Integrated Care Solutions Research Articles

Understanding depression, anxiety and stress in young people living with HIV in Ghana

Ghanaians with perinatally acquired human immunodeficiency virus (HIV) infection now live into adulthood. It is known that adolescents and young adults living with HIV have a high risk of mental health comorbidity. Despite increasing global attention on HIV–mental health interactions, the field remains understudied in Ghana, with an attendant lack of national integrated care solutions. This study aimed to measure the burden and explore the context of depression, anxiety and stress symptoms among young people living with HIV receiving care at a tertiary care hospital in Ghana. This was an explanatory sequential mixed-methods study. Depression, anxiety and stress symptoms were measured using the Depression, Anxiety and Stress Scale, and their associations with quality of life (QoL), socioeconomic status, internalised stigma, disease stage and HIV-related risk-taking behaviours were explored. After preliminary quantitative data analysis, semi-structured interviews were conducted for those who screened positive for depression and/or anxiety to explore their experience with this comorbidity. This study found a low prevalence of depression and anxiety symptoms, which were associated with higher stigma scores and lower QoL. We believe this low prevalence to be attributable to the effect of several psychosocial interventional programmes, which were previously piloted with the study cohort that have gradually normalised mental health discussions. Participants also showed marked resilience and knowledge about their condition. The results of this study present an opportunity to advocate and scale up effective locally adapted and strength-based solutions to address the mental illness–HIV syndemic in Ghanaian young people living with HIV.

Looking Toward the Future of Integrated Care: History, Developments, and Opportunities

For almost five decades, the development and implementation of integrated care—the simultaneous combination of primary care with mental health and substance use care—has been a major challenge for the behavioral health care field. Integrated care is exceptionally important because many people with behavioral health conditions also have chronic physical health conditions. Early research findings in the mid-1980s showed that persons with mental illness are likely to develop chronic physical conditions earlier and more severely than other people. These findings precipitated efforts to understand this problem and to develop further appropriate integrated care solutions. Subsequently, the US Surgeon General made care integration a major focus of his landmark 1999 Report on Mental Health, as did the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Patient Protection and Affordable Care Act. However, it was not until 2014, and later, that integrated care actually began to be implemented more broadly. This article reviews these major developmental milestones, examines current activities, and explores likely developments over the next several years. Major current issues include the response to the COVID-19 pandemic, adjusting to its effects on the behavioral health care workforce, and the growing realization that behavioral health care must address the social determinants of life. Likely developments over the next several years will include devising ways to address our workforce crisis, developing effective community interventions, and implementing population health management strategies; implementing the CMS Innovation in Behavioral Health Model; improving reimbursement practices; and exploring the potential of AI for integrated care. Implications for future service organization and training of behavioral health care providers also are discussed. Granted the severity of the current workforce crisis in behavioral health care, urgent efforts are needed to advance the deployment of integrated care in the short-term future.

Partnered Recruitment: Engaging Individuals With Lived Experience in the Recruitment of Co-Design Participants.

Young adults with type 1 diabetes (T1D) face complex health challenges, including a heightened risk for distress. To counter this distress, there is a need to develop accessible, acceptable comprehensive care solutions that integrate diabetes and mental health care to enhance self-efficacy and counter mental health challenges in this population. To describe the engagement of individuals with lived experience of T1D and mental health challenges in the development of a recruitment strategy to support the co-design of an innovative integrated care programme. Seven individuals with lived experience formed a Partner Advisory Council (PAC) to recruit young adults (18-29 years old) living with T1D, their friends or family and health researchers and professionals in co-design interviews (n = 19) and co-design events (n = 12). The PAC played a key role in developing a comprehensive recruitment strategy, overcoming traditional barriers and stigmas in the design of an integrated model of care. Assuming the presence of mental health challenges in young adults living with T1D during recruitment had far-reaching impacts on the development of a whole-person and integrated diabetes and mental health care solution. The efficient recruitment of this sample provided invaluable insights into the nuanced challenges experienced by young adults with T1D, the individual skills developed in response to their mental health challenges and the ways that this understanding can shape future programming to support mental health, quality of life and well-being. The ongoing involvement of the PAC as co-researchers underscores the enduring impact of patient engagement in developing integrated care solutions. The co-design of the TECC-T1D3 model was enriched by the invaluable contributions of individuals with lived experience. This included the engagement of a diverse PAC in the recruitment of participants in co-design interviews and co-design events. PAC members actively participated in research decision-making with their insights informing a robust recruitment strategy. Beyond recruitment, PAC members continue to serve as co-researchers, shaping ongoing research and actively contributing to the TECC-T1D3 project. Six PAC members are co-authors on this manuscript.

