Adult Care Services Research Articles

Institutional Traits in an African Residence for Older Adults: An Obstacle to Community Care?

This ethnographic study explores an old age home in a former township in Walvis Bay, Namibia as an institution to investigate its potential to be interwoven in community care services for older adults. Interviews with older adults from the community revealed highly negative opinions about the residence that equated it to an institution. These opinions are compared with conditions in the OAH and the residents’ views. The old age home was much more heterogenous as regards the composition of residents than what was perceived by older adults who lived in the community, who considered the home an option only for people who were childless or had been abandoned. Older adults who voluntarily lived alone in the home represented a new lifestyle that challenged the traditional family care practice that is the norm in later life. There was however some truth to the interviewees’ perceptions of coercive elements, both in terms of practices and architectural design. The paper argues that it is necessary to reduce the stigma that prevents residential care from being an accepted part of community care and a housing option in the future. The study result shows a number of potentialities that can contribute to this.

The Beacon Collaborative: A Journey to Excellence

The development of the Critical Care Beacon Collaborative to achieve meaningful recognition. Recognizing nurses for contributions to their work environment and care delivery is important for their professional and personal fulfillment, job satisfaction, and retention; such recognition can occur at the individual, unit, or organizational level. The American Nurses Credentialing Center's Magnet Recognition Program acknowledges nursing excellence at the organizational level. It would, however, be difficult for an organization to achieve Magnet designation without nursing excellence at the unit level. To recognize excellence at the unit level, the American Association of Critical-Care Nurses developed the Beacon Award in 2003. To describe one academic medical center's journey toward winning Beacon Awards across 8 units within the adult critical care service. The Critical Care Beacon Collaborative resulted in a Beacon Award for each unit and important staff outcomes. This article describes the organization, the process before the Critical Care Beacon Collaborative convened and the desired state, and the methods used to achieve our goal. It also discusses unit- and service-level stakeholder involvement. The successes, lessons learned, sustainability, and growth of the Critical Care Beacon Collaborative are shared to assist readers who aspire to pursue a Beacon Award.

Recovery, rehabilitation and follow-up services following critical illness: an updated UK national cross-sectional survey and progress report

ObjectiveTo comprehensively update and survey the current provision of recovery, rehabilitation and follow-up services for adult critical care patients across the UK.DesignCross-sectional, self-administered, predominantly closed-question, electronic, online survey.SettingInstitutions providing adult...

Health and social care access for adults with learning disabilities across the UK during the COVID-19 pandemic in 2020

PurposeThis paper aims to present data about access to health and social care services during the COVID-19 pandemic for adults with learning disabilities across England, Northern Ireland, Scotland and Wales.Design/methodology/approachData were collected directly from 621 adults with learning disabilities and through separate proxy reports by family carers and paid support staff of another 378 adults with learning disabilities. The data were collected between December 2020 and February 2021 and concerned the use of health and social care services since the start of the first COVID-19 national lockdown in March 2020.FindingsAccess to and use of health and social care services significantly reduced for adults with learning disabilities across the UK during the COVID-19 pandemic between March 2020 and February 2021, with many people not receiving any services at all during that period. Similar patterns were seen across England, Northern Ireland, Scotland and Wales. However, data suggest some variations between countries for some services.Practical implicationsFuture pandemic planning must ensure that access to these essential services is not completely lost for adults with learning disabilities and their family carers, as it was in some cases during the COVID-19 pandemic in 2020.Originality/valueThis is the largest study about the impact of the COVID-19 pandemic on health and social care services for adults with learning disabilities in the UK. The authors primarily collected data directly from adults with learning disabilities, and worked with partner organisations of people with learning disabilities throughout the study.

Integrating behavioral health into two primary care clinics serving vulnerable populations

Behavioral health (BH) problems and chronic disease often co-occur. Patients with both physical and behavioral conditions use more medical services, require more hospitalizations and readmissions, and experience poorer quality of life. The purpose of this article is to describe an innovative model in which BH services are integrated into nurse-led primary care clinics for uninsured and underinsured patients. BH providers, including a psychiatric mental health nurse practitioner, psychiatrist, clinical social worker, and care coordinator, were integrated into the ongoing Providing Access to Healthcare (PATH) and Heart FailuRe Transitional Care Services for Adults (HRTSA) clinics. In addition, other providers received training in BH screening and motivational interviewing. All patients were screened for depression, anxiety, tobacco and substance use at every visit. Examination of appointments revealed information about patient engagement with BH. A total of 520 unique patients at both clinics qualified for BH services and 250 remained engaged in treatment for approximately five visits. Improvement on measures of depression and anxiety was observed for both engaged and non-engaged patients. Integrated BH and primary care within the same clinic space, along with training for all clinicians, allows for early diagnosis and intervention which are crucial to patients with few resources and high needs.

