Social Care Systems Research Articles

The Evolving Complexities of MAID Care in Canada From a Nursing Perspective

Medical Assistance in Dying (MAID) legislation has evolved rapidly in Canada with significant impacts on nursing practice. The purpose of this paper is to describe evolving complexities in legislative context and practice standards that influence the experiences nurse practitioners and registered nurses have with MAID. Qualitative interviews were conducted with 25 registered nurses and 10 nurse practitioners from diverse contexts across Canada. Participants described their practices and considerations when discussing MAID as part of advance care planning; their use of, and challenges with, waivers of consent; their practice considerations in negotiating the complexities of clients for whom death is not reasonably foreseeable; and their moral wrestling with the inclusion of MAID for persons whose sole underlying medical condition is mental illness. Findings illustrate the moral complexities inherent in the evolving legislation and the importance of robust health and social care systems to the legal and ethical implementation of MAID in Canada.

The selection of indicators for monitoring health and social care integration in Dutch regions: a Delphi-study

Background: Health care systems in Western countries are increasingly pressured by population changes and labor market shortages. In response, Dutch health authorities and interest groups agreed on a reform agenda in 2018. A key reform principle is 'the right care in the right place': the regional coordination of initiatives to prevent, substitute, or relocate health and support services across health and social care systems in order to better meet the needs of residents and to improve their functioning. However, diverging stakeholder perspectives on this reform challenges regional partnerships to select useful indicators to determine local needs and improvement areas. We therefore aimed to facilitate academic and field expert consensus, and propose useful indicator sets in supporting the regional discussion about delivering 'the right care in the right place'.
 Methods: Modified Delphi and nominal group techniques were used. Invited experts included representatives from interest groups (patients, vulnerable residents, and care professionals), knowledge institutes, regional partnerships, municipalities and private health insurers. First, from published international research about measures used in the context of population health management, researchers identified indicators, clustered them in themes, which they then pre-selected for potential relevance. Second, a web-survey and validated scoring methods were used to establish expert consensus about relevant themes. Third, experts voted on themes, discussed initial voting results, and – if desired – changed votes during online meetings. Fourth, for the 25 prioritized themes, researchers identified available indicators from data collections in the Netherlands. Fifth, another web-survey was used for expert voting on indicator usefulness per theme. Sixth, indicator sets were presented, and next steps were discussed with experts. During rounds 2-6, experts added indicators, shared arguments on their selections, or both. These qualitative data were thematically coded.
 Results: Contributions by 40 experts resulted in: 1) a base set with available indicators with the highest aggregated score for the 25 prioritized themes, 2) a ‘optional set’ with other ‘not-low-scoring’ indicators, and 3) an indicator development agenda. Amongst themes with the highest priority, those about structure (e.g., ‘collaboration across health and social care systems’) and processes (e.g., ‘inflow, throughflow and outflow within care chains’) generally received more votes than those about outcomes (e.g., ‘healthy weight’). Experts argued mostly against the usefulness of available indicators for the highest prioritized themes. Arguments raised were often about ability to influence the indicator or whether the indicator says something about multi-system developments, e.g., both in health and social care. For twelve themes, experts did not comment on the indicators chosen for the base- and optional-set.
 Learned lessons and next steps: Consensus techniques facilitated the establishment of common ground for selecting useful indicators about regional health and social care integration. Although available indicators appeared acceptable for almost half of the prioritized themes, open and routinely collected data provide limited opportunities to indicate integrative regional reform as stakeholders intend. Prioritized and accepted indicators will be made accessible in an existing online data tool. Execution of the development agenda starts with instrument development for indicating cross-system regional collaboration.

The integration journey in Wales – moving below the waterline. Fitting with the conference theme of ‘Change management implementation' this presentation will explore the journey so far in Wales in creating structural, legislative and system change. 

In 2014 the ground-breaking Social Services and Wellbeing Wales Act set out a new vision for social care which was built on the principles of prevention, service user voice and control, co-production and integration. This was further supported by the vision set out in a Healthier Wales; our 10 year plan for Health and Social Care.
 This legislation placed a legal duty on Local Authorities and Local Health Boards to ‘co-operate’ in meeting the care and support needs of their population. It saw the creation of seven Regional Partnership Boards (RPBs) which brought together Health, Social Care, Housing and Third Sector partners with service providers, service users and unpaid carers to strategically plan care and support in their area. 
 Six years on RPBs have made some notable progress including integrated needs analysis and planning arrangements and the development of integrated service delivery models. However more work is needed to embed integration into our heath and social care system. 
 RPBs are increasingly being viewed as an iceberg, with partnership working so far being progressed ‘above the waterline’ with the small group of people and organisations committed to the integration journey. This presentation will set the ambition in Wales for moving ’below the waterline’ and engaging with wider stakeholders and partner organisations to mainstream integration.
 RPBs are made up of a wide range of stakeholders including service users and unpaid carers. They have all contributed to the integration journey so far and in 2022 these stakeholders have been working closely with Welsh Government officials to review and strengthen current structural arrangements.
 Recent work has included the co-production of an engagement charter to support the effective engagement of services users, carers and third sector organisations in the work of Regional Partnership Boards as true partners.
 
