Integrated health service delivery networks: concepts, policy options and a road map for implementation in the Americas

Health systems in the Americas are characterized by highly fragmented health services. Experience to date demonstrates that excessive fragmentation leads to difficulties in access to services, delivery of services of poor technical quality, irrational and inefficient use of available resources, unnecessary increases in production costs, and low user satisfaction with services received. (...) The region is home to several good practices in the creation of Integrated Health Service Delivery Networks (IHSDNs), especially in countries like Brazil, Canada, Chile, Costa Rica and Cuba, which have traditionally supported the development of networks. Other countries in Latin America and the Caribbean are adopting similar policies to organize their health services. Despite these efforts, addressing fragmentation and providing more equitable, comprehensive, integrated, and continuous health services remain significant challenges for the majority of countries in the Americas.

Resolution CD49. R22. Integrated health service delivery networks based on primary health care.

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Integrated health systems and cost: accountability and price control are also important.

Integrated Health Services are frequently thought as a tool to decrease healthcare-related costs, specially in systems with a high level of fragmentation. In the US healthcare system reform, Medicare has often been used as a reference point of the overall health expenditure. In this post, this hypothesis is analysed according to a recent article from the National Bureau of Economic Research ("The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured") where the authors review the costs of 306 Hospital Referral Regions in the US, showing a big discordance between Medicare costs and overall costs.

In the analysis of Josh Freeman it is said that the dominant position of some integrated health services in some regions is used to perform very efficient healthcare provission in the Medicare level but also to increase the rates to private insurers.

Framework on integrated, people-centred health services

This Framework proposes five interdependent strategies for health services to become more integrated and people-centred. It calls for reforms to reorient health services, putting individuals, families, carers and communities at their centre, supported by responsive services that better meet their needs and respect their preferences, and that are coordinated both within and beyond the health sector, irrespective of country setting or development status. These reforms also incorporate a human rights approach, enshrining access to health care as a basic right, without distinction of ethnicity, religion, gender, age, disability, political belief, and economic or social condition.

This document builds on the interim WHO Strategy on people-centred and integrated health services, published by the WHO in March 2015. It  incorporates the comments and suggestions gathered through a broad stakeholder consultation process: a web based-public consultation open to individuals and organizations (closed October 2015) and regional and Member State consultations (ongoing). The Framework ...

Unintended costs of health care integration.

Decreasing -or, at least, containing- costs is one of the most important values usually attributed to health services integration. In this post published in the Harvard Medical School website, cost containing is questioned according to a paper published in JAMA Internal Medicine, where researchers describe how anual outpatient spending has grown in some integrated areas by 3.1 percentage point even when changes in use of outpatient care were minimal.

In this text, the author hypothesizes that integration between physicians and hospitals turn their position with insurers stronger, specially for prices of outpatient care. Health care integration may, in some situations, promote positions of power in the market, so that could have an influence in price negotiation and healthcare spending.

This unexpected cost increasing should be considered when designing integrated care policies and incentives, in order to avoid unintended spending cost that could threaten the sustainability of integrated health services.

WHO global strategy on people-centred and integrated health services

This interim report, the WHO global strategy on people-centred and integrated health services, presents a compelling case for a people-centred and integrated health services approach, along with a look at the way forward. It is accompanied by the document "People-centred and integrated health services: an overview of the evidence".

Five principles behind the world’s most efficient health systems

Efficiency is said to be one of the main characteristics of sustainable health systems. In this article posted in Nuffield Trust’s Blog some of the key points that drive health systems towards efficiency are described: 1) integrated pharmacy, community and primary care; 2) hospitals as health systems; 3) standardize, simplify through IT, then shift the skill mix; 4) political courage, take social care seriously; 5) a dominant payer deliver a better health, care and value.

In this article, integrated care is mentioned not only as a health care issue, but also as a way of giving social care the importance it has. Israel health system is mentioned as an example of how integrated services could be a way to achieve efficiency in health care services.