Patient characteristics and outcome in three different working models of home-based rehabilitation: a longitudinal observational study in primary health care in Norway

BackgroundThe organisation of health care services for older adults varies within and between countries. In Norway, primary care physiotherapy services offer home-based rehabilitation to older adults. The aim of this study was to compare patients’ characteristics and treatment outcomes in three working models of home-based rehabilitation.MethodsPatients referred to home-based rehabilitation in a large municipality in Norway were invited to participate in this prospective observational study. The three working models, early intervention, reablement and regular physiotherapy, were organised according to the patients’ function and degree of independence. The older adults (≥ 65 years) were allocated to the different models by either a multidisciplinary group of health care personnel or by direct referral. Patients’ demographic and clinical characteristics, including physical function (Patient-specific functional scale, PSFS), physical performance (Short Physical Performance Battery, SPPB) and health-related quality of life (EQ-5D) were registered at baseline and follow-up (maximum 6 months after baseline). One-way ANOVA was used to analyse group differences in clinical characteristics and paired t-tests to analyse changes from baseline to follow-up.ResultsIn total, 603 and 402 patients (median (interquartile range) age: 84 (77–88) years) completed baseline and follow-up assessments, respectively. Patients in all three working models had an increased risk for functional decline. Patients receiving early intervention (n = 62) had significantly (p < 0.001) better physical performance and health-related quality of life (SPPB mean 7.9, SD 2.7; EQ-5D:mean 0.59, SD 0.19), than patients receiving reablement (n = 132) (SPPB: mean 5.5, SD 2.6; EQ-5D: mean 0.50, SD 0.15) and regular physiotherapy (n = 409) (SPPB: mean 5.6, SD 2.8; EQ-5D: mean 0.41, SD 0.22). At follow-up, the three working models showed significantly improvements in physical function (PSFS: mean change (95 % CI): 2.5 (1.9 to 3.2); 1.8 (0.5 to 3.1); 1.7 (0.8 to 2.6), for regular physiotherapy, reablement, and early intervention, respectively). Patients receiving regular physiotherapy and reablement also significantly improved physical performance and health-related quality of life.ConclusionsWhile older adults receiving reablement and regular physiotherapy showed similar patient characteristics and treatment outcomes, early intervention identified older patients at risk of functional decline at an earlier stage. These results are relevant for policy makers when designing and improving prevention and rehabilitation strategies in primary health care.

Predictors of community death in an Australian specialist palliative care service

Background In Australia, an aging population has intensified demand on residential aged care facilities, hospitals and palliative care services for end-of-life care. The likelihood of home death for cancer patients in South Australia has remained below 14%. Objectives: This research aims to investigate predictors for community death and preferred place of death of patients registered with an Australian community adult specialist palliative care service (SPCS). Methods: A consecutive cohort retrospective medical records and electronic database review of all referred patients who died between 1st January and 30th June 2017 was undertaken. Results: There were 456 registered patients who died in this period. The 62 rural patients and 32 patients with missing medical records were excluded. Of the remaining 362 patients, 62 did not have community face-to-face contact and were excluded. Of the 300 patients eligible, there were 143 females and mean age was 71 years. This study revealed an overall community death rate (private home and residential aged care facility) of 31.3% compared with private home death rate of 17%. There were two important predictors of community death. Firstly, family/caregiver preferred place of death had a far greater impact on likelihood of community death than patient preferred place of death. Secondly, the intensity of input from the whole palliative care team, in particular, community face-to-face visits and more specifically by nurses, were major predictors. Conclusion: Investing in community-based SPCSs may not only better support patient and family/caregiver preferences, and increase rates of community death but also reduces hospitalisation costs.