 Work has also been completed to fully align the strategic work of RPBs with Local Primary Care Cluster arrangements in order to ensure strategy and locality based delivery inform and complement each other. 
 Evidence to understand and shape the journey so far has also been provided by Audit Wales, a KPMG review of pooled budget arrangements across Wales and evaluations of the Integrated Care Fund and the Transformation Fund. These two evaluations provided the learning to shape the five year Regional Integration Fund (RIF) launched by Welsh Government in April 2022. The £144.6m a year RIF will seek to create sustainable system change through the integration of health and social care services so that by the end of the five year programme, we will have established and mainstreamed six new national models of integrated care. 
 This presentation will highlight the progress made in Wales in relation to creating structural, legislative and system change but will also raise the question of how to secure the necessary behavioural change to mainstream the integration of health and social care. It will focus on the importance of having the right balance and alignment between systems, structures and people, resources to lever change and the need for a new style of leadership. 

The Translational Work of Interoperability: Digital Health and Data Enabling Integrated Care Special Interest Group Workshop

Introduction: Members of the Digital Health and Data Enabling Integrated Care Special Interest Group came together at ICIC22 to discuss priority issues. One critical international struggle is the challenge of interoperability to support information and data sharing and communication as cornerstones of integrated health and social care systems. 
 Aims and Objectives: The emphasis of SIG work in 2023-2024 will be to deeply engage with the critical challenge of interoperability. From an integrated care perspective what is required is understanding the translational work needed to make the sharing of information and data useful and meaningful to those who need it. In this meeting, delegates will work together to unpack the translation problem of interoperability in terms of translating information between stakeholders (e.g. between patients, families and their care teams), between disciplines (e.g. between different clinicians and providers), and between sectors (e.g. between health and social care sectors), with the aim to share current work and identify knowledge and practice gaps that we can address as a SIG for the next year. 
 Audience: All existing and newly interested members of the SIG are welcome to join for this discussion. Our membership consists of patients and family caregivers, researchers, frontline providers, managers, system leaders and decision-makers, policy makers, informaticians, and industry partners. 
 Structure and engagement: This session will use the hour largely to engage with delegates to meet session objectives. To set up the discussion we will begin with a short introduction from SIG leads (C. Steele Gray, L. Lewis, I. Meyer) followed by SIG member (J. Piera-Jiménez) to present the case example of Catalonia’s Digital Health Strategy and their efforts towards improved interoperability that addresses limitations of current information systems, reduces loss of meaning in information exchange, and advances standardization of care processes. Delegates will next break into small groups (5-6 per table with one facilitator), to discuss what translation needs would be required to implement an interoperable system (like Catalonia’s), and how those needs could be met (e.g. consensus group discussions, technological solutions like Artificial Intelligence and Natural Language Processing). Facilitators will use a live Google Jamboard to record ideas shared by the individual groups. 
 Structure: 1) Introduction (10 minutes); 2) Catalonia Example (10 minutes); 3) Table Discussions (25 minutes); 4) Identification of current work and gaps (15 minutes)
 Summarizing take home messages: In the final 15 minutes of the session the full group will reconvene to review the live Google Jamboards and engage in priority setting of translation needs. Delegates will be asked to identify where they may already be working on identified needs, and where current gaps might exist. This exercise will allow us to bring together sub-groups to tackle translation problems who would then engage in webinars and/or discussion groups between ICIC23 and ICIC24 with the aim to generate a white paper, report, or journal special issue that would bring together current and new knowledge generated by SIG members of the translational work of interoperability.

Building a Better System to Support Family Caregivers: Engaging Multi-level Interdisciplinary Stakeholders in Micro, Meso, and Macro Level Learning Health System Design.  

The current Canadian healthcare workforce shortage and care crisis demands innovative solutions, yet it takes 17 years for healthcare innovations to reach 50% adoption in clinical practice. Healthcare workforce shortage solutions include expanding team-based care, moving integrated services closer to home[, and including Family Caregivers [FCGs] as partners on the care team, rather than treating them as visitors or patient accompaniments. Integrating FCGs as partners on the healthcare team improves patient care, health, and well-being, reduces the length of hospital stays, supports aging in the right place, promotes effective communication, and reduces healthcare providers’ workload. While FCGs and the people they care for require integrated care and services coordinated around their comprehensive needs, research confirms that FCGs remain invisible, and often marginalized by healthcare systems.
 Aim: Detail the micro-meso-macro-level elements and roles needed for building integrated FCG support systems.
 Results: As FCGs, the people they care for, and their care trajectories are diverse, an integrated system to support FCGs includes: 1) macro-level policy leadership 2) meso-level FCG-friendly communities, community organizations, health and social care systems, and providers trained to support FCGs; 3) micro-level assessment of FCGs needs and supports tailored to needs/goals, and 4) evaluation and practice improvement research. Three critical elements to Health Learning Approaches are: 1) Prioritize service needs and a design improvement approach; 2) Strengthen and link the assets required to operationalize rapid learning and a quality improvement approach, and 3) Establish a network of rapid-learning champions to drive and sustain action. Our Alberta-based Caregiver-Centered Care Research Program works at collaborating with stakeholders interested in enacting a collective impact approach to build a better system of all the essential elements of integrated health and social care programs and services needed to support FCG's well-being and sustain their caregiving. First, we convened a series of consultations to prioritize approaches to support FCGs. Stakeholders prioritized competency-based education for healthcare providers about person-centered care for FCGs. Accordingly, we engaged FCGs, researchers, health and social care providers/leaders, and policymakers to co-design and deliver free, online Foundational and Advanced education about providing person-centered care for FCGs to health and social care providers. Now, we need to strengthen our network and link assets. We convened a series of six webinars designed to raise awareness of FCGs' work, the need for systemic FCGs support, and to consult stakeholders about the next steps to integrate health and social care systems to support FCGs (October 20 – November 29, 2022). The webinars have also built our network of Canadian collaborators.
 Conclusions: The collaboration required to build a better system to support Canadian FCGs takes facilitation and time. The learning health system framework seems appropriate to approach the complex system and culture changes required more efficiently and effectively. 
 Implications: Learning Health Systems and co-design by communities of patients, FCGs, health and social care providers/leaders, and researchers are currently regarded as a superior approach to improving healthcare and health outcomes. A strength of our team is collaborative, trusting relationships. 

