BackgroundSpiritual well-being is considered an important component of health and is increasingly integrated at all levels of healthcare. Delivering good integrated spiritual care requires coordination between different colleagues in which interprofessional collaboration is crucial. However, this interprofessional collaboration is not always self-evident. What spiritual care entails, is often poorly understood by their healthcare colleagues. Developing a shared professional identity is a crucial component of the shift towards professionalisation in chaplaincy.ObjectivesWe aim to answer the following research question: how do healthcare chaplains in the Netherlands describe their work and their professional identity in relation to other healthcare professionals?Design and subjectsAnalysis of open-ended questions of a survey among healthcare chaplains regarding professional self-understanding in the Netherlands.Results107 Dutch chaplains working in a healthcare setting completed the five open-ended questions in the survey. The field of healthcare chaplaincy is changing from an exclusive focus at patients, towards more activities at staff and organisational level such as educating other healthcare professionals and, being involved in ethics and policy making.ConclusionsOur research shows that the professional self-understanding of chaplains entails many leads to foster interprofessional collaboration. At the same time, there are concerns about the professional identity of the chaplain which is not always clear to every healthcare professional. Healthcare teams can benefit from an extensive integration of chaplains in the healthcare team, by including the non-patient-related activities of chaplains, such as staff training, moral deliberation and policy advice.

IntroductionPost-COVID-19 syndrome is associated with significant health and potential socioeconomic burden. Due to its novel nature, there is a lack of clarity over best practice for the rehabilitation of patients with ongoing or new symptoms following acute COVID-19 infection. We conducted a systematic review of clinical and service guidelines for post-COVID-19 syndrome rehabilitation.MethodsThis review was registered on PROSPERO and is reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included guidelines formally published or endorsed by a recognised professional body, covering rehabilitation of people with symptoms following resolution of acute COVID-19 infection. We searched Medline, Embase, PsycINFO, CINAHL, Web of Science, NHS Evidence, MedRxiv, PsyArXiv and Google for terms related to COVID-19, rehabilitation and guideline. Two reviewers independently screened articles for inclusion, data extracted and quality assessed using the AGREE II and AGREE-REX tools for clinical guidelines and the AGREE-HS tool for service guidelines. We included guidelines of sufficient quality in a narrative synthesis.ResultsWe identified 12 790 articles, of which 37 guidelines (19 clinical only, 7 service only and 11 combined clinical and service) were included. Guidelines covered a range of countries, rehabilitation types, populations and rehabilitation settings. Synthesis of clinical guidelines (n=4) was structured following the patient pathway, from identification, to assessment, treatment and discharge, with consideration of specific patient groups. Synthesis of service guidelines (n=8) was structured according to the Donabedian framework.DiscussionThough the available post-COVID-19 syndrome rehabilitation guidelines were generally of poor quality, there was a high degree of consensus regarding the breadth of symptoms, the need for holistic assessment by a broad multidisciplinary team and person-centred care. There was less clarity on management options, measuring outcomes and discharge criteria.PROSPERO registration numberCRD42021236049.

Between 2011 and 2019, an integrated communication programme to address reproductive, maternal, neonatal and child health was implemented in the Indian state of Bihar. Along with mass media, community events and listening groups, four mobile health services were co-designed with the government of Bihar. These were Mobile Academy—a training course for frontline health workers (FLHWs) supporting them as the last mile of the health system; Mobile Kunji—a job aid to support FLHWs’ interactions with families; Kilkari—a maternal messaging service delivering information directly to families’ mobile phones, encouraging families to seek public health services through their FLHWs; and GupShup Potli—mobile audio stimulus used by FLHWs in community events. While Mobile Kunji and GupShup Potli scaled to other states (two and one, respectively), neither was adopted nationally. The Government of India adopted Kilkari and Mobile Academy and scaled to 12 additional states by 2019. In this article, we describe the programme’s overarching person-centred theory of change, reflect on how the mHealth services supported integration with the health system and discuss implications for the role of health communication solutions in supporting families to navigate healthcare systems. Evaluations of Kunji, Academy and GupShup Potli were conducted in Bihar between 2013 and 2017. Between 2018-2020, an independent evaluation was conducted involving a randomised controlled trial for Kilkari in Madhya Pradesh; qualitative research on Kilkari and Academy and secondary analyses of call record data. While the findings from these evaluations are described elsewhere, this article collates key findings for all the services and offers implications for the role digital and non-digital communication solutions can play in supporting joined-up healthcare and improving health outcomes.

