Pub Date : 2025-10-01DOI: 10.1016/j.healthpol.2024.105188
Francesca Costanza , Giada Li Calzi
This research deals with Social Innovation (SI) and integrated and connected care in the hospital care, presenting a successful experience of telemedicine's implementation within the Italian context. Nowadays integrated care and connected care are relevant concepts for delivering people-centered healthcare; though their operationalization is challenging and requires accounting for systems’ complexity. In this regard, SI may be a catalyst, since it consists in a kind of innovation motivated by social needs. Extant research on SI in healthcare is scant and fragmentary, overlooking operational features and enabling conditions. Considering these gaps, the paper investigates the potential contribution of SI management to integrated and connected care. For the purpose, it offers a revelatory case study, concerning the pediatric research hospital Gaslini (Genoa, Italy), which is, to our knowledge, the first Italian public hospital to have hired a SI manager. By referring to a telemedicine pilot project, the study analyzes main features of the SI management process and its approach to promote integrated and connected care. Research data are analyzed by combining Gioia methodology and systems thinking. The resulting grounded theory model is causal loops-shaped and highlights virtuous mechanisms of SI unveiling generative voids and existing skills.
本研究涉及医院护理中的社会创新（SI）和综合互联护理，介绍了在意大利实施远程医疗的成功经验。如今，综合护理和互联护理是提供以人为本的医疗保健服务的相关概念；尽管其操作具有挑战性，需要考虑系统的复杂性。在这方面，SI 可以起到催化剂的作用，因为它是一种以社会需求为动力的创新。关于医疗保健中的社会创新的现有研究很少且零散，忽略了操作特点和有利条件。考虑到这些差距，本文研究了 SI 管理对综合互联医疗的潜在贡献。为此，本文提供了一个具有启发性的案例研究，涉及加斯利尼儿科研究医院（意大利热那亚），据我们所知，该医院是意大利第一家聘用 SI 管理员的公立医院。通过参考远程医疗试点项目，该研究分析了 SI 管理流程的主要特点及其促进整合和连接护理的方法。研究数据结合了 Gioia 方法和系统思维进行分析。由此产生的基础理论模型是因果循环型的，并强调了揭示产生性空白和现有技能的 SI 良性机制。
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Pub Date : 2025-10-01DOI: 10.1016/j.healthpol.2025.105391
Nelly D. Oelke , Ashmita Rai , Peter Hirschkorn , Breton Mylaine , Catherine Donnelly , Stephanie Montesanti , Gaboury Isabelle , Karin Maiwald , Paul Wankah
Primary health care teams are a key strategy in providing integrated care, particularly for patients with multiple chronic conditions. Despite a strong commitment to improving primary health care through team-based care globally, challenges to its implementation remain. A comparative policy analysis was conducted in four Canadian provinces (British Columbia, Alberta, Ontario, and Quebec) to examine the policies and structures supporting service integration for patients with two or more chronic conditions through primary health care teams. Results are reported on Phase 3 of the project, including a national knowledge translation event to refine recommendations and develop actions for implementing recommendations related to team-based primary health care in policy and practice. Our virtual knowledge translation event took place in June 2022; with 25 participants including policymakers, decision-makers, providers, patients and researchers. Eight key recommendations were discussed and revised with feedback and strategies for implementation developed. Five themes were identified from the discussions: 1) composition of the team and access; 2) communication and electronic health records; 3) remuneration; 4) patient engagement; and performance measurement. Recommendations for policy and practice are outlined and compared to existing Canadian and international literature.