PROCare4Life lessons learned.

PeRsOnalised Integrated CARE Solution for Elderly (PROCare4Life) was an EU-funded project that ran from January 2020 until June 2023, whose focus was to further develop and integrate previous ICT solutions developed by several previous EU-funded projects into a unique modular system able to support the autonomy and empowerment and to increase the Quality of Life (QoL) of elderly people living with Parkinson's, Alzheimer's, or similar dementia, having also tested the system for elderly people living with comorbidities. This article focuses on the methodology and results used to identify the internal lessons learned. PROCare4Life was developed using a codesign approach involving more than 2,000 participants whose input has been listened to and transformed into valuable changes of the system and also into lessons learned included in this case study report. Since the beginning of the implementation of PROCare4Life, there has been a commitment to make invisible knowledge visible through open discussion and including our lessons learned in each of our deliverables. In the last six months of implementation, qualitative research has been implemented by the PROCare4Life consortium to identify and select our most relevant challenges and recommendations for future projects and initiatives. PROCare4Life was highly impacted by the COVID-19 pandemic, and it is acknowledged in the lessons learned. However, the consortium has focused on the recommendations that could be more valuable for ordinary implementation of future projects and initiatives developing eHealth tools for elderly citizens living with conditions that might affect their cognitive or mobility capacities.

A Nationwide Chronic Disease Management Solution via Clinical Decision Support Services: Software Development and Real-Life Implementation Report.

The increasing population of older adults has led to a rise in the demand for health care services, with chronic diseases being a major burden. Person-centered integrated care is required to address these challenges; hence, the Turkish Ministry of Health has initiated strategies to implement an integrated health care model for chronic disease management. We aim to present the design, development, nationwide implementation, and initial performance results of the national Disease Management Platform (DMP). This paper's objective is to present the design decisions taken and technical solutions provided to ensure successful nationwide implementation by addressing several challenges, including interoperability with existing IT systems, integration with clinical workflow, enabling transition of care, ease of use by health care professionals, scalability, high performance, and adaptability. The DMP is implemented as an integrated care solution that heavily uses clinical decision support services to coordinate effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines and, hence, to increase the quality of health care delivery. The DMP is designed and implemented to be easily integrated with the existing regional and national health IT systems via conformance to international health IT standards, such as Health Level Seven Fast Healthcare Interoperability Resources. A repeatable cocreation strategy has been used to design and develop new disease modules to ensure extensibility while ensuring ease of use and seamless integration into the regular clinical workflow during patient encounters. The DMP is horizontally scalable in case of high load to ensure high performance. As of September 2023, the DMP has been used by 25,568 health professionals to perform 73,715,269 encounters for 16,058,904 unique citizens. It has been used to screen and monitor chronic diseases such as obesity, cardiovascular risk, diabetes, and hypertension, resulting in the diagnosis of 3,545,573 patients with obesity, 534,423 patients with high cardiovascular risk, 490,346 patients with diabetes, and 144,768 patients with hypertension. It has been demonstrated that the platform can scale horizontally and efficiently provides services to thousands of family medicine practitioners without performance problems. The system seamlessly interoperates with existing health IT solutions and runs as a part of the clinical workflow of physicians at the point of care. By automatically accessing and processing patient data from various sources to provide personalized care plan guidance, it maximizes the effect of evidence-based decision support services by seamless integration with point-of-care electronic health record systems. As the system is built on international code systems and standards, adaptation and deployment to additional regional and national settings become easily possible. The nationwide DMP as an integrated care solution has been operational since January 2020, coordinating effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines.

