Primary Care Physicians In Ten Countries Report Challenges Caring For Patients With Complex Health Needs

A compelling article that explores some of the current challenges facing the integration of primary care within the health systems of 10 high income countries. The data comes from the 18^th annual Commonwealth Fund International Health Policy Survey of Primary Care Physicians which was completed in 2015 in Australia, Canada, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. While primary care physicians reported being well prepared for multiple chronic medical conditions, several health areas such as mental health and addiction were noted for being weak points for providers. A frequent challenge was a lack of communication with other parts of the health care system as well as with social services although there was significant variation between countries. An important finding of the study was “that having an electronic health record does not ensure electronic flow of information with doctors outside of one ...

Achieving Effective Universal Health Coverage And Diagonal Approaches To Care For Chronic Illnesses

Health systems in low- and middle-income countries were designed to provide episodic care for acute conditions. However, the burden of disease has shifted to be overwhelmingly dominated by chronic conditions and illnesses that require health systems to function in an integrated manner across a spectrum of disease stages from prevention to palliation. Low- and middle-income countries are also aiming to ensure health care access for all through universal health coverage. This article proposes a framework of effective universal health coverage intended to meet the challenge of chronic illnesses. It outlines strategies to strengthen health systems through a “diagonal approach.” We argue that the core challenge to health systems is chronicity of illness that requires ongoing and long-term health care. The example of breast cancer within the broader context of health system reform in Mexico is presented to illustrate effective universal health coverage along the chronic disease continuum and across health ...

Exploring payment schemes used to promote integrated chronic care in Europe

The rising burden of chronic conditions has led several European countries to reform healthcare payment schemes. This paper aimed to explore the adoption and success of payment schemes that promote integration of chronic care in European countries. A literature review was used to identify European countries that employed pay-for-coordination (PFC), pay-for-performance (PFP), and bundled payment schemes. Existing evidence from the literature was supplemented with fifteen interviews with chronic care experts in these countries to obtain detailed information regarding the payment schemes, facilitators and barriers to their implementation, and their perceived success.

Austria, France, England, the Netherlands, and Germany have implemented payment schemes that were specifically designed to promote the integration of chronic care. Prominent factors facilitating implementation included stakeholder cooperation, adequate financial incentives for stakeholders, and flexible task allocation among different care provider disciplines. Common barriers to implementation included misaligned incentives across stakeholders and gaming. The implemented payment schemes targeted ...

Developing care for a changing population: Supporting patients with costly, complex needs

Patients with multiple chronic conditions are a challenge for health care organization. In this report, it is offered a review of the most recent evidence regarding new models of care, and they are summarized in 10 points: (I) There are no specific ‘European’ answers to the problem of high cost/complexity, but a growing body of policy-relevant evidence is emerging, (II) Multifaceted interventions seem to work best for complex problems , (III) Identifying who is at risk of complexity is a crucial first step , (IV) The needs of patients identified as ‘complex’ are likely to vary considerably , (V) Good outcomes for complex patients need to be rooted in patient preferences and are likely to include non-medical goals, (VI) Interventions may not reduce high costs, at least in the short term, (VII) Chronic care models may not be fit for purpose for complex patients, (VIII) Although highly relevant, the implications for the ...

Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment

In 2008, the WHO facilitated the primary health care (PHC) revitalisation agenda. The purpose was to strengthen African health systems in order to address communicable and non-communicable diseases. The aim of this study was to assess the position of civil society-led community unity home based care programmes (CHBC), which serve the needs of patients with HIV, within this agenda. It examined how their roles and place in health systems evolved, and the prospects for these programmes in national policies and strategies to revitalise PHC, as new health care demands arise. 

The SELFIE framework for integrated care for multi-morbidity: Development and description

The rise of multi-morbidity constitutes a serious challenge in health and social care organisation that requires a shift from disease-towards person-centred integrated care. The aim of the current study was to develop a conceptual framework that can aid the development, implementation, description, and evaluation of integrated care programmes for multi-morbidity. The framework structures relevant concepts in integrated care for multimorbidity and can be applied by different stakeholders to guide development, implementation, description, and evaluation. 

The Western Sydney Integrated Care Program (WSICP): Qualitative Evaluation

The ageing population together with an increasing prevalence of chronic conditions require a systems wide integrated approach to health care. This includes overcoming barriers between primary and secondary care, physical and mental health, and health and social care in order to provide patient centred care. In Australia, the New South Wales Ministry of Health is piloting an innovative Integrated Care Program in Western Sydney, foccussed on care facilitator roles to coordinate patient care between General Practices and hospitals. 

