Implementation of an integrated care model between general practitioner and cardiologist

2019 ◽  
Vol 27 (4) ◽  
pp. 305-315 ◽  
Author(s):  
Marijke Paula Margaretha Vester ◽  
Greetje Johanna de Grooth ◽  
Tobias Nicolaas Bonten ◽  
Bas Leendert van der Hoeven ◽  
Marieke Susanne de Doelder ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Integrated Care ◽  
Healthcare Delivery ◽  
Real Life ◽  
Cost Savings ◽  
Care Model ◽  
Potential Cost ◽  
Content Type ◽  
Program Costs

Purpose Integrated care models have shown to deliver efficient healthcare, but implementation has proven to be difficult. The Support Consultation is an integrated care model, which enables full integration by bundled payment, insurer involvement, predefined care pathways and strengthening of primary care. The purpose of this paper is to provide an indication of the improvements in healthcare delivery after implementation of this proposed model and to create a base for extension to similar interfaces between primary and secondary care. Design/methodology/approach A retrospective study was used to compare the effect on the number of referred patients with non-acute cardiac complaints and the cost effectiveness before and after implementation of the Support Consultation. Patients who previously would have been referred to the cardiologist were now discussed between general practitioner and cardiologist in a primary care setting. Findings The first consecutive 100 patients (age 55±16 years, male 48 percent), discussed in the Support Consultation, were analyzed. Implementation of the Support Consultation resulted in a net costs (program costs and referral costs) reduction of 61 percent compared with usual care. All involved parties were positive about the program. Research limitations/implications The Support Consultation has the ability to provide more effective healthcare delivery and to reduce net costs. The setting of the current study can be used as example for other specialties in countries with a similar healthcare system. Originality/value This study provides the potential cost savings after implementation of an integrated care model, based on real-life data.

Prescription of compression stockings in France in primary care

2013 ◽  
Vol 29 (6) ◽  
pp. 390-396
Author(s):  
J-P Benigni ◽  
X Ansolabehere ◽  
X Saudez ◽  
M Toussi ◽  
S Branchoux ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Retrospective Analysis ◽  
General Practitioners ◽  
Real Life ◽  
Venous Disease ◽  
Compression Stocking ◽  
Actual Situation ◽  
Compression Stockings ◽  
One Year

Objectives Recent French data describing real-life compression stocking use are lacking. This study aimed to describe the actual situation for patients who were prescribed compression stockings by their general practitioner and to assess annual treatment costs from a societal perspective. Methods A retrospective analysis using Disease Analyzer database data from 6349 adults with at least one compression stocking prescription between July 2009 and June 2010. Results Mean patient age was 58 years, and 72.3% of patients were women. Seven out of 10 patients received only a single compression stocking prescription over one year. The estimated mean annual per patient cost was 152.2 ± 100.7 Euros. Conclusion Most patients received only a single compression stocking prescription during one year. General practitioners prescribing compression stockings more often may have a better understanding of venous disease and may manage their patients differently. Although more expensive, this approach may be one which should be accepted more widely.

scholarly journals Effect of an integrated care pathway on use of primary and secondary healthcare by patients at high risk of emergency inpatient admission: a matched control cohort study in Tower Hamlets

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026470 ◽  
Author(s):  
Will Parry ◽  
Arne Timon Wolters ◽  
Richard James Brine ◽  
Adam Steventon
Keyword(s):  
General Practitioner ◽  
High Risk ◽  
Integrated Care ◽  
Care Pathway ◽  
Real Life ◽  
Healthcare Utilisation ◽  
Inpatient Admission ◽  
First Year ◽  
Secondary Endpoints ◽  
Integrated Care Pathway

