Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature

This article reports the results of a review of the research evidence related to joint working in the field of adult health and social care services in the UK. It explores whether recent reforms to joint working have met the objectives set by policy‐makers. The review followed an established methodology: electronic databases were searched using predetermined terms, abstracts were screened against inclusion criteria, studies that met the criteria were read in full and assessed for inclusion and data were extracted systematically. The findings of the review suggest that there is some indication that recent developments, in particular the drive to greater integration of services, may have positive benefits for organisations as well as for users and carers of services. However, the evidence consistently reports a lack of understanding about the aims and objectives of integration, suggesting that more work needs to be done if the full potential of the renewed policy agenda on integration is to be realised. Additionally, while the review acknowledges that greater emphasis has been placed on evaluating the outcome of joint working, studies largely report small‐scale evaluations of local initiatives and few are comparative in design and therefore differences between ‘usual care’ and integrated care are not assessed. This makes it difficult to draw firm conclusions about the effectiveness of UK‐based integrated health and social care services.     

A systematic review of working hours and mental health burden]

There is growing concern over the possible increase in mental health problems among Japanese workers. This trend is generally regarded as a reflection of Japan's prolonged economic depression and changes in working environment. In fact, claims for compensation for industrial accidents related to mental health diseases have been rapidly increasing in recent years. Working hours, personal-relationships, support from supervisors/co-workers, job demand, job control, and payment are known to affect workers mental health. In 2004, the Government announced a guideline to combat overwork and mental health problems at work places. This guideline articulates that long overtime working is a major indicator, and workers who work over 100 h overtime in a month should be encouraged to see an occupational physician. This guideline takes into account the practicalities of occupational health at work places and the empiric knowledge that long working hours might associate with workers mental health status. It may be reasonable to assume that long working hours affect workers health status both psychologically and physiologically, interacting with a variety of occupational factors, particularly job stress. However, the association between working hours and workers mental health status has not been fully clarified. The present article aimed to provide a systematic review of the association between working hours and mental health problems. The authors conducted a systematic review of the published literature on the association between working hours and mental health problems using PubMed. Of 131 abstracts and citations reviewed, 17 studies met the predefined criteria. Ten of these are longitudinal studies, and the others are cross-sectional studies. Seven of the 17 studies report statistically significant associations between working hours and mental health problems, while the others report no association. In addition, comparison among these studies is difficult because a variety of measurements of working hours were used. The present review found inconsistent results in the association between working hours and mental health burden.     

Clinical leadership and integrated primary care: A systematic literature review

Background: Leaders are needed to address healthcare changes essential for implementation of integrated primary care. What kind of leadership this needs, which professionals should fulfil this role and how these leaders can be supported remains unclear.

Objectives: To review the literature on the effectiveness of programmes to support leadership, the relationship between clinical leadership and integrated primary care, and important leadership skills for integrated primary care practice.

Methods: We systematically searched PubMed, CINAHL, Embase, PsycINFO until June 2018 for empirical studies situated in an integrated primarycare setting, regarding clinical leadership, leadership skills, support programmes and integrated-care models. Two researchers independently selected relevant studies and critically appraised studies on methodological quality, summarized data and mapped qualitative data on leadership skills.

Results: Of the 3207 articles identified, 56 were selected based on abstract and title, from which 20 met the inclusion criteria. Selected papers were of mediocre quality. Two non-controlled studies suggested that leadership support programmes helped prepare and guide leaders and positively contributed to implementation of integrated primary care. There was little support that leaders positively influence implementation of integrated care. Leaders’ relational and organizational skills as well as process-management and change-management skills were considered important to improve care integration. Physicians seemed to be the most adequate leaders.

Conclusion: Good quality research on clinical leadership in integrated primary care is scarce. More profound knowledge is needed about leadership skills, required for integrated-care implementation, and leadership support aimed at developing these skills.     

Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis

Interprofessional primary care (IPPC) teams are promoted as an alternative to single profession physician practices in primary care with focus on preventive care and chronic disease management. Characteristics of teams can have an impact on their performance.We synthesized quantitative, qualitative or mixed-methods evidence addressing the design of IPPC teams. We searched Ovid MEDLINE, Embase, CINAHL, and PAIS using search terms focused on IPPC teams. Studies were included if they discussed the influence of team structure, organization, financial arrangements, or policies and procedures, or either health care processes or outputs, health outcomes, or costs, and were conducted in Australia, Canada, the United Kingdom or New Zealand between 2003 and 2016. We screened 11,707 titles, 5366 abstracts, and selected 77 full text articles (38 qualitative, 31 quantitative and 8 mixed-methods).Literature focused on the implications of team characteristics on team processes, such as teamwork, collaboration, or satisfaction of patients or providers. Despite heterogeneity of contexts, some trends are observable: shared space, common vision and goals, clear definitions of roles, and leadership as important to good teamwork. The impacts of these on health care outputs or patient health are not clear. To move the state of knowledge beyond perception of what works well for IPPC teams, researchers should focus on quantitative causal inference about the linkages between team characteristics and patient health.     

医疗卫生服务体系整合型改革对医务人员工作动机及行为影响的系统综述

目的:探究医疗卫生服务体系整合型改革中医务人员工作动机和行为的改变.方法:采用系统综述法检索筛选文献,主题综合法提取文献信息,基于ERG理论分析工作动机影响机制.结果:纳入的19篇研究发现整合型改革有利于满足医务人员不同需求层次,提高了工作满意度或降低职业倦怠和工作压力.但是各类整合改革都存在薪酬体制改革滞后,难以弥补...     

Continuous and integrated health care services in rural areas. A literature study

This article presents the result of a literature review examining possible ways to improve healthcare services in rural areas. While there is abundant literature on making healthcare programs integrated, interdisciplinary and managed in order to reduce fragmentation and improve continuity and coordination of care, only some part of this relates to rural issues. An added challenge is the lack of a generally accepted international definition of rurality, which makes it difficult to generalise from one region to another, and to develop an evidence-based understanding of rural health care. In evaluating the literature it was found that the development of new forms of interaction is particularly relevant in rural regions - such as interdisciplinary and team-based work with flexibility of roles and responsibilities, delegation of tasks and cultural adjustments. In addition, programs such as integrated and managed care pathways, outreach programs , shared care and telemedicine were relevant initiatives. These may be associated with greater equity in access to care, and more coherent services with greater continuity, but they are not necessarily linked to reduced costs; they may, in some cases, entail additional expenses. Such endeavours are, to a large degree, dependent on a well-functioning primary healthcare system as a base.     

A before and after study of integrated training sessions for children's health and care services

Recent UK policy drivers such as the National Collaboration for Integrated Care and Support and Making Every Contact Count prioritise integrated care, an approach that seeks to provide more coordinated and seamless health and social care. In children's services, despite many partners, there are challenges around integrating care. A deprived borough of London ran short training and networking sessions for services supporting children and young people. This study examined whether intersectoral training would improve participants' knowledge of local services and joint working (including communication, navigation and confidence in collaboration). As part of a service evaluation, the study utilised a pre–post Likert scale survey design for each training session, a 1‐month follow‐up survey, and telephone interviews with a subsample of participants. The educational intervention was three sets of 1.5 hr educational workshops from December 2016 to February 2017. There were 302 attendances from 202 individuals from the health (n = 99), education (n = 145), social care (n = 39) and voluntary (n = 19) sectors. The pre and post surveys found significant increases in self‐assessed knowledge of health/education/social care/voluntary services and in some elements of joint working. However, these increases were not sustained in any domain after 1 month of follow‐up. There was also no difference in self‐assessments amongst those who attended three sessions compared to those who attended one or two. Telephone interviewees highlighted networking as being helpful and suggested that informative tasks and diverse attendance would be beneficial in future. To conclude, this study suggests that although short‐learning sessions may seem to improve immediate knowledge and some elements of joint working in the short term, any gains are not sustained in the long term. The cost effectiveness of such schemes is in doubt but may be improved by a more targeted delivery of content.     

A systematic review of different models of home and community care services for older persons

Background

The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap.

Methods

Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007.

Results

The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals.

Conclusions

The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health care costs proportionally. Instead, productivity will rise in particular in under-utilized private health care institutions. The results of this study also show that private-for-profit health care facilities are not only the luxurious providers catering exclusively for the rich but also play an important role in the service provision for the poorer population. The study findings also demonstrated a high degree of cost variability across private providers, suggesting differences in quality and efficiencies.     

