International Journal of Integrated Care最新文献

Introduction: In integrated care models, third sector organisations (TSOs) are essential but often undervalued parts of the health and care ecosystem to address care fragmentation and inequity of access. In this study, we illustrate the value contributed by TSOs in a co-production setting.

Methods: In this qualitative study, frame analysis was used to explore the varied interpretations of TSOs' value contributions at different levels of the ecosystem. The qualitative interview data were collected from 16 informants in the context of a Nordic welfare state, Finland. The interviewees represented a variety of health and care TSOs.

Results: The resulting frames were seen as organising principles that are socially shared. The analysis revealed a threefold interpretative schema of TSOs' value contributions: strengthening the ideals of civil society, advancing the public service system and connecting people to communities.

Discussion: The findings demonstrate that TSOs contribute values in health and care ecosystems at all levels-micro, meso and macro-by integrating short- and long-term policy objectives, ensuring that their actions result in meaningful and sustainable benefits across all levels of the public service ecosystem.

Conclusions: This study underlines the need to integrate civil society into the health and care ecosystem and, specifically, to acknowledge the holistic contribution of TSOs when developing integrated care models. The key contribution of this study is demonstrating the diverse ways in which TSOs can contribute value for integrated care.

Introduction: Ontario, Canada, is shifting to a more integrated healthcare delivery system through the Ontario Health Team (OHT) initiative. The extent to which OHTs have the capabilities to engage in integrated care is unknown and important to designing implementation supports. This article describes the development and psychometric testing of the Ontario Integrated Care Leadership Survey (OICLS), in 30 OHTs. The OICLS was informed by the Context and Capabilities for Integrated Care framework (CCIC).

Methods: The 42-item survey was distributed electronically to 765 eligible leaders across 30 OHTs; 480 (63%) responded representing approximately 600 organizations. Item analyses and scale psychometric analyses were undertaken to reduce the number of items in the CCIC survey tool while maintaining validity and reliability.

Results: The OICLS survey is comprised of 10 domains covering 12 of 17 capabilities identified in the CCIC. In the total sample, Cronbach's alpha exceeded 0.7 for nine of the ten domains. Descriptive responses to each of the 39 OICLS closed-ended survey questions illustrate the areas of strength and weakness and where supports are warranted to advance the formation of integrated care delivery systems.

Conclusion: The OICLS offers a brief and valid assessment of foundational aspects of multi-organizational integrated care initiatives.

Introduction: This study aims to identify success factors and challenges of an integrated care model, with an underlying goal of addressing the labor shortage in dementia care. The research investigates the interdisciplinary communication in a long-term care facility in Amsterdam, focusing on the collaboration between the so-called 'Happymakers' (non-medically trained staff) and qualified personnel. The Relational Coordination Theory serves as theoretical framework, emphasizing the need for shared goals, knowledge, and mutual respect for effective communication.

Methods: Using qualitative methods, the research involved interviews with thirty staff members in 2022.

Results: Work satisfaction was rated very positively. The collaboration between the 'Happymakers' and qualified care workers was generally positive, perspectives on risk perception and task alignment varied. Trust and a culture allowing mistakes were deemed crucial.

Discussion conclusion: Overall, the findings suggest that the integration model which includes the paradigm shift from care to well-being, positively influences care quality as well as job satisfaction potentially alleviating the labor market shortage. The study suggests further research on strategies for integrating formal with informal care work and comparative research between integrated dementia care and more traditional, medical oriented types of care.

Introduction: Medical Psychiatry Units (MPUs) offer integrated care for patients needing both medical and mental healthcare in hospitals. MPUs provide unique care not covered by Psychiatric Consultation-Liaison Services (PCS). Despite their increasing number, little research exists on why referrers choose MPUs, though their perspectives shape patient populations and reflect MPU goals.

Aims: 1. Asses physician satisfaction with the Erasmus Medical Center MPU and its alignment with initial expectations.2a. Evaluate whether referrals match the intended patient population needing disruptive behavior management and compare this with PCS referrals.2b. Identify unintended reasons for MPU referrals.

Method: We conducted interviews with physicians and analyzed questionnaires on MPU or PCS referrals from November 2020 to May 2021.

Results: 1. Physicians report that the MPU improves care quality, job satisfaction, collaboration, safety, educational value and reduces stigmatization.2a. Among 62 referrals, the MPU admitted nearly twice the disruptive patients.2b. Common MPU referral reasons included nursing care load, department expertise and suicidality, while PCS referrals were more often due to delirium.

Conclusion: The Erasmus MC MPU meets its founding goals. Physicians recognize its added value, particularly in managing patients with disruptive behaviors and high care needs. The integration of medical and psychiatric expertise has fulfilled expectations.

Archipel Ontario Health Team (OHT) developed as part of the provincial call to organize health and social service providers into integrated care delivery systems. With nearly 70 multi-disciplinary and multi-sectoral partners, unequal power dynamics must be considered when creating governance structures. With the aim of collaboratively elevating the voice of voluntary and community sector partners, Archipel OHT deliberately implemented a sustainable integrated governance strategy that encourages community and voluntary sector leadership and equitable shared decision-making. This perspective paper describes applied strategies, lessons learned, and efforts to maintain an environment that prioritizes their representation.

Introduction: Peer support programmes are important complementary support forms in integrated care. This study investigates formal peer support experiences among family caregivers in Finland by scrutinising multidimensional input and output mechanisms of emotional, informational, and appraisal support.

Methods: Seventeen family caregivers were interviewed through focus group and individual interviews. The qualitative data was analysed using a socioecological model for formal peer support.

