International Journal of Integrated Care最新文献

Introduction: Ignited by the persistent health inequalities many cities and neighbourhoods, the 'Healthy and Happy The Hague' network in the Netherlands wanted to gain insight in how prevention and health promotion could become successful in one deprived neighbourhood, Moerwijk.

Methods: The cycle of Look-Think-Act of Participatory Action Research was used in which both citizens and professionals got involved from the start. Besides interviews, field notes were analysed, visualised and discussed in several rounds of focus groups.

Results: Thematic analysis yielded seven themes: Healthy Eating and Exercise, Healthy Money, Healthy Mind, Healthy Relationships, Growing up healthy, Healthy Environment and Healthy Collaboration. During sessions around combination of themes, eight initiatives were co-created by citizens and professionals together, improving the feeling of ownership and interconnectedness.

Discussion and conclusion: This PAR sheds a light on the mismatch between the system world's solutions for individuals and the living world's needs for solutions for the collective. Findings provides a better insight into the social, political, and cultural mechanisms and processes that influence clustering and interaction of health conditions. PAR is a promising process of citizens and professionals working together is an excellent way to learn about the conditions under which people experience health inequalities, and how to combat these inequalities.

Introduction: The Esther Network (EN) person-centred care (PCC) advocacy training aims to promote person-centred attitudes among health practitioners in Singapore. This study aimed to assess the relationship between the training and practitioners' PCC attributes over a 3-month period, and to explore power sharing by examining the PCC dimensions of "caring about the service user as a whole person" and the "sharing of power, control and information".

Methods: A repeated-measure study design utilising the Patient-Practitioner Orientation Scale (PPOS), was administered to 437 training participants at three time points - before training (T1), immediately after (T2) and three months after training (T3). A five-statement questionnaire captured knowledge of person-centred care at T1 and T2. An Overall score, Caring and Sharing sub-scores were derived from the PPOS. Scores were ranked and divided into three groups (high, medium and low). Ordinal Generalised Estimating Equation (GEE) model analysed changes in PPOS scores over time.

Results: A single, short-term training appeared to result in measurable improvements in person-centredness of health practitioners, with slight attenuation at T3. There was greater tendency to "care" than to "share power" with service users across all three time points, but the degree of improvement was larger for sharing after training. The change in overall person-centred scores varied by sex and profession (females score higher than males, allied health showed a smaller attenuation at T3).

Conclusion: Training as a specific intervention, appeared to have potential to increase health practitioners' person-centredness but the aspect of equalising power was harder to achieve within a hierarchical structure and clinician-centric culture. An ongoing network to build relationships, and a supportive system to facilitate individual and organisational reflexivity can reinforce learning.

Introduction: The Kids Guided Personalised Service (KidsGPS) is an integrated model of care coordination for children and young people (CYP) living with medical complexity. After successful implementation in an urban setting, the model of care will be rolled-out at scale to four rural regions in New South Wales, Australia to establish RuralKidsGPS. This paper describes the approach and methods for the outcome and implementation evaluation of RuralKidsGPS.

Description: The evaluation aims to assess health, economic and implementation outcomes and processes whilst identifying barriers and enablers to inform future rollouts. Measures of health service utilisation (primary outcome), child health related quality of life and parent/carer experiences will be assessed. The implementation evaluation will occur alongside the outcomes evaluation and is underpinned by the Consolidated Framework for Implementation Research and informed by validated quantitative measures and qualitative interviews with patients, families, healthcare providers and service managers. An economic analysis will determine incremental cost effectiveness ratios for the new model of care using health service utilisation data.

Conclusion: RuralKidsGPS, if effective, has the potential to improve equity of access to integrated care for CYP and their families and this protocol may inform other evaluations of similar models of care delivered at scale.

Introduction: Integration in health and care can improve quality and outcomes, but it is challenged by expansion of medical knowledge, social pressures on patient needs, and demands to deliver critical information. In Latin American and in other lower and middle-income countries integrated care remains in development. This paper examined the available literature on integrated care to understand how Latin American countries identify and measure integration, and what factors influence success.

Methods: This integrative literature review included systematic searches in Global Health, PubMed, SciELO and BVSPsi databases for articles on integrated care in Spanish, Portuguese, and English in the period from January of 1999 to December 2020. The articles were screened for selection and assessed independently by five reviewers that used the inclusion criteria of papers about integration in health care systems. The sample excluded articles that did not deal with the integration of health care, which addressed issues related to public health campaigns, programs to control endemics and epidemics, reports on the experience of implementing health services, health promotion guidelines, food safety, oral health, and books evaluation.

Results: 24 articles were included: qualitative (75%), quantitative (12,5%), and mixed-method research (4%) published between 2000 and 2017. All studies were undertaken in Brazil, and two of them were also conducted in Latin American countries. In 15 articles there was an interchangeable use between concepts of integration of services and integrated care, while nine studies did not define integration. Barriers to integration included absence of shared understanding of knowledge among members of interprofessional teams, lack of clarity on professional roles, missing consensus on a definition and measurement of integrated care, power struggles between professionals, poor institutional support, insufficient team preparation and training and unequal valuation of professions by society.