Individualising Chronic Care Management by Analysing Patients’ Needs – A Mixed Method Approach

Modern health systems are increasingly faced with the challenge to provide effective, affordable and accessible health care for people with chronic conditions. As evidence on the specific inmet needs and their impact on health outcomes is limited, practical research is needed to tailor chronic care to individual needs of patients with diabetes. Qualitative approaches to describe professional and informal caregiving will support understanding the complexity of chronic care. Results are intended to provide practical recommendations to be used for systematic implementation of sustainable chronic care models. 

Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment

In 2008, the WHO facilitated the primary health care (PHC) revitalisation agenda. The purpose was to stregthen African health systems in order to address communicable and non-communicable diseases. The aim of this article was to assess the position of civil society-led community home based care programmes (CHBC), which serve the needs of patients with HIV, within this agenda. It examined how their roles and place in health systems evolved, and the prospects for these programmes in national policies and strategies to revitalise PHC, as new health care demand arise. 

Barriers and Facilitators to Workforce Changes in Integrated Care

Health systems are faced with an ageing population and an increase in chronic conditions. These challenges require more appropriate approaches than the current largely single-disease and acute-care focussed health care systems. Integrated care is seen as one of the most promising of these approaches by targeting the health system, patient-provider relationships, care process design, communication infrastructures, community resources, and how care is delivered by health professionals. The aim of the study is to investigate the barriers and facilitators to the implementation of workforce changes implemented as part of integrated chronic care interventions.

Patient-centred care for multimorbidity: an end in itself?

Multimorbidity, which is defined as living with two or more chronic health problems, is a major and growing problem, especially in societies with ageing populations and substantial socioeconomic disparities. It is associated with reduced quality of life, impaired functional status, poor physical and mental health, and increased mortality

Management of multimorbidity using a patient-centred care model: a pragmatic cluster-randomised trial of the 3D approach

The management of people with multiple chronic conditions challenges health-care systems designed around single conditions. There is international consensus that care for multimorbidity should be patient-centred, focus on quality of life, and promote self-management towards agreed goals. However, there is little evidence about the effectiveness of this approach. The article´s hypothesis was that the patient-centred, so-called 3D approach (based on dimensions of health, depression, and drugs) for patients with multimorbidity would improve their health-related quality of life, which is the ultimate aim of the 3D intervention.

The Core Dimensions of Integrated Care: A Literature Review to Support the Development of a Comprehensive Framework for Implementing Integrated Care

As part of the EU-funded Project INTEGRATE, the research sought to develop an evidence-based understanding of the key dimensions and items of integrated care associated with successful implementation across varying country contexts and relevant to different chronic and/or long-term conditions. This paper identifies the core dimensions of integrated care based on a review of previous literature on the topic

The impact of a comprehensive electronic patient portal on the health service use: an interrupted time-series analysis

EPPs hold promise for reducing hospital readmissions. Certain patient populations with chronic conditions may differentially benefit from portal use depending on their needs for communication with their providers.
However, there is little empirical research on the potential benefit that electronic patient portals (EPP) can have on the care quality and health outcomes of diverse multi-ethnic international populations. The purpose of this study is to determine the extent to which an EPP was associated with improvements in health service use.

Non-communicable diseases in sub-Saharan Africa: a scoping review of large cohort studies

Non-communicable diseases (NCDs) cause a large and growing burden of morbidity and mortality in sub-Saharan Africa. Prospective cohort studies are key to study multiple risk factors and chronic diseases and are crucial to our understanding of the burden, aetiology and prognosis of NCDs in SSA. The aim of this study was to identify the level of research output on NCDs and their risk factors collected by cohorts in SSA.

Rethinking Integrated Care: A Systematic Hermeneutic Review of the Literature on Integrated Care Strategies and Concepts

Integrated care is a broad concept, used to describe a connected set of clinical, organizational, and policy changes aimed at improving service efficiency, patient experience, and outcomes. Despite examples of successful integrated care systems, evidence for consistent and reproducible benefits remains elusive. This review identified four perspectives on integrated care: patients’ perspectives, organizational strategies and policies, conceptual models, and theoretical and critical analysis.

