Adoption and Initial Implementation of a National Integrated Care Programme for Diabetes: A Realist Evaluation

The implementation of models of integrated care for chronic conditions is not well understood. We conducted a realist evaluation to determine how and why the implementation of the National Diabetes Programme in Ireland worked (or not). This study showed that, locally important contexts facilitating implementation included staff experience of delivering diabetes care, capacity, and familiarity with the intended purpose of new clinical posts. The extent to which integrated care was adopted and implemented depended on judgements made by professionals working in these contexts; specifically, judging the relative advantage of the programme and whether to engage in negotiations to legitimize their new roles in diabetes care.

Development and Implementation of an Integrated Care Fellowship

Integrated care is a common approach to leverage scarce psychiatric resources to deliver mental health care in primary care settings. The Integrated Care clinical fellowship serves as a model for training programs seeking to provide training in clinical and systems-based skills needed for practicing integrated care. Whether such training is undertaken as a standalone fellowship or incorporated into existing consultation-liaison psychiatry programs, such skills are increasingly valuable as integrated care becomes commonplace in practice.  

The role of the home health care physician in mobile integrated care: a qualitative phenomenograpic study

An increasing older population, along with the organizational principle of remaining at home, has moved health care from institutions into the older person’s home, where several health care providers facilitate care. The Mobile Integrated Care Model strives to provide cost-efficient, coherent, person-centered health care in the home. In the integrated care team, where the home health care physician is the medical authority, several health care professions work across organizational borders. Therefore, the aim of this study was to describe Home Health Care Physicians perceptions of working and providing health care in the Mobile Integrated Care Model, as well as perceptions of participating in and forming health care.

EFPC 2022 Conference Ghent. Integrated Community Care: a new opportunity for Primary Care

The European Forum for Primary Care Association is happy to announce its 2022 annual conference with a focus on Integrated Community Care. 

Values Underpinning Integrated, People-Centred Health Services: Similarities and Differences among Actor Groups Across Europe

In addition to the functional aspects of healthcare integration, an understanding of its normative aspects is needed. This study explores the importance of values underpinning integrated, people-centred health services, and examines similarities and differences among the values prioritised by actors across Europe.

General practitioners' perceptions of distributed leadership in providing integrated care for elderly chronic multi-morbid patients: a qualitative study

Distributed Leadership (DL) has been suggested as being helpful when different health care professionals and patients need to work together across professional and organizational boundaries to provide integrated care (IC). This study explores whether General Practitioners (GPs) adopt leadership actions that transcend organizational boundaries to provide IC for patients and discusses whether the GPs’ leadership actions in collaboration with patients and health care professionals contribute to DL.

Social workers coordination in primary healthcare for patients with complex needs: A scoping review

Care coordination has been part of social work for some time. It has been recognized as contributing to care coordination for long-term care for the elderly and mental health but less is known about their contribution in primary care with patients with complex health and social needs. As social workers are increasingly present in primary healthcare, this scoping review aims to provide a synthesis of social workers’ coordination activities for patients with complex needs in primary healthcare.

International comparisons of the quality and outcomes of integrated care: Findings of the OECD pilot on stroke and chronic heart failure

Across OECD countries, two in three people aged over 65 years live with at least one chronic condition often requiring multiple interactions with different providers, making them more susceptible to poor and fragmented care. This has prompted calls for making health systems more people-centred, capable of delivering high-quality integrated care. Despite promising, mostly local-level, experiences, systems remain fragmented, focused on acute care and unsuitable to solve complex needs. Moreover, assessing and comparing the benefits of integrated care remains difficult given the lack of technically sound, policy-relevant indicators. This report presents the results of the first OECD pilot of a new generation of indicators to support international benchmarking of quality of integrated care. Lessons from the pilot call for further work on:

(1) expanding work on indicator development;

(2) performing policy analysis to understand cross-country variations on governance models and health financing;

(3) upscaling data linkage; and

(4) measuring care fragmentation.

IFIC Scotland Integrated Care Matters: Webinar Series 7

IFIC Scotland and partners are delighted to announce the webinars in our Integrated Care Matters Series 7. This series will consider innovations in holistic and personalised approaches to integrated care and support.

Each webinar will be accompanied by a topic resource with links to further information. All who register will receive links to the recordings and topic resources.

Join us @IFICInfo #IFICScotland for #IntegratedCareMatters7

Integrated care with digital health innovation: pressing challenges

Digital health care has emerged as one of the most important means to deliver integrated care by care providers in recent years. As the use of digital health increases, there are some pressing issues such as interoperability of data across different healthcare information systems, regulatory environment and security and privacy of patient’s information which need to be discussed and addressed in order to reduce information silos and to ensure efficient and seamless use of digital health technologies. The purpose of this paper is to address these issues.

Countries of the Americas Seek to Ensure Uninterrupted Care by Reducing Fragmentation of Health Systems

Ministers of Health of the Region of the Americas agreed on a new policy to address the fragmentation of health systems, a problem that affects the organization, management, and delivery of care in almost the entire Region. The Policy on Integrated Care for Improved Health Outcomes was adopted by the 30th Pan American Sanitary Conference of the Pan American Health Organization (PAHO), which meets this week in Washington, DC.

Integrating Health and Social Services in Finland: Regional Approaches and Governance Models

The study explores regional approaches to integrated care, focusing on regions with regular municipality-based and integrated unified health and social care administration. The aim is to describe a governance approach that supports care integration in the regions.

