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Persson MH, Søndergaard J, Mogensen CB, Skjøt-Arkil H, Andersen PT. Healthcare professionals' experiences and attitudes to care coordination across health sectors: an interview study. BMC Geriatr 2022; 22:509. [PMID: 35729544 PMCID: PMC9210644 DOI: 10.1186/s12877-022-03200-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background The number of older people is increasing, resulting in more people endure chronic diseases, multimorbidities and complex care needs. Insufficient care coordination across healthcare sectors has negative consequences for health outcomes, costs and patient evaluation. Despite introducing initiatives to solve coordination challenges within healthcare, the need remains for more consistent solutions. In particular, improved care coordination would benefit older adults characterised by complex care needs, high use of healthcare resources and multiple care providers. Aims and objectives To identify and analyse healthcare professionals’ perspectives and approaches to care coordination across sectors when older people are acutely hospitalised. Design Qualitative interview study. Methods Semi-structured, individual interviews with 13 healthcare professionals across health sectors and professions were conducted. The strategy for the qualitative analysis was inspired by Kirsti Malterud and labelled ‘systematic text condensation’. This strategy is a descriptive and explorative method for thematic cross-case analysis of qualitative data. Results Four themes/categories emerged from the analysis; “Organisational factors”, “Approaches to care”, “Communication and knowledge”, and “Relations”. Conclusion Different organisational cultures can discourage intersectoral care coordination. Approaches to care vary at all levels across health sectors and professions. Organisational, leadership and professional identity affect the working cultures and must be considered in the future recruitment and socialisation of healthcare staff. Our research suggests that combinations of healthcare standardisations and flexible, adaptive solutions are required to improve intersectoral care coordination. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03200-6.
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Affiliation(s)
- Maiken Hjuler Persson
- Department of Public Health, University of Southern Denmark, Degnevej 14, 6705, Esbjerg, Denmark.
| | - Jens Søndergaard
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense, Denmark
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern, Winsløwparken 19,3, 5000, Odense, Denmark
| | - Helene Skjøt-Arkil
- Emergency Department, Hospital Sønderjylland, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern, Winsløwparken 19,3, 5000, Odense, Denmark
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Lanford D, Petiwala A, Landers G, Minyard K. Aligning healthcare, public health and social services: A scoping review of the role of purpose, governance, finance and data. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:432-447. [PMID: 34018268 PMCID: PMC9291477 DOI: 10.1111/hsc.13374] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/28/2021] [Accepted: 03/10/2021] [Indexed: 06/01/2023]
Abstract
Organisations spanning social services, public health and healthcare have increasingly experimented with collaboration as a tool for improving population health and reducing health disparities. While there has been progress, the results have fallen short of expectations. Reflecting on these shortcomings, the Robert Wood Johnson Foundation (RWJF) recently proposed a new framework for cross-sector alignment intended to move the field towards improved outcomes. A central idea in this framework is that collaboratives will be more effective and sustainable if they develop collaborative systems in four core areas: shared purpose, governance, finance and shared data. The goal of this paper is to provide a foundation for research on the four core areas of the cross-sector alignment framework. Accordingly, this study is based on two guiding questions: (1) how are collaboratives currently implementing systems in the four core areas identified in the framework, and (2) what strategies does the literature offer for creating sustainable systems in these four areas? Given the emergent nature of research on health-oriented cross-sector collaboration and the broad research questions, we conducted a systematic scoping review including 179 relevant research papers and reports published internationally from the years 2010-2020. We identified the main contributions and coded each based on its relevance to the cross-sector alignment framework. We found that most papers focused on programme evaluations rather than theory testing, and while many strategies were offered, they tended to reflect a focus on short-term collaboration. The results also demonstrate that starting points and resource levels vary widely across individuals and organisations involved in collaborations. Accordingly, identifying and comparing distinct pathways by which different parties might pursue cross-sector alignment is an imperative for future work. More broadly, the literature is ripe with observations that could be assessed systematically to produce a firm foundation for research and practice.
