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.

Pursuing Equity to Combat Fragmentation in the Home Care Sector: A Study of Using Integrated Care Programs to Deliver Health and Social Care to Elderly Persons Living at Home

Abstract: Integrated care programs (ICPs) deliver care that is coordinated across carers, care sites, and support systems; continuous over time and between visits; tailored to clients' expressed needs and preferences; and based on shared responsibility for optimizing health among clients, carers, and the state. This research asks how ICPs combat issues of fragmentation in a home care sector fundamentally reshaped by neoliberalism. Using a post-positivist epistemological approach, I collect and analyze data from government documents, NGO reports, scholarly literature, and 117 interviews with program administrators, paid and unpaid carers, and elderly clients in five Canadian ICPs working in the home care sector. These include Aging in Place in Ottawa, Ontario; SMILE in South Eastern Ontario; Carefirst in Scarborough, Ontario; CHOICE in Edmonton, Alberta; and Hope Home Health in Hope, British Columbia. My central argument is that ICPs are most useful as a policy solution to fragmented home care when they use policy techniques that promote equitable processes and outcomes as opposed to focusing on enhancing cost-efficiencies for the state. To understand the interrelations among fragmentation, efficiency, equality, and equity, I use a Feminist Political Economy theoretical framework to assess the gendered, classed and racialized impacts of the policy techniques used by ICPs. By looking at which groups are affected through their involvement in ICPs, in what ways, and under what conditions, I find that policy techniques aimed at achieving cost savings for the state often increase inequality/inequity between, and among, clients and carers. Increasing inequality/inequity increases fragmentation. In contrast, ICPs that use policy techniques that challenge neoliberal ways of working often promote equality/equity as their primary policy goal. These techniques help mitigate fragmentation. Understanding if, how and why ICPs meet the expressed needs of clients and carers in different contexts is essential for program administrators looking to improve their programs, as well as for the clients and carers involved in the daily relations of home care. Knowing that ICPs are most useful as a policy solution to fragmented home care when they promote equitable processes and outcomes gives a clear direction for future reforms that can benefit clients and carers alike.

Integrated care for pregnant women on methadone maintenance treatment Canadian primary care cohort study

Abstract: Objective To describe the characteristics of a national cohort of pregnant women on methadone maintenance treatment (MMT) and to provide treatment outcome data for integrated care programs. Design Retrospective chart review. Setting Three different integrated care programs in geographically distinct cities: the Toronto Centre for Substance Use in Pregnancy in Toronto, Ont; the Herzl Family Practice Centre in Montreal, Que; and the Sheway clinic in Vancouver, BC. Participants Pregnant women meeting criteria for opioid dependence and attending an integrated care program between 1997 and 2009. Women were excluded if they were on MMT only for chronic pain. Main outcome measures Patient demographic characteristics, concurrent medical and psychiatric disorders, and substance use outcome data. Results A total of 102 opioid-dependent pregnancies were included. The mean age was 29.7 years and 64% of women were white. Women in Montreal were more likely to have partners and had fewer children. Differences in living and housing situations among the sites tended to resolve by the time of delivery. Almost half of this cohort tested positive for hepatitis C. Women had a high prevalence of depression and anxiety across all sites. Half of this cohort was on MMT before conception and for the other half, MMT was initiated at a mean gestational age of 20.7 weeks, resulting in a mean dose of 82.4 mg at delivery. At the first visit, polysubstance use was common. Prescription opioid use was more frequent in Toronto and heroin use was more prevalent in Vancouver and Montreal. For the entire population, significant reductions were found by the time of delivery for illicit ( P P = .001), cocaine ( P P = .009), and alcohol use ( P Conclusion Despite geographic differences, all 3 integrated care programs have been associated with significant decreases in substance use in pregnant opioid-dependent women.

Rehabilitation of Geriatric Patients

Abstract: Objective To describe the role of geriatric rehabilitation, the methods of practice, and the mechanisms underlying integrated care in rehabilitation medicine. Design We reviewed the rehabilitation-related medical literature and outlined an approach to the evaluation of impairment in older patients and subsequent rehabilitation planning. Results For optimal rehabilitation of geriatric patients, knowledge of general principles of rehabilitation and key areas affecting the elderly population is important. A rehabilitation program will be most successful if a team approach—including a physician, rehabilitation nurse, physical therapist, occupational therapist, psychologist, medical social worker, and recreational therapist—is used. Attention should be paid to special considerations in older patients (such as the presence of comorbid conditions) and potential barriers to care in order to maximize benefit. Conclusion Rehabilitation of elderly patients can assist in preserving functional independence and improving the quality of life. Assessment and management in an individual patient ate best performed by a team approach.

Policy Levers to Promote Access to and Utilization of Children's Mental Health Services: A Systematic Review.

Abstract: Policies have potential to help families obtain behavioral healthcare for their children, but little is known about evidence for specific policy approaches. We reviewed evaluations of select policy levers to promote accessibility, affordability, acceptability, availability, or utilization of children’s mental and behavioral health services. Twenty articles met inclusion criteria. Location-based policy levers (school-based services and integrated care models) were associated with higher utilization and acceptability, with mixed evidence on accessibility. Studies of insurance-based levers (mental health parity and public insurance) provided some evidence for affordability outcomes. We found no eligible studies of workforce development or telehealth policy levers, or of availability outcomes.