REGIONAL SYSTEM OF INTEGRATED HEALTH AND SOCIAL CARE FOR ELDERLY PEOPLE: EXPERIENCE AND EXPERTISE OF SAINT-PETERSBURG

2021 ◽  
pp. 809-824
Author(s):  
В. Н. Анисимов ◽  
А. А. Редько ◽  
А. В. Финагентов ◽  
В. Х. Хавинсон ◽  
А. В. Шабров
Keyword(s):  
Quality Of Life ◽  
Elderly People ◽  
Social Care ◽  
Federal District ◽  
Pilot Project ◽  
Saint Petersburg ◽  
The North ◽  
Health And Social Care ◽  
Integrated Health

В публикации рассматриваются проблемы создания в России системы комплексной медико-социальной помощи (далее - Система) гражданам старшего поколения, которые приобретают особую значимость с учетом необходимости преодоления негативного влияния пандемии COVID -19 на качество жизни и психофизиологическое состояние граждан старшего поколения (далее - Граждан) с учетом динамики развития у них возраст-ассоциированных хронических заболеваний. Представлены структура Системы, условия и предпосылки ее создания, функциональные составляющие системной поддержки повышения качества жизни Граждан. Обоснована необходимость использования позитивного и негативного опыта регионов, внедрения российских научно-практических наработок в области геронтологии и гериатрии, организации конструктивного и равноправного сотрудничества органов государственной власти с научными и профессиональными сообществами, негосударственными организациями. Авторы предлагают рассматривать Санкт-Петербург в качестве модельного региона при создании Системы. В публикации приводится перечень наиболее значимых проектов и мероприятий, реализованных в городе за период с 2012 по 2020 г., по системной поддержке организации оказания комплексной медико-социальной помощи Гражданам, которые не коррелированы с реализацией федеральных программ. Объективная научно-практическая оценка опыта и наработок Санкт-Петербурга и других регионов России позволит использовать их при создании Систем в субъектах Российской Федерации, не располагающих достаточными собственными ресурсами. Предлагается поэтапное разворачивание Системы в России на уровне федеральных округов, в частности пилотного проекта на территории СевероЗападного Федерального округа, с использованием опыта и наработок Санкт-Петербурга. The article examines the challenges of creating a system of integrated health and social care for elderly people (the System) in Russia, these challenges being of particular significance in the light of the negative effects of the COVID -19 pandemic on the quality of life and mental and general health of elderly people, which need to be mitigated with due consideration of the dynamics of progression of age-associated chronic diseases of elderly people. The article describes the structure of the System, and the conditions and background of its establishment. It also looks at the components of system-based support of improvement of quality of life of elderly people. The article argues that it is essential to use the positive and negative experiences of different regions, to implement the practical and scientific expertise in the field of gerontology and geriatrics made so far in Russia, and to establish a meaningful and equal partnership among the state, research organizations, communities of professionals and non-public organizations. The authors suggest to look on Saint-Petersburg as a model region when establishing the System. The article contains a list of the major projects and events in the city from 2012 to 2020 aimed to provide system-based support for integrated health and social care for elderly people, not affiliated with any federal programs. Unbiased evaluation of the experience and expertise of Saint-Petersburg and other regions of Russia will allow to use them when establishing similar systems in other Russia’s regions that do not possess sufficient resources. The authors suggest to establish the System in a step-wise manner at the federal district level. For example, a pilot project may be launched in the North-Western Federal District using the experience and expertise of Saint-Petersburg.

SYSTEM-BASED SUPPORT OF IMPROVEMENT OF QUALITY OF LIFE FOR ELDERLY PEOPLE IN RUSSIA: OUTLOOK AND CHALLENGES

2021 ◽  
pp. 825-837
Author(s):  
В. Н. Анисимов ◽  
А. А. Редько ◽  
А. В. Финагентов ◽  
В. Х. Хавинсон ◽  
А. В. Шабров
Keyword(s):  
Quality Of Life ◽  
Elderly People ◽  
Social Services ◽  
Social Care ◽  
Healthcare Providers ◽  
Health And Social Care ◽  
Integrated Health ◽  
Geriatric Service ◽  
Older Populations

