Health and Social Care coordination in Andalusia within the European project VIGOUR

Health care networks are international phenomena that can be found within all types of health care system from publicly funded systems in Europe, Canada and Australasia to the private business models of the United States. Moreover, networks in health care include a wide spectrum of agencies including purchasers, providers, professionals, consumers and policy-makers. The range of agencies involved in health care networks reflects the often fragmented nature of health care delivery, particularly for vulnerable client groups (such as the frail elderly) and for complex chronic illnesses that are now the most prevalent health problems in terms of both cost and impact in developed countries. The rise of clinical and hospital networks has been a system-response to this new paradigm of care. As Wagner (1998) describes, the current challenge for health systems is the development of a chronic care model, the features of which include the integration of primary and secondary care; the co-ordination of health and social care; and the development of team-based services where the skills of nurses and doctors are used to their best advantage.

Medical generalists and specialists: time for proportional representation?

Health information technology (HIT) can help coordinate health and social actors involved in patients' pathways. We assess five regional HIT-based programmes ('Territoires de Soins Numériques' or TSN) introduced in France, covering the period 2012-2018. This was a quasi-experimental controlled before/after mixed design. We used data from the French National Health Insurance database, qualitative and quantitative surveys, and information extracted from project documents and databases. We assessed the impact of TSN using four main impact indicators: emergency room visits, unplanned hospitalizations, avoidable hospitalizations and rehospitalization within 30days. We also collected qualitative and secondary quantitative data covering perceived needs, knowledge, use, satisfaction, adoption and understanding of projects, pathway experience, impact on professional practices and appropriateness of hospitalizations. TSN implemented a heterogeneous mix of HIT. Implementation was slower than expected and was not well documented. Users perceived the HIT as having a positive but weak overall effect. There were no significant differences in trends for the main impact indicators, nor on the appropriateness of hospitalizations, but favourable trends on secondary polypharmacy indicators. If similar innovations take place in future, they should be based on a logical framework that defines causal, measurable links between services provided and expected impacts.

Previous studies have documented the application of electronic health insurance claim data for health services research purposes. In addition to administrative and billing details of healthcare services, insurance data reveal important information regarding professional interactions and/or links that emerge among healthcare service providers through, for example, informal knowledge sharing. By using details of such professional interactions and social network analysis methods, the aim of the present study was to develop a research framework to explore health care coordination and collaboration. The proposed framework was used to analyse a patient-centric care coordination network and a physician collaboration network. The usefulness of this framework and its applications in exploring collaborative efforts of different healthcare professionals and service providers is discussed.

Primary Health Care Matters.

BackgroundThe collaborative care planning study (COCAPP) is a cross-national comparative study of care planning and coordination in community mental healthcare settings. The context and delivery of mental health care is diverging between the countries of England and Wales whilst retaining points of common interest, hence providing a rich geographical comparison for research. Across England the key vehicle for the provision of recovery-focused, personalised, collaborative mental health care is the care programme approach (CPA). The CPA is a form of case management introduced in England in 1991, then revised in 2008. In Wales the CPA was introduced in 2003 but has now been superseded by The Mental Health (Care Co-ordination and Care and Treatment Planning) (CTP) Regulations (Mental Health Measure), a new statutory framework. In both countries, the CPA/CTP requires providers to: comprehensively assess health/social care needs and risks; develop a written care plan (which may incorporate risk assessments, crisis and contingency plans, advanced directives, relapse prevention plans, etc.) in collaboration with the service user and carer(s); allocate a care coordinator; and regularly review care. The overarching aim of this study is to identify and describe the factors that ensure CPA/CTP care planning and coordination is personalised, recovery-focused and conducted collaboratively.Methods/designCOCAPP will employ a concurrent transformative mixed methods approach with embedded case studies. Phase 1 (Macro-level) will consider the national context through a meta-narrative mapping (MNM) review of national policies and the relevant research literature. Phase 2 (Meso-level and Micro-level) will include in-depth micro-level case studies of everyday ‘frontline’ practice and experience with detailed qualitative data from interviews and reviews of individual care plans. This will be nested within larger meso-level survey datasets, senior-level interviews and policy reviews in order to provide potential explanations and understanding.DiscussionCOCAPP will help identify the key components that support and hinder the provision of personalised, recovery-focused care planning and provide an informed rationale for a future planned intervention and evaluation.

