International Journal of Integrated Care最新文献

Introduction: The complexity and transversality of the care for patients with immune-mediated inflammatory diseases (IMIDs) represents a challenge for the usual structure of health care services and requires a transformation of existing clinical management models. We describe the design, implementation and evaluation of a new collaborative care model for patients with IMIDs.

Description: A group of multidisciplinary professionals including specialists from the rheumatology, gastroenterology, dermatology and pharmacy services designed and implemented an innovative health care model for patients with IMIDs that has changed the traditional model of care. One of the main challenges is the transversal leadership system in collaboration with all the hospital services involved, including the Medical Directorate of the hospital and patients, which promotes greater responsibility and empowerment.

Discussion: Although IMID patient care by a multidisciplinary team is widely recommended, guidelines for IMID-specific models are lacking and few authors have reported controversial results of this strategy.

Conclusions: CEIMI is a pioneering collaborative and multidisciplinary care model for patients with immune-mediated inflammatory diseases. This new model is integrated by physicians, pharmacists and specialised nurses and is oriented to meet the needs and expectations of the patients.

Purpose: Mental health illnesses are more common in people living with HIV (PLHIV) than in the general population, and mental health issues can make it more difficult for individuals to stay engaged in HIV care, which can negatively affect treatment outcomes. Therefore, integrating mental health services into routine HIV care can improve treatment outcomes for PLHIV. This study assessed patients' and healthcare workers' perceptions of enablers and barriers to integrating mental health interventions in routine Antiretroviral treatment (ART) services in Windhoek, Namibia.

Design/methodology: In-depth interviews were conducted to explore the perspectives of PLHIV, healthcare providers providing ART services, and health managers supporting the national HIV program on integrated mental health services. To assist with data organization, data analysis software (NVivo V.12) was used. Colaizzi's (1978) inductive thematic analysis was then applied to explore key concepts.

Findings: The Barriers reported were the lack of awareness of mental illnesses among PLHIV, healthcare worker attitudes, limited physical space at health facilities, insufficient financial resources to address staff shortages, and lack of training for healthcare workers. The enablers reported were integrated screening of mental illnesses, training of Healthcare workers, management support, integration policies and guidelines, and community sensitization and awareness on mental health issues.

The work of the 2020-2023 Connecting People & Community for Living Well Health Canada grant initiative focused on determining what contributes to the wellbeing of those living with dementia and their caregivers, across rural Alberta communities, as well as determining what supports the work of the voluntary and community sector (VCS) teams who seek to better support them. These VCS teams included representatives from across local health, social and community sector partners, including local collaboratives. Evaluation findings highlighted the need to support VCS teams to sustain collaborative community-based work and to build and enhance individual and community wellbeing.

Introduction: Rising dementia rates can worsen the strain on the healthcare system and increase hospital admissions. Hospitals decondition persons living with dementia (PLWD), for which volunteers can offer support. We reviewed existing literature on volunteer-led/supported care transition services available to PLWD, assessing PLWD representation and the extent to which their needs are addressed.

Methods: We conducted a secondary analysis of a scoping review examining volunteer and third-sector personnel providing post-discharge support. Of the review's 49 articles, we considered services offered to PLWD and persons with cognitive impairment (PWCI). The Camberwell Assessment of Needs for the Elderly (CANE) guided the thematic analysis.

Results: Four of our nine selected articles highlighted services supporting PLWD, though only one was developed explicitly for them. The most common themes of needs targeted or met were physical health (n = 7), company (n = 7), food (n = 6), medications (n = 6), and psychological distress (n = 6).

Discussion: We described the characteristics and outcomes of these volunteer-led/supported care transition interventions. Comparing the leading PLWD needs against those the interventions primarily addressed revealed potential oversight of their most critical needs. However, volunteers remain valuable in supporting discharged community-dwelling PLWD.

Conclusion: In hospital-to-home care transitions, volunteer-led/supported transitional care models benefit PLWD and their caregivers. However, few available interventions explicitly focus on this patient population. Therefore, this is an opportunity to understand better how volunteers and third-sector organizations could optimally support those living during care transitions through an integrated care approach.

Introduction: This study aimed to evaluate the impact of integrating social and health home care services (HCSs) on institutionalization, survival, and utilization of health and social care services and associated expenditures.