ObjectiveTo assess the cost of implementation, delivery and cost-effectiveness (CE) of a flagship community-based integrated care model (OPEN ARCH) against the usual primary care.DesignA 9-month stepped-wedge cluster-randomised trial.Setting and participantsCommunity-dwelling older adults with chronic conditions and complex care needs were recruited from primary care (14 general practices) in Far North Queensland, Australia.MethodsCosts and outcomes were measured at 3-month windows from the healthcare system and patient’s out-of-pocket perspectives for the analysis. Outcomes included functional status (Functional Independence Measure (FIM)) and health-related quality of life (EQ-5D-3L and AQoL-8D). Bayesian CE analysis with 10 000 Monte Carlo simulations was performed using the BCEA package in R (V.3.6.1).ResultsThe OPEN ARCH model of care had an average cost of $A1354 per participant. The average age of participants was 81, and 55% of the cohort were men. Within-trial multilevel regression models adjusted for time, general practitioner cluster and baseline confounders showed no significant differences in costs, resource use or effect measures regardless of the analytical perspective. Probabilistic sensitivity analysis with 10 000 simulations showed that OPEN ARCH could be recommended over usual care for improving functional independence at a willing to pay above $A600 (US$440) per improvement of one point on the FIM Scale and for avoiding or reducing inpatient stay for any willingness-to-pay threshold up to $A50 000 (US$36 500).Conclusions and implicationsOPEN ARCH was associated with a favourable Bayesian CE profile in improving functional status and dependency levels, avoiding or reducing inpatient stay compared with usual primary care in the Australian context.Trial registration numberACTRN12617000198325.

ObjectivesThe iConnect Care programme provided integrated ‘virtual care’ (VC) for patients with chronic kidney disease (CKD) in the South Eastern Sydney Local Health District. VC is an alternative to outpatient care which expedites time to specialists’ opinions and is safe. Comparing different outpatient care models is important to understand the role of telehealth and integrated care, especially following the COVID-19 pandemic. This study aimed to compare a VC model with existing CKD outpatient care.Design, participants and settingA multisite, comparative, retrospective cohort study with parallel groups. 374 patients with mild CKD were recruited (July 2013 and August 2015) from public and private outpatients and followed for 12 months (n=304) or via VC (n=70). Estimated glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (ACR) were compared at baseline, 6 and 12 months.ResultsAt 12 months, no significant differences existed among groups in eGFR or ACR or haemoglobin, but serum creatinine was lower in the VC cohort. A significant difference existed in time to see a patient from time of referral; 7 days for VC clinic and 35–42 days for outpatient clinic. Patients interviewed felt VC was efficient and they were well managed.ConclusionVC can be a faster mechanism to access a nephrologist and other specialists. It provided similar outcomes to outpatient care. VC represents an additional assessment and follow-up pathway supported in the community. Time to deliver is similar, but specific resources are needed. It has the potential to evolve into a standard component of chronic disease care.

