International Journal of Integrated Care最新文献

Introduction: As healthcare systems increasingly embrace population health management, the integration of health and social care to improve the health and well-being of individuals is crucial. Thus, we conducted a qualitative study in Singapore to understand health and social care professionals' (HCPs and SCPs) perception of the roles they played in delivering community-based care.

Methods: A descriptive phenomenological research design was adopted. HCPs and SCPs (n = 53) providing services in community settings were recruited purposefully and interviewed through eleven focus group discussions. Each session was recorded and transcribed. Thematic analysis was applied.

Results: Our results revealed eight themes in three main categories describing the roles played by HCPs and SCPs, including: (1) delivering needs-based care in community settings; (2) activating and empowering clients in health care, and (3) fostering community-based sustainable support networks. Six barriers encountered while performing these roles were also identified.

Discussion and conclusion: Our results highlight that the roles of HCPs and SCPs go beyond the provision of direct medical and social care. They were involved in activating and empowering clients to take care of their health, and importantly, fostering community-based sustainable support networks to better empower individuals in coping with health challenges. The identified barriers shed light on areas for potential improvements for integrated community care.

Introduction: Many older people present to emergency departments annually, often with complex geriatric syndromes, yet current acute care models and traditional admissions process may under-serve their needs. The multidisciplinary Aged Care Rapid Investigation and Assessment (ARIA) Unit seeks to bridge this gap, by actively identifying and assessing patients.

Methods: A prospective case-control study was undertaken at a single-centre tertiary referral institution. Patients were eligible for inclusion in ARIA group if admitted to ARIA via case-finding by the geriatrician or Aged Care Services Emergency Team, whilst standard geriatric admissions formed the control group. This study evaluates whether ARIA reduced hospital length-of-stay (LOS) and representation rates.

Results: 370 patients were included (185 each arm) with similar baseline demographics, frailty scores, and Charlson Comorbidity Indices. Patients admitted to ARIA had significantly shorter hospital LOS than those via standard pathway (3.3 days [IQR2.2-5.8] vs 7.5 days [IQR4.2-13.7], p < 0.00001). There were no significant differences in 90-day representation rates (n = 66 [35.7%] vs n = 64 [34.6%], p = 0.82).

Discussion/conclusion: Introduction of an ARIA unit with a targeted approach to frontline geriatric services and case-finding is associated with improved LOS of older acute hospital patients. An economical cost analysis of this study would be beneficial in exploring potential financial savings.

Background: Patients with chronic disease have become one of the major challenges for health and social protection systems in developed countries. Integrated care models (ICM) have demonstrably improved the quality of care of chronic patients. However, new models of integration need further evaluation of its effectiveness and outcomes.

Methods: The ICM studied promoted coordination between the health and social sectors during a 6-month period, through an ad hoc developed application (app) that enabled a constant flow of communication between professionals from both sectors. Patients' quality of life, treatment adherence, chronic patient experience and caregiver overload were assessed by questionnaires at baseline, at the end of the intervention and 6 months post-intervention.

Results: The implementation of the new health and social ICM permitted new case detection and medical and social services offered to chronic patients. Furthermore, the quality of life and treatment adherence of patients and caregiver overload were significantly improved. These positive effects lasted at least 6 months after the intervention.

Conclusions: Integrated care may facilitate access to care services, increase perceived patient quality of life and treatment adherence. Enhanced access to medical and social services from complex chronic patients may have important implications for caregivers and the care systems who are struggling to adapt to an expanding demand.

Introduction: The Flexible Assertive Community Treatment (FACT) model has rapidly become a way of organising services for people with severe mental illness. FACT describes the integrated approach of interprofessional teams.

Method: A qualitative study of interprofessional collaboration in three FACT teams was conducted. Thirty observations of the teams' board meetings were conducted, and field notes were thematically analysed.

Results: This study generated three themes in interprofessional collaboration in FACT teams. The first theme reflects the challenges of working in line with the model, the second suggests an unclear understanding of a shared caseload, and the third shows different approaches to working with a shared caseload.

Discussion: The themes suggest that there is increased opportunity for the shared caseload in the FACT team board meeting. The findings reflect that there is a lack of either the resources necessary for working with a shared caseload or an understanding of the intention of a shared caseload.

Conclusion: The potential of the shared caseload in FACT team board meetings are dependent on sufficient resources and a collective understanding of the FACT model and the shared caseload among professionals. Further research on how a shared caseload is experienced and facilitated in FACT teams can provide insight into their practices.

Introduction: Community pharmacists are accessible primary care providers and therefore in a good position to detect unmet psychosocial needs of their patients and pharmacy visitors.

Description: A collaboration between pharmacists and psychosocial work was set up in Flanders, Belgium. Community pharmacists were trained to discuss psychosocial needs, to inform patients about possible help and refer them to a Center for General Wellbeing if needed. During the pilot of the project between October 2021 and January 2022, the feasibility and potential of this collaboration were examined.

Discussion: A total of 79 patient contacts about psychosocial wellbeing were reported using an online registration form, the majority of which concerned women. Family problems and mental health problems were most often reported. Focus group discussions with 28 participating pharmacists showed that they experience their role in psychosocial care as fulfilling and of valuable. Patient satisfaction was mentioned to be a major motivating factor, while time and privacy are barriers. Adequate training in psychosocial wellbeing and care was considered crucial.

Conclusion: Pharmacists can be valuable partners in the recognition and referral of patients with unmet psychosocial needs. Structural collaborations between community pharmacy and psychosocial care should be further supported.

Introduction: Well-integrated community aged care services empower and enable older people to live and thrive in the community by supporting activities of daily living. To inform integrated community aged care service planning and delivery in South Western Sydney Australia, a needs assessment with consumers (i.e., older people), their caregivers, and healthcare providers was conducted. This study details the comprehensive and inclusive needs assessment process undertaken, with a focus on translating the findings into practice to improve integrated care.

