Conducting a Health Needs Assessment to Identify Potentials for Population-based Integrated Care Models in Socially Deprived Urban Regions – The Example of the Integrated Care Project “Billstedt-Horn” in Hamburg, Germany

Against the background of regional differences in morbidity and social determinants of health small-scale health services research is becoming increasingly relevant, particularly for planners of population-based integrated care models. Despite of longstanding research of regional variation especially by John Wennberg neither are there scientifically or practically accepted standards on how to identify regions which are in a special need for integrating health services nor is there a precisely defined set of methods which could be used to identify and prioritize problems in health services delivery.

Germany - Country case study on the integrated delivery of long-term care (2020)

This report describes the provision of long-term care in Germany, with an emphasis on identifying efforts to foster the integrated delivery of services. There is mandatory statutory or private long-term care insurance for the entire population; eligibility for long-term care is open to people with any restricted competencies in daily life. Long-term care encompasses cash benefits, benefits in kind or residential care. Health expenditure is high, and coordination of care across ambulatory, hospital, rehabilitative and long-term care remains a challenge. Although the system performs well by several measures, strengthening the role of general practitioners and primary care could result in reduction in amenable mortality and preventable hospitalization while fostering integration of care and case management in long-term care.

Romania - Country case study on the integrated delivery of long-term care (2020)

This report describes the main findings and policy pointers of an assessment of the current conditions of integrated delivery of long-term health and social services in Romania. The country has advanced in enacting legislation to regulate the provision of long-term care. Service provision is limited to social services, whereas the health component is not defined by law. The current provision of long-term care is insufficient, services are fragmented and there are no defined pathways of care. The system relies heavily on families to provide care, but services for unpaid caregivers are underdeveloped. There is an acute shortage of workers, caused by migration of workers to other European countries.

Implementation of patient-centred care: which system-level determinants matter from a decision maker’s perspective? Results from a qualitative interview study across various health and social care organisations

The healthcare system is characterised by a high degree of complexity and involves various actors at different institutional levels and in different care contexts. To implement patient-centred care (PCC) successfully, a multidimensional consideration of influencing factors is required. Our qualitative study aims to identify system-level determinants of PCC implementation from the perspective of different health and social care organisations (HSCOs).

The results showed the necessity of enforcing paradigm changes at the system level from disease-centredness to patient-centredness while aligning policy and reimbursement decisions directly with patient needs and values. A systematic, long-term planned strategy that extends across all organisations is lacking, rather each organisation seeks its own possibilities to implement PCC activities under external restrictions.

How do nurses support chronically ill clients’ participation and self-management in primary care? A cross-country qualitative study

In the context of the advancement of person-centered care models, the promotion of the participation of patients with chronic illness and complex care needs in the management of their care (self-management) is increasingly seen as a responsibility of primary care nurses. It is emphasized that nurses should consider the psychosocial dimensions of chronic illness and the client’s lifeworld. Little is known about how nurses shape this task in practice. The aim of this analysis is to examine how primary care nurses understand and shape the participation of patients with chronic illness and complex care needs regarding the promotion of self-management. Guided interviews were conducted with nurses practicing in primary care and key informants in Germany, Spain, and Brazil with a subsequent cross-case evaluation.