GPCC at SASUF 2020: Person-centred eHealth in healthcare

The University of Gothenburg Centre for Person-Centred Care (GPCC) is providing this workshop "Person-centred eHealth in healthcare", on 25 November 2020, within the South Africa - Sweden University Forum 2020 event, online.

The goal with this event is to discuss innovative strategies to integrate person-centred care in healthcare. These discussions about person-centred care in Sweden and South Africa intend to give new perspectives regarding new technologies that have the purpose to contribute to the development of person-centred care approaches. *This session will be recorded*.

Programme

(Central European Time)

9:00-9:05, Welcome, Stefan Nilsson, Associate professor & Ensa Johnson, PhD

9:05-9:20, Biomarkers as evaluation of a digital tool – Is it possible?, Jonas Bergquist, Professor

9:20-9:35,South African children with cancer sharing their lived experience in coping with their illness and treatment, Karen van Zijl, PhD & CHOC social workers

9:35-9:50, Person-centred care and Universal Design as theoretical ...

EHMA value-based primary care executive workshop

The European Health Management Association (EHMA) is hosting a two-day executive workshop on value-based primary care, on 15-16 February 2021. The workshop will discuss the latest frameworks and experiences on how primary care is evolving in the ever-changing healthcare systems and how services/management adapted to take into consideration the new reality created by COVID-19.

Comparison of experiences from different countries will be discussed, with a specific focus on the Catalan case of CASAP and the Italia Lombardy Region reform based on proactive population health management, Chronic Related Groups (CReGs) and individual care contracts.

Save a spot, participate in the interactive workshop and collaborate with healthcare professionals at all levels within health systems and primary care sector.

Programme and further information

Digital tools as promoters for person-centered care practices in chronic care? Healthcare professionals’ experiences from rheumatology care

Person-centered care (PCC) emphasize the importance of supporting individuals’ involvement in care provided and self-care. PCC has become more important in chronic care as the number of people living with chronic conditions is increasing due to the demographic changes. Digital tools have potential to support interaction between patients and healthcare providers, but empirical examples of how to achieve PCC in chronic care and the role of digital tools in this process is limited. The aim of this study was to investigate strategies to achieve PCC used by the healthcare professionals at an outpatient Rheumatology clinic (RC), the strategies’ relation to digital tools, and the perceived impact of the strategies on healthcare professionals and patients.

Integrated care in Europe: Keys, challanges and best practices

The unexpected events of the past year have led to a neglect of chronic conditions. We have witnessed a decline in the physical, mental, and emotional health of our older citizens in Europe.

Now more than ever, there is a need for an integrated approach to care, shifting the focus from a silo-based approach to social and health care delivery.

The Horizon 2020 ValueCare pilot site partners of Valencia, Spain, in coordination with the Covenant on Demographic Change are delighted to announce the international online event, free and open to the general public: INTEGRATED CARE IN EUROPE: KEYS, CHALLENGES AND BEST PRACTICES, to be held next 16^th March 2021, from 09:30 to 11:30 hrs CET.

This event aims to raise awareness and increase knowledge of Integrated Care among the various stakeholders at a European level. It is a chance to impart the knowledge of experts in the ...

The conceptualisation of patient-centred care: A case study of diabetes management in public facilities in southern Malawi

Patient-centred care (PCC) is one of the pillars of Malawi’s quality of care policyinitiatives. The role of PCC in facilitating quality service delivery is well documented, and its importance may heighten in chronic disease management. Yet, PCC conceptualisation is known to be context specific. The prominent themes emerging from the participants’ conceptualisation of PCC included the following: meeting individual needs, goals and expectations, accessing medication, supporting relationship building, patient involvement, information sharing, holistic care, timeliness and being realistic.

Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: A qualitative methods study

Abstract

What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium

Although many countries have been implementing integrated care, the scale-up remains difficult. Macro-level system barriers play an important role. By selecting three key policies, which have implemented integrated care in Belgium over the last 10 years, we aim to go beyond the identification of their specific barriers and facilitators to obtain an overarching generic view.

Integrated care for older persons who live with complex health and social care requirements: a core set of indicators

Performance measures are an important mediating mechanism that influences the design and delivery of care. Unfortunately, it is still commonly the case that acute care indicators are employed to assess the efficacy of integrated care. This hinders the ability to accurately assess and continuously improve integrated care efforts for priority populations, including older persons who live with complex health and social care requirements. A core set of indicators is needed from which to assess the quality and impact of integrated care on these older persons and care partners.