Co-design of an integrated home-based primary care model for older adults living with frailty in Ontario, Canada

Background: The demand for home care is predicted to increase with increasing senior population and the aging-at-home phenomenon. Countries world-wide are preparing for this growing demand by making changes to their health care and social care systems. This change is much needed given that, globally, evidence shows that seniors are experiencing fragmented care particularly when they are living with frailty. To address this problem, the Central West Ontario Health Team in Canada is creating an integrated home-based primary care model for individuals 65+ who are living with frailty. At the ICIC23 Conference, I plan to share our research findings, design of the program, learnings from every phase of our co-design and change management approach, and findings from the evaluation of the pilot program. 
 Methods: The program is being co-designed (using Experienced Based Co-Design) in collaboration with patients, caregivers, primary care, hospitals, the municipality, mental health organizations, social workers, home and community care, and other community groups. To date, the co-design team has worked together in partnership to share experiences, segment the population, conduct an environmental scan of documents, and conduct quantitative and qualitative research. First, the team performed descriptive data analysis of hospitalization and community data, and then, three separate focus groups were held with local organizations, service providers, and patients and caregivers (n=60). The data that emerged from the focus groups was then thematically analyzed. The co-design team is now finalizing the program as it is set to be piloted in January 2023, at which point, the program will be evaluated (on measures such as emergency department (ED) diversion and patient experience), updated, and scaled up appropriately.
 Results: Research showed that 80% of Alternate-Level-of-Care days in the Region are among those who are 65+. A cohort of the older adult population are also high users of the ED who are being discharged home each time. Reported reasons for high ED use include isolation, confusion about the health care system, caregiver burnout, and not receiving proper care in the community in a timely manner. Our research also identified frail older adults to be particularly vulnerable. The program I will describe in the presentation will aim to address these issues. It is novel to Ontario, Canada, and will consist of a screening process to identify “at risk” older adults presenting to the ED, a comprehensive assessment, and ongoing access to an intraprofessional team (consisting of physicians, nurses, physiotherapists, nutritionists, pharmacists, and mental health professionals) that will work together on a shared care plan for each patient. All the tools are being adapted to meet a multi-faceted definition of frailty as well as local needs given that the Central West Region is one of the most ethnically diverse regions in the province. By co-designing, the aim is to implement an integrated program that matches the preferences of patients and their family-members and caregivers.
 Discussion: The learnings will be helpful to the many groups world-wide who are also planning on creating integrated co-designed primary-care based programs for diverse older adults experiencing frailty.

Barcelona Aging coLLaboratory (BALL): an open-innovation ecosystem to co-create and test innovative solutions for older people in real-life settings.

