Journal of Integrated Care最新文献

{"title":"Hospital-based ambulatory clinic adoption of video and telephone visits before and during the COVID-19 pandemic: a convergent mixed-methods study","authors":"V. Stamenova, Suman Budhwani, C. Soobiah, J. Fujioka, Rumaisa Khan, Rebecca Liu, Ilana Halperin, R. Bhatia, L. Desveaux","doi":"10.1108/jica-01-2022-0011","DOIUrl":"https://doi.org/10.1108/jica-01-2022-0011","url":null,"abstract":"PurposeThe purpose of this study is to understand virtual care use (e.g. telephone and video visits) during the COVID-19 pandemic across three hospital-based ambulatory clinics (i.e. mental health, renal and respiratory care) and to describe associated patient and provider experiences.Design/methodology/approachA mixed-methods convergent study was conducted including quantitative electronic medical records data on virtual care use, electronic surveys assessing domains of experience (e.g. satisfaction, acceptance and technology use) among patient and providers and semi-structured interviews exploring the associated barriers and facilitators of virtual care adoption.FindingsVirtual care adoption rates and relative modality use (telephone vs video) varied across specialty clinics. Mental health clinics) showed the greatest use of virtual care and greater use of video over telephone, as compared to renal and respiratory care, where telephone was used almost exclusively. Patients and providers reported an overall good satisfaction and acceptance of virtual care (60–72%) across clinics, but commonly observed barriers (technical problems, behavioral adaptations needed and inequity) persisted. Good value propositions, tech support and the presence of early adopters who can support others in workflow re-design and highlight value propositions of virtual care were listed as adoption facilitators.Originality/valueThe study provides a unique opportunity to compare the rate of virtual care adoption before and during the COVID-19 pandemic across distinct specialties that operate within the same organizational and political setting. This study showed that the nature of the condition (e.g. mental health conditions) and the characteristics of the users (e.g. younger patients) may drive models of care with higher rate of video use. Focusing on removing common barriers, like providing tech support and ensuring equitable access to patients, continues to be important even in the context of high virtual care adoption rates during the pandemic.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85006626","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":"Healthcare provider selection for elderly patients suffering from NCD's: an analysis with the combined approach of DEMATEL and AHP","authors":"Ankit Singh, A. Jha, Shankar Purbey, Priya Ravi","doi":"10.1108/jica-11-2021-0056","DOIUrl":"https://doi.org/10.1108/jica-11-2021-0056","url":null,"abstract":"PurposeElderly patients suffering from non-communicable disease face a dilemma in the selection of healthcare providers. This study attempts to identify the key variables playing a crucial role and identify the appropriate healthcare destination with the help of a combination of Decision-making Trial and Evaluation Laboratory (DEMATEL) and analytic hierarchy process (AHP) techniques. The primary objective is to introduce the DEMATEL and AHP as efficient decision-making methods to choose the right healthcare provider for elderly patients suffering from non-communicable diseases.Design/methodology/approachAn integrative approach utilizing DEMATEL and AHP is used to reach the ideal solution for healthcare provider selection decisions. The DEMATEL approach is used to segregate the cause and effect variables. Similarly, the AHP is used to identify the weights of the top five cause-inducing variables, and the paired comparison method is used to select the healthcare provider.FindingsThe variables such as dependency on family members, easily accessible services, and patient autonomy play a vital role in the selection decision of healthcare providers in elderly patients suffering from non-communicable diseases.Practical implicationsIn terms of priority, home healthcare should be considered the preferred provider for elderly patients suffering from non-communicable diseases followed by neighbourhood registered medical practitioners and hospitals.Originality/valueThis is the first of its kind study which has attempted to solve the healthcare provider selection decision with the combined approach of DEMATEL and AHP.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88360713","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":"Integration, population commissioning and prison health and well-being – an exploration of benefits and challenges through the study of telemedicine","authors":"Chantal Edge, N. Luffingham, G. Black, Julie George","doi":"10.1108/jica-11-2021-0055","DOIUrl":"https://doi.org/10.1108/jica-11-2021-0055","url":null,"abstract":"PurposeThis paper seeks to understand relationships between prison healthcare and integrated care systems (ICS), including how these affect the delivery of new healthcare interventions. It also aims to understand how closer integration between prison and ICS could improve cross system working between community and prison healthcare teams, and highlights challenges that exist to integration between prison healthcare and ICS.Design/methodology/approachThe study uses evidence from