scholarly journals Using a new matrix to describe real-life integrated care innovation for older persons in primary care

2018 ◽  
Vol 18 (s2) ◽  
pp. 334
Author(s):  
Antonius J Poot ◽  
Claudia S De Waard ◽  
Annet W Wind ◽  
Monique AA Caljouw ◽  
Jacobijn Gussekloo
Keyword(s):  
Primary Care ◽  
Integrated Care ◽  
Older Persons ◽  
Real Life ◽  
Care Innovation

scholarly journals 211 A Novel Integrated Care Approach: Supporting Older Persons to Remain at Home

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Sarah Tormey ◽  
Laura Binions ◽  
Aoife Dunne ◽  
Josephine Soh ◽  
Marie O'Connor ◽  
...  
Keyword(s):  
Primary Care ◽  
Integrated Care ◽  
Older Persons ◽  
Care Team ◽  
Resource Utilisation ◽  
Day Hospital ◽  
Clinical Frailty Scale ◽  
Integrated Network ◽  
Rapid Access ◽  
Co Morbidity

Abstract Background An Integrated Care Team (ICT) was established within our Day Hospital in September 2018 serving a catchment of older persons encompassing 3 Community Healthcare Organisations. The geographical spread of our patients poses challenges to the ICT in establishing an integrated network of services for patients. Provided here is a descriptive analysis of our patient cohort including basic demographics, co-morbidities, interventions and outcomes. Methods The team comprises of a Senior Physiotherapist, Occupational Therapist and Medical Social Worker supported by two Geriatricians. Referrals to the ICT are via the Day Hospital with a weekly multi-disciplinary team (MDT) meeting where they are discussed and prioritised. Interventions offered include domiciliary and day hospital based assessments. Following assessment appropriate targeted therapeutic intervention is provided which includes rapid access to enabling equipment, access to community supports and rapid access Geriatrician review. Additionally the ICT communicate with the acute and primary care services to identify existing or previous resource utilisation. Results In the inaugural 15 weeks of the service,132 referrals were received. This cohort had a mean age of 81,range (60-102) years; 58% female, 42%male. The Charlson Co-morbidity Index (CCI) score ranged from 2-9 with a mean score of 5. Of these, 50% had a Dementia diagnosis, 33% had a Falls history and 17% had a Stroke diagnosis. The mean Rockwood Clinical Frailty Scale score was 5; range ( 2-7). 62% of referrals were reviewed by both Physiotherapy and Occupational therapy, 58% by Medical Social Work. 34/132 required input from all 3 disciplines. Conclusion The ICT service has augmented the existing Day Hospital with timely multi-disciplinary assessment and treatment enabling older persons’ independence within their home in addition to forward planning if dependency levels increase. Additional benefits include reduction of primary care team waiting lists and forging links with our community and local rehab services. Future ambitions include recruitment of specialist nursing and direct referral pathways from our community colleagues.

Implementation of an integrated care model between general practitioner and cardiologist

2019 ◽  
Vol 27 (4) ◽  
pp. 305-315 ◽  
Author(s):  
Marijke Paula Margaretha Vester ◽  
Greetje Johanna de Grooth ◽  
Tobias Nicolaas Bonten ◽  
Bas Leendert van der Hoeven ◽  
Marieke Susanne de Doelder ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Integrated Care ◽  
Healthcare Delivery ◽  
Real Life ◽  
Cost Savings ◽  
Care Model ◽  
Potential Cost ◽  
Content Type ◽  
Program Costs

Purpose Integrated care models have shown to deliver efficient healthcare, but implementation has proven to be difficult. The Support Consultation is an integrated care model, which enables full integration by bundled payment, insurer involvement, predefined care pathways and strengthening of primary care. The purpose of this paper is to provide an indication of the improvements in healthcare delivery after implementation of this proposed model and to create a base for extension to similar interfaces between primary and secondary care. Design/methodology/approach A retrospective study was used to compare the effect on the number of referred patients with non-acute cardiac complaints and the cost effectiveness before and after implementation of the Support Consultation. Patients who previously would have been referred to the cardiologist were now discussed between general practitioner and cardiologist in a primary care setting. Findings The first consecutive 100 patients (age 55±16 years, male 48 percent), discussed in the Support Consultation, were analyzed. Implementation of the Support Consultation resulted in a net costs (program costs and referral costs) reduction of 61 percent compared with usual care. All involved parties were positive about the program. Research limitations/implications The Support Consultation has the ability to provide more effective healthcare delivery and to reduce net costs. The setting of the current study can be used as example for other specialties in countries with a similar healthcare system. Originality/value This study provides the potential cost savings after implementation of an integrated care model, based on real-life data.