Currently, more than 700 million people worldwide are, at least, 65 years old, with this number expected to surpass 1 billion by 2050. Multi-morbidity and complex health and social care needs will increase in turn, exacerbating the demands for policies and services aimed at older adults, which the COVID-19 pandemic has highlighted as lacking. Furthermore, the increased life expectancy and a more participatory society underline a change in roles, with seniors becoming not just consumers but also producers, constituting a vital part of the economy. 
 With other nine institutions from Catalonia, Spain, the PSPV recently launched the Barcelona Aging coLLaboratory (BALL), an open-innovation, person-centered ecosystem, based on the systemic co-creation of services and products with older people. BALL aims to integrate research and innovation processes in the real-life settings of our communities, as well as to act as an intermediary between citizens, research institutions, universities, private companies and public administrations, thereby adopting a quadruple-helix innovation framework, to co-create value and to prototype, validate and scale-up innovation. The ten participating organizations represent older adults and their caregivers, health and social care providers, research centers and universities, and small- and medium-sized enterprises. Aligned with UN Sustainable Development Goals, BALL seeks to: establish communities of practice aimed at carrying out systemic diagnoses in our communities to identify real needs and challenges related to aging, and propose strategic and operational plans; co-create and implement complex interventions and new services that respond to those real needs; co-create innovative products and test them with end-users in real-life settings. BALL is creating an ethics framework to guarantee the protection, safety and reward of participants in the co-creation process. 
 Since its conception in 2021, BALL has incorporated several innovative projects in its catalogue: ADMIT, focused on transforming the health and social care model in order to ensure integrated care; MoviMent, which alters the physical environment and employs gamification techniques to improve physical activity and cognitive function in older adults admitted to hospitals or long-term care facilities; UDhA-AGIL-App, aimed at guiding healthcare professionals in the prescription of physical activity for older adults according to their needs (physical and cognitive function and technological knowledge) and preferences through a decision support algorithm; AI-EAT, a care robot that seeks to assist disabled older adults with feeding; A-MIDA, a person-centered approach for optimizing pharmacological interventions according to life expectancy and frailty instead of age; and QCOA, a toolkit for evaluating long-term care facilities based on PROMs and PREMs. 
 The impact of BALL will be evaluated yearly in terms of: number of projects, number of pilots tested, number of solutions introduced into the marketplace, number of co-creation sessions and personal interviews performed, different user profiles, number of grant applications and their characteristics (national or European), visibility in media and congresses, number of new sponsorships and market impact/value, among others. We expect to influence the health and social care system and society as a whole by increasing awareness on aging challenges, influencing polices for healthy aging and enhancing local economic activities related to aging." Results: The core components of PN programmes for cancer prevention among PEH agreed cross-nationally with all the relevant key participants are (1) Promote cancer awareness and self-management (Facilitate the delivery of cancer education; Promote healthy behaviours and preventative measures; Encourage user involvement in health-related decisions), (2) Identify health needs and barriers (Develop a personalised approach to assessing user need; Seek solutions regarding barriers to care), (3) Co-ordinate access to care (Develop trusting relationships with and facilitate communication between local health and social care providers; Enhance understanding of the needs of PEH among local health and social care providers; Arrange referrals to healthcare services and cancer screening; Co-ordinate and support attendance of appointments), (4) Offer practical assistance (Arrange transportation, mobile phones, clothing, access to hygiene facilities, and storage of medication; Assist with completion of paperwork).
 Lessons learned: Results from the discussions indicate a high level of consistency and cross-national agreement about what the core components of the intervention should be, and how this should be designed and implemented.
 Next Steps: This intervention will be adapted to reflect the country-specifics, to ensure that the PN is appropriate to the four local contexts in which it is piloted. 
 Bibliography
 Carmichael, C., Smith, L., Aldasoro, E., Gil-Salmerón, A., Alhambra-Borrás, T., Doñate-Martínez, A.,
 Seiler-Ramadas, R. & Grabovac, I. (2022) Exploring the application of the navigation model with
 people experiencing homelessness: a scoping review, Journal of Social Distress and Homelessness. DOI:
 10.1080/10530789.2021.2021363

Integration of a web application in Osakidetza Basque Health Service information system to optimize and adapt pharmacy therapeutic of multimorbid patients.

Background: Due to population aging and advances in medical science, people with chronic diseases and polypharmacy are living longer. Challenges are how healthcare systems can cope with the cost burden of chronic disease, sustain a quality independent living for patients; and ensure sustainable healthcare and social care systems. Innovative solutions as well as sustainable integrated workforce solutions are emerging as an alternative to tackle this challenge.
 Methods: Within Gatekeeper, the Basque Country region is carrying out a “management of people with chronic diseases and polypharmacy"" quasi-experimental study (non-randomized, concurrent and controlled study). The aim is to assess the effectiveness and experience of using a mobile application (My Treatment) to improve adherence of patients with polypharmacy and boost the optimization of pharmacological prescriptions by using a web platform (CheckTheMeds). This study plans to advance as well in the enhancement of Primary Care teamwork, coordination, and communication to acquire new roles to support each other, and offer holistic care to patients.
 The intervention has been deployed in 11 Integrated Health Organizations of Osakidetza Basque Health Service, Basque Country (Spain). More than 275 healthcare professionals (doctors, nurses, and pharmacy staff) from Primary Care (PC) centers are participating in the intervention. Trained PC healthcare professionals have started the piloting. They have recruited 690 patients who meet the inclusion criteria (65 years of age or older, with 2 or more chronic diseases and 9 or more chronic or on-demand medicines prescribed). The piloting will last until June 2023.
 Results: 690 patients (intervention and control group) have been included in the study. After signing the informed consent, their health status (Barthel test), prescribed drugs (CheckTheMeds platform), and adherence to treatment (Morisky Green test) are completed at baseline and after a 6-month follow-up. Preliminary data extracted from OAS (Oracle Analytics Services) of Osakidetza reflected that the average age of the recruited patients is 77.9 years, and 58% are male. The average prescription of these patients is 13.10 medicines. 51% of the users are independent (Barthel Test) and 80% of the patients are compliant (Morinsky Green test).
 The evaluation is being conducted with a mixed methods approach, integrating quantitative and qualitative techniques, by organizing a workshop (November 2022) and a focus group. 
 Discussion and Conclusions: Improved appropriate polypharmacy, together with adherence to prescribed medication, will result in more effective treatments with fewer PRMs and health complications, and therefore, in improved efficiency in the use of healthcare resources. As a consequence, a better use of resources, increasing coordination, and teamwork among primary care healthcare professionals,s and introduction of new roles can improve the efficiency of health systems. Thus, the coordinated action of healthcare professionals, in close collaboration with the patient, is postulated as a common denominator in strategies aimed at improving adherence to treatment and offering new caring skills. This integrated care model is flexible and can be replicated at large scales in different environments.

