PurposeThis paper aims to analyze the on-going implementation of the integration of health service post of elderly and non-communicable diseases (NCDs) in order to better understand Indonesia’s preparedness for future integration through the life cycle health post.Design/methodology/approachThis study employs a mixed-method explanatory sequential design with two research phases. The quantitative research using the Donabedian frameworks (structures–process–outcome) and qualitative approach was utilized to corroborate and further investigate the findings from the quantitative research through focus group discussion and in-depth interview.FindingsThis study concluded that the attendance of human resources during the program varied slightly between posts with = 5 cadres and those with >5 cadres; the government support of the toolkit was not yet distributed equally. The funding system was sourced from Health Operational Assistance and voluntary funds (Iuran Warga). Conversely, educational materials and monitoring books were unavailable during the program due to insufficient funds, which also affected the uneven training opportunities for cadres, resulting in a lack of confidence to provide clear health education or instruction to the users. This study also highlights the lack of defined indicators to evaluate the program’s success.Research limitations/implicationsThe research was limited by the fact that the sample does not represent all health service posts for the elderly and NCDs in Depok City. However, the survey utilized a diverse range of demographic areas and employed a mixed-methods approach. Additional research with a larger sample size and expanded geographic scope, including other regions of Indonesia, is necessary to further assess the country’s preparedness to implement integrated primary healthcare (PHC), particularly for the integrated Posyandu program.Originality/valueThis study specifically investigated the current implementation of the integrated program through health services post for the elderly and NCDs to better understand Indonesia’s preparedness for future integration program through the life cycle health post.

PurposeMultiprofessional team working is assumed to be difficult. This is often associated with professional identity and jurisdiction. Despite anticipated difficulties, few studies examine teams working in their main arena: team meetings. One important function of these multiprofessional team meetings is to determine future tasks and next steps for patients. This paper examines the negotiation between professionals of what these next steps should be.Design/methodology/approachData was collected in 2018 and 2019, from three Community Learning Disability Teams in the UK, with a total length of 12 h and 37 min. Conversation analysis (CA) was used to analyse 22 extracts, at points in the interactions when there were negotiations on the next steps the team should take for clients.FindingsNegotiations were characterised by propositions and counter propositions. They occurred when a course of action was proposed that made a specific professional’s role relevant, which were then countered by that professional. Countering was achieved by professionals separating themselves from the team, using first-person pronouns and making statements on their next steps. In both propositions and counters professionals orient to epistemics and deontics, important for how their turns-at-talk were receipted by other team members.Originality/valueThis paper shows that instead of problematic, professional identity was used as a conversational resource. Negotiations are key for multiprofessional teams to determine optimal next steps for patients, and who could and should do specific tasks. Professionals orient to knowledge of professional identity to propose tasks that others could do, and to counter these propositions.

PurposeAdvance care planning (ACP) is an essential part of palliative dementia care and should embrace a collaborative approach involving people with dementia (PwD), family members and various healthcare professionals (HCPs). This study aimed to develop a guidance document for IPC in ACP in dementia care for HCPs working in nursing homes.Design/methodology/approachThe methodology is characterised by a mixed-method design and an appreciative inquiry approach comprising semi-structured focus groups and interviews with HCPs. The study participants (N = 18) included certified nurses, registered nurses, a quality nurse, nurse specialists, team leaders, physicians specialized in geriatric medicine, psychologists and a teacher/researcher (mean age 43.8 years; 79% female). The data analysis indicated six elements to include in the guidance document.FindingsThe first three elements concerned common awareness of collaborative ACP in dementia care, role clarification for various professions and actively working towards shared goals in collaborative ACP in dementia care. The last three themes focused on the dynamic processes in collaborative ACP in dementia care: interprofessional communication, coordination, monitoring and evaluation. This study provides a guidance document that HCPs could use in practice to identify the elements they can address to improve collaborative ACP in dementia care.Originality/valueThis study provides a guidance document that HCPs could use in practice to identify the elements they can address to improve collaborative ACP in dementia care.

