scholarly journals A gap analysis between the outline document for the integrated care programme and draft models of care for four chronic diseases in Ireland

2018 ◽  
Vol 18 (s2) ◽  
pp. 347
Author(s):  
Claire Mary Buckley ◽  
Deirdre Mulholland ◽  
Orlaith O'Reilly
Keyword(s):  
Integrated Care ◽  
Chronic Diseases ◽  
Gap Analysis ◽  
Models Of Care ◽  
Care Programme

scholarly journals Implementing integrated care for multi-morbidity: analysis of experiences in 17 European programmes

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
V Struckmann ◽  
W Looman ◽  
E van Ginneken ◽  
R Bal ◽  
R Busse ◽  
...  
Keyword(s):  
Integrated Care ◽  
Data Extraction ◽  
Disruptive Innovation ◽  
Models Of Care ◽  
Macro Level ◽  
Successful Implementation ◽  
Care Programme ◽  
Horizon 2020 ◽  
Incremental Growth ◽  
Innovation Approach

Abstract Background Many countries are experimenting with new models of care provision and numerous integrated care programmes have been established internationally. However, little information is available on how to implement integrated care. The aim is to provide more in-depth insights in the implementation of integrated care for developers and managers of integrated care programmes, policy makers, health insurers, and researchers. Methods 17 integrated care programmes addressing multi-morbidity were selected and studied in 8 European countries as part of the Horizon 2020-funded project SELFIE (Sustainable intEgrated care modeLs for multi-morbidity: delivery, FInancing and performancE). An overarching analysis with data extraction forms of the Thick Descriptions completed for all 17 programmes in combination with previous insights from the literature was applied. Information about the implementation of integrated care was extracted and coded according to the six components of the SELFIE framework: service delivery, leadership & governance, workforce, financing, technologies & medical products, and, information & research and sub-elements of each component at the micro, meso and macro level. Results The results show the interrelatedness of the six SELFIE framework components and that alignment work between them, different elements and levels is important. The meso-level seems to be the driving force of implementation and that a stepwise approach to change by building upon what is already there (e.g. existing collaborative networks) and gradually expand and broaden the scope of the integrated care programmes was supportive. Conclusions Implementation activities should simultaneously focus at the micro, meso and macro-levels at which integration occurs as they strongly influence each other. Alignment of the integrated care programme and the active influence of the macro-level context by creating an enabling environment facilitates successful implementation. Key messages Integrated care should be implemented with an incremental growth model rather than from a disruptive innovation approach. Integrated care should involve bottom-up and top-down implementation at different levels of the programme.

Effect of an integrated care programme on re-hospitalization of patients with chronic obstructive pulmonary disease

Respirology ◽  
2012 ◽  
Vol 17 (4) ◽  
pp. 707-714 ◽  
Author(s):  
GRÉGORY MOULLEC ◽  
KIM L. LAVOIE ◽  
KHALIL RABHI ◽  
MARCEL JULIEN ◽  
HÉLÈNE FAVREAU c ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Integrated Care ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Care Programme ◽  
Obstructive Pulmonary Disease

scholarly journals The Development of an Inclusion Health Integrated Care Programme for Homeless Adults in Dublin, Ireland

2018 ◽  
Vol 18 (s2) ◽  
pp. 184 ◽  
Author(s):  
Clíona Ní Cheallaigh ◽  
Ann-Marie Lawlee ◽  
Jess Sears ◽  
Joanne Dowds
Keyword(s):  
Integrated Care ◽  
Care Programme ◽  
Homeless Adults

scholarly journals An integrated care programme in London: qualitative evaluation

2018 ◽  
Vol 26 (4) ◽  
pp. 296-308 ◽  
Author(s):  
Thomas Round ◽  
Mark Ashworth ◽  
Tessa Crilly ◽  
Ewan Ferlie ◽  
Charles Wolfe
Keyword(s):  
Nursing Home ◽  
Integrated Care ◽  
Hospital Admissions ◽  
Clinical Care ◽  
System Transformation ◽  
Care Programme ◽  
Content Type ◽  
Lessons Learnt ◽  
Health And Social Care ◽  
Shared Ownership

