Integrated Care Search: development and validation of a PubMed search filter for retrieving the integrated care research evidence

Integrated care is an increasingly important principle for organising healthcare. Integrated care models show promise in reducing resource wastage and service fragmentation whilst improving the accessibility, patient-centredness and quality of care for patients. Those needing reliable access to the growing research evidence base for integrated care can be frustrated by search challenges reflective of the topic’s complexity. The aim of this study is to report the empirical development and validation of two search filters for rapid and effective retrieval of integrated care evidence in PubMed. One filter is optimised for recall and the other for precision.

Capturing the Role of Context in Complex System Change: An Application of the Canadian Context and Capabilities for Integrating Care (CCIC) Framework to an Integrated Care Organisation in the UK.

If integrated care approaches are to be properly adapted to local contexts, a better understanding is required of key determinants of implementation and how these might be appropriately supported. This study applied the Canadian Context and Capabilities for Integrating Care (CCIC) Framework to investigate factors influencing the implementation and outcomes of a complex integrated care change programme in Torbay and South Devon (TSD) and, more specifically, in one of five sub-localities, Coastal.

Collaborative Governance for Integrated Care: Insights from a Policy Stakeholder Dialogue

Integrated care is a goal of many health care systems. However, operationalizing and implementing integrated care remains challenging especially in continuously evolving policy environments. We report on a policy symposium held in 2017 focused on operationalizing a particular integrated care policy in the context of policy evolution in Ontario, Canada.

Communication and Coordination Processes Supporting Integrated Transitional Care: Australian Healthcare Practitioners’ Perspectives

Although a large body of research has identified effective models of transitional care, questions remain about the optimal translation of this knowledge into practice. In Australia, the introduction of a model of consumer-directed care uniquely challenges the practice of integrated care transitions for older adults. This study aimed to identify strengths and weaknesses in transitional care for older adults in an Australian setting by describing healthcare practitioners’ experiences of care provision.

Comparing International Models of Integrated Care: How Can We Learn Across Borders?

Providers, managers, health system leaders, and researchers could learn across countries implementing system-wide models of integrated care, but require accessible methods to do so. This study assesses if a common framework could describe and compare key components of international models of integrated care.

A “Behind-the-Scenes” Look at Interprofessional Care Coordination: How Person-Centered Care in Safety-Net Health System Complex Care Clinics Produce Better Outcomes

While the effectiveness of team-based care and wrap-around services for high utilizers is clear, how complex care clinics deliver effective, person-centered care to these vulnerable populations is not well understood. This paper describes how interactions among interprofessional team members enabled individualized, rapid responses to the complex needs of vulnerable patients.

Challenges to Introducing Integrated Diabetes Care to an Inner-Regional Area in South Western Sydney, Australia

Diabetes care often requires collaboration between general practitioners, allied health professionals, nurses, and/or medical specialists. This study highlights the need to integrate new diabetes services with existing health activities in the community and the importance of allowing flexibility and regular contact with local healthcare professional and community to encourage their involvement.

Integrated Care Programs for People with Multimorbidity in European Countries: eHealth Adoption in Health Systems

eHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), also supporting multidisciplinary care. The aim of this paper is to explore how widely eHealth tools have been currently adopted in integrated care programs for (older) people with MM in European countries, including benefits and barriers concerning their adoption, according to some basic health system characteristics.

Realising the True Value of Integrated Care: Beyond COVID-19

Stronger and more resilient care systems and communities are better able to cope, respond and adapt to new challenges and crises such as the current COVID-19 pandemic. They are able to quickly come together to ‘act as one’ and collaborate across disciplines and sectors towards a common goal. This is the essence of integrated care and this is what the International Foundation for Integrated Care (IFIC) stands for – creating a more connected health and care system.

Challenges in Implementing Integrated Care in Central and Eastern Europe – Experience of Poland

During their transition, Central and Eastern European countries’ health and social care systems have undergone significant changes, and are currently dealing with serious problems of disintegration, coordination, and a lack of control over the market environment, especially for meeting patients’ needs. The increased health and social needs related to the ageing society and epidemiological patterns in these countries also require increased funding, reformation of rationing, sectors to be integrated (the managed care approach), and the development of an analytical information base for surveillance of new health and social care solutions.

Driving and accelerating a 'one system' response: why COVID-19 has shone a spotlight on Integrated Care

High performing health and social care systems provide exceptional care, quality and experiences for patients, caregivers and providers. Pivotal to this, is how we work across health and social care as one team. The need for integrated care is a global priority and is poised to address fragmentation and accelerate the improvements that are needed. During a global pandemic, the need to work as an integrated system is even more pressing and gives us an opportunity to pause, reflect and respond.

In situations where systems are subjected to unprecedented pressure, organizations and sectors may respond from the lens of what can their individual organization or sector do, rather than responding as a cohesive and interconnected system.

Organizations that have embraced collaborative models of response and care and were already working to advance integration pre-pandemic appear to be more effective in responding as one connected team and community.

This webinar will ...

Impact Assessment of an Innovative Integrated Care Model for Older Complex Patients with Multimorbidity: The CareWell Project

In aging populations, multimorbidity (two or more chronic diseases in the same person) is very common. Patients with multimorbidity have complex health and social needs, are at risk of being admitted to the hospital or residential care home and require a wide range of interventions.

To satisfy the needs of these patients and their families, new innovative integrated care models are needed. To be effective, they should have primary care as the cornerstone of care, effective integration between care levels, empower patient and carers/families, and should be patient-centered. The use of information and communication technology (ICT) platforms could facilitate and improve communication promoting patient empowerment and home support. This innovative interoperability should increase effectiveness, efficiency, and equity.

The aim of the CareWell project was to implement and to assess the effectiveness of an integrated care program based on the coordination between health providers, home-based care, and patient empowerment, supported ...

The Odyssey of Integration: Is Management its Achilles’ Heel?

The importance of management to the implementation of integrated care is recognised in evidence and practice. Despite this recognition, there is a lack of clarity about what ‘good’ management of integrated care looks like, if the competences are different to management for ‘traditional’ care, and how such competences can be acquired.