Hospital transformation into regional health care

Hospitals in Germany are under enormous pressure. Legal reforms and shortages of nurses and doctors are forcing hospitals to review inpatient services to assess whether they can be provided on an outpatient basis. Legislation is now promoting such transformation processes through changes in hospital planning and financ-ing. Hospitals, thus, have become attractive partners and designers of regional integrated care solutions.
 OptiMedis is currently supporting various hospitals in the planning and conceptualization of regional, inte-grated health care with more centralized inpatient services and increased outpatient care options Smaller hospitals, which are no longer needed for inpatient care after the centralization of inpatient services, can be transitioned towards regional outpatient care. Here, outpatient practices, rehabilitative facilities, therapists, CHN, social workers, case and care managers, among others, can then work together intersectorally under one roof. There are already some concepts and German words describing this: Intersectoral Health Center, Primary Care Center, and Extended Outpatient Care. It is important to determine what needs exist in each region.
 This presentation will describe the different concepts pertaining to the transformation of smaller hospitals into regional outpatient intersectoral health care centers and discuss the implications for further development of integrated healthcare in Germany.

Towards Active Integrated Waiting Lists: The Patient Lived Experience

Background: Specialist healthcare providers internationally face challenges managing elective care waiting lists. There is an increase focus on how we can provide integrated care solutions to achieve active rather than passive waiting. This requires potentially complex interactions across care boundaries and care providers alongside novel digital solutions. Crucially however we must also understand the lived patient experience of people on those waiting lists. Little research has considered the lived experience of people on waiting lists for specialist care.
 Methods: 46,000 individual patients on waiting lists at a major tertiary referral centre in the West Midlands, United Kingdom were sent a survey to understand their experiences of waiting for specialist care whilst remaining in the community context. Patients were contacted via SMS initially with a link to a web-portal with follow up contact via letter for those who did not complete the initial survey. This work is linked to/informed by extensive, commissioned, independent deliberative patient and public involvement work looking at waiting list management previously completed for this organization. This was approved locally as a service evaluation.
 Results: 20,741 responses were received, representing a 45% response rate. 62% of response were received via the website, with 38% via letter. 1,633 patients (7.9%) wished to be removed form the waiting list. 18.5% felt that being on the waiting list was severely stopping them from carrying out normal tasks, 17.7% reported that being on the waiting list was severely impacting their ability to work and 14.0% reported that being on the waiting list severely impacted their ability to care for others. 20.7% felt their condition had got severely worse whilst on the list. Impact of being on the waiting list was most notable for those in the most deprived population groups, with 25% of patients in the most deprived areas having been severely impacted by the wait time, compared with 14% in the least deprived areas. There was additional variation on the impact of waiting based on ethnicity, age and work status.
 Discussion: High healthcare demands result in an inevitability of patients waiting for specialist services. This work demonstrates the diversity of lived experiences for patients on elective care waiting lists, stressing differences between key population groups including those with protected characteristics. Patient cohorts within specialist waiting lists must be seen as diverse and dynamic. Much promised prioritisation and active waiting initiatives must be individualised to meet the diverse needs of the people on the waiting lists and recognise further work is needed to better understand how to engage with these groups.
 Funding received from: West Midlands Academic Health Science Network: Safety Innovation and Improvement Fund

