Strengthening local capacity to implement integrated community health services in rural Romania

Through strengthening leadership capacity of local leaders, the initiative hopes to improve health and social services delivery within local communities; a longstanding international partnership built from experience collaborating on other projects was important for establishing the initiative; training was necessary to strengthen the management skills of local leaders to enable them to assess, coordinate and manage delivery of health and social services orientated to community needs; integration of health, social and community services at the local level was encouraged to support a comprehensive response to community needs, particularly for underserved groups.

Peer-delivered HIV/AIDS community testing and prevention services in Lisbon, Portugal

A community centre was opened in Lisbon to provide free, anonymous and peer-delivered HIV testing and prevention services targeted to the MSM community; generating political buy-in took considerable time and was described as a “long and persuasive process” with a need to “repeat the message endless times”; strong grassroots advocacy and persistent lobbying efforts by a patient organization were essential for securing funding; incorporating the target population in the provision of services helped ensure wider community engagement and trust; absence of a formal legislative framework and financial incentives required partnerships with self-motivated health professionals to be sought out.

Shifting towards community-oriented mental health care in Belgium

Changes to legislation, policy and care guidelines at the national level guided mental health reform and government funding was made available to promote the implementation of local community mental health projects aligned with the new national vision for mental health; top-down support for bottom-up ideas ensured both the necessary resources and local ownership needed to optimize mental health reform; a supportive legislative framework helped solidify a common vision for mental health reform, providing a unified focus for local efforts to align with; space for experimentation in the delivery of mental health care was allowed for, motivating locally-adapted projects and sparking grassroots innovation; increasing the provision of community- and home-based care supported greater consideration of patients’ environments.  

Community support programmes for people affected by dementia in Athens, Greece

The nonprofit organization AAADRD opened four day care centres across Athens to directly provide support services to people affected by dementia. The organization also campaigned extensively to gain attention for their cause and pushed the government to develop a national dementia action plan; highly motivated actors directly affected by dementia or working in related fields played an important role in identifying and understanding service delivery gaps; as a specialized organization, AAADRD was able to mobilize a large network of dedicated supporters. Connections established with similar organizations furthered advocacy efforts; sustainability of the initiative relies on growing government commitment, securing resources for activities and successfully implementing the national dementia action plan.

Establishing ambulatory care for patients with tuberculosis in Uzbekistan

Médecins Sans Frontières (MSF), in partnership with the Government of the Republic of Karakalpakstan, introduced ambulatory care from day one (ACD1) as an alternative model for TB care; a strong understanding of service delivery challenges led to a solution that met patients’ needs; a supportive political and legal framework, developed prior to implementation, helped to sustainably embed reforms within the health system; strong relationships between key actors who had a history of working together aided the initiative.

Introducing community-based lifestyle clinics to improve population health in Malta

Lifestyle Clinics offering healthy-living support were introduced across Malta to expand availability of health promotion and disease prevention services; a motivated, multidisciplinary group of primary care professionals led the initiative through collaborative teamwork; the initiative capitalized on recent government policies supporting chronic disease prevention and a newly-established postgraduate community nursing programme; an initial information campaign helped raise awareness and gain public acceptance for new services; patients responded well to being offered a more active role in their health; further, patients play a key advocacy role in expanding the initiative.

Implementing early childhood development centres in Bosnia and Herzegovina

As part of a wider initiative for the social protection of children in post-war Bosnia and Herzegovina, UNICEF partnered with cantons and municipal governments in 2010 to establish Integrated Early Childhood Development (IECD) Centres; a situational analysis and piloting of the approach supported a sharpening of priorities and the development of practical solutions; longstanding partnerships between government actors and development agencies allowed for gradual capacity-building at the subnational level, enabling local uptake of new roles and responsibilities relating to early childhood development; aligning national policy with municipal action encouraged widespread adoption of changes, increasing consistency in approaches and securing sustainability of local efforts.

Strengthening community-based mental health services in Cyprus

New political commitments to mental health reform led the government to pass the Mental Health Act in 1997 to promote community-based mental health care; a wide variety of community-based mental health services have been made available, with emphasis on services for prevention, early treatment, rehabilitation and home care; advocacy from the health workforce motivated reforms and helped define the vision for care transformations; strategic timing was an important contributing factor in achieving political support for mental health reform; partnerships with NGOs and volunteer organizations helped expand the continuum of mental health care.

