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Journal of Integrated Care
Journal Prestige (SJR): 0.275
Citation Impact (citeScore): 1
Number of Followers: 18  
 
Hybrid Journal Hybrid journal   * Containing 8 Open Access Open Access article(s) in this issue *
ISSN (Print) 1476-9018 - ISSN (Online) 2042-8685
Published by Emerald Homepage  [360 journals]
  • Social work's contribution to integrated primary health care teams in the
           UK for older adults with complex needs

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      Authors: Di Bailey , Gabriella Jennifer Mutale
      Abstract: This study examined the contribution of adult social work in integrated teams in the UK. The study design was realist, evaluation research using a mixed methods approach. Data collection methods included interviews and focus groups. Types of social work activities were extracted from older adults' case records and used to calculate costs of care. The presence or absence of indicators of care quality was recorded using the same sample of case records. Data were collected from three primary care teams in which social work was integrated. They were compared with data from three social-work-only teams in the same districts. Narrative data was analysed thematically. Inferential and descriptive statistics were used to compare costs and care quality. When social work was embedded or attached to a primary care team, costs of care delivery were lower than in their social-work-only team and more indicators of good quality care outcomes were recorded. Results suggest that embedding social work in integrated primary care teams contributes to cost-effective, quality care for older people if certain conditions for integration are met. This is the first study to triangulate three data sources to quantify the social work contribution to integrated primary health care teams for older adults.
      Citation: Journal of Integrated Care
      PubDate: 2022-04-26
      DOI: 10.1108/JICA-10-2021-0053
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • Personal health budgets: a mechanism to encourage service
           integration'

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      Authors: Elizabeth Welch , Karen Jones , Diane Fox , James Caiels
      Abstract: Integrated 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. During 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. Overall, 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. The 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.
      Citation: Journal of Integrated Care
      PubDate: 2022-03-30
      DOI: 10.1108/JICA-07-2021-0038
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • Impact of integrated behavioral health services on adherence
           to long-acting injectable antipsychotics

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      Authors: Ashley J. Maister , Caitlin McCarthy , Lee G. Ruszczyk , Rachael Evans , Megan E. Maroney
      Abstract: Integrated 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. Subjects 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. There 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. Because 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 assess a larger number of patients between both types of primary care settings, as well as the impact of the clinical psychiatric pharmacist as a member of the treatment team.
      Citation: Journal of Integrated Care
      PubDate: 2022-03-28
      DOI: 10.1108/JICA-08-2021-0046
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • Utilising dentist-dental health educator skill-mix to implement oral
           health promotion that better supports diverse communities

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      Authors: Bhaven Modha
      Abstract: Dentists 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. This paper aims to share some examples of dentist-DHE collaborations, where OHE initiatives were implemented within an ethnically diverse London Borough in England. It was found that such interprofessional, skill-mix efforts were more productive, when the dentist and DHE worked together, rather than the latter working independently. There 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.
      Citation: Journal of Integrated Care
      PubDate: 2022-03-18
      DOI: 10.1108/JICA-08-2021-0043
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • The patient experience of telehealth access and clinical encounters in
           Australian health care during COVID-19: implications for enhancing
           integrated care

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      Authors: Jennifer White , Julie Byles , Tom Walley
      Abstract: Telehealth consultations are likely to continue while living with COVID-19 and the risk of other pandemics. Greater understanding of patient perceptions is important in order to inform future integrated care models involving telehealth. An interpretative qualitative study. Fifteen, in-depth qualitative interviews were conducted with diverse range of community dwelling patients who attended outpatient clinics at The John Hunter Hospital, Newcastle. Data were analysed using an inductive thematic approach. Key themes were identified: (1) telehealth is valuable in a pandemic; (2) telehealth accessibility can be challenging; (3) there are variations in care experiences, especially when visual feedback is lacking; (4) telehealth for acute and complex care needs may lead to gaps and (5) considerations towards the future of telehealth, beyond a pandemic. There is a shortfall in evidence of the patient experience of integrated care within a telehealth framework. The results provided practical insights into how telehealth services can play a greater role in integrated care. Apart from the need for affordable access to high-speed data for basic Internet access, the author posit the need for patient and clinician training towards promoting communication that is underpinned by choice, trust and shared decision-making. Telehealth is important towards keeping patients safe during COVID-19. Key findings extend knowledge of the practical implications need to promote integrated telehealth systems. While there is a benefit in extending telehealth to more preventative activities, there is also a need for greater service coordination and sharing of information between treating clinicians. Overall the results highlight telehealth consultations to be an effective means of treating well-known conditions and for follow-up rather than for acute conditions.
      Citation: Journal of Integrated Care
      PubDate: 2022-02-04
      DOI: 10.1108/JICA-05-2021-0024
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • The European Health Data Space: a step towards digital
           and integrated care systems