Social and health care coordination: Towards a new culture of care

Provider status effort engaged on Capitol Hill

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

Digital health holds promise for enhancing care coordination and supporting patient self-management. However, various barriers, including at the healthcare professional level, hinder its adoption. This cross-sectional study explored the eHealth profile of primary care physicians and its relationship with care coordination. As part of "The Commonwealth Fund's 2022 International Health Policy Survey of Primary Care Physicians in 10 Countries", 1114 physicians in Switzerland completed a questionnaire on their sociodemographic and workplace characteristics, digital health use and care coordination practices. Based on their responses concerning the modality, frequency and application of digital health tools, we created a digital health score. Based on responses describing the collaboration with specialists and paramedical health professionals, we created a care coordination score. The associations between both scores were assessed using stratified analyses and multiple linear regression. Among the 1114 participants (46% women, mean age 52 years), 83% used electronic patient records, 96% used teleconsultations for less than 5% of consultations, and 63% never used connected health tools to monitor patients with chronic diseases. Further, 16% allowed online appointments, 20% online medical prescriptions, 52% the possibility of electronically communicating lists of medications with other healthcare professionals, and 89% the possibility of email or web communications with the patient. The eHealth score was positively associated with the number of weekly working hours, being an internal medicine specialist or practising physician, the number of full-time equivalents in the practice and being in a group practice setting. The higher the eHealth profile score, the higher the care coordination score. Digital health and care coordination were positively associated. This could underscore the potential benefits of digital health in enhancing collaborative and interprofessional care practices.

This paper deals with the some of the important variable factors relating to health care in Saudi Arabia, with special emphasis on primary health. Other aspects considered are the financial influen...

We describe the implementation of a novel electronic platform for specialty referral and consultation, eConsult Mental Health. This innovation aims to address mental health care access and coordination challenges in the nation's second largest public health system in Los Angeles. eConsult Mental Health is one of the largest documented electronic platforms to facilitate the integration of behavioral health services in primary care. Although implementation has been met with barriers unique to mental health care, eConsult Mental Health appears to be a promising tool to expand the spectrum of care for Los Angeles County safety net primary care providers in patient-centered medical homes.

This retrospective chart review examined care coordination among pediatric patients with varying levels of medical complexity who received care in a rural-urban health system. Care coordination utilization across patient acuity levels was examined for meaningful differences in frequency and duration of care coordination services. Results indicated that patients with more severe medical complexity had increased frequency and duration of care coordination services, as well as different patterns of care coordination activity utilization. This model of pediatric outpatient care coordination provides a flexible and highly targeted approach for stratification of care and services based on the needs of the individual patient.

Health care leaders are always trying to find out how the most famous and best - resourced hospitals in the world do the things. Large scale reforms in US, such as the medical homes, are building integrated care sys-tems to improve quality of health. Evidence from the literature suggests that this may not be how it works in the developing world. But the present literature shows time and again that great ideas often come from un-likely places in the developing countries. As health systems around the world struggle to do more with less, solutions are coming from developing countries, which have been finding innovative and in-expensive ways to care for their populations. There's a lot of literature that suggests General Practitioners (GPs) should be at the center of the integ-rated approach, and policy makers may build models around them. This makes sense if we think practical. Few Teaching Institutions in less developed / less rich countries are now reaching to their patients out-side their teaching hospitals by launching the Commu-nity - Based Chronic Disease Management (CCDM) program with General Practitioners in the core , Com-munity Nurses, Paramedics and Religious Community Leaders. They perform medical assessments, adjust medications, and provide prescriptions and arrange screenings, give preventive education, and coordinate specialist health care services. CCDM engages Gen-eral Practitioners who are the most independent group of health care professionals As result of CCDM practice, on average, 61% of patients with hypertension achieved a reduction in both systolic and diastolic BP of at least 5 mmHg, dia-betic patients saw an average 15% reduction in A1c levels. Given that each 5 mmHg reduction in diastolic BP has been shown to reduce the risk of stroke by 34% and ischemic heart disease by 21%, we can imagine the impact of CCDM on care costs and patients' qua-lity of life. I hope the readers will find this information stimu-lating for reforming health care.

Coordination is a central element in the public sector, especially for introducing complex innovations. In health care, this issue takes on great importance since many stakeholders are involved, pursuing multiple interests, and influencing the outputs and outcomes of the health care system. This paper discusses the introduction of a specific health care innovation (i.e. electronic patient records) in two Italian regions, and it aims to contribute to the debate on coordination in health care, depicting the coordination mechanisms that took place in two different contexts in order to introduce the same kind of innovation, and highlighting any potential enabling conditions.