{"title":"Developing recommendations and actions for integrated services delivery through primary health care teams in Canada: a deliberative dialogue approach for a national knowledge translation event","authors":"Nelly D. Oelke , Ashmita Rai , Peter Hirschkorn , Breton Mylaine , Catherine Donnelly , Stephanie Montesanti , Gaboury Isabelle , Karin Maiwald , Paul Wankah","doi":"10.1016/j.healthpol.2025.105391","DOIUrl":"10.1016/j.healthpol.2025.105391","url":null,"abstract":"<div><div>Primary health care teams are a key strategy in providing integrated care, particularly for patients with multiple chronic conditions. Despite a strong commitment to improving primary health care through team-based care globally, challenges to its implementation remain. A comparative policy analysis was conducted in four Canadian provinces (British Columbia, Alberta, Ontario, and Quebec) to examine the policies and structures supporting service integration for patients with two or more chronic conditions through primary health care teams. Results are reported on Phase 3 of the project, including a national knowledge translation event to refine recommendations and develop actions for implementing recommendations related to team-based primary health care in policy and practice. Our virtual knowledge translation event took place in June 2022; with 25 participants including policymakers, decision-makers, providers, patients and researchers. Eight key recommendations were discussed and revised with feedback and strategies for implementation developed. Five themes were identified from the discussions: 1) composition of the team and access; 2) communication and electronic health records; 3) remuneration; 4) patient engagement; and performance measurement. Recommendations for policy and practice are outlined and compared to existing Canadian and international literature.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"160 ","pages":"Article 105391"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.healthpol.2025.105418
Tom Ling, Nick Fahy, Jessica Dawney
There is global interest in integrated care, often associated with how to improve system efficiency, strengthen clinical and cost-effectiveness, avoid gaps in patient care, and improve patient experiences and outcomes, through improved coordination across services. Despite considerable activity in both delivering and evaluating integrated care, evaluations have not greatly helped to understand how to ‘do’ it better. Evaluations of integrated care have often arrived at similar conclusions, frequently including the generic finding that results are patchy and context dependent. In this article, we explore and discuss these challenges to evaluation, how these challenges are understood in recent key publications, and suggest an alternative perspective.
We explore technical inadequacies of evaluations (concerning definitions, metrics, and timing) as well as deeper problems (such as integrated care being dynamic and relational, and operating across multiple, larger systems). In re-framing how to evaluate integrated care, we propose an approach that involves a recursive evaluation architecture. This draws on systems thinking. This approach also recognises that we can better understand evaluations of integrated care as co-producing knowledge and applying this to learning and adaptation.
{"title":"Reframing the evaluation of integrated care; examples from the NHS in England","authors":"Tom Ling, Nick Fahy, Jessica Dawney","doi":"10.1016/j.healthpol.2025.105418","DOIUrl":"10.1016/j.healthpol.2025.105418","url":null,"abstract":"<div><div>There is global interest in integrated care, often associated with how to improve system efficiency, strengthen clinical and cost-effectiveness, avoid gaps in patient care, and improve patient experiences and outcomes, through improved coordination across services. Despite considerable activity in both delivering and evaluating integrated care, evaluations have not greatly helped to understand how to ‘do’ it better. Evaluations of integrated care have often arrived at similar conclusions, frequently including the generic finding that results are patchy and context dependent. In this article, we explore and discuss these challenges to evaluation, how these challenges are understood in recent key publications, and suggest an alternative perspective.</div><div>We explore technical inadequacies of evaluations (concerning definitions, metrics, and timing) as well as deeper problems (such as integrated care being dynamic and relational, and operating across multiple, larger systems). In re-framing how to evaluate integrated care, we propose an approach that involves a recursive evaluation architecture. This draws on systems thinking. This approach also recognises that we can better understand evaluations of integrated care as co-producing knowledge and applying this to learning and adaptation.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"160 ","pages":"Article 105418"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adults with complex needs require health and social services from a variety of providers. Appropriate care for these people calls for integrated care. However, few studies have assessed the organizational conditions conducive to implementing integrated care programs in preparation for scale-up.
Objective
This study aimed to 1) implement a case management program as part of an integrated care program initiative for adults with complex needs in health and social services organizations and primary care clinics, 2) evaluate the organizational factors influencing implementation, and 3) share recommendations from key stakeholders to facilitate scale-up.
Methods
A qualitative multiple-case study was conducted in two health and social services organizations and five primary care clinics in Quebec, Canada. We collected data through participant observation, semi-structured interviews, and focus groups with stakeholders. The data were analyzed using deductive (RE-AIM framework) and inductive thematic analysis. Case stories were developed and then compared.
Results
Identifying patients targeted by the program was challenging. Better access to health information technology for case-finding was strongly recommended. Remuneration methods compatible with family physicians’ expected levels of commitment to the program were needed to promote their engagement. Appropriate change management was also important to promote implementation and ensure sustainability of the program over time.
Conclusion
This study may inform stakeholders interested in scaling up integrated care programs for adults with complex needs.