Towards Integrated Youth Care: A Systematic Review of Facilitators and Barriers for Professionals

To overcome fragmentation in support for children and their families with multiple and enduring problems across life domains, professionals increasingly try to organize integrated care. However, it is unclear what facilitators and barriers professionals experience when providing this integrated care. Our systematic review, including 55 studies from a broad variety of settings in Youth Care, showed that integrated care on a professional level is a multi-component entity consisting of several facilitators and barriers. Findings were clustered in seven general themes: 'Child's environment', 'Preconditions', 'Care process', 'Expertise', 'Interprofessional collaboration', 'Information exchange', and 'Professional identity'. The identified facilitators and barriers were generally consistent across studies, indicating broad applicability across settings and professional disciplines. This review clearly shows that when Youth Care professionals address a broad spectrum of problems, a variety of facilitators and barriers should be considered.

Implementation of the Integrated Care of Older People (ICOPE) App in Primary Care: New Technologies in Geriatric Care During Quarantine of COVID-19 and Beyond

The COVID-19 pandemic due to a novel coronavirus (SARS-CoV-2) in December 2019 has rapidly spread worldwide. The mortality rate is about 2.3% in general population, with high human-to-human transmission of 0.41 (credible interval [0.27, 0.55]), and nasopharyngeal asymptomatic carriers act as vectors within the population. The World Health Organization (WHO) declared the pandemic on March 2020, and established objectives and action plan. First, WHO aimed at limiting the transmission of SARS-CoV-2, which required large isolation actions (country borders lockdown and individual quarantine). Second, WHO aimed at guiding and supporting the different health care systems across countries. Finally, developing therapeutic interventions appeared as a global priority as available evidence were still scarce. More than 860 clinical trials are ongoing worldwide.

Organisational development to support integrated care in East London: the perspective of clinicians and social workers on the ground

Organisational Development (OD), with its focus on partnership working and distributed leadership, is increasingly advocated as an effective approach to driving change. Our evaluation of the impact of OD on delivery of integrated care in three London boroughs sheds light on how OD is being understood and implemented within health services, and what impact it is having on delivery of care.

ICIC20 – 20th International Conference on Integrated Care (Virtual Edition)

Driving and Accelerating a ‘One System’ Response: Why COVID-19 has Shone a Spotlight on Integrated Care

Supporting Resilient Communities in Times of Public Health Crisis

Building integrated care as the cornerstone of our new reality

This webinar allowed decision makers and managers in health and health care to learn about the integrated care approaches that have been implemented and the considerations that have been made to address the continuum of care and support needs of individuals, beyond public health issues and crisis management.

IFIC Scotland Integrated Care Matters: Build Back Better Webinar Series

IFIC’s new report, Realising the true value of integrated care describes the steps we must take to create a radically different future beyond Covid-19. The report is a powerful call to reset our compass to a new reality based on solidarity and collaboration for population health.

IFIC Scotland and partners will explore this new future in series 5 of their Integrated Care Matters webinars. Guest panelists, members of IFICs international Special Interest Groups, will share their experiences and insights and challenge us to design a better future that improves lives and opportunities for all.

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.

Upcoming Webinars

Hold the dates and register for the free webinars – broadcast live 4-5pm (5-6pm CET) .

Click the links to Register:

Enhanced healthcare support in care homes – from ...

Communication, Collaboration and Care Coordination: The Three-Point Guide to Cancer Care Provision for Aboriginal and Torres Strait Islander Australians

Pathways for accessing cancer care for Indigenous Australians can be more complex than for other Australians, with additional challenges for them relating to culture, language, and lack of familiarity with navigating services and institutions in the wider health care system. Besides coming to terms with a cancer diagnosis, accessing diagnostic and cancer treatment often involves travel and being away from home for extended periods of time. Cancer care also often involves accessing multiple healthcare providers (e.g. radiation oncologists, surgeons, pathology services) and across a range of settings.

The World Health Organisation (WHO) developed the framework on integrated people-centred health services (IPCHS) recommending a fundamental shift of health systems from being disease-focused to people-focused. The framework identifies the primary drivers of continuity and coordination of care. Continuity of care promotes an environment to develop ongoing relationships that support seamless interactions between service providers within and across sectors that enable coordination ...

More that unites us than divides us? A qualitative study of integration of community health and social care services

The integration of community health and social care services has been widely promoted in the UK as a vital step to improve patient-centred care, reduce costs, reduce admissions to hospital and facilitate timely and effective discharge from hospital. The complexities of integration raise questions about the practical challenges of integrating health and care given embedded professional and organisational boundaries in both sectors.

This study describes how an English city created a single, integrated care partnership, to integrate community health and social care services. This led to the development of 12 integrated neighbourhood teams, combining and co-locating professionals across three separate localities.

The aim of this research was to identify the context and the factors enabling and hindering integration from a qualitative process evaluation.

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.

Rethinking workforce planning for integrated care: using scenario analysis to facilitate policy development

A goal of health workforce planning is to have the most appropriate workforce available to meet prevailing needs. However, this is a difficult task when considering integrated care, as future workforces may require different numbers, roles and skill mixes than those at present. With this uncertainty and large variations in what constitutes integrated care, current health workforce policy and planning processes are poorly placed to respond. The scenario-based workforce shows that through applying techniques that have been developed to accommodate uncertainty, health workforce planning can benefit when confronting issues associated with integrated care.

Digital Solutions: Adoption, Adaptation and their role in post-Covid19 health and social care delivery

Cohort Profile: Effectiveness of a 12-Month Patient-Centred Medical Home Model Versus Standard Care for Chronic Disease Management Among Primary Care Patients in Sydney, Australia

Evidence suggests that patient-centred medical home (PCMH) is more effective than standard general practitioner care in improving patient outcomes in primary care. This paper reports on the design, early implementation experiences, and early findings of the 12-month PCMH model called 'WellNet' delivered across six primary care practices in Sydney, Australia.

Shifting care from hospital to community, a strategy to integrate care in Singapore: process evaluation of implementation fidelity

Accessibility to efficient and person-centered healthcare delivery drives healthcare transformation in many countries. In Singapore, specialist outpatient clinics (SOCs) are commonly congested due to increasing demands for chronic care. Through collaborations between SOCs at the National University Hospital and primary and community care (PCC) clinics in the western region of the county, the program was designed to facilitate timely discharge and appropriate transition of patients, who no longer required specialist care, to the community.

