Journal of Integrated Care最新文献

{"title":"Are community health agents the link to integrating care? Lesson from Brazil","authors":"Larissa Veríssimo, Helen Rainey, Roberta Lindemann, Anne Hendry","doi":"10.1108/jica-08-2023-0067","DOIUrl":"https://doi.org/10.1108/jica-08-2023-0067","url":null,"abstract":"Purpose This viewpoint piece will highlight the contribution of trained lay community health workers to the integrated workforce in rural, remote and island settings, drawing on experience from a system strengthening project involving community health agents (CHAs) in four municipalities in Litoral Norte, a remote coastal and island region in the state of São Paulo, Brazil.Design/methodology/approach This viewpoint reflects on experiential learning from a unique north–south collaboration that spanned the period of a global pandemic. It adds to the international literature on the value of community health workers in public health and chronic disease management and highlights their potential pivotal role as integrators at point of care.Findings CHAs took forward actions that touched the lives of thousands of vulnerable families with low income and complex needs in communities with high levels of social and health inequalities. They acted as a bridge between patients and families at home, primary healthcare professionals and wider community partners and services. Their valuable insight into the healthcare issues and social challenges experienced by the community informed and supported family centred practice and population health goals. The CHAs rapidly pivoted to became an essential public health workforce during the Covid-19 pandemic.Practical implications As the authors establish integrated care systems and embrace proactive care and population health, the conditions are favourable for introducing a similar role in the UK. For psychological safety and avoidance of burnout people in such new roles will require training, supervision and full integration within community teams.Originality/value This viewpoint reflects experiential learning from a unique north–south collaboration that spanned the period of a global pandemic. It adds to the international literature on the value of community health workers in public health and chronic disease management and highlights their potential pivotal role as integrators at point of care.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"8 10","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139438170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Full Engagement with the NHS in an integrated age: reflections on past endeavours (the Wanless Report) and current challenges (the anti-vaxxer movement)","authors":"Jill Manthorpe, S. Iliffe, Richard Bourne","doi":"10.1108/jica-09-2023-0070","DOIUrl":"https://doi.org/10.1108/jica-09-2023-0070","url":null,"abstract":"PurposeIt is over 20 years since the publication of the Wanless Report, “Securing our Future Health: Taking a Long-Term View”. The Wanless Report argued that the National Health Service (NHS) would survive in its current form only if the population became “fully engaged” with it.Design/methodology/approachIn this discussion paper, the authors explored what “fully engaged” meant to Wanless, what it might mean now (allowing for the impact of the anti-vaxxer movement) and what policymakers could do to enhance public engagement.FindingsAlthough the Wanless Report neatly fitted into other long-term thinking about the NHS, it was unique in that it built economic models to predict the costs and impact of different patterns of NHS performance. Wanless predicted that people’s poor levels of health would put considerable pressure on the NHS. This pressure could swamp efforts to meet healthcare targets and improve health outcomes, despite its sizeable investment of money. Wanless set out three possible scenarios for public engagement with the NHS: solid progress, slow uptake and fully engaged.Practical implicationsThe authors pose questions for policymakers and practitioners. Would a reboot of the Wanless approach be worth the effort for policymakers? If yes, how would it differ from the original? The NHS faces the whole of society; could it be the vehicle for engaging the anti-vaxxer public with the truthfulness of medical science, and will it be this, that is, Wanless' enduring legacy?Originality/valueThe exploration of the Wanless Report is complicated (at least for the time being) by the rise of the anti-vaxxer movement’s resistance to health promotion and mistrust of part of the NHS.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"26 5","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139125885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tackling health inequalities through integrated care in English police custodies: an inclusion perspective and model of care","authors":"Mihai Picior","doi":"10.1108/jica-04-2023-0022","DOIUrl":"https://doi.org/10.1108/jica-04-2023-0022","url":null,"abstract":"PurposeThe purpose of this research is to identify novel ways of tackling health inequalities of underserved populations. It explores the opportunities presented by the changes in health and social care legislation to employ historically underused services, such as police custody healthcare providers, in addressing health inequalities.Design/methodology/approachThis research analyses the policy approaches to tackling health inequalities in the UK in the past 40 years with an emphasis on those experienced by the people detained in English police custodies. It analyses the current model of healthcare in police custody and proposes a novel integrated model of care and joint commissioning opportunities in funding it.FindingsPolicies to tackle health