UN General Assembly High-Level Meetings on health 2023: Universal Health Coverage

Primary care and the older person with complex needs: reflections on the implementation of a primary–secondary model of integrated care

The demand and complexity of the health needs of older people is growing. Traditionally siloed, condition-centric care is no longer appropriate. It is costly to the Australian health system and life-threatening to the individual. In parallel to demographic change is increasing global awareness of the impact of social, behavioural, and environmental factors on health outcomes. Although significant when not addressed, the amenable nature of many personal contextual factors is an opportunity to improve health and quality of life. A move away from reactive, episodic models of health care delivery towards patient focussed integrated care is required to meet the changing demands of an aging population. This forum article provides a reflection on the current state of integration for older people with complex needs through the lens of a local community facing model: OPEN ARCH. Australia still has some way to go to establishing system level enablers for an integrated approach ...

Person-centred care to prevent hospitalisations – a focus group study addressing the views of healthcare providers

The primary healthcare sector comprises various health services, including disease prevention at local level. Research shows that targeted primary healthcare services can prevent the development of acute complications and ultimately reduce the risk of hospitalisations. While interdisciplinary collaboration has been suggested as a means to improve the quality and responsiveness of personal care needs in preventive services, effective implementation remains a challenge.

Meaningful use of a digital platform and structured telephone support to facilitate remote person-centred care - a mixed-method study on patient perspectives

Process evaluations are useful in clarifying results obtained from randomised controlled trials (RCTs). Traditionally, the degree of intervention usage in process evaluations is monitored by measuring dose or evaluating implementation fidelity. From a person-centred perspective, such evaluations should be supplemented with patients’ experiences of meaningful use, given that intervention use should be agreed upon between interested parties and tailored to each patient. This study aimed to elucidate patients’ experiences of a remote person-centred care (PCC) intervention by deepening the understanding of, if, how and for whom the intervention contributed to meaningful use.

Integrated Care - Defining for the Future through the Eye of the Beholder

The central defining features of integrated care which cuts across all stakeholders (people and communities, individual providers, a system of organisations, and policymakers) are continuity and coordination. Continuity occurs temporally and coordination occurs spatially. For the person at the centre of care, their experience is seamless across formal/informal care, professional, organisational and sectoral boundaries and continuous over time. For providers, they design care to effectively manage transitions from one profession, organisation or sector to another over multiple episodes of care. For policymakers, integrated care requires them to ensure that the wider context supports continuity and coordination and does not work against them.

Lessons in the Design and Initial Implementation of the System on Prevention, Early Identification, Referral, and Intervention for Delays, Disorders, and Disabilities in Early Childhood in the Philippines

Approximately 1 in every 10 children has a disability and in developing countries, fewer than one out of 10 of them go to school (1) (2). Persons with disabilities experience overlapping deprivations that contribute to marginalization, significant discrimination, and ultimately, exclusion in societal participation, perpetrating the vicious cycle of disability and poverty (3) (4).

Early childhood is the time when the impact of disability into adulthood can be maximally mitigated. It is, therefore, crucial for identification to be carried out at the earliest possible instance and appropriate intervention is provided.

In the Philippines, efforts are underway to implement a system on prevention, early identification, referral, and intervention for delays, disorders, and disabilities in early childhood in select subnational areas. This is a project that is being implemented through the national Early Childhood Care and Development Council and the Department of Health with support from UNICEF and Humanity and Inclusion.

Important ...

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.

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 ...

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.

Addressing safety risks in integrated care programs for older people living at home: a scoping review

Many older people live at home, often with complex and chronic health and social care needs. Integrated care programs are increasingly being implemented as a way to better address these needs. To support older people living at home, it is also essential to maintain their safety. Integrated care programs have the potential to address a wide range of risks and problems that could undermine older people’s ability to live independently at home. The aim of this scoping review is to provide insight into how integrated care programs address safety risks faced by older people living at home - an area that is rather underexplored.

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. 

