scholarly journals The patient at the centre: evidence from 17 European integrated care programmes for persons with complex needs

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Thomas Czypionka ◽  
Markus Kraus ◽  
Miriam Reiss ◽  
Erik Baltaxe ◽  
Josep Roca ◽  
...  
Keyword(s):  
Integrated Care ◽  
Care Delivery ◽  
European Countries ◽  
Care Process ◽  
Care Needs ◽  
Thick Description ◽  
Holistic View ◽  
Complex Needs ◽  
Contact Points ◽  
Health And Social Care

Abstract Background As the prevalence of multi-morbidity increases in ageing societies, health and social care systems face the challenge of providing adequate care to persons with complex needs. Approaches that integrate care across sectors and disciplines have been increasingly developed and implemented in European countries in order to tackle this challenge. The aim of the article is to identify success factors and crucial elements in the process of integrated care delivery for persons with complex needs as seen from the practical perspective of the involved stakeholders (patients, professionals, informal caregivers, managers, initiators, payers). Methods Seventeen integrated care programmes for persons with complex needs in 8 European countries were investigated using a qualitative approach, namely thick description, based on semi-structured interviews and document analysis. In total, 233 face-to-face interviews were conducted with stakeholders of the programmes between March and September 2016. Meta-analysis of the individual thick description reports was performed with a focus on the process of care delivery. Results Four categories that emerged from the overarching analysis are discussed in the article: (1) a holistic view of the patient, considering both mental health and the social situation in addition to physical health, (2) continuity of care in the form of single contact points, alignment of services and good relationships between patients and professionals, (3) relationships between professionals built on trust and facilitated by continuous communication, and (4) patient involvement in goal-setting and decision-making, allowing patients to adapt to reorganised service delivery. Conclusions We were able to identify several key aspects for a well-functioning integrated care process for complex patients and how these are put into actual practice. The article sets itself apart from the existing literature by specifically focussing on the growing share of the population with complex care needs and by providing an analysis of actual processes and interpersonal relationships that shape integrated care in practice, incorporating evidence from a variety of programmes in several countries.

scholarly journals Increasing the Focus on Children's Complex and Integrated Care Needs: A Position Paper of the European Academy of Pediatrics

2021 ◽  
Vol 9 ◽  
Author(s):  
Maria Brenner ◽  
Josephine Greene ◽  
Carmel Doyle ◽  
Berthold Koletzko ◽  
Stefano del Torso ◽  
...  
Keyword(s):  
Integrated Care ◽  
Care Delivery ◽  
Complex Care ◽  
Care Needs ◽  
European Academy ◽  
Complex Needs ◽  
Health And Social Care ◽  
Multidisciplinary Working ◽  
Initial Work ◽  
Effective Development

There is wide variation in terminology used to refer to children living with complex needs, across clinical, research and policy settings. It is important to seek to reconcile this variation to support the effective development of programmes of care for this group of children and their families. The European Academy of Pediatrics (EAP) established a multidisciplinary Working Group on Complex Care and the initial work of this group examined how complex care is defined in the literature. A scoping review was conducted which yielded 87 papers with multiple terms found that refer to children living with complex needs. We found that elements of integrated care, an essential component of care delivery to these children, were repeatedly referred to, though it was never specifically incorporated into a term to describe complex care needs. This is essential for practice and policy, to continuously assert the need for integrated care where a complex care need exists. We propose the use of the term Complex and Integrated Care Needs as a suitable term to refer to children with varying levels of complexity who require continuity of care across a variety of health and social care settings.

scholarly journals Defining good health and care from the perspective of persons with multimorbidity: results from a qualitative study of focus groups in eight European countries

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e021072 ◽  
Author(s):  
Fenna R M Leijten ◽  
Maaike Hoedemakers ◽  
Verena Struckmann ◽  
Markus Kraus ◽  
Sudeh Cheraghi-Sohi ◽  
...  
Keyword(s):  
Focus Groups ◽  
Integrated Care ◽  
Group Discussion ◽  
Well Being ◽  
Good Health ◽  
European Countries ◽  
Care Process ◽  
Good Care ◽  
Total N ◽  
Health And Social Care