How do we know? An assessment of integrated community case management data quality in four districts of Malawi

The World Health Organization contracted annual data quality assessments of Rapid Access Expansion (RAcE) proyects to review integrated community case management (iCCM) data quality and the monitoring and evaluation (M&E) system for iCCM, adn to suggest ways to improve data quality. 

This data quality assessment illuminates where an otherwise strong M&E system for iCCM fails to ensure some aspects of data quality. Prioritizing data management with documented protocols, additional training and approaches to create efficient supervision practices may improve iCCM data quality. 

Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care

Personal support services enable many individuals to stay in their homes, but there are no standard ways to classify need for functional support in home and community care settings. The goal of this proyect was to develop and evidence-based clinical tool to inform service planning while allowing for flexibility in care coordinator judgment in response to patient and family circumstances. 

Agency of Integrated Care

AIC seeks to create a vibrant care community enabling people to live well and age gracefully. AIC coordinates and facilitates efforts in care integration to achieve the best care outcomes for our clients. They empower their clients with health and social care information and arrange for their care when they are discharged from hospitals. They enable stakeholders to raise the quality of care, and also enhance collaboration by working with health and social care providers to increase services to support the ageing population. Their work in the community brings care services and information closer to those in need.

Agency of Integrated Care

The Agency of Integrated Care (AIC) seeks to create a vibrant care community enabling people to live well and age gracefully. AIC coordinates and facilitates efforts in care integration to achieve the best care outcomes. They empower with health and social care information and arrange for their care when they are discharged from hospitals. They enable stakeholders to raise the quality of care, and also enhance collaboration by working with health and social care providers to increase services to support the ageing population. Their work in the community brings care services and information closer to those in need.

Addressing safety risks in integrated care programs for older people living at home: a scoping review

Many older people live at home, often with complex and chronic health and social care needs. Integrated care programs are increasingly being implemented as a way to better address these needs. To support older people living at home, it is also essential to maintain their safety. Integrated care programs have the potential to address a wide range of risks and problems that could undermine older people’s ability to live independently at home. The aim of this scoping review is to provide insight into how integrated care programs address safety risks faced by older people living at home - an area that is rather underexplored.

(Dis)Integrated Care? Lessons from East London

This paper examines one of the NHS England Pioneers programmes of Integrated Care, which was implemented in three localities in East London, covering the area served by one of the largest hospital groups in the UK and bringing together commissioners, providers and local authorities. The partners agreed to build a model of integrated care that focused on the whole person.

This qualitative and participatory evaluation looked at how an ambitious vision translated into the delivery of integrated care on the ground. The study explored the micro-mechanisms of integrated care relationships based on the experience of health and social care professionals working in acute and community care settings.

Indicators of an Integrated Home Care Model Shaped by the Needs of Patients Discharged from the Emergency Department

Developing community care models aims to satisfy the needs of patients’ in-home care comprehensively. This is crucial to decrease adverse events and prevent rehospitalization.

The growing burden of chronic diseases, patients experiencing fragmented care, and increasing demand for coordination across providers in the health and social sector correlates with the need for the integration of care. The starting point in developing an integrated care strategy should be identifying and assessing population needs.

Models of integrated care may enhance patient satisfaction, increase the perceived quality of care, and enable access to services. The term ‘new models of care’ refers to a wide range of interventions aiming to address issues of integration across healthcare and between health and social care. Improved discharge planning and flow of care, and improved sharing of knowledge between practitioners, are essential components of new models of integrated care. Discharge of the patient from the hospital to the ...

Rethinking Primary Care Delivery Models: Can Integrated Primary Care Teams Improve Care Experience?

Integrated Primary Care Teams (IPCTs) have four key characteristics (intensive interdisciplinary practice; advanced nursing practice with an expanded role; group practice; increased proximity and availability) aimed at strengthening primary care in Quebec, Canada. The purpose of this paper is to examine the care experience over time of patients who have an IPCT as their primary source of care.

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 ...