Measuring the benefits of the integration of health and social care: qualitative interviews with professional stakeholders and patient representatives

Integrated care has the potential to ease the increasing pressures faced by health and social care systems, however, challenges around measuring the benefits for providers, patients, and service users remain. This paper explores stakeholders’ views on the benefits of integrated care and approaches to measuring the integration of health and social care.

Leveraging service design for healthcare transformation: toward people-centered, integrated, and technology-enabled healthcare systems

This paper explores how service design can contribute to the evolution of health service systems, moving them toward people-centered, integrated and technology-enabled care; the paper develops a research agenda to leverage service design research for healthcare transformation.

Context matters: a qualitative study of the practicalities and dilemmas of delivering integrated chronic care within primary and secondary care settings in a rural Malawian district

With the increasing double burden of communicable and non-communicable diseases (NCDs) in sub-Saharan Africa, health systems require new approaches to organise and deliver services for patients requiring long-term care. There is increasing recognition of the need to integrate health services, with evidence supporting integration of HIV and NCD services through the reorganisation of health system inputs, across system levels. This study investigates current practices of delivering and implementing integrated care for chronically-ill patients in rural Malawi, focusing on the primary level.

Care during and beyond the COVID-19 Crisis: Workforce Capacity and Capability

Impact of the CareWell integrated care model for older patients with multimorbidity: a quasi-experimental controlled study in the Basque Country

Older patients with multimorbidity have complex health and social care needs, associated with elevated use of health care resources. The CareWell program for older patients with multimorbidity, is based on the coordination between health providers, home-based care and patient empowerment, supported by information and communication technology tools. The implementation of CareWell integrated care model changed the profile of health resource utilization, strengthening the key role of primary care and reducing the number of emergency visits and hospitalizations

Integrated Care for Older Adults: A Struggle for Sustained Implementation in Northern Netherlands

Integrated care has been suggested as a promising solution to the disparities in access and sustained high quality long-term care emerging in Europe’s ageing population. The Dutch integrated person-centred health service for older adults was based on two evidence-based models (the Chronic Care Model and the Kaiser Permanente Triangle). In this case study we assess the impact of the programme based on past evaluations, reflect on why it ended, lessons learned and ideas to take forward.

Cost and effects of integrated care: a systematic literature review and meta-analysis

Health and care services are becoming increasingly strained and healthcare authorities worldwide are investing in integrated care in the hope of delivering higher-quality services while containing costs. The cost-efectiveness of integrated care, however, remains unclear. This systematic review and meta-analysis aims to appraise current economic evaluations of integrated care and assesses the impact on outcomes and costs.

Policy Brief: The Impact of COVID-19 on older persons

The COVID-19 pandemic is causing untold fear and suffering for older people across the world. As the virus spreads rapidly to developing countries, likely overwhelming health and social protection systems, the mortality rate for older persons could climb even higher. Efforts to protect older persons should not overlook the many variations within this category, their incredible resilience and positivity, and the multiple roles they have in society, including as caregivers, volunteers and community leaders.

COVID-19 recovery is an opportunity to set the stage for a more inclusive, equitable and age-friendly society.

Integrated Care in Latin America, cornerstone of the new reality: Atención Integrada en Iberoamérica piedra angular de la nueva realidad

In this webinar hosted in Spanish, we want to identify and share emerging integrated care practices to respond to the COVID-19 pandemic in Ibero-America, as well as discuss new opportunities in the integration of health services and systems in the future.

Wednesday August 05/Miércoles 05 de Agosto
Hora: 11:00 h (Costa Rica) 12:00 h (Colombia, Mexico), 13:00 h (Bolivia, Chile), 14:00 h (Argentina, Uruguay), 19:00 h (España)

La actual pandemia de COVID-19 ha impactado rápidamente nuestras vidas, particularmente, está creando un desafío sin precedentes para nuestros sistemas de salud y sociales en todo el mundo. En este contexto todos los países están tomando numerosas medidas para responder a las necesidades de atención urgente de las personas afectadas por COVID-19, al mismo tiempo que intentan reducir al máximo el impacto entre los grupos vulnerables.

La Fundación ...

Who Cares? Attracting and Retaining Care Workers for the Elderly

This report presents the most up-to-date and comprehensive cross-country assessment of long-term care (LTC) workers, the tasks they perform and the policies to address shortages in OECD countries. It highlights the importance of improving working conditions in the sector and making care work more attractive and shows that there is space to increase productivity by enhancing the use of technology, providing a better use of skills and investing in prevention.

Webinar: Integrated care in Latin America and the Caribbean beyond COVID-19

Online Learning: Certificate in Integrated Care

The Integrated Care Academy, from the International Foundation for Integrated Care (IFIC), is embracing a new digital, innovative and dynamic learning platform.

The Certificate in Integrated Care has been designed using IFIC’s 9 Pillars of Integrated Care as a module based course of online learning. The accessible, high quality programme is offered through a virtual online campus. If you are a health and care professional looking to further your knowledge in Integrated Care, sign up now to be the first to hear about the course.

The course is based on The 9 Pillars of Integrated Care with the 5 modules as follows:

•    Module 1: Introduction to Integrated Care with Shared Values and Vision

•    Module 2: Workforce Capacity and Capability + People as Partners in Health and Care

•    Module 3: System-wide Governance and Leadership + Aligned Payments Systems

•    Module 4: Population Health and Local Context + Resilient Communities and New Alliances

•    Module 5 ...

Realising the value of integrated care in Australia beyond

PROFESSOR NICK GOODWIN, Director, Central Coast Research Institute for Integrated Care, University of Newcastle and Central Coast LHD. Co-Founder, International Foundation for Integrated Care

Over the past decade there has been a growing realisation of the need to reform health and care systems in Australia to better coordinate care, improve quality and promote value.

For example, recent reports such as the 2017 Productivity Commission’s Shifting the Dial and the 2018 CSIRO report Future of Health criticised the existing disease-based, episodic, medicallydominated and institutionally- led characteristics of the Australian health system as being unable to respond effectively to the new challenges of age-related chronic illnesses and the very high percentage of Australians living in ill-health.

A more person-centred and integrated approach was required, including a shift in funding away from rewarding volume to incentivising value, empowering consumers, addressing health inequality, unlocking the value of digital health, and building integrated care ...