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Affiliation(s)
- Daniel Lanford
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| | - Aliza Petiwala
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| | - Glenn Landers
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
| | - Karen Minyard
- Georgia Health Policy CenterAndrew Young School of Policy StudiesGeorgia State UniversityAtlantaGAUSA
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Persson MH, Mogensen CB, Søndergaard J, Skjøt-Arkil H, Andersen PT. Healthcare professionals' practice and interactions in older peoples' cross-sectoral clinical care trajectories when acutely hospitalized - a qualitative observation study. BMC Health Serv Res 2021; 21:944. [PMID: 34503461 PMCID: PMC8431887 DOI: 10.1186/s12913-021-06953-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare services have become more complex, globally and nationally. Denmark is renowned for an advanced and robust healthcare system, aiming at a less fragmented structure. However, challenges within the coordination of care remain. Comprehensive restructures based on marketization and efficiency, e.g. New Public Management (NPM) strategies has gained momentum in Denmark including. Simultaneously, changes to healthcare professionals' identities have affected the relationship between patients and healthcare professionals, and patient involvement in decision-making was acknowledged as a quality- and safety measure. An understanding of a less linear patient pathway can give rise to conflict in the care practice. Social scientists, including Jürgen Habermas, have highlighted the importance of communication, particularly when shared decision-making models were introduced. Healthcare professionals must simultaneously deliver highly effective services and practice person-centered care. Co-morbidities of older people further complicate healthcare professionals' practice. AIM This study aimed to explore and analyse how healthcare professionals' interactions and practice influence older peoples' clinical care trajectory when admitted to an emergency department (ED) and the challenges that emerged. METHODS This qualitative study arises from a hermeneutical stand within the interpretative paradigm. Focusing on the healthcare professionals' interactions and practice we followed the clinical care trajectories of seven older people (aged > 65, receiving daily homecare) acutely hospitalized to the ED. Participant observations were combined with interviews with healthcare professionals involved in the clinical care trajectory. We followed-up with the older person by phone call until four weeks after discharge. The study followed the code of conduct for research integrity and is reported in accordance with the Standards for Reporting Qualitative Research (SRQR) guidelines. RESULTS The analysis revealed four themes: 1)"The end justifies the means - 'I know what is best for you'", 2)"Basic needs of care overruled by system effectiveness", 3)"Treatment as a bargain", and 4)"Healthcare professionals as solo detectives". CONCLUSION Dissonance between system logics and the goal of person-centered care disturb the healthcare practice and service culture negatively affecting the clinical care trajectory. A practice culture embracing better communication and more person-centered care should be enhanced to improve the quality of care in cross-sectoral trajectories.
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Affiliation(s)
- Maiken Hjuler Persson
- Emergency Department, Hospital Sønderjylland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark.
- Research Unit for Health Promotion, Department of Public Health, University of Southern Denmark, Degnevej 14, 6705, Esbjerg, Denmark.
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
- Department of Regional Health Research, Winsløwparken 19,3, 5000, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, J. B. Winsløws Vej 9A, 5000, Odense, Denmark
- Research Unit for Health Promotion, Department of Public Health, University of Southern Denmark, Degnevej 14, 6705, Esbjerg, Denmark
| | - Helene Skjøt-Arkil
- Emergency Department, Hospital Sønderjylland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
- Department of Regional Health Research, Winsløwparken 19,3, 5000, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Research Unit for Health Promotion, Department of Public Health, University of Southern Denmark, Degnevej 14, 6705, Esbjerg, Denmark
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HUGHES GEMMA, SHAW SARAE, GREENHALGH TRISHA. Rethinking Integrated Care: A Systematic Hermeneutic Review of the Literature on Integrated Care Strategies and Concepts. Milbank Q 2020; 98:446-492. [PMID: 32436330 PMCID: PMC7296432 DOI: 10.1111/1468-0009.12459] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Policy Points Integrated care is best understood as an emergent set of practices intrinsically shaped by contextual factors, and not as a single intervention to achieve predetermined outcomes. Policies to integrate care that facilitate person-centered, relationship-based care can potentially contribute to (but not determine) improved patient experiences. There can be an association between improved patient experiences and system benefits, but these outcomes of integrated care are of different orders and do not necessarily align. Policymakers should critically evaluate integrated care programs to identify and manage conflicts and tensions between a program's aims and the context in which it is being introduced. CONTEXT Integrated care is a broad concept, used to describe a connected set of clinical, organizational, and policy changes aimed at improving service efficiency, patient experience, and outcomes. Despite examples of successful integrated care systems, evidence for consistent and reproducible benefits remains elusive. We sought to inform policy and practice by conducting a systematic hermeneutic review of literature covering integrated care strategies and concepts. METHODS We used an emergent search strategy to identify 71 sources that considered what integrated care means and/or tested models of integrated care. Our analysis entailed (1) comparison of strategies and concepts of integrated care, (2) tracing common story lines across multiple sources, (3) developing a taxonomy of literature, and (4) generating a novel interpretation of the heterogeneous strategies and concepts of integrated care. FINDINGS We identified four perspectives on integrated care: patients' perspectives, organizational strategies and policies, conceptual models, and theoretical and critical analysis. We subdivided the strategies into four framings of how integrated care manifests and is understood to effect change. Common across empirical and conceptual work was a concern with unity in the face of fragmentation as well as the development and application of similar methods to achieve this unity. However, integrated care programs did not necessarily lead to the changes intended in experiences and outcomes. We attribute this gap between expectations and results, in part, to significant misalignment between the aspiration for unity underpinning conceptual models on the one hand and the multiplicity of practical application of strategies to integrate care on the other. CONCLUSIONS Those looking for universal answers to narrow questions about whether integrated care "works" are likely to remain disappointed. Models of integrated care need to be valued for their heuristic rather than predictive powers, and integration understood as emerging from particular as well as common contexts.