PurposeA well-funded, four-year integrated care programme was implemented in south London. The programme attempted to integrate care across primary, acute, community, mental health and social care. The purpose of this paper is to reduce hospital admissions and nursing home placements. Programme evaluation aimed to identify what worked well and what did not; lessons learnt; the value of integrated care investment.Design/methodology/approachQualitative data were obtained from documentary analysis, stakeholder interviews, focus groups and observational data from programme meetings. Framework analysis was applied to stakeholder interview and focus group data in order to generate themes.FindingsThe integrated care project had not delivered expected radical reductions in hospital or nursing home utilisation. In response, the scheme was reformulated to focus on feasible service integration. Other benefits emerged, particularly system transformation. Nine themes emerged: shared vision/case for change; interventions; leadership; relationships; organisational structures and governance; citizens and patients; evaluation and monitoring; macro level. Each theme was interpreted in terms of “successes”, “challenges” and “lessons learnt”.Research limitations/implicationsEvaluation was hampered by lack of a clear evaluation strategy from programme inception to conclusion, and of the evidence required to corroborate claims of benefit.Practical implicationsKey lessons learnt included: importance of strong clinical leadership, shared ownership and inbuilt evaluation.Originality/valuePrimary care was a key player in the integrated care programme. Initial resistance delayed implementation and related to concerns about vertical integration and scepticism about unrealistic goals. A focus on clinical care and shared ownership contributed to eventual system transformation.

The business of integrated care: implementing new models of care in a fee-for-service setting

2018 ◽  
Vol 26 (1) ◽  
pp. 16-28 ◽  
Author(s):  
Serena Yu ◽  
Kees van Gool ◽  
Karen Edwards ◽  
Sue Kirby ◽  
Karen Gardner ◽  
...  
Keyword(s):  
Data Collection ◽  
Integrated Care ◽  
Models Of Care ◽  
Rural Setting ◽  
Fee For Service ◽  
Content Type ◽  
Practice Level ◽  
South Wales ◽  
Administration Time ◽  
Rural Sites

Purpose The Western New South Wales Integrated Care Strategy (ICS) was rolled out from November 2014 across three rural sites. The purpose of this paper is to assess its impact on general practices, and examine the feasibility of implementing an ICS, within a predominantly fee-for-service delivery model. Design/methodology/approach Mixed methods were used to analyse the implementation of the ICS, including practice-level patient data on changes in service provision. This includes unit-record data on 130 enroled patients across three rural sites, as well as qualitative data collection from providers. Findings There were significant increases in both revenue-generating and non-revenue-generating activities (primarily care coordination activities) associated with implementing the ICS. Each occasion of service involved greater contact time with practice staff other than GPs, as well as greater administration time. There is evidence that ICS activities such as case conferencing and team care planning substitute for traditional GP consultations. Overall, the study found that a significant investment of resources – namely staff time devoted to a range of activities – was required to support the implementation of the ICS. Such an investment was supported both externally and through revenue-generating practice-level activities. Research limitations/implications The data collection and evaluation project is ongoing, with analysis based on the first wave of data from three sites. Practical implications At the practice level, a substantial commitment of resources is required to invest in, and sustain, a new model of integrated care (IC). This commitment can currently be supported both through higher revenue generation at the practice level, and externally by health system stakeholders, but changes in financial settings could impact on financial viability. Originality/value This paper provides evidence on the role of blended payment mechanisms in facilitating the implementation of IC in a rural setting where there are medical workforce constraints.