inequalities have largely failed, as they became entrenched. But recent changes in the health and social care legislation in England offer opportunities to address them by employing historically underused healthcare services, such as those operating in police custodies.Research limitations/implicationsThe research does not touch upon ethical considerations related to the patient privacy aspect of integrated care. Interventions by and interactions with police custody healthcare providers would be visible to all professionals with access to the patient’s health record. As with all novel interventions or innovative models of care, the effectiveness of such clinical interventions remains to be established by further research. It opens a new line of research on quality improvement through integration of care and explores understudied aspects of joint commissioning of integrated care.Practical implicationsIt offers health commissioners and public health leaders the opportunity to employ police custody healthcare services in reaching their population health management objectives and meeting their health inequalities objectives at local level. It also gives police and crime commissioners the opportunity to address the health drivers of criminal behaviour that overlap with health inequalities. It offers funding opportunities presented by jointly commissioning services at lower costs to both police and health commissioners alike. It improves the health outcomes of historically underserved populations by facilitating access to health and social care services and facilities.Social implicationsReducing health inequalities and disparities in health outcomes can decrease the costs of the healthcare services over the long term and might contribute to reducing criminality by addressing inequities and some health drivers of criminal behaviour.Originality/valueThe paper explores understudied opportunities offered by the recent changes in health and social care legislation in England and includes underused resources to tackle health inequalities.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":" 46","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138961984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated child mental health care provision in Pakistan: End-user and provider perspectives","authors":"P. Vostanis, Sajida Hassan, Syeda Zeenat Fatima, Michelle O’Reilly","doi":"10.1108/jica-08-2023-0068","DOIUrl":"https://doi.org/10.1108/jica-08-2023-0068","url":null,"abstract":"PurposeChildren in majority world countries (MWC) have high rates of unmet mental health needs, with limited access to specialist resources. Integration of child mental health in existing psychosocial care can improve provision. Through a Train-the-Trainer (ToT) cascade approach, this study aimed to provide a framework for such integration in resource-constrained communities in Karachi, Pakistan and to establish hindering and enabling factors.Design/methodology/approachEight practitioners attended a child mental health ToT program, including training on a five-domain service transformation framework. Trainers co-designed and implemented interventions that integrated child mental health knowledge and skills on each domain. These were attended by 136 end-users (youth, parents, teachers, managers), of whom a sub-sample of 47 stakeholders, as well as the trainers, attended focus groups on their experiences. Data were analysed through a thematic codebook.FindingsEstablished themes reflected common ingredients across all domains/interventions that were deemed important for child mental health care integration. These included child-centric approaches, positive parenting, community mobilization and systemic changes.Originality/valueIntegrated child mental health care informed by the Train-of-Trainer approach can be a useful model for resource-constrained MWC contexts. Integrated interventions should be co-produced with communities.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"39 13","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138593880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health care model for people living in nursing homes based on integrated care","authors":"Mariona Espaulella-Ferrer, Felix Jorge Morel-Corona, Mireia Zarco-Martinez, Alba Marty-Perez, Raquel Sola-Palacios, Maria Eugenia Campollo-Duquela, Maricelis Cruz-Grullon, E. Puigoriol-Juvanteny, Marta Otero-Viñas, J. Espaulella-Panicot","doi":"10.1108/jica-07-2023-0059","DOIUrl":"https://doi.org/10.1108/jica-07-2023-0059","url":null,"abstract":"PurposeOlder people living in nursing homes have complex care needs and frequently need specialists’ advice and support that can be challenging to deliver in a rural setting. The aim of this paper is to describe a model of integrated care in a rural area supported by a nurse case manager.Design/methodology/approachA real-world evidence study of people living in Ribes de Freser nursing home, was conducted between specific timeframes in 2019 and 2022, comparing the casemix and outcomes of a traditional care model with the integrated interdisciplinary model.FindingsThe integrated care model led to a significant reduction in transfers to the emergency department, hospitalisations, outpatient medical visits and a reduction in the number of medicines. In addition, the number of residents receiving end-of-life care at the nursing home showed a substantial increase.Originality/valueThis case study contributes valuable evidence supporting the implementation of an integrated model of nurse case manager support in nursing homes, particularly in the rural contexts, where access to specialist medical staff may be limited. The findings highlight the potential benefits of person-centred integrated care for older adults, addressing their complex needs and improving end-of-life care in nursing home settings.