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.

Community-based care for healthy ageing: lessons from Japan

Abstract: Problem The measures for long-term care prevention that the Japanese government had introduced in 2006 were unsuccessful because of the failures to identify high-risk individuals and to enrol enough participants in the community prevention programme. Approach The Japanese government shifted its primary strategy from a high-risk strategy to a community-based population strategy in 2015, by reforming the Long-term Care Insurance Act. This act is focusing on community-based care and social determinants of health. The Act and the government's plans for long-term care prevention are inspired by a social participation intervention called ikoino saron, that is gathering salons for people older than 65 years. These salons, managed by local volunteers, are held once or twice a month in communal spaces within walking distance of community members' homes and have a low participation fee. At the gatherings, older people can meet and interact with others through enjoyable, relaxing and sometimes educational programmes. Local setting Japan has the world's largest ageing population, with 27.7% (35.2 million/126.7 million) of people older than 65 years. Relevant changes Studies have shown that participation in the salons was associated with a halved incidence in long-term care needs and about one-third reduction in the risk of dementia onset. Evidence also suggests that financially vulnerable older adults were more likely to participate in such interventions. In 2017, 86.5% (1506/1741) of the Japanese municipalities had implemented the salons. Lessons learnt Integrated care for long-term care prevention should consider interventions targeting the whole community in addition to high-risk individuals.

Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight For the Future?

Abstract: Integrated care has been recognised as a key initiative to resolve the issues surrounding care for older people living with multi-morbidity. Multiple strategies and policies have been implemented to increase coordination of care globally however, evidence of effectiveness remains mixed. The reasons for this are complex and multifactorial, yet many strategies deal with parts of the problem rather than taking a whole systems view with the older person clearly at the centre. This approach of fixing parts of the system may be akin to shuffling the deckchairs on the Titanic, rather than dealing with the fundamental reasons why the ship is sinking. Attempts to make the ship more watertight need to be firmly centred on the older person, pay close attention to implementation and embrace approaches that promote collaborative working between all the stakeholders involved.

Role of a clinical facilitator in introducing an integrated care pathway for the care of the dying.

Abstract: Integrated care pathways (ICPs) have been developed as a tool for improving end-of-life care. The Liverpool Care Pathway for the Dying (LCP) is a multidisciplinary and evidence-based approach to caring for the dying person. At Wythenshawe hospital a clinical facilitator was appointed to facilitate the introduction of the LCP. This full time post, which existed for 18 months, involved supporting and educating staff about the pathway. The LCP is now used throughout the general surgical and medical wards and acute and regional coronary care units. This article reflects on the different aspects of the role and the development of the project.

Integrated oncogeriatric approach: a systematic review of the literature using concept analysis.

Abstract: Objectives The purpose of this study was to provide a more precise definition of an integrated oncogeriatric approach (IOGA) through concept analysis. Data sources The literature was reviewed from January 2005 to April 2011 integrating three broad terms: geriatric oncology, multidisciplinarity and integrated care delivery models. Study eligibility criteria Citation selection was based on: (1) elderly cancer patients as the study population; (2) disease management and (3) case studies, intervention studies, assessments, evaluations and studies. Inclusion and exclusion criteria were refined in the course of the literature search. Interventions Initiatives in geriatric oncology that relate to oncology services, social support services and primary care services for elderly cancer patients. Participants Elderly cancer patients aged 70 years old or more. Study appraisal and synthesis methods Rodgers’ concept analysis method was used for this study. The analysis was carried out according to thematic analysis based on the elements of the Chronic Care Model. Results The search identified 618 citations. After in-depth appraisal of 327 potential citations, 62 articles that met our inclusion criteria were included in the analysis. Three IOGA main attributes were identified, which constitute IOGA9s core aspects: geriatric assessment (GA), comorbidity burden and treatment outcomes. The IOGA concept comprises two broad antecedents: coordinated healthcare delivery and primary supportive care services. Regarding the consequents of an integrated approach in geriatric oncology, the studies reviewed remain inconclusive. Conclusions Our study highlights the pioneering character of the multidimensional IOGA concept, for which the relationship between clinical and organisational attributes, on the one hand, and contextual antecedents, on the other, is not well understood. We have yet to ascertain IOGA9s consequents. Implications of key findings There is clearly a need for a whole-system approach to change that will provide direction for multilevel (clinical, organisational, strategic) interventions to support interdisciplinary practice, education and research.