Barriers and enablers to integrating maternal and child health services to antenatal care in low and middle income countries

For most women in low and middle income countries (LMIC), antenatal care (ANC) plays a highly important dual role: not only does ANC provide effective interventions to reduce the risks associated with pregnancy and childbirth, it can also serve as a delivery platform for other health services. Particularly in settings where the prevalence of HIV/AIDS, sexually transmitted infections (STIs), tuberculosis (TB) and malaria is high, integrating services for these conditions with ANC can significantly expand their reach. In fact, the World Health Organization (WHO) identified integration of ANC with other health programmes as a key strategy for reducing missed opportunities for patient contact and improving maternal and child health (MCH). Evidence from the countries studied, however, suggests that in practice integrated delivery of ANC with other health services is not systematic or adequate and that opportunities for providing care for women are lost.

Several factors enable or hinder the ...

4th International Conference on Evidence-based Policy in Long-term Care

The 4th International Conference on Evidence-based Policy in Long-term Care will be held from 4th to 7th of September 2016 at the London School of Economics and Political Science, London. Building on the success of the three previous editions, the conference will focus on empirical research with direct relevance to long-term care policy offering an opportunity to debate with international experts policy issues related to the organisation, delivery, funding and regulation of long-term care services.

Some of the main thematic areas to be covered include: care models; case management; economics of long-term care; equity and efficiency; funding systems; health and social care integration; housing and care; institutional dynamics and politics; international comparative analysis; local vs. central policy interactions; personalisation of the care system; policy implications of dementia; service commissioning and regulation; technology and long-term care; unpaid carers; workforce and migrant workers. Abstracts on other relevant LTC policy evaluation topics will ...

The MDG To SDG Transition: the role of hospitals and integrated primary care.

In 2016, the world will be moving from the Millenium Development Goals (MDG) to the Sustainable Development Goals (SDG). Regarding health-related goals, most of the funding in recent years has been focusing on disease-specific programmes and strengthening primary care; nevertheless, public health, health promotion, prevention, and controlling risk factors through a broad range of policy interventions, both within and outside the health sector, must be an important focus in the era of SDGs.

In this post, integrated health services are seen as a main factor to achieve the health-related topics in the SDGs. The author defends not only strong primary care services to deliver broad quality care, but also that these services should be integrated with essential hospital services. The article emphasizes that this kind of integration would be even more important in countries with a weak health system, in order to build a strong system that could face the ...

Age UK’s Personalised Integrated Care Programme: where are we now?

Age UK launched its personalised integrated care programme in 2012 in Cornwall. In this post, published in its blog, some data about its evaluation are shown and discussed.

The main objectives of this programme are to improve health and wellbeing of older people by tailoring services to meet their needs, improve the experience and quality of care received, and to reduce unplanned hospital admissions amongst older people with multiple long-term conditions.

The evaluation showed a 31% reduction in all hospital admissions, a 26% reduction in emergency ones, and a 20% improvement in older people’s health and wellbeing. In addition, one fifth of aged people participating in the programme became volunteers in order to be able to improve other people’s health and wellbeing.

In 2015, this programme expanded to nine more places across the United Kingdom, a substantial challenge because, as it is said in the post, the needs ...

Integrated care – taking specialist medical care beyond the hospital walls

The Royal College of Physicians has published in 2016 a document titled “Integrated care -  taking specialist medical care beyond the hospital walls”.

In the first part of this document they are described some of the main topics about integrated care, how it is conceptualize and what it really implies for patients, professionals and for the whole system.

Afterwards, some study cases are shown as examples to go deeper into different dimensions of integrated care such as the need for sustainable models of integrated care, leadership, management and governance or self-management and care.

Finally, the document lists five key areas where physicians should focus in order to improve integrated care: (I) Ensure that the patient’s and carer’s perspective is the organising principle of service delivery across organisations, (II) Support population health and wellbeing outside the hospital walls, while offering specialist care within the hospital and being an advocate for ...