{"title":"Planning the scale-up of integrated care programs: A qualitative multiple-case study of case management for adults with complex needs in Quebec, Canada","authors":"Catherine Hudon , Alexandra Lemay-Compagnat , Mathieu Bisson , Maud-Christine Chouinard , Gregory Moullec , Lourdes Rodriguez del Barrio , Émilie Angrignon-Girouard , Marie-Dominique Poirier , Marie-Mychèle Pratte","doi":"10.1016/j.healthpol.2025.105321","DOIUrl":"10.1016/j.healthpol.2025.105321","url":null,"abstract":"<div><h3>Background</h3><div>Adults with complex needs require health and social services from a variety of providers. Appropriate care for these people calls for integrated care. However, few studies have assessed the organizational conditions conducive to implementing integrated care programs in preparation for scale-up.</div></div><div><h3>Objective</h3><div>This study aimed to 1) implement a case management program as part of an integrated care program initiative for adults with complex needs in health and social services organizations and primary care clinics, 2) evaluate the organizational factors influencing implementation, and 3) share recommendations from key stakeholders to facilitate scale-up.</div></div><div><h3>Methods</h3><div>A qualitative multiple-case study was conducted in two health and social services organizations and five primary care clinics in Quebec, Canada. We collected data through participant observation, semi-structured interviews, and focus groups with stakeholders. The data were analyzed using deductive (RE-AIM framework) and inductive thematic analysis. Case stories were developed and then compared.</div></div><div><h3>Results</h3><div>Identifying patients targeted by the program was challenging. Better access to health information technology for case-finding was strongly recommended. Remuneration methods compatible with family physicians’ expected levels of commitment to the program were needed to promote their engagement. Appropriate change management was also important to promote implementation and ensure sustainability of the program over time.</div></div><div><h3>Conclusion</h3><div>This study may inform stakeholders interested in scaling up integrated care programs for adults with complex needs.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"160 ","pages":"Article 105321"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.healthpol.2025.105458
I Litchfield , L Harper , M Syed , F Dutton , M Melyda , C Wolhuter , C Bird
Background: The UK’s National Health Service has provided funds for developing localized services integrating health and social care intended to address the health inequities prevalent in children and young people living in marginalized communities. However, little is understood of the factors that influence their design and delivery, nor which combined health and social care models are most effective.
Objective: To use evidence drawn from staff delivering a collocated integrated health and social support service for children, also known as the Sparkbrook Children’s Zone, to inform similar care offers.
Methods: A qualitative exploration of staff experience using a directed content analysis to populate and present the results within the Sustainable integrated chronic care model for multi-morbidity: delivery, financing, and performance (SELFIE) framework. The analysis presented here focusses on the domain of Service delivery, predominantly relating to the content and access of care.
Results: A total of 14 staff were interviewed: clinicians from primary and secondary care, social care providers, local voluntary groups, and school-based family mentors. Participants described at the Micro- level how the service increased engagement of families and facilitated referral to social support and preventive care; at a Meso- level the benefits of collocation, collaborative working, and community outreach and at the Macro level, improvements to the access and availability of appropriate care.
Conclusions: The pilot appeared to deliver multiple benefits for both patients and staff particularly through collocating health care and social support. However, sustainable integrated health and social care requires greater institutional commitment and leadership.
