International Journal of Integrated Care最新文献

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.

Introduction: People with advanced chronic obstructive pulmonary disease (COPD) are well recognised to experience high levels of unaddressed physical and psychosocial symptom burden. Palliative care provides viable support that strives to relieve the sufferings and optimise quality of life for patients. This study aimed to identify factors that contribute to satisfaction and well-being of people with advanced COPD while attending services which offer palliative care approaches.

Methods: A descriptive exploratory qualitative study using semi-structured interviews was conducted. Nineteen participants (67 ± 9 years) were recruited through Breathe Easy clinic (n = 13), and day hospice (n = 6) in the United Kingdom.

Results: Both types of services were noted for bringing substantial contributions to patients' lives. Healthcare professionals' empathy and skilled communication were particularly important, with participants adjusting and accepting their limitations more easily when they understood their disease. Early introduction to services with palliative care approaches, along with referrals to support groups and education, helped normalise their experiences and improve symptom management.

Conclusion: Providing psychological and educational interventions can lead to improvements in social aspects of patients' lives or the development of self-management techniques to cope with the disease both physically and mentally. Early palliative care involvement is essential in this population.

Introduction: This review examines the institutional diversity in integrated care due to various institutional logics and explores the essential management strategies for navigating this diversity effectively.

Methods: This systematic literature review involved a comprehensive search across Scopus, Medline and Google Scholar. This process identified 1747 articles, with rigorous screening narrowing them down to eight key articles.

Results: The study unveils five primary institutional logics in integrated care, focusing on their unique characteristics and how they interrelate, and highlights crucial management strategies for maintaining a balance among these diverse logics.

Discussion: Applying the institutional logic perspective, this study uncovers the complex interplay of diverse logics shaping integrated care-a previously underexamined facet. Examining the foundational beliefs underlying organizational behaviour offers deeper insights into institutional complexities often overlooked in previous literature. This highlights the necessity for effective management strategies to reconcile conflicting logics, promoting more sustainable integrated care solutions.

Conclusion: The review comprehensively explores institutional logics in integrated care, emphasizing the importance of holistic management strategies. It highlights the imperative for policymakers and healthcare administrators to balance operational efficiency, patient-focused care, and professional independence-essential elements in crafting successful integrated care frameworks.

Introduction: Children with medical complexity (CMC) are a vulnerable population with high healthcare utilisation and significant care coordination challenges. This study evaluates the early implementation results of a short-term Care Coordination Model designed to address these challenges within the Hunter New England Local Health District (HNELHD) in New South Wales, Australia. The Model aims to provide an intensive, time-limited "dose" of care coordination, followed by a Maintenance Phase, to improve healthcare use and reduce the coordination burden on families and healthcare staff.

Description: The Model consists of two phases; an Intensive Phase led by a Paediatric Care Coordinator, providing focused support and care planning for 6-12 months, and a Maintenance Phase where care is handed over to a member of a Paediatric Care Coordination Network for ongoing monitoring and support. A pre-post evaluation of hospital utilisation data for the first 20 children enrolled in the Model was conducted, covering six months before and six months after enrolment. Outcomes measured included outpatient appointments, coordinated appointments, inpatient stays, emergency department presentations, and travel distance for care.

Discussion: The early results from the pilot phase indicate promising outcomes. The Intensive Phase of the Model has led to more coordinated appointments, and reduced travel for families. The concept of "coordination respite" emerged as a significant benefit, where families experienced relief from the constant pressures of managing their child's care. This respite allowed families to regroup, organise, and find the mental space to learn how to better coordinate their child's care independently. The Intensive Phase provides critical support during the most demanding times, while the Maintenance Phase is positioned to support sustained, long-term assistance.

Conclusion: The early implementation of the short-term Care Coordination Model for CMC in HNELHD shows significant potential. The Model's intensive, time-limited approach, combined with a Maintenance Phase and a strong focus on family empowerment and Network collaboration, offers a sustainable approach to care coordination. Future research should continue to explore the optimal dose of care coordination that is aligned with the principles of value-based care and further evaluate the Model's long-term impact, beyond the Intensive Phase.

Background: Health justice partnerships (HJP) embed legal support into health care teams to address patient unmet legal needs. Families experiencing adversity are likely to have multiple legal needs yet are unlikely to seek legal assistance. Implementing a HJP within an integrated health and social care hub may improve outcomes for families by addressing adversity related to unmet legal need.

Methods: A mixed-method evaluation of new HJPs was conducted across two sites in Australia. Process data were collected regarding the use of the legal services. Qualitative data explored the experience of legal support.

