Hybrid journal * Containing 4 Open Access article(s) in this issue * ISSN (Print) 1476-9018 - ISSN (Online) 2042-8685 Published by Emerald[362 journals]
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Authors:Narender Nalajala, Mitesh Panchal, Laura Gotting Abstract: Orthopaedics, rheumatology, pain management, specialist radiology and therapy services were brought under one umbrella to form Northwest Surrey integrated musculoskeletal (IMSK) services and introduced advance clinical practice, a multi-disciplinary team triage with a formalised straight to test (STT) process defined in 2018. Historically, prior to these services' integration, there were a primary and second care triage systems within individual specialities. The aim of this service evaluation is to assess the impact of a single IMSK multidisciplinary triage (MDT) system and the efficacy of STT from triage, which allows patients to be sent for diagnostics based on the cluster of symptoms and past medical history in order to achieve early identification of serious pathologies. This is a complex adaptive system with pathways spanning into the core areas of orthopaedics, rheumatology, therapies, pain management services, radiology and some less frequent specialities such as neurology, oncology, vascular and gynaecology. One of the objectives of this study was to identify how many referrals were triaged to consultants, Advance practice and therapies. In addition, the authors wanted to highlight the proportion of referrals that were sent straight to test from triage and the percentage of these that had sinister pathology identified. This information would then be compared against existing red flag literature to identify common themes. This study aims to discuss the aforementioned objectives. Data were extracted retrospectively from a hospital database from January to December 2019 for all the adult musculoskeletal service referrals. The data collected were analysed on a Microsoft Excel sheet with information including date of triage, hospital number, ordering clinician, body part, type of diagnostic, indications for scanning, outcome for STT, serious pathology findings (named code 5 within our trust) and outcome of appointment. A total of 47,039 referrals were received into the IMSK service. Of these referrals 19,967 were directly referred to therapies, with 27,072 referrals received into the IMSK service MDT process. Within triage, 718 patients were directed to STT to rule out serious pathology. A total of 28 patients (3.9%) had sinister pathology identified on their investigation. A total of 46% of patients were discharged from their first consultation following STT. Overall, 50% of the total number of referrals into the IMSK service was seen by advanced practitioners with 16% of patients directed to consultants with pre-consultation diagnostic work up. This service evaluation highlights that STT allows early access to diagnostics, resulting in quicker access to identification of sinister pathology. A one stop MDT system has been shown to be effective in guiding the referral to the right place with increased referrals into allied health advance practice clinics and access to therapies directly. It has resulted in a reduction of unwarranted referrals to consultant care, duplication of investigations and identified patients on multiple pathways. Citation: Journal of Integrated Care PubDate: 2023-04-04 DOI: 10.1108/JICA-11-2022-0052 Issue No:Vol. ahead-of-print, No. ahead-of-print (2023)
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Authors:Nitish Nachiappan, Sophie Ward, Nachiappan Chockalingam, Ruth Chambers Abstract: The ageing population is a global phenomenon that is occurring in many countries around the world, including the UK. According to the Office for National Statistics (ONS), the proportion of the UK population aged 65 years and over is projected to increase, reaching 25% by 2045. This increase will have a significant impact on a range of social and economic issues. One of the ways to reduce this impact is to improve self-care. The availability of simple assistive devices can facilitate physical activity and help complete daily living activities. These devices can also help in the self-management of long-term health and well-being. To encourage self-care, it is essential to create awareness about these assistive products. Simple assistive products such as shoe horns, magnifying glasses or a sphygmomanometer that are readily available to buy from shops were grouped into four boxes or kits. The authors provided these simple devices to 175 community-dwelling older adults in deprived areas and followed them up via a phone survey after 4–6 weeks. The authors recorded overall positive feedback on individual products and the kit. The results indicate that there was a sense of empowerment and ability by the recipients to take control of their health and well-being and management of their health condition using items contained in the kit provided. The study results show that simple assistive products empower older adults to self-care and can provide a positive impact on their activities of daily living. Previous studies have shown that regular exercise can enhance both physical and mental abilities and reverse certain chronic health issues. Simple household devices can aid in increasing physical activity. This work highlights how these devices enable older adults to take care of themselves, with a focus on capturing their personal perspectives and experiences. Citation: Journal of Integrated Care PubDate: 2023-03-30 DOI: 10.1108/JICA-08-2022-0043 Issue No:Vol. ahead-of-print, No. ahead-of-print (2023)
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Authors:Marcel Canoy, Yvonne Krabbe, Xander Koolman Abstract: The article demonstrates the dangers of gerontocracy and offers solutions. The article combines desk research, literature review and economic analytical reasoning. Gerontocracy in developed countries is a threat to financial, labour market and political sustainability of care for older people. Without actions today, the problem will become bigger every year, not least because of increased electoral weight of older people. This article proposes to handle gerontocracy in two ways. First is by using the potential of healthy retired people as volunteers, thereby mitigating the intergenerational solidarity challenges. Second is by taxing part of the windfall profits on the housing market, where older generation profited disproportionally. The added value of the article is twofold. First, it signals a serious problem in affluent societies that is largely ignored, both in the academic world and in politics. Second, it offers original solutions that mitigate the problem. Citation: Journal of Integrated Care PubDate: 2023-03-13 DOI: 10.1108/JICA-07-2022-0036 Issue No:Vol. ahead-of-print, No. ahead-of-print (2023)