В статье рассмотрены проблемы и перспективы реализации функций системной поддержки деятельностиорганизацийздравоохраненияисоциального обслуживания населения в процессе оказания ими медицинских, социальных и психологических услуг гражданам старших возрастных групп (далее - Граждане), в частности в связи с преодолением кризисных ситуаций, таких как пандемия COVID -19. Представлены понятие, структура и алгоритм оказания комплексной медико-социальной помощи (далее - Комплексная помощь)Гражданам. Показано, что организация системы оказания Комплексной помощи позволит обеспечить повышение качества жизни Граждан и продление периода их активного долголетия за счет предоставления им услуг социального профиля в составе индивидуальных пакетов, сформированных на основе персонифицированного подхода. Приводится понятие и детализируются функции системной поддержки оказания Комплексной помощи Гражданам. Описаны условия организации системной поддержки на уровне отдельного региона. Анализируются состав, задачи и формы организации Гериатрической службы как базовой составляющей системы оказания Комплексной помощи Гражданам, проблемы организации согласованной работы подразделений Гериатрической службы, их взаимодействия с учреждениями социального обслуживания населения и профильными медицинскими организациями. Обоснована необходимость создания в составе Гериатрической службы специализированной научно-методической структуры - Центра системной поддержки. The article examines the outlook and challenges relating to the provision of system-based support of healthcare providers and social services in the course of delivering their healthcare, mental health and social services to elderly people, in particular amidst a crisis, such as the COVID-19 pandemic. The article gives the definition of integrated health and social care, its structure and the algorithm of delivering integrated health and social care to elderly people. The article argues that a system of integrated health and social care will improve the quality of life of older populations and extend their active longevity through a person-centered social services plan offered according to an older person’s needs. The article gives the definition and a detailed description of the goals of system-based support of integrated health and social care for older populations. It describes the conditions for providing such system-based support in one specific region of the country. The article analyses the structure, aims and type of entity of the Geriatric Service which is viewed by the authors as a building block of the system of integrated health and social care for elderly people, and discusses the issues relating to coordination of activities among various divisions of the Geriatric Service and their cooperation with social services and healthcare providers. The article explains why it is important to establish a special research and methodological unit - the Center for System-Based Support - within the Geriatric Service.

Investigating the relative value of health and social care related quality of life using a discrete choice experiment

2019 ◽  
Vol 233 ◽  
pp. 28-37 ◽  
Author(s):  
Brendan Mulhern ◽  
Richard Norman ◽  
Richard De Abreu Lourenco ◽  
Juliette Malley ◽  
Deborah Street ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Social Care ◽  
Relative Value ◽  
Health And Social Care ◽  
Related Quality ◽  
Value Of Health

scholarly journals Assessing the impact of care farms on quality of life and offending: a pilot study among probation service users in England

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019296 ◽  
Author(s):  
Helen Elsey ◽  
Tracey Farragher ◽  
Sandy Tubeuf ◽  
Rachel Bragg ◽  
Marjolein Elings ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pilot Study ◽  
Social Care ◽  
Recruitment And Retention ◽  
Health And Social Care ◽  
Probation Service ◽  
Assess Quality ◽  
The Impact

ObjectivesTo assess the feasibility of conducting a cost-effectiveness study of using care farms (CFs) to improve quality of life and reduce reoffending among offenders undertaking community orders (COs). To pilot questionnaires to assess quality of life, connection to nature, lifestyle behaviours, health and social-care use. To assess recruitment and retention at 6 months and feasibility of data linkage to Police National Computer (PNC) reconvictions data and data held by probation services.DesignPilot study using questionnaires to assess quality of life, individually linked to police and probation data.SettingThe pilot study was conducted in three probation service regions in England. Each site included a CF and at least one comparator CO project. CFs are working farms used with a range of clients, including offenders, for therapeutic purposes. The three CFs included one aquaponics and horticulture social enterprise, a religious charity focusing on horticulture and a family-run cattle farm. Comparator projects included sorting secondhand clothes and activities to address alcohol misuse and anger management.ParticipantsWe recruited 134 adults (over 18) serving COs in England, 29% female.Results52% of participants completed follow-up questionnaires. Privatisation of UK probation trusts in 2014 negatively impacted on recruitment and retention. Linkage to PNC data was a more successful means of follow-up, with 90% consenting to access their probation and PNC data. Collection of health and social-care costs and quality-adjusted life year derivation were feasible. Propensity score adjustment provided a viable comparison method despite differences between comparators. We found worse health and higher reoffending risk among CF participants due to allocation of challenging offenders to CFs, making risk of reoffending a confounder.ConclusionsRecruitment would be feasible in a more stable probation environment. Follow-up was challenging; however, assessing reconvictions from PNC data is feasible and a potential primary outcome for future studies.

scholarly journals Strategic planning toolkit in the social development of the regions of the north caucasus federal district

