Integrated Care, the future of care systems

Senior patient looking at camera with doctor on background

We live longer and birth rates are lower. European population is ageing and this trend is expected to continue for several decades[1]. From the health perspective incidence and prevalence of chronic diseases are increasing and therefore we will have increasing needs of chronic care. From the financial perspective lower workforce and active population will need to support the social services for increasing numbers of elderly populations and additionally the increasing needs for chronic care. Both dimensions of the problem will highly pressure our health and social care systems, thus becoming a major challenge for our European society.

The increase of chronic patients has proven that present day acute health care systems are unable to tackle efficiently the current population needs. They were designed and organized to address acute care processes and not the continuous and life-long needs of chronic and multi-morbidity patients. Chronic care models are needed to address a person-centered perspective, coordinating care services to support long-term care.

Moreover, the World Health Organization (WHO) published in March 2015 the “WHO global strategy on people-centred and integrated health services”[2] to address the need for shifting the way health services are funded, managed and delivered. The suggested strategy enforces the need for people-centred health services for patients, families and communities. According to this view, they would participate in their own care, provided by integrated health services that would ensure the continuum of health promotion, prevention, diagnosis and treatment at the different levels of care.

The objectives to address these challenges are well reflected on The Triple Aim[3], which refer to the simultaneous pursuit of improving the patients’ experience of care, improving the health of populations and reducing the per capita cost of health care[4]. Several public and private institutions are focusing their initiatives and approaches to achieve this triple dimension objective with different integrated care models.

IHI Triple Aim

Integrated Care

Integrated care models address how care services could be coordinated and delivered in order to address people’s continuous care in a more efficient way and taking into account all stakeholders’ needs and perspectives. In order to do so there are several integration dimensions. In order to address the changing needs of the population the Triple Integration[5] stated by Simon Stevens described the different levels of integration needed to address integrated care services depending on the care services and stakeholders involved:

  • Integration between primary and specialist services: Integration between health professionals at hospital or out-of-hospital care to facilitate the continuum of care and to get health services closer to the patient.
  • Integration between physical and mental health services: currently, physical needs of people with mental disorders are neglected, while mental needs of patients with physical long-term conditions are also neglected[6].
  • Integration of Health and Social Care Services: Integration of health and social services to coordinate the efforts of the different services that support patients.

The participation of patients, caregivers and community within the care processes has to be added to the dimensions mentioned above, in order to address a people-centred approach also based on their own perspectives and needs as stated in the WHO strategy.

Therefore, addressing integrated care needs is a complex process and requires a clear view, strong leadership, coordination and open communication to achieve the aimed changes across organizational boundaries, cultural differences (doctors, professional caregivers, informal caregivers) and different care perspectives, in order to change towards integrated care.

ICT4Life was present in the 2016 International Conference on Integrated Care (ICIC16)[7] in Barcelona, where several initiatives were presented and are currently taking place in several regions and organizations around the world. These include: the Alaska Native Health System[8], where physical, mental, emotional and spiritual wellness are integrated within teams to support patients; the NHS pioneers initiative[9], where several local areas have become pioneers for demonstrating innovative approaches for integrated care in order to analyze the results afterwards; the Mitsugi Hospital Complex[10] that serves the Mitsugi rural area and integrates Medical care, Long-term care, public administration, preventive care and home-visit care and which has improved patient quality of care, reduced hospital admissions and reduced healthcare costs.

Initiatives are mainly based on the integration of health professionals (primary and specialty integration / physical and mental health integration) and also within organizational boundaries. There is still much to do in the integration regarding social care organizations and services and the inclusive participation of caregivers and patients in the care processes. Within one of the main hall sessions of the ICIC16 conference, that attracted a large audience, to the question “How many of you do actually do collaborative work with patients and carers?” only one person raised his hand. We still have much to do, but interesting and promising initiatives give us hope that integrated care will be a reality over the next decade.

Author:

Alejandro Sánchez-Rico de las Heras,

ICT4Life Project Coordinator and
Director of eHealth at Artica Telemedicina

[1] United Nations World Population Prospects: https://esa.un.org/unpd/wpp/

[2] World Health Organization global strategy on people-centred and integrated health services. http://www.who.int/servicedeliverysafety/areas/people-centred-care/en/

[3] The IHI Triple Aim framework was developed by the Institute for Healthcare Improvement in Cambridge, Massachusetts (www.ihi.org).”

[4] The Triple Aim: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=63

[5] Simon Stevens – Chief Executive of NHS England –  http://www.kingsfund.org.uk/audio-video/simon-stevens-nhs-five-year-forward-view

[6] http://www.kingsfund.org.uk/audio-video/norman-lamb-physical-mental-health-services

[7] International Foundation for Integrated Care – http://integratedcarefoundation.org/

[8] https://www.southcentralfoundation.com/nuka/

[9] https://www.england.nhs.uk/pioneers/

[10] https://vimeo.com/168833221

[11] Freepic Picture: http://www.freepik.com/free-photos-vectors/fondo

 

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