How Do Older People Experience Person-Centred Integrated Care? An Integrative Review of the Evidence

Evaluations of integrated care often focus on systemic or clinical outputs. Theoretically informed research emphasising values, preferences and voice of older persons in relation to the experiential dimensions of PCIC for service users is less prominent. This paper presents key findings and recommendations of a multiple qualitative case study exploring older persons’ and caregivers’ experiences of PCIC in NICPOP, an Irish integrated care programme. Conceptual underpinnings of person-centred care (PCC) and of McCormack and McCance’s interprofessional Person-Centred Practice Framework (PCPF) (McCormack and McCance, 2021) were used as a sensitising framework to interpret data generated in 23 interviews with 32 service users across 3 heterogeneous NICPOP sites. This study addressed the dearth of research on older people’s experiences of PCIC. While the terms ‘integrated care’ and ‘PCC’ abound in health care policy and practice documents, there remain contested definitions on integrated care (Baxter et al, 2018), PCC (Mitchell, 2022), and PCIC (Greenfield, 2014) and a lack of data concerning service users’ felt experiences of PCIC. A key finding of this study was the central importance of the therapeutic relationship and alliance between NICPOP staff and the client and caregiver and the significant value participants placed on this. Participants cited relational processes of care as more important to them than clinical or transactional processes in terms of constituting a good care experience for them. Findings reveal the importance of care context and model of care delivery for this care relationship. An intensive and long-term case management model was found to foster and maintain this trusted relationship, ensuring that clients and caregivers had a single and consistent point of contact with NICPOP. This in turn enabled enhanced service provider understandings of complex and changing needs in the context of chronic illness and multimorbidity and required holistic care responses. Case manager relationships resulted in reassuring felt experiences of coordination of care for service users. Home-based, as compared with clinical hub based, models of care enabled relationship building, providing for greater insight into the psychosocial contexts of older people and their families, revealing vulnerabilities, priorities and related care needs, and facilitating more personalised holistic care. Findings suggest that longer-term models of care or finite interventions with the capacity of a follow-up check-in built in following discharge to enable re-engagement where necessary contribute to felt experiences of management and relational continuity. Findings also elucidated the necessity of understanding the power dynamics at play within relationships between service providers and service users and caregivers. Power and power relations were evident in terms of PCIC that empowers, and health system fragmentation and related inaccessibility of services that are disempowering and disenfranchising for clients and their caregivers. Finally, this paper presents recommendations for policy and practice regarding the further development of NICPOP. These include the continuation of longer-term home-based models of care, especially for more vulnerable and complex presentations and the establishment of dynamic and adaptive approaches to longer-term engagement and incorporation of the potential to re-engage with ICTOP in response to emerging needs, ensuring management continuity of care.

<h3>Context:</h3> Person-centred integrated primary care delivery is often at odds with how current health care systems are structured, resulting in slower than expected uptake of the model. Adopting goal-oriented care, an approach which uses patient priorities, or goals, to drive what kinds of care are appropriate and how care is delivered, may offer a way to improve implementation. <h3>Objective:</h3> This case report presents three international cases of community-based primary health care models in Ottawa (Canada), Vermont (USA) and Flanders (Belgium) that adopted goal-oriented care to stimulate clinical, professional, organizational and system integration. The Rainbow Model of Integrated Care is used to demonstrate how goal-oriented care drove integration at all levels. <h3>Study design:</h3> Theoretical concept mapping using comparative case studies to illustrate theoretical connections. <h3>Setting:</h3> 3 interprofessional primary care practices delivering goal-oriented care in Ottawa (Canada), Flanders (Belgium), and Vermont (United States). <h3>Population studied:</h3> Interprofessional primary care practices. <h3>Intervention:</h3> Interprofessional teams delivering goal-oriented care. <h3>Outcome measures:</h3> Describe how goal-oriented care advances clinical, professional, organizational and system level integration. <h3>Results:</h3> The three cases demonstrate how goal-oriented care has the potential to catalyze integrated care. In Ontario, goal-oriented care enabled integration at clinical and professional levels, helping clinicians to work together across professional boundaries. In Vermont, the model enabled professional and organizational integration, helping professionals to work across organizational boundaries to support high needs patients. In Flanders, goal-oriented care is being adopted as part of a larger primary care system transformation. In all cases goal-oriented care served to activate formative and normative integration mechanisms; supporting processes that enable integrated care, while providing a framework for a shared philosophy of care. <h3>Conclusions:</h3> The framework presented in this work helped to demonstrate how goal-oriented care can be used to establish a common vision and philosophy to drive shared processes, acting as a powerful tool to enable integrated care delivery. This comparative case work provides lessons for other systems seeking to provide integrated care within and across primary care teams.

