“Joining up the dots”: Integrated care as an element of the Andalusian public health strategy

Abstract

Introduction: “The notion of integrated care has begun to recognise the need to take a more population-oriented approach to promote public health, prevent ill-health and secure wellbeing for populations. Yet, for the most part, public health has remained somewhat separate to the planning and purchasing of health and social care services and, as a result, public health interventions have often tended to operate in separate silos to traditional care provision” Goodwin and Ferrer 2017. Hence, there have been calls for those involved in integrated care and public health to 'join up the dots' Alderwick et al., 2015. Description of policy context and objective: The Autonomous Community of Andalucia is widely recognised for having led the public health agenda in Spain, having embraced over time the “Health in all policies” through different policies and interventions, aiming at reducing health disparities and promoting health assets IV Health Plan, 2014. This agenda has crystallised into transformative interventions such as the Local Health Action Network Red de Accion Local en Salud, RELAS - which promotes the development of local public health plans under the leadership of local authorities – or the Strategy to support people suffering from high adversity situations RED AL LADO, that redefines care pathways by working with care professionals, patient associations and the community. The notion and goal of care coordination and health and social care collaboration has been debated in Andalucia since the 1980s, frequently intertwining with the public health agenda. Many policies, strategies and interventions had been developed within the integrated care objective: actually, there is a long list of integrated care interventions from Andalusia registered as best practices at the Spanish Observatory on Integrated Care OMIS. However, these efforts had not translated into formal coordination structures or been framed into the wider public health strategy. Highlights: In 2017, the Andalusian Health Department has started the formulation of an integrated care framework that latches onto its broader public health agenda. The framework builds upon the contributions and initiatives that have been developed over the years, including the development and adoption of integrated clinical pathways procesos asistenciales integrados, the expansion of the role of nursing care managers, the production of different narratives for person-centred coordinated care see, for example, the 2002 PAI Ataque Cerebrovascular or the integrated health information systems. The presentation will describe the ongoing initiative, which includes the development of the bases for the Andalusian integrated care model and a person-centred integrated care narrative through collaborative and inclusive processes. Conclusions: At the time of the ICIC18, a local pilot will be launched, so the authors hope to be able to present preliminary insights of progress, challenges and strategies being developed.