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

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.

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

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.

Central European Banking Sector Integration and Shocks During the Global Pandemic (COVID-19)

This chapter aims to analyze the impact of the global 2020 pandemic on the banking sectors of the Czech Republic, Hungary, Poland, Romania, Russia, and Slovakia countries in the period from January 2, 2017 to August 10, 2020. The results of the Gregory-Hansen test, in the covid subperiod, show 27 integrations (in 30 possible). When comparing the pre-covid and covid subperiods, the level of integration has increased 386% between markets, which could call into question portfolio diversification, validating the first research question. In corroboration, the authors have verified that the results of Granger's causality tests, in the COVID-19 subperiod, increased significantly. In view of these results and bearing in mind the results of integration, they can show that the crisis caused by the global pandemic of 2020 has increased the synchronization between these regional banking sectors, significantly decreasing the hypothesis of implementing efficient portfolio diversification, thus validating the second research question.

Converging infrastructures

Converging infrastructures illustrate the complexity of the processes involved in both operational sector coupling and socio-technical sector integration. What consequences of this development can technology impact research estimate today and what difficulties will arise in doing so? This article introduces the TATuP special topic as well as the individual contributions and also addresses socio-political aspects, beyond the usual questions of technical feasibility and efficiency: What strategies are developed to initiate and control comprehensive change? What are the mechanisms to maintain the ability to act despite great uncertainties for all those concerned with future converging infrastructures for energy, transport, and heating/cooling. The interdisciplinary approach to the topic focuses on three central “socio-technical problems” and gives a first insight into the conditions under which converging infrastructures emerge and what consequences these processes might have.

Amplified socio-technical problems in converging infrastructures

Converging infrastructures illustrate the complexity of the processes involved in both operational sector coupling and socio-technical sector integration. What consequences of this development can technology impact research estimate today and what difficulties will arise in doing so? This article introduces the TATuP special topic as well as the individual contributions and also addresses socio-political aspects, beyond the usual questions of technical feasibility and efficiency: What strategies are developed to initiate and control comprehensive change? What are the mechanisms to maintain the ability to act despite great uncertainties for all those concerned with future converging infrastructures for energy, transport, and heating/cooling. The interdisciplinary approach to the topic focuses on three central “socio-technical problems” and gives a first insight into the conditions under which converging infrastructures emerge and what consequences these processes might have.

Recent evolution of the informal recycling sector in Argentina within the ‘popular economy’: Measuring its impact through a case study in Tandil (Buenos Aires)

The integration of the informal recycling sector into formal waste management systems is imperative to the implementation of the circular economy in the Global South. In Argentina, after the 2001 crisis, some large cities such as Buenos Aires greatly improved their informal recycling sector integration. In medium-size cities from the rest of the province, this was not the case. However, the formation of a national coalition between different sectors of what is now called the ‘popular economy’ forced the enactment, in the context of a new crisis, of a Social Emergency Law, which includes a Complementary Social Salary equivalent to half the minimum wage, among its main features. In this paper, we recap these recent changes and we use the InteRa framework in a case study to measure how, along with academic and civil society support actions, they influenced the informal recycling sector integration in an intermediate city of Buenos Aires province. Our results show that the inclusion of the informal recycling sector improved rapidly after the availability of the Complementary Social Salary. Nevertheless, we registered a hard-to-overcome stagnation in some indicators of the InteRa framework, related to the weak engagement of the local municipal government with the informal recycling sector. Importantly, the advent of the Complementary Social Salary was not reflected in any indicator because there is no specific action related to this aspect in the InteRa framework. This may give an insight into future methodology improvement.