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Authors:Steve Willcocks, Edward Joshua Willcocks Abstract: The purpose of this paper is to explore leadership in the context of the hub and spoke network in oral and maxillofacial surgery (OMFS) in the English National Health Service (NHS). This paper is a conceptual paper using literature relating to the antecedents of shared leadership and relevant policy documents pertaining to both NHS policy and the development of OMFS. The paper is informed, theoretically by the conceptual lens of shared leadership. The paper identifies the challenges that may be faced by policymakers and those involved in the hub and spoke network in developing shared leadership. It also reveals the implications for policymakers in developing shared leadership. The paper is conceptual. It is acknowledged that this is a preliminary study and further work will be required to test the conceptual framework empirically. The paper discusses the policy implications of developing leadership in the hub and spoke network. As networks are of interest internationally this has wider relevance to other countries. There is limited research on the antecedents of shared leadership. In addition, the conceptual framework is applied to a new policy context. Citation: Journal of Integrated Care PubDate: 2023-01-10 DOI: 10.1108/JICA-11-2022-0058 Issue No:Vol. ahead-of-print, No. ahead-of-print (2023)
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Authors:Parisa Diba, Jonathan Bowden, Andrew Divers, Beth Taylor, Dorothy Newbury-Birch, Jonathan Ling Abstract: Integrated service models aim to simplify access, enable effective delivery, remove duplication and provide a holistic and person-centred approach. This project explored the development of integrated well-being services in two local authorities in North-East England. The purpose of this paper is to address this issue. Underpinned by public health and co-production approaches, the project utilised a mixed-methods approach. Data were collected via online surveys (n = 95), virtual interviews with members of the local population (n = 8) and practitioners and commissioners (n = 8) to explore needs for a new service. Thematic analysis was used to identify key themes and issues. Several benefits of an integrated service were highlighted by both staff and service users, with a central anticipated benefit being the provision of holistic care. Improvement in information sharing was also seen to increase the efficiency of services and communication barriers between services. Beneficial aspects and barriers related to the COVID-19 pandemic on current service provision were reported that have informed our future recommendations. The authors’ findings provide a much deeper insight into function, care, social inclusion and ongoing support needs, from both the perspectives of staff and service users. Service users and staff saw value in an integrated model for themselves, as well as the wider community. The authors’ findings indicate that the integrated service model is a promising one for the development of services within local authorities. Citation: Journal of Integrated Care PubDate: 2023-01-09 DOI: 10.1108/JICA-06-2022-0031 Issue No:Vol. ahead-of-print, No. ahead-of-print (2023)
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Authors:Tuomas Hujala, Harri Laihonen Abstract: This article analyses a major healthcare and social welfare reform establishing new regional and integrated wellbeing services counties in Finland. The authors approach the reform and service integration as a knowledge management (KM) issue and analyse how KM appears and contributes in the context of integrated care, specifically in the process of integrating social and health care. The article analyses the case organisation's KM initiatives in light of the integrated care literature and recognises the tasks and requirements for effective KM when building integrated health and social care system. The empirical research material for this qualitative study consisted of the case organisation's strategy documents, the results of an external maturity assessment, KM workshop materials and publicly available documentation of the Finnish health and social care reform. This study identifies the mechanisms by which KM can support health and social services integration. At the macro level, national coordination and regional co-operation require common information structures. At the meso level, a shared regional strategy with shared objectives guides both organisational decision-making and collaboration between professionals. At the micro level, technology supported and data-driven planning of service chains complements the experiences of professionals and may help remove obstacles to integration. This study contributes to the literature on integrated care by providing a more comprehensive view of the role and tasks of knowledge and KM when reforming health and social services than approaches focussing solely on health informatics and internal efficiency. Citation: Journal of Integrated Care PubDate: 2023-01-02 DOI: 10.1108/JICA-06-2022-0032 Issue No:Vol. ahead-of-print, No. ahead-of-print (2023)