Experiencing Integrated Health: Ontarians’ views of health care coordination and communication

Health Quality Ontario (HQO) has published an analysis using data from the 2014 Commonwealth Fund International Health Policy Survey of Older Adults in order to identify, from a patient perspective, how well different parts of health system are working together.

The HQO extracted a sample with the population from Ontario; Ontarians reported similar results as top-ranking countries in some indicators related to coordination of care; about 80% of Ontarians said they received help from their regular physicians to coordinate their care with other providers.

The sample from Ontario population made able to identify some key points where Canadian Health System can improve in order to get better communication and coordination of care.

Ten actions required to improve health, social care and well-being in Wales

Health and social care organizations from Wales joined in the Welsh NHS Confederation’s 2016 Challenge Policy Forum and the published  a document called “Ten actions required to improve health, social care and well-being in Wales", trying to establish their priorities in order to get a better system.

The ten priorities described are: long term vision, ensuring financing, planning workforce, person centred and integrated care, public health perspective, improve preventive measurements, creating a culture of honest and open communication with population, improving mental health support, ensuring equal access to health and social care and improving the use of technology.

Learning about patients’ experiences of care in their own homes

Patient’s experiences are a main factor in order to design how health care services should work. Many different ways of measuring these experiences have been developed; in this post hosted by the King’s Fund Blog, Jo Maybin explains how they have used face-to-face interviews in patient’s home, what difficulties they have found and what they have been able to investigate thanks to this kind of methodology.

As it is said in the post, patient’s own homes interviews enabled the interviewers to get in contact with external carers, to analyze their point of view in relation to health care coordination and integration, and to identify what aspects should be improved in order to increase patient’s satisfaction with the care provided.

On the other hand, this post lists some of the difficulties found when doing face-to-face interviews, specially in what concerns to the amount of resources or ...

New primary care model yielding early results

Several ways of shaping primary care are being developed all around the world. Improving the role of nurses or giving general practitioners new competences are just a couple of ways of moving primary care towards a more comprehensive way of working.

In this post in the NHS Confederation Blog, some of the initiatives performed to change primary care are explained and some of the challenges that future primary care will face are listed.

One of the main points outstanded is the need of integrating care and workforce from different levels of health care. As it is said in this post “Patients will benefit from easy access to a single integrated, multidisciplinary team drawn from a wide range of health and social care professionals”

Transforming integrated health service delivery in the WHO European Region

"Everything starts with people. Without people there is no health system." This sentiment was echoed in keynote presentations, illustrative country cases and expert interventions throughout the 2-day final consultation of the European Framework for Action on Integrated Health Services Delivery in discussions of entry points and processes for integrated health service delivery that took place in Copenhagen, Denmark on 2-3 May 2016. The event marked the final step in the development of the Framework for Action, which is centred around four key domains: people, services, system and change. The European Framework for Action resulting from this consultation will be presented at the 66th session of the WHO Regional Committee for Europe in September 2016. It will represent a significant milestone in strengthening people-centred health systems in the European Region, as set out in Health 2020.

Strengthening a competent health workforce for the provision of coordinated/ integrated health services

The paper proposes a list of competencies to be consolidated by the health workforce in order to realize coordinated/integrated health services delivery. To this end, the paper proposes a cycle for the process of competencies consolidation, identifying strategies required at the services delivery level and possible tools for implementation as well as describing the enabling conditions at the health system level and providing an overview of roles and responsibilities of key stakeholders involved.

Integrating Addiction Services into General Medicine

Importance:
National epidemiologic information from recently collected data on the new DSM-5 classification of alcohol use disorder (AUD) using a reliable, valid, and uniform data source is needed.

Objective:
To present nationally representative findings on the prevalence, correlates, psychiatric comorbidity, associated disability, and treatment of DSM-5 AUD diagnoses overall and according to severity level (mild, moderate, or severe).

Design, Setting, and Participants:
We conducted face-to-face interviews with a representative US noninstitutionalized civilian adult (≥18 years) sample (N = 36?309) as the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III). Data were collected from April 2012 through June 2013 and analyzed in October 2014.