This paper concerns the findings of a qualitative study exploring service user experiences of PCIC. Using McCormack and McCance’s Person-Centred Practice (PCP) Framework, with a focus on the process and outcome domains at the micro level, the research validates the utility of the framework in an integrated care context. Drawing on a case study methodology, thirty interviews were conducted with service users engaging with integrated care services across three sites within the National Integrated Care Programme for Older Persons in the Republic of Ireland. The PCP framework is an internationally recognised theoretical framework that supports healthcare service providers and teams in understanding the dimensions of person-centredness and how these can be represented and realised in practice (Slater, McCance and McCormack, 2017). The PCP framework centralises the establishment of the therapeutic relationship between the service provider and the service user, including their families and carers and identifies person-centred processes and consequent outcomes. In particular, this paper will focus on this micro level component, i.e. the outcome and process domains, of the framework. The findings of the study validate the outcome and process domains as key in service user experiences of PCIC. While the three sites differ in terms of the integrated care model applied, findings indicate that the processes of engagement; having a sympathetic presence; providing holistic care; engaging in shared decision making; and working with patient’s beliefs and values are evident; are all both experienced and valued by service users. In addition, across the three cases, service users identify the impact of their care as manifesting all four person-centred outcomes included in the framework: satisfaction with care; involvement with care; and feeling of well-being; and creating a therapeutic culture between service user and care professional. The findings also indicate key components pertinent to service user experiences of PCIC which may be considered as possible extensions to the framework’s stated outcomes. These include consideration on the felt experience of integration and coordination in terms of outcomes for the service user. While the framework includes the felt experience of feeling treated as an individual and being involved in care in outcome domains, the felt experience of coordination and integration could also be included. Findings of the study elucidate the importance of the biographical narrative and reveal how diversity of individuals’ personal and social resources and capacities impact on the differentiated nature of agency and its expression as part of the care experience. This agency of the older person, whether relating to their educational, economic or other capacities or their social network and ancillary informal social supports and care, will impact on how they engage with and participate in care processes and related care needs. Consideration of this key biographical information, in addition to individuals’ beliefs and values, will impact on how service providers can optimise supports provided and will inform processes around participation and shared decision making. The findings reveal how this framework can be successfully used and potentially extended as a meaningful evaluative tool to explore experiences of PCIC.

BackgroundChronic disease management is important in primary care. Disease management programmes focus primarily on the respective diseases. The occurrence of multimorbidity and social problems is addressed to a limited extent. Person-centred integrated care (PC-IC) is an alternative approach, putting the patient at the centre of care. This asks for additional competencies for healthcare professionals involved in the execution of PC-IC. In this scoping review we researched which competencies are necessary for healthcare professionals working in collaborative teams where the focus lies within the concept of PC-IC. We also explored how these competencies can be acquired.MethodsSix literature databases and grey literature were searched for guidelines and peer-reviewed articles on chronic illness and multimorbidity in primary care. A data synthesis was carried out resulting in an overview of the competencies that healthcare professionals need to deliver PC-IC.ResultsFour guidelines and 21 studies were included and four core competencies could be derived through the synthesis: 1. interprofessional communication, 2, interprofessional collaborative teamwork, 3. leadership and 4. patient-centred communication. Included papers mostly lack a clear description of the competencies in terms of knowledge, skills and attitudes which are necessary for a PC-IC approach and on how these competencies can be acquired.ConclusionThis review provides insight on competencies necessary to provide PC-IC within primary care. Research is needed in more depth on core concepts of these competencies which will then benefit educational programmes to ensure that healthcare professionals in primary care are better equipped to deliver PC-IC for patients with chronic illness and multimorbidity.

