Search results

We trace the evolution of a new integrated care policy in the English NHS (enhanced health in care homes, EHCH) from pilot model to wider roll out, over a 4-year period, into the circumstances of COVID-19.

Using published evidence and official documentation we compared and contrasted the original EHCH model/framework, subsequent draft specifications and the final proposals, ahead of implementation.

The Primary Care Network EHCH service specification has clearly arisen from the Vanguard programme; however, problems related to GP contracts and COVID-19 means, at least initially, there is likely to be some variability over who will be responsible for delivery. It is unknown whether this service, delivered at pace in the current circumstances, will achieve or affect the outcomes envisaged by the pilots.

This is our interpretation of the developing policy for enhanced health in care homes, which requires further follow-up research. We are beginning our final fieldwork phase in Summer 2020, to report on the Vanguard legacy.

Evaluations of policy success/failure should consider the context and the differing power relations that are present and may impact subsequent take-up and roll-out across the system. We recommend a longitudinal approach to enable a holistic view of policy implementation.

This paper reveals the fragility of health and care policymaking in the current climate. From initial concept, through development and testing, into forced early roll out, our observations reflect the unique impact of a global pandemic shock.

Providing high-quality and cost-efficient care of older people is an important development priority for many health and social care systems in the world. This paper suggests a shift from acute, episodic and reactive hospital-centered care toward longitudinal, person-centered and proactive home-centered care. The purpose of this paper is to contribute to the knowledge of a comprehensive development strategy for designing and providing home-centered care of older people.

The study design is based on qualitative research with an inductive approach. The authors study development initiatives at the national, regional and local levels of the Swedish health and social care system. The data collection methods included interviews (n = 54), meeting observations (n = 25) and document studies (n = 59).

The authors describe findings related to policy actions and system changes, attempts to achieve collaboration, integration and coordination, new forms of care offerings, characteristics of work settings at home and differences in patients' roles and participation at home and in the hospital.

The authors suggest home-centered care as a solution for providing person-centered and integrated care of older people and give examples of how this can be achieved.

The authors outline five propositions for research and development related to national policies, service modularity as a solution for customized and coordinated care, developing human resources and infrastructure for home settings, expanding services that enable older people living at home and patient co-creation.

Due to the evolution of the health-care scenario and the growing role of the primary care setting, the distribution processes of health technologies will be more and more in demand in the near future. This paper aims to investigate this theme, analyzing the performance, strengths and weaknesses of the current distribution practices, with the ultimate overarching aim to improve the provision of the primary care services.

The research framework is twofold. First, a tool to monitor the economic/quantitative performance of the distribution models was designed; second, the tool was applied to measure the performance of distribution models of absorbent devices for incontinence adopted by Local Health Authorities (LHA) in Lombardy Region (Italy). Quantitative data were collected by LHAs (from 2012 to 2016) and compared through data-benchmarking. Qualitative data from interviews and focus groups complemented the outcomes.

Two main distribution models were investigated: distribution through pharmacies and home delivery. Results show that there is no winning/preferable model in terms of economic/quantitative performance and service quality level, but a counterbalanced combination of strengths and weaknesses exists. Moving from the highlighted weaknesses and building on the strengths, an alternate distribution model is proposed for testing.

The present study approaches the theme of primary care services with a holistic approach, filling a literature gap. It also provides practitioners with a tool of performance analysis and management and real data, applicable also in international contexts. The collected real-world data also gives insights on the area of the quality of care, with particular reference to the patients’ experience. As a lesson learned, policymakers and the National Healthcare Service should re-think their current distribution models/practices in the light of the highlighted criticisms and opportunities for improvement.

Older people living in nursing homes have complex care needs and frequently need specialists’ advice and support that can be challenging to deliver in a rural setting. The aim of this paper is to describe a model of integrated care in a rural area supported by a nurse case manager.

A real-world evidence study of people living in Ribes de Freser nursing home, was conducted between specific timeframes in 2019 and 2022, comparing the casemix and outcomes of a traditional care model with the integrated interdisciplinary model.

The integrated care model led to a significant reduction in transfers to the emergency department, hospitalisations, outpatient medical visits and a reduction in the number of medicines. In addition, the number of residents receiving end-of-life care at the nursing home showed a substantial increase.

This case study contributes valuable evidence supporting the implementation of an integrated model of nurse case manager support in nursing homes, particularly in the rural contexts, where access to specialist medical staff may be limited. The findings highlight the potential benefits of person-centred integrated care for older adults, addressing their complex needs and improving end-of-life care in nursing home settings.

About five per cent of ‐ generally very frail ‐ older people live in long‐term care in the UK; approximately a fifth of all deaths occur in care homes. Depression and dementia are prevalent mental health conditions in care homes; depression is reported in around a third of residents and dementia in two thirds. While there is some evidence about efficacy of medication in treating psychiatric and behavioural symptoms among residents, much less is known about the potential role of psychosocial interventions in enhancing mental health and quality of life. Quality of care varies widely across the carehome sector including support from primary and specialist health and quality and level of training. In terms of enhancing care quality, there is evidence that investing in staff training and conditions, establishing good links with healthcare providers, and developing care standards that genuinely promote good practice are likely to improve resident quality of life. This is an exciting area for research development and practice innovation for the future; taking account of users perspective, holds particular potential.

