased for general practitioner services (€311) and home care (€1,632).

Discussion: These results highlight the importance of implementation of integrated palliative care and suitable payment. Further research in a larger sample is needed.

Conclusion: This study shows less potentially inappropriate end-of-life care and a shift in healthcare costs from hospital to general practitioner and home care with IPC.

Introduction: Integrated care has been posited as a potential solution to the global burden of youth mental health (YMH), but there is limited evidence on how best to design, staff, and evaluate different integrated care models. Our review aimed to consolidate the evidence on integrated models of mental healthcare for young people, to identify the core components of integration, and create a framework that can be used to analyse levels of YMH integration.

Methods: We conducted a systematic review of literature across PubMed, SCOPUS, and PsycINFO databases and the grey literature We performed a narrative synthesis extracting core components of integrated YMH care.

Results: Inductive themes from the literature described core components of integrated care. These themes were mapped into a novel framework combining the World Health Organisation health system building blocks and six intensity levels of integrated care to consider how best to implement and sustain integrated care within the YMH system.

Discussion: The Youth Integration Project framework can form a basis for the development, implementation and evaluation of well-articulated models of youth integrated mental health pathways, assisting services identify what operational changes are needed to best implement and sustain integrated care.

Background: In 2022, England embarked on an ambitious and innovative re-organisation to produce an integrated health and care system with a greater focus on improving population health. This study aimed to understand how nascent ICSs are developing and to identify the key challenges and enablers to integration.

Methods: Four ICSs participated in the study between November 2021 and May 2022. Semi-structured interviews with system leaders (n = 67) from health, social and voluntary care as well as representatives of local communities were held. A thematic framework approach supported by Leutz's five laws of integration framework was used to analyse the data.

Results: The benefits of ICSs include enhancing the delivery of good quality care, improving population health and providing more person-centred care in the community. However, differences between health and social care such as accountability, organisational/professional cultures, risks of duplicating efforts, tensions over funding allocation, issues of data integration and struggles in engaging local communities threaten to hamper integration.

Conclusions: Despite ICS's investing in the structural and relational components of integrated care, the unprecedented pressures on systems to reduce demand on primary and emergency care tackling elective backlogs may detract from a key goal of ICSs, improving population health and prevention.

Introduction: While populations of all ages were affected by the pandemic, older people with frailty had much worse outcomes. The NHS England has mandated identifying and proactively managing older people with moderate and severe frailty in the General medical services (GMS) contract 2017/18. As a result of this policy, an integrated care programme for older people with different frailty levels (OPDFL) was introduced in Luton in 2018 (known as, Luton Framework for Frailty - LFF). This study was conducted to explore the views of service providers in Luton regarding the impact of the COVID-19 pandemic on the implementation of LFF.

Methods: Semi-structured interviews were conducted with service providers in Luton between April 2021 to July 2021. The data were analysed using thematic analysis.

Results: Eighteen service providers took part in the study. Three main themes were identified, the first of which was that proactive and frailty-related health promotion services were halted. Secondly, existing relationships due to the LFF facilitated the implementation of services for care home residents during the pandemic. Finally, participants identified that some of the challenges impacting the delivery of health promotion services were those that affected the health system in general, such as healthcare staff feeling stressed and the centralised decision-making by the government.

Conclusion: The lessons learnt from this study could be useful in managing services for older people with frailty in times of emergencies or epidemics.

In many European countries, responsibilities for social care have been shifted to municipalities to enhance accessibility and stimulate integration of care and social services, and to cut costs. Multidisciplinary local Social Community Teams (SCTs) have become increasingly responsible for the provision of these integrated services, requiring them to collaborate with local health and societal organisations. To collaborate and to integrate services the SCTs must work across their own and stakeholders' boundaries (e.g., domain specific boundaries). We investigated how boundary work in SCTs' practices contributes to service integration in a dynamic multi-stakeholder context. In our embedded case study, for 18 months, we followed three SCTs in their efforts to integrate services, and used data from multiple sources, including bi-weekly questionnaires in which SCT members reflect on their stakeholder-directed goal achievements. The case analysis yielded four takeaways. First, it demonstrates how SCTs' bottom-up formulation of a long-term service integration vision brought internal coherence (boundary reinforcement), while the short-term action-goals increased collaboration with stakeholders (boundary spanning). Second, only SCTs that managed to incorporate constraints into their action-goals and practices, and to span and play with boundaries, continued with integrating services just-by-doing. Third, two stakeholder characteristics facilitated the SCTs' boundary spanning: well-organized stakeholders and prior familiarity with the stakeholder. Fourth, a new boundary work type emerged, "boundary play", consisting of informal, experimental collaboration efforts with stakeholders contributing to emergent service integration.

Introduction: Social prescribing can facilitate the integration of health, social care and community support but has a diverse and confusing terminology that impairs cross-sectoral communication and creates barriers to engagement.

Methods: To address this issue a mixed-methods approach that incorporated a scoping review, a group concept mapping study and consultation was employed to identify and classify the terminology associated with social prescribing. The findings were then used to inform the development of a glossary of terms for social prescribing.

Results: Many terms are used interchangeably to describe the same specific aspects of social prescribing. Much of the terminology originates from the health and social care literature of England.

Discussion: The terminology used in the academic literature may not accurately reflect the terminology used by the social prescribing workforce. The innovative and interactive glossary of terms identifies the terminology associated with social prescribing and provides additional contextual information. The process of developing the dual language glossary presented several considerations and challenges.

Conclusion: The glossary of terms will facilitate cross-sector communication and reduce barriers to engagement with social prescribing. It takes an important first step to help clarify and standardise the language associated with social prescribing, for professionals and members of the public alike.