ObjectivesThe prevalence of multimorbidity is increasing in many Western countries. Persons with multimorbidity often experience a lack of alignment in the care that multiple health and social care organisations provide. As a response, integrated care programmes are appearing. It is a challenge to evaluate these and to choose appropriate outcome measures. Focus groups were held with persons with multimorbidity in eight European countries to better understand what good health and a good care process mean to them and to identify what they find most important in each.MethodsIn 2016, eight focus groups were organised with persons with multimorbidity in: Austria, Croatia, Germany, Hungary, the Netherlands, Norway, Spain and the UK (total n=58). Each focus group followed the same two-part procedure: (1) defining (A) good health and well-being and (B) a good care process, and (2) group discussion on prioritising the most important concepts derived from part one and from a list extracted from the literature. Inductive and deductive analyses were done.ResultsOverall, the participants in all focus groups concentrated more on the care process than on health. Persons with multimorbidity defined good health as being able to conduct and plan normal daily activities, having meaningful social relationships and accepting the current situation. Absence of shame, fear and/or stigma, being able to enjoy life and overall psychological well-being were also important facets of good health. Being approached holistically by care professionals was said to be vital to a good care process. Continuity of care and trusting professionals were also described as important. Across countries, little variation in health definitions were found, but variation in defining a good care process was seen.ConclusionA variety of health outcomes that entail well-being, social and psychological facets and especially experience with care outcomes should be included when evaluating integrated care programmes for persons with multimorbidity.

scholarly journals Sharing a vision. Do participants in integrated care programmes have the same goals and objectives?

2019 ◽  
Vol 33 (3) ◽  
pp. 122-129
Author(s):  
Axel Kaehne
Keyword(s):  
Integrated Care ◽  
Social Care ◽  
Care Delivery ◽  
Shared Vision ◽  
Window Of Opportunity ◽  
Care Providers ◽  
Care Services ◽  
The North ◽  
Health And Social Care ◽  
Goals And Objectives

Integrating health and social care services remains one of the most difficult undertakings in the field of care delivery. One of the key requirements for success in integration programmes is a shared vision amongst care providers. Shared visions may contain views as to what the new services should look like, how it should operate and what it should be able to achieve. The paper reports findings of an evaluation of a service integration programme in the North of England. It confirms that a programme consensus on issues such as aims and objectives and programme logics is seen by participants as a key to success. Yet, the study also found that there is a specific window of opportunity in integration programmes when participating organisations start on relatively high levels of commitment and enthusiasm which tend to tail off relatively quickly. The paper closes with a discussion about the implications of the findings for programme designers and service planners.

scholarly journals Integrated care in mental health: next steps after the NHS Long Term Plan

2019 ◽  
Vol 214 (06) ◽  
pp. 315-317 ◽  
Author(s):  
Derek K. Tracy ◽  
Kara Hanson ◽  
Tom Brown ◽  
Adrian J. B. James ◽  
Holly Paulsen ◽  
...  
Keyword(s):  
Integrated Care ◽  
Royal College ◽  
Ageing Population ◽  
Select Committee ◽  
Complex Needs ◽  
Health And Social Care ◽  
Care Systems ◽  
The Uk

SummaryHealth and social care face growing and conflicting pressures: mounting complex needs of an ageing population, restricted funding and a workforce recruitment and retention crisis. In response, in the UK the NHS Long Term Plan promises increased investment and an emphasis on better ‘integrated’ care. We describe key aspects of integration that need addressing.Declaration of interestD.K.T. and S.S.S. are on the editorial board of the British Journal of Psychiatry and executives of the Academic Faculty at the Royal College of Psychiatrists. A.J.B.J., H.P. and Z.M. have roles at the Royal College of Psychiatrists that include evaluation of integrated care systems. A.J.B.J. is married to Dr Sarah Wollaston, Member of Parliament for Totnes and Chair of the Health Select Committee.

scholarly journals Disabled older people's use of health and social care services and their unmet care needs in six European countries

2013 ◽  
Vol 23 (6) ◽  
pp. 1032-1038 ◽  
Author(s):  
B. Bien ◽  
K. J. McKee ◽  
H. Dohner ◽  
J. Triantafillou ◽  
G. Lamura ◽  
...  
Keyword(s):  
Social Care ◽  
European Countries ◽  
Care Needs ◽  
Care Services ◽  
Health And Social Care

scholarly journals What are the priorities for the future development of integrated care? A scoping review