Different Contexts, Similar Challenges. SUSTAIN’s Experiences with Improving Integrated Care in Europe

SUSTAIN stands for ‘Sustainable Tailored Integrated Care for Older People in Europe’ (www.sustain-eu.org). The SUSTAIN-project was carried out between 2015 and 2019 by thirteen partners from eight European countries: Austria, Belgium, Estonia, Germany, Norway, Spain, the Netherlands, and the United Kingdom.

The SUSTAIN project was designed to support the development of integrated care for older people living at home with health and social care needs. Its objectives were twofold: 1. To support and monitor improvements to established integrated care initiatives and 2. To contribute to the adoption and application of such improvements to other health and social care systems and regions in Europe.

With the exception of partners in Belgium, all SUSTAIN researchers selected two integrated care initiatives in their countries for participation in the SUSTAIN-project. The different integrated care initiatives were committed to improving their current practices by working towards more person-centered, prevention-oriented, safe ...

Understanding integrated care at the frontline using organisational learning theory: A participatory evaluation of multi-professional teams in East London

Integrated care has been proposed as an organising principle to address the challenges of the rising demand for care services and limited resources. There is limited understanding of the role of learning in integrated care systems. Organisational Learning (OL) theory in the guise of ‘Learning Practice’ can offer a lens to study service integration and reflect on some of the challenges faced by multi-professional teams in developing a learning culture.

The study presents findings from two qualitative evaluations of integrated care initiatives in three East London boroughs, England, undertaken between 2017 and 2018.

Integrating care for non-communicable diseases into routine HIV services: key considerations for policy design in sub-Saharan Africa

There is great interest for integrating care for non-communicable diseases (NCDs) into routine HIV services in sub-Saharan Africa (SSA) due to the steady rise of the number of people who are ageing with HIV. Suggested health system approaches for intervening on these comorbidities have mostly been normative, with little actionable guidance on implementation, and on the practical, economic and ethical considerations of favouring people living with HIV (PLHIV) versus targeting the general population.The authors summarize opportunities and challenges related to leveraging HIV treatment platforms to address NCDs among PLHIV. It is emphasized key considerations that can guide integrated care in SSA and point to possible interventions for implementation.

Care during and beyond the COVID-19 crisis: Workforce capacity and capability

This podcast belongs to International Foundation of Integrated Care.

Health and care workers are our greatest asset, working alongside family carers, community partners and local networks of support. However, without reforms, sustaining the workforce is also one of our greatest challenges.

Core competencies for integrated care are highly relational: patient advocacy, communication, interdisciplinary working, people-centred care, and continuous learning. Leading and managing transformational change is a collective responsibility and sustainable improvements will only take place if a flexible approach to driving the change is embedded. Enabling individuals and the system to be their own change agents will create an environment that can effectively respond to the continuous evolution of communities and populations alongside being able to harness the potential of innovations and new ways of working.

The current pandemic has stretched our workforce beyond what we could have imagined. They have stepped up by extending scope of practice, blurring roles ...

From Crisis to Coordination: Challenges and Opportunities for Integrated Care posed by the COVID-19 Pandemic

COVID-19 has accentuated the stark reality that, despite the efforts of the past 20 years, there remains a continued failure to embrace integrated care systems. It has also demonstrated how quickly systems, organisations and individuals can change, if they must. The uptake in telehealth, eHealth and other technological support systems is unprecedented, even though only a couple of months ago this was unthinkable on a broad scale in many countries. The swiftness of multi-disciplinary teams coming together to find flexible solutions to the day-today challenges during lockdown has shown how we can achieve effective communication and collaboration.

Collaborative Experience Success Stories in Integrated Care of Older People: A Narrative Analysis

Inter-organisational collaboration is crucial in the care of older people, as is the development of integrated care. Storytelling in organisations is one way of understanding how to achieve successful collaboration. This article provides insights into the ways in which storytelling in collaborative experiences contributes to a collective identity instrumental in the successful collaborations involved in integrated care for older people.

Integrated older people care and advanced practice nursing: an evidence-based review.

The world's population is aging rapidly. This is a fact, and the demand for services adapted to this new reality is increasingly necessary. The World Health Organization has proposed an integrative strategy centered on people. Here present a systematic review of strategies that address the care of older adults with the integrated care-centered approach to people.

Effects of Training Health Workers in Integrated Management of Childhood Illness on Quality of Care for Under-5 Children in Primary Healthcare Facilities in Afghanistan

Neonatal and infant mortality in Afghanistan has decreased considerably since 1990. Despite this, infant morbidity and mortality remains among the highest in the world. In relation to this, the integrated training in the primary care of health workers regarding the main diseases that affect children is an effective strategy.
This article shows the results related to the quality of care for children under 5 years of age, from the training of health workers.

Health care for chronic neurological patients after COVID-19

Covid-19 has hit the world population hard. Its effects continue to arise at the community and individual level. However, recovered patients, who had a relatively long stay in the ICU due to the complications of the disease, present and will present very diverse sequelae: post-traumatic stress, transient cognitive alterations and neurological alterations. This article-commentary shows how the health system should reformulate certain priorities for the care of the neurological sequelae of the pandemic at the individual level.

What Do Parents Expect in the 21st Century? A Qualitative Analysis of Integrated Youth Care

To provide integrated Youth Care responsive to the needs of families with multiple problems across life domains, it is essential to incorporate parental perspectives into clinical practice. The parental perspectives on integrated Youth Care in this study emphasize that parents have a strong desire for a family-centred approach and active participation in decision making over their own care process. However, since parental expectations regarding these key components of integrated Youth Care are somewhat opposing, professionals should be aware of potential confusion and explicitly discuss mutual expectations during a care process. 

Evaluating Large-Scale Integrated Care Projects: The Development of a Protocol for a Mixed Methods Realist Evaluation Study in Belgium

The twelve Integrated Care Program pilot projects (ICPs) created by the government plan ‘Integrated Care for Better Health’ aim to achieve four outcome types (the Quadruple Aim) for people with chronic diseases in Belgium: improved population health, improved patient and provider experiences and improved cost efficiency. The Belgian plan is based on the model of integrated care by the World Health Organization. The objective of this study is to deliver policy recommendations on strategies and best practices to improve care integration in Belgium and to implement a sustainable monitoring system that serves both policy makers and the stakeholders within the ICPs.