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Affiliation(s)
- GEMMA HUGHES
- Nuffield Department of Primary Care Health SciencesUniversity of Oxford
| | - SARA E. SHAW
- Nuffield Department of Primary Care Health SciencesUniversity of Oxford
| | - TRISHA GREENHALGH
- Nuffield Department of Primary Care Health SciencesUniversity of Oxford
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Madsen SB, Beedholm K, Bro F, Ledderer LK, Vestergård LO, Burau V. Implementing Integrated Community-Based Primary Healthcare: Applying the iCoach-Approach to Case Selection to Denmark. Int J Integr Care 2019; 19:3. [PMID: 31749667 PMCID: PMC6838767 DOI: 10.5334/ijic.4663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/20/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The iCoach approach to case selection focuses on innovative models of community-based primary healthcare (CBPHC) and their contexts. The aim of this study was to assess the possibilities and limitations of the approach based on Denmark, which differs in significant ways from the jurisdictions initially included. THEORY AND METHODS Case study research suggests the approach is an interesting attempt to standardise case selection based on literal replication. The study reviewed the national grey literature and interviewed key informants at national and local levels. RESULTS Applying the approach to Denmark required redefining selection criteria related to collaboration and context to capture its specific institutional and policy context. Selecting cases at the organisational level also required assessing how the system level contexts compared to those of the initial three jurisdictions included in iCoach. DISCUSSION The iCoach approach allows collecting broadly comparable cases of innovative models of CBPHC across jurisdictions. However, the analysis of underlying conditions of implementing innovative models requires a more interactive approach to case selection. CONCLUSION Researchers need to be clearer about the specific purpose of the case selection. This is also highly relevant for practitioners to ensure that insights are applicable in specific local and national contexts.
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Affiliation(s)
| | | | | | | | | | - Viola Burau
- Department of Public Health, Aarhus University, DK
- Department of Political Science, Aarhus University, DK
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Inter-Sectoral Collaboration in Municipal Health Centres: A Multi-Site Qualitative Study of Supporting Organizational Elements and Individual Drivers. Int J Integr Care 2019; 19:9. [PMID: 31244563 PMCID: PMC6588026 DOI: 10.5334/ijic.4196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Community health centres accommodating different professional groups are expected to improve inter-sectoral collaboration between primary care providers. This study aimed to identify what has been done to support inter-sectoral collaboration between municipal professionals and general practitioners in health centres, and to explore the interactions that emerge between these professionals at the operational level. Methods The study was a multi-site qualitative study carried out in four municipal health centres in a Danish region. The study was based on documents and qualitative interviews with general practitioners, and municipal professionals and administrators in each of the health centres. A content analysis was conducted. Results The study found that little attention had been given to the organizational prerequisites for enhanced inter-sectoral collaboration in the health centres. Even though some health centres had employed coordinators, these did not play a significant role as facilitators of collaboration partly due to a lack of political and managerial attention. At the operational level, inter-sectoral collaboration was limited to ad hoc interactions between professionals. Although these interactions could be useful, they did not evolve into more systematic forms of collaboration. Conclusion The gap between policy visions and actual implementation efforts found in this study suggests that a more active and focused engagement from the political-administrative level is needed if the visions of increased inter-sectoral collaboration in health centres are to be realised.