         This is an Open Access Article Open Access Article

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      Authors: Stefano Genovese , Rafael Bengoa , John Bowis , Mary Harney , Bastian Hauck , Michel Pinget , Mike Leers , Tarja Stenvall , Nick Guldemond
      Abstract: The COVID-19 pandemic has demonstrated the urgency of better chronic disease management and the importance of making it an integral part of the recovery agenda in Europe. This paper aims to explore the shift towards digital and integrated care systems in Europe. In this viewpoint paper the Expert Group for Integrated Care and Digital Health Europe (EGIDE) group argues that an orchestrated shift towards integrated care holds the solution to the chronic disease pandemic. The development of integrated care cannot happen without shifting towards a digitalised healthcare system via large-scale initiatives like the European Health Data Space (EHDS) and the involvement of all stakeholders. The EGIDE group has identified some foundational principles, which can guide the way to realise the full potential of the EHDS for integrated care and can support the involved stakeholders’ thinking.
      Citation: Journal of Integrated Care
      PubDate: 2022-01-10
      DOI: 10.1108/JICA-11-2021-0059
      Issue No: Vol. ahead-of-print , No. ahead-of-print (2022)
       
  • Link workers, activities and target groups in social prescribing:
           a literature review

         This is an Open Access Article Open Access Article

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      Authors: Denis Rothe , Raffael Heiss
      Abstract: Social prescribing is a model of integrated care, in which primary healthcare staff can link patients to the social care sector. However, social prescribing can occur in different forms. To better understand the concept of social prescribing, this literature review examines the role of the link workers, activities and target groups. A literature review was conducted. Studies before May 2020 were considered. In total, 1,700 studies were identified using the databases Pubmed, PsycInfo, Cinahl, Web of Science and Cochrane Library. After eligibility checks, 16 studies were included in the final analysis. A few studies warned of a deeper engagement of the link worker due to service dependency, but most studies encouraged an active and supportive role of the link worker. Participants engaged in social, physical and counseling activities. The majority of studies emphasized the importance of linking group activities with personal preferences and identity needs. The main target groups were composed of individuals with psychosocial needs, but some studies also included patients with physical or mental illnesses. Social prescribing is widely advocated as an innovative model of integrated care. However, few studies have looked into the complex system of social prescribing. This study analyzes the linking processes, activities and target groups in extant social prescribing programs.
      Citation: Journal of Integrated Care
      PubDate: 2022-02-01
      DOI: 10.1108/JICA-09-2021-0047
      Issue No: Vol. 30 , No. 5 (2022)
       
  • Making a difference: workforce skills and capacity for integrated care
         This is an Open Access Article Open Access Article

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      Authors: Joy Akehurst, Paul Stronge, Karen Giles, Jonathon Ling
      Abstract: The aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform future workforce development and planning in a new integrated care system in England. Semi-structured interviews and focus groups with primary, community, acute care, social care and voluntary care, frontline and managerial staff and with patients and carers receiving these services were undertaken. Data were explored using framework analysis. Analysis revealed three overarching themes: achieving teamwork and integration, managing demands on capacity and capability and delivering holistic and user-centred care. An organisational development (OD) process was developed as part of the action research process to facilitate the large-scale workforce changes taking place. This study did not consider workforce development and planning challenges for nursing and care staff in residential, nursing care homes or domiciliary services. This part of the workforce is integral to the care pathways for many patients, and in line with the current emerging national focus on this sector, these groups require further examination. Further, data explore service users' and carers' perspectives on workforce skills. It proved challenging to recruit patient and carer respondents for the research due to the nature of their illnesses. Many of the required skills already existed within the workforce. The OD process facilitated collaborative learning to enhance skills; however, workforce planning across a whole system has challenges in relation to data gathering and management. Ensuring a focus on workforce development and planning is an important part of integrated care development. This study has implications for social and voluntary sector organisations in respect of inter-agency working practices, as well as the identification of workforce development needs and potential for informing subsequent cross-sector workforce planning arrangements and communication. This paper helps to identify the issues and benefits of implementing person-centred, integrated teamworking and the implications for workforce planning and OD approaches.
      Citation: Journal of Integrated Care
      PubDate: 2021-03-31
      DOI: 10.1108/JICA-05-2020-0030
      Issue No: Vol. ahead-of-print, No. ahead-of-print (2021)
       
  • Coordination of paediatric oncology care: an explorative Swedish case
           study