Building health and care system resilience and recovery

In April 2020, one month after many countries across the world went into lockdown and health and care systems in many countries were dealing with the consequences of the pandemic, the International Foundation for Integrated Care launched a webinar series over five months. We convened integrated care practitioners from across the world to share their immediate experience of coping with this challenge and the effect it was having on care and outcomes.

The International Foundation for Integrated Care are revisiting some of the webinars from the original series in the Autumn 2022. We will be bringing together international panels to explore the experience of integrated care in the context of the pandemic response, what we learnt and are taking forward to build health and care system resilience and recovery in different countries and what still needs to be learnt. We will link this to the Foundation’s 9 pillars of ...

A Systematic Review of Interventions that Use Multidisciplinary Team Meetings to Manage Multimorbidity in Primary Care

Multidisciplinary team (MDT) meetings could facilitate coordination of care for individuals living with multimorbidity, yet there is limited evidence on their effectiveness. We hence explored the common characteristics of MDT meetings in primary care and assessed the effectiveness of interventions that include such meetings, designed to improve outcomes for adults living with multimorbidity.

Beyond the Point of No Return: A Discourse Analysis of Healthcare Professionals’ Perceptions of Digitally Supported Person-Centred, Integrated, and Proactive Care

Most countries are facing a common challenge: a rise in the number of chronically ill patients and limited medical resources. The combination of digital support and the principles of person-centred, integrated, and proactive care (Digi-PIP care) services constitutes the most ambitious initiative for patients with long-term needs. While there is research on digital support, person-centred, integrated, and proactive care, the combination of these components has been less explored.

The data set consisted of 29 qualitative interviews with healthcare professionals involved in four Nordic Digi-PIP care initiatives. Building on prevailing discourses on the modernisation of healthcare, we used discourse analysis to determine how the professionals discussed their perceptions and experiences of the care transformation initiatives.

We identified four discourses illustrating that, despite challenges with adoption, the vision of Digi-PIP care was strongly embedded among participants across professions and contexts. In contrast to the discourses on their separate components, the emergent discourses ...

Commissioning [Integrated] Care in England: An Analysis of the Current Decision Context

The emergence of Integrated Care Systems (ICSs) across England poses an additional challenge and responsibility for local commissioners to accelerate the implementation of integrated care programmes and improve the overall efficiency across the system. To do this, ICS healthcare commissioners could learn from the experience of the former local commissioning structures and identify areas of improvement in the commissioning process. This study describes the investment decision process in integrated care amid the transition toward ICSs, highlights challenges, and provides recommendations to inform ICSs in their healthcare commissioning role.

Integrated Care Matters: Webinar Series 7: Proactive, Personalised Digital Care and Support in collaboration with Scotland’s Digifest22

IFIC Scotland and partners are delighted to announce the first webinar in our Integrated Care Matters Series 7. This series will consider innovations in holistic and personalised approaches to integrated care and support.

Each webinar will be accompanied by a topic resource with links to further information. All who register will receive links to the recordings and topic resources.

The impact of including a medication review in an integrated care pathway: A pilot study

The objective of the present study was to measure the impact of the intervention of combining a medication review with an integrated care approach on potentially inappropriate medications (PIMs) and hospital readmissions in frail older adults.

Users’ and Providers’ Perceptions about Integrated Health Care in Southern Denmark

Health care systems are increasingly complex, and evidence shows poor coordination of care within and between providers, as well as at the interface between different levels of care. The purpose of this study is to explore users’ and providers’ (stakeholders’) perspectives of integrated care in Denmark. We conducted qualitative interviews with 19 providers and 18 users that were analysed through inductive content analysis. Providers’ and stakeholders’ perceived deficits in system-level factors, lack of organizational culture, weaknesses in communication, a need for a shift towards considering equity in access to health services and focus on person-centeredness. Fundamental changes suggested by participants were better sharing of information and knowledge, focus on stronger trust building, efforts in making communication more effective, and changes in incentive structure. Users perceived poor navigation in the health care system, frustration when they experienced that the services were not based on their needs and lack of support for ...

Decision-Making Dilemmas within Integrated Care Service Networks: A Systematic Literature Review

The diverse nature of people’s care needs requires collaboration between different organisations and sectors. One way of achieving such collaboration is through integrated care service networks. Decision-making is considered an important aspect of network governance and key to achieve further integration of care services. As integrated care scholars only implicitly seem to touch upon the issue of decision-making, we aimed to identify multiple decision-making dilemmas.

Integration of mental health support teams in COVID-19 units within French general hospitals: a qualitative study

This study aimed to explore the lived experience of mental health professionals (mhPs) who had been redeployed on support teams (MHSTs) implemented in general hospital for patients with coronavirus disease 2019 (COVID-19) and their families, in order to scale up mental and physical health care integration in times of epidemic crisis.

Person- and family-centered approach of integrated care (IC) is essential to address fragmentation between mental and physical health care in times of epidemic crisis. Hospital and political leaders should support and draw from bottom-up mental health IC initiatives such as MHSTs, that embody this vision, in order to improve health systems preparedness for future crises.

From People-Centred to People-Driven Care: Can Integrated Care Achieve its Promise without it?

In this editorial, we argue that people-centred care has often remained too passive, condemns patients and carers to subservient roles, and as a result preserves a power imbalance that favours systems and professionals over people and communities. For integrated care to reach its full potential, we instead advocate for a deliberate shift towards ‘people-driven’ care where people have more agency in participating in their health and greater power in decision-making.