Main Outcomes and Measures:
Twelve-month and lifetime prevalences of AUD.

Results:
Twelve-month and lifetime prevalences of AUD were 13.9% and 29.1%, respectively. Prevalence was generally highest for men (17.6% and 36.0%, respectively), white (14.0% and 32.6%, respectively) and ...

Director-General’s Opening address to the 69th World Health Assembly

Dr. Margaret Chan’s opening address for the 69th World Health Assembly holding from the 23rd to the 28th of May 2016, in Geneva, called for celebration of the stunning health achievements to date, but warned that health challenges have grown far more numerous and complex.

The speech spanned across the various areas of focus of the WHO. As such, the global strategy on people-centred and integrated health services also featured:

“[…] Innovations help, but ambitious goals are feasible and affordable only if we cut out waste and inefficiency.

We do so through integrated, people-centred care that spans the life course, from pre-conception through ageing, and brings prevention to the fore. The target for universal health coverage moves us in that direction.

UHC is the target that underpins all others. It is the ultimate expression of fairness that leaves no one behind. It also has the best chance of meetings people ...

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

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

Ending Preventable Child Deaths with Integrated Community Case Management: Stronger Pharmaceutical Systems for Healthier Communities

Many child deaths in developing countries are preventable: Children die from treatable conditions, such as pneumonia, diarrhea, and malaria, because families in rural, hard-to-reach, or conflict-ridden areas can’t access or afford the treatments. The Sustainable Development Goals (SDGs), launched in September 2015, set ambitious targets of ending preventable child deaths by 2030 and reducing mortality among children under age five to at least 25 per 1,000 live births. Integrated community case management (iCCM) has been recognized as a key strategy for increasing access to essential treatments and meeting the objectives for children under five laid out in the SDGs. Integrated community case management entails training volunteer community health workers to serve as the first point of contact for medical treatment in remote areas, enabling them to recognize and treat common childhood illnesses. To be effective, community health workers must operate within a broader pharmaceutical system in which the ...

#IntegratedCare4People - help us spread the word

Help us spread the word about the Framework on integrated people-centred health services and its web platform by using the hashtag #IntegratedCare4People on your social media accounts.

Suggested hashtags:

Main hashtag: #IntegratedCare4People

Additional hashtags to link to related health conversations: #UHC, #SDGs, #integratedcare, #HealthForAll, #globalhealth, #primaryhealthcare, #healthsystems

Suggested messages:

#IntegratedCare4People is central to #UCH and reaching the #SDGs

What if #health was organized around people's needs rather than diseases? #IntegratedCare4People

Placing people at the heart of #healthservices and #health systems with #IntegratedCare4People

Suggested visuals are available under the URL below.

Can hospital services work in primary care settings?

In this post, the author analyzes how recent changes in primary care in the National Health Services could face the purpose of moving some services from hospital to primary care settings.

The author bases her discussion on a report published by RAND corporation (“Outpatient Services and Primary Care”) that identifies five main areas to be considered when moving services from hospital to primary care:

1. Transfer: The substitution of services delivered by specialists for services delivered by primary care clinicians.
2. Relocation: Shifting the venue of specialist care from hospitals to primary care settings.
3. Liaison: Joint working between specialists and primary care clinicians to provide care to individual patients.
4. Professional behaviour change: Changing the way GPs refer patients to specialists.
5. Patient behaviour change: Helping patients make informed decisions about their care.

There is not a unique way of moving these services; many studies suggest that patients’ satisfaction usually grows when services are ...

Supporting integration through new roles and working across boundaries

In 2015, The King’s Fund was commissioned by NHS Employers and the Local Government Association to produce an independent report on boundary-spanning roles to support integrated care. The work aimed to identify examples of new roles being developed and an understanding of the evidence to support these roles, including impact, features of success and key challenges.