Introduction: This workshop will build on an international integrated knowledge translation project that seeks to advance meaningful adoption of digital health services to enable delivery of high-quality and equitable person-centred integrated care. Problem: Digital health solutions and services are recognized as critical to achieve person-centred integrated health and social care. To date work in this area has focused on the development and adoption of these technologies in supporting the (functional) activities of integrated care delivery, but less known is how these technologies can advance, or upend, the (normative) values of the communities, teams, and organizations that underpin their vision for greater integration. With the global rapid uptake of digital health tools in the wake of the COVID-19 pandemic, systems are faced with the opportunity to quickly leverage innovative solutions, and the risk of doing so without a clear view the path this adoption sets us up to follow. Audience: To address the problem this workshop will share findings from the work of the Value Aligned Digital Health Consortium to develop a set of recommendations to inform implementation, evaluation, scale and spread of value-aligned technologies in person-centred integrated care. The Consortium includes researchers, providers, systems leaders, industry representatives as well as a central community partnership ensuring representation of diverse patient, caregiver and community stakeholders. As such, the audience for this workshop will include a similar range of representative groups, bringing in additional international perspectives to discuss how recommendations can be refined and adapted to meet local needs and contexts. Structure and engagement: The Consortium has been running a series of deliberative dialogues with diverse stakeholder groups to arrive at recommendations and guidelines. This workshop would run a modified dialogue session in which delegates will discuss and refine recommendations to account for contextual considerations across different regions. Delegates will work in small groups (5-6 per table), facilitated by our team members, to discuss three topics: values, implementation recommendations, and evaluation recommendations. Facilitators will use a live Google Jamboard to record ideas shared by the group. Workshop structure: 1) Introduction and background of the project (10 minute presentation from project co-leads Carolyn Steele Gray and Jay Shaw); 2) Understanding values of integrated care (10 minute presentation by Nick Zonneveld); 3) patient/community reflection from a patient consortium member (8 minutes) 4) Dialogue methods and activity set up (7 minute presentation by Marissa Bird to describe methods and set up the dialogue activity for delegates); 4) Facilitated small group work on 3 topics, values, implementation, evaluation (45 minutes; 15 minutes per topic); 5) Wrap-up (10 minutes – facilitators present the live Jamboards and elicit any additional feedback from delegates. Summarizing take home messages: This workshop will directly inform the final report to be published on this project. We will additionally be generating info-graphics and short videos to help disseminate learning generated by this workshop and the broader project. All delegates of the workshop will be invited to join the Consortium should they wish to have ongoing engagement.