Webinar IFIC Annual Survey 2022: Promoting Integrated Care Across the World

Webinar IFIC Annual Survey 2022: Promoting Integrated Care Across the World from Foundation for Integrated Care on Vimeo.

The World Health Organization (WHO) Integrated Care for Older People (ICOPE) Framework: A Narrative Review on Its Adoption Worldwide and Lessons Learnt

The World Health Organization (WHO) recently published guidelines on the implementation of a new Integrated Care for Older People (ICOPE) framework in 2017–2019. It is an integrated care framework for the screening, assessment, and management of intrinsic capacity (IC) declines. We aimed to examine where the early adopters of ICOPE are across the world, how these study teams and sites plan to apply the framework or have applied it, and the lessons learnt for future adopters. We systematically searched electronic medical and social sciences databases and grey literature published between 31 October 2017 and 31 March 2022. Records were systematically selected using precise inclusion criteria. There were 18 ICOPE study teams and sites across the 29 selected records. Of the 18 study teams and sites, seven were in the development stage, seven conducted feasibility studies, and four have commenced implementation of interventions that applied the ICOPE framework. Future ICOPE ...

“After all, we are all sick”: multi-stakeholder understanding of stigma associated with integrated management of HIV, diabetes and hypertension at selected government clinics in Uganda

Integrated care is increasingly used to manage chronic conditions. In Uganda, the integration of HIV, diabetes and hypertension care has been piloted, to leverage the advantages of well facilitated and established HIV health care provision structures. This qualitative study aimed to explore HIV stigma dynamics whilst investigating multi-stakeholder perceptions and experiences of providing and receiving integrated management of HIV, diabetes and hypertension at selected government clinics in Central Uganda. 

How do clients with multiple problems and (in)formal caretakers coproduce integrated care and support? A longitudinal study on integrated care trajectories of clients with multiple problems

Integrated care can create several advantages, such as better quality of care and better outcomes. These advantages apply especially to clients with multiple problems (CWMPs) who have multiple, interconnected needs that span health and social issues and require different health care (e.g., mental health care or addiction care), social care (e.g., social benefits) and welfare services at the same time. Integrated care is most often studied as a phenomenon taking place at the system, organizational, professional and clinical levels. Therefore, in many studies, clients seem to be implicitly conceptualized as passive recipients of care. Less research has been conducted on how clients and (in)formal caretakers coproduce integrated care.

Priorities in integrating primary and secondary care: a multimethod study of GPs

Throughout the world, healthcare policy has committed to delivering integrated models of care. The interface between primary–secondary care has been identified as a particularly challenging area in this regard. To that end, this study aimed to examine the issue of integrated care from general practitioners’ (GPs) perspectives in Ireland.

Integrated brief interventions for noncommunicable disease risk factors in primary care: the manual: BRIEF project

Brief interventions are recognized by WHO as an effective measure to help people quit tobacco, reduce or stop alcohol use and increase physical activity. They can also help to achieve and maintain healthy eating behaviours and manage weight for those living with overweight and obesity. Brief interventions can translate to significant health benefits at population level when systematically applied to a large proportion of people. The uptake of these interventions in the WHO European Region, however, remains low. This manual is an integral part of the WHO European Office for the Prevention and Control of Noncommunicable Diseases BRIEF project. The manual provides a guide to implementing brief intervention programmes in primary care settings, highlighting facilitators and barriers to implementation. It emphasizes an integrated approach to brief interventions, dealing with all four main behavioural risk factors – tobacco use, alcohol use, unhealthy eating and physical inactivity – and the physiological risk factor of ...

How can skill-mix innovations support the implementation of integrated care for people with chronic conditions and multimorbidity?

• The increasing and changing demands of complex patients (with chronic conditions and multimorbidity), combined with growing workloads and shortages of primary care providers, demand the reorganization of services for more patient-centred and more efficient care.
• Reorganizing health and social care services to integrate care requires that the health workforce adopt “skill-mix changes” including reskilling; a different approach to sharing tasks and roles; and improved coordination.
• Skill mix changes typically involve innovative re-allocation of tasks between professions; new supplementary roles; and/or the introduction of greater teamworking and flexibility.
• The most promising skill-mix innovations for improving integration of care of patients with complex needs are:

(1)    Shifting tasks and roles to achieve new divisions of work with advanced practitioners (nurses and pharmacists) taking on management of aspects of care and coordinating processes in close collaboration with physicians.

(2)    Relocation of care to other settings for example to nurse-led clinics or patients ...

Knowledge management in a regional integrated health and social care system

This article analyses a major healthcare and social welfare reform establishing new regional and integrated wellbeing services counties in Finland. The authors approach the reform and service integration as a knowledge management (KM) issue and analyse how KM appears and contributes in the context of integrated care, specifically in the process of integrating social and health care.

Promoting Integrated Care Across the World

Nursing Care Coordination in Primary Healthcare for Patients with Complex Needs: A Comparative Case Study

Despite nurses’ substantial role in care coordination, few education programs exist to better support them in this role. Identification of a set of core care coordination activities across heterogeneous care coordination programs would facilitate the development of a standard of practice. We sought to examine care coordination activities across two care coordination programs in Family Medicine Groups in Quebec, and their relationship to the program design.