Description: Qualitative interviews and community forum-style focus groups engaged 160 stakeholders including GPs, older people, and aged care workers. Transcribed data were thematically coded using an inductive approach. Data were organised into four themes: 1) access to community aged care services; (2) healthcare and medical needs; (3) social concerns and needs; and (4) education and information needs.

Discussion: The needs assessment undertaken identified unmet needs, gaps in service provision, and recommendations for improving integrated community aged care services.

Conclusion: Findings are novel in the context of South Western Sydney, Australia. The study design, methods employed, and lessons learned can be adapted internationally for future needs assessments to inform policy, strategies, and integrated aged care service delivery.

Introduction: Healthcare integration has become prevalent as health systems manage a growing population of older adults with multi-morbid conditions. The integrated general hospital (IGH) is the latest example of how services can be remodelled to achieve greater care integration.

Methods: We conducted a mixed-method evaluation to identify factors impacting the implementation and effectiveness of the IGH model. Data were collected through in-depth interviews (n = 15) and focus group discussions (n = 8 groups) with hospital staff, and a staff survey (n = 226).

Results: Staff perceived improvements in clinical practice and better clinical outcomes for patients. The care model empowered nursing and allied health staff through a more collegial team structure. However, staff reported an unequal workload distribution; a third reported burnout; and some observed inconsistencies between leaders' aspirations for IGH and what was happening on the ground. For IGH to sustain, staff's education on the IGH model needs to be improved. Further examination of work processes is recommended to boost staff morale and prevent burnout.

Conclusion: Overall, IGH provided better integrated, team-based care. The model challenged traditional team structures and empowered staff to expand their roles and responsibilities. Policymakers could consider the IGH model a successful approach for integrating services across the care continuum.

Background: To address issues related to suboptimal insight in outcomes, fragmentation, and increasing costs, stakeholders are experimenting with value-based payment (VBP) models, aiming to facilitate high-value integrated care. However, insight in how, why and under what circumstances such models can be successful is limited. Drawing upon realist evaluation principles, this study identifies context factors and associated mechanisms influencing the introduction of VBP in stroke care.

Methods: Existing knowledge on context-mechanism relations impacting the introduction of VBP programs (in real-world settings) was summarized from literature. These relations were then tested, refined, and expanded based on a case study comprising interviews with representatives from organizations involved in the introduction of a VBP model for integrated stroke care in Rotterdam, the Netherlands.

Results: Facilitating factors were pre-existing trust-based relations, shared dissatisfaction with the status quo, regulatory compatibility and simplicity of the payment contract, gradual introduction of down-side risk for providers, and involvement of a trusted third party for data management. Yet to be addressed barriers included friction between short- and long-term goals within and among organizations, unwillingness to forgo professional and organizational autonomy, discontinuity in resources, and limited access to real-time data for improving care delivery processes.

Conclusions: Successful payment and delivery system reform require long-term commitment from all stakeholders stretching beyond the mere introduction of new models. Careful consideration of creating the 'right' contextual circumstances remains crucially important, which includes willingness among all involved providers to bear shared financial and clinical responsibility for the entire care chain, regardless of where care is provided.

Introduction: An important aspect of Value-Based Healthcare (VBHC) is providing the full cycle of care for a specific medical condition through interprofessional collaboration. This requires employees from diverse professional backgrounds to interact, but there is limited knowledge on how professionals perceive such interprofessional collaboration. We aimed to provide insight into how different professionals perceive Integrated Practice Unit (IPU) composition and what factors influence the quality of interprofessional collaboration within IPUs.

Methods: A survey was administered to employees from different professional backgrounds (medical specialists, nurses, allied health professionals, administrative employees) working in IPUs to assess their perception of the composition of their IPU and the quality of the interactions. Subsequently, semi-structured interviews were conducted to gain a deeper understanding of the findings of the survey.

Results: Medical specialists and nurses were most frequently considered to be part of an IPU and indicated that they have high quality interactions. Allied health professionals were less often considered part of the team by all other professional groups and all report low quality interaction with this group. The extent to which a professional group is perceived as a team member depends on their visibility, involvement in the treatment of the patient, and shared interest. Differences in the quality of interprofessional collaboration are influenced by organizational structures, knowledge of each other's expertise, and by ways of communication.

Conclusions: In VBHC, there seems to be a lack of common perception of an IPU's composition and a failure to always achieve high quality interprofessional collaboration. Given the importance of interprofessional collaboration in VBHC, effort should be invested in achieving a shared understanding and improved collaboration.

Introduction: An in-depth understanding of patient perspectives contributes to high-quality, value-based health care. The aim of this study was to explore the values, needs, and preferences of stroke patients across the continuum of care.

Methods: We performed a qualitative study, as part of the larger ValueCare study, involving 36 patients who have had ischemic stroke within the past 18 months at the time of recruitment. Data were collected between December 2020 and April 2021 via one-to-one telephone interviews. All interviews were audio-taped and transcribed verbatim. The interview data were analysed using a thematic approach.

Results: The analysis resulted in five themes: (1) patients' values about health care, (2) information and education, (3) psychological support, (4) follow-up care, and (5) continuity and coordination of care. Patients valued a compassionate professional who is responsive to their needs. Furthermore, patients indicated a need for tailored health information, psychosocial services, pro-active follow-up care and improved coordination of care.

Discussion and conclusion: Stroke patients emphasised the need for tailored information, psychological support, pro-active follow-up, and improved coordination of care. It is advocated for professionals to use a value-based care approach in order to satisfy the individual needs of patients with regard to information, communication, and follow-up care.