The co-development of a mobile navigation app in an integrated care network in Ontario, Canada

Introduction: The complexity of navigating health and social care services is a common challenge to both providers and patients and their families. In the nineties, navigation programs arouse to assist cancer patients accessing services. Since then, those programs expanded to additional patient populations. Navigation programs can take various forms including virtual navigation. Virtual navigation in healthcare is a proactive process by which patients obtain information and support via internet resources to manage their illness demands.
 Approach: With a commitment to facilitate 24/7 access to its attributed population, Burlington Ontario Health Team (BOHT)-an integrated care network in Ontario- developed a mobile navigation app. Developing this app utilized experienced-based co-design approach. This approach took place via organizing a working group that included all stakeholders within the BOHT network of organizations and patient/caregiver partners. Over several months, the working group built potential personas of users, mapped their system navigation needs, created an inventory of navigation services within the network and designed the navigation app. Creation of the app was an iterative process including several testing and feedback loops to improve content and usability.
 Results: The first iteration of Burlington Navigation app was launched in Fall of 2021 accompanied by a comprehensive communication plan. The plan included digital signals at the hospital and primary care offices, social media posts and presentations to local providers including primary care physicians, community navigators. The first iteration focused on linking to health, social and community services offered by BOHT’s members and collaborators, and also services that were widely used in the community. Based on the feedback we received afterwards, the second iteration included links to provincial services. The third iteration includes capability to create a trusted account verified in the background by the same technology Interac uses. This will allow secure and seamless access to integrated services without a need for a separate username and password as well as access to the provincial patient portal
 Implications/highlights: Burlington Navigation app was the first community-based navigator app co-designed with patient partners, providers and community volunteers with lived experiences within the health and social care systems in Ontario. It resonated well with the users (providers and patients/caregivers) as local information became available at their fingertips. The success of the app allowed it to guide other OHTs on a similar digital navigator design journey. It also became the blueprint for a provincial solution for a multi-tenant navigator, which would allow multiple OHTs to showcase the local navigation information (based on geolocation) as well as provincial offerings.
 Conclusion: Sharing our journey co-developing the Burlington navigation app demonstrates that when local health integrated care networks utilize experienced-based co-design approaches to planning healthcare interventions, this has the potential to a) develop solutions that are well perceived by patients and providers and b) scale and spread these local solutions to larger-scale solutions that can improve the experiences of a wider spectrum of providers and patients.

Becoming Healthier

To meet the challenges of an ageing population, increasing chronic diseases, and rising healthcare costs, Singapore is embarking on a long-term, multi-year strategic reform to shift care to the community, to improve value for resources expended, and to make the prevention of diseases and complications the focus of the health and social care system. Healthier SG will launch in the middle of 2023 for those aged 60 and above.
 The reform will enlist, integrate and enhance the mostly-private primary care sector into primary care networks. Residents will enrol to a selected primary care provider for long-term care relationships based on individualised health plans incorporating primary and secondary preventive activities like lifestyle improvements, health screenings and vaccinations. Social prescribing to community partners will enhance the prevention of disease and complications. Corollary enablers will also be enhanced, from health and social information sharing, to manpower development, to financial incentives and support. Digital Health capabilities like the national patient information repositories and personal trackers will be part of the intended new health ecology.
 This presentation will describe the health and social care reform, its origins and drivers and currently intended plan and desired outcomes, and discuss its theory of change, implementational challenges and potential enablers and barriers for success. In particular, we will discuss the difficulties in the systematic measurement, monitoring and evaluation of a large-scale multi-year reform, and the governance and leadership challenges to maintaining coherence and shaping trajectories in such complex endeavours.

Community-based intervention for promoting healthy habits through MAHA mobile application in Basque elderly population.

Background: Population over 65 years of age in EU is increasing, rising costs in health and social care systems and making changes in biological, physiological, and psychosocial field. Promoting healthy ageing has become a key to improve the lifelong health and wellbeing of ageing population. Health technologies and eHealth tools can be an effective instrument to address the challenge of ageing. They provide an opportunity to improve the health and well-being of older people, and to prevent, treat and ensure the sustainability of health systems.
 Digital technologies aimed at promoting active ageing enable access to greater knowledge, better communication and a better relationship with people's environment, if they are designed in a person-centred way. They open up a range of new possibilities and resources that represent a way to reduce the generation gap and bring older people closer to the rest of the community.
 Methods: The Basque Country region has implemented a community-based intervention to promote active and healthy ageing through the use of a self-managed mobile MAHA App within Gatekeeper European project (H2020, nº857223). MAHA app developed in a co-creation process involving end-users and professionals from community settings is available in Google Play and App Store for iOS. The tool offers activities and materials to reinforce socialization and, promote healthy, meaningful, creative and fulfilling lives among elderly people.
 This quasi-experimental and longitudinal study is targeted at 10,000 older people and/or their caregivers from the Basque Country (Spain). The community-based intervention in the Basque Country has been designed to involve Primary Health Care services and key agents from different sectors at the community level that can influence the well-being and health of the elderly population. The Support Network created for the intervention has the participation of 39 community organisations and entities belonging to the Basque Health Ecosystem.
 Results: A mixed methods approach to evaluation will be carried out, using quantitative techniques, through validated questionnaires and usage metrics to assess effectiveness; and qualitative techniques, to collect user experience. An analysis of the implementation process has been executed, to identify the determinants, factors, and aspects that impact the intervention, and the commitment, adherence and dropout rate towards user engagement. The intermediate data shows that the actions implemented are effective, as the intervention has been widely disseminated and many people have been contacted. Although more than half have accepted to participate in the intervention, only 3% finally registered in the application. This intervention also shows low adherence to the intervention and a high level of dropout, as it is understood that once the user accepted to participate, they do not follow the study protocol. 
 Discussion and Conclusions: The community-based intervention implemented will contribute to generating awareness and new data on research into the intention-to-treat, adherence and attrition rate of the use of self-managed eHealth applications by the elderly. Likewise, a tool with these characteristics can be considered an effective health asset for improving elderly people's health, making healthy options more accessible and incorporating new habits in this population.
 