PurposeIntegrated behavioral health (IBH) has the potential to address the growing instances of chronic and behavioral health problems. Orienting IBH to the assets-based approach to health, such as salutogenesis, might further enhance its efficacy. In this context, the present paper proposes a conceptual framework for salutogenic integrated behavioral health (SIBH), focusing on utilizing individual assets following the principles of IBH.Design/methodology/approachWe adopted a narrative literature review to develop this conceptual framework. We analyzed the earlier works on IBH and the concepts of the salutogenesis model of health (SMH). Based on the available empirical evidence and the authors’ experience of utilizing these models in healthcare interventions, a conceptual framework of SIBH is proposed.FindingsThis paper identifies salutogenic orientation as one of the effective route maps for IBH and could enhance its efficacy. A salutogenic orientation to IBH will encourage the identification of the factors that promote well-being over pathogenesis. In addition, it paves the way for identifying individualistic and community resistance resources (bio-psycho-social assets) and mobilizing them through collaborative care.Originality/valueSIBH would help overcome the limitations of IBH and provide multiple benefits for stakeholders. This paper is the first of its kind to discuss the potential of combining the salutogenic orientation with IBH. This framework might be a foundation for implementing an assets-based approach to health over pathogenesis.

PurposeMusculoskeletal conditions present a significant care and disability burden on our societies, and current approaches focusing on specific diseases or anatomical sites result in episodic, procedure-focused care. A novel framework that combines integrated care principles and a life-course approach is needed.Design/methodology/approachThrough a combination of literature review and theoretical synthetic approach to current frameworks, an expert clinical workgroup synthesised and implemented a life-course and integrated framework and approach to musculoskeletal health.FindingsThe implemented framework (1) takes a life-course view of musculoskeletal and physical health, (2) shifts focus away from an anatomical to functional perspective, (3) encompasses activity and participation in addition to body structure/function, (4) demonstrates the associated mental and metabolic health issues and (5) highlights opportunities for primary, secondary and tertiary integrated interventions at different levels and care sites.Originality/valueThis life-course and integrated framework and approach can be applied to guide macro-meso-micro integrated care strategies, drive the research agenda and promote educational efforts for musculoskeletal and physical health.

PurposeThis study aims to develop a model promoting integrated care for patients with multimorbidity based on patients’ and healthcare professionals’ needs to share knowledge in cross-sectoral communication and coordination in the local setting.Design/methodology/approachWe used an action research design that involved healthcare professionals, patients and researchers. The research followed an interactive process through its four phases. This study focuses on phase two, developing interventions to strengthen integrated care. The data consisted of audio recordings of workshops and field notes.FindingsAn action research group and invited expert participants contributed to developing 25 proposals for improving cross-sectoral collaboration in integrated care. The fundamental principles were discussed among the action research group. Five key principles were identified to base the CIRCLE-CARE model: (1) collaboration, (2) involving patients and relatives, (3) relationships across sectors, (4) clear communication and (5) embrace knowledge.Originality/valueAn action research group developed the CIRCLE-CARE model to address the needs of integrated care communication in the local context. The model is ready for future studies of its applicability, impact on patient pathways and healthcare costs.

PurposeFrailty increases the risk of adverse outcomes such as falls and disability and has a major impact on health and care services. Admission to hospital confers significant risks, including deconditioning, delirium and hospital-acquired infection. In the UK, there has been a significant shift towards acute care at home using integrated “hospital at home” (HaH) services as the delivery model. The purpose of this study was to explore the implementation processes and staff experiences of a frailty home treatment service (FHTS) in England.Design/methodology/approachUsing a multi-method, qualitative case study design, data were collected using semi-structured interviews with seven external stakeholders of the FHTS. A focus group was also conducted with seven members of the FHTS team. Interviews and the focus group were audio-recorded and transcribed. Data were analysed thematically according to an implementation science conceptual framework.FindingsFacilitating factors for implementation included a shared purpose and vision, the presence of “champions” in leadership roles, the development of trusted relationships, a commitment to collaborative working and a multidisciplinary skill mix. Challenges included the need for clear eligibility criteria, management of staff workloads and interoperable IT systems for digital information sharing.Originality/valueThis paper illuminates the factors which support implementation, maintenance and sustainability of integrated HaH services for frailty. These factors should be explored when services are implemented in other contexts. The impact on staff workload and training needs also needs consideration.