{"title":"Understanding the influences on the design and delivery of an integrated child health and social care service in underserved communities in the UK: A qualitative exploration using the SELFIE framework","authors":"I Litchfield , L Harper , M Syed , F Dutton , M Melyda , C Wolhuter , C Bird","doi":"10.1016/j.healthpol.2025.105458","DOIUrl":"10.1016/j.healthpol.2025.105458","url":null,"abstract":"<div><div><strong>Background:</strong> The UK’s National Health Service has provided funds for developing localized services integrating health and social care intended to address the health inequities prevalent in children and young people living in marginalized communities. However, little is understood of the factors that influence their design and delivery, nor which combined health and social care models are most effective.</div><div><strong>Objective:</strong> To use evidence drawn from staff delivering a collocated integrated health and social support service for children, also known as the Sparkbrook Children’s Zone, to inform similar care offers.</div><div><strong>Methods:</strong> A qualitative exploration of staff experience using a directed content analysis to populate and present the results within the Sustainable integrated chronic care model for multi-morbidity: delivery, financing, and performance (SELFIE) framework. The analysis presented here focusses on the domain of <em>Service delivery</em>, predominantly relating to the content and access of care.</div><div><strong>Results</strong>: A total of 14 staff were interviewed: clinicians from primary and secondary care, social care providers, local voluntary groups, and school-based family mentors. Participants described at the <em>Micro-</em> level how the service increased engagement of families and facilitated referral to social support and preventive care; at a <em>Meso-</em> level the benefits of collocation, collaborative working, and community outreach and at the <em>Macro</em> level, improvements to the access and availability of appropriate care.</div><div><strong>Conclusions</strong>: The pilot appeared to deliver multiple benefits for both patients and staff particularly through collocating health care and social support. However, sustainable integrated health and social care requires greater institutional commitment and leadership.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"160 ","pages":"Article 105458"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.healthpol.2024.105243
Josefien van Olmen , Katrien Danhieux , Edwin Wouters , Veerle Buffel , Roy Remmen , Monika Martens
Introduction
Few integrated care studies elaborate how interventions are brought to wider scale. The SCUBY project developed interventions for scale-up of an Integrated Care Package (ICP) for two common diseases - type 2 diabetes and hypertension-, comprising evidence-based roadmaps and policy dialogues. This paper's aim is to report on the process evaluation of the ICP scale-up in Belgium. Specific objectives are: to describe the development of scale-up interventions; to assess the actual process outcomes; and to assess progress on three scale-up dimensions coverage, expansion and institutionalisation.
Methods
A case study design, with data collection including project diaries, stakeholder surveys and interviews. 11 Key informant interviews were held with five research team members and six external people. Tools were developed to visualise progress for coverage, institutionalisation and expansion.
Results
The roadmap included three themes: primary care practice organization, data and monitoring, and healthcare financing. 99 policy dialogues of varying size and type were held. Stakeholders rated all themes relevant. For scale-up outcomes, progress was most on the institutionalization axis.
Discussion
Scale-up of ICP demands a collaborative, networking approach to build trust and buy-in. Protagonists need to strike a balance between relevance and feasibility of scale-up strategies, being aware of context elasticity. A roadmap can be a living document serving change teams in communication, planning and monitoring, while allowing intervention plasticity.
{"title":"Scaling up integrated care for chronic diseases in belgium: A process evaluation","authors":"Josefien van Olmen , Katrien Danhieux , Edwin Wouters , Veerle Buffel , Roy Remmen , Monika Martens","doi":"10.1016/j.healthpol.2024.105243","DOIUrl":"10.1016/j.healthpol.2024.105243","url":null,"abstract":"<div><h3>Introduction</h3><div>Few integrated care studies elaborate how interventions are brought to wider scale. The SCUBY project developed interventions for scale-up of an Integrated Care Package (ICP) for two common diseases - type 2 diabetes and hypertension-, comprising evidence-based roadmaps and policy dialogues. This paper's aim is to report on the process evaluation of the ICP scale-up in Belgium. Specific objectives are: to describe the development of scale-up interventions; to assess the actual process outcomes; and to assess progress on three scale-up dimensions coverage, expansion and institutionalisation.</div></div><div><h3>Methods</h3><div>A case study design, with data collection including project diaries, stakeholder surveys and interviews. 11 Key informant interviews were held with five research team members and six external people. Tools were developed to visualise progress for coverage, institutionalisation and expansion.</div></div><div><h3>Results</h3><div>The roadmap included three themes: primary care practice organization, data and monitoring, and healthcare financing. 99 policy dialogues of varying size and type were held. Stakeholders rated all themes relevant. For scale-up outcomes, progress was most on the institutionalization axis.</div></div><div><h3>Discussion</h3><div>Scale-up of ICP demands a collaborative, networking approach to build trust and buy-in. Protagonists need to strike a balance between relevance and feasibility of scale-up strategies, being aware of context elasticity. A roadmap can be a living document serving change teams in communication, planning and monitoring, while allowing intervention plasticity.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"160 ","pages":"Article 105243"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Integrated care is considered to be essential in improving care for people with chronic conditions who need continuous care. In 2022, the Italian Government asked all regions to build or renovate a massive number of community care facilities, employing European Next Generation funds, to be spent by 2026. Under the theoretical lens of the Structural Contingency Theory, the paper aims at aims at describing the contextual and organizational factors underlying the interconnection between integrated care and community hospitals. The study employs a multiple-case study design, relying both on quantitative and qualitative data, conducted in a 6 months-period. It investigated seven community hospitals belonging to a single Local Health Authority in Emilia-Romagna region in Italy. The choice of the empirical context was driven by Emilia-Romagna's long- and well-established tradition of community-based care. Overall, our analysis shows that community hospitals offers opportunities of integrated care, including better integration between care sectors, between primary care and specialist staff, between healthcare structures and their local community. The study confirms the value of the Structural Contingency Theory and its key message: implementation is not a mechanical step of the policy cycle and requires important adjustments to the planning phase according to environment and organizational factors.