research on the implementation of a pilot study to establish telemedicine secondary care appointments between prisons and an acute trust in one English region (a cross-system intervention). Qualitative interview data were collected from prison (n = 12) and community (n = 8) healthcare staff related to the experience of implementing a cross-system telemedicine initiative. Thematic analysis was undertaken on interview data, guided by an implementation theory and framework.FindingsThe research found four main themes related to the closer integration between prison healthcare and ICS: (1) Recognition of prison health as a priority; (2) Finding a way to reconcile networks and finances between community and prison commissioning; (3) Awareness of prison service influence on NHS healthcare planning and delivery; and (4) Shared investment in prison health can lead to benefits.Originality/valueThis is the first article to provide research evidence to support or challenge the integration of specialist health and justice (H&J) commissioning into local population health.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91063129","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":"Does a discharge to assess programme introduced in England meet the quadruple aim of service improvement?","authors":"Stuart Jeffery, J. MacInnes, Lavinia Bertini, Susie Walker","doi":"10.1108/jica-02-2022-0018","DOIUrl":"https://doi.org/10.1108/jica-02-2022-0018","url":null,"abstract":"PurposeThis paper intends to examine and evaluate the implementation and delivery of a discharge to assess pathway based on the UK Department of Health and Social Care Hospital Discharge Policy in relation to the quadruple aim of healthcare improvement: improving patient experience, reducing costs, benefiting the wider population and improving the work life of staff.Design/methodology/approachUsing a place based partnership in the south of England, 18 staff involved the delivery of discharge to assess and four patients who had recently been through the pathway were interviewed and the narratives analysed using a framework method.FindingsAll four dimensions of the quadruple aim were felt to be positively impacted by the discharge to assess pathway in varying degrees. Staff described improvements to working lives; patients described a positive experience. There was no evidence of reduced costs and wider benefit through reduced length of stay was suggested rather than demonstrated. The study showed a need to ensure both information flows and discharge process are smooth, that there is sufficient community capacity and capability, a need for strong relationships and shared goals, for clarity of pathway and empowered staff, and for an avoidance of the over prescription of care.Originality/valueThe revised discharge to assess pathway in England has been in place since 2020 and no other assessments of the pathway were found that related the changes to the quadruple aim framework.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90074779","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":"Data and care integration for post-acute intensive care program of stroke patients: effectiveness assessment using a disease-matched comparator cohort","authors":"E. Vela, Aina Plaza, G. Carot-Sans, J. Contel, M. Salvat-Plana, Marta Fabà, Andrea Giralt, A. Ribera, S. Santaeugènia, J. Piera-Jiménez","doi":"10.1101/2022.04.13.22273573","DOIUrl":"https://doi.org/10.1101/2022.04.13.22273573","url":null,"abstract":"Purpose: To assess the effectiveness of an integrated care program for post-acute care of stroke patients, the return home program (RHP program), deployed in Barcelona (North-East Spain) between 2016 and 2017 in a context of health and social care information systems integration. Design: The health outcomes and resource use of the RHP program participants were compared with a population-based matched control group built from central healthcare records of routine care data. Findings: The study included 92 stroke patients attended within the RHP program and their matched-controls. Patients in the intervention group received domiciliary care service, home rehabilitation, and telecare significantly earlier than the matched-controls. Within the first two years after the stroke episode, recipients of the RHP program were less frequently institutionalized in a long-term care facility (5% vs. 15%). The use of primary care services, non-emergency transport, and telecare services were more frequent in the RHP group. Originality: Our analysis shows that an integrated care program can effectively promote and accelerate delivery of key domiciliary care services, reducing institutionalization of stroke patients in the mid-term. The integration of health and social care information allows not only a better coordination among professionals but also to monitor health and resource use outcomes of care delivery","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78747206","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":"Personal health budgets: a mechanism to encourage service integration?","authors":"Elizabeth Welch, Karen Spärck Jones, D. Fox, James Caiels","doi":"10.1108/jica-07-2021-0038","DOIUrl":"https://doi.org/10.1108/jica-07-2021-0038","url":null,"abstract":"PurposeIntegrated care continues to be a central aim within health and social care policy in England. Personal budgets and personal health budgets aim to place