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In many European countries, responsibilities for social care have been shifted to municipalities to enhance accessibility and stimulate integration of care and social services, and to cut costs. Multidisciplinary local Social Community Teams (SCTs) have become increasingly responsible for the provision of these integrated services, requiring them to collaborate with local health and societal organisations. To collaborate and to integrate services the SCTs must work across their own and stakeholders' boundaries (e.g., domain specific boundaries). We investigated how boundary work in SCTs' practices contributes to service integration in a dynamic multi-stakeholder context. In our embedded case study, for 18 months, we followed three SCTs in their efforts to integrate services, and used data from multiple sources, including bi-weekly questionnaires in which SCT members reflect on their stakeholder-directed goal achievements. The case analysis yielded four takeaways. First, it demonstrates how SCTs' bottom-up formulation of a long-term service integration vision brought internal coherence (boundary reinforcement), while the short-term action-goals increased collaboration with stakeholders (boundary spanning). Second, only SCTs that managed to incorporate constraints into their action-goals and practices, and to span and play with boundaries, continued with integrating services just-by-doing. Third, two stakeholder characteristics facilitated the SCTs' boundary spanning: well-organized stakeholders and prior familiarity with the stakeholder. Fourth, a new boundary work type emerged, "boundary play", consisting of informal, experimental collaboration efforts with stakeholders contributing to emergent service integration. [ABSTRACT FROM AUTHOR]

Introduction: To meet the needs of vulnerable people, the integration of services across different sectors is important. This paper presents a preliminary review of service integration across sectors in Europe. Examples of service integration between social services, health, employment and/or education were studied. A further aim of the study was to improve conceptual clarity regarding service integration across sectors, using Minkman's Developmental Model for Integrated Care (DMIC) as an analytical framework. Methods: The study methods comprised a literature review (34 articles) and a survey of practice examples across Europe (44 practices). This paper is based on a more comprehensive study published in 2016. Results: The study demonstrates that although the focus of integration across sectors is often on social services and health care, other arrangements are also frequently in place. The review shows that integration may be either tailored to a particular target group or designed for communities in general. Although systems to monitor and evaluate social service integration are often present, they are not yet fully developed. The study also highlights the importance of good leadership and organizational support in integrated service delivery. Discussion: The study shows that the DMIC can work as a conceptual framework for the analysis of service integration across sectors. However, as this is an exploratory study, further in-depth case studies are required to deepen our understanding of the processes involved in service integration across sectors. [ABSTRACT FROM AUTHOR]

Background: Over recent years, the number of compulsory admissions in many countries has increased, probably as a result of the shift from inpatient to outpatient mental health care. This might be mitigated by formal or collaborative relationships between services. Methods: In a retrospective record linkage study, we compared two neighboring districts, varying in level of service integration. Two periods were combined: 1991-1993 and 2001-2003. We included patients aged 18-60, who had a first emergency compulsory admission (n=830). Their psychiatric history was assessed, and service-use after admission was monitored over a 12-month follow-up. Results: Over a 10-year period, compulsory admission rates increased by 47%. Difference in relative increase between the integrated and non-integrated services was 14%. Patient characteristics showed different profiles in the two districts. Length of stay was >10 days shorter in the integrated district, where the proportion of involuntary readmissions decreased more, and where aftercare was swift and provided to about 10% more patients than in the non-integrated district. Conclusions: Services outcomes showed better results where mental healthcare was more integrated. However, limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions. [ABSTRACT FROM AUTHOR]

Introduction: Research suggests that flexible models of care which include across-discipline support and practices can overcome the limitations caused by scattered populations and fewer health practitioners in rural and remote areas across Australia. Innovative models of care bring together the clinician and the individual to plan and manage chronic disease to prevent hospital admissions, promote medication compliance and improve service provision. However, models of care cannot stand alone as effective tools for the management and minimisation of chronic diseases in any given area. A sound knowledge of what services are currently available within any given catchment is necessary in planning, commissioning and coordinating chronic care. Pinpointing the core activities of specific services on the ground can assist with integrating service provision. Practice Change: A recent pilot project has been completed to compile an Integrated Atlas of Chronic Care for Dubbo and Coonamble, providing the first detailed service provision description for a specific geographic region within Australia. Based on the international DESDE-LTC classification system, this document goes beyond simply listing services in a directory, toward being able to understand the functional service delivery teams working in a region, where there may be gaps in service provision and where the greatest need for care may be. Highlights: Furthermore, the consistent classification system employed by the atlas methodology allows for later comparison of service provision with other regions. The utility of a validated, comparable and transferable classification system enables policy makers, service planners and commissioning bodies to make informed decisions related to service provision based on the current service provision patterns. Conclusion: In order to ensure rural and remote communities are more likely to have their health needs met, there needs to be a comprehensive understanding of not only what communities need but also what services are currently available that could cooperate to meet the needs in appropriate ways. Locally relevant information on services therefore has a key role in improving rural and remote health. [ABSTRACT FROM AUTHOR]

Introduction: CervicalCheck - The National Cervical Screening Programme offers regular free smear tests to 1.2 million women aged 25-60 years. For the programme to be successful at least 80% of the population should be up to date with their cervical screening. To maximise participation among eligible women and among 'harder-to-reach' women, direct programme entry was introduced in year three of the programme. An online eligibility tool was also introduced to make it easier for women to register and participate in CervicalCheck. This tool can be accessed both by women and smear takers. Using the woman's PPS number and date of birth, the tool confirms the woman's details including the due date of her next smear test. Consequently this tool integrates service access and subsequent delivery of screening between the national programme, smeartakers and clients themselves. Theory/Methods: Access to Google Analytics for the CervicalCheck website was obtained and analyses were performed to determine the activity on the eligibility tool webpage during 2015. Results: In 2015, there were 909,637 unique visits to the CervicalCheck website, with 197,811 visits to the eligibility tool. This resulted in 37,272 new registrations to the programme (conversion rate 7.5%). Discussions: Participation in cervical screening reduces the incidence of and mortality from cervical cancer. This innovative IT tool enables women to access their own healthcare record and empowers women to take charge of their own health. The tool is an example of successful integration of access between all parties in the screening process and in addition it provides a link between women and a national health service. Conclusions: This successful IT tool was developed to support CervicalCheck to achieve population coverage of 80%, which has the potential to reduce the incidence and mortality rates of cervical cancer in Ireland. CervicalCheck will continue to actively monitor the impact of new technology and develop further to improve access to the programme. [ABSTRACT FROM AUTHOR]