Perspectives of people with Parkinson's disease and family carers about disease management in community settings: A cross-country qualitative study

The aim of this study was to explore perceptions of people with Parkinson's disease and family carers about the use and impact of health and social care services, community and voluntary sector resources for the management of Parkinson's disease. Resources from outside the formal health care system and collaborations between different levels and sectors could address the unmet needs of people with Parkinson's disease and their family carers and improve the management of Parkinson's disease in the community setting. An integrated and person-and-community-centred approach, which includes the participation of the health, social, voluntary and community sectors, is desired by people with Parkinson's disease and their family carers to improve the management of Parkinson's in the community setting. 

Does Integrated Care Carry the Gene of Bureaucracy? Lessons from the Case of Québec

Demographic and epidemiological transitions of industralized countries mean health systems have to integrate health and social services to respond to the changing needs of their populations. Efforts to integrate care involve important policy and structural changes. This paper examines whether integration efforts are lost in translation during the bureaucratic appropriation of models, or, in an allegorical way, do they reveal genes of bureaucracy?

Integrated Health and Social Care in the United States: A Decade of Policy Progress

Over the last decade in the United States (US), the burden of chronic disease, health care costs, and fragmented care delivery have increased at alarming rates. To address these challenges, policymakers have prioritized new payment and delivery models to incentivize better integrated health and social services. This paper outlines three major national and state policy initiatives to improve integrated health and social care over the last ten years in the US, with a focus on the Medicaid public insurance program for Americans with low incomes.

Health and Social Care Reform in Scotland – What Next?

This paper analyses the important enablers, barriers and impacts of country-wide implementation of integrated health and social care in Scotland. It offers insights for other systems seeking to advance similar policy and practice. Landmark legislation was based on a shared vision and narrative about improving outcomes for people and communities. Implementation has involved coordination of multiple policies and interventions for different life stages, care groups, care settings and local context within a dynamic and complex system.

The Implementation of Integrated Health Information Systems – Research Studies from 7 Countries Involving the InterRAI Assessment System

In the past years, governments from several countries have shown interest in implementing integrated health information systems. The interRAI Suite of instruments fits this concept, as it is a set of standardised, evidence-based assessments, which have been validated for different care settings. The system allows the electronic transfer of information across care settings, enabling integration of care and providing support for care planning and quality monitoring. The main purpose of this research is to describe the recent implementation process of the interRAI instruments in seven countries: Belgium, Switzerland, France, Ireland, Iceland, Finland and New Zealand.

Making Connections that Count – a Case Study of the Family Referral Service in Schools Program on the Central Coast, New South Wales, Australia

The Family-Referral-Services-In-Schools (FRSIS) is an early-intervention case management program for children and families with complex unmet needs, providing access to family support, housing, mental health care, and/or drug and alcohol services. The in-school trial setting was aimed at improving service uptake which was low in its community counterpart.

Understanding integrated care through patient journeys

In recent years, considerable investment has been made towards healthcare service redesign and reform in response to an increasingly diverse and ageing patient population. The shift towards person-centred care requires holistic care management approaches and has prompted health services to consider changing the ways they deliver care

Construct Validation of the Rainbow Model of Integrated Care Measurement Tool in Dutch Primary Care for Older Adults

are integration in primary elderly care is suboptimal. Validated instruments are needed to enable the implementation of integrated primary care. We aimed to assess construct validity of the Rainbow Model of Integrated Care measurement tool (RMIC-MT) for healthcare professionals working in an integrated primary elderly care setting in the Netherlands.

Integrating case management for patients with complex needs in the ground practice: the importance of context in evaluative designs

Responding to complex needs calls for integrating care across providers, settings and sectors. Among models to improve integrated care, case management demonstrates a good evidence base of facilitating the appropriate delivery of healthcare services. Since case management is a complex, multi component intervention, with its component parts interacting in a non-linear manner, effectiveness is largely influenced by the context in which the intervention is implemented. This paper discusses how to respond to implementation challenges to evaluating complex interventions for patients with complex needs. Building on the example of case management, we suggest that documenting innovation effectiveness remains important, but that evaluation needs to include theory-based and systems perspectives. We also suggest that implementation science needs to be part of intervention design while engaging stakeholders to define the most relevant research questions and implementation effectiveness, to optimize successful implementation and sustainability.

Family physicians collaborating for health system integration: a scoping review

In Canada, Ontario Health Teams (OHTs) are a new model for integrated healthcare. Core to OHTs are family physicians (FPs) and their ability to collaborate with other FPs and healthcare providers. Whereas the factors for intra-organizational collaboration have been well-studied, inter-organizational collaboration between FPs and other healthcare organizations as an integrated care network, are less understood. This paper aims to explore the structural factors, processes, and theoretical frameworks that support FPs’ collaboration for integrated healthcare.

Editorial: Why changes in primary care will affect integrated care

More and more emphasis in health service integration is placed on the role of primary care. What it means to have a “family doctor” may have changed over the last decades, but its key function of assessing, referring and treating patients remains the bedrock of our health systems. Or does it?

What are the Clinical and Social Outcomes of Integrated Care for Older People? A Qualitative Systematic Review

Older people with multiple chronic conditions have most to gain from successful integrated care models but there is a need to understand current evidence of outcomes for older people.

The Winter Strategy – a Multifaceted Integrated Care Intervention to Support People with Chronic and Complex Care Needs during the Australian Winter Period

Health care demands increase over the winter period, especially for people with chronic diseases. Hospital avoidance programs have potential to address seasonal surges.