Patient experience of an integrated care model in a family practice clinic and Federally Qualified Health Center (FQHC)

Behavioral health issues are daily challenges in all primary care settings. The integration of programs and strategies translates into better global results, which optimizes the effort of health workers. In this study, user satisfaction is evaluated, through validated surveys, in 727 patients from different centers, family practice clinic and a Federally Qualified Health Center.

Integrated care and platform solutions for a better provision of health and care service

This thematic workshop is the opportunity to discuss solutions of integrated care concepts rolled out by ICT-supported primary and secondary care interventions for older people living at home. Focus will be set onto the implementation challenges and the lessons learned from projects throughout EIP on AHA Reference Sites such as the Oberbergischer Kreis, the Portuguese Amadora as well as by the multi-stakeholder open platform concept rolled out in the EU-H2020 SHAPES project.

Identifying barriers in telemedicine-supported integrated care research: scoping reviews and qualitative content analysis

Integrated care is said to improve the way in which care is delivered. To support integrated care by ensuring close collaboration between involved stakeholders, information and communication technologies, especially telemedicine, are needed. Despite their potential, most telemedicine solutions never make it from pilot project stage to full implementation into usual care. Especially in integrated care scenarios, understanding of the barriers hampering successful telemedicine implementation and application is limited.

The influence of leadership facilitation on relational coordination among primary care team members of accountable care organizations.

Teamwork is a central aspect of integrated care delivery and increasingly critical to primary care practices of accountable care organizations. Although the importance of leadership facilitation in implementing organizational change is well documented, less is known about the extent to which strong leadership facilitation can positively influence relational coordination among primary care team members.

Supporting Older People to Live Safely at Home – Findings from Thirteen Case Studies on Integrated Care Across Europe

While many different factors can undermine older people’s ability to live safely at home, safety as an explicit aspect of integrated care for older people living at home is an underexplored topic in research. Integrated care services across Europe address older people’s safety in many ways. Further integration of health and social care solutions is necessary to enhance older people’s perceptions of safety.

Evaluating Large-Scale Integrated Care Projects: The Development of a Protocol for a Mixed Methods Realist Evaluation Study in Belgium

The twelve Integrated Care Program pilot projects (ICPs) created by the government plan 'Integrated Care for Better Health' aim to achieve four outcome types (the Quadruple Aim) for people with chronic diseases in Belgium: improved population health, improved patient and provider experiences and improved cost efficiency. The aim of this article is to present the development of a mixed methods realist evaluation of this large-scale, whole system change programme.

Can Integrated Care Help in Meeting the Challenges Posed on Our Health Care Systems by COVID-19? Some Preliminary Lessons Learned from the European VIGOUR Project

The COVID-19 pandemic puts health and care systems under pressure globally. This current paper highlights challenges arising in the care for older and vulnerable populations in this context and reflects upon possible perspectives for different systems making use of nested integrated care approaches adapted during the work of the EU-funded project VIGOUR (“Evidence based Guidance to Scale-up Integrated Care in Europe”).

Exploring the Team Climate of Health and Social Care Professionals Implementing Integrated Care for Older People in Europe

Team climate describes shared perceptions of organisational policies, practices and procedures. A positive team climate has been linked to better interprofessional collaboration and quality of care. Most studies examine team climate within health or social care organisations. This study uniquely explores the team climate of integrated health and social care teams implementing integrated care initiatives for older people in thirteen sites across seven European countries, and examines the factors which contribute to the development of team climate.

Health Networks in Action: The experiences of Argentina, Brazil, Colombia and Mexico

Dioselina is a 54-year-old divorcée who has no children and lives alone in a large city. She has been unemployed for a year and just started receiving welfare six months ago. As for her health, she has long-term obesity, chronic obstructive pulmonary disease, and diabetes. In recent months, she began to develop foot ulcers because her blood sugar was not being monitored properly, which is attributable in part to difficulty accessing healthcare services and getting medications and lab tests. If she does not receive rapid treatment and more specialized care for the ulcers, they could worsen and require hospitalization.

A growing number of people who seek health care have stories like Dioselina’s. Healthcare systems in Latin America and the Caribbean face significant health challenges affecting all age groups, which cause premature death and take a heavy social and economic toll.

Taking cues from the Declaration of Astana, nations ...

Health workforce planning under conditions of uncertainty: identifying supportive integrated care policies using scenario analysis

Integrated care presents health workforce planners with significant uncertainty. This results from:

• (1) these workforces are likely in the future to be different from the present.
• (2) integrated care's variable definitions.
• (3) workforce policy and planning is not familiar with addressing such challenges.

One means to deal with uncertainty is scenario analysis. In this study shows some aspects of integration-supportive workforce governance and planning policies that were derived from the application of scenario analysis.Through a mixed methods design that applies content analysis, scenario construction and the policy Delphi method, it's analized a set of New Zealand's older persons health sector workforce scenarios. Developed from data gathered from workforce documents and studies, the scenarios were evaluated by a suitably qualified panel, and derived policy statements were assessed for desirability and feasibility.

Integrated ambulatory care in the New Zealand health system: a scoping review

Integrated health systems, according to the World Health Organization (2017) are ''the organization and management of health services so that people get the care they need, when they need it, in ways that are user-friendly, achieve the desired results and provide value for money.'' This is a very important concept in today's day and age, as access to healthcare has become a challenge and the population has never been sicker.

In New Zealand and internationally, emerging trends across health systems include a fundamental shift of care from hospitals to community-based settings and increased integration of services to better link traditional community, primary and secondary/specialist. 

The aim of this review is to identify and describe New Zealand (NZ) and international countries evidence of integrated ambulatory care models and describes key implementation issues and lessons learned.

Understanding Young People and Their Care Providers’ Perceptions and Experiences of Integrated Care Within a Tertiary Paediatric Hospital Setting, Using Interpretive Phenomenological Analysis

Benefits of integrated care include improved health outcomes and more satisfaction with experiences of care for consumers. For children and young people with chronic and complex health conditions, their care may be fragmented due to the multitude of healthcare providers involved. This paper describes the experiences of integrated care in a paediatric tertiary hospital.