The key findings of the report are: 

• Where new roles have emerged, they have mainly done so due to developments in practice or to fill gaps in provision.
• There is a lack of evidence on the cost-effectiveness of new roles and the extent to which they improve patient outcomes.
• There are a number of ways in which integrated care is being delivered without the explicit need for new boundary-spanning roles.
• Engaging staff from the outset and building on the existing skills of the workforce can overcome cultural barriers between professionals and organisations to ...

Development, implementation and evaluation of a nurse led integrated, person-centred care with long term conditions

This proposal outlines a conceptual plan for innovative, integrated care designed for people living with long term condicions. This conceptual plan delivers a partnership between the health system, the person with long-term conditions (chornic), their family, and the community. The partnership aims to support people at home with access to effective treatment, consistent with the New Zealand Government Health Strategy. This concept of people-owned care is provided by nurses with advance practice skills, who co-ordinate care across services, locations and multiple long-term conditions. 

Exploring Integration of Care for Children Living with Complex Care Needs Across the European Union and European Economic Area

The United Nations Convention on the Rights of the Child (to which all european Union (EU) and European Economic Area (EEA) Member States are signatories) defines the highest attainable standard of healthcare as a fundamental right of every child. This study is embedded in the various peculiarities of national healthcare systems and the ethical and legal concerns bound to the sharing of child health data, being his aim to report on the development of surveys to explore integration of care for children living with complex needs across the European Union (EU) and European Economic Area (EEA)

Challenges and achievements in integrated care: different health and social care providers working together. Successful projects that show that this is the way

The Catalan health system is a public healthcare system, funded by taxes, with universal coverage and public healthcare services portfolio. There´s a mixed healthcare providers network. Delivery of integrated health and social care witha a shift to a patient-centered model is one of the main challenges of our public system. this artcile share three experiences of different models developed to improve integration of social and healthcare services, to guarantee the continuum of care and to achieve quality health and social care outcomes. 

Health and social care in aging population: an integrated care institution for the elderly in Greece

The purpose of this article was to describe the nature of the services actually offered to the elderly in Greece by an institution of integrated care, as opposed to those that should be offered according to the relevant law, and to investigate the factors influencian the supply of those services. 

How to assess and prepare health systems in low- and middle-income countries for integration of services—a systematic review

Despite growing support for integration of frontline services, a lack of information about the pre-conditions necessary to integrate such services hampers the ability of policy makers and implementers to assess how feasible or worthwhile integration may be, especially in low- and middle- income countries (LMICs). This article adopted a modified systematic review with aspects of realist review, including quantitative and qualitative studies that incorporated assessment of health system preparedness for capacity to implement integrated services. 

Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England

NHS England has recently changed the name of accountable care systems to integrated care systems, which describes more accurately the work being done in the 10 areas of England operating in this way. These updated long read looks at work under way in these systems and at NHS England´s proposals for an accountable care organization contract

Strategies to integrate community-based traditional and complementary healthcare systems into mainstream HIV prevention programs in resource-limited settings

Global spending for HIV prevention has been decreasing over the years. As a result, several low-income countries, including Nepal, are increasingly facing the challenge to minimize the funding gap to continue providing HIV prevention services to the people. This paper attempted to clarify why it is important to integrate community-based traditional and complementary healthcare systems and mobilize them into the mainstream HIV programs to ensure access to HIV prevention messages, HIV testing, and treatment in resource-limited settings.

A year of integrated care systems: Reviewing the journey so far

Where once the primary purpose of the health and care system was to provide
episodic treatment for acute illness, it now needs to deliver joined-up and proactive support for growing numbers of older people and people living with long-term conditions and complex needs.
In March 2017, NHS England set out an ambition to ‘use the next several years to make the biggest national move to integrated care of any major western country’. This aim is now being pursued through the development of sustainability and transformation partnerships (STPs) – local ‘place?based’ partnerships of NHS and local authority organisations. The most advanced local partnerships have been asked to develop ‘integrated care systems’ (ICSs). These systems will take more control of funding and services across local areas.
The purpose of this qualitative study was to understand how ICSs are being
developed in different parts of the country and to identify lessons for local ...