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Corey Burke ◽  
John Broughan ◽  
Geoff McCombe ◽  
Ronan Fawsitt ◽  
Áine Carroll ◽  
...  
Keyword(s):  
Integrated Care ◽  
Scoping Review ◽  
Care Delivery ◽  
Research Question ◽  
Future Research ◽  
Integration Of Care ◽  
Content Type ◽  
Priority Areas ◽  
Geographical Regions ◽  
Health And Social Care

Purpose“Integrated care” (IC) is an approach to health and social care delivery that aims to prevent problems arising from fragmented care systems. The collective content of the IC literature, whilst valuable, has become extensive and wide-ranging to such a degree that knowing what is most important in IC is a challenge. This study aims to address this issue.Design/methodology/approachA scoping review was conducted using Arksey and O'Malley's framework to determine IC priority areas.FindingsTwenty-one papers relevant to the research question were identified. These included studies from many geographical regions, encompassing several study designs and a range of populations and sample sizes. The findings identified four priority areas that should be considered when designing and implementing IC models: (1) communication, (2) coordination, collaboration and cooperation (CCC), (3) responsibility and accountability and (4) a population approach. Multiple elements were identified within these priorities, all of which are important to ensuring successful and sustained integration of care. These included education, efficiency, patient centredness, safety, trust and time.Originality/valueThe study's findings bring clarity and definition to what has become an increasingly extensive and wide-ranging body of work on the topic of IC. Future research should evaluate the implementation of these priorities in care settings.

scholarly journals Improving Behavioral Health Equity through Cultural Competence Training of Health Care Providers

2019 ◽  
Vol 29 (Supp2) ◽  
pp. 359-364 ◽  
Author(s):  
Brian McGregor ◽  
Allyson Belton ◽  
Tracey L. Henry ◽  
Glenda Wrenn ◽  
Kisha B. Holden
Keyword(s):  
Health Care ◽  
Cultural Competence ◽  
Integrated Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Ethnic Disparities ◽  
The United States ◽  
Care Providers ◽  
Care Needs

 Racial/ethnic disparities have long persisted in the United States despite concerted health system efforts to improve access and quality of care among African Americans and Latinos. Cultural competence in the health care setting has been recognized as an important feature of high-quality health care delivery for decades and will continue to be paramount as the society in which we live becomes increasingly culturally diverse. Unfortunately, there is limited empirical evidence of patient health benefits of a culturally competent health care workforce in integrated care, its feasibility of imple­mentation, and sustainability strategies. This article reviews the status of cultural competence education in health care, the merits of continued commitment to training health care providers in integrated care settings, and policy and practice strategies to ensure emerging health care professionals and those already in the field are prepared to meet the health care needs of racially and ethnically diverse populations. Ethn Dis. 2019;29(Supp 2):359-364. doi:10.18865/ed.29.S2.359

The development of integration in the elderly care sector: a qualitative analysis of national policies and local initiatives in France and Sweden

2017 ◽  
Vol 39 (5) ◽  
pp. 1022-1049 ◽  
Author(s):  
BLANCHE LE BIHAN ◽  
ALIS SOPADZHIYAN
Keyword(s):  
Older People ◽  
Integrated Care ◽  
Central Government ◽  
Local Level ◽  
Elderly Care ◽  
National Level ◽  
Qualitative Approach ◽  
Integration Policy ◽  
Care Needs ◽  
Health And Social Care

ABSTRACTDue to a significant increase in the complexity of the care demands of older people having multiple care needs, the necessity for integrated care is increasingly acknowledged. Proposing a qualitative approach based on a secondary literature analysis and an empirical survey, this paper explores the integration policy of health and social care for older people having complex needs in two European countries – France and Sweden – where various policy measures aiming at developing and delivering integrated care can be identified: at the national level, through the supportive measures of organisational, institutional and/or professional integration from central government, and at the local level, with the implementation of concrete integrative initiatives. Using a comparative qualitative approach, the authors investigate both of these levels, as well as the interplay between them. They show the importance of this double – local and national – approach of the issue of integration and highlight the continuous negotiation process which underlies the integration activities. Local integration initiatives are in fact constantly reshaped by top-down and bottom-up dynamics which appear to be strongly interconnected.

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