The multispecialty community provider (MCP) emerging care model and contract framework

Across the country, NHS leaders have been developing sustainability and transformation plans (STPs) to implement the NHS Five Year Forward View. Nearly all of the STPs involve creating new models of accountable care provision.  Some are planning MCPs, others the bigger primary and acute care systems (PACS) model, under which all hospital services are also included under a single  form of integrated provision. The underlying logic of an MCP is that by focusing on prevention and redesigning care, it is possible to improve health and wellbeing, achieve better quality, reduce  avoidable hospital admissions and elective activity, and unlock more efficient ways of delivering care.

This document defines what being a multispecialty community provider (MCP) means by assembling features from the 14 MCP vanguards into a common framework.

WHO European High-level Conference on Noncommunicable Diseases “Achieving Sustainable Development Goal targets in the WHO European Region through prevention and management of noncommunicable diseases over the life-course”

The year 2018 witnessed incredible global mobilization for the prevention and management of noncommunicable diseases (NCDs). Member States, WHO and partners expanded their commitments and the scope of their work to achieve ambitious targets. The third United Nations high-level meeting on NCDs and a series of high-level international meetings and conferences on the health system response to NCDs, primary health care, global mental health and air pollution will serve as context and background for the WHO European High-level Conference on Noncommunicable Diseases. The event will take place in Ashgabat, Turkmenistan, on 9–10 April 2019.

Digital Health and Care Congress 2018. Technology and data.

This two-day congress provides an established forum for health and care professionals to come together and learn from successful adoptions and practical implementations of digital health and care. The aim of the event is to share learning and encourage adoption, so your project should be active, showing digital technology in practice under one of the project themes above.

Project themes

Primary Care Home October 2017

The Primary Care Home programme has gathered huge momentum since its inception in autumn 2015. From 15 original rapid test sites– they now have more than 190 sites across England, covering eight million patients– 14 per cent of the population.

Applications continue to come in – all are very welcome to join what has all the hallmarks of a social movement across integrated care. Its success, they believe, is because it is bringing about the change that clinicians know is right for their patients – something they've always wanted to do. Staff now feel empowered and excited, with the freedom to innovate and drive improvements. It is also about the human scale of the change where people feel they belong, own local challenges and can make a real difference working alongside their patients. Many have started with small changes that have led to early benefits and created a compelling case for ...

From vision to action. Making patient-centred care a reality

The NHS have worked with The King´s Fund to translate their themes into outcomes for patients and set out the most important priorities for action to achieve these outcomes. Under each of their five themes: 

- Co-ordinated care

- Patients engaged decisions about their care

- Supported self-management

- Prevention, early diagnosis and intervention

- Emotional, psychological and practical support

they have described the outcomes that they most want to achieve for patients. In order to achieve these outcomes, they hace then selected the service improvements that, if met, will have a major impact on the quality and cost-effectiveness of care. 

The multispecialty community provider (MCP) emerging care model and contract framework

Across the country, NHS leaders have been developing sustainability and transformation plans (STPs) to implement the NHS Five Year Forward View. Nearly all of the STPs involve creating new models of accountable care provision.  Some are planning MCPs, others the bigger primary and acute care systems (PACS) model, under which all hospital services are also included under a single  form of integrated provision. The underlying logic of an MCP is that by focusing on prevention and redesigning care, it is possible to improve health and wellbeing, achieve better quality, reduce  avoidable hospital admissions and elective activity, and unlock more efficient ways of delivering care.

This document defines what being a multispecialty community provider (MCP) means by assembling features from the 14 MCP vanguards into a common framework.

Spreading change: A guide to enabling the spread of person- and community-centred approaches for health and wellbeing

This guide outlines how behavioural science can help spread the take-up of person- and community-centred approaches to health and wellbeing.

Key findings

•     The guide uses the EAST framework to organise ideas and examples. The core message of EAST is that if you want to encourage a behaviour, you should make it Easy, Attractive, Social and Timely.
•     The guide features a number of low-tech, pragmatic and manageable activities which can increase the spread of person- and community-centred health and wellbeing programmes.