From protocolized to person-centered chronic care in general practice: study protocol of an action-based research project (COPILOT)

The management of people with multiple chronic diseases challenges health care systems designed around single disease. Patients with multimorbidity often receive highly fragmented care that may lead to inefficient, ineffective and potentially harmful treatments and neglect of essential health needs. A more comprehensive, person-centered approach is advocated for persons with multiple morbidities. However, examples on how to provide more person-centered care and evidence of its impact are scarce.
The aim of this study was to develop a proactive person-centered care approach for persons with (multiple) chronic diseases in general practice, and to explore the impact on ‘Quadruple aims’: experiences of patients and professionals, patient outcomes and costs of resources use.

Evaluation of integrated care services in Catalonia: population-based and service-based real-life deployment protocols.

Comprehensive assessment of integrated care deployment constitutes a major challenge to ensure quality, sustainability and transferability of both healthcare policies and services in the transition toward a coordinated service delivery scenario. To this end, the manuscript articulates four different protocols aiming at assessing large-scale implementation of integrated care, which are being developed within the umbrella of the regional project Nextcare (2016-2019), undertaken to foster innovation in technologically-supported services for chronic multimorbid patients in Catalonia (ES) (7.5 M inhabitants). Whereas one of the assessment protocols is designed to evaluate population-based deployment of care coordination at regional level during the period 2011-2017, the other three are service-based protocols addressing: i) Home hospitalization; ii) Prehabilitation for major surgery; and, iii) Community-based interventions for frail elderly chronic patients. All three services have demonstrated efficacy and potential for health value generation.

Release of USAID ASSIST publications on promoting IPCHS in Mali and South Africa

The Integrated Health Services (formerly Service Delivery and Safety) department has collaborated with the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project to contribute to the development of integrated and people-centred health services (IPCHS) in different contexts and settings, including South Africa and Mali.

In Mali, work to improve the adoption of people-centred approaches in clinical consultations by health providers during pregnancy and delivery has been undertaken in collaboration with the Ministry of Health. In South Africa, collaboration has focused on HIV, and specifically, on how to promote patient-centredness in HIV services.

Reports describing both collaborations have been recently released.

Access the South Africa report here >>

Access the Mali report here >>

End-line Assessment of Integrated People-Centered Health Services in Nelson Mandela Metro Municipality, Eastern Cape Province, South Africa

Since 2013, the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project has been working closely with the South African Department of Health (DOH) and its partners in five provinces to accelerate the reduction of morbidity and mortality through improving access, utilization, and satisfaction with essential HIV services. Drawing on its partnership with the World Health Organization (WHO) Service Delivery and Safety Department to promote people-centered care as an essential pillar of health service quality, ASSIST secured support from the USAID Office of Health Systems to pilot WHO’s global framework on integrated people-centered health services (IPCHS) in the Nelson Mandela Metropolitan District in Eastern Cape Province.

The pilot project consisted of a baseline assessment to harvest patient, provider, and decision maker perceptions and satisfaction regarding integration and patient centeredness in HIV services at onset of the project; training in quality improvement and IPCHS concepts and methodology; facility-based identification ...

Exploring improvement plans of fourteen European integrated care sites for older people with complex needs

Integrated care programmes are increasingly being put in place to provide care to older people living at home. However, knowledge about further improving integrated care is limited. In fourteen integrated care sites in Europe, plans to improve existing ways of working were designed, implemented and evaluated to enlarge the understanding of what works and with what outcomes when improving integrated care. This paper provides insight into the existing ways that the sites were working with respect to integrated care, their perceived difficulties and their plans for working towards improvement. 

Survey on what people value in integrated health services in the European region launched

In collaboration with the World Health Organization, Tilburg University and Vilans have launched a European survey researching what values matter to different people in integrated health services. The web-based survey is aimed at a broad variety of stakeholders: users, informal carers, professionals, managers, policymakers and researchers in the European region. The survey is available in English and will take no more than approximately 10-15 minutes to complete. All information recorded is confidential, and names are not being included.