2021 ◽  
Vol 94 ◽  
pp. 01014
Author(s):  
Natalia Borovikova ◽  
Elena Kulikova ◽  
Svetlana Prozorova ◽  
Irina Romanko ◽  
Grigory Shibichenko
Keyword(s):  
Quality Of Life ◽  
Strategic Planning ◽  
Social Practice ◽  
Social Problems ◽  
Federal District ◽  
Human Potential ◽  
North Caucasus ◽  
The North ◽  
Low Efficiency

The article shows the need for strategic planning as an effective tool for solving social problems in the constituent entities of the North Caucasus Federal District. The regional strategies reveal the commonality of social goal-setting associated with the development of human potential and the growth of the quality of life, as well as particular specifics, reflecting the most acute life-supporting problems in the region. The work also demonstrates the low efficiency of state programs as a tool for implementing social priorities in the regions of the North Caucasus Federal District. Considering the status of the North Caucasus Federal District as a priority territory, it was proposed to make subprograms and design solutions in the context of federal projects dedicated exclusively to solving social problems in the subjects of the North Caucasus Federal District in the section “New quality of life” in the state federal programs and in socially oriented priority national projects. To implement project activities in strategic planning and state programming in social practice in the regions of the North Caucasus Federal District, an organizational and supporting mechanism for the development and implementation of socially significant regional projects has been substantiated.

scholarly journals What is the best approach to adopt for identifying the domains for a new measure of health, social care and carer-related quality of life to measure quality-adjusted life years? Application to the development of the EQ-HWB?

2021 ◽  
Author(s):  
Tessa Peasgood ◽  
Clara Mukuria ◽  
Jill Carlton ◽  
Janice Connell ◽  
Nancy Devlin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Care ◽  
Domain Identification ◽  
Life Years ◽  
Health And Social Care ◽  
Related Quality ◽  
Health Related ◽  
Informal Carers ◽  
The Impact

AbstractEconomic evaluation combines costs and benefits to support decision-making when assessing new interventions using preference-based measures to measure and value benefits in health or health-related quality of life. These health-focused instruments have limited ability to capture wider impacts on informal carers or outcomes in other sectors such as social care. Sector-specific instruments can be used but this is problematic when the impact of an intervention straddles different sectors.An alternative approach is to develop a generic preference-based measure that is sufficiently broad to capture important cross-sector outcomes. We consider the options for the selection of domains for a cross-sector generic measure including how to identify domains, who should provide information on the domains and how this should be framed. Beyond domain identification, considerations of criteria and stakeholder needs are also identified.This paper sets out the case for an approach that relies on the voice of patients, social care users and informal carers as the main source of domains and describes how the approach was operationalised in the ‘Extending the QALY’ project which developed the new measure, the EQ-HWB (EQ health and wellbeing instrument). We conclude by discussing the strengths and limitations of this approach. The new measure should be sufficiently generic to be used to consistently evaluate health and social care interventions, yet also sensitive enough to pick up important changes in quality of life in patients, social care users and carers.

Clinical outcomes, quality of life, and costs in the North Thames Dialysis Study of elderly people on dialysis: a prospective cohort study

The Lancet ◽  
2000 ◽  
Vol 356 (9241) ◽  
pp. 1543-1550 ◽  
Author(s):  
Donna L Lamping ◽  
Niculae Constantinovici ◽  
Paul Roderick ◽  
Charles Normand ◽  
Lynne Henderson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Clinical Outcomes ◽  
Elderly People ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
The North

Clinical outcomes and Quality of Life in Elderly Patients on Peritoneal Dialysis versus Hemodialysis

2002 ◽  
Vol 22 (4) ◽  
pp. 463-470 ◽  
Author(s):  
◽  
Susan A.C. Harris ◽  
Donna L. Lamping ◽  
Edwina A. Brown ◽  
Niculae Constantinovici
Keyword(s):  
Quality Of Life ◽  
Peritoneal Dialysis ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Elderly People ◽  
Life Questionnaire ◽  
The North ◽  
Relative Risks ◽  
Sf 36