Developing a tool to assess and monitor institutional readiness to address elder mistreatment in hospital emergency departments

ABSTRACT Hospital emergency departments (EDs) lack the tools and processes required to facilitate consistent screening and intervention in cases of elder abuse and neglect. To address this need, the National Collaboratory to Address Elder Mistreatment has developed a clinical care model that ED’s can implement to improve screening, referral, and linkage to coordinated care and support services for older adults who are at risk of mistreatment. To gauge ED readiness to change and facilitate adoption of the care model, we developed an organizational assessment tool, the Elder Mistreatment Emergency Department Assessment Profile (EM-EDAP). Development included a phased approach in which we reviewed evidence on best practice; consulted with multidisciplinary experts; and sought input from ED staff. Based on this formative research, we developed a tool that can be used to guide EDs in focusing on practice improvements for addressing elder mistreatment that are most responsive to local needs and opportunities.

Chronic diseases: Building up on the challenge of adolescence for a successful transition to adult care services

La transition de la prise en charge pédiatrique vers la prise en charge d’adulte est un processus qui nécessite d’être abordé très tôt dans le suivi d’un enfant porteur d’une maladie chronique. Elle doit tenir compte du rythme de chacun des intervenants : le praticien, l’adolescent et sa famille. L’interaction entre les bouleversements de l’adolescence et le processus de transition entraîne trop souvent une rupture du suivi, avec ses conséquences en termes de morbidité et de mortalité. Depuis quelques années, des guides et des structures dédiées sont mises en place pour favoriser un passage serein vers les structures pour adultes.

'Care literacy' in super aging Japan.

Accentuated by the ongoing coronavirus disease (COVID-19) pandemic, the change in Japan to community-based health and care services for older adults indicates an urgent need to enhance and spread citizens' understanding of care. This is a broader notion of care that incorporates conditions within the community to support the inclusion of older adults, involving not only those older adults receiving care and their direct providers of care, but also others in the community who are involved in the daily lives of these older adults. To underpin such a broader notion of care across citizens, this paper proposes 'care literacy' as a novel analytical concept, defined as the knowledge and capabilities that enable people in need of care to live their daily lives in the community and facilitate potential health and care solutions. Reflecting the interconnection of health and care and rooted in the local context, care literacy underpins aging by enabling this involvement of the broader community, and is disseminated through media and grassroot activities.

Outpatient physical therapy population has been aging faster than the general population: a total population register-based study

BackgroundThe Icelandic population is aging like other populations in the world, the life expectancy is high, and the national focus is to help people to age in their own homes. The objectives of this research was to describe 17 years of demographic changes among outpatient physical therapy (OPT) clients and to determine if these changes reflect aging in the total population.MethodsData was obtained from a national registry with information on all OPT clients reimbursed by Icelandic Health Insurance from 1999 to 2015, and general population data from the Statistics Iceland registry covering the same 17 years. Simple counts, proportions, Rate Ratios (RR) and 95 % Confidence Intervals (CI) were used to describe and compare the two time-points (1999 and 2015) in both populations, and regression analyses were used to estimate linear changes for each of these 17 years.ResultsComparing the endpoints of the 17-year period, the proportion of older adults within the total OPT clientele increased by 23 % (from 18.3 % to 1999 to 23.5 % in 2015; RR 1.23; 95 %CI 1.19–1.27).) while in the general Icelandic population, the proportion of older adults increased by 15 % (from 11.6 % to 1999 to 13.5 % in 2015; RR 1.15; 95 % CI 1.1–1.21). For each of these 17 years, there was an overall 5 % yearly increase in the rate of older adults from the general older Icelandic population who used an OPT (accounting for population aging), and an overall 3.5 % yearly increase in the proportional contribution of older adults to the total OPT clientele. Adjusting for sex and older age group revealed that this increase in rate and proportion was most pronounced among ≥ 85-year-old men.ConclusionsThis case of Iceland is an example of how health-related and population-based registers may potentially be used to routinely inform and facilitate optimal planning of future health care services for older adults.

Prevalence and predictors of dyslipidemia among hypertensive patients in Lumame Primary Hospital, Amhara, Ethiopia: A cross-sectional study