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"29 20","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138604289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A mixed-methods process evaluation of an integrated care system's population health management system to reduce health inequalities in COVID-19 vaccination uptake","authors":"Georgia Watson, Cassie Moore, Fiona Aspinal, Andrew Hutchings, R. Raine, Jessica Sheringham","doi":"10.1108/jica-07-2023-0050","DOIUrl":"https://doi.org/10.1108/jica-07-2023-0050","url":null,"abstract":"PurposeMany countries have a renewed focus on health inequalities since COVID-19. In England, integrated care systems (ICSs), formed in 2022 to promote integration, are required to reduce health inequalities. Integration is supported by population health management (PHM) which links data across health and care organisations to inform service delivery. It is not well-understood how PHM can help ICSs reduce health inequalities. This paper describes development of a programme theory to advance this understanding.Design/methodology/approachThis study was conducted as a mixed-methods process evaluation in a local ICS using PHM. The study used Framework to analyse interviews with health and care professionals about a PHM tool, the COVID-19 vaccination uptake Dashboard. Quantitative data on staff Dashboard usage were analysed descriptively. To develop a wider programme theory, local findings were discussed with national PHM stakeholders.FindingsICS staff used PHM in heterogeneous ways to influence programme delivery and reduce inequalities in vaccine uptake. PHM data was most influential where it highlighted action was needed for “targetable” populations. PHM is more likely to influence decisions on reducing inequalities where data are trusted and valued, data platforms are underpinned by positive inter-organisational relationships and where the health inequality is a shared priority.Originality/valueThe COVID-19 pandemic accelerated a shift toward use of digital health platforms and integrated working across ICSs. This paper used an evaluation of integrated data to reduce inequalities in COVID-19 vaccine delivery to propose a novel programme theory for how integrated data can support ICS staff to tackle health inequalities.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"2 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139217543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rural dermatology outreach service – a new model","authors":"Kirstin Abraham, Huw Thomas, Alyson Bryden","doi":"10.1108/jica-07-2023-0056","DOIUrl":"https://doi.org/10.1108/jica-07-2023-0056","url":null,"abstract":"PurposeThe dermatology service on the islands of Orkney, with a population of approximately 22,500, was taken over by National Health Service (NHS) Tayside in August 2018. This paper aims to provide an overview of the planning and review of a highly efficient and effective dermatology service for a rural island population.Design/methodology/approachThe service includes visiting dermatology consultants, enhanced electronic referral vetting, skin surgery services, a General Practice (GP) with extended role (GPwER) in dermatology, specialist virtual clinics, urgent advice for inpatients at the local district general hospital and remote systemic therapy monitoring. A new phototherapy service has been set up in an island GP practice.FindingsLocal GPs and consultant dermatologists find the enhanced vetting service useable, efficient and educational. Between August 2018 and November 2022, there have been 1,749 referrals. Of these referrals, 60% were seen in clinic or a GPwER surgery, with 40% managed remotely by providing advice back to the referring GP. The number of consultations performed by the GPwER has grown over the past 3 years, and in the last year, it accounted for more than 50% of patient appointments. The waiting time has been significantly reduced using this model.Originality/valueThis remote service uses an integrated approach of teledermatology (TD) whilst offering continual in-person services using local capabilities including a GPwER and island general surgeons. New treatment facilities are provided to the island population. Continual educational feedback to the primary care referrer is provided, and it enhances relationships that greatly aid the high-quality dermatology service provided.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"18 7","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139244921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the COVID-19 pandemic on the provision of physical health interventions to mental health consumers within Sydney Local Health District","authors":"Andrew Simpson, Lisa Parcsi, Andrew McDonald","doi":"10.1108/jica-06-2023-0036","DOIUrl":"https://doi.org/10.1108/jica-06-2023-0036","url":null,"abstract":"Purpose People living with severe mental illness (PLWSMI) experience disproportionately high rates of morbidity and mortality compared with the general population. Sydney Local Health District (SLHD) introduced the Living Well, Living Longer integrated care program in 2013 to address this inequity. This paper reports on the impact of the COVID-19 pandemic on the provision of physical health interventions to community mental health consumers in SLHD. Design/methodology/approach Rates of COVID-19 vaccinations were collated. Routinely collected service data were reviewed for changes in rates of metabolic monitoring, mental health shared care, physical health checks, cardiometabolic health clinic assessments and diet and exercise interventions. Findings 