Improving Integrated Care: Can Implementation Science Unlock the ‘Black Box’ of Complexities?

In a previous IJIC editorial they reflected on the fact that we have yet to make any significant breakthrough to understand the implementation and sustainability of complex service innovations that so characterise the development of integrated care programmes [1]. Without such knowledge we might be able to explain the core building blocks of integrated care systems, but we cannot adequately explain the intricacies of effective implementation nor fully understand the causes of the outcomes we observe. This article show how this is not simply a methodological problem but reflects a more deep-rooted challenge in the lack of value that is ...

Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis

Interprofessional primary care (IPPC) teams are promoted as an alternative to single profession physician practices in primary care with focus on preventive care and chronic disease management. Characteristics of teams can have an impact on their performance.

However, the empirical evidence of the implications of IPPC team design on various aspects of care processes or health outcomes is specific to particular contexts, but a general understanding of optimal team design is not available.

Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis

Interprofessional primary care (IPPC) teams are promoted as an alternative to single profession physician practices in primary care with focus on preventive care and chronic disease management. Characteristics of teams can have an impact on their performance.

Literature focused on the implications of team characteristics on team processes, such as teamwork, collaboration, or satisfaction of patients or providers. Despite heterogeneity of contexts, some trends are observable: shared space, common vision and goals, clear definitions of roles, and leadership as important to good teamwork. The impacts of these on health care outputs or patient health are not clear. So, this systematic ...

Development of the ACTIVE framework to describe stakeholder involvement in systematic reviews

Involvement of patients, health professionals, and the wider public (‘stakeholders’) is seen to be beneficial to the quality, relevance and impact of research and may enhance the usefulness and uptake of systematic reviews. However, there is a lack of evidence and resources to guide researchers in how to actively involve stakeholders in systematic reviews. In this paper, we report the development of the ACTIVE framework to describe how stakeholders are involved in systematic reviews

Shared Decision Making to Improve Care and Reduce Costs

Asleeper provision of the Affordable Care Act (ACA) encourages greater use of shared decision making in health care. For many health situations in which there's not one clearly superior course of treatment, shared decision making can ensure that medical care better aligns with patients' preferences and values. Shared decision making has the potential to provide numerous benefits for patients, clinicians, and the health care system, including increased patient knowledge, less anxiety over the care process, improved health outcomes, reductions in unwarranted variation in care and costs, and greater alignment of care with patients' values.

Patient centred care for multimorbidity improves patient experience, but quality of life is unchanged

The UK has an ageing population. A 2018 study of multimorbidity in England found that 54% of people over 65 had multimorbidity in 2015. This is expected to rise to 68% by 2035, with 17% of people over 65 expected to have four or more conditions. National guidelines tend to focus on single conditions. People with multimorbidity may have their conditions managed individually without due consideration of the overall burden of their diseases and treatments. Recognition of this prompted the National Institute for Health and Care Excellence (NICE) and other international organisations to develop guidelines on managing multimorbidity. These focus ...

Continuity of care and referral rate: challenges for the future of health care

As health care costs rise, an increasingly greater proportion of the gross domestic product is spent on health care. In this context, Continuity of care could reduce health care consumption by patients and reduce the number of referrals to specialist care, but it is unknown if there is a difference in referral rates to specific medical specialties.

The aim of this study was to determine the relationship between continuity of care and both the referral rate (referrals per patient per year) and the medical specialties for which this relationship was strongest.

Continuity of care and referral rate: challenges for the future of health care

Continuity of care could reduce health care consumption by patients and reduce the number of referrals to specialist care, but it is unknown if there is a difference in referral rates to specific medical specialties. The aim was to determine the relationship between continuity of care and both the referral rate (referrals per patient per year) and the medical specialties for which this relationship was strongest.

Closing the gap: Key areas for action on the health and care workforce

Staffing is the make-or-break issue for the NHS in England. Workforce shortages are already having a direct impact on patient care and staff experience. Urgent action is now required to avoid a vicious cycle of growing shortages and declining quality. The workforce implementation plan to be published later this year presents a pivotal opportunity to do this. In this joint report with the Nuffield Trust and the Health Foundation, they set out a series of policy actions that, evidence suggests, should be at the heart of the workforce implementation plan. They focus on nursing and general practice, where the workforce ...

Health literacy as a social practice: Social and empirical dimensions of knowledge on health and healthcare

Health literacy has become a hot topic in health research and public health promotion. Most definitions specify health literacy as an individual cognitive skill, and surveys such as the EU-HLS which ask people to self-rate their decision-making capacity in the health system, grade a majority of the population as having an inadequate health literacy. Inspired by a praxeological understanding of knowledge and based on an empirical study on welfare bricolage in superdiverse urban neighborhoods, this paper explores health literacy ethnographically and highlights people's knowledge, creative practices and experiences concerning health and healthcare.