scholarly journals OPEN ARCH: integrated care at the primary–secondary interface for the community-dwelling older person with complex needs

2020 ◽  
Vol 26 (2) ◽  
pp. 104
Author(s):  
Jennifer Mann ◽  
Rachel Quigley ◽  
Desley Harvey ◽  
Megan Tait ◽  
Gillian Williams ◽  
...  
Keyword(s):  
Primary Care ◽  
Integrated Care ◽  
Older Persons ◽  
Healthcare Delivery ◽  
Community Dwelling ◽  
Ageing Population ◽  
Preventative Care ◽  
Older Person ◽  
Complex Needs ◽  
Open Arch

Optimal care of community-dwelling older Australians with complex needs is a national imperative. Suboptimal care that is reactive, episodic and fragmented, is costly to the health system, can be life threatening to the older person and produces unsustainable carer demands. Health outcomes would be improved if services (health and social) are aligned towards community-based, comprehensive and preventative care. Integrated care is person-focussed in outlook and defies a condition-centric approach to healthcare delivery. Integration is a means to support primary care, with the volume and complexity of patient needs arising from an ageing population. Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) is a targeted model of care that improves access to specialist assessment and comprehensive care for older persons at risk of functional decline, hospitalisation or institutionalised care. OPEN ARCH was developed with primary care as the central integrating function and is built on four values of quality care: preventative health care provided closer to home; alignment of specialist and generalist care; care coordination and enablement; and primary care capacity building. Through vertical integration at the primary–secondary interface, OPEN ARCH cannot only improve the quality of care for clients, but improves the capacity of primary care to meet the needs of this population.

FRI0512 INTEGRATED CARE NETWORK AS A BUILDING STONE FOR SUSTAINABLE AND COMPREHENSIVE CARE FOR PATIENTS WITH ARTHRALGIA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 855.1-855
Author(s):  
E. Van Delft ◽  
K. H. Han ◽  
J. Hazes ◽  
D. Lopes Barreto ◽  
A. Weel
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Integrated Care ◽  
Usual Care Group ◽  
Inflammatory Arthritis ◽  
Care Setting ◽  
Primary Care Setting ◽  
Care Group ◽  
Care Network ◽  
The Right

Background:Western countries experience an increasing demand for care, particularly for inflammatory arthritis (IA), while the healthcare budget decreases1. The innovative value-based primary care strategy2includes integrated care networks, where primary and secondary care bundle their expertise to improve patient value by providing the right care at the right place.General practitioners (GPs) have difficulties recognising IA, leading up to only 20% IA diagnoses of all newly referred arthralgia patients. However, since IA needs to be treated as early as possible to overcome progression, it is worthwhile to analyse whether integrated care networks have an impact on patient outcomes and cost-effectiveness. Triage by a rheumatologist in a primary care setting is one of the most promising integrated care networks for efficient referrals3.Objectives:To assess the effect of triage by a rheumatologist in a primary care setting in patients suspect for inflammatory arthritis.Methods:The present study follows a cluster randomized controlled trial design. The intervention, triage by a rheumatologist in a local primary care centre, will be compared to usual care. Usual care means that patients are referred to a rheumatology outpatient clinic based on the opinion of the general practitioner.The primary outcome is the frequency of IA diagnoses assessed by a rheumatologist. Patient reported outcome measures (PROMs (EQ-5D)) and costs (work productivity (iPCQ) and healthcare utilization (iMCQ)) were determined at baseline, after three, six and twelve months. The target was to include 267 patients for each study group (power level 0.8). Since this study is still ongoing we can only show first results on the efficiency of referrals.Results:In the period between February 2017 and December 2019 a total of 543 participants were included; 275 in the usual care group and 268 in the triage group. Mean age (51.3 ± 14.6 years) and percentage of men (23.6%) were comparable between groups (page=0.139; psex=0.330).The preliminary data show that the number of referred patients in the triage group is n=28 (10.5%) (Fig. 1). 32 patients (11.9%) were not referred directly but advice was given for additional diagnostics. Since all patients in the usual care group were referred there is a decrease of at least 77.6% in referrals when rheumatologists are participating in the integrated practice units.Preliminary data on diagnosis are available for all referred patients in the triage group and for n=137 (49.8%) in the usual care group at this point. In the triage group n=18 (64.2%) of referred patients were diagnosed with IA (6.7% of the total study population). In the usual care group this was n=52 (38.0%) of the patients yet diagnosed.Conclusion:These preliminary results of an integrated care network are promising. Approximately three-quarters of all patients can be withheld from expensive outpatient care. PROMs data and cost-effectiveness analysis will give clear answers in order to provide evidence whether this integrated care network can be implemented as a standard of care.References:[1] Rijksoverheid. (2018). Bestuurlijk akkoord medisch-specialistische zorg 2019 t/m 2022.https://www.rijksoverheid.nl/.[2] Porter ME, Pabo EA, Lee TH. (2013). Redesigning Primary Care: a strategic vision to improve value by organizing around patients’ needs. Health affairs, 32(3);516-525[3] Akbari A, et al. (2008). Interventions to improve outpatient referrals from primary care to secondary care. Cochrane Database Syst Rev, 4,CD005471.Disclosure of Interests:None declared