Integrated Care Systems in England: Progress towards forming new multi-stakeholder partnerships to develop quality.

Background: Health and social care services in England have been restructured to 42 Integrated Care Systems (ICS). ICSs are responsible for delivering integrated services in their local area to prevent illness; identify and treat illness effectively; and provide support to improve quality of life for people with long-term illness or disability. Under the umbrella of ICSs, previously siloed organisations need to work together to deliver quality care. This study aimed to understand how these new ways of working impact on the development of their quality agenda.
 Methods: Semi-structured interviews were undertaken with senior representatives in demographically and geographically diverse ICS. Interviews were audio recorded, transcribed verbatim and analysed in NVivo using a thematic framework approach. Two Patient and Public Involvement team members contributed to the study design and data analysis. The study is conducted at two points in time; the data reported here is the baseline collected shortly (November 2021 to May 2022) before the ICSs’ formal constitution in July 2022.
 Results: Sixty interviews across four ICSs were conducted with senior representatives (e.g. ICS CEO, chief nurse, quality leads, director of social services, director of public health, the public and local communities). Across all ICSs, progress had been made with creating ICS specific committees, with new roles created and leaders appointed, and new partnerships emerging. Positive learning on collaborating with diverse partners had occurred during the COVID-19 pandemic and through previous local initiatives to integrate services. In two ICSs, there was less history of such collaborative work and their new partnerships were emerging more slowly. 
 Generally, it was agreed that strong leadership, supported by broad and effective system partnerships, was essential to develop the ICSs’ structure and to deliver quality. Key partners to support the leadership were senior partners in acute hospital trusts, primary care, social care, public health, Healthwatch (the health and social care champion for service users), voluntary services, and patient representatives. 
 Some concerns were raised that made collaborations more challenging, including differences in language and work culture between the key partners, and health dominating the quality agenda. Overall, it was felt that social care, public health and voluntary services were heard less. They were being consulted, but rarely had leadership roles and leaders from these communities often felt that they were not equal partners. Most participants highlighted the importance of consulting patients and the public and acknowledged that this was not done effectively yet with too few people, who lacked diversity, consulted; and an overreliance on Healthwatch. 
 Discussion: This restructure of the health and social care system shows that new partnerships can be formed between previously siloed organisations but that these take time to develop. In particular, organisations or people who have traditionally been less consulted such as social care, public health, and patients and the public still need to become more equal partners in developing the quality agenda. Follow up interviews will bring greater clarity on how this restructure will maintain and promote quality across services. 

E-Health, m-Health, personalised medicine – challenges faced by healthcare systems in Central and Eastern Europe

Background and purpose: The purpose of this study aims to explore measures intended to remove barriers to the implementation of innovative interventions and identify best practices applicable in European countries that support the implementation of cutting-edge e-health, m-health and personalised medicine (PM) interventions at the micro-, meso- and macro-regional levels. Thanks to PM, people are closer to more accurate, predictable and powerful healthcare tailored to individual patients [1]. PM indicates treatment adapted to the patient's characteristics, needs and preferences. PM categorises patients according to the risk of developing a particular disease or degree of response to a given treatment using appropriate diagnostic markers. PM also aims to increase control over the optimisation of medical treatment outcomes and increase the precision of medical treatment, as well as improve disease prediction [2]. The study concept constitutes one of the indicators of the Regions4PerMed project entitled "Interregional coordination for a fast and deep uptake of personalised health" (Horizon 2020).
 Group of respondents: The group of respondents included stakeholders of the Regions4PerMed project - members of the Regions4PerMed Advisory Board, organisations associated with the Patients’ Organisations Council, small and medium enterprises involved in e-health innovation, presenters at conferences and workshops associated with research institutions, private funders, policymakers, policy advisors, project managers, researchers, patient representatives, physicians, academic staff and healthcare consultants.
 Techniques and tools: The qualitative research took the form of online questionnaires and focus group interviews (semi-structured) to identify key barriers and facilitators to the implementation of innovative e-health interventions at the micro-, meso- and macro-regional levels within health and social care systems conducted according to the following five thematic priorities of the Regions4PerMed project which are:
 1.Medical Big Data, Electronic Health Records and Health Governance
 2.Connected health: Better system integration and patient management
 3.Health industry: Driving healthcare innovations
 4.Facilitation of the flow of innovation in healthcare
 5.Socio-Economic Aspects – basic principles.
 
 Outcomes and contexts: The ongoing research will provide data for the development of recommendations that identify the limitations to and benefits of the implementation of innovative e-health interventions for health and social care, with regard to chronic diseases, at the micro-, meso-, and macro-regional levels. In Poland (as well as throughout Eastern Europe), there are still tangible barriers to the development of e-health and m-health in terms of chronic diseases.
 

