Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight For the Future?

Harvey, Gill; Dollard, Joanne; Marshall, Amy; Mittinty, Manasi Murthy

doi:10.15171/ijhpm.2017.144

Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight For the Future?

Document Type : Editorial

Authors

Gill Harvey ¹

Joanne Dollard ²

Amy Marshall ¹

Manasi Murthy Mittinty ¹^{, 3}

¹ Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia

² Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia

³ Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia

10.15171/ijhpm.2017.144

Abstract

Integrated care has been recognised as a key initiative to resolve the issues surrounding care for older people living with multi-morbidity. Multiple strategies and policies have been implemented to increase coordination of care globally however, evidence of effectiveness remains mixed. The reasons for this are complex and multifactorial, yet many strategies deal with parts of the problem rather than taking a whole systems view with the older person clearly at the centre. This approach of fixing parts of the system may be akin to shuffling the deckchairs on the Titanic, rather than dealing with the fundamental reasons why the ship is sinking. Attempts to make the ship more watertight need to be firmly centred on the older person, pay close attention to implementation and embrace approaches that promote collaborative working between all the stakeholders involved.

Highlights

Commentaries Published on this Paper

Achieving Integrated Care for Older People: What Kind of Ship?; Comment on “Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight for the Future?”

Abstract | PDF

Care Integration – From “One Size Fits All” to Person Centred Care; Comment on “Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight for the Future?”

Abstract | PDF

Authors' Response to the Commentaries

Creating the Right Sort of Ship to Achieve Integrated Care: A Response to Recent Commentaries

Abstract | PDF

Keywords

Integrated Care

Older People

Multi-morbidity

Subjects

Health Policy Analysis

"Watch the Video Summary"

Glendinning C, Means R. Rearranging the deckchairs on the Titanic of long-term care - is organizational integration the answer? Crit Soc Policy. 2004;24(4):435-57. doi:10.1177/0261018304046671
Care Quality Commission. Building bridges, breaking barriers. How care is integrated across health and social care and the impact on older people who use services, and their families and carers. Newcastle-upon-Tyne: Care Quality Commission; 2016. https://www.cqc.org.uk/sites/default/files/20160712b_buildingbridges_report.pdf.
Shaw S, Rosen R, Rumbold R. What is integrated care? An overview of integrated care in the NHS. London: Nuffield Trust; 2011. https://www.nuffieldtrust.org.uk/files/2017-01/what-is-integrated-care-report-web-final.pdf.
Britt HC, Harrison CM, Miller GC, Knox SA. Prevalence and patterns of multimorbidity in Australia. Med J Aust. 2008;189(2):72-77.
Wodchis WP, Dixon A, Anderson GM, Goodwin N. Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis. Int J Integr Care. 2015;15:e021. doi:10.5334/ijic.2249
Sarnak D, Ryan J. How High-Need Patients Experience the Health Care System in Nine Countries. The Commonwealth Fund; 2016.
Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ. 2012;345:e5205. doi:10.1136/bmj.e5205
Harvey D, Foster M, Strivens E, Quigley R. Improving care coordination for community-dwelling older Australians: a longitudinal qualitative study. Aust Health Rev. 2017;41(2):144-150. doi:10.1071/AH16054
Dollard J, Harvey G, Dent E, Hoon E, Karnon J, Kitson A, et al. Local solutions to improve health systems: towards an integrated care model for older people. Adelaide: School of Nursing, University of Adelaide; 2014.
Joynt KE, Jha AK. Thirty-Day Readmissions — Truth and Consequences. N Engl J Med. 2012;366(15):1366-1369. doi:10.1056/NEJMp1201598
Nielsen M, Buelt L, Patel K, Nichols LM. The Patient-Centred Medical Home's Impact on Cost and Quality. Annual Review of Evidence 2014-2015. Washington DC: Patient-Centred Primary Care Collaborative; 2016. https://www.pcpcc.org/resource/patient-centered-medical-homes-impact-cost-and-quality-2014-2015.
Report of the Primary Health Care Advisory Group. Better Outcomes for People with Chronic and Complex Health Conditions. Commonwealth of Australia: Department of Health; 2016. https://www.health.gov.au/internet/main/publishing.nsf/Content/76B2BDC12AE54540CA257F72001102B9/$File/Primary-Health-Care-Advisory-Group_Final-Report.pdf.
Ministry of Health. Better, Sooner, More Convenient health care in the community. Wellington: Ministry of Health; 2011. https://www.health.govt.nz/system/files/documents/publications/better-sooner-more-convenient-health-care_0.pdf.
Janamian T, Jackson CL, Glasson N, Nicholson C. A systematic review of the challenges to implementation of the patient-centred medical home: lessons for Australia. Med J Aust. 2014;201(3 Suppl):S69-S73. doi:10.5694/mja14.00295
National Voices. 2013 Integrated care: what do patients, service users and carers want?
https://www.nationalvoices.org.uk/sites/default/files/public/publications/what_patients_want_from_integration_national_voices_paper.pdf. Accessed September 25, 2017.
Sheaff R, Halliday J, Byng R, et al. Bridging the discursive gap between lay and medical discourse in care coordination. Sociol Health Illn. 2017;39(7):1019-1034. doi:10.1111/1467-9566.12553
Greenhalgh T, Jackson C, Shaw S, Janamian T. Achieving research impact through co‐creation in community‐based health services: literature review and case study. Milbank Q. 2016;94(2):392-429. doi:10.1111/1468-0009.12197
Kitson A, Brook A, Harvey G, et al. Using complexity and network concepts to inform healthcare knowledge translation. Int J Health Policy Manag. 2018; forthcoming. doi:10.15171/ijhpm.2017.79