Evolutionary Trends in Integrated Care in 2000-2020 in China: A Scientometric Review Using CiteSpace

Owing to an increasing demand for a continuous and coordinated health service, integrated care is being promoted worldwide. Chinese research on integrated care has rapidly increased over the last 20 years. However, popular topics, paths and trends of integrated care research in China have not been systematically summarised. The study aimed to examine the evolution of integrated care research in China and predict future research trends.

Successful ingredients of effective Collaborative Care programs in low- and middle-income countries: A rapid review

Integrating mental health care in primary healthcare settings is a compelling strategy to address the mental health treatment gap in low- and middle-income countries (LMICs). Collaborative Care is the integrated care model with the most evidence supporting its effectiveness, but most research has been conducted in high-income countries. Efforts to implement this complex multi- component model at scale in LMICs will be enhanced by understanding the model components that have been effective in LMIC settings. Following Cochrane Rapid Reviews Methods Group recommendations, we conducted a rapid review to identify studies of the effectiveness of Collab- orative Care for priority adult mental disorders of mhGAP (mood and anxiety disorders, psychosis, substance use disorders and epilepsy) in outpatient medical settings in LMICs. Article screening and data extraction were performed using Covidence software. Data extraction by two authors utilized a checklist of key components of effective interventi ns. Information was aggregated to examine ...

Integrated care for children living with complex care needs: an evolutionary concept analysis

Children with complex care needs (CCNs) are in need of improved access to healthcare services, communication, and support from healthcare professionals to ensure high-quality care is delivered to meet their needs.

Integrated care is viewed as a key component of care delivery for children with CCNs, as it promotes the integration of healthcare systems to provide family and child-centred care across the entire health spectrum. There are many definitions and frameworks that support integrated care, but there is a lack of conceptual clarity around the term. Furthermore, it is often unclear how integrated care can be delivered to children with CCNs, therefore reinforcing the need for further clarification on how to define integrated care. An evolutionary concept analysis was conducted to clarify how integrated care for children with CCNs is defined within current literature. We found that integrated care for children with CCNs refers to highly specialised individualised care within ...

The future integrated care workforce

This toolkit brings together those with first-hand experience of designing, delivering, evaluating and participating in a Longitudinal Integrated Clerkship (LIC) within a UK Higher Education Institution and those working closely on programmes focussing on Health Education England (HEE)'s and NHS England's national priorities.

In August 2022, a collaborative workshop was held for students and tutors participating in a London-based LIC in 2021–2022, faculty with prior experience in running LICs, and HEE representatives. The aim of the workshop was to co-produce a toolkit to guide undergraduate institutions, who may wish to introduce an LIC within their medical school curriculum that aligns to these national priorities. Although this toolkit primarily focuses on a UK audience, we anticipate that other health systems facing a need for similar educational reform may also find use for this toolkit.

Integrated Care for Older People with Different Frailty Levels: A Qualitative Study of Local Implementation of a National Policy in Luton, England

The NHS England General Medical Services 2017-18 contract made it mandatory for general practices in England to identify and manage older people proactively. In response to the national policy, the Luton Framework for Frailty (LFF) programme was developed to target older residents of Luton and offer interventions according to their frailty level. The aim of this study was to gain a deeper understanding of the LFF and the factors that affect the implementation of a proactive integrated care service for older people with different frailty levels (OPDFL).

Lessons learnt while integrating services for children: qualitative interviews with professional stakeholders

In the English NHS, integrated care is seen as an opportunity to deliver joined-up care for children and families. This paper examines the lessons learnt by professional stakeholders in the process of developing different examples of integrated models of care/frameworks for children’s services.

Integrated care for children living with complex care needs: navigating the long and winding road

An increasing number of children are living with complex care needs resulting from multiple concurrent conditions. Due to these conditions, various health problems can arise and necessitate screening, prevention, and treatment at different ages during childhood. Each child has an individual constellation and combination of health problems, which implies that multiple health and social care providers across various sectors are required to address these health problems.

Supporting critically conscious integrated care: A toolbox for the health professions

Health professions education has a growing obligation to develop practitioners who are conscious of health inequalities and the sociocultural dynamics of health care. This obligation is reflected in many of the competency and regulatory frameworks that drive current curricula. The central aim of integrated care is to improve patient experiences across health care settings by enhancing service coordination. Although addressing health inequalities is one of the core purposes of integrated care and its systems, educators have little guidance on how to effectively translate this into teaching activities. The reality of health care funding and constraints means that integrated care services may struggle to challenge health inequalities in a meaningful way. Patients from minoritised and marginalised backgrounds are more likely to fall through the cracks between health care services, experiencing fragmented care and negative effects on their physical and mental health due to poor integration. Further, scholars have continually drawn attention ...

Barriers and challenges to integrated care

Integrated care is critical to the successful delivery of modern day health and social care services, however the implementation into practice poses many barriers and challenges. This article seeks to identify these barriers and present methods through which to aim to address and overcome these.

Components and Outcomes in Under-and Postgraduate Medical Education to Prepare for the Delivery of Integrated Care for the Elderly: A Scoping Review

The ageing society requires physicians who can deliver integrated care, but it is unclear how they should be prepared for doing so. This scoping review aims to create an overview of educational programmes that prepare (future) physicians to deliver integrated care while addressing components and outcomes of the interventions.