service users at the centre of decision-making and are part of a wider long-term initiative working towards personalised and integrated care. Personal budgets began in social care with the national pilot programme of individual budgets, which aimed to incorporate several funding streams into one budget, but in practice local authorities limited these to social care expenditure. Personal budgets then moved into the health care sector with the introduction of a three-year personal health budgets pilot programme that started in 2009. The purpose of the paper is to explore the post-pilot implementation of personal health budgets and explore their role in facilitating service integration. We examine this through the RE-AIM framework.Design/methodology/approachDuring 2015 and 2016, eight organisational representatives, 23 personal health budget holders and three service providers were interviewed, 42 personal health budget support plans were collected and 14 service providers completed an online survey.FindingsOverall, personal health budgets continued to be viewed positively but progress in implementation was slower than expected. Effective leadership, clear communication and longer-term implementation were seen as vital ingredients in ensuring personal health budgets are fully embedded and contribute to wider service integration.Originality/valueThe paper highlights the importance of policy implementation over the longer-term, while illustrating how the venture of personal health budgets in England could be a mechanism for implementing service integration. The findings can serve to guide future policy initiatives on person-centred care and service integration.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73223450","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":"Impact of integrated behavioral health services on adherence to long-acting injectable antipsychotics","authors":"A. Maister, C. McCarthy, Lee G. Ruszczyk, Rachael Evans, Megan E. Maroney","doi":"10.1108/jica-08-2021-0046","DOIUrl":"https://doi.org/10.1108/jica-08-2021-0046","url":null,"abstract":"PurposeIntegrated health care occurs when specialty and general care providers work together to address both the physical and mental health needs of their patients. The Substance Abuse and Mental Health Services Administration model of integration is broken into six levels of coordinated, co-located and integrated care. Our institution offers both co-located and integrated care among eight clinic sites. The care team is typically composed of the primary care provider, nurse and medical assistant, but other professionals may be introduced based on the patient’s medical and psychiatric conditions. The purpose of this prospective, quality improvement study was to compare the rates of adherence to long-acting injectable antipsychotics (LAIAs) between both types of integrated primary care settings at our institution. The comparison of the two settings sought to determine which environment provides improved outcomes for patients with serious psychiatric illnesses. Additionally, we aimed to assess the quality of medication-related monitoring and care team composition between care settings, and the ability of pharmacists to deliver interprofessional care team training and education on LAI use in clinical practice.Design/methodology/approachSubjects were identified and included in the study if they had received primary care services from our institution within the previous 12 months. Patient demographic and laboratory variables were collected at baseline and when clinically indicated. The rates of adherence between care settings were assessed at intervals that align with the medication’s administration schedule (e.g. every four weeks). Medication-related monitoring parameters were collected at baseline and when clinically indicated. The interprofessional care team completed Likert scale surveys to evaluate the pharmacist’s LAIA education and training.FindingsThere was not a statistically significant difference detected between integrated primary care settings on the rates of adherence to LAIAs. Additionally, there was not a statistically significant difference between rates of adherence to medication-related monitoring parameters or the effect of the patient treatment team composition. There was a statistically significant difference between pre- and post-session survey scores following interprofessional education and training provided by a pharmacist.Originality/valueBecause overall rates of adherence were low, both primary care settings were found to be equivalent. Our study may have been underpowered to detect a difference in the primary endpoint because of the small sample size. However, our study demonstrates that interprofessional education and training may lend itself to changes in practice, which is evident by the clinically significant relative increase in adherence. The Henry J. Austin Health Center network will be implementing a standard operating procedure regarding LAIA management within the primary care setting. Further studies are needed to","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76990057","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":"Utilising dentist-dental health educator skill-mix to implement oral health promotion that better supports diverse communities","authors":"Bhaven Modha","doi":"10.1108/jica-08-2021-0043","DOIUrl":"https://doi.org/10.1108/jica-08-2021-0043","url":null,"abstract":"PurposeDentists