BackgroundSerum lipid profile abnormalities are major predictors for coronary artery diseases. The relationship between demographic factors and dyslipidemia in Ethiopia is not completely explored. Thus, this study aimed to assess the prevalence and predictors of dyslipidemia among hypertensive patients in Lumame Primary Hospital. MethodsA cross-sectional study was conducted from June to August 30, 2020, on the hypertensive patients in Lumame Primary Hospital. All adult hypertensive patients who visited the adult hypertensive care services during the study period were included. Interview-guided self-administered questionnaire and a chart review were used for data collection. Statistical Package for the Social Sciences (SPSS) software version 24.0 was used for data analysis. ResultsOut of 372 hypertensive patients, 190(51.1%) were females and the mean age of the study participants was 43.56 years (SD ± 4.31). The overall prevalence of dyslipidemia in this study was 48.4%. Besides the overall prevalence, the prevalence of TC, TG, LDL-c, and HDL-c was 73(19.6%), 91(24.5%), 60(16.1%), and 115(30.9%), respectively. Females were at higher risk for having high levels of TC (AOR = 2.31, 95% CI = 1.54–3.13), TG (AOR = 1.70, 95% CI = 1.34–3.79), LDL-c (AOR = 2.15, 95% CI = 1.56–2.86), and HDL-c (AOR = 2.67, 95% CI = 1.44–5.67) than males. Respondents who were from urban were at higher risk for having high levels of TC (AOR = 1.98, 95% CI = 1.04–6.83), TG (AOR = 1.78, 95% CI = 1.09–2.86), LDL-c (AOR = 3.01, 95% CI = 1.45–7.43), and HDL-c (AOR = 2.01, 95% CI = 1.94–4.55) than respondents who were from rural. Similarly, obese respondents were at higher risk for having high levels of TC (AOR = 2.03, 95% CI = 1.64–2.00), TG (AOR = 3.78, 95% CI = 1.06–6.42), LDL-c (AOR = 1.92, 95% CI = 1.66–2.12), and HDL-c (AOR = 4.23, 95% CI = 2.84–4.32) than to respondents who were underweight. ConclusionThe prevalence of dyslipidemia among hypertensive patients was high. Independent variables such as age, gender, residence, family history of HTN, smoking, alcohol drinking, fruit diet habits, physical activity, DM, and BMI were significant determinants of dyslipidemia.

Patterns of use of oral health care services in Australian rural adults: the Crossroads-II Dental sub-study.

As part of a larger study, the Crossroads-II Dental sub-study determined the patterns of, and barriers to, oral health care service utilization in a rural area of Victoria. In this cross-sectional sub-study predisposing, enabling, needs-related, and oral health variables were considered in association with patterns of oral health care utilization. A logistic regression was performed to explain the use of oral health care services. Overall, 574 adults participated, with 50.9% reporting having visited an oral health care service in the previous 12 months. Age, number of chronic health conditions and holding a health card; were associated with increased visit to a dentist (OR = 1.01; 95% CI: 1.00-1.03; OR = 1.08; 95% CI: 1.01-1.16; OR = 2.06; 95% CI: 1.26-3.36, respectively). Perceived barriers to care and number of missing teeth decreased the odds of using services (OR = 0.46; 95% CI: 0.36-0.58; OR = 0.95; 95% CI: 0.92-0.98, respectively). Results suggest that use of oral health care services is associated with a range of financial, educational, health and structural barriers. Increasing the use of oral health care services in rural populations requires additional efforts beyond the reduction of financial barriers.

Characteristics of Hospitalized Adults with Opioid Use Disorder in the United States: Nationwide Inpatient Sampl

BACKGROUND: Although the clinical significance and treatment management of opioid use disorder (OUD) is sufficiently discussed, utilization of healthcare services associated with OUD has not been adequately studied in the United States. OBJECTIVE: To provide a descriptive assessment of the utilization of health care services for adults with OUD in the United States. STUDY DESIGN: A retrospective cross-sectional study design based on the National Inpatient Sample (NIS) developed by the Healthcare Cost and Utilization Project. SETTING: All OUD cases included in the 2016 NIS database. Adults aged 18 years or older were included in the study. METHODS: We analyzed a stratified probability sampling of 7.1 million hospital discharges weighted to 35.7 million national discharges. We used ICD-10-CM codes to identify OUD cases. Groups were compared using the Student’s t-test for continuous variables and the chi-square test for categorical variables. Total cost per hospital discharge was determined by converting the total per case hospital charge to a hospital cost estimate (estimate = total charges X hospital cost-to-charge ratio). RESULTS: In 2016, an estimated 741,275 Americans were associated with OUD. Among patients with OUD, 73% were White, 12% were African-American, 8% were Hispanic, 0.6% Asian-American/Pacific Islander, 0.9% were Native Americans, and 2% were other race; 49% of patients with OUD were women. A large proportion (43%) of the OUD hospitalizations were billed to Medicaid. The average hospital length of stay for all OUD patients was 5.6 days, and the average cost per discharge was $11,233. A higher average LOS was observed for patients who died during hospitalization (8.4 days), Asian-American/Pacific Islander patients (6.8 days), patients covered by self-pay (6.8 days), patients with median household income of 71,000 or more (5.8 days), patients discharged from hospitals in the Northeast ($10,540) and patients discharged from hospitals in large hospitals ($12,570). The most frequently observed diagnosis associated with patients with OUD were alcohol/drug abuse or dependence, psychosis, and septicemia. LIMITATIONS: These data sources are comprised of hospital discharge records, originally collected for billing purposes, and may be subject to provider biases and variations in coding practices. CONCLUSIONS: In the United States, very few health issues have garnered the attention of such diverse sectors as the opioid crisis. Our analysis of 2016 NIS data found that patients with OUD accounted for approximately 740,000 discharges that year. This represents about a 55% increase over 2015. We also demonstrate that inpatient settings provide a unique opportunity for targeting evidence-based, comprehensive interventions at patients with OUD. Key words: Opioid use disorder, discharge diagnosis, hospital resource utilization, cost-to-charge ratio, HCUP, NIS, AHRQ