Experiencing integration in Australian primary health care: a pilot study

Introduction: This workshop will build on an international integrated knowledge translation project that seeks to advance meaningful adoption of digital health services to enable delivery of high-quality and equitable person-centred integrated care. Problem: Digital health solutions and services are recognized as critical to achieve person-centred integrated health and social care. To date work in this area has focused on the development and adoption of these technologies in supporting the (functional) activities of integrated care delivery, but less known is how these technologies can advance, or upend, the (normative) values of the communities, teams, and organizations that underpin their vision for greater integration. With the global rapid uptake of digital health tools in the wake of the COVID-19 pandemic, systems are faced with the opportunity to quickly leverage innovative solutions, and the risk of doing so without a clear view the path this adoption sets us up to follow. Audience: To address the problem this workshop will share findings from the work of the Value Aligned Digital Health Consortium to develop a set of recommendations to inform implementation, evaluation, scale and spread of value-aligned technologies in person-centred integrated care. The Consortium includes researchers, providers, systems leaders, industry representatives as well as a central community partnership ensuring representation of diverse patient, caregiver and community stakeholders. As such, the audience for this workshop will include a similar range of representative groups, bringing in additional international perspectives to discuss how recommendations can be refined and adapted to meet local needs and contexts. Structure and engagement: The Consortium has been running a series of deliberative dialogues with diverse stakeholder groups to arrive at recommendations and guidelines. This workshop would run a modified dialogue session in which delegates will discuss and refine recommendations to account for contextual considerations across different regions. Delegates will work in small groups (5-6 per table), facilitated by our team members, to discuss three topics: values, implementation recommendations, and evaluation recommendations. Facilitators will use a live Google Jamboard to record ideas shared by the group. Workshop structure: 1) Introduction and background of the project (10 minute presentation from project co-leads Carolyn Steele Gray and Jay Shaw); 2) Understanding values of integrated care (10 minute presentation by Nick Zonneveld); 3) patient/community reflection from a patient consortium member (8 minutes) 4) Dialogue methods and activity set up (7 minute presentation by Marissa Bird to describe methods and set up the dialogue activity for delegates); 4) Facilitated small group work on 3 topics, values, implementation, evaluation (45 minutes; 15 minutes per topic); 5) Wrap-up (10 minutes – facilitators present the live Jamboards and elicit any additional feedback from delegates. Summarizing take home messages: This workshop will directly inform the final report to be published on this project. We will additionally be generating info-graphics and short videos to help disseminate learning generated by this workshop and the broader project. All delegates of the workshop will be invited to join the Consortium should they wish to have ongoing engagement.

Background: Integrated care is about removing barriers to effective, coordinated, and person-centred care. Often, the language used to describe barriers revolves around fragmentation, for example, siloed care delivery or communication gaps. However, even the joining-up of services will not achieve the ideal of “the right care at the right time in the right place” without addressing other barriers to accessing care. These barriers include stigma, discrimination, mistrust, and power imbalances that operate at all levels (micro to macro), and directly and indirectly (via health inequity) contribute to poor health. In our project, we focus on an underserved vulnerable population living and working in a community-based congregate setting (residential care facilities; RCFs) in a Canadian city. RCF residents often have complex and multi-layered needs, which may include mental health and/or addictions, history of homelessness or precarious living, or both. As well, the majority of staff are personal support workers who are mostly women and among the lowest paid care workers in the health care system. Issues such as stigma affect the everyday lives of residents and staff. Despite the needs of this population, historically, RCFs have not been included in health system planning. Objectives: We are working on a three-year project in collaboration with the Greater Hamilton Health Network and a ~40-member group including health, social, and housing partners. The first phase is about comprehensively gathering information on the population health needs, system gaps, and opportunities. Ultimately, we seek to co-design, implement, and evaluate a model of integrated primary care across several RCFs. In this workshop, we will share our project journey from proposal development to present-day, including findings from two sub-studies: (1) Semi-structured interviews were conducted with 20 RCF operators and 20 organizations/individuals providing support to RCF residents, (2) Ethnographic fieldwork was used to understand resident and staff perspectives from several RCFs. We will utilize our project to highlight issues related to stigma, mistrust, and power as well as facilitators such as relationship building and joint working. Audience: Through this workshop, we hope to engage with health and social care organizations/providers, policymakers, administrators, people with lived experiences (i.e., living or working in congregate care settings), caregivers, researchers, and anyone who is passionate about health equity. The 90-minute workshop will be structured as follows: 5 minutes: Introduction 15 minutes: Project overview 10 minutes: Small group discussion - What does person-centred integrated care look like from your perspective? 15 minutes: Interviews (methods &amp; findings) 10 minutes: Small group discussion - How do the issues we share from our findings resonate with your experiences? What is similar/different? 15 minutes: Fieldwork (methods &amp; findings) 10 minutes: Small group discussion - How do the issues we share from our findings resonate with your experiences? What is similar/different? 10 minutes: Group reflection &amp; closing Outcome: Using this Canadian example, workshop participants will consider and understand practical tips/approaches from different perspectives on how to identify and address barriers (e.g., stigma, power imbalances) and facilitators (e.g., trust, joint working) of equitable access to integrated care.