Evaluating the maturity of integrated care organizations

Introduction: Given the difficulty of measuring and demonstrating the added value of integrated care organizations over traditional ones by using conventional evaluation methods, we used—and adapted—the SCIROCCO Maturity Model for Integrated Care to be considered as a steering tool for integrated care organizations to measure their maturity over time and enable improvements.
 Methods: Three organizations located in Switzerland that have brought together the local hospital (with inpatient and outpatient care services), the nursing home, the day center for elderly people, the home care services and the primary care practice will be evaluated using the adapted SCIROCCO tool and approach (SCIROCCO-POL). The original SCIROCCO validated tool assesses the readiness and capacity of a healthcare system, at the level of a region or country, to adopt and scale-up integrated care solutions by capturing stakeholders’ perceptions of current progress towards integration.¹ Following the SCIROCCO methodology, healthcare stakeholders will be asked to assess (individually and then through consensus-building workshops) the maturity of their integrated care organization along 12 dimensions (e.g. governance, funding, digital infrastructure, process coordination, citizen empowerment). Since we aimed at obtaining a steering tool for integrated care organizations, a revision of the SCIROCCO tool is necessary, so that 1) the description of each dimension is adapted to the language used by local healthcare actors, including non-specialists, in the context of an organization, and 2) the 0-5 rating scales follow the same logic throughout the dimensions in terms of maturity progression. This tailoring and systematization will allow us to build a tool that healthcare organizations can easily use to monitor their level of maturity and make progress towards integrated care. The adapted version of the SCIROCCO tool will be used within three integrated care organizations, allowing for comparison and knowledge transfer.
 Results and next steps: Currently, the evaluation process is ongoing. At the end of the full SCIROCCO evaluation process, management bodies of the three integrated care organizations, in conjunction with their stakeholders, will be invited to define SCIROCCO’s priority dimensions and action plans to address the identified maturity gaps; they will also prepare strategic roadmaps for the three identified priority dimensions. 
 We propose to present the adapted version of the SCIROCCO tool that allows the assessment of an organization’s level of maturity towards integrated care, and to discuss its advantages and more specifically its use as a steering and improvement tool that integrated care organizations can use on a regular basis. 
 ¹ https://www.sciroccoexchange.com/

PROCare4Life lessons learned

PeRsOnalised Integrated CARE Solution for Elderly (PROCare4Life) has been an EU funded project running since January 2020 until June 2023, whose focus has been to further develop and integrate previous ICT solutions developed by several previous EU funded projects into a unique modular system able to support the autonomy, empowerment and to increase the Quality of Life (QoL) of elderly people living with Parkinson’s, Alzheimer’s, or similar dementia, having also tested the system for elderly people living with comorbidities. This article focuses on the methodology and results used to identify the internal Lessons Learned. PROCare4Life has been developed using a codesign approach involving more than 2000 participants whose support has been listened to and transformed into valuable changes of the system and also into lessons learned included in this case study report. Since the beginning of the implementation of PROCare4Life there has been a commitment to make invisible knowledge visible through open discussion and including our lessons learned in each of our deliverables. In the last six months of implementation, to the previous results internal qualitative research has been implemented by the PROCare4Life consortium to identify and select our most relevant challenges and recommendations for future projects and initiatives. PROCare4Life was highly impacted by the COVID-19 pandemic, and it is acknowledged in the lessons learned. However, the consortium has focused on the recommendations that could be more valuable for ordinary implementation of future projects and initiatives developing eHealth tools for elderly citizens living with conditions that might affect their cognitive or mobility capacities.

Meeting the complex health and social care needs of older adults: a response to the recent viewpoint paper on “how to handle gerontocracy”

PurposeThis paper aims to provide a response to the previously published paper on “Gerontocracy”.Design/methodology/approachThis paper views care services through the lens of safeguarding, risks and responsibility in contradistinction from the largely economic and cost relevant argument put forward in the original paper.FindingsThis paper articulates the contribution of informal carers to integrated care solutions solely from an economic perspective overlooks the wider human and social dimensions of care provision in society.Originality/valueEngaging in the wider debate about the status, contribution of informal carers to care solutions highlights the complexity of the carers' role in society which should evoke a more holistic debate of this important topic.