{"title":"Scaling up integrated care: Can community hospitals be an answer? A multiple-case study from the Emilia-Romagna region in Italy","authors":"Francesca Meda , Michela Bobini , Michela Meregaglia , Giovanni Fattore","doi":"10.1016/j.healthpol.2024.105192","DOIUrl":"10.1016/j.healthpol.2024.105192","url":null,"abstract":"<div><div>Integrated care is considered to be essential in improving care for people with chronic conditions who need continuous care. In 2022, the Italian Government asked all regions to build or renovate a massive number of community care facilities, employing European Next Generation funds, to be spent by 2026. Under the theoretical lens of the Structural Contingency Theory, the paper aims at aims at describing the contextual and organizational factors underlying the interconnection between integrated care and community hospitals. The study employs a multiple-case study design, relying both on quantitative and qualitative data, conducted in a 6 months-period. It investigated seven community hospitals belonging to a single Local Health Authority in Emilia-Romagna region in Italy. The choice of the empirical context was driven by Emilia-Romagna's long- and well-established tradition of community-based care. Overall, our analysis shows that community hospitals offers opportunities of integrated care, including better integration between care sectors, between primary care and specialist staff, between healthcare structures and their local community. The study confirms the value of the Structural Contingency Theory and its key message: implementation is not a mechanical step of the policy cycle and requires important adjustments to the planning phase according to environment and organizational factors.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"160 ","pages":"Article 105192"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.healthpol.2025.105334
Stefanie Tan , Julie Farmer , Walter P. Wodchis , Sara Allin
Background
Integrated care aims to coordinate the care needs of a population, particularly individuals requiring complex care, across community, primary and secondary care settings. This study explores policy supports for integrated models of care in England, Germany, and The Netherlands to consider the implications for policy transfer for Canada.
Methods
We reviewed academic and grey literature about integrated models of care across three comparator countries and conducted in-depth qualitative interviews with 14 expert informants in Autumn 2023. Results were mapped against a framework for analysis about policy supports and transfer.
Results
Integrated care initiatives varied in scale and scope with local population initiatives (Germany), devolved decision-making initiatives (England), or by addressing population subgroups (Netherlands). There are power and relative funding imbalances between the health and social services sectors that impede collaboration. Voluntary approaches to organisational governance reforms and partnerships with primary care providers promote uptake but policy entrepreneurs are crucial to facilitating implementation. Workforce adaptations and upskilling initiatives can enable interprofessional collaboration and intersectoral knowledge to address implementation gaps. There remain practical challenges with data infrastructure and sharing.
Conclusions
Legislation is an important enabling factor for supporting governance. New financing streams can reward collaborative working for interdisciplinary teams. Policymakers at the macro- and meso‑level must support policy from intention to implementation.
{"title":"How do policy supports enable the implementation, scale, and sustainability of integrated care programs in England, Germany, and The Netherlands? Lessons for Canada","authors":"Stefanie Tan , Julie Farmer , Walter P. Wodchis , Sara Allin","doi":"10.1016/j.healthpol.2025.105334","DOIUrl":"10.1016/j.healthpol.2025.105334","url":null,"abstract":"<div><h3>Background</h3><div>Integrated care aims to coordinate the care needs of a population, particularly individuals requiring complex care, across community, primary and secondary care settings. This study explores policy supports for integrated models of care in England, Germany, and The Netherlands to consider the implications for policy transfer for Canada.</div></div><div><h3>Methods</h3><div>We reviewed academic and grey literature about integrated models of care across three comparator countries and conducted in-depth qualitative interviews with 14 expert informants in Autumn 2023. Results were mapped against a framework for analysis about policy supports and transfer.</div></div><div><h3>Results</h3><div>Integrated care initiatives varied in scale and scope with local population initiatives (Germany), devolved decision-making initiatives (England), or by addressing population subgroups (Netherlands). There are power and relative funding imbalances between the health and social services sectors that impede collaboration. Voluntary approaches to organisational governance reforms and partnerships with primary care providers promote uptake but policy entrepreneurs are crucial to facilitating implementation. Workforce adaptations and upskilling initiatives can enable interprofessional collaboration and intersectoral knowledge to address implementation gaps. There remain practical challenges with data infrastructure and sharing.</div></div><div><h3>Conclusions</h3><div>Legislation is an important enabling factor for supporting governance. New financing streams can reward collaborative working for interdisciplinary teams. Policymakers at the macro- and meso‑level must support policy from intention to implementation.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"160 ","pages":"Article 105334"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.healthpol.2025.105283
L. Fischer , R.G.M. Smeets , M. Rijken , A.M.J. Elissen
Background
Integrated care attempts to address multiple care needs, but barriers to implementation remain. The service user perspective can guide policy and practice to advance implementation.
