scholarly journals Integrated primary care and social services for older adults with multimorbidity in England: a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hajira Dambha-Miller ◽  
Glenn Simpson ◽  
Lucy Hobson ◽  
Paul Roderick ◽  
Paul Little ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Integrated Care ◽  
Population Health ◽  
Social Services ◽  
Scoping Review ◽  
Integrated Primary Care ◽  
Integration Of Services ◽  
Multi Level ◽  
Sector Integration

Abstract Background As the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the physical and psycho-social needs of this cohort. This study describes and summarises current evidence, clinical provision and progress towards integrated primary care and social services for older adults with multimorbidity in England. Methods A scoping review was conducted involving systematic searches of a range of electronic academic and policy databases. Articles were screened and extracted in duplicate by two independent reviewers. Data were extracted onto a charting sheet and thematic synthesis was used to summarise findings. Articles were included if published in English and related to primary care, social care and multimorbidity in older adults in England. Conceptually, the review was framed using the Rainbow Model of Integrated Care. Results The search yielded 7656 articles of which 84 were included. Three themes were identified: (1) a focus on individual level services rather than multi-level or multi-sector integration, with an increasing emphasis on the need to consider broader determinants of population health as critical to integrated care for older adults with multimorbidity; (2) the need for policymakers to allow time for integration to embed, to enable new structures and relationships to develop and mature; and (3) the inherent tension between top-down and bottom-up driven approaches to integrated care requires a whole-systems structure, while allowing for local flexibilities. Conclusions There is limited evidence of multi-level and multi-sector integration of services for older adults with multimorbidity in England. The literature increasingly acknowledges wider determinants of population health that are likely to require integration beyond primary care and social services. Improving clinical care in one or two sectors may not be as effective as simultaneously improving the organisation or design across services as one single system of provision. This may take time to establish and will require local input.

scholarly journals Integrated Primary Care and Social Services for Older Adults With Multimorbidity in England: A Scoping Review

2021 ◽  
Author(s):  
Hajira Dambha-Miller ◽  
Glenn Simpson ◽  
Lucy Hobson ◽  
Paul Roderick ◽  
Paul Little ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Integrated Care ◽  
Population Health ◽  
Social Services ◽  
Scoping Review ◽  
Integrated Primary Care ◽  
Integration Of Services ◽  
Multi Level ◽  
Sector Integration

Abstract Background: As the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the range of physical and social needs of the population. The aim of this study is to describe and summarise current evidence, clinical provision and progress towards integrated primary care and social services for older adults with multimorbidity in an English context. Methods: A scoping review was conducted which included a systematic electronic search of Medline, EMBASE, The Cochrane Library, Web of Science, the Cumulative Index to Nursing and Allied Health Literature, Science and Social Science Citation Indices and Opengrey from data inception until the 16th June 2020. Articles were screened and extracted in duplicate by two independent reviewers. Data were extracted onto a charting sheet and thematic synthesis used to summarise findings.Results: Our search yielded 7656 papers of which 84 papers were included. Three themes were identified: (1) diverse focus on individual level services rather than multi-level or multi-sector integration, with an increasing emphasis on the need to consider broader determinants of population health as critical to integrated care in multimorbidity; (2) time was needed for integration to embed to allow new structures and relationships to develop and mature; and (3) we identified inherent tension between top-down and bottom-up driven approaches to integrated care that requires a whole-systems structure while allowing for local flexibilities.Conclusions: There is limited evidence of multi-level and multi-sector integration of services for older adults with multimorbidity in an English context. The literature increasingly acknowledges wider determinants of population health that are likely to require integration beyond primary care and social services. Improving clinical care in one or two sectors may not be as effective as simultaneously improving the organisation or design across services as one single system of provision. This may take time to establish and will require local input.

scholarly journals Information and Communication Technologies (ICTs) Enabling Integrated Primary Care for Complex Patients: A Protocol for a Scoping Review

2021 ◽  
Author(s):  
Farah Tahsin ◽  
Alana Armas ◽  
Apery Kirakalaprathapan ◽  
Heather Cunningham ◽  
Mudathira Kadu ◽  
...  
Keyword(s):  
Primary Care ◽  
Information And Communication Technologies ◽  
Scoping Review ◽  
Communication Technologies ◽  
Integrated Primary Care ◽  
Multiple Chronic Conditions ◽  
Care Model ◽  
Primary Care Model ◽  
Complex Patients ◽  
Information And Communication