Radiation Skin Injury Care in Radiotherapy for Oncology: Mechanisms, Drug Therapy and Novel Biomaterial Application Strategies

AbstractRadiation skin injury (RSI) is a frequent adverse effect of radiation therapy for malignant tumors. It often leads to problems such as decreased quality of life in patients and interferes with the normal course of radiation therapy (RT). With the rising incidence of tumors and the burgeoning number of patients undergoing RT, the care of RSI is of crucial importance in cancer patient treatment. Currently, drugs and biomaterials are widely used in the care of RSI. However, there is no international consensus on the current protocol for the therapeutic care of RSI. Many drugs and biomaterials cannot be applied to the appropriate type of radiation dermatitis, resulting in unfavorable results in the therapeutic care of RSI. The choice of appropriate drugs and biomaterials for the therapeutic care of the different types of RSI is essential to improving the quality of life of patients. This article first reviews the main mechanisms of acute and chronic RSI. Subsequently, the application of drugs and novel biomaterials in the preventive, acute, and chronic phases of the care of RSI is summarized. Finally, the suggestions and protocols for the application of novel biomaterials in the care of RSI are discussed, as are the current challenges and future prospects for the development of combined biomaterials and integrated care solutions.

Healthcare use by children in North West London 2015-2019 by deprivation and integrated care access

Abstract Background England has a health system offering universal coverage, but disparities in healthcare use are increasing. Between 2007-2017, children living in more deprived areas had higher rates of unplanned care (Emergency Department (ED) attendance and hospital admissions), whereas children from less deprived areas had higher rates of planned care (General Practitioner (GP) contact and outpatient appointments). More detailed research to find solutions for this divergent pattern is required. Aim To assess the rates of GP contact, outpatient appointments, hospital admissions and ED attendance in North West London, by Index of Multiple Deprivation (IMD) decile of home postcode and access to an integrated care service providing linked care between multiple child health professionals ‘Connecting Care for Children (CC4C)', for children aged 0-18 years between 2015-2019. Methods Retrospective analysis of a de-identified database of integrated care records for 495,357 children. Results Children from the most deprived decile had higher rates of emergency admissions (0.070 per child per year vs. overall mean 0.040), elective admissions (0.076 vs. 0.032), ED attendances (0.754 vs. 0.358) and outpatient appointments (1.702 vs. 0.756) between 01.01.2015- 31.12.2019. Children from the least deprived decile had the second highest rates of outpatient appointments (0.911 vs. 0.756) and GP contact (8.192 vs. 5.390) between 01.01.2015- 31.12.2019. Children with access to the CC4C service, despite being from more deprived backgrounds, had lower rates of emergency admissions (0.028 vs. 0.037) compared to patients with access to usual care. P values <0.001 in all cases. Conclusions Greater deprivation was linked to higher rates of emergency admissions, but this was partially mitigated by access to more integrated healthcare models. Children from the least deprived decile continued to have disproportionately higher use of planned care. Key messages • Despite universal health coverage, children from more deprived areas continue to have disproportionately higher use of unplanned care. • Further research is required to explore whether integrated care solutions can reduce the burden on unplanned health services and inequalities in access to care.

CAREPATH: Developing Digital Integrated Care Solutions for Multimorbid Patients with Dementia.

CAREPATH project is focusing on providing an integrated solution for sustainable care for multimorbid elderly patients with dementia or mild cognitive impairment. The project has a digitally enhanced integrated patient-centered care approach clinical decision and associated intelligent tools with the aim to increase patients' independence, quality of life and intrinsic capacity. In this paper, the conceptual aspects of the CAREPATH project, in terms of technical and clinical requirements and considerations, are presented.

Implementation of evidence-based health policy in the field of integrated care: A Ritka Betegségek Nemzeti Erőforrás Központjának tervezési folyamata

