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A new model of multidisciplinary team working with health and social care is being developed in Exeter. This article describes how inclusion of a domiciliary pharmacist in the team has improved medicines management for patients with long‐term conditions and for adult patients identified as needing support with their medicines. Initial results are discussed, case studies are described and future developments for the service are outlined.

The impact of population ageing is significant, multifaceted and characterised by frailty and multi-morbidity. The COVID-19 pandemic has accelerated care pathways and policies promoting self-management and home-based care. One under-researched area is how patients and family caregivers manage the complexity of end-of-life therapeutic medicine regimens. In this position paper the authors bring attention to the significant strain that patients and family caregivers experience when navigating and negotiating this aspect of palliative and end-of-life care.

Focussing on self-care and organisation of medicines in the United Kingdom (UK) context, the paper examines, builds on and extends the debate by considering the underlying policy assumptions and unintended consequences for individual patients and family care givers as they assume greater palliative and end-of-life roles and responsibilities.

Policy makers and healthcare professionals often lack awareness of the significant burden and emotional work associated with managing and administering often potent high-risk medicines (i.e. opioids) in the domiciliary setting. The recent “revolution” in professional roles associated with the COVID-19 pandemic, including remote consultations and expanding community-based care, means there are opportunities for commissioners to consider offering greater support. The prospect of enhancing the community pharmacist's medicine optimisation role to further support the wider multi-disciplinary team is considered.

The paper takes a person-focused perspective and adopts a holistic view of medicine management. The authors argue for urgent review, reform and investment to enable and support terminally ill patients and family caregivers to more effectively manage medicines in the domiciliary setting. There are clear implications for pharmacists and these are discussed in the context of public awareness, inter-professional collaboration, organisational drivers, funding and regulation and remote care delivery.

To assess the effectiveness of an integrated care program for post-acute care of stroke patients, the return home program (RHP program), deployed in Barcelona (North-East Spain) between 2016 and 2017 in a context of health and social care information systems integration.

The RHP program was built around an electronic record that integrated health and social care information (with an agreement for coordinated access by all stakeholders) and an operational re-design of the care pathways, which started upon hospital admission instead of discharge. The health outcomes and resource use of the RHP program participants were compared with a population-based matched control group built from central healthcare records of routine care data.

The study included 92 stroke patients attended within the RHP program and the patients' matched controls. Patients in the intervention group received domiciliary care service, home rehabilitation, and telecare significantly earlier than the matched controls. Within the first two years after the stroke episode, recipients of the RHP program were less frequently institutionalized in a long-term care facility (5 vs 15%). The use of primary care services, non-emergency transport, and telecare services were more frequent in the RHP group.

The authors' analysis shows that an integrated care program can effectively promote and accelerate delivery of key domiciliary care services, reducing institutionalization of stroke patients in the mid-term. The integration of health and social care information allows not only a better coordination among professionals (thus avoiding redundant assessments) but also to monitor health and resource use outcomes of care delivery.

The aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform future workforce development and planning in a new integrated care system in England.

Semi-structured interviews and focus groups with primary, community, acute care, social care and voluntary care, frontline and managerial staff and with patients and carers receiving these services were undertaken. Data were explored using framework analysis.

Analysis revealed three overarching themes: achieving teamwork and integration, managing demands on capacity and capability and delivering holistic and user-centred care. An organisational development (OD) process was developed as part of the action research process to facilitate the large-scale workforce changes taking place.

This study did not consider workforce development and planning challenges for nursing and care staff in residential, nursing care homes or domiciliary services. This part of the workforce is integral to the care pathways for many patients, and in line with the current emerging national focus on this sector, these groups require further examination. Further, data explore service users' and carers' perspectives on workforce skills. It proved challenging to recruit patient and carer respondents for the research due to the nature of their illnesses.

Many of the required skills already existed within the workforce. The OD process facilitated collaborative learning to enhance skills; however, workforce planning across a whole system has challenges in relation to data gathering and management. Ensuring a focus on workforce development and planning is an important part of integrated care development.

This study has implications for social and voluntary sector organisations in respect of inter-agency working practices, as well as the identification of workforce development needs and potential for informing subsequent cross-sector workforce planning arrangements and communication.

This paper helps to identify the issues and benefits of implementing person-centred, integrated teamworking and the implications for workforce planning and OD approaches.

Polypharmacy is common in older people, who are more likely to have multiple co‐morbidities. Coupled with age‐related physiological decline, undoubtedly this carries the risk of adverse drug reactions, drug interactions and multiple adverse symptoms, with consequent increased hospital admissions. This article discusses a recent audit on polypharmacy in older people conducted by the authors in a district general hospital.