Mental health services in Sydney nursing homes

Abstract: Senior nursing staff of the 58 nursing homes in one health area of Sydney were interviewed concerning mental health services and staff education. One or more psychiatrically trained staff were employed in 45 per cent of the nursing homes. Most nursing homes received services from a psychiatrist or another mental health professional, but the average time per month provided by them to see residents was less than one hour in 18 (31 per cent), one to two hours in 16 (28 per cent), and three hours or more in only 11 (19 per cent). Forty-four (76 per cent) wanted more mental health services to be provided, especially for advice on management of disturbed behaviour. A substantial number of the nursing homes (at least 28 per cent) provided no ongoing education to their staff about dementia or other psychiatric problems. There is good reason to encourage greater use of mental health professionals in Sydney nursing homes; enhanced funding of area psychiatric services for elderly people is desirable to allow these services to be more readily available.     

Mental health services in Perth nursing homes

Directors of nursing (DONs) in 42 nursing homes in Perth were asked for information concerning mental health services provided for their residents. A questionnaire similar to those used by other researchers in Sydney and in Ontario was utilised to enable meaningful comparisons among the three studies. According to the DONs' perceptions, the mean proportion of residents in Perth nursing homes with psychiatric and/or behavioural problems was between 50% and 75%. The mental health services provided to nursing homes were significantly less than that desired by the DONs. Other variables assessed in this study included the number of transfers per year because of psychiatric problems; the number of staff with psychiatric qualifications; the provision of psychiatric training for staff; the most frequently occurring psychiatric problems in residents and the most valued mental health services provided to nursing homes. Results were comparable to those of the Sydney and Ontario studies. This study suggests that there is a significant psychiatric population in Perth nursing homes that, like those in Sydney and Ontario are seriously neglected regarding appropriate professional psychiatric care. Existing psychogeriatric community assessment teams could provide more of these services if adequately staffed and resourced.     

The need for integrated primary health care to enhance the effectiveness of health services

With the increasing prevalence of chronic illnesses and health compromising behaviours, health care expenditure is escalating with the expansion of hospital services. Integrated primary health care would enhance the cost effectiveness of health care delivery. Recent studies on primary care health services research in Hong Kong indicated that there is a high level of inappropriate utilisation of hospital emergency services, a high prevalence of youth health risk behaviours particularly mental health which would lead to a heavy burden on health services in the future. The community based rehabilitation provided a better quality of life for chronic illness patients, better drug compliance for chronic illness patients in family practice, and a disproportionate amount of budget is spent on law reinforcement and treatment for drug abuse rather than on prevention and education. The findings strongly indicate the need to have a strong primary health care team with well trained family physicians and trained health professionals as primary care practitioners to provide services on health promotion; curative; rehabilitation and supporting services; supporting self help activities of individuals, families and groups. This would minimize compartmentalisation in health care delivery, and is also a cost effective way of providing high quality holistic and comprehensive care that meets the needs of the majority of the population.     

Relationship between health services for maternal and child health and working hours of public health nurses]

Based on the "Maternal and Child Health Service Act", public health centers and municipalities offer health education, health counseling, health examination, and home visits for district children and for their mothers. The relationship between the number of the MCH services offered and the working hours of public health nurses at the public health centers and the municipalities was analyzed. Data were taken by a survey in 1989, which was used for evaluating services provided to the children and their mothers in 1988. Questionnaires were sent to 23 health centers and their districts and 100 responses from 8 wards, 20 cities, 47 towns, and 25 villages were analyzed. When total working hours of the public health nurse for MCH are allocated to the four parts-planning, implementation, evaluation and training-86.7% of working hours are for implementation itself. The correlation coefficient between the total working hours of the public health nurse for MCH and the population, and the number of births per year, were significantly positive. A total of 107 hours were supplied for the infant child health examination per 100 births per year, for which 64% was for implementation itself. In the case of the health examination for three-year-old children, total working hours were 143 hours, for with 79% was for implementation itself. The number of mother-child handbooks issued, the number of health education classes and health counselings conducted, various health examinations performed, and home visits made were correlated significantly with the working hours of the public health nurse.     

Managed care and integrated health care

Managed care and integrated care may be viewed as stages in the evolution of the U.S. health care system. The authors discuss the essential characteristics of an integrated delivery system, including patient satisfaction, maintenance of clinical skills, cost-effective practice, and professional reputation.