Tackling health inequalities by creating new practices of integrated health access

Abstract

Abstract Background Health inequalities often emerge in-between health and social care sectors, as part of transitions between providers across the two sectors. Integrated health access is important for addressing these inequalities. Therefore, we need to understand processes of organising integrated health access and how these shape pathways of accessing care. We draw on sociological understandings of organising as practice that emerges as part of interactions between professionals and users. Methods We did observations of interactions between professionals and users (n = 18 days) and semi-structured interviews with users, professionals, and managers (n = 33) in the specialised mental health services in Central Denmark Region and FACT-inspired teams in 3 municipalities. We also conducted 3 focus groups with regional and municipal professionals from these teams. Data was analysed through a qualitative thematic analysis. Results Each team had distinct cultures of collaboration and different levels of cross-sectoral collaboration. Creating new, more integrated practices seemed to rely on both, supportive organisational structures and committed engagement in inter-sectoral spaces to change professional meaning systems. When teams were able to collaborate closely, it was easier to retain hard-to-reach users in treatment. However, professional differences could easily create division and therefore maintaining and building relationships were highly important. These mechanisms illustrate the importance of ensuring meaningful spaces for cross-sectoral work, where professionals can interact and create the needed changes. Conclusions Organising integrated health access is not merely about providing structures but is also highly dependent on interactions between professionals and users. Analysing interactions between professionals from across sectors, is important to understand the sustainability of integrated health access. In turn, this could help to tackle social inequalities in health. Key messages • Introducing integrated health access is highly dependent on interactions among professionals. • Integration of professional practices across sectors helps retain hard-to-reach users in treatment.