Abstract IntroductionAn increasing number of individuals are living with multiple chronic conditions, often combined with psychosocial complexities. For these patients with complex conditions, an integrated primary care model that provides care coordination and a team-based approach can help manage their multiple needs. Information and communication technologies (ICTs) are recognized as a critical enabler of integrated primary care. A better understanding of the use of ICTs in an integrated care setting and how ICTs are being leveraged would be beneficial to identify knowledge gaps and could lead to successful implementation for ICT-based interventions.ObjectiveThis study will systematically scope the literature on the topic of ICT-enabled integrated healthcare delivery models for patients with complex care needs to identify which technologies have been used in integrated primary care settings. MethodThis study protocol outlines a scoping review of the peer-reviewed literature, using Arksey and O’Malley’s (enhanced by Levac et al.) scoping review methodology. Peer-reviewed- literature will be identified using a multi-database search strategy. The results of the search will be screened, abstracted, and charted in duplicate by 6 research team members. DiscussionThe key findings of the study will be thematically mapped to describe the implemented ICTs aimed for complex patients within the integrated primary care model and interactions of the elements (ICT, health model, and targeted patients). This review will be the first step to formally identify how ICT is used to support integrated primary health care models. The results will be disseminated through peer-reviewed publications, conference presentations, and special interest groups.

scholarly journals What does integrated care mean from an older person’s perspective? A scoping review

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e035157
Author(s):  
Michael T. Lawless ◽  
Amy Marshall ◽  
Manasi Murthy Mittinty ◽  
Gillian Harvey
Keyword(s):  
Older Adults ◽  
Integrated Care ◽  
Scoping Review ◽  
Data Extraction ◽  
Grey Literature ◽  
Secondary Outcome ◽  
Coordinated Care ◽  
Healthcare Settings ◽  
Care Relationships ◽  
Integrated Or

ObjectiveTo systematically map and synthesise the literature on older adults’ perceptions and experiences of integrated care.SettingVarious healthcare settings, including primary care, hospitals, allied health practices and emergency departments.ParticipantsAdults aged ≥60 years.InterventionsIntegrated (or similarly coordinated) healthcare.Primary and secondary outcome measuresUsing scoping review methodology, four electronic databases (EMBASE, CINAHL, PubMed and ProQuest Dissertation and Theses) and the grey literature (Open Grey and Google Scholar) were searched to identify studies reporting on older adults’ experiences of integrated care. Studies reporting on empirical, interpretive and critical research using any type of methodology were included. Four independent reviewers performed study selection, data extraction and analysis.ResultsThe initial search retrieved 436 articles, of which 30 were included in this review. Patients expressed a desire for continuity, both in terms of care relationships and management, seamless transitions between care services and/or settings, and coordinated care that delivers quick access, effective treatment, self-care support, respect for patient preferences, and involves carers and families.ConclusionsParticipants across the studies desired accessible, efficient and coordinated care that caters to their needs and preferences, while keeping in mind their rights and safety. This review highlights the salience of the relational, informational and organisational aspects of care from an older person’s perspective. Findings are transferable and could be applied in various healthcare settings to derive patient-centred success measures that reflect the aspects of integrated care that are deemed important to older adults and their supporters.

scholarly journals A Usability and Feasibility Study: GENIE - An App Supporting Self-Management among Older Adults who are High Users of the Health Care System (Preprint)

2020 ◽  
Author(s):  
Ruta Valaitis ◽  
Laura Cleghorn ◽  
Ivaylo Vassilev ◽  
Anne Rogers ◽  
Jenny Ploeg ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
Social Networks ◽  
Social Services ◽  
Health Care System ◽  
Self Management ◽  
Health And Social Services ◽  
Primary Care Clinicians ◽  
Care System

