International Journal of Integrated Care最新文献

This thesis explores the relationship between organizational learning and integrated care in health systems. Through a mixed-methods approach, it analyzes how healthcare organizations develop learning capabilities and how these contribute to the effectiveness of integrated care models. These findings indicate that fostering a culture of continuous learning enhances care coordination and patient outcomes. However, structural and cultural barriers may hinder learning processes. This study provides insights for policymakers and healthcare managers on leveraging organizational learning to improve integrated care implementation.

Introduction: This project aimed to develop a Person-Centred Co-ordinated Care (P3C) pathway for low back pain (LBP).

Description: A national working group was formed consisting of representatives from all regional healthcare organisations in Sweden and included all relevant healthcare professions, academia, and patient organisations. A mixed method iterative design and consensus approach was applied in the development of the P3C pathway.

Discussion: As a foundation, patient interviews along with a review of literature were conducted investigating the evidence base for healthcare interventions, earlier regional care programs/pathways and guidelines in Sweden as well as patient experiences and challenges with healthcare for LBP. Updated evidence-based clinical recommendations, tools supporting the practical use of the national P3C pathway and national healthcare data registry-based quality outcome indicators were then developed. Thereafter, an open consultation period provided review and feedback for final revisions and consensus.

Conclusions: Essential factors for integrating best praxis according to scientific evidence and patient and healthcare professional perspectives were identified to establish a Swedish national P3C pathway for LBP. This provides a novel and innovative example of feasible methodology applicable in the international context. Future research will evaluate potential improvements in healthcare quality outcomes and effectiveness of dissemination and implementation strategies.

Background: The global shift toward aging populations, driven by advancements in the economy, healthcare, and society, has transformed once-lethal diseases into chronic conditions. Complex patient management scenarios emerge through this trend, coupled with demographic changes, given that multiple chronic diseases coexist within an individual. The TEC-MED project, which spans multiple countries, aims to evaluate whether the TEC-MED model can improve the quality of life and reduce care dependency among older adults in the Mediterranean region.

Methods: This study employs a mixed-method approach including a longitudinal analytical quasiexperimental design, economic evaluation, and qualitative techniques such as interviews and focus groups. The sample includes at least 20,000 older adults and their caregivers from the Mediterranean basin countries. Quantitative data analysis encompasses descriptive and bivariate statistical analyses, regression models, and economic evaluation, whereas qualitative analysis involves discourse analysis and thematic categorization.

Discussion: The TEC-MED project's focus on integrating social and health care is expected to improve health outcomes and quality of life for older people and their caregivers. The anticipated outcomes will contribute valuable insights into the TEC-MED model's effectiveness in promoting person-centered care and addressing global challenges posed by aging populations.

Trial registration: NCT06184178 (ClinicalTrials.gov).

Date of registration: 27/12/2023.

Introduction: Goal oriented care (GOC) and its readiness for implementation has been described in scientific literature, but research on GOC implementation in primary care organisations is limited. This study aims to capture the experiences of primary care organisations in implementing GOC in their context.

Method: A qualitative study, with data triangulation, was conducted. Primary care organisations that experimented with the implementation of GOC in their context were followed. Data were analysed using inductive thematic analysis.

Results: Seven themes supporting GOC implementation were identified. Project leaders from the primary care organisations experienced that related concepts can serve as a foundation for initiating the implementation of GOC. The implementation process is an iterative and reflective process, with resistance viewed as an integral part of the process, offering opportunities for reflection. Collaborating with partners, especially the active participation of patients, was seen as a facilitator. Furthermore, having a clear vision for GOC is necessary. Projects invested in adapting tools and processes to align with GOC and provided relevant training.

Discussion and conclusion: The findings led to recommendations that can guide the implementation of future GOC projects. Effective implementation extends beyond the development and adaptation of tools; it requires translating theoretical concepts into practical application and creating a shared vision on GOC.

Introduction: To realize an integrated specialised care approach for families with multiple, severe, and enduring problems, specialised teams providing integrated care are emerging. In this qualitative evaluation, we aimed to gain insight into the key elements promoting an integrated specialised care approach at the level of professionals by studying five Specialist Integrated care Teams (SITs).

Methods: Perspectives of families, professionals, managers, and policymakers were gathered by conducting 52 semi-structured interviews. Additionally, 40 observations of case meetings were conducted. A theory-driven framework method was applied to analyse the transcripts both deductively and inductively.

Results: Five key elements promoting an integrated specialised care approach were identified: i) a broad view on families, ii) an integration of specialised perspectives, iii) providing specialised care flexible and timely, iv) working from families' preferences and needs, and v) organising a well-structured care process and multidisciplinary evaluations.

Discussion: When providing integrated specialised care, a family-centred focus, flexibility to tailor care within a well-structured care process, and investing in collaborative relationships with families are key.

Conclusion: Although SITs are a promising form of an integrated specialised care approach, ensuring integrated care is the responsibility of every professional and (specialised) care service involved in families' care.

Introduction: Community-based interventions to support orphans and vulnerable children were the basis for this systematic review, which was undertaken using the available literature based on different studies that outlined community-based interventions.

