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A research program on implementing integrated care for older adults with complex health needs (iCOACH): an international collaboration
- Authors:
- WODCHIS Walter P., et al
- Journal article citation:
- International Journal of Integrated Care, 18(2), 2018, p.11. Online only
- Publisher:
- International Foundation for Integrated Care
Health and social care systems across western developed nations are being challenged to meet the needs of an increasing number of people aging with multiple complex health and social needs. Community based primary health care (CBPHC) has been associated with more equitable access to services, better population level outcomes and lower system level costs. Itmay be well suited to the increasingly complex needs of populations; however the implementation of CBPHC models of care faces many challenges. This paper describes a program of research by an international, multi-university, multidisciplinary research team who are seeking to understand how to scale up and spread models of Integrated CBPHC (ICBPHC). The key question being addressed is “What are the steps to implementing innovative integrated community-based primary health care models that address the health and social needs of older adults with complex care needs?” and will be answered in three phases. In the first phase we identify and describe exemplar models of ICBPHC and their context in relation to relevant policies and performance across the three jurisdictions (New Zealand, Ontario and Québec, Canada). The second phase involves a series of theory-informed, mixed methods case studies from which we shall develop a conceptual framework that captures not only the attributes of successful innovative ICBPHC models, but also how these models are being implemented. In the third phase, we aim to translate our research into practice by identifying emerging models of ICBPHC in advance, and working alongside policymakers to inform the development and implementation of these models in each jurisdiction. The final output of the program will be a comprehensive guide to the design, implementation and scaling-up of innovative models of ICBPHC. (Edited publisher abstract)
'It's not just the word care, it’s the meaning of the word...(they) actually care': caregivers' perceptions of home-based primary care in Toronto, Ontario
- Authors:
- SMITH-CARRIER Tracy, et al
- Journal article citation:
- Ageing and Society, 38(10), 2018, pp.2019-2040.
- Publisher:
- Cambridge University Press
The frail and homebound older adult populations currently experience difficulties accessing primary care in the medical office. Given this fundamental access to care problem, and the questionable care quality that arises when navigating a labyrinthine health-care system, these populations have typically been subject to inadequate primary care. To meet their needs better, growing research stresses the importance of providing comprehensive home-based primary care (HBPC), delivered by an inter-professional team of health-care providers. Family care-givers typically provide the majority of care within the home, yet their perceptions of HBPC remain under-researched. The purpose of this study was to explore unpaid care-givers' perceptions of and experiences with HBPC programmes in Toronto, Canada. The research conducted qualitative inductive content analysis, using analytic procedures informed by grounded theory, to discover a number of themes regarding unpaid care-givers' understandings of HBPC. Findings suggest that, compared to the standard office-based care model, HBPC may better support unpaid care-givers, providing them assistance with system navigation and offering them the peace of mind that they are not alone, but have someone to call should the need arise. The implications of this research suggest that HBPC could be a model to help mitigate the discontinuities in care that patients with comorbid chronic conditions and their attendant unpaid care-givers experience when accessing fragmented health, home and social care systems. (Edited publisher abstract)
Cost effectiveness of using cognitive screening tests for detecting dementia and mild cognitive impairment in primary care
- Authors:
- TONG Thaison, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1392-1400.
- Publisher:
- Wiley
Introduction: The authors estimated the cost effectiveness of different cognitive screening tests for use by General Practitioners (GPs) to detect cognitive impairment in England. Methods: A patient-level cost-effectiveness model was developed using a simulated cohort that represents the elderly population in England (65 years and older). Each patient was followed over a lifetime period. Data from published sources were used to populate the model. The costs include government funded health and social care, private social care and informal care. Patient health benefit was measured and valued in Quality Adjusted Life Years (QALYs). Results: Base-case analyses found that adopting any of the three cognitive tests (Mini-Mental State Examination, 6-Item Cognitive Impairment Test or GPCOG (General Practitioner Assessment of Cognition)) delivered more QALYs for patients over their lifetime and made savings across sectors including healthcare, social care and informal care compared with GP unassisted judgement. The benefits were due to early access to medications. Among the three cognitive tests, adopting the GPCOG was considered the most cost-effective option with the highest Incremental Net Benefit (INB) at the threshold of £30 000 per QALY from both the National Health Service and Personal Social Service (NHS PSS) perspective (£195 034 per 1000 patients) and the broader perspective that includes private social care and informal care (£196 251 per 1000 patients). Uncertainty was assessed in both deterministic and probabilistic sensitivity analyses. Conclusions: The analyses indicate that the use of any of the three cognitive tests could be considered a cost-effective strategy compared with GP unassisted judgement. The most cost-effective option in the base-case was the GPCOG. (Edited publisher abstract)
Developing a model of short-term integrated palliative and supportive care for frail older people in community settings: perspectives of older people, carers and other key stakeholders
- Authors:
- BONE Anna E., et al
- Journal article citation:
- Age and Ageing, 45(6), 2016, pp.863-873.
