International Journal of Integrated Care最新文献

Introduction: Comorbidities of HIV/AIDS and non-communicable diseases (NCDs) are increasingly prevalent, affecting up to 30% of individuals living with HIV/AIDS, particularly in Sub-Saharan Africa. Conventional approaches that treat NCDs separately from HIV/AIDS care have been deemed inefficient, highlighting the need for integrated models. This study aims to develop a framework for integrating NCD care into HIV programs at primary healthcare facilities in Southern Africa.

Methods: As part of a broader study examining the burden, extent and cost of HIV/NCD integration we employed a modified 'Best fit' framework synthesis method. Thematic analysis was the primary method of analysis used to inform the framework.

Results: The study expanded on existing framework themes related to effective team-working, organizational leadership, patient-centered care, community/patient/provider partnerships. It introduced seven additional themes: country specific NCD prioritization, multi stakeholder partnerships, healthcare worker mental wellbeing, unified health information systems, with enhanced privacy, establishing costing databases for HIV/NCD integrated care, robust monitoring and evaluation mechanisms, and opportunities for regional coordination.

Conclusion: Improving existing frameworks for integrating HIV/NCD care is feasible by leveraging established HIV care platforms. These enhancements can support more efficient holistic healthcare delivery across primary healthcare facilities in Southern Africa.

Introduction: Increasing healthcare complexity necessitates the integration of perspectives from professionals with diverse expertise, patients, and families for optimal care. However, there is no consensus on 'care complexity', and expectations for integrated care planning vary. This study examines how different health domains influence professionals' perceptions and preferences.

Methods: Ninety-eight medical doctors and nursing professionals assessed care complexity, integrated care planning needs, and interprofessional collaboration using thirteen paper cases based on five domains from the International Classification for Functioning (ICF). Conjoint analysis explored perceptions, preferences, and variations by occupation and work experience.

Results: Higher care complexity and need for integrated care planning were linked to impairments of body functions, complex personal factors in terms of chronic health condition and medical needs, and external factors. Allied health, social, and external professionals were more frequently included in multidisciplinary team meetings based on domain-specific complexities. Medical doctors showed a greater tendency than nursing professionals to involve family in integrated care planning.

Discussion: The study identifies key drivers of care complexity and integrated care planning, revealing occupation- and experience-based differences. Addressing these differences is crucial for improving interprofessional collaboration.

Conclusion: This research provides a multidimensional view of care complexity, highlighting the factors that shape professionals' preferences for integrated care planning.

Background: Integrated Acute Care for Older People (IACOP) close to home is a promising approach to overcome care fragmentation, but little is know about effective meso- and macro-strategies to foster integration. This Realist Evaluation (RE) explores which strategies were employed and recommended in nine Dutch regional partnerships.

Methods: The Rainbow Model, RE-theory, Coleman's boat and ripple effects functioned as theoretical basis. We conducted a document analysis (n = 19), semi-structured interviews (n = 11) and two focus groups (n = 8). Participants were (project) managers, directors and experts. The qualitative data were clustered into guiding principles, underpinned with strategy-context-mechanism-outcome configurations.

Results: Six guiding principles for transformation towards IACOP close to home emerged. Meso-level principles included: 1) committing to a shared regional IACOP vision and goals; 2) fostering a culture of collaborative and coordinated action; 3) prioritising, implementing and developing micro-level interventions systematically. Macro-level principles were: 4) ensuring congruent policy; 5) stimulating functional integration and 6) stimulating normative integration.

Conclusions: Transforming towards IACOP close to home is complex and requires continuous action across integration levels, health practices and sectors. The meso-level principles guide regional partnerships in applying context-specific strategies; activating the underlying mechanisms for transformation like 'enjoying the process'. Yet, successful transformation also hinges on actions by system stakeholders.

Introduction: Many people with acquired brain injury (PwABI) and their family face long-term psychosocial problems and unmet needs. Currently, there are no structural and integrated health care services supporting life after brain injury. We evaluated Case Management (CM) for PWABI which aims to facilitate access to and integration of health care and social services for people with complex problems.