ObjectivesTo assess the effects of an integrated care pathway on the use of primary and secondary healthcare by patients at high risk of emergency inpatient admission.DesignObservational study of a real-life deployment of integrated care, using patient-level administrative data. Regression analysis was used to compare integrated care patients with matched controls.SettingA deprived, inner city London borough (Tower Hamlets).Participants1720 patients aged 50+ years registered with a general practitioner in Tower Hamlets and at high risk of emergency inpatient admission enrolled onto integrated care during 2014. These patients were matched to control patients, also selected from Tower Hamlets, with respect to demographics, diagnoses of health conditions, previous hospital use and risk score.InterventionsEnrolled patients were eligible for a range of interventions, such as case management, support with self-care and enhanced care coordination. Control patients received usual care.Primary and secondary endpointsNumber of emergency inpatient admissions in the year after enrolment onto integrated care. Secondary endpoints included numbers of elective inpatient admissions, inpatient bed days, accident and emergency attendances, outpatient attendances and general practitioner contacts in the year after enrolment.ResultsThere was no evidence that the integrated care pathway reduced patients’ healthcare utilisation in the first year post-enrolment. Matched controls and integrated care patients were similar at baseline. Following enrolment, integrated care patients were more likely than matched controls to experience elective inpatient admissions (adjusted incidence rate ratio (IRR)=1.27, 95% CI 1.08 to 1.49, p=0.004). They were also more likely to experience general practitioner contacts (adjusted IRR=1.11, 95% CI 1.06 to 1.16, p<0.001), but other endpoints were not significantly different between the groups.ConclusionsThe integrated care pathway was not associated with a reduction in healthcare utilisation in the first year, but appeared to have increased elective inpatient admissions and general practitioner workload.

Why care about integrated care? Part 2. Integrated care systems: an irresistible force changing mental health services

2020 ◽  
pp. 1-12 ◽  
Author(s):  
Derek K. Tracy ◽  
Frank Holloway ◽  
Kara Hanson ◽  
Nikita Kanani ◽  
Matthew Trainer ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Integrated Care ◽  
Healthcare Delivery ◽  
Local Implementation ◽  
The Past ◽  
Care Systems

SUMMARY Part 1 of this three-part series on integrated care discussed the drivers for change in healthcare delivery in England set out in the NHS Long Term Plan. This second part explores the evolution of mental health services within the wider National Health Service (NHS), and describes important relevant legislation and policy over the past decade, leading up to the 2019 Long Term Plan. We explain the implications of this, including the detail of emerging structures such as integrated care systems (ICSs) and primary care networks (PCNs), and conclude with challenges facing these novel systems. Part 3 will address the practical local implementation of integrated care.

scholarly journals Reducing vitamin D requests in a primary care cohort: a quality improvement study

BJGP Open ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. bjgpopen20X101090
Author(s):  
Veena Patel ◽  
Clare Gillies ◽  
Prashanth Patel ◽  
Timothy Davies ◽  
Sajeda Hansdot ◽  
...  
Keyword(s):  
Primary Care ◽  
Vitamin D ◽  
Cost Savings ◽  
Request Form ◽  
Post Intervention ◽  
Potential Cost ◽  
Cost Modelling ◽  
Clinically Significant ◽  
Primary Care Practitioners ◽  
The Uk

BackgroundSince 2000, vitamin D requests have increased 2–6 fold with no evidence of a corresponding improvement in the health of the population. The ease of vitamin D requesting may contribue to the rapid rise in its demand and, hence, pragmatic interventions to reduce vitamin D test ordering are warranted.AimTo study the effect on vitamin D requests following a redesign of the electronic forms used in primary care. In addition, any potential harms were studied and the potential cost-savings associated with the intervention were evaluated.Design & settingAn interventional study took place within primary care across Leicestershire, England.MethodThe intervention was a redesign of the electronic laboratory request form for primary care practitioners across the county. Data were collected on vitamin D requests for a 6-month period prior to the change (October 2016 to March 2017) and the corresponding 6-month period post-intervention (October 2017 to March 2018), data were also collected on vitamin D, calcium, and phosphate levels.ResultsThe number of requests for vitamin D decreased by 14 918 (36.2%) following the intervention. Changes in the median calcium and phosphate were not clinically significant. Cost-modelling suggested that if such an intervention was implemented across primary care in the UK, there would be a potential annual saving to the NHS of £38 712 606.ConclusionA simple pragmatic redesign of the electronic request form for vitamin D test led to a significant reduction in vitamin D requests without any adverse effect on the quality of care.