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Abstract
Introduction: To meet the needs of vulnerable people, the integration of services across different sectors is important. This paper presents a preliminary review of service integration across sectors in Europe. Examples of service integration between social services, health, employment and/or education were studied. A further aim of the study was to improve conceptual clarity regarding service integration across sectors, using Minkman’s Developmental Model for Integrated Care (DMIC) as an analytical framework. Methods: The study methods comprised a literature review (34 articles) and a survey of practice examples across Europe (44 practices). This paper is based on a more comprehensive study published in 2016. Results: The study demonstrates that although the focus of integration across sectors is often on social services and health care, other arrangements are also frequently in place. The review shows that integration may be either tailored to a particular target group or designed for communities in general. Although systems to monitor and evaluate social service integration are often present, they are not yet fully developed. The study also highlights the importance of good leadership and organizational support in integrated service delivery. Discussion: The study shows that the DMIC can work as a conceptual framework for the analysis of service integration across sectors. However, as this is an exploratory study, further in-depth case studies are required to deepen our understanding of the processes involved in service integration across sectors.
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Andersen AB, Frederiksen K, Kolbaek R, Beedholm K. Governing citizens and health professionals at a distance: A critical discourse analysis of policies of intersectorial collaboration in Danish health-care. Nurs Inq 2017; 24. [DOI: 10.1111/nin.12196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Anne Bendix Andersen
- Department of Science in Nursing; Aarhus University Health; Aarhus Denmark
- Medical Department and Department of Cardiology; Regional Hospital Viborg; Viborg Denmark
- Center for Clinical Research in Nursing; Regional Hospital Viborg; Viborg Denmark
| | | | - Raymond Kolbaek
- Center for Clinical Research in Nursing; Regional Hospital Viborg; Viborg Denmark
| | - Kirsten Beedholm
- Department of Science in Nursing; Aarhus University Health; Aarhus Denmark
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Rustad EC, Cronfalk BS, Furnes B, Dysvik E. Continuity of Care during Care Transition: Nurses’ Experiences and Challenges. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojn.2017.72023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Scheele CE, Vrangbæk K. Co-location as a Driver for Cross-Sectoral Collaboration with General Practitioners as Coordinators: The Case of a Danish Municipal Health Centre. Int J Integr Care 2016; 16:15. [PMID: 28316555 PMCID: PMC5354220 DOI: 10.5334/ijic.2471] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/22/2016] [Indexed: 11/28/2022] Open
Abstract
The issue of integrated care and inter-sectoral collaboration is on the health policy agenda in many countries. Yet, there is limited knowledge about the effects of the different policy instruments used to achieve this. This paper studies co-location as a driver for cross-sectoral collaboration with general practitioners (GPs) acting as coordinators in a municipal health centre. The purpose of the health centre, which is staffed by health professionals from municipal, regional and private sectors, is to provide primary health services to the citizens of the municipality. Co-locating these professionals is supposed to benefit e.g., elder citizens and patients with chronic diseases who frequently require services from health professionals across administrative sectors. Methodologically, the analysis is based on qualitative data in the form of semi-structured interviews with the health professionals employed at the health centre and with administrative managers from municipal and regional government levels. The study finds that co-location does not function as a driver for cross-sectoral collaboration in a health centre when GPs act as coordinators. Cross-sectoral collaboration is hampered by the general practitioners' work routines and professional identity, by organisational factors and by a lack of clarity concerning the content of collaboration with regard to economic and professional incentives.
