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Introduction: In addition to the functional aspects of healthcare integration, an understanding of its normative aspects is needed. This study explores the importance of values underpinning integrated, people-centred health services, and examines similarities and differences among the values prioritised by actors across Europe. Methods: Explorative cross-sectional design with quantitative analysis. A questionnaire of 18 values was conducted across Europe. A total of 1,013 respondents indicated the importance of each of the values on a nine-point scale and selected three most important values. Respondents were clustered in four actor groups, and countries in four European sub-regions. Results: The importance scores of values ranged from 7.62 to 8.55 on a nine-point scale. Statistically significant differences among actor groups were found for ten values. Statistically significant differences across European sub-regions were found for six values. Our analysis revealed two clusters of values: 'people related' and 'governance and organisation'. Discussion and conclusion: The study found that all 18 values in the set are considered important by the respondents. Additionally, it revealed distinctions in emphasis among the values prioritised by actor groups and across sub-regions. The study uncovered two clusters of values that contribute to a conceptually based definition of integrated, people-centred health services. [ABSTRACT FROM AUTHOR]

Introduction: Coordination of healthcare professionals seems to be particularly important for patients with complex chronic disease, as they present a challenging interplay of conditions and symptoms. As one solution, to counteract or prevent this, improving collaboration between general practitioners (GPs) and specialists has been the aim of studies by linking or coordinating their services along the continuum of care. This scoping review summarises role distributions and components of this collaboration that have potential for improvement for the care of patients with complex chronic conditions. Methods: Scoping review as a knowledge synthesis for components of collaboration and role distributions between medical specialists and GPs in intervention studies. The PubMed database was searched for literature from 2010-2020. Results: Literature search and reference screening generated 2,174 articles. 30 articles originating from 22 unique projects were included in our synthesis. In the interventions to improve collaboration, the GP is most commonly in charge of patient management and extends the scope of practice. The specialist provides support when needed. Clear definition of roles, resources for knowledge transfer and education from specialists are commonly utilised interventions. Typically, combinations of process and system changes addressing communication and coordination issues are applied. Most interventions improve provider and patient satisfaction, health outcomes, and reduce care fragmentation. Conclusion: This review showed that interventions to improve collaboration between GPs and medical specialists seem promising. Further efforts should be made to test and apply the findings systematically in broad clinical practice. [ABSTRACT FROM AUTHOR]

There have been numerous initiatives for a long period of time to enhance integration in healthcare in many countries, but these processes still prove to be challenging. More research is needed to understand the interplay between different factors and different collaboration contexts, and this paper makes a contribution in this respect. We explore how collaboration can be established and sustained across organizational boundaries. Theory and methods: We draw on the concept of sense-making (Weick) as we investigate the complex interplay between structure and agency in facilitating or constraining collaboration across organizational boundaries. The empirical material consists of 35 interviews with health personnel participating in three different collaboration initiatives between primary and secondary care regarding obesity and diabetes in Norway. The health care providers involved are all public. The aim of the collaboration is to enhance knowledge sharing and to improve prevention and treatment across primary and secondary care providers tailored to the needs of the patient. The study is part of The Research Council of Norway's evaluation program of The Coordination Reform, a reform addressing coordination and collaboration in healthcare. Results: We find that structure, competence, equality and commitment are important elements to establish and sustain collaboration across organizational boundaries. Discussion: Organizational, technological and financial structures can both facilitate and constrain collaboration. When participants determine their scope of action, they do so by interpreting the latitude provided by structural frames, but also by how they interpret the interaction with others. When participants in primary and secondary care each interpret each other as competent professionals, this enhances collaboration. Furthermore, when participants in both organizations experience the relationship between them as equal, this also enhances collaboration. Likewise, if one part interprets the other part as regarding them as less competent or superior in the relationship, this represents a barrier for collaboration. Many collaboration initiatives have one or several dedicated persons who are highly committed to the collaboration and who drive the work forward in spite of many challenges. However, if not other participants in the collaboration initiatives, as well as in their local community, interpret the collaboration as meaningful and commit themselves to the work, this represents a barrier for collaboration over time. Conclusions: Collaboration depends on participants finding collaboration meaningful. Development of integrated care in our study is neither a result of structural adaptation alone, nor of strategic action alone, but a result of the interactions between concerned actors and their interpretations of structural frames and the actions of others. Implications for policy makers and practitioners are to pay attention to both agency and structure when planning for integration of healthcare services. Limitations: The majority of the informants come from primary care. This could possibly imply a bias towards perspectives from primary care. On the other hand, informants from secondary care are included, and the collaboration initiatives are originally initiated by secondary care. Suggestions for future research: Possible future research includes focusing on how different groups of patients and their carers experience these and other collaboration initiatives. [ABSTRACT FROM AUTHOR]