Healthcare staff perceptions of integrated care in a programme for complex chronic patients admitted to hospital because of heart failure (ProMIC)

2019 ◽  
Vol 22 (2) ◽  
pp. 81-89 ◽  
Author(s):  
Cristina Domingo ◽  
Iratxe Regidor ◽  
Edurne Alonso ◽  
Ariadna Besga ◽  
Domingo Orozco ◽  
...  
Keyword(s):  
Heart Failure ◽  
Integrated Care ◽  
Large Scale ◽  
Care Needs ◽  
Chronic Patients ◽  
Care Programme ◽  
Patients With Heart Failure ◽  
Care Approach ◽  
Study Participants ◽  
Complex Care Needs

Introduction Patients with heart failure are usually a frail population characterised by complex care needs. To ensure an integrated care approach, it is necessary to work collaboratively across organisational boundaries. The purpose of this study is to measure and understand the perception of collaboration between clinicians participating in a comprehensive care programme for patients with heart failure, known as PROMIC. Methods A sequential mixed-method study design was used. A sample of PROMIC clinicians completed a survey in which they evaluated 10 dimensions of collaboration in 2010 and in 2014. The perspectives of clinicians were studied more in depth in a focus group in 2012, which was analysed using content analysis. Outcomes: Professionals’ perception of collaboration showed an improvement by 1.18 points (53%) over the period 2010–14. The comprehensive programme proved to be of major support to the professionals. Sometimes, the study participants did not feel prepared to manage cases due to the complexity of the situations with regard to patients’ care. Both, the quantitative and the qualitative methods, showed up a congruent information about the positive perception of participants of the programme itself and the collaboration. Discussion The complexity of care processes and the need for continuity of care mean that large-scale collaboration is necessary between care levels as well as major interdisciplinary teamwork, to achieve the best possible outcomes in terms of health. ProMIC intervention has helped to improve professionals’ perception in terms of collaboration between levels.

Assessing the impact of food insecurity on HIV medication adherence in the context of an integrated care programme for people living with HIV in Vancouver, Canada

2019 ◽  
Vol 23 (4) ◽  
pp. 683-690 ◽  
Author(s):  
Katrina Koehn ◽  
Taylor McLinden ◽  
Alexandra B Collins ◽  
Patrick McDougall ◽  
Rosalind Baltzer-Turje ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Integrated Care ◽  
Household Food Security ◽  
People Living With Hiv ◽  
Care Programme ◽  
Health Related ◽  
Living With Hiv ◽  
The Impact ◽  
The Relationship

AbstractObjective:Food insecurity, or self-reports of inadequate food access due to limited financial resources, remains prevalent among people living with HIV (PLHIV). We examined the impact of food insecurity on combination antiretroviral therapy (cART) adherence within an integrated care programme that provides services to PLHIV, including two meals per day.Design:Adjusted OR (aOR) were estimated by generalized estimating equations, quantifying the relationship between food insecurity (exposure) and cART adherence (outcome) with multivariable logistic regression.Setting:We drew on survey data collected between February 2014 and March 2016 from the Dr. Peter Centre Study based in Vancouver, Canada.Participants:The study included 116 PLHIV at baseline, with ninety-nine participants completing a 12-month follow-up interview. The median (quartile 1–quartile 3) age was 46 (39–52) years at baseline and 87 % (n 101) were biologically male at birth.Results:At baseline, 74 % (n 86) of participants were food insecure (≥2 affirmative responses on Health Canada’s Household Food Security Survey Module) and 67 % (n 78) were adherent to cART ≥95 % of the time. In the adjusted regression analysis, food insecurity was associated with suboptimal cART adherence (aOR = 0·47, 95 % CI 0·24, 0·93).Conclusions:While food provision may reduce some health-related harms, there remains a relationship between this prevalent experience and suboptimal cART adherence in this integrated care programme. Future studies that elucidate strategies to mitigate food insecurity and its effects on cART adherence among PLHIV in this setting and in other similar environments are necessary.

Integrated care in the management of chronic diseases: an Italian perspective

2016 ◽  
Vol 36 ◽  
pp. e9-e10 ◽  
Author(s):  
Ilario Stefani ◽  
Francesca Scolari ◽  
Davide Croce ◽  
Antonino Mazzone
Keyword(s):  
Integrated Care ◽  
Chronic Diseases
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