Use of Home Care Services Reduces Care-Related Strain in Long-Distance Caregivers.

Prior work examining the role of older adult home care service use in alleviating strain in family caregivers has resulted in contradictory findings. However, prior research has been entirely limited to caregivers who live within close geographical proximity to their care recipients. Long-distance caregivers are a unique caregiving subgroup that has remained understudied. Guided by the stress process model, this study examined if the association between primary caregiving stressors (the care recipient's functional and cognitive status) and secondary stressors (perceived role strains related to work and to other family responsibilities) in long-distance caregivers was mediated by the care recipient's utilization of home care services. The sample included 166 long-distance caregivers in the United States who provide and manage care to a community-dwelling care recipient living 2 or more hours away. Participants reported on their care recipient's cognitive and functional status, perceived interference of caregiving with work and other family responsibilities, and the care recipient's use of home care services. Path analyses show that home care use by the care recipient fully mediated the association between care recipients' functional impairment and caregiver strains (work and family). Furthermore, home care use partially mediated the effects of care recipients' cognitive impairment on caregiver strains. Results indicate that the care recipient's home care service utilization may serve as a protective factor against care-related strain in long-distance caregivers. These findings can be used to inform intervention efforts focused on a family-centered care approach that can be specifically tailored to long-distance caregivers.

Integrating primary care and social services for older adults with multimorbidity: policy implications.

Over the next 20 years, the proportion of over-65s in the UK will rise by a quarter,1 around two-thirds of whom will live with multimorbidity (multiple long-term conditions).2 This change in demographic is likely to lead to a significant growth in care needs,3 further increasing demand on primary care and social services. In response, policymakers have been trying to accelerate the drive towards integrated care4 to deliver service efficiencies, cost savings and, concomitantly, improvements in outcomes for patients and service users. To this end, a variety of integrated care pilots have been trialled.4 There have been concerns that some of these testbeds have been rolled out nationally without a strong evidence base or comprehensive evaluation, for example, ’social prescribing’ initiatives.5 This has led to uncertainty around the efficacy of integrated care initiatives, and no consensus on how best to integrate primary care and social services for older adults with multimorbidity. To address this gap in the evidence base, we carried out a mixed methods programme of research. This included a scoping review of the literature,6 and a qualitative interview study to elicit key stakeholder views on drivers and barriers to integration of primary care and social services in England. Stakeholders included patients, care service users, carers, primary and secondary care clinicians, social prescribers, community nurses, social workers, voluntary sector workers, and multiple other relevant individuals.7 We used Valentijn’s Rainbow Model of Integrated …

Meeting the needs of autistic adults in Qatar: Stakeholder perspectives on gaps in services and priorities for future programming.