IntroductionThe economic case for preventive care delivered in or near citizens’ homes is strong, and there is growing evidence of the role of local-level support in supporting people’s health and...

PurposeDue to the need for the development of person-centred integrated models of care with a population health approach, this paper explored contemporary literature in this arena.Design/methodology/approachA systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Papers included in this review focused upon person-centred integrated care and a health promotion/public health approach (January 2018–October 2020). Papers were excluded due to not being written in English, not fitting the age criteria and not being peer reviewed.FindingsEight studies met the inclusion criteria and three overarching themes were identified with regards to person-centred integrated care as a health promotion/public health approach: Core components; Development, implementation, and evaluation of models of care and relationship to population health and wellbeing outcomes.Research limitations/implicationsThe need for person-centred integrated care as a health promotion/public health approach, to enhance population health and well-being outcomes requires further research to continue to develop, implement and evaluate models of care.Originality/valueThe international scope of this contemporary review brought together the three concepts of person-centred integrated care and public health, exploring the translation of policy into practice (WHO, 2016). The juxtaposition of public health approaches in the background/consequential or foreground/active agent demonstrates how promotion, prevention and population health can be re-valued in integrated people-centred health services (WHO, 2016).

The SELFIE framework for integrated care for multi-morbidity: Development and description

IntroductionIntegrated care has the potential to mitigate patient safety risks by enhancing collaboration and maintaining a patient-centred approach. However, best practices for successful implementation are lacking. This study aims to identify and describe key components of best practices for integrating health and social care to increase understanding of successful implementation.MethodsA Collaborative Reflexive Deliberative Approach was used. The data comprised twenty-one published articles and five unpublished manuscripts from 2015 to 2023, along with the experiences of ten clinicians and researchers in integrated care, and the research team itself.ResultsComponents identified as best practices for integrated care, each describing different aspects shaped by and for the patient, were: holistic co-creation in an ethical stance, trust through physical and relational proximity, flexible caring, learning and adaptable organizations and flexible information and communication.Discussion/conclusionThe study emphasizes the importance of building trust through proximity and adaptable organizational learning, and the need for a holistic perspective, acknowledging both the limitations and potentials of health and social care integration. Embracing innovative thinking and recognizing that not everyone needs all services at all times can foster flexible, person-centred integrated care. Addressing these complexities is essential for successful integration efforts.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12875-025-03062-y.

BackgroundThe policy shift towards person-centred integrated primary care systems drives interest in primary care across higher education programs. In Flanders, the Primary Care Academy (PCA) is established to support this policy shift. The PCA focusses on the concepts of goal-oriented care, self-management, and interprofessional collaboration to support the shift towards integrated care and to integrate them in curricula in order to strengthen and develop a futureproof health system. Therefore, the aim of this study is if and how lecturers implement these concepts in the curriculum and what they need for a successful implementation.MethodsA sequential explanatory mixed method study design was used combining quantitative and qualitative data. A cross-sectional survey was sent to 276 Flemish health care education programs. Qualitative data was collected through focus groups in which lecturers participated.ResultsThe results showed that 89% of the higher education programs address goal-oriented care, self-management, and interprofessional collaboration with regard to primary care. Further analysis of courses within the programs reveals that the concept of self-management is covered in only 58%, while goal-oriented care (73%) and interprofessional collaboration (80%) appear more frequently. The level at which the themes are addressed in the courses are often limited to an introduction.The focus groups revealed that primary care is present in education programs, however lecturers are limited aware where primary care is integrated in their own and other programs. Lectures expressed a need for more collaboration between research, education and practice in developing educational content. When new concepts are introduced, lecturers want them to be translated into educational content, learning objectives and competencies.ConclusionsThe study shows that the concepts of goal-oriented care, self-management, and interprofessional collaboration are present in higher education programs to a varying degree. Lecturers are eager to implement these new primary concepts but they lack collaboration between education, research and practice. Lecturers indicate the need for a competence profile for primary care professionals as common framework to guide curriculum development.