Towards an Australian Declaration on Integrated Care: Aligning finances and incentives

One of the keys to successful integrated care programs are financing and incentive arrangements that directly promote integrated care provision. Moreover, that these incentives are collective – in other words, how both financial commitments and gains are shared between care organisations and participating professionals. The ability to align financial incentives is a global issue but especially so in Australia where financial flows are highly fragmented. This webinar seeks to examine the challenges that misaligned finance and incentives bring and the potential solutions. The webinar will conclude with a discussion forum that seeks to establish the key messages that policy makers need to hear if integrated care at a clinical or service level can be better enabled. This webinar forms part of a series helping to support IFIC Australia co-produce an evidence-informed ‘Declaration on Integrated Care’ that provides a clear and compelling case for the policies and actions required to achieve it.

(Dis)Integrated Care? Lessons from East London

This paper examines one of the NHS England Pioneers programmes of Integrated Care, which was implemented in three localities in East London, covering the area served by one of the largest hospital groups in the UK and bringing together commissioners, providers and local authorities. The partners agreed to build a model of integrated care that focused on the whole person.

This qualitative and participatory evaluation looked at how an ambitious vision translated into the delivery of integrated care on the ground. The study explored the micro-mechanisms of integrated care relationships based on the experience of health and social care professionals working in acute and community care settings.

A critical realist evaluation of an integrated care project for vulnerable families in Sydney, Australia

Healthy Homes and Neighbourhoods (HHAN) Integrated Care Initiative was established to improve the care of families with complex health and social needs who reside in Sydney Local Health District. HHAN seeks to provide long-term multi-disciplinary care coordination as well as enhance capacity building and promote integrated care. Findings of this study supported the initial programme theory that engagement and trust building with clients, alongside enhanced collaboration and integration of services, improved outcomes for vulnerable families with complex needs.

Integrated Care Toolkit

Health Education England, Skills for Health, and Skills for Care have produced the Person-Centred Approaches Core Skills and Education Training Framework.

Those interested in integrated care can access any of the following resources mapped for different users.

Integrated Care Toolkit: resources by user groups

Goal-Oriented Care: A Catalyst for Person-Centred System Integration

Person-centred integrated care is often at odds with how current health care systems are structured, resulting in slower than expected uptake of the model worldwide. Adopting goal-oriented care, an approach which uses patient priorities, or goals, to drive what kinds of care are appropriate and how care is delivered, may offer a way to improve implementation.

ValueCare: Cork/Kerry Pilot Site

Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis

To address the challenges of caring for a growing number of older people with a mix of both health problems and functional impairment, programmes in different countries have different approaches to integrating health and social service supports. The goal of this analysis is to identify important lessons for policy makers and service providers to enable better design, implementation and spread of successful integrated care models.

Refining Program Theory for a Place-Based Integrated Care Initiative in Sydney, Australia

A number of families living in our community experience many barriers to accessing health and social care. The problems that these families face are highly complex, often spanning over generations, and cannot be addressed by one agency alone.  The Healthy Homes and Neighbourhoods (HHAN) Integrated Care Initiative attempts to connect services to address these barriers, and ensure families have their complex health and social needs met; keep themselves and their children safe; and keep families connected to society.

This article shows that in addition to serving families in Sydney, HHAN has also established place-based initiatives (PBI) in disadvantaged areas such as Redfern. Redfern PBI shares the HHAN location with housing, drug and alcohol services, and financial and legal services. This integration is intended to facilitate access to services and multi-agency support for vulnerable families in Redfern. Therefore, this study aims to assess for whom, when and why the HHAN GDP ...

Leadership in integrated care networks: A literature review and opportunities for future research

This article reviews research on leadership in integrated care networks. It is timely as scholars and policy makers regard integrated care as a key part in reforming healthcare systems to cope with demographic aging, the rising prevalence of chronic diseases and the growing demand for long-term care.

In many countries, elderly patients with chronic conditions require a web of services delivered by several providers collaborating in inter-organisational networks. In view of their global importance, it is surprising how little we know how these networks are led. Like traditional organisations, networks require leadership to function effectively. This paper reviews central characteristics of leadership in integrated care networks and proposes opportunities for future research.

In this article, 73 studies published in the main academic journals are analyzed. This article consolidates the research on means, practices, activities and results of leadership, covering the levels of analysis of networks, policies and organizations.

Research in Integrated Care: The Need for More Emergent, People-Centred Approaches

The International Foundation for Integrated Care (IFIC) recently celebrated its 20^th International Conference (ICIC20) through a virtual event that brought together patients and carers, academics, care professionals, NGOs, policy-makers and industry partners from across the global integrated care community. The International Journal for Integrated Care (IJIC) used this opportunity to host a workshop on published research in integrated care, specifically to reflect on the quality of existing scientific enquiry. A lively discussion on the current state of integrated care research concluded that there remained significant shortcomings to current methodologies – for example, in their ability to provide the depth of understanding required to support the knowledge needed to best inform policy and practice, particularly when addressing people-centredness. In part, the debate recognized how the nature of existing research funding, and prevailing attitudes and preferences towards certain research methodologies, were partly to blame (as has been noted by IJIC previously). The ...

Towards an Integrated Care Organisation from a CEO Perspective

Many experimental projects towards Person-Centred Care (PCC) are successful in the early stages, but founder when the attempt is made to scale them up to encompass the whole organisation. This case study therefore focusses on one manager’s attempts to extend the successes of a preliminary project ‘Etxean Ondo’ that aimed to provide adequate support for the elderly living at home or in nursing homes, as well as for their families and care professionals. Through in-depth interviews with stakeholders, this qualitative study, based on Grounded Theory, sets out to analyse which behaviours, attitudes and values on the part of management appeared to favour full-integration of PCC in this wider context. Analysis of the data gathered allowed the researcher to generate an experimental case model which suggests how the extrinsic, intrinsic and transcendent motivation of stakeholders can be aligned with the goals of upper management to promote full-integration of PCC in ...

mHealth for Integrated People-Centred Health Services in the Western Pacific: A Systematic Review

The global move towards achieving Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs) requires a fundamental shift towards integrated healthcare systems. This vision of ‘Integrated care’ has been defined as a “coherent set of methods and models on the funding, administrative, organisational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between the cure and care sectors.”

Digital Health includes the use of mobile health (mHealth) applications, social media and health information systems and data. With the Internet of Things (IoT), it improves the data flow and interface between self-care, home-based services, primary care, ambulatory care, outreach services, and hospital-based curative and palliative services

This review analized how mobile health (mHealth) to support integrated people-centred health services has been implemented and evaluated in the World Health Organization (WHO) Western Pacific Region (WPR).