BACKGROUND Primary care providers have been tasked with fostering self-management through managing referrals and linking patients to community-based health and social services. This study evaluated a web-based tool –GENIE (Generating Engagement in Network InvolvEment)– as a component of the Health TAPESTRY program to support self-management of older adults who are high health care system users. GENIE aims to empower patients to leverage their personal social networks to access community services towards reaching their health goals. GENIE maps client’s personal networks, elicits preferences, and filters local health and social resources from a community service directory based on results of a questionnaire that explores client’s interests. In the Health TAPESTRY program, volunteers conducted home visits to gather health information on tablets and implemented the GENIE tool. A report was generated for the primary care team for follow up. OBJECTIVE This study examined the usability, feasibility, and perceived outcomes of the implementation of GENIE with older adults who were enrolled in Ontario’s Health Links Program, which coordinates care for the highest users of the health care system. METHODS This study involved two primary care clinician focus groups, one clinician interview, a volunteer focus group, client telephone interviews, field observations, and GENIE utilization statistics. RESULTS Eight patients, three volunteers, and 16 primary care clinicians participated. Patients were most interested in services that were health-related (exercise and socialization). Overall, participants perceived GENIE to be useful and easy to use, despite challenges related to email set up, disease terminology, instructions for personal network mapping, and clarity of questionnaire items. Volunteer facilitation was critical to support implementation of Genie. Tool completion averaged 39 minutes. Almost all patients identified a community program or activity of interest using GENIE. Half followed up on health and social services and added new members to their network over 6 months, while one participant lost a member. Clinicians had concerns about accuracy, suitability, and quantity of suggested programs and services generated from the tool and believed that they could better tailor choices for their patients highlighting the inherent tension between user-centred preferences focused on capabilities and bio-medical definitions of need shaping professional judgement. However, clinicians did note that GENIE strengthened their understanding of patients’ personal social networks. CONCLUSIONS This study demonstrated GENIE’s potential, facilitated by volunteers, to expand patients’ social networks and link them to relevant health and social services to support self-management. Volunteers require training to effectively implement GENIE for self-management support and can help overcome time limitations that primary care clinicians face. Refining the filtering capability of GENIE to allow for better tailoring of results to address the complex needs of those who are high system users may help to improve primary care provider’s confidence in such tools. CLINICALTRIAL Not applicable

scholarly journals Intersectoral coordination and multiprofessional teams: merging primary care and social services

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
T Sinervo ◽  
I Keskimäki ◽  
V Niiranen ◽  
S Laulainen ◽  
L Hietapakka
Keyword(s):  
Integrated Care ◽  
Social Services ◽  
Planning Process ◽  
Health Centre ◽  
National Level ◽  
Psychosocial Care ◽  
Well Being ◽  
Joint Health ◽  
Integration Of Services ◽  
Group Interviews

Abstract Background Since the 2000s, integrated care has been a policy aim in Finland. Reforms for creating larger care authorities have failed at national level, but municipalities have established regional joint health and social integrated care authorities. Our study focuses on integration of services for children and young people and adults’ psychosocial care. The aim is to evaluate integration in terms of success and its underpinning factors in two authorities with merged primary and specialised healthcare and social services. Methods South Karelia and North Karelia were selected as case studies, because these regions were pioneers in establishing integrated care authorities in 2010 and 2017. Document analysis and individual and group interviews with managers (32) and employees (22) were carried out; the analysis draws on Auschra’s classification of barriers and facilitators of integration. Results The regions (pop. 130.000-169.000) comprise a larger town, a specialised hospital and several rural municipalities. The integration of children’s and young people’s services is based on organisational changes, in which the services from primary healthcare, hospitals, social work and schools (pupils’ and students’ healthcare) were merged into one organisation. The health and well-being centres were created by bringing mental health, substance abuse services and social services into health centre facilities, but under their own managers. In both cases, the experiences are mostly positive but the success of implementation varies; commitment and cooperation between managers, shared goals and mutual understanding of each other’s work as well as the planning process were crucial factors to support implementation. Conclusions Comprehensive organisations with unified management foster integration. The implementation of multiprofessional work is facilitated by organisational culture and collaboration between managers.

scholarly journals Smart Environments and Social Robots for Age-Friendly Integrated Care Services

2020 ◽  
Vol 17 (11) ◽  
pp. 3801 ◽  
Author(s):  
Ionut Anghel ◽  
Tudor Cioara ◽  
Dorin Moldovan ◽  
Marcel Antal ◽  
Claudia Daniela Pop ◽  
...  
Keyword(s):  
Older Adults ◽  
Integrated Care ◽  
Social Services ◽  
Independent Living ◽  
Cognitive Activity ◽  
Assistive Technologies ◽  
World Health ◽  
Smart Environments ◽  
Care Services ◽  
Intervention Point

The world is facing major societal challenges because of an aging population that is putting increasing pressure on the sustainability of care. While demand for care and social services is steadily increasing, the supply is constrained by the decreasing workforce. The development of smart, physical, social and age-friendly environments is identified by World Health Organization (WHO) as a key intervention point for enabling older adults, enabling them to remain as much possible in their residences, delay institutionalization, and ultimately, improve quality of life. In this study, we survey smart environments, machine learning and robot assistive technologies that can offer support for the independent living of older adults and provide age-friendly care services. We describe two examples of integrated care services that are using assistive technologies in innovative ways to assess and deliver of timely interventions for polypharmacy management and for social and cognitive activity support in older adults. We describe the architectural views of these services, focusing on details about technology usage, end-user interaction flows and data models that are developed or enhanced to achieve the envisioned objective of healthier, safer, more independent and socially connected older people.

Sign in / Sign up

Export Citation Format

Share Document