Topic
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.
Papers published on a yearly basis
Papers
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TL;DR: It was found that, although there were few differences between the sites in residents’ use of resources, the differences in service integration between the NHS and care homes did reflect how these institutions approached activities that supported relational working.
Abstract: Background: Care homes are the institutional providers of long-term care for older people. The OPTIMAL
study argued that it is probable that there are key activities within different models of health-care provision
that are important for residents’ health care. Objectives: To understand ‘what works, for whom, why and in what circumstances?’. Study questions
focused on how different mechanisms within the various models of service delivery act as the ‘active
ingredients’ associated with positive health-related outcomes for care home residents. Methods: Using realist methods we focused on five outcomes: (1) medication use and review; (2) use of
out-of-hours services; (3) hospital admissions, including emergency department attendances and length of
hospital stay; (4) resource use; and (5) user satisfaction. Phase 1: interviewed stakeholders and reviewed
the evidence to develop an explanatory theory of what supported good health-care provision for further
testing in phase 2. Phase 2 developed a minimum data set of resident characteristics and tracked their care
for 12 months. We also interviewed residents, family and staff receiving and providing health care to residents.
The 12 study care homes were located on the south coast, the Midlands and the east of England. Health-care
provision to care homes was distinctive in each site. Findings: Phase 1 found that health-care provision to care homes is reactive and inequitable. The realist
review argued that incentives or sanctions, agreed protocols, clinical expertise and structured approaches to
assessment and care planning could support improved health-related outcomes; however, to achieve change NHS professionals and care home staff needed to work together from the outset to identify, co-design and
implement agreed approaches to health care. Phase 2 tested this further and found that, although there
were few differences between the sites in residents’ use of resources, the differences in service integration
between the NHS and care homes did reflect how these institutions approached activities that supported
relational working. Key to this was how much time NHS staff and care home staff had had to learn how to
work together and if the work was seen as legitimate, requiring ongoing investment by commissioners
and engagement from practitioners. Residents appreciated the general practitioner (GP) input and, when
supported by other care home-specific NHS services, GPs reported that it was sustainable and valued work.
Access to dementia expertise, ongoing training and support was essential to ensure that both NHS and care
home staff were equipped to provide appropriate care. Limitations: Findings were constrained by the numbers of residents recruited and retained in phase 2 for
the 12 months of data collection. Conclusions: NHS services work well with care homes when payments and role specification endorse the
importance of this work at an institutional level as well as with individual residents. GP involvement is
important but needs additional support from other services to be sustainable. A focus on strategies that
promote co-design-based approaches between the NHS and care homes has the potential to improve
residents’ access to and experience of health care. Funding: The National Institute for Health Research Health Services and Delivery Research programme.
63 citations
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TL;DR: Substantial evidence indicates that patients with psychiatric and substance use disorders can successfully receive interferon-based antiviral therapies in an integrated or multidisciplinary health-care setting, and several strategies for optimizing outcomes for patients with HCV.
63 citations
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TL;DR: This study identifies the obstacles which hinder the delivery of primary palliative care and its determinants and can help in choosing the (additional) expertise needed in the future and in the realisation of the preferred expertise advancement activities.
Abstract: Introduction: In order to facilitate GPs in their work and increase the possibilities for patients to remain at home, it is important to identify the obstacles which hinder the delivery of primary palliative care. From previous research we learned about some of the problems experienced by GPs. In this survey we aimed to identify the prevalence of such problems in providing palliative care and its determinants.Methods:The prevalence of obstacles and its determinants were identified by a questionnaire to 320 GPs in three regions of the Netherlands. Obstacles were grouped as follows: communication, organisation & co-ordination of care, knowledge & expertise, integrated care, time for relatives. The potential determinants were GP characteristics and expertise development activities.Results:The response rate was 62.3%. GPs experienced considerable obstacles in all aspects of palliative care. The most prevalent were: problems with bureaucratic procedures (83.9%), the time necessary to arrange home care technolo...
63 citations
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TL;DR: The nature of ‘partnership’ is explored and whether it can deliver integrated care and three illustrative examples of health care integration models developed in Scotland are considered.
Abstract: Integrated health care is a key policy aim of Scotland's newly devolved government. ‘Partnership working’ is the mechanism that has been selected to achieve this goal. Three illustrative examples of health care integration models developed in Scotland are considered; system organisation and structure; Local Health Care Co-operatives (LHCCs); and Managed Clinical Networks. Using these examples the paper explores the nature of ‘partnership’ and asks if it can deliver integrated care.
63 citations
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TL;DR: First evaluations, especially of disease management programmes, indicate that the new forms of care improve coordination and outcomes, yet the process of strengthening primary care as a lever for better care coordination has only just begun.
Abstract: Problem statement: Health care delivery in Germany is highly fragmented, resulting in poor vertical and horizontal integration and a system that is focused on curing acute illness or single diseases instead of managing patients with more complex or chronic conditions, or managing the health of determined populations. While it is now widely accepted that a strong primary care system can help improve coordination and responsiveness in health care, primary care has so far not played this role in the German system. Primary care physicians traditionally do not have a gatekeeper function; patients can freely choose and directly access both primary and secondary care providers, making coordination and cooperation within and across sectors difficult. Description of policy development: Since 2000, driven by the political leadership and initiative of the Federal Ministry of Health, the German Bundestag has passed several laws enabling new forms of care aimed to improve care coordination and to strengthen primary care as a key function in the German health care system. These include on the contractual side integrated care contracts, and on the delivery side disease management programmes, medical care centres, gatekeeping and ‘community medicine nurses’. Conclusion and discussion: Recent policy reforms improved framework conditions for new forms of care. There is a clear commitment by the government and the introduction of selective contracting and financial incentives for stronger cooperation constitute major drivers for change. First evaluations, especially of disease management programmes, indicate that the new forms of care improve coordination and outcomes. Yet the process of strengthening primary care as a lever for better care coordination has only just begun. Future reforms need to address other structural barriers for change such as fragmented funding streams, inadequate payment systems, the lack of standardized IT systems and trans-sectoral education and training of providers.
63 citations