Canadian Quality and Patient Safety Framework for Health Services: Communications Toolkit

The Canadian Patient Safety Institute (CPSI) and Health Standards Organization (HSO), with the dedicated support of hundreds of stakeholders across Canada, recognized the need for a greater commitment to quality and safety improvement. We are pleased to share the Canadian Quality and Patient Safety Framework for Health Services, the first of its kind in Canada. By committing to improving quality and patient safety, we can achieve better health care for all.

Be sure to take full advantage of all the communications tools and resources in this package:

Five Goals to Align Canada on Patient Safety and Quality Improvement

This people-centred framework defines five goal areas designed to drive improvement and to align Canadian legislation, regulations, standards, organizational policies, and public engagement on patient safety and quality improvement.

Goal 1 | People-Centred Care

People using health services are equal partners in planning, developing, and monitoring care to make sure it meets ...

“It’s Difficult, There’s No Formula”: Qualitative Study of Stroke Related Communication Between Primary and Secondary Healthcare Professionals

The proportion of people living with stroke is growing. In England, National Institute for Health and Care Excellence (NICE) Guidelines for stroke recommend that a person with suspected or confirmed stroke event is admitted to a specialist stroke unit, in order to receive required treatment promptly. Stroke rehabilitation follows, which involves providing stroke survivors with support and treatment from a multidisciplinary rehabilitation team. Stroke survivors’ transition from acute settings to rehabilitation can take place either in hospital, at home or the community.

One model of care is Early Supported Discharge (ESD), which offers community-based health and social care as an alternative to inpatient care. NICE recommend that transfers of care from hospital to community should include all pertinent health and social care information, given to relevant health and social care professionals and patients promptly.Long-term care led by generalists in the community is recommended and stroke survivors are encouraged to ...

Patient Privacy and Integrated Care: The Multidisciplinary Health Care Team

This article explores legislative provisions in relation to patient privacy in the context of integrated health and social care and the development of multidisciplinary health care teams that include practitioners from private sector and government agencies in the health, education, child protection, family welfare, disability, aged-care, housing, local government and criminal justice sectors. 

Screening Isn’t Enough: A Call to Integrate Behavioral Health Providers in Women’s Health and Perinatal Care Settings

This paper aims to enhance the current understanding of integrated mental health services in the United States and how they can be better incorporated in perinatal and women’s health specialty care from the perspective of a behavioral health provider. 

Indicators of an Integrated Home Care Model Shaped by the Needs of Patients Discharged from the Emergency Department

Developing community care models aims to satisfy the needs of patients’ in-home care comprehensively. This is crucial to decrease adverse events and prevent rehospitalization.

The growing burden of chronic diseases, patients experiencing fragmented care, and increasing demand for coordination across providers in the health and social sector correlates with the need for the integration of care. The starting point in developing an integrated care strategy should be identifying and assessing population needs.

Models of integrated care may enhance patient satisfaction, increase the perceived quality of care, and enable access to services. The term ‘new models of care’ refers to a wide range of interventions aiming to address issues of integration across healthcare and between health and social care. Improved discharge planning and flow of care, and improved sharing of knowledge between practitioners, are essential components of new models of integrated care. Discharge of the patient from the hospital to the ...

Building a Digital Bridge to Support Patient-Centered Care Transitions From Hospital to Home for Older Adults With Complex Care Needs: Protocol for a Co-Design, Implementation, and Evaluation Study

Older adults with multimorbidity and complex care needs (CCN) are among those most likely to experience frequent care transitions between settings, particularly from hospital to home. Transition periods mark vulnerable moments in care for individuals with CCN. Poor communication and incomplete information transfer between clinicians and organizations involved in the transition from hospital to home can impede access to needed support and resources. Establishing digitally supported communication that enables person-centered care and supported self-management may offer significant advantages as we support older adults with CCN transitioning from hospital to home.

This protocol outlines the plan for the development, implementation, and evaluation of a Digital Bridge co-designed to support person-centered health care transitions for older adults with CCN. The Digital Bridge builds on the foundation of two validated technologies: Care Connector, designed to improve interprofessional communication in hospital, and the electronic Patient-Reported Outcomes (ePRO) tool, designed to support goal-oriented care planning ...

Care Coordination for Vulnerable Families in the Sydney Local Health District: What Works for Whom, under What Circumstances, and Why?

 Healthy Homes and Neighbourhoods (HHAN), an integrated care programme in the Sydney Local Health District (SLHD), seeks to address the needs of disadvantaged families through care coordination, as one of its components. This research aims to determine for whom, when and why the care coordination component of HHAN works, and establish the reported outcomes for clients, service-providers and partner organisations.

Population Health Management in Diabetes Care: Combining Clinical Audit, Risk Stratification, and Multidisciplinary Virtual Clinics in a Community Setting to Improve Diabetes Care in a Geographically Defined Population. An Integrated Diabetes Care Pilot in the North East Locality, Oxfordshire, UK

Disparities in diabetes care are prevalent, with significant inequalities observed in access to, and outcomes of, healthcare. A population health approach offers a solution to improve the quality of care for all with systematic ways of assessing whole population requirements and treating and monitoring sub-groups in need of additional attention.

Collaborative working between primary, secondary and community care was introduced in seven primary care practices in one locality in England, UK, caring for 3560 patients with diabetes and sharing the same community and secondary specialist diabetes care providers. Three elements of the intervention included 1) clinical audit, 2) risk stratification, and 3) the multi-disciplinary virtual clinics in the community.

This paper discusses a project designed to address three specific issues. Firstly, it reflects on the split between primary and specialist diabetes care and the impact this has on the quality of diabetes care in populations. Secondly, it proposes a population ...

Effect of an integrated care model for pre-frail and frail older people living in community

The objective of this article is to evaluate the effect of an integrated care model for pre-frail and frail community-dwelling older people.

Revisiting the future of integrated health services delivery

In this presentation, Dr. Minkman share some thoughts about the future of integrated care and integrated health services, by proposing an overview of main four components that support integrated services delivery. In addition, she presents a recent body of knowledge in this area identifying 18 underlying values of integrated service delivery in different contexts.