Patient-Centered Integrated Model of Home Health Care Services in South Korea (PICS-K)

As South Korea is fast becoming an aging society, the need for integrated care of the elderly has increased. ‘Community Integrated Care Initiatives’ have been implemented by the Ministry of Health and Welfare. However, home healthcare is insufficient to meet this need.

Learning from long COVID: integrated care for multiple long-term conditions

Long COVID is a multisystem condition requiring a range of medical, therapeutic, and psychological inputs. Given the complexity of the illness affecting multiple organ systems, often impacting physical and mental health, individuals can be heavy healthcare users across primary, secondary, and emergency services.

The long COVID clinics commissioned in England have provided an opportunity to innovate within a complex care pathway, bringing multiple providers together to meet needs broader than has been historically possible for many other complex conditions. Designing these new services from a blank page has enabled teams to co-create services with patient groups and work more effectively in an integrated way. Significant benefits have been seen, including skills transference between professions.

Exploring the Evidence: Using Technology to Improve Integrated Care Coordination

A transition of care is defined as a change in level of health care services, as patient care needs change from one location to another during acute or chronic illness. The location of services can vary from the hospital, skilled nursing facility, an outpatient setting, a primary care provider's office, or home health. Care coordination gaps can occur due to a lack of information exchange through the electronic health record, a lack of evidence-based standards, and poor communication among providers. Often, clinicians work with a silo mentality, resulting in poor health outcomes and negatively impacting the patient care experience. Patients with chronic kidney disease (CKD) are vulnerable to suboptimal integrated care coordination during transitions of care, as individuals seek treatment from diverse practitioners within multiple settings to meet their medical needs. This article discusses methods to improve integrated care, emphasizing the use of technology-based interventions to facilitate care transitions ...

Ethical challenges and principles in integrated care

Integrated care is an established approach to delivery in parts of the healthcare infrastructure, and an ideal which, it is claimed, should be realized system-wide. Its ethical weight derives from its defence of a view about how healthcare ought to operate. Although the goal of integration is laudable, it is ethically and practically complex, involving trade-offs.

Citizen Leadership & Integrated Care Report

Integrated care is at its heart about health, social care and wider services being better coordinated around people, families, and communities. This requires those who plan, design, and deliver services to understand what is important to people on an individual and collective basis. People’s circumstances and aspirations may change with their health conditions and social situations and through new challenges arising in wider society. It is therefore important that opportunities to influence and co-produce services are not a one-off exercise, but rather are ongoing and responsive to people’s interests and perspectives.

Professor Robin Miller and Dr Caroline Jackson (Social Care theme) have been collaborating with research partners in Europe and Canada to understand how people with lived experience of health and/or social care can influence the development of integrated care.

The first report from the research is now available for download: Citizen Leadership & Integrated Care Report.

Integrated Care: Reflections on Change in Health Services

This book critically examines integrated care, looking at integration from an unconventional angle to reveal the tacit assumptions we make when we manage and change health services. Kaehne questions our premises on health services management, the motivations for change and the shortcomings of health policy in complex environments.

Implementing integrated care clinics for HIV-infection, diabetes and hypertension in Uganda (INTE-AFRICA): process evaluation of a cluster randomised controlled trial

Sub-Saharan Africa is experiencing a dual burden of chronic human immunodeficiency virus and non-communicable diseases. A pragmatic parallel arm cluster randomised trial (INTE-AFRICA) scaled up ‘one-stop’ integrated care clinics for HIV-infection, diabetes and hypertension at selected facilities in Uganda. These clinics operated integrated health education and concurrent management of HIV, hypertension and diabetes. A process evaluation (PE) aimed to explore the experiences, attitudes and practices of a wide variety of stakeholders during implementation and to develop an understanding of the impact of broader structural and contextual factors on the process of service integration.

Operational Framework for Primary Health Care

The World Health Assembly in resolution WHA72.2 (2019) requests the Director-General inter alia “to develop, in consultation with, and with the involvement of more expertise from, Member States, and in time for consideration by the Seventy-third World Health Assembly, an operational framework for primary health care, to be taken fully into account in the WHO general programmes of work and programme budgets in order to strengthen health systems and support countries in scaling-up national implementation efforts on primary health care”. This operational framework builds on an initial draft that was prepared as part of a technical series to support the Global Conference on Primary Health Care (Astana, 25 and 26 October 2018). It was then revised following expert review, public consultation, civil society consultation, key informant interviews and consultations with Member States.

This operational framework, the related Vision for primary health care in the 21st Century, and associated technical ...

Clinic for Multimorbidity: An Innovative Approach to Integrate General Practice and Specialized Health Care Services

Caring for patients with multimorbidity in general practice is increasing in amount and complexity. To integrate care for patients with multimorbidity and to support general practitioners (GPs), the Clinic for Multimorbidity (CM) was established in 2012 at Silkeborg Regional Hospital, Denmark. This case study aims to describe the CM and the patients seen in it.

Transnational Forum on Integrated Community Care (TransForm)

Integrated Care for Older People: Theories and Practices

As the first Chinese monograph to explicitly connect the “Yiyang Jiehe” with “integrated care for older people”, this book presents readers with a thorough overview of integrated care for older people, from theoretical content, management tools, to practices in China and international learning.