ASSESSING THE SCALABILITY OF A COMMUNITY PROGRAM FOR OLDER ADULTS WITH DIABETES: BRIDGING THE RESEARCH–PRACTICE GAP

Abstract Implementing person-centred, cost-effective, and comprehensive self-management programs for older adults with multimorbidity and their caregivers in the health and social care system is challenging. Innovations that are effective under controlled research conditions often fail to produce similar results when implemented in real world settings to reach larger populations of older adults. Scalability assessment is a promising methodology to reduce this research-practice gap. This study aims to examine the scalability of a self-management intervention for older adults with diabetes and multimorbidity and their caregivers in two Canadian provinces. Provincial working groups, including patient partners, participated in the scalability assessment. The Intervention Scalability Assessment Tool (ISAT) guided data collection and analysis. Multiple methods were used to collect data, including an environmental scan, document review, and interviews with key informants. Provincial workshops were held to review scalability results, determine the program’s scale-up readiness, and identify strategies to enhance scalability. Patient partners, health and social care providers and leaders, provincial decision-makers, and researchers gave high ratings to the readiness of the intervention and its alignment with practice and strategic policy initiatives. The evidence of effectiveness, delivery setting and workforce, and sustainability domains were rated lower. Participants recommended: 1) focusing on high-risk patients, which would be cost effective and likely to demonstrate impact and 2) piloting targeted sites to embed the program within existing health care settings and infrastructure to gather more evidence on program effectiveness and implementation. Collaborative and structured scalability assessments are critical to mobilize innovative programs into health and social care practice.

The cost-utility of an intervention for children and adolescents with a parent having a mental illness in the framework of the German health and social care system: a health economic evaluation of a randomized controlled trial

BackgroundChildren of families with a parent with a mental illness have an increased risk of developing social and mental health problems resulting in decreased quality of life. Therefore, children and adolescents living in families with a parent with mental illness are regarded as a target group for preventive interventions. To date, only a few economic evaluation studies for interventions directed at preventing the intergenerational transmission of mental health problems exist. In this investigation we estimated the cost utility of an intervention for the support of children and adolescents with a parent having a mental illness from the perspective of the German health and social care system.MethodsWe randomly assigned a total of 214 families with 337 children and adolescents to the intervention (INT) group (108/170) or the control (TAU) group (106/167). Families in the intervention group received on average eight intervention sessions (50–90 min) over 6 months. We estimated total cost of illness by means of the Children and Adolescent Mental Health Service Receipt Inventory (CAMHSRI) over 24 months. For the estimation of Quality-Adjusted Live Years (QALYs) we applied the KIDSCREEN-10. For estimating the incremental cost-utility of the intervention compared to treatment as usual we used the net-benefit approach.ResultsWe estimated the annual cost of illness amounting to € 3784.59 (SD € 8581.11) in the TAU group and € 3264.44 (SD € 9431.89) in the INT group. The annual cost difference between INT and TAU was € − 516.14 (SE 1124.95) which was not significant (p ≤ 0.05). We estimated the average QALY to be 0.759 (SD 0.073) in the TAU group and 0.763 (SD 0.072). The QALY difference between INT and TAU was 0.0037 (SE 0.0092) which was not significant (p ≤ 0.05). The incremental cost utility ratio (ICUR) indicated that the gain of one additional year in full health by means of the intervention was associated with the saving of € 139.49. However, the stochastic insecurity of the ICUR did not allow a unique decision about the cost-utility of the intervention.ConclusionsMore information on the economic value of the intervention for families with a parent with mental illness in comparison to treatment as usual in Germany is needed.Trial registration: ClinicalTrials.gov, identifier NCT02308462; German Clinical Trials Register: DRKS00006806.

WHO WORKS LONGER IN LATER LIFE? KEY VARIATIONS IN WORKING LIFE EXPECTANCY IN INTERNATIONAL PERSPECTIVE

Abstract In the context of population aging, policymakers are eager to encourage and enable longer working lives, assuming this will lead to increased tax revenue and reduced demand on social security and health care systems. Simultaneously, individuals who work longer will gain additional income and may experience the psychosocial benefits that come from workplace engagement. However, many factors drive early labor market exit, and blanket policy strategies to extend working lives often ignore the nuances that shape the length of real working lives. Such policies have emerged partly from increased life expectancies, although these measures fail to capture subgroup differences in the capacity to continue working. They also do not account for often discontinuous labor market trajectories, particularly around retirement. As such, scholars have turned to more refined methodologies and concepts like working life expectancy (WLE) to better inform policies that actively aim to increase retirement ages. This symposium highlights an ongoing program of work by the IDEAR network, which examines WLE using longitudinal studies of aging in Europe. The symposium features results from Sweden and England, estimating WLE using multi-state models. Unlike other approaches to estimate life expectancy employing the Sullivan method, this approach allows for reversible transitions between work and non-work, reflecting the dynamic and complex nature of modern labor market transitions and exits. The symposium further presents how WLE varies according to key determinants, including socioeconomic status, healthy lifestyles, and unpaid caregiving, highlighting the policy implications that emerge from recognizing inequalities and variations in WLE across vulnerable subgroups.

