Ending Preventable Child Deaths with Integrated Community Case Management: Stronger Pharmaceutical Systems for Healthier Communities

Many child deaths in developing countries are preventable: Children die from treatable conditions, such as pneumonia, diarrhea, and malaria, because families in rural, hard-to-reach, or conflict-ridden areas can’t access or afford the treatments. The Sustainable Development Goals (SDGs), launched in September 2015, set ambitious targets of ending preventable child deaths by 2030 and reducing mortality among children under age five to at least 25 per 1,000 live births. Integrated community case management (iCCM) has been recognized as a key strategy for increasing access to essential treatments and meeting the objectives for children under five laid out in the SDGs. Integrated community case management entails training volunteer community health workers to serve as the first point of contact for medical treatment in remote areas, enabling them to recognize and treat common childhood illnesses. To be effective, community health workers must operate within a broader pharmaceutical system in which the ...

Integrated Care: theory to practice

"Integrated care" is pitched as the solution to current health system challenges. In the literature, what integrated care actually involves is complex and contested. Multi-disciplinary team management is frequently the primary focus of integrated care when implemented internationally. This study examine the practical application of integrated care in the NHS in England to exemplify the prevalence of the case management focus. It looks at the evidence for effectiveness of multi-disciplinary team case management, for the focus on high-risk groups and for integrated care more generally. They suggest realistic expectations of what integration of care alone can achieve and additional research questions. 

Case Management for Patients with Complex Multimorbidity: Development and Validation of a Coordinated Intervention between Primary and Hospital Care

In the past few years, healthcare systems have been facing a growing demand related to the high prevalence of chronic diseases. Case management programs have emerged as an integrated care approach for the management of chronic desease. Nevertheless, there is little scientific evidence on the impact of using case management program for patients with complex multimorbidity regarding hospital resource utilisation. 

This study tested wheter improved continuity of care resulting from the integration of community-based and hospital services reduced the use of hospital resources amongst patientes with complex multimorbidity. 

The Impact of Integrated Case Management on Health Services Use and Spending Among Nonelderly Adult Medicaid Enrollees

Medicaid plans, whose patients often have complex medical, social, and behavioral needs, seektools to effectively manage enrollees and imprive access to quality care while containing costs. 

The aim of this study is to examine the effects of an integrated case management (ICM) program operated by a Medicaid managed care plan on health service use and spending for nonelderly, non-pregnant adults. 

Family Medicine Clinic: a case study of a hospital–family medicine practice redesign to improve chronic disease care in the community in Singapore

Singapore´s health care system is strained by the health care needs of a rapidly aging population. The unprecedented collaboration between a public hospital and a private family practice to set up the Family Medicine Clinic (FMC) to co-manage patients with chronic desease is an example of efforts to shift care to community. 

Impact of integrated healthcare: Taiwan’s Family Doctor Plan

Integration of health services has been pursued worldwide. Diversity in integration approaches and in the contexts in which integrated programmes operate, however, hinders comparative analysis of care integration in both high-income countries (HICs) and low- and middle-income countries (LMICs). This study evaluates an HIC programme implemented in a delivery system resembling those of LMICs, especially its weak primary care system. 

Case management service quality and patient-centered care

Providing care that is patient-centered is an important objective in the modern healthcare industry. Despite this objective, hospital inpatient case managers and the services they provide are evaluated routinely without including patients' perspectives. Therefore, the purpose of this study is to fill this research gap by using patient expectations and perceptions to assess the overall quality of and patient satisfaction with hospital case management services.

OPEN ARCH integrated care model: experiences of older Australians and their carers

There is worldwide recognition of the need to redesign health service delivery with a focus on strengthening primary health care and aligning health and social care through integrated models. A defining feature of integrated models is improved patient and carer experience of care. This study explored the experiences of older people and their carers enrolled in a unique model of integrated care that provides a specialist geriatric intervention in the primary care setting for older adults with complex needs in Far North Queensland. A qualitative exploratory descriptive design using semistructured interviews was used to address the study aims. Seventeen older people and nine carers took part in the study. Data were analysed inductively, guided by the principles of thematic analysis. Three themes emerged: getting by; achieving positive change; and improving and maintaining the OPEN ARCH (Older Persons ENablement And Rehabilitation for Complex Health conditions) approach. The findings indicate that enablement ...

Integrated care in Western Europe: a wise solution for the future?

Integrated care (IC) is a term commonly adopted across the world underpinning a positive attitude against fragmentation of healthcare service provision. While the principles supporting IC are simple, their implementation is more controversial.

Supporting retention in HIV care through a holistic, patient-centred approach: a qualitative evaluation

HIV is a complex disease which affects different facets (social, economic, physical, emotional and spiral) of an individual’s life, making the goals of retention in care and adherence to treatment difficult to achieve. Holistic patient-centred approaches to providing care for people living with HIV bind together economic, social, emotional and physiological aspects and have the potential to improve retention in care and ART adherence. Case management is a holistic, patient-centred approach which is increasingly being implemented in the management of chronic illnesses.

Primary care and the older person with complex needs: reflections on the implementation of a primary–secondary model of integrated care

The demand and complexity of the health needs of older people is growing. Traditionally siloed, condition-centric care is no longer appropriate. It is costly to the Australian health system and life-threatening to the individual. In parallel to demographic change is increasing global awareness of the impact of social, behavioural, and environmental factors on health outcomes. Although significant when not addressed, the amenable nature of many personal contextual factors is an opportunity to improve health and quality of life. A move away from reactive, episodic models of health care delivery towards patient focussed integrated care is required to meet the changing demands of an aging population. This forum article provides a reflection on the current state of integration for older people with complex needs through the lens of a local community facing model: OPEN ARCH. Australia still has some way to go to establishing system level enablers for an integrated approach ...

Social workers coordination in primary healthcare for patients with complex needs: A scoping review

Care coordination has been part of social work for some time. It has been recognized as contributing to care coordination for long-term care for the elderly and mental health but less is known about their contribution in primary care with patients with complex health and social needs. As social workers are increasingly present in primary healthcare, this scoping review aims to provide a synthesis of social workers’ coordination activities for patients with complex needs in primary healthcare.

Integrating case management for patients with complex needs in the ground practice: the importance of context in evaluative designs

Responding to complex needs calls for integrating care across providers, settings and sectors. Among models to improve integrated care, case management demonstrates a good evidence base of facilitating the appropriate delivery of healthcare services. Since case management is a complex, multi component intervention, with its component parts interacting in a non-linear manner, effectiveness is largely influenced by the context in which the intervention is implemented. This paper discusses how to respond to implementation challenges to evaluating complex interventions for patients with complex needs. Building on the example of case management, we suggest that documenting innovation effectiveness remains important, but that evaluation needs to include theory-based and systems perspectives. We also suggest that implementation science needs to be part of intervention design while engaging stakeholders to define the most relevant research questions and implementation effectiveness, to optimize successful implementation and sustainability.