Results: The family caregivers described their caregiving situation as a source of pain enabling receiving emotional support from peer support participants with similar experiences - although norms of privacy and taboo hindered participation. Organisational aspects of programme delivery such as setting expectations, rules of confidentiality, environmental setting, group dynamics and leadership influenced experiences of informational and appraisal support. Overburden created barriers to receiving emotional and informational peer support. The participants wanted to influence society and contribute to other family caregivers through formal peer support - highlighting its socioecological nature.

Conclusions: Each attribute of peer support [emotional, informational, and appraisal support] formed its own, yet interlinked, ecosystem. Experiences of peer support are beyond programme delivery, and future studies could employ a socioecological framework when further delving into attributes of formal peer support among family caregivers in specific target groups and/or settings.

Introduction: Oral and general health are closely related, and many oral and chronic-systemic diseases have the same risk factors. However, in most countries dental and general health care systems are separated. Integration of care for patients with closely related, multiple conditions is therefore important to ensure they receive the best quality of care. We aimed to develop a short and easy-to-understand survey to be used by patients to assess integration of dental and primary health care through their perceptions.

Methods: This study used both qualitative and quantitative methods. A modified online Delphi method was used for development of the survey. A panel consisting of seven experts assessed the survey in three rounds. The experts were based in the United States, Germany and the Netherlands and had different professional backgrounds, including general practice and dentistry. The initial framework and set of proposed questions were based on a previous survey with a similar focus. During two discussion rounds and one online round the framework and the questions were assessed and modified by the experts. The survey was then assessed for understandability among 18 patients and thereafter piloted among 199 patients.

Results: The final questionnaire derived from the consensus procedure contains thirteen questions which address the following five domains: patients' wishes, expectations, awareness and concerns regarding communication between health care providers; patients' perception of health care providers' knowledge; health care provider-patient communication about health status; utilization of health care; and self-rated health. The consensus procedure also yielded improvements in the understandability of survey items: one survey item was changed from a multiple-choice question into a yes/no question, answer options were added to three other survey items, four survey items were slightly changed in wording, and five items remained unchanged.

Conclusion: We developed the short, easy-to-understand Integrated Care Reported by Patients Survey to assess integration of dental and primary health care as perceived by patients. In the future, the developed survey is intended to be tested for validity and translated to other languages. The survey provides opportunities for usage in research and as a tool in quality improvement and feedback systems for health care providers.

Introduction: Intercultural collaboration in integrated community care faces a paradox. Some view community care as a 'local craft', intimately embedded within its socio-cultural context, and therefore it cannot be exported. Others view it as 'interventions' that are transferable and scalable, like other health innovations. This article proposes a middle-ground approach, highlighting the role of interpersonal relationships as a foundation for intercultural collaboration in integrated community care.

Description: Over a five-year period, we pursued an intercultural collaboration between two integrated community care initiatives in Canada and Japan. Both initiatives are grounded in the principles of community empowerment, linkages across health and social care, and complementarity of lived experience and professional knowledge. Our collaboration evolved in three interrelated phases: 1) intercultural discovery and exploration; 2) intercultural relationship-building and strengthening; and 3) intercultural explicitation and influence.

Discussion: While the implementation science literature largely focuses on cognitive processes of knowledge exchange, our experience highlights deeper relational dimensions that are essential to intercultural learning and impact across community care initiatives, including socialisation among collaborators, beyond their professional roles and identities.

Conclusion: Relational and socialisation processes should be recognised, nurtured and valued as integral components of intercultural collaborative efforts in integrated community care. Knowledge gained from this experience can inform cross-cultural efforts to support the global integrated community care movement.

Introduction: This case study provides practice-based reflections on challenges and potential solutions for young people with multiple disadvantages across housing, substance misuse, mental health, criminal justice, and domestic abuse systems, informed by 4 local principles: trauma informed, learning based, an alliance commissioning ethos, and workforce development.

Description: To improve the current experiences of 17-25-year-olds in service transition iterative insights drew from networking staff across sectors, clinical audit and following live cases, and appreciative enquiries with young people. This was conducted by a practitioner researcher in a local Young Person's charity and was supported by peer researchers with lived experience and embedded researchers-in-residence.

Discussion: This describes the scale of the challenge where compound need and intersectional disadvantage, wider determinants, complex pathways, and public and third sector service systems collide. Relational practices were tested to support navigating system challenges, better tailor to young people's abilities and needs and improve integrated care partnership working and workforce development.

Conclusion: Plymouth has a history of integration with the Alliance for Complex Needs. Context and localised solutions matter for integrating care, yet remain underreported especially for underserved, and marginalised young people and using whole systems approaches co-produced with the third sector. Investment into academia-practice partnerships is crucial to make learning portable.

Introduction: Day care services have a long history in the support of older people, both internationally and in England. However, despite their longevity there is no consensus about the aims of day care services and their contribution to integrated care is unrecognised. This paper defines day care as community building-based services that provide care and/or health related services and/or clubs and activities specifically for older people (65+) with care and support needs, which support wellbeing and health, and/or support people to remain living at home and/or enable informal carers to sustain care.

Methods: The paper draws on qualitative data collected in a national study to reimagine day care services for older people in England. Eight sites participated, all from the voluntary sector.

Results: Day care services act as both a site of, and facilitator to, integrated care and whilst settings experienced many of the challenges faced by voluntary sector organisations, including a reliance on limited and uncertain funding, they had developed a range of strategies to partially manage them.

Conclusions: Collective forms of day care services have the potential to play a more significant role in the provision of local place based integrated care in England.