Human involvement in autonomous decision-making systems. Lessons learned from three case studies in aviation, social care and road vehicles

This paper draws on three case studies to examine some of the challenges and tensions involved in the use of Autonomous Decision-Making Systems (ADMS). In particular, the paper highlights: (i) challenges around the shifting “locale” of the decision, and the associated consequences for stakeholders; (ii) potential implications for stakeholders from regulation such as the General Data Protection Regulation (GDPR); (iii) the different values that stakeholder groups bring to the “decision” question; (iv) how complex pre-existing webs of stakeholders and decision-making authorities may be disrupted or disempowered by the use of an automated system and the lack of evaluation of possible consequences; (v) how ADMS for non-technical users can lead to circumvention of the boundaries of intended system use. We illustrate these challenges through case studies in three domains: adult social care, aviation, and vehicle driver monitoring systems. The paper closes with recommendations for both practice and policy in the deployment of ADMS.

The vulnerability of Central & Eastern European and Zimbabwean migrant home care workers’ wellbeing in the UK: the intersectional effects of migration and social care systems

ABSTRACT The UK welfare system and growth in social care escalate the demand for migrant care workers (MCWs) as a system-level intervention. However, the UK migration regime creates structural barriers and facilitators for different groups of MCWs. The nature of the UK migration and social care policies, combined with societal systems, including racism, affect the wellbeing of MCWs. This article addresses current literature gaps investigating the interplay of migration governance and social care systems’ effects on MCWs’ wellbeing. We utilise qualitative interviews collected from two groups of MCWs: Zimbabwean and Central East European migrants. These two groups have been subject to differentiated migration policies and societal perceptions during the data collection (2019), which coincided with the Brexit process. Data were analysed thematically guided by a wellbeing of care workers’ framework while allowing for new themes specific to the intersectionality of migration and social care systems to emerge. The analysis highlights that migration shapes MCWs’ wellbeing through two distinct mechanisms. First, the migration experience interacts with the same underlying factors that influence all care workers’ dimensions of wellbeing at work. Second, migration and the specific profile of migrant social care adds a new layer of factors that influence MCWs’ wellbeing in additional ways. The latter is affected by structural systems, such as the migration regime, and systemic challenges, such as the experience of inequalities and racism, exacerbated by the migration regime.

Developing Topics.

Currently, there is a search for timely care and intervention on patients with dementia, which have reasonable costs and allow the sustainability and efficiency of national health and social care systems (Livingston et al., 2017). Cognitive interventions delivered in the patient's home can be an excellent alternative, due to their feasibility(Jang et al., 2021) and accessibility (Rai et al., 2021) to the intervention. The aim of this paper is to describe the evidence on cognitive intervention performed at home for patients with MCI and mild dementia. To describe its characteristics and outcomes, and to address its feasibility and usability. A systematic review was performed using the PRISMA recommendations. We reviewed 190 records from four databases: PubMed, CINAHL, Web of Science, and PsycInfo.The quality of the studies was assessed using the tool "Assessment (mERA) checklist7" (World Health Organization, 2016) RESULT: Ten papers were included. With a mean quality score of 0.76/1 (91.7% agreement). The sample contains (N = 777) patients (MA 75.9). 80% have an education >7 years. 87.1% have a diagnosis of mild dementia. There are (N = 628) caregivers (MA 64.8). Seventy percent (n = 440) are women. Positive results were found in: 71% of studies that looked for results on cognition. 66% of the studies that looked for results on mood and behavioral symptoms. 83% of studies that looked for results on functionality/quality of life. 100% of the studies that looked feasibility, and 75% of the studies that looked for results on the caregiver. Cognitive intervention in the home of patients with MCI and early dementia showed positive results at a cognitive, emotional and behavioral levels. Likewise, in the caregiving relationship, emotional health and quality of life of caregivers. The use of assistive technologies in the home has some benefits over face-to-face care. Outcome-cost ratio can be a cost-effective solution for the sustainability and efficiency of national health and social care systems.

Workshop 2: Humanitarian Crisis and Old Age Mental Health

In 2020 there were 727 million persons aged 65 years or over in the world and this number is expected to reach over 1.5 billion in 2050. Of these, 20% suffer of a mental health condition and 60% live in low- and middle-income countries where barriers (stigma, poor access to social and health care systems) present issues even during stable times. A humanitarian crisis is defined as a singular event or a series of events that are threatening in terms of health, safety or wellbeing of a community or group of individuals, and require action that is usually urgent and often non-routine. Examples of such crisis are wars, natural disasters, epidemics and forced immigration. There is an urgent need of an international commitment to planning for humanitarian emergencies that include individual and community psychosocial support for older adults with mental health conditions. The current lack of inclusion for these older adults in humanitarian response is dramatic and constitute a clear violation of their Human Rights. Governments and humanitarian actors need to do more during crisis to ensure that individual's specific needs are addressed. A humanitarian response includes the collective actions of actors responding to the global needs. Each state has the responsibility first to take care of the victims of these emergencies occurring on its territory. Humanitarian actors must provide assistance in accordance with the principles of humanity, neutrality and impartiality. Promoting and ensuring compliance with these principles are essential elements of effective humanitarian coordination, in respect of the Human Rights principles, in particular when vulnerable people such older adults with mental health conditions are involved. The symposium intends to describe the consequences on older adults’ mental health during humanitarian emergencies and discuss potential solutions to improve the humanitarian response for all in need.