91.9% of consumers received at least two COVID-19 vaccinations and 61.3% received a booster. However, there was a 37.3% reduction in rates of metabolic monitoring, 20.1% reduction in Mental Health Shared Care agreements, 60.6% reduction in physical health checks with general practitioners, 65.4% reduction in cardiometabolic clinic assessments and 19.8% reduction of diet and exercise interventions. Practical implications The impact of the pandemic may lead to an exacerbation of poorly managed comorbid disease and increased premature mortality in people living with severe mental illness. Service providers should consider the local impact of the pandemic on the provision of physical health interventions and ensure steps are taken to address any deficits. Originality/value There is a paucity of published analysis regarding the impact of the pandemic on the provision of physical health interventions to people living with severe mental illness.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":" 63","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135340890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Substituting professional with informal care? A response to “how to handle gerontocracy”","authors":"Barbara Gösenbauer","doi":"10.1108/jica-08-2023-0063","DOIUrl":"https://doi.org/10.1108/jica-08-2023-0063","url":null,"abstract":"Purpose The comment addresses the idea of substituting professional elder care with informal care provided by early retirees to save economic costs. Design/methodology/approach The comment arose from reading “How to handle gerontocracy”, scientific research and critical, analytical thinking. Findings While having early pensioners deliver elderly care has positive implications, substituting professional with informal care must be challenged. First, the “unused reservoir” of early pensioners might be overestimated, as they often already have care responsibilities. Second, the substitution of professional services is already happening due to staff shortages. Third, untrained caregivers might struggle to provide the needed care quality, resulting in worse health outcomes (and higher follow-up costs). Finally, there are concerns of social sustainability: because of role expectations, mainly women may take on care tasks, reinforcing social inequality. Also, the third sector might lose hours of volunteer work. Originality/value The comment appeals to a critically rethinking of the idea of substituting professional services with informal care provision and argues for differentiated and well-tailored policy measures, taking into account the complex nature of (informal) caregiving.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"5 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135315923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated care for older persons who live with complex health and social care requirements: a core set of indicators","authors":"Jeanette Prorok, Kelly Kay, Adam Morrison, Salinda Anne Horgan","doi":"10.1108/jica-04-2023-0024","DOIUrl":"https://doi.org/10.1108/jica-04-2023-0024","url":null,"abstract":"Purpose Performance measures are an important mediating mechanism that influences the design and delivery of care. Unfortunately, it is still commonly the case that acute care indicators are employed to assess the efficacy of integrated care. This hinders the ability to accurately assess and continuously improve integrated care efforts for priority populations, including older persons who live with complex health and social care requirements. A core set of indicators is needed from which to assess the quality and impact of integrated care on these older persons and care partners. Design/methodology/approach A modified Delphi process was employed that comprised of the following steps: (1) selection of an indicator inventory (2) defining criteria for ranking and achieving consensus, (3) recruiting participants, (4) iterative voting rounds and analysis and (5) selection of a core indicator set. Findings The study produced a core set of 16 indicators of integrated care that pertain to older persons who live with health and social care requirements. The set can be applied by health and social care organizations and systems to assess the quality and impact of integrated care for this population across the continuum of care. Research limitations/implications Although the gap in the availability of relevant indicators was the impetus for the study, this also meant there was a dearth of validated indicators to draw from. There are significant gaps in commonly used data sets with respect to indicators of integrated care as it relates to older persons and care partner. Practical implications The indicator set is intended to follow the older person and care partner throughout their health journey, enabling a whole systems view of their care. The set can be used in full or in part by health and social care systems and organizations across various primary, acute, rehabilitative and community settings for program development and evaluation purposes. Social implications The core set of indicators that emerged out of this study is a first step toward ensuring that older persons who live with complex health and social care requirements and their care partners receive quality integrated care across the continuum of care. Originality/value The findings are informed by the perspectives of older persons, care partners and healthcare professionals. Future research is needed to test, validate and potentially expand the indicator set.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":"34 1-4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135219441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}