Methods: One-group repeated measures study including 62 PwABI and 36 caregivers in the Netherlands. Assessments were conducted every six months for 18-24 months. Primary outcome was psychosocial well-being (Hospital Anxiety and Depression Scale). Secondary outcomes were self-efficacy, participation, life satisfaction, and needs for PwABI and caregivers; and caregiver burden.

Results: Anxiety reduced significantly in both PwABI and their caregivers. Over time, PwABI reported significantly fewer unmet needs, but more participation restrictions. Caregivers reported significantly less caregiver burden and more self-efficacy over time.

Discussion: CM seems promising for reducing unmet needs in PwABI and improving some psychosocial outcomes in PwABI and caregivers. Lifelong CM may however be necessary. A randomized controlled study is needed to confirm whether the positive outcomes are due to CM.

Conclusion: This study warrants further research to establish the effectiveness of CM for PWABI.

Introduction: People with acquired brain injury (PwABI) and their families may face psychosocial problems and unmet needs. We assessed the feasibility of Case Management (CM) for PWABI in the Netherlands which aims to facilitate access to and integration of health care and social services for people with complex problems.

Methods: We evaluated if CM was delivered according to plan, if participants and case managers (CMrs) were satisfied with CM, and which factors affected implementation. Data were collected using evaluation forms, logs and minutes, and interviews.

Results: Twenty-eight PwABI, 13 caregivers, 17 CMr and all 3 project leaders participated. CM key elements were applied. PwABI and their caregivers generally expressed satisfaction with CM, though for some it did not meet expectations. CMrs valued the continuous involvement and the ability to support family. Facilitators were CMr working independent from existing care services and the diversity in expertise in the CMr teams. Barriers were imposed when a region offers medical stroke care but no integrated long-term services after brain injury.

Discussion: It is important to ensure clear communication with PwABI and their family regarding the roles of CMr, as well as managing and aligning expectations.

Conclusion: CM after ABI is feasible and warrants further research.

Introduction: Disability research and policy emphasize cross-sector collaboration due to the complexity of disability. This study aimed to assess service providers' awareness of disability-related community resources and evaluate their perceptions of the importance, frequency, and satisfaction with intersectoral collaboration.

Methods: A cross-sectional study was conducted in Gyeonggi Province, Korea, using a mixed-methods design. The quantitative component examined community health and social workers' awareness, perceived importance, frequency, and satisfaction with intersectoral collaboration. Qualitative data were collected through an open-ended survey question and analyzed using content analysis.

Results: Findings revealed low awareness of medical and public health agencies, particularly newly designated disability-focused organizations in Korea, and infrequent collaboration despite its recognized importance. Differences in perceived importance and collaboration frequency across sectors were visualized using the IPA grid. Six key themes emerged from the qualitative analysis: 'Information,' 'Governance,' 'Administrative processes,' 'Workforce,' 'Resources,' and 'Clients.'

Discussion: The differences and commonalities in service providers' perceptions, depending on their sector affiliation, highlight opportunities for policymakers to implement strategies that foster cross-sector partnerships.

Conclusions: This study underscores the role of awareness and perceived importance in fostering cross-sector collaboration, offering insights for future policies and initiatives aimed at improving collaboration in disability care.

Introduction: Community-based healthcare models are crucial for reforming primary care delivery and integrating prevention, health promotion, and care services within communities. Volunteer organizations are increasingly recognized for their potential contributions; however, their integration within Italy's emerging Community Health Center (CHC) model still needs to be explored. This study investigated the role of volunteer organizations in developing Italy's CHC model by focusing on how these groups can enhance care coordination and community health outcomes.

Methods: A qualitative descriptive approach was employed, combining semi-structured interviews and focus groups with key stakeholders, including CHC managers, primary care directors, social service providers, and volunteer organization representatives in the Piacenza area of Emilia Romagna. Data collection spanned July 2021 to March 2022, and thematic analysis was used to identify core themes related to the integration of volunteer organizations in CHCs.

Results: The study identified four key areas where volunteer organizations contribute: (i) prevention and health promotion, (ii) identifying unmet needs and caregiver support, (iii) collaborative initiatives between CHCs and volunteers, and (iv) creating spaces for teamwork. Despite these contributions, challenges related to organizational coordination, limited operational specialization, and geographic disparities have been noted. Volunteer organizations were found to play a critical role in addressing gaps in community services, yet their involvement in CHC planning and execution varied across territories.