This study examines the variation in preventable hospitalization rates of Medicaid children in California to extend our understanding of racial and ethnic disparity in primary care quality. The results show that primary care quality varies substantially by race and ethnicity even when financial access is ensured by Medicaid. Moreover, the domain of primary care that minority children experience disadvantage varies by race and ethnicity. Compared to white children, African-American children lack continuity and comprehensiveness of care that is necessary for the management of chronic conditions. Hispanic children, on the contrary, have inadequate first contact care. Asian children experience a better quality of care overall than white children. Independent of race, a primary language other than English has a protective effect on preventable hospitalization rates, indicating that language need not be a barrier to quality primary care for racial and ethnic minority groups. The possible reasons underlying the observed differences in health outcome by race/ethnicity and primary language are discussed.

A growing ageing population with complex healthcare needs is a challenge to the organisation of healthcare support for older people residing in care homes. The lack of specialised healthcare support for care home residents has resulted in poorer outcomes, compared with community-dwelling older people. However, little is known about the forms, staff mix, organisation and delivery of such services for residents’ physical healthcare needs. The paper aims to discuss these issues.

This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to provide an overview of the range of healthcare services delivered to care homes and to identify core features of variation in their organisation, activities and responsibilities. The eligibility criteria for studies were services designed to address the physical healthcare needs of older people, permanently residing in care homes, with or without nursing. To search the literature, terms relating to care homes, healthcare and older people, across ten electronic databases were used. The quality of service descriptions was appraised using a rating tool designed for the study. The evidence was synthesised, by means of a narrative summary, according to key areas of variation, into models of healthcare support with examples of their relative effectiveness.

In total, 84 studies, covering 74 interventions, identified a diverse range of specialist healthcare support services, suggesting a wide variety of ways of delivering healthcare support to care homes. These fell within five models: assessment – no consultant; assessment with consultant; assessment/management – no consultant; assessment/management with consultant; and training and support. The predominant model offered a combination of assessment and management. Overall, there was a lack of detail in the data, making judgements of relative effectiveness difficult. Recommendations for future research include the need for clearer descriptions of interventions and particularly of data on resident-level costs and effectiveness, as well as better explanations of how services are implemented (review registration: PROSPERO CRD42017081161).

There is considerable debate about the best means of providing healthcare to older people in care homes. A number of specialist initiatives have developed and this review seeks to bring these together in a comparative approach deriving models of care of value to policy makers and commissioners.

The purpose of this paper is to consider how the evolving concept of the “primary care home” (PCH) that is developing in England might be an effective vehicle for the delivery of the goals of “population health”. The authors examine evidence from earlier initiatives to achieve similar objectives of primary care-led health system planning and care integration to understand relevant lessons for the PCH.

This paper is based on a descriptive review of the PCH using documentary sources and a non-systematic review of literature relating to primary care commissioning initiatives and recent initiatives to deliver general practice services on a larger scale.

The PCH is likely to bring forth relatively high engagement from general practitioners due to its neighbourhood scale, voluntary nature and its focus on professional partnership, personalisation of care and outcomes. It is important that participants have sufficient autonomy to act and that financial incentives are aligned with the goals of population health. It is also important that, unlike some earlier primary care initiatives, the PCH is given time to develop to maturity.

The PCH is a recent phenomenon that is developing in England and elsewhere. This paper locates the PCH within a historical context and draws conclusions from a relevant evidence base.

The purpose of this paper is to report on the origins, development and early impacts of a Health Care Home (HCH) model of care being rolled out around New Zealand (NZ).

This paper draws on a literature review on HCHs and related developments in primary health care, background discussions with key players, and a review of significant HCH implementation documents.

The HCH model of care is emerging from the sector itself and is being tailored to local needs and to meet the needs of local practices. A key focus in NZ seems to be on business efficiency and ensuring sustainability of general practice – with the assumption that freeing up general practitioner time for complex patients will mean better care for those populations. HCH models of care differ around the world and NZ needs its own evidence to show the model’s effectiveness in achieving its goals.

It is still early days for the HCH model of care in NZ and the findings in this paper are based on limited evidence. Further evidence is needed to identify the model’s full impact over the next few years.

This paper is one of the first to explore the HCH model of care in NZ.

Despite many calls to strengthen connections between health systems and communities as a way to improve primary healthcare, little is known about how new collaborations can effectively alter service provision. The purpose of this paper is to explore how a health authority, municipal leaders and physicians worked together in the process of transforming primary healthcare.

A longitudinal qualitative case study was conducted to explore the processes of change at the regional level and within seven communities across Northern British Columbia (BC), Canada. Over three years, 239 interviews were conducted with physicians, municipal leaders, health authority clinicians and leaders and other health and social service providers. Interviews and contextual documents were analyzed and interpreted to articulate how ongoing transformation has occurred.

Four overall strategies with nine approaches were apparent. The strategies were partnering for innovation, keeping the focus on people in communities, taking advantage of opportunities for change and encouraging experimentation while managing risk. The strategies have bumped the existing system out of the status quo and are achieving transformation. Key components have been a commitment to a clear end-in-view, a focus on patients, families, and communities, and acting together over time.

This study illuminates how partnering for primary healthcare transformation is messy and complicated but can create a foundation for whole system change.