Methods: Retrospective study including all individuals who initiated social HCSs for dependent people in Catalonia during 2018-2019 with a paired case-control, pre/post design (differences-in-differences), using integrated data from the Autonomy and Dependency Care System database and the Catalan Health Surveillance System. Individuals were categorized based on their perceived level of integration in the residing areas (high level: Case Group, and low level: Control Group).

Results: We included 4381 cases and 13143 matched controls. HCS integration decreased the risk of institutionalization in a nursing home by 19.5% and the length of stays in any center by 7.7%. Integration increased day centers' use by 23.7% and primary care service utilization by 3.0%, and also reduced associated social expenditures after HCS initiation by 19.1% and overall social and health expenditures by 2.6%.

Conclusion: Integration of social and health HCSs resulted in a shift from institutionalization services to primary care services and day care centers, prolonging recipients' lives in their homes.

Voluntary Community and Social Enterprise organisations (VCSEs) bring valuable knowledge of local health and care needs and have skills in engaging underserved communities. This makes them ideal partners for integrated health and care researchers. Yet, they are often excluded from research. This paper reflects on the benefits and challenges of VCSE-researcher collaborations and shares examples from Australia and the UK of how these have been overcome in practice. We explore how integrated care researchers can work with VCSEs to empower the voice of lived experience, bring greater inclusivity in research methodologies and deliver meaningful findings within local and diverse contexts.

The Voluntary and Community Sector (VCS) is a critical contributor to integrated care, bridging gaps between health and social care services. However, operational inefficiencies and challenges in adapting to dynamic care environments hinder its full potential. This paper clarifies the perspective-drawn from research and practice-on applying Lean Management principles and Dynamic Capabilities Theory to enhance VCS operations. Using practical vignettes, it illustrates how these frameworks can improve volunteer recruitment, retention, and resource allocation, fostering efficiency and adaptability. Recommendations focus on specific aspects of integrated care, including service coordination, crisis adaptability, and volunteer management, leading to better patient outcomes.

Introduction: Health and social care systems are constantly undergoing major reforms to meet the rising demands of an increasing proportion of older patients, with many such reforms aiming to improve integration and coordination. The aim of this systematic review was to synthesize the evidence on inter-organizational coordination interventions between hospitals and outpatient (health- and social care) providers for older patients with complex needs during- and after hospital discharge.

Methods: A systematic search of four databases was performed to identify interventions of inter-organizational coordination at hospital discharge for older patients with complex needs. The retrieved literature was analyzed using a narrative synthesis.

Results: Twelve studies were included (seven randomized controlled trials and five non-randomized intervention studies). The most common intervention components were; needs assessments, dedicated care coordinators and multi-professional teams. Findings show that inter-organizational coordination could decrease- or even increase readmission rates, with similar findings for hospital length of stay and mortality. Furthermore, inter-organizational coordination seemed to have a positive impact on quality of life and activities of daily living.

Conclusion: Inter-organizational coordination could potentially reduce health-care utilization and improve quality of life for older patients with complex needs. However, the findings remain uncertain and further research is warranted.

Introduction: Integrated care pathways may help to bridge evidence-practice gaps. To overcome the limitations of traditional researcher-centred and linear pathway development frameworks, a more user-centred approach is needed. In this study, we propose design thinking as a framework for developing integrated care pathways, specifically targeting rehabilitation of patients undergoing lumbar fusion surgery.

Description: From 2017 to 2022, we utilized the design thinking infinity loop to create an evidence-based rehabilitation pathway for patients undergoing lumbar fusion surgery. This approach consisted of five phases: (1) empathizing with user needs, (2) defining problem statements, (3) ideating through meta-analysis, expert consensus, and brainstorming, (4) prototyping the pathway, and (5) testing its effectiveness and implementability.

Discussion: Through the proposed design thinking phases, innovative elements such as prehabilitation, early mobilization, and consistent communication emerged as the building blocks of the new rehabilitation pathway, addressing the needs of both patients and healthcare providers. These results serve as a practical guide for applying design thinking in developing integrated care pathways.

Conclusion: Design thinking, represented by the infinity loop, presents a user-centred framework for developing integrated care pathways, and has the potential to effectively bridge the gap between evidence and clinical practice.