Conclusion: Several types of integration and factors contributing to the success of implementation of integrated care in various contexts in Brazil were identified. The concept of integration reflected the varied local and regional realities including different health settings and levels of health and care, suggesting a need for further clarifications on its objective and components especially in LMIC contexts.

Objective: Recently, cancer patients have challenges with self-management. This study aims to improve symptoms of chronic pain, and anxiety and depression associated with cancer by PRO-SELF nursing intervention.

Methods: Sixty-four patients were randomly assigned to an intervention and a control group from Jan 2016 to Dec 2019, 34 usable cases in the intervention group and 30 cases in the control group were collected. The control group received a routine cancer pain nursing intervention, whereas the intervention group received a PRO-SELF based multidisciplinary collaborative cancer pain nursing intervention. After three months of intervention, the Numeric Rating Scale (NRS), Medication Compliance Questionnaire (MCQ), Social Support Rating Scale (SSRS), Self-rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), Quality of Life Scale (FACT-G Chinese version) and Chronic Pain Self-efficacy Scale were resent to compare the differences in the observation indicators included evaluation of patients' social support degree, anxiety and depression score, quality of life scores and self-efficacy scores between two groups. The t-test and rank-sum test were used for statistic analysis.

Results: No significant differences were found between groups for pain and medication compliance (P > 0.05). However, significant differences were found between groups in social support, life quality, chronic pain self-efficacy, and self-rating anxiety and depression index scores (P < 0.001). The intervention group report more social support, pain self-efficacy and less anxiety and depression (P < 0.001).

Conclusion: The PRO-SELF pain symptoms in patients with a cancer pain management programme improved degree of social support, life quality, self-efficacy, anxiety, depression which is worthy of clinical application.

Introduction: Co-design has been cited as playing a major role in the future of effective integrated care, however, there is a lack of reporting and reflection on the methods used. Information sharing is fundamental when working in integrated care, however sharing across professions, service settings and localities can be complex. Through co-design, we seek to establish a shared understanding of information needs within a newly formed integrated care team. In doing so we aim to inform future practice in the understanding of co-design.

Description: Co-design Workshop 1 (N = 24 participants, plus 6 facilitators), collected 'Current Position' understanding of service information needs. Co-design Workshop 2 (N = 18 participants, plus 6 facilitators) sought a 'Future Position' understanding, identifying solutions and next steps for establishing information-need solutions. Reflection on the co-design process was conducted to inform future co-design practices.

Conclusion: Identified was a wide range of future service information needs under the themes of Culture Building, Health System Needs, and Processes. We conclude with 4 key learning points on co-designing. 1. Ensure simplicity in format. 2. Interdisciplinary co-design and co-facilitation of workshops are beneficial. 3. Planning and preparation are key. 4. Co-designing can enhance communication for service improvement.

Over the last three decades, integrated care has emerged as an important health system strategy to improve population health while addressing the unique needs of structurally marginalised communities. However, less attention has been given to the role of integrated care in addressing issues related to inequities in health and health care. In this commentary we introduce the concept of Equity Promoting Integrated Care (EPIC) that situates integrated care in a social justice context to frame the actions necessary to center equity as a priority for integrated care. We suggest that efforts to advance the design and implementation of integrated care should focus on three avenues for future research and practice, namely, the collaborative mobilization of a global network of integrated care stakeholders to advocate for social justice and health equity, investing in equity-focused approaches to implementation science that highlight the importance of social concepts such as colonialism and intersectionality to advance the theory and practice of implementing EPIC models of care, and leveraging innovative approaches to measuring equity-related aspects of integrated care to inform continuous improvement of health systems.

Introduction: At all levels, effective collaboration between actors with different backgrounds lies at the heart of integrated care. Much attention has been given to the structural features underlying integrated care, but even under structurally similar circumstances, the effectiveness of collaboration varies largely.

Theory and methods: Social and organizational psychological research shows that the extent to which collaboration is effective depends on actors' behaviours. We leverage insights from these two research fields and build a conceptual framework that helps untangle the behavioural processes underlying effective collaboration.

Results: We delineate that effective collaboration can be realized when actors (1) speak up about their interests, values, and perspectives (voice behaviour), (2) listen to the information that is shared by others, and (3) thoroughly process this information. We describe these behaviours and explain the motivations and conditions driving these. In doing so, we offer a conceptual framework that can be used to explain what makes actors collaborate effectively and how collaboration can be enhanced.

Discussion and conclusion: Fostering effective collaboration takes time and adequate conditions, fitting the particular context. As this context continuously changes, the processes and conditions require continuous attention. Integrated care, therefore, actually requires a carefully designed process of integrating care.