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Emerald Group Publishing Limited
All change: the core of integration?
Article Type: Editorial From: Journal of Integrated Care, Volume 22, Issue 2.
Integration should be fundamentally concerned with ensuring that people who require support and their families experience a co-ordinated response that is tailored to their needs and uses available resources as efficiently and effectively as possible. A major concern of this journal is therefore how to being about the changes needed to make this happen. From previous editions of this journal and the wider research regarding integration, it appears that it is possible to facilitate such changes but success is far from guaranteed. Furthermore there is a danger that integration can have no impact, or in some cases the impact may even be negative if not properly thought through and managed correctly. There are many factors that can waylay or derail such changes, and it is vital that we draw upon all available evidence to learn the lessons of what has worked (and what has not) in order to avoid duplicating the errors and losing the positive aspects of previous initiatives. It is therefore apt that change is a central theme of the papers in this edition.
Practice-based evidence is the basis for John Sloan's thoughtful reflection on his work as a doctor within the HomeViVE programme in Vancouver, in which homebound elderly people were supported by a multi-disciplinary team of doctors, nurses and therapists. He advocates for the importance of patient-centred care both to improve the outcomes for the individual and to avoid the waste caused through intensive care that does not meet the expectations and priorities of the person concerned. For John, core to succeeding in changing our model of care is a sustained relationship of trust between clinician and patient.
Nicholas Vogelpoel and Kara Jarrold take a more formal approach to evidence in their evaluation of a participatory arts programme for older people with sensory impairments. Their findings highlight that integration can be encompass a broader set of services and disciplines than is traditionally considered, and that with the correct pathways in place an arts based approach can lead to positive social and health outcomes for individuals who are vulnerable to isolation and depression. This project underlines that professionals can adopt new practices if they are provided the necessary information and guidance, and that they are well-placed to can encourage their patients and users to consider such options.
Catherine Mangan, Robin Miller and Jeremy Cooper attempt to open the “black box” of the general practice – social care relationship. Due to their roles as the gatekeepers of publically funded health and social care services in the UK both have a vital contribution to facilitating better integration around individuals. Despite this, there is surprisingly little known about how they work together in practice, and what we do know suggests that there are often tensions and distance between the two service areas. This paper reflects on an innovative programme which sought to use local evidence gathered from GPs, social workers, and older people as a means to understand how to improve joint working and then act as a “burning platform” for change.
Ailsa Cameron et al. provide a broader view of the whole evidence base for change in integrated care through an update on their systemic review published in 2003. Echoing their original study they have discovered that there is a lack of robust research and in particular that which compares integrated to non-integrated approaches, which is undertaken on a larger scale and which engages people accessing services. They do see signs of emerging evidence that integration can lead to positive change in line with the objectives of government policy and more importantly the expectations of individuals and their families. Shared understanding of the purpose of integration and its potential to improve the quality of care appear vital to secure the enthusiasm and commitment of the professionals who must deliver it.
The chronic care research described by Jenny Carryer et al. respond to to the concerns of Ailsa regarding the scale of research through drawing on two longitudinal studies in New Zealand that involved a combined total of over 800 participants. They mirror the views of John Sloan that a person-centred focus is a vital ingredient within an integrated care service and that it should not be assumed that professionals will automatically adopt related practices. In particular, clinicians appear to maintain their focus on the primary condition for which they are responsible and the interventions that appear to work with such individuals rather than taking a more holistic and flexible approach.
In conclusion, this edition highlights that integration can be a positive catalyst for change and that if we are sensitive to context we can learn from local and global initiatives. Most of all though, this edition highlights that the individuals accessing services and their families must be at the centre of our plans for integrated change and their subsequent evaluations.
Robin Miller, Helen Dickinson and Jon Glasby