- Publisher:
- Oxford University Press
Background: Understanding how best to provide palliative care for frail older people with non-malignant conditions is an international priority. The authors aimed to develop a community-based episodic model of short-term integrated palliative and supportive care (SIPS) based on the views of service users and other key stakeholders in the United Kingdom. Method: Transparent expert consultations with health professionals, voluntary sector and carer representatives including a consensus survey; and focus groups with older people and carers were used to generate recommendations for the SIPS model. Discussions focused on three key components of the model: potential benefit of SIPS, timing of delivery and processes of integrated working between specialist palliative care and generalist practitioners. Content and descriptive analysis was employed and findings were integrated across the data sources. Findings: The authors conducted two expert consultations (n = 63), a consensus survey (n = 42) and three focus groups (n = 17). Potential benefits of SIPS included holistic assessment, opportunity for end of life discussion, symptom management and carer reassurance. Older people and carers advocated early access to SIPS, while other stakeholders proposed delivery based on complex symptom burden. A priority for integrated working was the assignment of a key worker to co-ordinate care, but the assignment criteria remain uncertain. Interpretation: Key stakeholders agree that a model of SIPS for frail older people with non-malignant conditions has potential benefits within community settings, but differ in opinion on the optimal timing and indications for this service. The findings highlight the importance of consulting all key stakeholders in model development prior to feasibility evaluation. (Edited publisher abstract)
An overview of home-based primary care: learning from the field
- Authors:
- KLEIN Sarah, HOSTETTER Martha, McCARTHY Douglas
- Publisher:
- Commonwealth Fund
- Publication year:
- 2017
- Pagination:
- 20
- Place of publication:
- New York
Interest in home-based primary care has increased in the United States in recent years as evidence emerges that helping frail and older patients with complex needs avoid hospitals, emergency departments, and nursing home placements results in cost savings and improves quality of care as well as patient and family member satisfaction. Drawing on the experiences of six case study sites in the United States and the views of a range of experts, this briefing paper describes the key components of home-based primary care, explores challenges to scaling the model, and makes policy recommendations for ensuring house-bound patients have access to effective care. Key components of successful home-based primary care are identified as: the delivery holistic care by interdisciplinary teams; the ability to respond rapidly, when necessary; providing care which incorporates mental health care and social supports; and the provision of palliative care and end-of-life planning. It also finds that home-based care practices have achieved cost savings, but that making the model more widely available would require training for the workforce and innovative payment models. (Edited publisher abstract)
Early intervention and dementia care: innovation and impact
- Authors:
- SEABROOKE Viniti, MILNE Alisoun
- Journal article citation:
- Quality in Ageing and Older Adults, 15(1), 2014, pp.34-45.
- Publisher:
- Emerald
Purpose: This study aims to systematically evaluate the impact and effectiveness of two early intervention services in NW Kent. Design/methodology/approach: Data were gathered via evaluation questionnaires for both projects; these included quantitative post-intervention data and qualitative comments. Data on referrals to secondary care and a specialist third sector organisation were also collected for the primary care project. Findings: Findings from the primary care project indicate that targeting a specific age cohort of patients can be effective in terms of: early identification of dementia-related concerns, the provision of support, appropriate referrals to secondary care, and increased referrals to a third sector dementia service. At the end of the project most practitioners felt they were better informed about dementia, more committed to facilitating early diagnosis, and had gained confidence in using a screening tool (the General Practitioner Assessment of Cognition Test). Evidence from evaluating the Carers Group suggests that attendance helped members manage emotional difficulties, increased understanding of dementia, and enhanced coping skills. They also felt less isolated and knew how to access support services. Practical implications: The projects offer two models of intervention: how a proactive third sector agency can work with primary care professionals to enhance commitment to dementia case finding and the provision of group support to relatives of those in receipt of a recent dementia diagnosis. Originality/value: The study provides insights into early intervention in dementia care how to evaluate impact of effectiveness. (Publisher abstract)
Improving health care for assisted living residents
- Authors:
- KANE Robert L., MACH John R.