         This is an Open Access Article Open Access Article

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      Authors: Christian Gadolin, Erik Eriksson, Patrik Alexandersson
      Abstract: The aim of this paper is to empirically describe and analyze factors deemed to be relevant for the successful provision of coordinated paediatric oncology care by physicians and nurses involved. A qualitative case study primarily consisting of interviews. The paper's findings indicate that certain factors (i.e. distinct mission, clear treatment protocols and support from external stakeholders) relevant for the provision of coordinated paediatric oncology care have not received sufficient attention in previous research. In addition, emphasis is placed on the necessity of facilitating constructive working relationships and a bottom-up perspective when pursuing improved care coordination. The factors described and analyzed may act as insights for how paediatric oncology might be improved in terms of care coordination and thus facilitate care integration. In addition, the paper's findings identify factors relevant for further empirical studies in order to delineate their generalizability.
      Citation: Journal of Integrated Care
      PubDate: 2021-03-23
      DOI: 10.1108/JICA-10-2020-0063
      Issue No: Vol. ahead-of-print, No. ahead-of-print (2021)
       
  • Measuring integrated care at the interface between primary care and
           secondary care: a scoping review

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      Authors: Aimee O'Farrell, Geoff McCombe, John Broughan, Áine Carroll, Mary Casey, Ronan Fawsitt, Walter Cullen
      Abstract: In many healthcare systems, health policy has committed to delivering an integrated model of care to address the increasing burden of disease. The interface between primary and secondary care has been identified as a problem area. This paper aims to undertake a scoping review to gain a deeper understanding of the markers of integration across the primary–secondary interface. A search was conducted of PubMed, SCOPUS, Cochrane Library and the grey literature for papers published in English using the framework described by Arksey and O'Malley. The search process was guided by the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA). The initial database search identified 112 articles, which were screened by title and abstract. A total of 26 articles were selected for full-text review, after which nine articles were excluded as they were not relevant to the research question or the full text was not available. In total, 17 studies were included in the review. A range of study designs were identified including a systematic review (n = 3), mixed methods study (n = 5), qualitative (n = 6) and quantitative (n = 3). The included studies documented integration across the primary–secondary interface; integration measurement and factors affecting care coordination. Many studies examine individual aspects of integration. However, this study is unique as it provides a comprehensive overview of the many perspectives and methodological approaches involved with evaluating integration within the primary–secondary care interface and primary care itself. Further research is required to establish valid reliable tools for measurement and implementation.
      Citation: Journal of Integrated Care
      PubDate: 2021-03-19
      DOI: 10.1108/JICA-11-2020-0073
      Issue No: Vol. ahead-of-print, No. ahead-of-print (2021)
       
  • The impact of structural changes to community nursing services on the rate
           of emergency hospital use of older people: a longitudinal ecological study
           of based on 140 primary care trusts in England

         This is an Open Access Article Open Access Article

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      Authors: Steven Wyatt, Robin Miller, Peter Spilsbury, Mohammed Amin Mohammed
      Abstract: In 2011, community nursing services were reorganised in England in response to a national policy initiative, but little is known about the impact of these changes. A total of three dominant approaches emerged: (1) integration of community nursing services with an acute hospital provider, (2) integration with a mental health provider and (3) the establishment of a stand-alone organisation, i.e. without structural integration. The authors explored how these approaches influenced the trends in emergency hospital admissions and bed day use for older people. The methodology was a longitudinal ecological study using panel data over a ten-year period from April 2006 to March 2016. This study’s outcome measures were (1) emergency hospital admissions and (2) emergency hospital bed use, for people aged 65+ years in 140 primary care trusts (PCTs) in England. The authors found no statistically significant difference in the post-intervention trend in emergency hospital admissions between those PCTS that integrated community nursing services with an acute care provider and those integrated with a mental health provider (IRR 0.999, 95% CI 0.986–1.013) or those that did not structurally integrate services (IRR 0.996, 95% CI 0.982–1.010). The authors similarly found no difference in the trends for emergency hospital bed use. PCTs were abolished in 2011 and replaced by clinical commissioning groups in 2013, but the functions remain. The authors found no evidence that any one structural approach to the integration of community nursing services was superior in terms of reducing emergency hospital use in older people. As far as the authors are aware, previous studies have not examined the impact of alternative approaches to integrating community nursing services on healthcare use.
      Citation: Journal of Integrated Care
      PubDate: 2021-01-20
      DOI: 10.1108/JICA-09-2020-0056
      Issue No: Vol. ahead-of-print, No. ahead-of-print (2021)
       
  • What are the priorities for the future development of integrated care'
           A scoping review

