Integrated care

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Integrated care, also known as integrated health, coordinated care, comprehensive care, seamless care, interprofessional care or transmural care, is a worldwide trend in health care reforms and new organizational arrangements focusing on more coordinated and integrated forms of care provision. Integrated care may be seen as a response to the fragmented delivery of health and social services being an acknowledged problem in many health systems. [1] [2] [3] This model of care is working towards moving away from a siloed and referral-based format of care to a team-based model.

Contents

Central concepts

The integrated care literature distinguishes between different ways and degrees of working together and three central terms in this respect are autonomy, co-ordination, and integration. While autonomy refers to the one end of a continuum with least co-operation, integration (the combination of parts into a working whole by overlapping services) refers to the end with most co-operation and co-ordination (the relation of parts) to a point in between. [2]

Distinction is also made between horizontal integration (linking similar levels of care like multiprofessional teams) and vertical integration (linking different levels of care like primary, secondary, and tertiary care). [2]

Continuity of care is closely related to integrated care and emphasizes the patient's perspective through the system of health and social services, providing valuable lessons for the integration of systems. Continuity of care is often subdivided into three components:

Integrated care seems particularly important to service provision to the elderly, as elderly patients often become chronically ill and subject to co-morbidities and so have a special need of continuous care. [3]

The NHS Long Term Plan, and many other documents advocating integration, claim that it will produce reductions in costs or emergency admissions to hospital but there is no convincing evidence to support this. [4]

Collaborative care

Collaborative care is a related healthcare philosophy and movement that has many names, models, and definitions that often includes the provision of mental-health, behavioral-health and substance-use services in primary care. Common derivatives of the name collaborative care include integrated care, primary care behavioral health, integrated primary care, and shared care.

The Agency for Healthcare Research and Quality (AHRQ) published an overview of many different models as well as research that supports them. [5] These are the key features of collaborative care models:

There are various national associations committed to collaborative care such as the Collaborative Family Healthcare Association.

According to Shivam Shah collaborative care is a form of systematic team-based care involving:

There are organizations in many countries promoting these ideas such as the American Collaborative Family Healthcare Association, a multi-guild member association based in Chapel Hill, North Carolina, which supports healthcare professionals in integrating physical and behavioral health. [8] The University of Washington has an Advancing Integrated Mental Health Solutions Center, founded by Jürgen Unützer, to promote primary care behavioral health. [9]

The Coalition for Collaborative Care was established in England in 2014. It focuses on re-framing the relationship between a person with long-term health conditions and the professionals supporting them. [10]

Contrast to merging roles

The proper integrating of care does not mean the merging of roles. It remains uneconomical to make a physician serve as a nurse. Besides, the opposite approach is strictly prohibited by accreditation and certification schemes. The mix of staff for the various roles is maintained to enable a profitable integration in caring.

Examples

See also

Related Research Articles

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References

  1. ↑ Kodner, DL & Spreeuwenberg, C (2002): Integrated care: meaning, logic, applications, and implications – a discussion paper. International Journal of Integrated Care Archived 2014-02-01 at the Wayback Machine , Vol. 2, 14. Nov. 2002
  2. 1 2 3 4 Gröne, O & Garcia-Barbero, M (2002): Trends in Integrated Care – Reflections on Conceptual Issues. World Health Organization, Copenhagen, 2002, EUR/02/5037864
  3. 1 2 Kai Leichsenring (September 2004). "Developing integrated health and social care services for older persons in Europe". International Journal of Integrated Care . 4 (3): e10. doi: 10.5334/ijic.107 . PMC   1393267 . PMID   16773149. Archived from the original on March 4, 2016. Retrieved June 24, 2011.
  4. ↑ Georghiou, Theo (January 31, 2019). "Little evidence that integrated care initiatives deliver". Health Service Journal. Retrieved March 5, 2019.
  5. ↑ Butler M, Kane RL, McAlpine D, Kathol, RG, Fu SS, Hagedorn H, Wilt TJ. Integration of Mental Health/Substance Abuse and Primary Care No. 173 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-02-0009.) AHRQ Publication No. 09-E003. Rockville, MD. Agency for Healthcare Research and Quality. October 2008.
  6. ↑ Ramanju, Parashar; Pincus, Harold (April 26, 2019). "Collaborative care: enough of the why; what about the how?". British Journal of Psychiatry. 215 (4): 573–576. doi: 10.1192/bjp.2019.99 . PMID   31025616. S2CID   133607267.
  7. ↑ Shah, Shivam (January 22, 2018). "An Exploration into Core Tenets, Fidelity, and Policy". Centre for Mental Health. Retrieved November 12, 2022.
  8. ↑ "Workers Compensation Doctors". Compensation Doctors. Retrieved May 30, 2023.
  9. ↑ "WHO WE ARE". University of Washington. 2022. Retrieved November 12, 2022.
  10. ↑ "New alliance in social care and health launched". NHS England. November 21, 2014. Retrieved November 12, 2022.
  11. ↑ Amal N. Trivedi & Regina C. Grebla (June 2011). "Quality and equity of care in the Veterans Affairs health-care system and in Medicare Advantage health plans". Medical Care . 49 (6): 560–568. doi:10.1097/MLR.0b013e31820fb0f6. PMID   21422951. S2CID   23926259.
  12. ↑ Lawrence, David (2005). Building a Better Delivery System: A New Engineering/Health Care Partnership — Bridging the Quality Chasm (PDF). Washington, DC: National Academy of Sciences. p. 99. ISBN   0-309-65406-8.
  13. ↑ "The Integrated Care Framework". ICPOP. Archived from the original on August 10, 2020. Retrieved July 24, 2024.
  14. ↑ Edwards, Elaine (2017). "Health Service Executive paid consulting firm €2.2m in 2016". The Irish Times.
  15. ↑ "Preliminary versions of the Framework on integrated people-centred health services". World Health Organization . Archived from the original on July 19, 2016. Retrieved July 24, 2024.
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