Background: Many health care systems attempt to develop an integrated care approach that is a whole population health-oriented system. However, knowledge of strategies to support this effort are scarce and fragmented. The aim of the current paper is to investigate existing concepts of integrated care and their elements from a public health perspective and to propose an elaborated approach that could be applied to explore the public health orientation of integrated care. Design and methods: We applied a scoping review approach. A literature search was conducted in Embase, Medline, CINAHL, Scopus and Web of Science for the period 2000–2020 yielding 16 studies for inclusion. Results: Across the papers, 14 frameworks were identified. Nine of these referred to the Chronic Care Model (CCM). Service delivery, person-centeredness, IT systems design and utilization and decision support were identified as the core elements of most of the included frameworks. The descriptions of these elements were mainly clinical-oriented focusing particularly on clinical care processes and treatment of diseases instead of wider determinants of population health. Conclusions: A synthesized model is proposed that emphasizes the importance of mapping the unique needs and characteristics of the population it aims to serve, leans on the social determinants approach with a commitment to individual and community empowerment, health literacy and suggests reorienting services to meet the expressed needs of the population.
Health care systems are increasingly complex, and evidence shows poor coordination of care within and between providers, as well as at the interface between different levels of care. The purpose of this study is to explore users’ and providers’ (stakeholders’) perspectives of integrated care in Denmark. We conducted qualitative interviews with 19 providers and 18 users that were analysed through inductive content analysis. Providers’ and stakeholders’ perceived deficits in system-level factors, lack of organizational culture, weaknesses in communication, a need for a shift towards considering equity in access to health services and focus on person-centeredness. Fundamental changes suggested by participants were better sharing of information and knowledge, focus on stronger trust building, efforts in making communication more effective, and changes in incentive structure. Users perceived poor navigation in the health care system, frustration when they experienced that the services were not based on their needs and lack of support for improving their health literacy. The study showed health care weaknesses in improving user involvement in decision-making, enhancing the user–provider relationship, coordination, and access to services. Public health within integrated care requires policies and management practices that promote system awareness, relationship-building and information-sharing and provides incentive structures that support integration.
Background Working at multiple levels (intrapersonal, interpersonal and structural) and within multiple settings (medical, communities/municipalities, regional, and governmental) plays a significant role in promoting health and preventing chronic diseases. We analyzed determinants of the use of multilevel approach-based work on the example of the management of type II diabetes in the Region of Southern Denmark.Method A qualitative interview study comprising 19 individual interviews with health professionals at different levels and two focus group interviews with diabetes patients in municipalities of the Region of Southern Denmark.Results Communication, funding, lack of clarity of content and aims of collaboration, and organizational, structural, and legislative issues were identified as the main barriers to effective multilevel approach-based management of type II diabetes.Conclusion Organizational, structural and capacity-related barriers should be addressed in order to develop an effective multilevel public health approach to target type II diabetes and potentially other non-communicable diseases.
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