- Journal article citation:
- Gerontologist, 47(3), December 2007, pp.100-109.
- Publisher:
- Oxford University Press
The purpose of this article is to explore how medical care is delivered to older people in assisted living (AL) settings and to suggest ways for improving it. It draws on a review of the limited research available on health care for older AL residents and on building testable models of better ways to organize primary health care and other health services for AL residents. Results found AL residents are frequently frail older persons who need good chronic care. The predominant care models today do not respond adequately to this challenge. Medical care for AL residents is currently practiced very much like that for persons living in the community. The potential for using the aggregation of patients has not been effectively tapped. The authors review some managed care models from other elements of long-term care, including the Evercare model, to look for ways that might be adapted. However, the current funding approach emphasizes living settings rather than inherent client characteristics. A research agenda might include ways to improve communication between AL and medical providers and to get AL staff more actively involved in daily care. Research support might produce the data necessary to entice the Centers for Medicare and Medicaid Services into changing its current reimbursement policies to create a climate better suited to delivering good chronic disease care in AL facilities.
Designing services for older people: lessons for practitioners
- Author:
- -
- Journal article citation:
- Community Practitioner, 73(8), August 2000, pp.716-718.
- Publisher:
- Community Practitioners' and Health Visitors' Association
This third article in the assessment of older people in the community series looks at community oriented primary care (COPC) methodology and introduces phase I of the primary care for older people programme, which applies the COPC model to innovative primary care for the elderly.
Integrated care for community dwelling older Australians
- Authors:
- MANN Jennifer, DEVINE Sue, McDERMOTT Robyn
- Journal article citation:
- Journal of Integrated Care, 27(2), 2019, pp.173-187.
- Publisher:
- Emerald
Purpose: Integrated care is gaining popularity in Australian public policy as an acceptable means to address the needs of the unwell aged. The purpose of this paper is to investigate contemporary models of integrated care for community dwelling older persons in Australia and discuss how public policy has been interpreted at the service delivery level to improve the quality of care for the older person. Design/methodology/approach: A scoping review was conducted for peer-reviewed and grey literature on integrated care for the older person in Australia. Publications from 2007 to present that described community-based enablement models were included. Findings: Care co-ordination is popular in assisting the older person to bridge the gap between existing, disparate health and social care services. The role of primary care is respected but communication with the general practitioner and introduction of new roles into an existing system is challenging. Older persons value the role of the care co-ordinator and while robust model evaluation is rare, there is evidence of integrated care reducing emergency department presentations and stabilising quality of life of participants. Technology is an underutilised facilitator of integration in Australia. Innovative funding solutions and a long-term commitment to health system redesign is required for integrated care to extend beyond care co-ordination. Originality/value: This scoping review summarises the contemporary evidence base for integrated care for the community dwelling older person in Australia and proposes the barriers and enablers for consideration of implementation of any such model within this health system. (Edited publisher abstract)
Patient-centred care for older people with complex needs: evaluation of a new care model in outer east London
- Authors:
- SHERLAW-JOHNSON Chris, et al
- Publisher:
- Nuffield Trust
- Publication year:
- 2018
- Pagination:
- 76
- Place of publication:
- London
An evaluation Health 1000, a new model of care providing a ‘one-stop’ primary care service within three London boroughs for older people with complex health care needs. The service aimed to improve quality of life and address health and social care needs through personalised care delivered by a multidisciplinary team, focusing on prevention and early intervention. The evaluation looks at the impact of the pilot on the use of primary and secondary care services, specifically hospital inpatient visits, attendance at A&E, outpatient appointments and primary care contacts. It also assesses the experiences of patients and staff, through in-depth interviews over two phases. The results found the majority of patients interviewed were satisfied with the service, highlighted the attentiveness of clinical staff, the availability of GP appointments and the caring nature of the service. Staff also felt that Health 1000 had improved the quality of care patients were able to access. However, there were no significant differences in use of hospital services between the cases and the matched controls. Though it is noted that it was possible there were not enough patients followed up for sufficient time to detect a significant change. There were also significantly more primary care contacts among the Health 1000 patients. The report concludes the results show mixed results, with the service having a positive impact on quality of care, and on the experiences of both patients and staff, but little evidence that it has improved outcomes or reduced use of hospital services. (Edited publisher abstract)