Few will complain that 1974 has not been an eventful year; in a number of significant respects, it has made history. Local Government and National Health Services reorganizations are such events. This is indeed the day of the extra‐large authority, massive monoliths for central administration, metropolitan conurbations for regional control, district councils corresponding to the large authorities of other days; and in a sense, it is not local government any more. As in other fields, the “big batallions” acquire greater collective power than the total sum of the smaller units, can wield it more effectively, even ruthlessly, but rarely appearing to take into account the masses of little people, the quiet people, who cannot make themselves heard. As expected, new names of authorities are replacing the old; new titles for departments and officers, ambitious and high‐sounding; a little grandiose for the tongues of ordinary folk. Another history‐making event of 1974, in the nature of a departmental transfer but highly significant for the course of future events as far as work in the field is concerned, was handing over of the personal health services—health of expectant mothers, babies, children, domiciliary midwifery, the school health services and their mainly medical and nursing personnel—from local health authorities to the newly created area health authorities. The public health departments over fifty years and more had created them, built them up into the highly efficient services they are. If anything can be learned from the past, new authorities are always more expensive than those they replace; they spend freely and are lavish with their accommodation and furnishings. In their first few months of existence, the new bodies have proved they are no exception. News of their meetings and activities in many areas is now scanty; even local newspapers which usually thrive on Council news—or quarrels—seem to have been caught on the wrong foot, especially in the small towns now merged into larger units. The public are relatively uninformed, but this doubtless will soon be rectified.

The purpose of this paper is to investigate the problems patients and caregivers have with using medicines appropriately, their desire for assistance with managing medications and their self‐perceived need for the Australian Home Medicines Review (AHMR).

A qualitative research study was conducted with eight semi‐structured focus groups, including a total of 50 HMR‐eligible patients and caregivers. Participants who were purposively sampled represented older males, older females, younger chronically ill patients, patients from Chinese and Arabic backgrounds and the general HMR target group.

According to the types of medicine problems encountered by participants, their level of medicine understanding and their desire for assistance with using medicines, four distinct patient segments are identified and explicated: the heedless patient, the aware patient, the scrupulous patient and the self‐sufficient patient.

The uptake of the HMR service can be effectively increased by direct‐to‐consumer HMR promotion that is tailored to the behaviors, needs, and desires of eligible patients and caregivers. The proposed segmentation model of HMR‐eligible consumers addresses these differences and can be used to inform health policy makers regarding a more effective promotion of the HMR service.

This is the first study to investigate how the HMR‐uptake could be increased, from the perspective of eligible patients and their caregivers.

Polypharmacy, the concurrent use of multiple medicines by one individual, is a common and growing challenge driven by an ageing population and the growing number of people living longer with chronic conditions. Up to 11% of unplanned hospital admissions in the UK are attributable to, mostly avoidable, harm from medicines. However, this topic is not yet central to integrated practice. This paper reviews the challenge that polypharmacy presents to the health and care system and offers lessons for integrated policy and practice.

Two commonly encountered scenarios illustrate the relevance of addressing inappropriate polypharmacy to integrated practice. An overview of the literature on polypharmacy and frailty, including two recent large studies of policy and practice in Europe, identifies lessons for practitioners, managers, policy makers and commissioners.

Comprehensive change strategies should extend beyond pharmacist led deprescribing initiatives. An inter-professional and systems thinking approach is required, so all members of the integrated team can play their part in realising the value of holistic prescribing, appropriate polypharmacy and shared decision making.

Awareness and education about polypharmacy should be embedded in inter-professional training for all practitioners who care for people with multimorbidity or frailty.

This paper will help policy makers, commissioners, managers and practitioners understand the value of addressing polypharmacy within their integrated services. Best practice national guidance developed in Scotland illustrates how to target resources so those at greatest risk of harm from polypharmacy can benefit from effective pharmaceutical care as part of holistic integrated care.

The purpose of this paper is to explore and assess the configuration, role and likely contribution of the new integrated care partnerships (ICPs) established in Northern Ireland.

The approach is based on the assessment of policy background, strategy papers, implementation plans and initial activities of ICPs.

ICPs have been created with limited powers and an unclear relationship with the existing system of structurally integrated health and social care. The initial priorities and activities of ICPs suggest a focus on integrating health which may impede the further integration of health and social care.

Paper concludes there is a need for robust evaluation including monitoring of progress, performance and outcomes.

First published paper on implementation of ICPs in Northern Ireland. Contributing to comparative studies of structures of health and social care, with particular relevance to integration.