Qatar is expanding the services that it offers for autistic people, but these services focus mainly on diagnosing and treating young children. Because there are not enough autism providers in Qatar and few opportunities for autistic youth to participate in the community, more and more autistic teens and young adults have unmet needs during their transition to adulthood. The goal of this study was to conduct a needs assessment of transition-age autistic youth in Qatar and their families in order to inform the development of an adult respite care and support center. Respite care is a service that provides families with stress relief and time to participate in activities that are more difficult to do when their loved one with a disability is with them. The objective of this study was to use family and stakeholder input to identify the needs and preferences for respite care for autistic youth in Qatar. The project was conducted with a local research team in Qatar and a team of clinical researchers in the United States specializing in autism. Stakeholders, including parents of autistic people and providers working with individuals with autism, completed surveys and participated in focus groups. Families and providers in Qatar were very interested increasing services for young adults with autism to improve quality of life, although wanted to make sure the service providers would be reliable and trustworthy. Implications from this study may substantially improve the lives of autistic adults in Qatar.

Special Need Pooled Trust Disbursements and the Well-being of Nursing Facility Residents Receiving Medicaid Benefits

ABSTRACT Medicaid is the largest health insurer in America, comprising one-sixth of the nation’s total healthcare expenditures. Of this, 40% covers long-term care services for older adults and adults with disabilities. Yet, Medicaid does not provide access to all goods and services needed. Pooled special needs trusts (pooled trusts) are a program through which older individuals, requiring long-term care, may set aside assets and remain Medicaid eligible. Pooled trust funds purchase items such as medical devices, telecommunications and funeral services. This article explores the relationship between Medicaid, pooled trusts and their role in nursing home residents’ well-being. To understand this relationship, a descriptive study sorts the disbursements from a pooled trust into the 5 Gallup-Healthways Index well-being domains. The analysis shows that pooled trust funds purchased goods and services related to well-being. Thus, pooled trusts offer a means for states to expand the support they provide individuals in nursing facilities beyond the medical services covered by Medicaid to include goods and services associated with well-being.

Nurses' assessments of horizontal collaboration in municipal health and care services for older adults: A cross-sectional study.

Interprofessional and interorganizational collaboration is considered key to achieving high-quality care and positive patient outcomes, but there is limited research into how nurses working in nursing homes and home care services perceive collaboration with other municipal health and care service providers and how their assessments of collaboration vary with individual characteristics and context. The objective of this study was to map variation in nurses' assessments of horizontal collaboration with core care services for older adults, specifically nursing homes, home care services, general practitioners, the allocation office and physio- and occupational therapy services. The study draws on findings from a nationwide cross-sectional survey on posthospital care for older adults, conducted among nurses working in nursing homes and home care services in Norway (N = 3717). Nurses were asked to assess collaboration with these five services. Independent variables were workplace, age, years at current workplace, part-time work, postgraduate education, and municipality size. Statistical analyses were conducted using descriptive statistics and analysis of variance (ANOVA). A majority of nurses evaluated horizontal collaboration as good. Collaboration with the home care services was evaluated as best, while collaboration with general practitioners was evaluated as least good. The study showed that workplace and municipality size were important for nurses' assessments of collaboration. Generally, nurses in smaller municipalities evaluated collaboration as better than nurses in larger municipalities. That workplace and municipality size impact on nurses' evaluations of collaboration in municipal care services for older adults is important knowledge for leaders and policy-makers aiming to improve patient care and teamwork.

Integrating primary care and social services for older adults with multimorbidity: a qualitative study.

BackgroundGrowing demand from an increasingly ageing population with multimorbidity has resulted in complex health and social care needs requiring more integrated services. Integrating primary care with social services could utilise resources more efficiently, and improve experiences for patients, their families, and carers. There is limited evidence on progress including key barriers to and drivers of integration to inform large-scale national change.AimTo elicit stakeholder views on drivers and barriers of integrated primary care and social services, and highlight opportunities for successful implementation.Design and settingA qualitative interview study.MethodSemi-structured interviews with maximum variation sampling to capture stakeholder views across services and professions.ResultsThirty-seven interviews were conducted across England with people including GPs, nurses, social care staff, commissioners, local government officials, voluntary and private sector workers, patients, and carers. Drivers of integration included groups of like-minded individuals supported by good leadership, expanded interface roles to bridge gaps between systems, and co-location of services. Barriers included structural and interdisciplinary tension between professions, organisational self-interest, and challenges in record sharing.ConclusionDrivers and barriers to integration identified in other contexts are also present in primary care and social services. Benefits of integration are unlikely to be realised if these are not addressed in the design and execution of new initiatives. Efforts should go beyond local- and professional-level change to include wider systems- and policy-level initiatives. This will support a more systems-wide approach to integrated care reform, which is necessary to meet the complex and growing needs of an ageing multimorbid population.