Objective
To map barriers and facilitators to integrated primary care from the perspective of people with chronic conditions and multiple care needs.
Methods
A scoping review was conducted by searching PubMed, Embase, Web of Science, CINAHL, and grey literature. Eligible studies were analysed by categorising barriers and facilitators at the micro, meso, and macro levels of the healthcare system. They were further mapped by the components retrieved from the SELFIE framework for integrated care for multimorbidity.
Results
Across the 34 included studies, people with multiple care needs identified more barriers and facilitators at the micro level than at the meso and macro levels. Mapped under ‘the individual and their environment’, social and personal barriers (e.g. socioeconomic disadvantages, lack of social support) hindered integrated care. Mapped under ‘service delivery’ and ‘workforce’, a trusting relationship with a key care provider as part of a multidisciplinary care team was identified to facilitate integrated care.
Conclusions
Our findings show that ‘soft’ relational and social factors are critical to integrated care. These ‘soft’ factors are primarily created at the micro level, but seem actionable at meso and macro levels. The unique perspective of people with multiple care needs suggests that more rigorous involvement of service users at higher levels is needed to inform policymakers and care providers on how to shape enabling conditions for the implementation of integrated care.
背景：综合护理试图解决多种护理需求，但实施的障碍仍然存在。服务用户视角可以指导政策和实践以推进实施。目的：从慢性病患者和多重护理需求的角度分析综合初级保健的障碍和促进因素。方法：通过检索PubMed、Embase、Web of Science、CINAHL和灰色文献进行范围综述。通过对医疗保健系统的微观、中观和宏观层面的障碍和促进因素进行分类，对符合条件的研究进行了分析。通过对多病综合护理的自拍框架检索的组件进一步绘制了它们。结果：在34项纳入的研究中，有多种护理需求的人在微观层面上比在中观和宏观层面上发现了更多的障碍和促进因素。在“个人及其环境”下，社会和个人障碍（如社会经济劣势、缺乏社会支持）阻碍了综合护理。在“服务交付”和“劳动力”下，与关键护理提供者建立信任关系，作为多学科护理团队的一部分，以促进综合护理。结论：我们的研究结果表明，“软”关系和社会因素对综合护理至关重要。这些“软”因素主要是在微观层面产生的，但在中观和宏观层面似乎是可行的。有多种护理需求的人的独特视角表明，需要更高层次的服务使用者更严格地参与，以便向决策者和护理提供者提供信息，了解如何为实施综合护理创造有利条件。
{"title":"Barriers and facilitators to integrated primary care from the perspective of people with chronic conditions and multiple care needs: A scoping review","authors":"L. Fischer , R.G.M. Smeets , M. Rijken , A.M.J. Elissen","doi":"10.1016/j.healthpol.2025.105283","DOIUrl":"10.1016/j.healthpol.2025.105283","url":null,"abstract":"<div><h3>Background</h3><div>Integrated care attempts to address multiple care needs, but barriers to implementation remain. The service user perspective can guide policy and practice to advance implementation.</div></div><div><h3>Objective</h3><div>To map barriers and facilitators to integrated primary care from the perspective of people with chronic conditions and multiple care needs.</div></div><div><h3>Methods</h3><div>A scoping review was conducted by searching PubMed, Embase, Web of Science, CINAHL, and grey literature. Eligible studies were analysed by categorising barriers and facilitators at the micro, meso, and macro levels of the healthcare system. They were further mapped by the components retrieved from the SELFIE framework for integrated care for multimorbidity.</div></div><div><h3>Results</h3><div>Across the 34 included studies, people with multiple care needs identified more barriers and facilitators at the micro level than at the meso and macro levels. Mapped under ‘the individual and their environment’, social and personal barriers (e.g. socioeconomic disadvantages, lack of social support) hindered integrated care. Mapped under ‘service delivery’ and ‘workforce’, a trusting relationship with a key care provider as part of a multidisciplinary care team was identified to facilitate integrated care.</div></div><div><h3>Conclusions</h3><div>Our findings show that ‘soft’ relational and social factors are critical to integrated care. These ‘soft’ factors are primarily created at the micro level, but seem actionable at meso and macro levels. The unique perspective of people with multiple care needs suggests that more rigorous involvement of service users at higher levels is needed to inform policymakers and care providers on how to shape enabling conditions for the implementation of integrated care.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"160 ","pages":"Article 105283"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caring for patients with multiple chronic conditions requires integration, but more evidence is needed on what makes reform initiatives work. This study aims to identify and analyse the critical success factors of a Hungarian care coordination experiment (1999-2008).