ObjectivesFirst impact assessment analysis of an integrated care model (ICM) to reduce hospital activity in the London Borough of Hillingdon, UK.MethodsWe evaluated a population-based ICM consisting of multiple interventions based on self-management, multidisciplinary teams, case management and discharge management. The sample included 331 330 registered Hillingdon residents (at the time of data extraction) between October 2018 and July 2020. Longitudinal data was extracted from the Whole Systems Integrated Care database. Interrupted time series Poisson and Negative binomial regressions were used to examine changes in non-elective hospital admissions (NEL admissions), accident and emergency visits (A&E) and length of stay (LoS) at the hospital. Multiple imputations were used to replace missing data. Subgroup analysis of various groups with and without long-term conditions (LTC) was also conducted using the same models.ResultsIn the whole registered population of Hillingdon at the time of data collection, gradual decline over time in NEL admissions (RR 0.91, 95% CI 0.90 to 0.92), A&E visits (RR 0.94, 95% CI 0.93 to 0.95) and LoS (RR 0.93, 95% CI 0.92 to 0.94) following an immediate increase during the first months of implementation in the three outcomes was observed. Subgroup analysis across different groups, including those with and without LTCs, showed similar effects. Sensitivity analysis did not show a notable change compared with the original analysis.ConclusionThe Hillingdon ICM showed effectiveness in reducing NEL admissions, A&E visits and LoS. However, further investigations and analyses could confirm the results of this study and rule out the potential effects of some confounding events, such as the emergence of COVID-19 pandemic.

BackgroundChronic myelogenous leukaemia (CML) is a pathological clinical condition with a yearly incidence between 10 and 15 cases per million people, 14 in Italy. Its incidence increases with age, reaching 20–25 yearly cases per million individuals in people over 70 years. A growing importance has been given to the need of a multidisciplinary approach (MDA) for the management of patients with CML.ObjectiveTo analyse the importance of MDA as compared with the current Italian standard of care for the management of CML patients based on the involvement of several health professional figures.MethodsA group of healthcare professionals from several healthcare structures were gathered in a first Advisory Board (AB) and divided into as many groups as the number of belonging health structures representative of the Italian provision of therapeutic approaches for CML. In a second AB, the results were validated by the same panel of experts.ResultsThe number of dedicated health professionals within the dedicated ward ranged from 1 to 13. Most structures rely on several professionals intervening only in case of necessity. Only one centre provides a booking service based on clinical needs to avoid waiting times. Most centres report there is basically no disagreement in the definition of the clinical pathway and there is a high adherence to national and international CML guidelines.ConclusionsThe development of forms of interorganisational and interprofessional coordination to improve the diagnosis and the treatment of CML patients have been for long on the agenda of policy makers, managers and professionals for more than 20 years. This analysis represents a starting reference to consider for the evaluation of an MDA in the Italian context.

ObjectiveTo explore how a clinical leadership training programme contributes to successful implementation of integrated dementia care in local primary care networks.Methods and analysisA qualitative design was used in local primary care networks in the Netherlands. Twenty-six primary care professionals, nurses (n=22), general practitioners (n=2) and occupational therapists (n=2) followed a 2-year practice-based educational programme including individual coaching and interactive group training. Embedded leadership training created opportunities for direct application of acquired leadership skills. Reports of coaching sessions and transcripts of semi-structured interviews with 20 leadership trainees, 8 network members and a focus group interview with 9 leadership trainees were thematically analysed.ResultsThey identified 50 learning goals, mostly associated with personal leadership competences. These professionals perceived some improvement in their leadership behaviour and preferred a duo-network leadership arrangement. Individual coaching sessions and group training sessions were perceived as fruitful support. Coaching sessions were found to facilitate learning processes regarding personal competencies, collaboration issues and role clarification. Group meetings were appreciated for exercises on transformational leadership behaviour and exchange of experiences. Network leaders and members observed improved quality of care and mentioned continuity of leadership, perseverance of leaders and a sufficient time period to bring about change as important facilitating factors.ConclusionClinical leadership training to stimulate integrated primary care is promising as it was positively valued and contributed to improved perceived leadership competencies. Network leaders and members experienced improved quality of care when at least continuity in leadership was warranted.

COVID-19 rapidly evolved into a global pandemic, initially without available preventative or therapeutic interventions. The licensing and provision of outpatient treatments in the UK since December 2021 has caused a paradigm shift in our approach to treatment of COVID-19 infection.[1][1] This