It is of huge importance to include the views of informal carers in the study. So if you are an informal carer, an informal carer representative, a user representative, an advocate, or a professional/researcher in this field, please help them out by completing this survey. Your experiences and perspectives are very important and will be much appreciated.

The survey can be accessed via this link and will run until 31 January ...

Building a Thriving Primary Health Care System: The story of Costa Rica

Situated in Central America, Costa Rica’s 4.9 million citizens have access to one of the most effective primary health care systems in the world. The country’s unique, team-based model of primary care service delivery successfully combines preventive and curative care to provide comprehensive primary health care to nearly all Costa Rican citizens. This case study examines the process by which Costa Rica developed its laudable primary health care system, fully describes the functioning of the system through both clinical and patient perspectives, and elucidates key lessons about primary health care delivery that can be learned from the Costa Rican experience.

Are patients ready for integrated person-centered care? A qualitative study of people with epilepsy in Ireland

The National Clinical Programme for Epilepsy (NCPE) in Ireland aims to deliver a holistic model of integrated person-centered care (PCC) that addresses the full spectrum of biomedical and psychosocial needs of people with epilepsy (PwE). However, like all strategic plans, the model encompasses an inherent set of assumptions about the readiness of the environment to implement and sustain the actions required to realize its goals. In this study, through the lens of PwE, the Irish epilepsy care setting was explored to understand its capacity to adopt a new paradigm of integrated PCC.  

Community health alliances as social enterprises that digitally engage citizens and integrate services: A case study in Southwestern Sydney (protocol)

Community health alliances (CHAs) are a population health approach for addressing the challenges faced by people who are united by a common area of residence, sociocultural characteristic or health need, and are generally characterised by a shared mission, shared resource needs and the task of acquiring/developing necessary organisational knowledge and skills. In South Western Sydney, CHAs are being explored as an innovative approach to support the provision of integrated health services. 

Much of the population live in local government areas with levels of disadvantage higher than the state average, with a predominance of non-communicable and chronic diseases that are typically associated with age-related and behavioural factors which necessitate integrated primary and social care. 

Social enterprises can utilise digital health interventions and citizen engagement strategies to integrate health services. 

This study aims to (a) explore how CHAs in South Western Sydney operate as social enterprises that utilise digital health and ...

Integrated health and care systems in England: can they help prevent disease?

The National Health Service (NHS) in England plans for the entire country to be covered by integrated care systems (ICSs) by April 2021. The aims of these local health and care partnerships are broad and include improving disease prevention and population health while maintaining NHS financial sustainability. Yet, the evidence for more integrated care leading to better disease prevention is weak.

Although nearly all of the 2016 sustainability and transformation partnership (STP) plans included a prevention or population health strategy, the content varied widely, often lacked detail, and had little on population-level interventions affecting the social determinants of health.

The 2019 STP and ICS 5-year strategic plans, and the roll out of ICSs across England by April 2021, provide an opportunity for local health and care services to work together more effectively to prevent disease and improve population health. In light of limited evidence on the relationship between integrated care ...

The long-term impacts of new care models on hospital use: An evaluation of the Integrated Care Transformation Programme in Mid-Nottinghamshire

In this briefing, the Improvement Analytics Unit – a partnership between the Health Foundation and NHS England and NHS Improvement – has found evidence that integrated care programmes have the potential to reduce hospital utilisation and that the best results are delivered when new ways of working start to become embedded.   

It is important that the analysis was?able to?look?at the impact of the programme?over such a long time. Integrated care programmes usually aim to reduce hospital admissions, however previous?evaluations?were not able to demonstrate?whether reductions in hospital use might begin to materialise over a longer period.?This briefing?provides?promising evidence that integrated care programmes have the potential to reduce hospital use over the longer?term, even if there are increases in the short-term.? 

The briefing also underlines the importance of ongoing evaluation when implementing new ways of delivering care. Having a mechanism for robust evaluation ...