Introduction: Lithuanian society is one of the rapidly aging societies in Europe. The rise of aging population challenges to rethink policies and to develop new forms and strategies of long term care for chronically ill and dependent elderly. In Lithuania Social welfare and Health care systems are functioning separately and lack patient centered approach to service provision. Assurance sustainability for shifting society forces for intensive transformation of systems. The questions raise how to shape long term home care services for elderly persons based on patient centered approach and how to develop co-ordinated assistance between social and health care providers. The first step of health and social care systems transformation to integrated long term home care is seen the development of mobile teams of health and social care providers. Recently in twenty municipalities departments of social care started experimental integrated home care projects with mobile teams assembled of social and health care providers. Aims: to evaluate the development of new organizational form "mobile teams" in providing integrated home care and interaction of this new form with existing health and social care structures. Methods/settings/participants: conducted qualitative study based on social constructivist strategy. Five semi structured interviews with 5 administrators of mobile teams and focus groups with 5 mobile teams of care providers from five municipalities. Results: In the departments social care provision one part of day social care providers were restructured into mobile teams: next to social worker were employed nurses. The understanding of integrated care provision distinguished between health and social care providers. The social care and health care providers differed in approach to care provision. In the mobile team social care provider seeked empowerment of client in self care activities, the nurses assisted clients without encouraging them to be active in the care process. The nurses tended to take passive role in care planning and see their role to follow physician's prescription. The health care providers were used to subordinated professional interaction, where the physician is responsible for treatment process. The social worker took responsibility for case management, but nurses ignored or did not react to social worker's requests related to persons health care. The health care providers were reluctant to discuss issues as they are not used to dialog culture. The mobile teams' service providers seeking to overcome challenges of integrated care provision initiated round tables discussions with health care service providers and administrators of other municipalities. Challenges in working together provoked new communication models. models: social care providers used psychosocial and health care providers (nurses) applied biomedical model in integrated care provision. The professional status unequalilies caused tension between care providers in the mobile teams. The new model of mobile teams provoked turn of care towards patient centered approach and integration processes between existing social and health care structures. [ABSTRACT FROM AUTHOR]

Background: The successful mainstreaming of assisted living technologies remains an important policy and commercial concern within the UK. Despite this, local telehealth services have not developed at the pace and scale anticipated. This project, funded by the Technology Strategy Board through the Assisted Living Innovation Platform, aims to understand and seeks ways to overcome the financial, organisational and operational barriers to mainstreaming telehealth. Aim: To highlight and reflect on the methodological and practical issues in conducting participatory research in collaboration with telehealth services. Methods: Within the MALT study, a multi-disciplinary consortium of research organisations are collaborating with telehealth services in four specific sites in the Yorkshire and Humber region. The research is composed of two phases: phase 1 involves producing detailed qualitative case studies to identify barriers and facilitators to successful delivery of telehealth, with a view to developing 'change projects'; the implementation and delivery of which will be explored through action research in phase 2. Results: The role of the research team in participatory action research is one of partnership and collaboration. However, there is a consultative element to projects of this nature, as the researchers work alongside stakeholders using the findings from phase 1 to inform the telehealth change projects to initiate and evaluate in phase 2. While participatory research methods are useful for understanding and evaluating change, this partnership approach blurs the role of researchers, who may be seen as imposing change by encouraging sites to look at ways to expand or improve their existing service at a time when cost effectiveness and patient benefit remain unclear. The pace of development regarding the wider use of assisted living technologies also has implications for this research project, given the growing consensus that telehealth should form only one part of a wider menu of digital options that clinicians use with their patients to promote self-management. This broad approach to technology adoption underpins the Department of Health's 3 Million Lives initiative, which can also be seen as an additional top down pressure at the local level to drive forward adoption and upscaling. This makes for complex, yet interesting, case studies within a context of wider structural and commissioning changes for NHS primary care, and equivocal evidence on the effectiveness of telehealth. Conclusion: The MALT study highlights the complexity of telehealth service re-design and the importance of the shifting policy emphasis and technological advancements. Crucially, as local services respond to these developments, the changes can be reactive and organic, and difficult to capture as the research moves forward. It is therefore crucial for the research team to maintain close and regular contact with participants to ensure the ongoing relevance of data collection, analysis and recommendations, and to manage the sometimes competing expectations for the research among different stakeholders. Maintaining this relationship is an integral aspect of the research, however the blurring of researcher roles requires careful reflection on both the extent of and limits to the role played in service development. [ABSTRACT FROM AUTHOR]