Emerging Researchers and Professionals in Integrated Care (ERPIC) to launch a Journal Club

In 2021, Emerging Researchers and Professionals in Integrated Care (ERPIC) is preparing to launch a new networking activity: ERPIC Journal Club! Beginning in February, every 2 months the ERPIC Journal Club will host discussion sessions with the author(s) of foundational academic articles on integrated care. Details will follow.

In March 2021, the second round of the ERPIC Mentorship Program will commence. A call will be advertised for Mentors and Mentees in January.

Book reviews are still open! In collaboration with the International Journal of Integrated Care (IJIC), a list of books on integrated care to be reviewed is available. ERPIC members are invited to choose a book to review (a free copy will be sent to you) and your review will be published in IJIC.

Join ERPIC today!   Link (https://integratedcarefoundation.org/emerging-researchers-professionals-in-integrated-care)

JICA Special Issue: Integrated Palliative and End of Life Care for People with Advanced Dementia or Frailty

This special issue now seems uncannily prescient in view of the devastating impact of COVID-19 on people with advanced dementia or severe frailty, particularly in care homes.

The pandemic has heightened awareness of the possibility of a sudden and rapid transition from relative health to a palliative or end of life stage. This has opened up conversations about the potential burden from intensive treatments that are likely to be futile and the benefits of advance care planning.

The collection of papers in this special issue will be of interest to readers involved in planning, commissioning or delivering palliative and end of life care services for our most vulnerable citizens at this time, whether at home or in a hospital, care home or hospice.

Read the full Guest Editorial and the collection of papers of this special issue

Patient Empowerment: An introduction. Patient Empowerment Mini-Series with CEmPaC

Factors supporting the implementation of integrated care between physical and mental health services: an integrative review

In Australia and internationally there is a strong policy commitment to the redesign of health services toward integrated physical and mental health care. When executed well, integrated care has been demonstrated to improve the access to, clinical outcomes from, and quality of care while reducing overtreatment and duplication. Despite the demonstrated effectiveness and promise of integrated care, exactly how integrated care is best achieved remains less clear. The aim of this review study was to identify factors that support the implementation of integrated care between physical and mental health services. An integrative review was conducted following the framework developed by Whittemore and Knafl, with quantitative and qualitative evidence systematically considered. To identify studies, Medline, PubMed, PsychINFO, CINAHL were searched for the period from 2003 to 2018, and reference lists of included studies and review articles were examined. Nineteen studies were included. Synthesis of study findings identified seven key factors supporting ...

Successful implementation of integrated care in Slovenian primary care

For the purpose of celebrating the 40th anniversary of Alma Ata declaration, the WHO published a successful model of integrated patient care being performed in Slovenia. After two years, the WHO experts evaluated the success in practise during a visit to the Slovenian primary care environment. This report showed that Slovenia was a notable exception regarding developing effective primary care systems. The country has an impressive primary care which performs very well.

Achieving integrated care: the need for digital empowerment

In this article, Knight and Burdett look at the complex challenges involved in integrating care systems as part of the NHS Long-Term Plan of 2019, and the importance of digitalising services and records for implementing this.

Age Friendly, Healthy, Connected Communities. IFIC Scotland Integrated Care Matters: Build Back Better Webinar Series

IFIC's new report, Realising the true value of integrated care describes the steps we must take to create a radically different future beyond Covid-19. The report is a powerful call to reset our compass to a new reality based on solidarity and collaboration for population health. IFIC Scotland and partners will explore this new future in series 5 of their Integrated Care Matters webinars. Guest panelists, members of IFICs international Special Interest Groups, will share their experiences and insights and challenge us to design a better future that improves lives and opportunities for all. 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.

Professor Anne ...

IFIC Scotland Integrated Care Matters: Build Back Better Webinar Series

The new report from the International Foundation for Integrated Care (IFIC), Realising the true value of integrated care describes the steps we must take to create a radically different future beyond Covid-19. The report is a powerful call to reset our compass to a new reality based on solidarity and collaboration for population health. IFIC Scotland and partners will explore this new future in series 5 of their Integrated Care Matters webinars.

Guest panelists, members of IFICs international Special Interest Groups, will share their experiences and insights and challenge us to design a better future that improves lives and opportunities for all. 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.

Elements and Performance Indicators of Integrated Healthcare Programmes on Chronic Diseases in Six Countries in the Asia-Pacific Region: A Scoping Review

Globally, hospital-based healthcare models targeting acute care, are not effective in addressing chronic conditions. Integrated care programmes for chronic diseases have been widely developed and implemented in Europe and North America and to a much lesser extent in the Asia-Pacific region to meet such challenges.

This scoping review aims to examine the elements of programmes identified in the literature from select study countries in the Asia-Pacific, and discuss important facilitators and barriers for design and implementation.

Integrating Primary and Secondary Care to Enhance Chronic Disease Management: A Scoping Review

In Ireland, as in many healthcare systems, health policy has committed to delivering an integrated model of care to address the increasing burden of chronic disease.

Integrated care is an approach to healthcare systems delivery that aims to minimise fragmentation of patient services and improve care continuity. To this end, how best to integrate primary and secondary care is a challenge.

This paper aims to undertake a scoping review of empirical work on the integration of primary and secondary care in relation to chronic disease management.

A Conceptual Framework for Integrated Community Care

The various health and social care services provided in a given local area (i.e., place-based) must not only deliver primary care in proximity to the population, but act upstream on the social determinants of health. This type of care, when provided in a holistic and integrated manner, aims to improve the physical and mental health—but also the well-being and social capital—of individuals, families, groups and communities. This type of approach is known as Integrated Community Care (ICC).

This article was developed from a non-systematic review of scientific and grey literature followed by a qualitative analysis and researcher reflections on ICC. It presents the core concepts of ICC, namely temporality, local area, health care, social care, proximity and integration. These concepts are unpacked and a conceptual diagram is set forth to put the dynamic links between the concepts into perspective.

The purpose of the article is to provide ...

Physician Assistants and Nurse Practitioners in Primary Care Plus: A Systematic Review

Shifting specialist care from the hospital to primary care/community care (also called primary care plus) is proposed as one option to reduce the increasing healthcare costs, improve quality of care and accessibility.

The aim of this systematic review was to get insight in primary care plus provided by physician assistants or nurse practitioners.