Integrated care

About: Integrated care is a research topic. Over the lifetime, 7318 publications have been published within this topic receiving 106960 citations. The topic is also known as: Integrated Delivery of Health Care & Delivery of Health Care, Integrated.

Working together to address multiple exclusion homelessness

Abstract: This article draws on preliminary findings from a two-year exploratory study to describe how different agencies and professionals work together to identify and manage the intersections between homelessness and other facets of deep social exclusion. We assess the extent to which current practice is informed by policy frameworks for ‘personalised and integrated care planning’ focusing in particular on the ‘coordinating’ and ‘sign-posting’ role of the housing support worker. We conclude with some initial thoughts as to how policy and practice might be strengthened in this area to ensure more ‘joined-up’ and continuous support for people with experience of multiple exclusion homelessness.

Impact of Bridging Income Generation with Group Integrated Care (BIGPIC) on Hypertension and Diabetes in Rural Western Kenya.

Abstract: Rural settings in Sub-Saharan Africa (SSA) consistently report low participation in non-communicable disease (NCD) treatment programs and poor outcomes. The objective of this study is to assess the impact of the implementation of a patient-centered rural NCD care delivery model called Bridging Income Generation through grouP Integrated Care (BIGPIC). The study prospectively tracked participation and health outcomes for participants in a screening event and compared linkage frequencies to a historical comparison group. Rural Kenyan participants attending a voluntary NCD screening event were included within the BIGPIC model of care. The BIGPIC model utilizes a contextualized care delivery model designed to address the unique barriers faced in rural settings. This model emphasizes the following steps: (1) find patients in the community, (2) link to peer/microfinance groups, (3) integrate education, (4) treat in the community, (5) enhance economic sustainability and (6) generate demand for care through incentives. The primary outcome is the linkage frequency, which measures the percentage of patients who return for care after screening positive for either hypertension and/or diabetes. Secondary measures include retention frequencies defined as the percentage of patients remaining engaged in care throughout the 9-month follow-up period and changes in systolic (SBP) and diastolic blood pressure (DBP) and blood sugar over 12 months. Of the 879 individuals who were screened, 14.2 % were confirmed to have hypertension, while only 1.4 % were confirmed to have diabetes. The implementation of a comprehensive microfinance-linked, community-based, group care model resulted in 72.4 % of screen-positive participants returning for subsequent care, of which 70.3 % remained in care through the 12 months of the evaluation period. Patients remaining in care demonstrated a statistically significant mean decline of 21 mmHg in SBP [95 % CI (13.9 to 28.4), P < 0.01] and 5 mmHg drop in DBP [95 % CI (1.4 to 7.6), P < 0.01]. The implementation of a contextualized care delivery model built around the unique needs of rural SSA participants led to statistically significant improvements in linkage to care and blood pressure reduction.

ARIA guideline 2019: treatment of allergic rhinitis in the German health system.

Abstract: Background The number of patients affected by allergies is increasing worldwide. The resulting allergic diseases are leading to significant costs for health care and social systems. Integrated care pathways are needed to enable comprehensive care within the national health systems. The ARIA (Allergic Rhinitis and its Impact on Asthma) initiative develops internationally applicable guidelines for allergic respiratory diseases. Methods ARIA serves to improve the care of patients with allergies and chronic respiratory diseases. In collaboration with other international initiatives, national associations and patient organizations in the field of allergies and respiratory diseases, real-life integrated care pathways have been developed for a digitally assisted, integrative, individualized treatment of allergic rhinitis (AR) with comorbid asthma. In the present work, these integrated care pathways have been adapted to the German situation and health system. Results The present ICP (integrated care pathway) guideline covers key areas of the care of AR patients with and without asthma. It includes the views of patients and other healthcare providers. Discussion A comprehensive ICP guideline can reflect real-life care better than traditional guideline models.

Therapeutic alliance and treatment outcome in the primary care behavioral health model

Abstract: The current study investigated therapeutic alliance and clinical improvement within an integrated primary care behavioral health model. Participants included 542 primary care patients seen in two large family medicine clinics. Mental health symptoms and functioning were assessed using the 20-item Behavioral Health Measure (Kopta & Lowery, 2002) at the beginning of each patient appointment. Therapeutic alliance was measured with the Therapeutic Bond Scale (CelestHealth Solutions, 2008) following an initial appointment with one of 22 behavioral health consultants (BHCs). Primary care patients rated their therapeutic alliance following a first appointment with a BHC as statistically stronger than alliance ratings from a previously reported sample of outpatient psychotherapy patients after the second, third, and fourth psychotherapy sessions (Kopta, Saunders, Lutz, Kadison, & Hirsch, 2009). Results of a bootstrapped linear regression analysis indicated that therapeutic alliance assessed after the first primary care behavioral health appointment was not associated with eventual clinical change in mental health symptoms and functioning. A strong therapeutic alliance was able to be formed in a primary care behavioral health modality. This exceeded the magnitude found in outpatient psychotherapy alliance ratings. Early therapeutic alliance was unrelated to overall clinical improvement in primary care.

Family Integrated Care: changing the culture in the neonatal unit

Abstract: Family Integrated Care (FIC) is a new model of neonatal care which supports parents to be primary caregivers, as partners with the clinical team.1 The inspiration for FIC comes from lower resource settings where families provide care through necessity rather than choice.2 3 This approach has been adapted for modern neonatal intensive care by pioneering FIC teams in Canada, Scandinavia and the UK. Trials in preterm infants have demonstrated improved rate of weight gain, reduced parental stress and shorter length of stay.4 5 By supporting and combining the benefits of breast feeding, kangaroo mother care (KMC) and parental presence, FIC may have even greater long-term benefits for infants and their families.6 FIC builds on the foundations of Family-Centred Care, a well-established approach with accepted standards supported by Unicef and the neonatal charity Bliss.7 8 FIC takes parental involvement to a new level placing families at the centre of care and empowering them as primary caregivers (table 1). View this table: Table 1 Comparison of FCC and FIC at RHC, Glasgow Though the concept of FIC is intuitive and the potential benefits compelling, delivering this model of care may be challenging. We took on this challenge in our neonatal unit, the largest unit in Scotland with approximately 1000 admissions per year and over 200 staff. Our patients include extremely preterm infants as well as those requiring specialist medical and surgical care including extracorporeal membrane oxygenation (ECMO). Implementing FIC in a unit of this size and diversity has its own specific challenges, but has been hugely rewarding. In this article, we share our approach and lessons learnt, and describe the transformative effect on families and staff. FIC means not just physically involving families, but equally importantly changing the culture and relationships with staff.9 10 Staff engagement is potentially the greatest challenge. FIC requires a …