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Authors:Gabriela Uribe, Ferdinand Mukumbang, Corey Moore, Tabitha Jones, Susan Woolfenden, Katarina Ostojic, Paul Haber, John Eastwood, James Gillespie, Carmen Huckel Schneider Abstract: Integrated health and social care initiatives are increasing and health and social care systems are aiming to improve health and social outcomes in disadvantaged groups. There is a global dialogue surrounding improving services by shifting to an integrated health and social care approach. There is consensus of what is “health care”; however, the “social care” definition remains less explored. The authors describe the state of “social care” within the current integrated care literature and identify the depth of integration in current health and social care initiatives. A narrative literature review, searching Medline, PsychINFO, CINAHL, PubMed, Scopus and Cochrane databases and grey literature (from 2016 to 2021), employing a search strategy, was conducted. In total. 276 studies were eligible for full-text review, and 33 studies were included and categorised in types: “social care as community outreach dialogues”, “social care as addressing an ageing population”, “social care as targeting multimorbidity and corresponding social risks factors” and “social care as initiatives addressing the fragmentation of services”. Most initiatives were implemented in the United Kingdom. In total, 21 studies reported expanding integrated governance and partnerships; 27 studies reported having health and social care staff with clear integrated governance; 17 had dedicated funding and 11 used data-sharing and the integration of systems’ records. The authors' demonstrate that social care approaches are expanding beyond the elderly, and these models have been used to respond to multimorbidity [including coronavirus disease 2019 (COVID-19)], targeting priority groups and individuals with complex presentations. Citation: Journal of Integrated Care PubDate: 2023-03-14 DOI: 10.1108/JICA-08-2022-0045 Issue No:Vol. 31, No. 5 (2023)
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Authors:Maria Goddard Abstract: Policies on integrated care have waxed and waned over time in the English health and care sectors, culminating in the creation of 42 integrated care systems (ICSs) which were confirmed in law in July 2022. One of the four fundamental purposes of ICSs is to tackle health inequalities. This paper reports on the content of the overarching ICS plans in order to explore how they focus on health inequalities and the strategies they intend to employ to make progress. It explores how the integrated approach of ICSs may help to facilitate progress on equity. The analysis is based on a sample of 23 ICS strategic plans using a framework to extract relevant information on health inequalities. The place-based nature of ICSs and the focus on working across traditional health and care boundaries with non-health partners gives the potential for them to tackle not only the inequalities in access to healthcare services, but also to address health behaviours and the wider social determinants of health inequalities. The plans reveal a commitment to addressing all three of these issues, although there is variation in their approach to tackling the wider social determinants of health and inequalities. This study adds to our knowledge of the strategic importance assigned by the new ICSs to tackling health inequalities and illustrates the ways in which features of integrated care can facilitate progress in an area of prime importance to society. Citation: Journal of Integrated Care PubDate: 2023-02-13 DOI: 10.1108/JICA-08-2022-0044 Issue No:Vol. 31, No. 5 (2023)
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Authors:Shane Dunlea, Geoff McCombe, John Broughan, Áine Carroll, Ronan Fawsitt, Joe Gallagher, Kyle Melin, Walter Cullen Abstract: Throughout the world, healthcare policy has committed to delivering integrated models of care. The interface between primary–secondary care has been identified as a particularly challenging area in this regard. To that end, this study aimed to examine the issue of integrated care from general practitioners’ (GPs) perspectives in Ireland. This multimethod study involved a cross-sectional survey and semi-structured interviews with GPs in the Ireland East region. A total of 1,274 GPs were identified from publicly available data as practising in the region, of whom the study team were able to identify 430 GPs with email addresses. An email invite was sent to 430 potential participants asking them to complete a 34-item online questionnaire and, for those who were willing, an in-depth interview was conducted with a member of the study team. In total, 116 GPs completed the survey. Most GPs felt that enhancing integration between primary and secondary care in Ireland was a priority (n = 109, 93.9%). Five themes concerning the state of integrated care and initiatives to improve matters were identified from semi-structured interviews with 12 GPs. The uniqueness of this study is that it uses a multimethod approach to provide insight into current GP views on the state of integrated care in Ireland, as well as their perspectives on how to improve integration within the Irish healthcare system. Citation: Journal of Integrated Care PubDate: 2022-12-16 DOI: 10.1108/JICA-06-2022-0030 Issue No:Vol. ahead-of-print, No. ahead-of-print (2022)
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Authors:Katie Chadd, Sophie Chalmers, Kate Harrall, Kathryn Moyse, Gemma Clunie Abstract: Long COVID is a complex and highly heterogeneous condition with a variable symptom profile, and calls have been made for an integrated care approach to be taken for its management. To date, no studies have explored speech and language therapy services or needs associated with long COVID. This service evaluation aimed to gauge the level of demand on speech and language therapy services for individuals with long COVID in the UK; their clinical needs, the organisational arrangements of services and the barriers and facilitators of delivering quality care. A service evaluation was undertaken via distribution of an online survey to speech and language therapists (SLTs) receiving referrals for individuals with long COVID. Analysis was completed using descriptive statistics, with thematic analysis to evaluate qualitative data. One hundred and eleven SLTs responded. Eighty-six percent were seeing individuals with long COVID in their “everyday” service, in uni- or multi-disciplinary teams, without any “dedicated” resource. Dysphagia and dysphonia were the most reported symptoms. Most respondents (66.7%) indicated the individuals they were seeing were of working age, and that an individuals' speech and language therapy needs were impacting their wellbeing. Perceived barriers to quality care included fragmented and non-integrated care pathways. Multi-disciplinary and integrated working was a key enabler. This study provides novel insights into the current speech and language therapy needs of and care pathways for individuals with long COVID in the UK SLTs have unique expertise and are integral to supporting individuals with long COVID and should be a part of integrated care teams. Citation: Journal of Integrated Care PubDate: 2022-11-30 DOI: 10.1108/JICA-07-2022-0038 Issue No:Vol. ahead-of-print, No. ahead-of-print (2022)
Hybrid journal * Containing 4 
Open Access article(s) in this issue *
