Abstract
The importance of multidisciplinary teams (MDTs) as critical implementation drivers emerged from this case study conducted with three pioneer sites implementing integrated care for older persons in Ireland as part of the Integrated Care Programme for Older Persons (ICPOP). We describe the practices of MDTs learning to deliver integrated care in service delivery settings, including the framework, resourcing, strategies, challenges and barriers they encounter.The study was conducted by a team of researchers in collaboration with ICPOP at both national programme and pioneer site levels. Qualitative methods of participant observation, workshopping, and documentary analysis were used to build a rich description, and using organisational and systems lenses identification of critical factors as both themes and resources for learning.The case study suggests the MDT is an essential driver of integrated care delivery. For example, ICPOP MDTs working across pioneer sites develop new service models and care opportunities, troubleshoot and challenge the systemic status quo, and disrupt professional silos. However, they also deliver on programme goals.Nonetheless, progress is constrained by organisational factors including fragmented funding structures, high turnover of senior level decision-makers, a lack of multiannual funding and complex professional arrangements.This study finds ICPOP offers practical and timely insight to inform health system reform. It embraces the complexity of delivery at national, local and community levels. The MDT emerges as an essential mechanism to manage such complexity and deliver on wider reform goals such as patient-centredness and timely access.
Highlights
Integrated care is an important concept in the design and delivery of population, acute, primary and community care given the changes to health demographics in medium to high-income countries [1]
The themes explored highlight a range of specific implementation factors characterising the experiences of multidisciplinary teams (MDTs) and Integrated Care Programme for Older Persons (ICPOP) in general
ENGAGEMENT WITH CASE SITES AND SITE DESCRIPTIONS One research team member spent up to three days in each pioneer site, spending time with MDT members and observer participating in MDT activities, including meetings, patient consultations and domiciliary visits, and availing of opportunistic conversations with individual team members
Summary
Integrated care is an important concept in the design and delivery of population, acute, primary and community care given the changes to health demographics in medium to high-income countries [1]. It means optimising early intervention and timely access to care in the community [2], and an emphasis on social supports and personcenteredness [3] – all complex service delivery goals. Ireland was late to commit to a comprehensive integrated care policy, only formally adopting one from 2018 as part of its ten-year Sláintecare Reform Programme mapping a path to universal healthcare [4,5,6]. In order to set this project in the broader context of whole-of-system change and healthcare reform in general, an organisational factors lens is used to analyse the case data and identify themes for discussion, reflection and learning
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