Discussion: Although volunteer organizations have the potential to significantly enhance community-based care, their integration into Italy's CHC model is hindered by limited coordination, funding constraints, and uneven involvement across regions. Strengthening partnerships, improving operational support, and creating dedicated collaboration spaces are essential to fully leveraging their contributions. Future research should explore strategies for enhancing the sustainability and scalability of volunteer-led initiatives within the CHC framework.

Background: Integrated cardiovascular risk management care pathways are initiated nationwide to decrease the morbidity, mortality, and costs of cardiovascular diseases. However, evidence on cardiovascular risk management care pathways is needed to support broader scaling up of these initiatives.

Aim: To evaluate a Dutch cardiovascular risk management care pathway to identify benefits for patients and professionals and determine working mechanisms for upscaling integrated care initiatives.

Methods: Process and clinical indicators: retrospective cohort design combined with quasi-experimental time-series design with longitudinal data (2014 to 2019, n = 3779) examined using an ANOVA with contrasts. Team indicator: a survey. Working mechanisms: multidisciplinary focus groups and interviews with patients.

Results: Process, team, and clinical indicators showed that cardiovascular risk management care pathway is beneficial for enhancing quality of care and inter-professional collaboration. Six working mechanisms were identified: boundary spanners, boundary objects, network platform, continuous learning and improvement, mixed-methods evaluation, and multilevel connection for upscaling.

Conclusion: Vertical integration formalized in a care pathway benefits both patients and professionals in primary and secondary care settings. Also, evaluation with multiple research methods enables a more comprehensive understanding of the context in which care pathways are implemented and working mechanisms, which is essential for scaling up integrated care initiatives.

Introduction: In low-resource settings, fragmented family planning (FP) services limit contraceptive access, contributing to high unmet needs and unintended pregnancies. Integrating FP with existing reproductive health services can improve access and continuity of care. This review examines the integration strategies in low and middle-income countries (LMICs).

Theory and methods: We conduct a scoping review across five databases for peer-reviewed literature and Google Scholar for grey literature, guided by Joanna Briggs Institute (JBI) and Arksey & O'Malley's frameworks. Data were charted study characteristics and details of integration process. Results were reported following PRISMA-ScR guidelines.

Results: The total of 37 studies from LMICs were included. Only five studies provided explicit definitions of integration. Key strategies involved aligning FP with other services, promoting dual-method use in HIV care, and incorporating long-acting reversible contraception with post-abortion and postpartum care. Training was provided to various health workers to support services integration. Most Models used co-location of services within the same facility. Innovative approaches, such as; the Happy Client Model and private counselling spaces. Integration was influenced by provider skills, workload, communication dynamics, training gaps, and supply constraints.

Conclusion: A review identified diverse methods and factors for integrating family planning services. Clear operational definitions and innovative services delivery models are critical for effective integration. Further research should inform context-adaptable frameworks for implementation in resource-constrained settings. These findings can inform integrated care policy by highlighting the need for coordinated service models, provider training, and context-sensitive strategies to optimise FP access in LMICs.

Introduction: Within the UK, NHS England has outlined the integral role of third sector organisations as a strategic partner in integrated care systems. This study sought to explore the embedding of a 'new relationship' in the co-design and delivery of 'local' services.

Methods: Thirteen semi-structured interviews were conducted within a local authority area in England, with leaders from both the statutory and third sector. Interviews were analysed using framework analysis.

Findings and discussion: Findings suggest there is a need to go beyond the rhetoric in embedding a 'new relationship' with the third sector. More needs to be done to change the narrative as to how the third sector is perceived, for sectoral stereotypes to be dispelled, to move beyond tokenistic engagement and focus on how improving health can be tackled together. Whilst place-based forms of governance will differ, a greater understanding by the statutory sector of 'local' organisational and individual dynamics, capabilities and perspectives is paramount.

Conclusion: The study concludes that policy narratives are not underpinned with institutional structures and mechanisms. Without a concerted effort and commitment to meaningful engagement, there is a risk that third sector goodwill dissipates in the face of the latest iteration of policy rhetoric.