Global approaches to integrated care: Best practices and ongoing innovation

The integration of behavioral health in primary care is critical for addressing worldwide concerns for access to, and quality of, health care services for physical and mental health promotion, prevention, and disease management. Clearly, promoting knowledge exchange internationally is critical to progress. In late 2015, the American Psychological Association convened an interdisciplinary summit on global approaches to integrated health care, bringing together 82 health care professionals (nurses, primary care physicians, psychologists, psychiatrists, and social workers) and scholars from diverse disciplines in medicine, psychology, economics, health policy, public health, and demography; participants came from 10 countries. The Global Summit provided an opportunity to share best practices and innovation in patient-centered integrated health care internationally. In this article, Global Summit participants from different countries reflect on the recommendations for future interprofessional endeavors across the following themes: build international interprofessional communities for change; advocate for, and promote social equity with, a population health and patient focus; advance research and program evaluation in integrated care; advance interprofessional training and education in integrated care; and develop financially sustainable models for integrated primary care. Building upon these recommendations and reflecting on current advancement in health care policy and integrated care research, new directions are suggested for clinicians, researchers, administrators, and policymakers working toward the advancement of integrated care to improve health care services globally. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The primary care home: a new vehicle for the delivery of population health in England

Purpose

The purpose of this paper is to consider how the evolving concept of the “primary care home” (PCH) that is developing in England might be an effective vehicle for the delivery of the goals of “population health”. The authors examine evidence from earlier initiatives to achieve similar objectives of primary care-led health system planning and care integration to understand relevant lessons for the PCH.

Design/methodology/approach

This paper is based on a descriptive review of the PCH using documentary sources and a non-systematic review of literature relating to primary care commissioning initiatives and recent initiatives to deliver general practice services on a larger scale.

Findings

The PCH is likely to bring forth relatively high engagement from general practitioners due to its neighbourhood scale, voluntary nature and its focus on professional partnership, personalisation of care and outcomes. It is important that participants have sufficient autonomy to act and that financial incentives are aligned with the goals of population health. It is also important that, unlike some earlier primary care initiatives, the PCH is given time to develop to maturity.

Originality/value

The PCH is a recent phenomenon that is developing in England and elsewhere. This paper locates the PCH within a historical context and draws conclusions from a relevant evidence base.

Evaluation of a programme in population health management for GP trainees

OBJECTIVES

There is an increasing focus on improving outcomes for populations. General practice has a key role to play in achieving better patient outcomes. A programme in population health management was developed for GP trainees in their fourth year. The objective was to evaluate this educational intervention for impact upon learners, and lessons learned in the delivery of this innovative programme.

METHODS

The evaluation approach combined qualitative and quantitative approaches involving GP trainees, GP trainers, and faculty.

RESULTS

Involvement in the programme had a positive impact upon trainees' knowledge of population health management, developed transferable skills, and encouraged a shift in mindset to considering the needs of a practice population. The impact upon patients and practices is also described. Lessons learned for enhancing the programme are explained.

CONCLUSIONS

Encouraging GP trainees to become involved with population health has significant benefits for their professional development. The Royal College of General Practitioners (RCGP) curriculum should consider incorporating population health competencies.

Teaching GP trainees to use health coaching in consultations with patients: evaluation of a pilot study

PURPOSE

The purpose of this paper is to describe the results of an evaluation of teaching health coaching to GP trainees for use in consultations with patients.

DESIGN

Fourteen GP trainees were invited to attend a coaching skills training course. Each trainee was asked to apply coaching skills to up to four patients with long-term conditions. The evaluation used observation, surveys, review of trainee portfolios, and interviews with GP trainees, patients, and other stakeholders.

FINDINGS

This evaluation found that it is feasible and useful to train GPs in health coaching. It had positive benefits for GP trainees, their patients, and the wider system. Lessons were also learned about the timing of the training, the style and content, the challenges of practising coaching skills within clinical practice, and selecting the most appropriate patients for coaching.

LIMITATIONS

This is a small pilot with a keen group of GP trainees. Further research is needed to determine if such an approach provides meaningful changes to patient outcomes and whether such approaches are cost-effective.

Evaluating the care of patients with long term conditions

Approaches to evaluating the care of patients with long-term conditions first need to be framed around defining outcomes that 'matter to people', rather than those that are focused on disease and easily measurable. Secondly, approaches to evaluating such care should be organised with the ability to 'deliver what matters to people' - such models of care must allow for the opportunity to maximise the impact of primary care. Finally, any approach to evaluation must also 'enable the delivery of what matters to people', including approaches to promote self-care, well-being and interprofessional workforce development organised around educational networks.

Workplace-based assessment

Workplace-based assessment is now widespread throughout medicine. If carried out well, such assessments reconnect teaching and testing to the benefit of the learner. But workplace-based assessment brings a unique set of challenges to medical education and requires fresh thinking about how we consider and construct assessment programmes.

Workplace assessment for licensing in general practice

With the redesign of general practice training implicit in the Department of Health's programme of reform, Modernising Medical Careers, there is the opportunity to bring summative assessment and the MRCGP examination together into a unified assessment framework for licensing. It is likely that assessment in the workplace will play a central role in such a process. Workplace assessment is of high validity and has the potential to reconnect teaching and testing in general practice. Five principles to underpin the design of a workplace assessment are proposed, namely that it should be: competency-based, developmental, evidential, locally assessed, and triangulated. Successful implementation of workplace assessment will not only serve to reduce the current testing burden on trainees, but will also harness the involvement of medical teachers. In doing so, general practice has the opportunity to create a powerful tool for professional development.