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Affiliation(s)
- Christian Elling Scheele
- University of Copenhagen, Department of Public Health, Centre for Healthy Aging, Centre for Health Economics, DK
| | - Karsten Vrangbæk
- University of Copenhagen, Department of Public Health, Centre for Healthy Aging, Centre for Health Economics, DK
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Kirchhoff R, Ljunggren B. Aspects of Equality in Mandatory Partnerships - From the Perspective of Municipal Care in Norway. Int J Integr Care 2016; 16:6. [PMID: 27616962 PMCID: PMC5015551 DOI: 10.5334/ijic.2025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/04/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION This paper raises questions about equality in partnerships, since imbalance in partnerships may effect collaboration outcomes in integrated care. We address aspects of equality in mandatory, public-public partnerships, from the perspective of municipal care. We have developed a questionnaire wherein the Norwegian Coordination Reform is an illustrative example. The following research question is addressed: What equality dimensions are important for municipals related to mandatory partnerships with hospitals? THEORY/METHODS Since we did not find any instrument to measure equality in partnerships, an explorative design was chosen. The development of the instrument was based on the theory on partnership and knowledge about the field and context. A national online survey was emitted to all 429 Norwegian municipalities in 2013. The response rate was in total 58 percent (n = 248). The data were mainly analysed using Principal component analysis. RESULTS It seems that the two dimensions "learning and expertise equality" and "contractual equality" collects reliable and valid data to measure aspects of equality in partnerships. DISCUSSION Partnerships are usually based on voluntarism. The results indicate that mandatory partnerships, within a public health care system, can be appropriate to equalize partnerships between health care providers at different care levels.
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Affiliation(s)
- Ralf Kirchhoff
- Associate Professor, Trøndelag R&D Institute, Steinkjer,
Norway
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Interorganisational Integration: Healthcare Professionals' Perspectives on Barriers and Facilitators within the Danish Healthcare System. Int J Integr Care 2016; 16:4. [PMID: 27616948 PMCID: PMC5015550 DOI: 10.5334/ijic.2449] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Despite many initiatives to improve coordination of
patient pathways and intersectoral cooperation, Danish health care is still
fragmented, lacking intra- and interorganisational integration. This study
explores barriers to and facilitators of interorganisational integration as
perceived by healthcare professionals caring for patients with chronic
obstructive pulmonary disease within the Danish healthcare system. Methods: Seven focus groups were conducted in January through July
2014 with 21 informants from general practice, local healthcare centres and a
pulmonary department at a university hospital in the Capital Region of
Denmark. Results and discussion: Our results can be grouped into five
influencing areas for interorganisational integration: communication/information
transfer, committed leadership, patient engagement, the role and competencies of
the general practitioner and organisational culture. Proposed solutions to
barriers in each area hold the potential to improve care integration as
experienced by individuals responsible for supporting and facilitating it.
Barriers and facilitators to integrating care relate to clinical, professional,
functional and normative integration. Especially, clinical, functional and
normative integration seems fundamental to developing integrated care in
practice from the perspective of healthcare professionals.
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Tsiachristas A, Lionis C, Yfantopoulos J. Bridging knowledge to develop an action plan for integrated care for chronic diseases in Greece. Int J Integr Care 2015; 15:e040. [PMID: 27118957 PMCID: PMC4843177 DOI: 10.5334/ijic.2228] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 11/20/2022] Open
Abstract
The health, social and economic impact of chronic diseases is well documented in Europe. However, chronic diseases threaten relatively more the 'memorandum and peripheral' Eurozone countries (i.e., Greece, Spain, Portugal and Ireland), which were under heavy recession after the economic crisis in 2009. Especially in Greece, where the crisis was the most severe across Europe, the austerity measures affected mainly people with chronic diseases. As a result, the urgency to tackle the threat of chronic diseases in Greece by promoting public health and providing effective chronic care while flattening the rising health care expenditure is eminent. In many European countries, integrated care is seen as a means to achieve this. The aim of this paper was to support Greek health policy makers to develop an action plan from 2015 onwards, to integrate care by bridging local policy context and needs with knowledge and experience from other European countries. To achieve this aim, we adopted a conceptual framework developed by the World Health Organization on one hand to analyse the status of integrated care in Greece, and on the other to develop an action plan for reform. The action plan was based on an analysis of the Greek health care system regarding prerequisite conditions to integrate care, a clear understanding of its context and successful examples of integrated care from other European countries. This study showed that chronic diseases are poorly addressed in Greece and integrated care is in embryonic stage. Greek policy makers have to realise that this is the opportunity to make substantial reforms in chronic care. Failing to reform towards integrated care would lead to the significant risk of collapse of the Greek health care system with all associated negative consequences. The action plan provided in this paper could support policy makers to make the first serious step to face this challenge. The details and specifications of the action plan can only be decided by Greek policy makers in close cooperation with other health and social care partners. This is the appropriate time for doing so.
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Affiliation(s)
- Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - Christos Lionis
- Clinic of Social and Family Medicine, Medical School, University of Crete, Greece
| | - John Yfantopoulos
- School of Economics and Political Science, University of Athens, Greece
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