scholarly journals Cross-sectional study evaluating the association between integrated care and health-related quality of life (HRQOL) in Dutch primary care

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e040781
Author(s):  
Pim P Valentijn ◽  
Marcel Kerkhoven ◽  
Jantien Heideman ◽  
Rosa Arends
Keyword(s):  
Primary Care ◽  
Integrated Care ◽  
Primary Care Practice ◽  
Anxiety And Depression ◽  
Care Practice ◽  
Cross Sectional ◽  
Practice Population ◽  
Related Quality ◽  
Health Related

ObjectivesThe aim of this study was to evaluate the association between integrated care and health-related quality of life (HRQOL) in a primary care practice population.DesignA cross-sectional survey study.SettingPrimary care practice population.ParticipantsA sample (n=5562) of patients in two general practitioner practices in the Netherlands.Primary outcome measuresThe Rainbow Model of Integrated Care Measurement Tool patient version and EQ-5D was used to assess integrated service delivery and HRQOL. The association between integrated care and HRQOL groups was analysed using multivariate logistic regression.ResultsOverall, 933 respondents with a mean age of 62 participated (20% response rate) in this study. The multivariate analysis revealed that positive organisational coordination experiences were linked to better HRQOL (OR=1.87, 95% CI 1.18 to 2.95), and less anxiety and depression problems (OR=0.36, 95% CI 0.20 to 0.63). Unemployment was associated with a poor HRQOL (OR=0.15, 95% CI 0.08 to 0.28). Ageing was associated with more mobility (OR=1.06, 95% CI 1.04 to 1.09), self-care (OR=1.06, 95% CI 1.02 to 1.11), usual activity (OR=1.03, 95% CI 1.01 to 1.05) and pain problems (OR=1.02, 95% CI 1.01 to 1.04). Being married improved the overall HRQOL (OR=1.60, 95% CI 1.13 to 2.26) and decreased anxiety and depression (OR=0.47, 95% CI 0.31 to 0.72). Finally, females had a poor overall HRQOL (OR=1.67, 95% CI 0.48 to 0.93) and more pain and discomfort problems (OR=1.47, 95% CI 1.11 to 1.95).ConclusionThis study shows for the first time that organisational coordination activities are positively associated with HROQL of adult patients in a primary care context, adding to the evidence of an association between integrated care and HRQOL. Also, unemployment, ageing and being female are accumulating risk factors that should be considered when designing integrated primary care programmes. Further research is needed to explore how various integration types relate to HRQOL for people in local communities.

scholarly journals Reducing unscheduled hospital care for adults with diabetes following a hypoglycaemic event: which community-based interventions are most effective? A systematic review

2021 ◽  
Author(s):  
Aoife Watson ◽  
Donna McConnell ◽  
Vivien Coates
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Integrated Care ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Community Based Interventions ◽  
Community Based ◽  
Integrated Care Pathways ◽  
Effective Community ◽  
Balance Of Care