Heart Failure Integrated Care Project: overcoming barriers encountered by primary health care providers in heart failure management

2020 ◽  
Vol 44 (3) ◽  
pp. 451
Author(s):  
Victar Hsieh ◽  
Glenn Paull ◽  
Barbara Hawkshaw
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
General Practice ◽  
Integrated Care ◽  
Significant Proportion ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Model ◽  
Care Project ◽  
Effective Delivery

ObjectiveHeart failure (HF) is associated with increased morbidity and mortality. A significant proportion of HF patients will have repeated hospital presentations. Effective integration between general practice and existing HF management programs may address some of the challenges in optimising care for this complex patient population. The Heart Failure Integrated Care Project (HFICP) investigated the barriers encountered by primary healthcare providers in providing care to patients with HF in the community. MethodsFive general practices in the St George and Sutherland regions (NSW, Australia) that employed practice nurses (PNs) were enrolled in the project. Participants responded to a printed survey that asked about their perceived role in the management of HF patients and their current knowledge and confidence in managing this condition. Participants also took part in a focus group meeting and were asked to identify barriers to improving HF patient management in general practice, and to offer suggestions about how the project could assist them to overcome those barriers. ResultsBarriers to effective delivery of HF management in general practice included clinical factors (consultation time limitations, underutilisation of patient management systems, identifying patients with HF, lack of patient self-care materials), professional factors (suboptimal hospital discharge summary letters, underutilisation of PNs), organisation factors (difficulties in communication with hospital staff, lack of education regarding HF management) and system issues (no Medicare rebate for B-type natriuretic peptide testing, insufficient Medicare rebate for using PN in chronic disease management). ConclusionsThe HFICP identified several barriers to improving integrated management for HF patients in the Australian setting. These findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between hospitals and primary care providers in delivering better care to HF patients. What is known about the topic?Multidisciplinary HF programs are heterogeneous in their structures, they have low patient participation rates and a significant proportion of HF patients have further presentations to hospital with HF. Integrating the care of HF patients into the primary care system following hospital admission remains challenging. What does this paper add?This paper identified several factors that hinder the effective delivery of care by primary care providers to patients with HF. What are the implications for practitioners?The findings provide important insights into how an HF integrated care model can be implemented to strengthen the working relationship between tertiary health facilities and primary care providers in delivering better care to HF patients.

Practice-integrated care teams – learning for a better future

2015 ◽  
Vol 23 (2) ◽  
pp. 74-87 ◽  
Author(s):  
Angela Beacon
Keyword(s):  
General Practice ◽  
Integrated Care ◽  
Secondary Care ◽  
Social Care ◽  
Cost Savings ◽  
Building Blocks ◽  
Urgent Care ◽  
Recent Experience ◽  
Content Type ◽  
Health And Social Care

Purpose – The purpose of this paper is to present a case study of one element of the integrated work which has taken place in Central Manchester, the development of multi-disciplinary Practice-Integrated Care Teams (PICT). The paper will show how working together has become a practical reality for members of these teams, and is forming the building blocks for further integration across neighbourhoods. Design/methodology/approach – This paper draws on the author’s experience of working in the PICT project from 2012 to 2014. The report will draw on the evaluation work which took place during the project, and will include reflections from others involved in the project and members of the teams. Findings – The integrated care teams which have been developed in Central Manchester have started to make significant changes to the ways that professionals work together, to the experience that patients have and to the costs of urgent care provision. Whilst there is still a long way to go, there has been significant learning from the PICT. This includes improved patient outcomes and experience. There has been an overall reduction in secondary care activity for patients the teams have been working with, with the largest reduction being in emergency admissions. Alongside this, patient feedback has reinforced the value of this personalised approach and increased overall satisfaction with the care and advice received from health and social care professionals and an improved professional experience. Evaluation has demonstrated that amongst professionals involved in the team there is a strong commitment to the principles of integrated care and that the confidence, skills and capacity of the teams have strengthened since this way of working has been introduced. As monitoring of financial impact continues to develop, cost savings from secondary care, particularly around emergency unplanned care, are encouraging. Originality/value – This paper draws on the recent experience of designing and delivering integrated care across a range of multi-agency, multi-professional partners. The model which has been developed centres around the role of general practice, and has enabled primary care to take a key role in the development of an out-of-hospital integrated care system. This has enabled community professionals such as nurses and social workers to build a much stronger relationship with general practice and enable system linkages which will be essential to the delivery of joined-up health and social care in the future. The project has been accompanied by thorough and ongoing evaluation to support the validity of the learnings which have been reported.