Methods
The Hungarian Care Coordination System is described and analysed based on three feasibility dimensions: conceptual (problem-based policymaking), technical, and political. Data are from documentary analysis, official statistics and implementation experiences of a care coordinator organisation.
Results
The conceptual and technical feasibility of the pilot is characterised by innovative features: provider and financial incentive (functional integration) based implementation; virtual fundholding; design features, which counterbalance incentives to undertreat, eliminate bankruptcy risks, exclude risk selection practices and ensure easy upscalability; the utilisation of advanced provider payment information systems for monitoring. The conceptual flaw of calculating the virtual budget should have been corrected and the risk of cost increase due to better access and quality could have been addressed. The experiment failed in terms of political feasibility. Better communication, more transparency, systematic monitoring and more frequent evaluation would have been needed.
Discussion
The model did not upset existing arrangements. Efficiency was ensured through a balance of decentralised and centralized functions: care coordination by providers and revenue-generation, pooling, and purchasing by central agencies.
Conclusion
The Hungarian Care Coordination System is a unique health system innovation, still relevant in the current Hungarian context, and for other countries to learn from.
{"title":"Evaluation of the implementation experiences of the Hungarian integrated care coordination pilot","authors":"Peter Andras Gaal , Tamas Evetovits , Eszter Sinko , Krisztina Davidovics , Judit Lam","doi":"10.1016/j.healthpol.2025.105417","DOIUrl":"10.1016/j.healthpol.2025.105417","url":null,"abstract":"<div><h3>Background</h3><div>Caring for patients with multiple chronic conditions requires integration, but more evidence is needed on what makes reform initiatives work. This study aims to identify and analyse the critical success factors of a Hungarian care coordination experiment (1999-2008).</div></div><div><h3>Methods</h3><div>The Hungarian Care Coordination System is described and analysed based on three feasibility dimensions: conceptual (problem-based policymaking), technical, and political. Data are from documentary analysis, official statistics and implementation experiences of a care coordinator organisation.</div></div><div><h3>Results</h3><div>The conceptual and technical feasibility of the pilot is characterised by innovative features: provider and financial incentive (functional integration) based implementation; virtual fundholding; design features, which counterbalance incentives to undertreat, eliminate bankruptcy risks, exclude risk selection practices and ensure easy upscalability; the utilisation of advanced provider payment information systems for monitoring. The conceptual flaw of calculating the virtual budget should have been corrected and the risk of cost increase due to better access and quality could have been addressed. The experiment failed in terms of political feasibility. Better communication, more transparency, systematic monitoring and more frequent evaluation would have been needed.</div></div><div><h3>Discussion</h3><div>The model did not upset existing arrangements. Efficiency was ensured through a balance of decentralised and centralized functions: care coordination by providers and revenue-generation, pooling, and purchasing by central agencies.</div></div><div><h3>Conclusion</h3><div>The Hungarian Care Coordination System is a unique health system innovation, still relevant in the current Hungarian context, and for other countries to learn from.</div></div>","PeriodicalId":55067,"journal":{"name":"Health Policy","volume":"160 ","pages":"Article 105417"},"PeriodicalIF":3.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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