This action-focused guide is part of the NHS England-funded Realising the Value programme, which seeks to develop person- and community-centred approaches for health and wellbeing. The programme is doing so by building the evidence base and developing tools, resources and networks to support the spread and impact of these approaches.

It is aimed at people who champion these approaches in health and social care, in other statutory bodies and in ...

Promoting Policy, Systems, and Environment Change to Prevent Chronic Disease: Lessons Learned From the King County Communities Putting Prevention to Work Initiative.

Initiatives that convene community stakeholders to implement policy, systems, environment, and infrastructure (PSEI) change have become a standard approach for promoting community health. To assess the PSEI changes brought about by the King County, Washington, Communities Putting Prevention to Work initiative and describe how initiative structures and processes contributed to making changes.

Behavioural health consultants in integrated primary care teams: a model for future care

Significant challenges exist within primary care services in the United Kingdom (UK). These include meeting current demand, financial pressures, an aging population and an increase in multi-morbidity. Psychological services also struggle to meet waiting time targets and to ensure increased access to psychological therapies. Innovative ways of delivering effective primary care and psychological services are needed to improve health outcomes.

Advocacy: the silence of Europe’s public health associations is deafening

National public health associations (PHAs) have a key role to play in advocating for effective, evidence-based policies (in both the public and private spheres) and practices that have positive impacts on population health and health equity. In some instances, PHAs are the only civil society voice for public health.

From integrated care towards DIY Health - Combining person-centered health care delivery, mobile technology and entrepreneurship

Introduction and objectives:

To achieve the level of impact necessary to reverse current trends of rising incidence and costs of multimorbidity and enabling healthy ageing will require new health care policy and practices. Notwithstanding integrated care receiving worldwide attention in improving healthcare delivery, the value of data driven and mobile technology for integration of health and care services remains unclear. Nevertheless, person-centered and data driven mobile health (mHealth) has the potential to evolve integrated care from business process re-design towards a new digital health ecosystem that is truly centered around a person facing health challenges. The objective of our study was to identify the opportunities and barriers of mHealth to do this.

Highlights:

MHealth applications attack the underlying causes of the multimorbidity and ageing challenge in various ways. First, mHealth lifestyle apps promise to help in the prevention of chronic disease and multimorbidity by attacking high risk conditions such as ...

Counting the cost of child mortality in the World Health Organization African region

Background: Worldwide, a total of 6.282 million deaths occurred among children aged less than 5 years in 2013. About 47.4 % of those were borne by the 47 Member States of the World Health Organization (WHO) African Region. Sadly, even as we approach the end date for the 2015 Millennium Development Goals (MDGs), only eight African countries are on track to achieve the MDG 4 target 4A of reducing under-five mortality by two thirds between 1990 and 2015. The post-2015 Sustainable Development Goal (SDG) 3 target is "by 2030, end preventable deaths of new-borns and children under 5 years of age". There is urgent need for increased advocacy among governments, the private sector and development partners to provide the resources needed to build resilient national health systems to deliver an integrated package of people-centred interventions to end preventable child morbidity and mortality and other structures to address all ...

Local leadership, new approaches: improving the health of local communities

In February 2015, Public Health England and the Local Government Association published a report on how local authorities and the health sector have worked together to improve the health of communities through prevention and early intervention.

An example of this coordination is highlighted in a case study on the new Integrated Wellbeing Service in Blackburn with Darwen. The service has been developed in a joint effort by the borough council and the local GP-led Clinical Commissioning Group (CCG). It combines CCG-funded projects concerning specific long-term conditions (e.g. COPD or stroke), together with public health-funded services (e.g. tobacco cessation, health trainers, community physical activity), as well as core council services to address employment, housing and financial issues. 

As Councillor Mohammed Khan, Chair of Blackburn with Darwen Health and Wellbeing Board, explains: “[L]ocally we have a lot of services that can improve health and wellbeing. But when you put ...