♦ Objective To compare clinical outcomes and quality of life (QOL) in elderly patients on peritoneal dialysis (PD) and hemodialysis (HD) in the North Thames Dialysis Study. ♦ Design A 12-month prospective cohort study. ♦ Setting Four hospital-based renal units in London, UK. ♦ Patients 174 patients that were 70 years or older at the start of dialysis, separated into two cohorts: 78 new patients (36 PD, 42 HD) that were recruited after 90 days of chronic dialysis; and 96 stock patients (42 PD, 54 HD) that were already on dialysis during the recruitment period. ♦ Main Outcome Measures 12-month survival and hospitalization rate, and QOL assessed at baseline and at 6 and 12 months by the SF-36 and the Symptoms/Problems scale of the Kidney Disease Quality of Life Questionnaire (KDQOL). ♦ Results Peritoneal dialysis and HD patients were similar for sociodemographic and clinical characteristics. Annual mortality and hospitalization rates in PD versus HD patients were 26.1 versus 26.4 deaths/100 person–years and 1.9 versus 2.0 admissions/person–year, respectively. Adjusted relative risks showed no effect of modality on clinical outcomes. Multiple linear regression analyses of QOL at baseline showed similar SF-36 scores between PD and HD patients, but higher KDQOL scores in PD patients (3.5 points higher, 95% confidence interval 0.3 – 6.6). There was, however, no effect of dialysis modality on QOL at 6 or 12 months. ♦ Conclusions Clinical outcomes and QOL are similar in elderly people on PD and HD. Peritoneal dialysis is a viable option for more than a carefully selected minority of elderly people requiring dialysis.

scholarly journals Improving care for older people with long-term conditions and social care needs in Salford: the CLASSIC mixed-methods study, including RCT

2018 ◽  
Vol 6 (31) ◽  
pp. 1-188 ◽  
Author(s):  
Peter Bower ◽  
David Reeves ◽  
Matt Sutton ◽  
Karina Lovell ◽  
Amy Blakemore ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older People ◽  
Integrated Care ◽  
Patient Outcomes ◽  
Social Care ◽  
Health Coaching ◽  
Long Term Conditions ◽  
Community Assets ◽  
Health And Social Care

BackgroundThe Salford Integrated Care Programme (SICP) was a large-scale transformation project to improve care for older people with long-term conditions and social care needs. We report an evaluation of the ability of the SICP to deliver an enhanced experience of care, improved quality of life, reduced costs of care and improved cost-effectiveness.ObjectivesTo explore the process of implementation of the SICP and the impact on patient outcomes and costs.DesignQualitative methods (interviews and observations) to explore implementation, a cohort multiple randomised controlled trial to assess patient outcomes through quasi-experiments and a formal trial, and an analysis of routine data sets and appropriate comparators using non-randomised methodologies.SettingSalford in the north-west of England.ParticipantsOlder people aged ≥ 65 years, carers, and health and social care professionals.InterventionsA large-scale integrated care project with three core mechanisms of integration (community assets, multidisciplinary groups and an ‘integrated contact centre’).Main outcome measuresPatient self-management, care experience and quality of life, and health-care utilisation and costs.Data sourcesProfessional and patient interviews, patient self-report measures, and routine quantitative data on service utilisation.ResultsThe SICP and subsequent developments have been sustained by strong partnerships between organisations. The SICP achieved ‘functional integration’ through the pooling of health and social care budgets, the development of the Alliance Agreement between four organisations and the development of the shared care record. ‘Service-level’ integration was slow and engagement with general practice was a challenge. We saw only minor changes in patient experience measures over the period of the evaluation (both improvements and reductions), with some increase in the use of community assets and care plans. Compared with other sites, the difference in the rates of admissions showed an increase in emergency admissions. Patient experience of health coaching was largely positive, although the effects of health coaching on activation and depression were not statistically significant. Economic analyses suggested that coaching was likely to be cost-effective, generating improvements in quality of life [mean incremental quality-adjusted life-year gain of 0.019, 95% confidence interval (CI) –0.006 to 0.043] at increased cost (mean incremental total cost increase of £150.58, 95% CI –£470.611 to £711.776).LimitationsThe Comprehensive Longitudinal Assessment of Salford Integrated Care study represents a single site evaluation, with consequent limits on external validity. Patient response rates to the cohort survey were < 40%.ConclusionsThe SICP has been implemented in a way that is consistent with the original vision. However, there has been more rapid success in establishing new integrated structures (such as a formal integrated care organisation), rather than in delivering mechanisms of integration at sufficient scale to have a large impact on patient outcomes.Future workFurther research could focus on each of the mechanisms of integration. The multidisciplinary groups may require improved targeting of patients or disease subgroups to demonstrate effectiveness. Development of a proven model of health coaching that can be implemented at scale is required, especially one that would provide cost savings for commissioners or providers. Similarly, further exploration is required to assess the longer-term benefits of community assets and whether or not health impacts translate to reductions in care use.Trial registrationCurrent Controlled Trials ISRCTN12286422.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 31. See the NIHR Journals Library website for further project information.

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