         This is an Open Access Article Open Access Article

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      Authors: Corey Burke , John Broughan , Geoff McCombe , Ronan Fawsitt , Áine Carroll , Walter Cullen
      Abstract: “Integrated care” (IC) is an approach to health and social care delivery that aims to prevent problems arising from fragmented care systems. The collective content of the IC literature, whilst valuable, has become extensive and wide-ranging to such a degree that knowing what is most important in IC is a challenge. This study aims to address this issue. A scoping review was conducted using Arksey and O'Malley's framework to determine IC priority areas. Twenty-one papers relevant to the research question were identified. These included studies from many geographical regions, encompassing several study designs and a range of populations and sample sizes. The findings identified four priority areas that should be considered when designing and implementing IC models: (1) communication, (2) coordination, collaboration and cooperation (CCC), (3) responsibility and accountability and (4) a population approach. Multiple elements were identified within these priorities, all of which are important to ensuring successful and sustained integration of care. These included education, efficiency, patient centredness, safety, trust and time. The study's findings bring clarity and definition to what has become an increasingly extensive and wide-ranging body of work on the topic of IC. Future research should evaluate the implementation of these priorities in care settings.
      Citation: Journal of Integrated Care
      PubDate: 2021-08-17
      DOI: 10.1108/JICA-01-2021-0002
      Issue No: Vol. 30 , No. 5 (2021)
       
  • Achieving sustainable governance of horizontal integration of care
           services: progress and democratic accountability of strategic coordination
           bodies for older people

         This is an Open Access Article Open Access Article

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      Authors: Stefan Szücs , Inger Kjellberg
      Abstract: The purpose is to analyse the relationship between democratic accountability and how sustainable governance is achieved by horizontally integrating care services for older people through collaboration in a coordination body of key leaders from across the health and social care system. The data and measures come from two surveys with coordination body members in Sweden (politicians, administrators, professionals) from a sample of 73 bodies in 2015 (n = 549) and the same/corresponding 59 bodies in 2019 (n = 389). The governance of integrating care scale and the accountability scales repeatedly show consistency among individual members. Systematic progress is found among large coordination bodies: the greater the average perception of governance of horizontally integrating care in 2015, the greater it was in 2019 – and regardless of the period, the stronger the internal administrative or political monitoring and reviewing of the coordination body, the greater its governance (while the relationship to the external monitoring and reviewing is weak). However, the growing importance of external accountability is indirect, shown by stronger correlations between the internal political and external monitoring and reviewing, regardless of size. The scales are based on self-reported perceptions that cannot be objectively verified, but they can be linked to changes in outcomes and user experiences in the later stages of the research. Repeatedly verified scales of internal and external accountability for analysing and evaluating governance of integrating care services horizontally, which is useful for improving strategic coordination of integrated care.
      Citation: Journal of Integrated Care
      PubDate: 2020-12-30
      DOI: 10.1108/JICA-06-2020-0042
      Issue No: Vol. 30 , No. 5 (2020)
       
  • Beyond the workforce training pipeline: embracing the meandering stream of
           “whole of life” and career to strengthen the retention of health
           professionals rurally

         This is an Open Access Article Open Access Article

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      Authors: Richard Colbran , Robyn Ramsden , Michael Edwards , Emer O'Callaghan , Dave Karlson
      Abstract: While Australia has continued to invest in polices and strategies aimed at improving rural health service provision, many communities still confront a disproportionate share of the rural workforce shortage. The NSW Rural Doctors Network (RDN) contributes its perspectives about the importance of a whole of life career and the meandering stream concept to support the retention of health professionals rurally. We unpack these concepts and examine how they bring to light a new and useful approach to addressing rural workforce challenges and potentially contribute to building a stronger integrated care approach. The approach used involved tapping into RDN's 30-years of experience in recruitment and retention of remote and rural health professionals, combined with insights from relevant existing and emerging evidence. We suggest that reframing retention to consider a life stage approach to career will guide more effective targeting of rural health policies, workforce planning, collaborative approaches and allocation of incentives. We posit that an understanding and acceptance of modern lifestyles and career pathways, and a celebration of career commitment to serving rural communities, is necessary for successful recruitment and retention of Australia's future rural health workforce beyond the training pipeline. We outline and visually represent RDN's meandering stream approach to building and retaining a capable rural health workforce through addressing life cycle and workforce level needs. This perspective paper draws on RDN's direct experience in the field.
      Citation: Journal of Integrated Care
      PubDate: 2020-12-01
      DOI: 10.1108/JICA-04-2020-0022
      Issue No: Vol. 30 , No. 5 (2020)
       
  • Journal of Integrated Care

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