Methodology: A systematic literature searches for quantitative, mixed methods, and qualitative studies describing the community-based intervention to support HIV and AIDS orphans and vulnerable children in Africa was performed in the following databases: Google Scholar, PubMed, EBSCOhost and Science Direct. The search utilized keywords, Boolean operators, and search engine filters, guided by inclusion and exclusion criteria as part of the search strategy. The keywords used included: community-based interventions, support (psychosocial, economic, material, and social), OVC, and Africa. A thematic approach was used to analyze common emerging themes in the community-based interventions to support HIV and AIDS orphans and vulnerable children in Africa.

Results: In total, 16 studies met the inclusion criteria, documenting a range of community-based interventions to support OVC in Africa. These included food and/or food parcels, child protection, healthcare services, as well as educational, legal and psychosocial support.

Conclusion: Community-based intervention support plays a crucial role in enhancing the lives of orphans and vulnerable children in Africa. Community-based intervention support needs to be integrated into a wider social service system. Further research focusing on the cost of community-based intervention support and successful programs for mainstreaming community-based intervention into a wider social system is needed.

The impact of chronic non-cancer pain on individuals is complex, multidimensional, and with healthcare needs that challenge fragmented healthcare systems. There have been significant advances in generating scientific evidence, ministerial guidelines, and even laws in Chile. However, there is still a considerable gap that remains in the implementation in clinical practice. Despite this, clinical teams have implemented three pilot programs in different countries. This perspective discusses these pilots, their implementation process, acquired knowledge, and the challenge of advancing toward scaling up.

Introduction: Participatory, emergent, and reflective approaches are needed in research on person-centred integrated care. This paper describes and explores the process of developing a complex care transition intervention for stroke survivors, along with the lessons learned.

Description: This study concerns the Missing Link project, which aimed to develop and evaluate a care transition intervention from hospital to home. The care transition was developed according to the Medical Research Council (MRC) Framework and included studies on context, co-design workshops, and prototype development.

Discussion: The development process faced challenges relating to understanding the emergence within the studied context and the complex adaptive systems. We failed to have a continuous and sustained involvement of healthcare professionals, patients, and significant others during the different phases of the project. Hence, a lack of shared understanding is conceivable as the emergence might have been interpreted and understood differently by the actors.

Conclusion: Challenges in achieving shared understanding throughout the project underline the importance of investing in relationship building, meaningful interaction, and continuous feedback loops. While the MRC framework provides guidance for developing complex interventions, the phased approach may only partially capture the emergence and self-organisation within complex adaptive systems.

Aim: We aim to provide practical guidelines on how to develop integrated service plans that incorporate care provided by multiple specialties.

Introduction: Bringing specialties together to strategically plan future health service delivery is challenging. In Australia, collaboration between specialties is required to prepare for the introduction of the National Lung Cancer Screening Program (NLCSP). The purpose of this investigation is to provide practical guidelines on how to develop integrated service plans that incorporate care provided by multiple specialties.

Description: Collaborative planning was undertaken in Western Sydney Local Health District (WSLHD) to develop a WSLHD Thoracic Oncology Program Service Plan. The planning process included oversite by a steering committee, engagement of a range of stakeholders, a series of interviews, meetings and workshops, and the documentation of the strategies and actions required to implement the plan. The planning process was analysed to produce an Integrated Service Planning Tool (ISPT).

Discussion: The ISPT includes five key enablers for the planning process: foster a strong culture of collaboration; establish strategic governance; identify a patient journey framework; conduct extensive and flexible stakeholder consultation; and formalise the plan with documentation of a roadmap. Key actions for each enabler translate the ideas into activities.

Conclusion: A culture of collaboration across specialties supports the development of an integrated service plan that encompasses the full patient journey. The ISPT provides a blueprint for overcoming a traditional siloed approach to service planning for diseases and conditions that require interdisciplinary care.

Introduction: Whole-person approach represents a fundamental tenet of integrated care globally. However, there remains a lack of consensus regarding its precise definition and an inclination towards superficial and formal implementation. This study aims to compare the similarities and differences between Western medicine and Traditional Chinese Medicine (TCM) perspectives on the whole-person approach, and their potential implications for integrated care.

Methods: We performed a scoping review search of original articles with a sufficient definition of a whole-person approach published in English (Wed of Science) and Chinese (China National Knowledge Infrastructure) between January 2010 and July 2024. A total of 127 articles deemed relevant to this overview were synthesized using a thematic analysis.

Results and discussion: The study reveals that both Western medicine and TCM adopt a whole-person approach in integrated care, characterized by multidimensionality, dynamism, capability, and collaboration. However, the study also highlights that the goals and focuses of the whole-person approach in Western medicine and TCM differ. The research further discusses the importance of developing a genuine integration of the best ideas from both Western medicine and TCM to achieve a comprehensive and effective whole-person approach to integrated care.

Conclusions: This study highlights the culture-specific perspectives in the whole-person approach to integrated care, and also underscores the necessity of integrating the strengths of this approach derived from diverse cultural contexts.