Community-based primary health care describes a model of service provision that is oriented to the population health needs and wants of service users and communities, and has particular relevance to supporting the growing proportion of the population with multiple chronic conditions. Internationally, aspirations for community-based primary health care have stimulated local initiatives and influenced the design of policy solutions. However, the ways in which these ideas and influences find their way into policy and practice is strongly mediated by policy settings and institutional legacies of particular jurisdictions. This paper seeks to compare the key institutional and policy features of Ontario, Québec and New Zealand that shape the 'space available' for models of community-based primary health care to take root and develop. Our analysis suggests that two key conditions are the integration of relevant health and social sector organisations, and the range of policy levers that are available and used by governments. New Zealand has the most favourable conditions, and Ontario the least favourable. All jurisdictions, however, share a crucial barrier, namely the 'barbed-wire fence' that separates funding of medical and 'non-medical' primary care services, and the clear interests primary care doctors have in maintaining this fence. Moves in the direction of system-wide community-based primary health care require a gradual dismantling of this fence. [ABSTRACT FROM AUTHOR]

Introduction and background: Few financial incentives in the United States encourage coordination across the health and social care systems. Supportive Service Programs (SSPs), operating in Naturally Occurring Retirement Communities (NORCs), attempt to increase access to care and enhance care quality for aging residents. This article presents findings from an evaluation conducted from 2004 to 2006 looking at the feasibility, quality and outcomes of linking health and social services through innovative NORC-SSP and health organization micro-collaborations. Methods: Four NORC-SSPs participated in the study by finding a health care organization or community-based physicians to collaborate with on addressing health conditions that could benefit from a biopsychosocial approach. Each site focused on a specific population, addressed a specific condition or problem, and created different linkages to address the target problem. Using a case study approach, incorporating both qualitative and quantitative methods, this evaluation sought to answer the following two primary questions: 1) Have the participating sites created viable linkages between their organizations that did not exist prior to the study; and, 2) To what extent have the linkages resulted in improvements in clinical and other health and social outcomes? Results: Findings suggest that immediate outcomes were widely achieved across sites: knowledge of other sector providers' capabilities and services increased; communication across providers increased; identification of target population increased; and, awareness of risks, symptoms and health seeking behaviors among clients/patients increased. Furthermore, intermediate outcomes were also widely achieved: shared care planning, continuity of care, disease management and self care among clients improved. Evidence of improvements in distal outcomes was also found. Discussion: Using simple, familiar and relatively low-tech approaches to sharing critical patient information among collaborating organizations, inter-sector linkages were successfully established at all four sites. Seven critical success factors emerged that increase the likelihood that linkages will be implemented, effective and sustained: 1) careful goal selection; 2) meaningful collaboration; 3) appropriate role for patients/clients; 4) realistic interventions; 5) realistic expectations for implementation environment; 6) continuous focus on outcomes; and, 7) stable leadership. Focused, micro-level collaborations have the potential to improve care, increasing the chance that organizations will undertake such endeavors. [ABSTRACT FROM AUTHOR]