In Hungary, significant achievements have been made in the care of patients with rare diseases in recent years. A next step could be the establishment of the National Resource Centre for Rare Diseases (hereinafter: Centre) to facilitate patient-centered complex care by the integration and supplementation of existing health, social and educational services. This research aimed to develop recommendations based on international scientific methodology to overcome potential implementation barriers of the aforementioned Centre. To evaluate the feasibility of the implementation, we organized an interdisciplinary workshop with representatives of different stakeholder groups, adopting the methodology developed in the SELFIE H2020 research project. During the workshop, we discussed the previously ranked, most significant implementation barriers and made recommendations for potential solutions. The potential implementation barriers were considered relevant by the participants and, reflecting on these barriers, altogether 17 recommendations were developed by consensus. These recommendations were related to the content of service delivery, use of supportive technologies, overcoming workforce issues, establishing effective leadership, implementing a complex financing structure and creating research opportunities. Implementation of the Centre would shift the care of rare diseases towards personalized and integrated health, social and educational services. Our recommendations will contribute to the establishment of the Centre, subject to positive policy decision. Furthermore, our methodological approach could support the feasibility assessment of future integrated care solutions and programs. Several predictable barriers must be overcome to establish the Centre. Recommendations developed by representatives of relevant stakeholders could support successful implementation and societal value generation. Orv Hetil. 2021; 162(45): 1818-1825.

DigitalHealthEurope twinnings to scale up innovative person-centred integrated care solutions

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Stakeholder engagement in developing population-based integrated care solutions – Insights from Germany

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

What do older people want from integrated care? Experiences from a South Australian co-design case study.

The challenges of improving the integration of care for older people with complex care needs are well recognised. Evidence suggests that solutions should be co-designed with older people to ensure they are contextually relevant and person-centred. As a first step in a co-design project to improve integrated care for older people, seven interviews and three workshops were held with older people and service providers. Data collected via recordings, notes and journey maps were inductively analysed. Five themes were identified: relationships and roles, patient capacity and safety, information and systems, multiway communication, and transitions and flow. This created a more holistic and person-centred picture of integrated care than typically derived from published literature. Older people perceive integrated care from relational, organisational, informational and individual viewpoints. This reinforces the central importance of adopting a person-centred, as opposed to health system-focused, approach to designing and implementing integrated care solutions.

Addressing the needs of people over the age of 65 in Grudziadz (Poland): a model for a local integrated care solution

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

An integrated care solution for the electrocardiogram monitoring

PurposeThis study has demonstrated how technology may contribute to integrated care solutions by comparing conventional ward telemetry (WT) to a wearable ECG monitor (S-Patch) to detect atrial fibrillation (AF) in patients with stroke.Design/methodology/approach51 patients admitted for stroke workup were recruited across two major tertiary centres to compare WT monitoring for two days versus S-Patch for four days in the detection of AF. The efficacy to detect AF using both technologies was assessed via data extractions and medical officer review. A matrix was used to measure nursing/patient satisfaction and setup/resource times were assessed.FindingsPatients (84–94%) and nursing staff (75–95%) preferred the S-Patch wearable technology. Non-parametric tests indicated significant time saving for removal of S-Patch versus WT [2.2 min vs 5.1 min (p = 0.00)]. Efficacy of S-Patch to detect AF following medical officer review was greater than WT, with seven patients identified with AF by S-Patch versus one using WT. The S-patch had a false positive rate of 78%.Research limitations/implicationsThe S-Patch is sensitive in the detection of AF; however, it showed a high false-positive rate with automated reporting. This study has provided insight into the details of delivery of integrated healthcare using wearable technology.Originality/valueThe technology and partnership were the first-in-kind in Australia. The S-Patch had a higher detection rate of AF compared to WT which allows patients to be anti-coagulated appropriately for the prevention of further stroke. The results of this study will be ideally placed to inform future policy in integrated healthcare using new technologies.

Nearly a Century of Insulin at Sanofi: Looking Back Over the Decades of Production and Development.

Almost a century ago, the first insulin was produced by Banting, Best, MacLeod and Collip in Toronto, thereby enabling life-saving treatment for people with diabetes. Since then, there have been many advancements in insulin production and development of new insulin analogues. In this article, we reflect on the rich heritage of Sanofi and its predecessor, Hoechst, in insulin production and development, from being one of the first companies to produce insulin in Europe in 1923, to modern-day insulin analogues and integrated care solutions at present-day Sanofi.