may be seen as the most prominent figures within dentistry. Yet, a number of dental care professionals make significant contributions to the profession. The dental health educator (DHE) is one prime example. This teammate is typically a dental nurse who has achieved a post-registration qualification in oral health education (OHE). Through interactions with patients, members of the community and other pertinent stakeholders, the DHE empowers people through promoting the importance of good oral health. The purpose of this paper is to cast light on the unique and invaluable roles that DHEs can play within their organisations.Design/methodology/approachThis paper aims to share some examples of dentist-DHE collaborations, where OHE initiatives were implemented within an ethnically diverse London Borough in England.FindingsIt was found that such interprofessional, skill-mix efforts were more productive, when the dentist and DHE worked together, rather than the latter working independently.Originality/valueThere exists great potential for DHEs to act as ambassadors for their dental establishments, network and collaborate with other organisations and build worthwhile relations with other healthcare professionals and stakeholders.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77337273","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":"“One of the team” patient experience of integrated breast cancer care","authors":"H. Tucker","doi":"10.1108/jica-11-2021-0058","DOIUrl":"https://doi.org/10.1108/jica-11-2021-0058","url":null,"abstract":"PurposeThis paper presents my experience of breast cancer care in which I describe my care as positive and integrated.Design/methodology/approachI have applied an autoethnographical approach to my patient story to analyse my care in order to reflect and share insights. I have applied my knowledge and experience in integrated care through my research, management and practice.FindingsIn my patient story I describe being empowered and feeling like “one of the team.” Vertical and horizontal integration was evident across staff services and agencies. This included integrated working across multi‐disciplinary teams, between primary and secondary care and also between the NHS and a voluntary agency. I identified features that were important to me in my care under the headings of: certainty, communication, contact, compassion, continuity, cohesive, care and collaboration.Practical implicationsI consider the implications of sharing patient stories to inform quality improvement, influence education and training for staff and design support for patients. I consider how patients can be more involved in the evaluation of their care.Originality/valueThis viewpoint has been written from my perspective as a patient and a professional, and was written in order to recognise good practice and share the learning for continual quality improvement. There is every sign that person-centred integrated care is starting to be embedded in some of our services and hopefully this will be recognised, celebrated and sustained.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76883452","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":"Discourses of middle managers' cross-boundary collaboration in health and social care","authors":"Anneli Hujala, H. Taskinen, Sanna Laulainen, Charlotte Klinga, S. Schruijer","doi":"10.1108/jica-10-2021-0054","DOIUrl":"https://doi.org/10.1108/jica-10-2021-0054","url":null,"abstract":"PurposeIn the implementation of integrated care, the role of managers is important and their mutual collaboration should be addressed more visibly. The purpose of this study was to investigate how cross-boundary collaboration is constructed in the discourse of middle-level managers in health and social care.Design/methodology/approachThe study was based on a discursive approach. Group discussions with three groups of Finnish middle managers (n = 39) were analyzed using discourse analysis.FindingsFive ways of talking about cross-boundary collaboration were identified, labeled “ideal”, “structure”, “defence”, “money” and “support” discourses. In the ideal discourse, cross-boundary collaboration appeared as a “good thing” and is self-evident. Structural discourse defined managers as passive actors in self-sustaining entities. Defensive discourse highlighted the problems of cross-boundary collaboration and the hierarchy within the health and social sectors. Financial discourse constituted the ultimate obstacle to successful cross-boundary collaboration, and both strengthened and explained defensive discourse. Supportive discourse portrayed other managers as partners and as an important resource.Research limitations/implicationsCross-boundary collaboration can be experienced as a resource, helping managers cope with their workload. However, identification of and continuous attention to challenges at macro, meso and micro levels of integrated care is crucial for successful collaboration. Thus, critical discussion of collaboration needs to be given space.Originality/valueThe study design and discursive approach highlights the power of language and give voice to middle managers who are key actors when implementing integrated care.","PeriodicalId":51837,"journal":{"name":"Journal of Integrated Care","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86285961","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}