PurposeSocial prescribing is a growing movement in healthcare systems worldwide. This article shares the opinion of the authors that social prescribing’s longevity is dependent on student involvement.Design/methodology/approachTo argue this viewpoint, the authors share examples of how student collaborations have previously been utilised successfully to promote social prescribing.FindingsIt is concluded that future social prescribing success could therefore rely on continued student involvement.Research limitations/implicationsThis work is a viewpoint article, meaning it is subjective in nature and influenced by the authors’ lived previous experiences of the benefits they noticed to their learning by themselves being involved with social prescribing schemes as students.Originality/valueThis original viewpoint article offers a valuable perspective regarding what education may be necessary in relation to social prescribing. This is because it shares the viewpoints of authors who all have different lived experiences of social prescribing education by holding various roles within worldwide social prescribing peer-learning schemes.

PurposeOlder patients with multimorbidity often experience fragmented care between multiple healthcare providers, underscoring the need for integrated care. We examined characteristics of general practitioners and geriatricians who prioritise integrated care for older patients with multimorbidity in Japan.Design/methodology/approachIn June 2022, an anonymous mail survey was sent to 3,300 certified family medicine specialists, primary care-certified physicians and geriatric specialists to assess the importance of integrated care and challenges in managing multimorbid patients. Physicians scoring above the median on integrated care items were classified as “high priority for integrated care”. Associations were examined using modified Poisson regression of physicians’ four-point ratings of difficulties in adhering to practice guidelines, considering treatment burden, patient healthcare utilisation and challenges in managing coexisting conditions.FindingsData from 738 respondents (22.4%) were analysed. Factors linked with a higher priority for integrated care included years of experience (prevalence ratio [PR]: 1.004), providing outpatient care (PR: 0.836), providing home medical care (PR: 1.108), population >100,000 (PR: 1.143), challenges with guidelines (PR: 1.109), focus on treatment burden (PR: 1.150) and patient attendance at multiple institutions (PR: 1.328).Originality/valueThe findings suggest essential considerations for medical education and policy to enhance integrated care for this population.

PurposeEuropean countries are experiencing a phenomenon known as “double aging,” which is placing long-term care regimes under considerable strain. The majority of long-term care is provided by relatives, and this informal care is vital for the functioning of care regimes. Most of this informal long-term care (iLTC) is provided by women. The consequences of the unequal distribution of care within society are a crucial, yet poorly addressed aspect of social policy research. We address this research gap and provide insights into the socio-economic impacts of the unequal gender distribution of iLTC.Design/methodology/approachFor the review, systematic database searches were performed in PubMed and EBSCO CINAHL, using the SPIDER methodology. A total of 7,385 abstracts were screened, whereof 11 studies were included. A critical appraisal tool, the PRISMA checklist and a qualitative synthesis were applied.FindingsThree analytical themes were identified: (1) Social Experiences and Norms, (2) Informal Caregivers’ Labour Market Participation and (3) Economic Costs of iLTC. The results showed that women and men are impacted differently: Women are quantitatively discriminated, while caregiving men are likely to face qualitative discrimination within their tasks due to role expectations and gender norms.Originality/valueNovel insights emerge from embedding fragmented empirical findings into a holistic societal perspective, opening possibilities for addressing (adverse) outcomes together on a policy level. The findings are of interest for policy makers developing measures to ensure sufficient care supply whilst taking action against gender inequality.