Inter-Disciplinary Work in the Context of Integrated Care – a Theoretical and Methodological Framework

Inter-disciplinary team working is an essential mechanism for the delivery of integrated care. This paper summarises a narrative review of the research on the ‘work’ that teams do to develop inter-disciplinary practices, addressing the question ‘How do interdisciplinary teams ‘become’ in the context of models of integrated care?’.

The narrative review identities a gap in our understanding of the active boundary work that different disciplines working together to deliver care integration engage in when creating new interdisciplinary knowledge, creating an inter-disciplinary team identity and negotiating new social and power relations. This gap is particularly significant in relation to the role played by patients and care-givers.

This paper presents a way of examining inter-disciplinary working as a process of creating knowledge, identity and power relations both in terms of a theoretical lens, circuits of power, and a methodology, institutional ethnography.

An explicit focus on understanding power relations within inclusive inter-disciplinary teams ...

Integrated care strategy, health and wellbeing board and joint forward plan guidance: what you need to know

Key points

• The Department for Health and Social Care has released guidance for:

1. the preparation of integrated care strategies by integrated care partnerships
2. health and wellbeing boards and how they will work with and within integrated care systems
3. principles for integrated care partnership engagement with adult social care providers
4. principles for integrated care partnership engagement with health overview and scrutiny committees.

• NHS England has released guidance on developing the joint forward plan, to support integrated care boards and their partner trusts to develop their first 5-year joint forward plans.
• Integrated care partnerships may wish to publish an initial interim strategy by December 2022 if they want to align and influence integrated care boards' first five-year joint forward plans.
• Integrated care boards (ICBs) and their partner trusts are required to prepare a joint forward plan before the start of each financial year, and share the final version with their integrated care ...

How can Ireland mobilise social care community networks across the island to better support people to live healthily and ‘age in place’ throughout the life course?

Population aging is a phenomenon affecting almost every developed country worldwide and one that is increasingly prevalent in many of the globe’s most advanced economies such as Japan, USA and Europe. In seeking to address the impact of this issue, policy-makers are often heavil  focussed on the social and economic consequences of aging populations, such as a reduction in economic growth or increased pressures on public expenditure. However some have argued that policy should instead be more future-focussed, supporting states to build greater resilience to demographic changes and ensuring resources are redistributed to maintain wellbeing across the life course.

Models of Integrated Care: The global experience

This Global Experience Paper on Integrated Health Care was developed to provide the Primary Health Care Institute (PHCI) in Libya with insights as it designs and develops its plans to rebuild primary health care (PHC). The findings are informed by a review of recent international literature, and by insights provided by selected international experts. The paper uses the Framework on Integrated, People-Centered Health Services from the World Health Organization to structure the analysis of global experiences. Overall, there is no single model of integration that can or should be adopted in countries seeking to develop primary health care. There is, however, evidence of good practice in designing and developing local, context-specific solutions. Evidence to support effective strategies and policies relevant for conflict-affected situations is scarce. However, there are some common themes and issues relating to the need to rebuild trust in the quality and safety of services; to build from ...

When the Note Doesn't Fit: Social Workers Documenting in the Electronic Health Record on Integrated Health Teams

A qualitative study was conducted to understand how social workers document their work in the electronic health record (EHR) in integrated primary care settings. Three themes emerged from the analysis of the focus groups: 1) considerable variability in where and how social workers document their practice within the EHR; 2) EHR functions are not designed for social work practice; and 3) EHR documentation practices as helpful for demonstrating social workers’ contributions to other integrated care team members. Education, training, and EHR adaptations are needed as social workers and other nontraditional healthcare providers continue to partake in team-based service delivery, especially in integrated primary care.

Regional framework on the future of primary health care in the Western Pacific

Regional Framework on the Future of Primary Health Care (PHC) was adopted by Member States at the seventy-third session of the Regional Committee for the Western Pacific in 2022. The framework outlines five key attributes of PHC including people and community-centered, continuous, high-quality and equitable, integrated, and innovative. It highlights five strategic areas of actions needed which pivot around models of service delivery, individual and community empowerment, workforce and provider base, financing, enabling and supportive environment to enable this transformation. It calls on critical health system transformation for the future to achieve Universal Health Coverage and Sustainable Development Goals.

Personalized Integrated Care Promoting Quality of Life for Older People: Protocol for a Multicenter Randomized Controlled Trial

Alzheimer disease (AD) and Parkinson disease (PD) are the 2 most common neurodegenerative diseases affecting millions of people worldwide. The Personalized Integrated Care Promoting Quality of Life for Older People (PC4L) project proposes an integrated, scalable, and interactive care ecosystem that can be easily adapted to the needs of several neurodegenerative and chronic diseases, care institutions, and end user requirements.

The Integrated Care Workforce: What does it Need? Who does it Take?

The health and care workforce was under pressure long before the pandemic due to the development of new technologies, recurring policy reforms and dwindling ressources. It has though taken the outcry in the aftermath of COVID-19 for researchers and policymakers to realise that something fundamental needs to change. In the integrated care literature and in this journal, the fact that integrated care implementation does not work without the involvement and support of the workforce has been a recurring theme, but also little heeded. Concepts like the Quadruple Aim or the WHO European Framework for Action for integrated health services delivery have helped to shift the focus on workforce planning, education and training or role definitions for integrated care.

Integrated care and the behavioral health primary care provider

Primary care remains the main setting for delivery of psychiatric care. An integrated approach improves the ability of primary care providers (PCPs) to care for complex patients with behavioral health needs. This article describes integrated care and how physician associates/assistants can gain additional training to become behavioral health specialists.