Results: Forty caregivers were referred across two sites with 38 seen over the first 12 months. Caregivers had an average 2.5 legal issues each; 65% of referrals were for family violence and family law matters, 31% were for civil law matters and 4% were for criminal matters. Qualitative data demonstrated the value of HJP to increase practitioner confidence and understanding of legal support pathways while empowering caregivers to access legal support.

Conclusions: These HJPs improved access to legal support for families experiencing adversity and enabled early intervention. Improved outcomes from HJP depends upon the level of investment from each partner and the level of assistance the HJP can provide.

Introduction: Following hospitalization, older adults with complex health and social care needs are often deemed to need an "alternate level of care" (ALC) where care needs are misaligned with resources. Coordinated networks can implement integrated care programs for this group in home settings. Understanding the experiences of providers, caregivers, and patients will inform ongoing implementation efforts.

Methods: A qualitative case study was undertaken of North York Community Access to Resources Enabling Support (NYCARES), a novel integrated care program implemented during the COVID-19 pandemic. Data collection consisted of semi-structured interviews, document analysis, and observational field notes; data were thematically analyzed.

Results: Thirty-six providers, caregivers, and patients were interviewed. Three themes were developed: 1) NYCARES as a lifeline; 2) Experiences tempered by expectations and connection; and 3) The role of integrated care.

Discussion: The NYCARES program was seen as valuable, but implementation posed challenges for each participant group due to varying expectations and perceived degree of connection between patients, families, and providers.

Conclusions: The local coordinated network successfully implemented the NYCARES program for ALC patients despite challenges in stakeholder connections. Similar programs should formally support caregivers and forefront multidirectional communication, particularly between providers in different implementation roles.

Introduction: The healthcare response to the COVID-19 pandemic in long term care facilities (LTCF), constitutes one of the challenges faced by governments and institutions worldwide. Our aim was to analyze the facilitators and barriers of this response, for the future integrated care model in these facilities.

Methods: From a retrospective observational study, we present the experience and lessons learned of the implementation of an integrated response at the meso level in LTCF for older people and for people with physical and mental conditions in the North Metropolitan area of Barcelona, in Catalonia, during the COVID-19 pandemic.

Results: We analyzed the care provided to 13,369 institutionalized people. The major facilitating points were: the adaptation of proactive care teams, the creation of a tool to improve communication with institutions, and the management of epidemiological data for planning collaboration between different actors. Main barriers were not including users and family members views in the response adaptation, and the lack of LTCF resources to respond to changing needs.

Conclusions: Increasing proactivity and adapting interventions based on updated information were key to minimize infections and mortality. Improving the communication and the collaboration between actors, and people involvement in the response planning, need to be considered for the future.

Introduction: Families experiencing adversity often have complex needs and face barriers to accessing health and social care. This study evaluated the acceptability, feasibility and preliminary effectiveness of a Wellbeing Coordination (WBC) program to improve access to services. The program combined care navigation and social prescribing within an integrated health and social care Child and Family Hub.

Methods: Mixed-methods design, with data collected through surveys and interviews from: 1) caregivers who participated in the WBC program (n = 11) and those who did not (n = 18), and 2) practitioners working in the Hub (n = 21).

Results: Caregivers and practitioners found the WBC program acceptable and mostly feasible, demonstrating the potential to alleviate caregivers' loneliness and enhance their health, connection to the community, and knowledge and confidence in supporting child and family health and wellbeing.

Discussion: Future WBC program enhancements could include a robust communication strategy to ensure what the program offers is clearly understood by practitioners and caregivers, establishing organisational structures to provide adequate support for the wellbeing coordinator and adopting flexible eligibility criteria.

Conclusion: The WBC program appears acceptable and feasible. Future research should establish program effectiveness with larger and more diverse caregiver samples.

Introduction: Value-based healthcare is a current global trend in health and policy where digital technologies can play an important role to measure what matters to the people. The digitalisation of value-based healthcare is only possible if the care team and people trust in this new concept and the tools provided. In this framework, a participatory co-desing approach was implemented to identify the core elements of an innovative value-based, integrated health and social care delivery model supported by ICT solutions: the VALUECARE model for older people with comorbidities.

Description: The main guiding principles for care delivery have been obtained by means of a literature review. Qualitative data was collected from 369 participants using focus groups and interviews in 6 European countries (Croatia, Ireland, Portugal, Italy, Spain & The Netherlands). The eHealth Enhanced Chronic Care Model was used as a heuristic tool to integrate the participants' discourses.

Discussion: The VALUECARE model fits with the features for the integrated care practice facilitating the transformation of care delivery addressing the needs of the growing old population and the rapidly development of technologies.

Conclusion: VALUECARE model highlights best practice value-based, integrated care delivery through the application of a set of 6 guiding principles across 7 different core elements.