Abstract Aim To determine which community-based interventions are most effective at reducing unscheduled hospital care for hypoglycaemic events in adults with diabetes. Methods Medline Ovid, CINAHL Plus and ProQuest Health and Medical Collection were searched using both key search terms and medical subject heading terms (MeSH) to identify potentially relevant studies. Eligible studies were those that involved a community-based intervention to reduce unscheduled admissions in adults with diabetes. Papers were initially screened by the primary researcher and then a secondary reviewer. Relevant data were then extracted from papers that met the inclusion criteria. Results The search produced 2226 results, with 1360 duplicates. Of the remaining 866 papers, 198 were deemed appropriate based on titles, 90 were excluded following abstract review. A total of 108 full papers were screened with 19 full papers included in the review. The sample size of the 19 papers ranged from n = 25 to n = 104,000. The average ages within the studies ranged from 41 to 74 years with females comprising 57% of the participants. The following community-based interventions were identified that explored reducing unscheduled hospital care in people with diabetes; telemedicine, education, integrated care pathways, enhanced primary care and care management teams. Conclusions This systematic review shows that a range of community-based interventions, requiring different levels of infrastructure, are effective in reducing unscheduled hospital care for hypoglycaemia in people with diabetes. Investment in effective community-based interventions such as integrated care and patient education must be a priority to shift the balance of care from secondary to primary care, thereby reducing hospital admissions.

scholarly journals Identifying priorities for primary care investment in Ireland through a population-based analysis of avoidable hospital admissions for ambulatory care sensitive conditions (ACSC)

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e028744 ◽  
Author(s):  
Geraldine McDarby ◽  
Breda Smyth
Keyword(s):  
Primary Care ◽  
Ambulatory Care ◽  
Integrated Care ◽  
Hospital Admissions ◽  
Acute Hospital ◽  
Ambulatory Care Sensitive Conditions ◽  
Hospital System ◽  
Bed Days ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

BackgroundIn 2016, the Irish acute hospital system operated well above internationally recommended occupancy targets. Investment in primary care can prevent hospital admissions of ambulatory care sensitive conditions (ACSCs).ObjectiveTo measure the impact of ACSCs on acute hospital capacity in the Irish public system and identify specific care areas for enhanced primary care provision.DesignNational Hospital In-patient Enquiry System data were used to calculate 2011–2016 standardised bed day rates for selected ACSC conditions. A prioritisation exercise was undertaken to identify the most significant contributors to bed days within our hospital system. Poisson regression was used to determine change over time using incidence rate ratios (IRR).ResultsIn 2016 ACSCs accounted for almost 20% of acute public hospital beds (n=871 328 bed days) with adults over 65 representing 69.1% (n=602 392) of these. Vaccine preventable conditions represented 39.1% of ACSCs. Influenza and pneumonia were responsible for 99.8% of these, increasing by 8.2% (IRR: 1.02; 95% CI 1.02 to 1.03) from 2011 to 2016. Pyelonephritis represented 47.6% of acute ACSC bed days, increasing by 46.5% (IRR: 1.07; 95% CI 1.06 to 1.08) over the 5 years examined.ConclusionsPrioritisation for targeted investment in integrated care programmes is enabled through analysis of ACSC’s in terms of acute hospital bed days. This analysis demonstrates that primary care investment in integrated care programmes for respiratory ACSC’s from prevention to rehabilitation at scale could assist with bed capacity in acute hospitals in Ireland. In adults 65 years and over, including chronic obstructive pulmonary disease patients, the current analysis supports targeting community based pulmonary rehabilitation including pneumococcal and influenza vaccination programmes in order to reduce the burden of infection and hospitalisations. Further exploration of pyelonephritis is necessary in order to ascertain patient profile and appropriateness of admissions.

Impact of a structured older persons health assessment on herpes zoster vaccine uptake in Australian primary care

2021 ◽  
pp. 106946
Author(s):  
Jialing Lin ◽  
Timothy Dobbins ◽  
James G. Wood ◽  
John J. Hall ◽  
Bette Liu
Keyword(s):  
Primary Care ◽  
Herpes Zoster ◽  
Older Persons ◽  
Health Assessment ◽  
Vaccine Uptake ◽  
Zoster Vaccine
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