How to Get Published in Integrated Care Webinar

IFIC Australia in partnership with the International Foundation for Integrated Care (IFIC) and the International Journal of Integrated Care (IJIC) invite you to join for their next webinar, How to get published in Integrated Care, taking place Monday, 18 September.

About the Webinar

The How to Get Published in Integrated Care webinar is aimed at all those interested in promoting their research and practice in integrated are and writing scientific papers on their programs or initiatives. Whether you are an emerging researcher or an experienced, published academic, whether you are a professional or a consumer, this webinar will allow you to dig deep into the ins and outs of publishing with IJIC and the do’s and don’ts of scientific writing. Engage directly with leading names in integrated care, who will share their advice on how to get published.

Health systems in crisis: Countering shockwaves and fatigue (Eurohealth)

This Eurohealth special issue provides a pre-reader for the 2023 European Health Forum Gastein, a key platform for health policy exchange, bringing together stakeholders and decision-makers from the public and private sector, civil society, and science and academia. The 2023 conference will facilitate discussion on how to ride out the current shockwaves and explore how crises can help catalyse the development of new approaches to health system problems.

The 24th International Conference on Integrated Care (ICIC24)

The 24th International Conference on Integrated Care (ICIC24) in partnership with IFIC Ireland and the International Journal of Integrated Care (IJIC) and supported by the Department of Health, Northern Ireland and Visit Belfast will take place in ICC Belfast on 22-24 April 2024, with the overarching theme ‘Taking the leap: making integrated care a reality for people and communities’, the conference will bring together leaders, researchers, clinicians, managers, community representatives, patients and caregivers from around the world who are engaged in the design and delivery of integrated health and care.

Co-design with Integrated Care Teams: Establishing Information Needs

Co-design has been cited as playing a major role in the future of effective integrated care, however, there is a lack of reporting and reflection on the methods used. Information sharing is fundamental when working in integrated care, however sharing across professions, service settings and localities can be complex. Through co-design, we seek to establish a shared understanding of information needs within a newly formed integrated care team. In doing so we aim to inform future practice in the understanding of co-design.

Integrated care for older people with cancer: a primary care focus

Estimates from a 2023 study indicate that cancer will continue to grow as a leading cause of health and economic burden alongside global population ageing.

Consequently, health-care providers, including primary care teams, will increasingly face substantial challenges in caring for older people with cancer who have evolving, complex, and specific needs. More than 60% of new cancer diagnoses occur in adults aged 65 years and older in high-income countries, underpinning the importance of empowering primary health-care providers (including general practitioners, community nurses, allied health professionals, and pharmacists) to provide high-quality care to this at-risk population.

Nevertheless, geriatric oncology remains peripheral in the awareness of primary health-care providers. Therefore, raising awareness of the growing importance of geriatric oncology and fostering collaboration between primary health-care providers and oncogeriatric teams is essential to ensure optimal care for older people with cancer.

Implementation Toolbox to Document and Analyze Primary Health Care Innovations

Implementation science is a multidisciplinary field that focuses on studying and promoting effective strategies for translating evidence-based interventions (EBIs) into routine practice to improve outcomes in real-world settings. It has been increasingly used to document and assess interventions, as it helps to make sense of how, when, where, and why research results and EBI are, or are not, being successfully used. When compared to traditional project design, implementation, and management of health care interventions, implementation science can add value by addressing the specific complexities and challenges associated with implementing and scaling up these interventions. More specifically, it helps to analyze and understand the contextual factors, stakeholder dynamics, and system-level barriers that can hinder the successful adoption and integration of health care interventions. In this sense, by integrating implementation science principles the World Bank can tailor strategies, develop robust implementation plans, and leverage evidence-based practices to overcome implementation problems, which is ...

Integrated care in a Beveridge system: experiences from England and Denmark

Health systems internationally face demands to deliver care that is better coordinated and integrated. The health system financing and delivery model may go some, but not all the way in explaining health system fragmentation. In this paper, we consider the road to care integration in two countries with Beveridge style health systems, England and Denmark, that are both ranked as highly Integrated systems in Toth's health integration index. We use the SELFIE framework to compare the policies and reforms that have affected care integration over the past 30 years in the two countries. The countries both started their reform path by reforming to introduce choice and competition, but did so in different ways that set them on different pathways. Nevertheless, after two decades, the countries ended the period with largely similar structures that emphasised the creation of a cross-sectoral governance structure. In the relatively centralised England, by introducing decentralised ...

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.

'Walking-the-talk': How to co-design an innovative and sustainable integrated care learning programme

Integrated care facilitates better outcomes for patients and their family, health workforce and health and social care systems. Accordingly, integrated care is a global and inherent area of work for health professionals. Despite this, formal learning programmes for workforce development in integrated care are still rare. In this paper, I have shared lessons about developing an innovative and sustainable integrated care learning programme for teachers, practitioners and learners in integrated care discipline. These lessons are drawn from my experience of leading an integrated care specialisation programme (that sits at Australian Qualification Framework Level 9) at a public university in Australia. An integrated care learning programme should be designed with appropriate philosophies (e.g., social constructivism and connected learning) and relevant multidisciplinary content that addresses deficiencies in practices of integrated care. Moreover, the programme should aim for sustainability, through financial feasibility and continuity with offering of creative and effective solutions in ...