Integrated health and social care is emerging as a trending area of interest in the governmental policy agenda in Europe. Most governments are facing great challenge to overcome barriers to facilitate Integrated Care between health and social services. Integrated care has been in the health policy agenda but new challenges should be coped regarding the incorporation of social services, especially for the persons with complex chronic condition with health and social needs. Although this integration improves both health and social care systems, it is a difficult task to get both groups to work together due to different factors. Early this year, the Government of Catalonia issued a new Integrated Health and Social Care Plan to promote, lead and participate in the transformation of the social and health care model to achieve person-centred full integrated care and so to deliver holistic care to high-cost, high-need citizens in order to help to lower costs, enhance quality of care, and improve outcomes. During this session it will be shortly presented the journey from the Chronic Condition Prevention and Care Program to the new Integrated Health and Social Care Plan in Catalonia, but it’s going to be focused specifically on the implementation strategy through Local Partnerships. 9 of this Local Partnerships Implementation Projects have been assessed by the Catalan Agency for Quality in Health and Assessment so we can present and discuss the results of this evaluation about: Structure and functioning of experiences identified that include a collaborative model (mainly: social services and primary care services). Barriers and facilitators of collaborative models. Perceived benefits and expected results and areas for improvement. Propose a conceptual model of assessment and possible common pool of indicators 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 1 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-117003 – http://www.ijic.org/

Introduction: Digital health has been identified as a valuable method in supporting older adults’ self-management and well-being in their home setting. The ValueCare Project is a European research project, funded by Horizon2020, which seeks to co-design and deliver integrated care to older people living with chronic health conditions to improve their quality of life, as well as their integrated care providers, and support the sustainability of healthcare systems in Europe. Aims: To describe the implementation process of digital health technology within an integrated care setting for older people living with frailty in Ireland. Highlights: Digital health technology was implemented at two community-based integrated care hubs for older people and the wider community in Cork and Kerry. Several key learnings emerged from the implementation process: (1) co-designing digital health technology with older people, family caregivers and integrated care professionals ensured that the technology aligned with current clinical practice while providing an enhanced integrated care pathway for older people; (2) strong relationships between the research team and integrated care teams were crucial to enable effective communication and trust during the process; (3) using an adaptable digital tool enabled the research team to focus on and revise the content of the solution; (4) challenges in participant recruitment occurred due to related to patient eligibility within the integrated care hubs and lack of interest in research or technology (5) it was necessary to actively adapt to the requirements of each clinical practice to implement new technology and (6) emphasising the potential educational benefits regarding positive ageing that participants may gain was important for the recruitment process, as well as the awareness of supporting the ageing population in Ireland in the future. The context of the implementation phase must be also considered, which occurred following the COVID-19 pandemic. Clinical services were experiencing significant change and re-adjustment to provide care to older people who were considered most at-risk for the disease. Conclusions: Successful implementation was dependent on collaborative and transparent communication amongst researchers, technology partners, older people, family caregivers and integrated care professionals during the co-design and implementation within the Irish healthcare system. Acknowledging that this project is the first of its kind in Ireland, learnings from this process can inform future digital health implementation activities, policy and research regarding older people living with health conditions and other populations within integrated care settings, both in Ireland and internationally.