IFIC Ireland Webinar: Rehabilitation Care. Making Integrated Care Happen

The International Foundation for Integrated Care (IFIC) Ireland hosts and facilitates a series of webinars titled ‘Making Integrated Care Happen’ which forms one of the key delivery mechanisms enabling knowledge mobilisation across all stakeholders with an interest in developing and implementing integrated care within the healthcare systems on the island of Ireland.

Next session in the 2020 webinar series will focus on rehabilitation care and how various initiatives in Ireland are enhancing the experience of integrated care for patients, informal caregivers and health care professionals.

Edina O’Driscoll, National Clinical Lead – Rehabilitation Medicine, HSE will speak about The Rehab Landscape in Ireland: A journey towards change on the rollout of the National Clinical Programme for Rehabilitation Medicine across Ireland. We will also hear from Fiona Steed, Group Lead Allied Health at UL Hospital Group on the development and evolution of the Intermediate Care Facility at UL Arena initially deployed as ...

Primary care networks explained

The National Health Service (NHS) is the umbrella term for the publicly-funded healthcare systems of the United Kingdom (UK). Since 1948 they have been funded out of general taxation. There are four systems, one for each of the four countries of the UK: The NHS in England, NHS Scotland, NHS Wales and Health and Social Care in Northern Ireland. They were established together in 1948 as one of the major social reforms following the Second World War. The founding principles were that services should be comprehensive, universal and free at the point of delivery a health service based on clinical need, not ability to pay. Each service provides a comprehensive range of health services, free at the point of use for people ordinarily resident in the UK, apart from dental treatment and optical care. In England, NHS patients have to pay prescription charges; some, particularly those receiving state benefits, are ...

The state of integrated care systems 2021/22

An assessment of integrated care systems' progress in 2021/22, based on the views of system leaders across England

Though they have been in operation for several years in many parts of the country, integrated care systems (ICSs) across England are set to become new statutory bodies from July 2022. This will represent a significant shift in how health and care services are planned and delivered – away from the model of fragmentation and competition followed in previous decades (and reinforced through the Health and Social Care Act 2012), and towards one of collaboration between services.

“ICSs are a revolution in the mindset, not just a reorganisation of services.” A system leader

As we look ahead to July, this report seeks to assess the progress made so far. It presents the views of system leaders in autumn 2021, both on where they feel they have progressed well and where improvements are ...

Implementing care for healthy ageing

The WHO concept of Healthy Ageing (ie, the process of developing and maintaining the functional ability that enables well-being in older age) has initiated a global discussion about the need for shifting paradigms to reorient health and social services towards person-centred and coordinated models of care. In particular, the integration of health and social care services is critical to provide the basis for comprehensive information sharing and service delivery to support the evolution of the older person over time. The capability to monitor and respond to an older person’s changing health and social care needs will enable prompt and personalised health and social care plans to be implemented.

Facilitating integration through team-based primary healthcare: A cross-case policy analysis of four Canadian provinces

Team-based care can improve integrated health services by increasing comprehensiveness and continuity of care in primary healthcare (PHC) settings. Collaborative models involving providers from different professions can help to achieve coordinated, high-quality person-centred care.

In Canada, five key components were found that influenced IPHC and integrated health services: patient-centred care; team structures; information systems; financial management; and performance measurement. 

An assertive, practical, and substantive agenda to catalyse meaningful change

The Lancet Global Health Commission on financing primary health care combines a shared vision with practical guidance on how to align health financing with overall reform strategies that place primary care service delivery at the core. The Commission reinforces key messages that WHO has put forward on health financing reforms to enable progress towards universal health coverage. It then extends these by application to primary care as a critical service delivery element for the progressive realisation of UHC.

WHO's guidance on health financing is crystallised into a framework for regular country assessment to inform policy dialogue. The alignment of the Commission with this guidance is clear, as reflected in the table. While the decision to limit the operational definition of primary health care to service delivery platforms was made for the purposes of the Commission, certain key financing issues merit further attention. We point to these towards the end ...