Stroke: the critically neglected first year post-stroke

2018 ◽  
Vol 26 (1) ◽  
pp. 4-15
Author(s):  
Kenneth Gaines ◽  
Patricia Commiskey
Keyword(s):  
Integrated Care ◽  
Care Delivery ◽  
Care Facility ◽  
Stroke Care ◽  
Evidence Based ◽  
Care Model ◽  
Stroke Patients ◽  
Post Discharge ◽  
Content Type ◽  
The Impact

Purpose Stroke is a leading cause of death and disability in the USA and worldwide. While stroke care has evolved dramatically, many new acute approaches to therapy focus only on the first 3-12 hours. Significant treatment opportunities beyond the first 12 hours can play a major role in improving outcomes for stroke patients. The purpose of this paper is to highlight the issues that affect stroke care delivery for patients and caregivers and describe an integrated care model that can improve care across the continuum. Design/methodology/approach This paper details evidence-based research that documents current stroke care and efforts to improve care delivery. Further, an innovative integrated care model is described, and its novel application to stroke care is highlighted. Findings Stroke patients and caregivers face fragmented and poorly coordinated care systems as they move through specific stroke nodes of care, from acute emergency and in-hospital stay through recovery post-discharge at a care facility or at home, and can be addressed by applying a comprehensive, technology-enabled Integrated Stroke Practice Unit (ISPU) Model of Care. Originality/value This paper documents specific issues that impact stroke care and the utilization of integrated care delivery models to address them. Evidence-based research results document difficulties of current care delivery methods for stroke and the impact of that care delivery on patients and caregivers across each node of care. It offers an innovative ISPU model and highlights specific tenets of that model for readers.

scholarly journals Realism and rhetoric in the evaluation of a new care model

2019 ◽  
Vol 27 (3) ◽  
pp. 204-214 ◽  
Author(s):  
Tom Grimwood
Keyword(s):  
Integrated Care ◽  
Large Scale ◽  
Realist Evaluation ◽  
Scale Transformation ◽  
Care Model ◽  
Content Type ◽  
Realist Approach ◽  
Dynamic Form ◽  
Multiple Audiences ◽  
Objective System

Purpose The purpose of this paper is to discuss the methodological challenges to evaluating one of the 50 vanguard sites of the new care model (NCM) programme for integrated care in England, and make the case for a modified realist approach to this kind of evaluation. Design/methodology/approach The paper considers three challenges to evaluating the NCM in this particular vanguard: complexity, strategy and rhetoric. It reflects on how the realist approach negotiates these philosophical challenges to delivering integrated care, in order to provide contextualised accounts of who a programme works for, in what context, and why. Findings The paper argues that, in the case of this particular vanguard site, the tangible benefit of the realist approach was not in providing a firm epistemological basis for evaluation, but rather in drawing out and articulating the ontological rhetoric of such large-scale transformation programmes. By understanding the work of the NCM less as an objective “system”, and more as a dynamic form of persuasion, aimed at securing the “adherence of minds” (Perelman and Olbrechts-Tyteca, 2008, p. 8) in multiple audiences, the paper suggests that realist evaluation can be used to address both the systematic issues and localised successes the NCMs encountered. Originality/value The paper identifies a number of aspects of new models of integrated care for evaluators to consider. It offers ways of negotiating the challenges to conventional outcome-focused evaluation, by drawing attention to the need for contextualised, time-situated and audience-sensitive value of NCMs.

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