Enablers and Barriers in Implementing Integrated Care

Maruthappu, Mahiben; Hasan, Ali; Zeltner, Thomas

doi:10.1080/23288604.2015.1077301

Cited by 101 publications

(126 citation statements)

References 25 publications

(51 reference statements)

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“…This resulted in 18 studies ultimately included in our review [45681113141516171819202122232425]. From each of the selected contributions, we identified and extracted items considered influential for care integration.…”

Section: Resultsmentioning

confidence: 99%

The Core Dimensions of Integrated Care: A Literature Review to Support the Development of a Comprehensive Framework for Implementing Integrated Care

González-Ortiz¹,

Calciolari²,

Goodwin³

et al. 2018

International Journal of Integrated Care

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Objective:As part of the EU-funded Project INTEGRATE, the research sought to develop an evidence-based understanding of the key dimensions and items of integrated care associated with successful implementation across varying country contexts and relevant to different chronic and/or long-term conditions. This paper identifies the core dimensions of integrated care based on a review of previous literature on the topic.Methodology:The research reviewed literature evidence from the peer-reviewed and grey literature. It focused on reviewing research articles that had specifically developed frameworks on integrated care and/or set out key elements for successful implementation. The search initially focused on three main scientific journals and was limited to the period from 2006 to 2016. Then, the research snowballed the references from the selected published studies and engaged leading experts in the field to supplement the identification of relevant literature. Two investigators independently reviewed the selected articles using a standard data collection tool to gather the key elements analyzed in each article.Results:A total of 710 articles were screened by title and abstract. Finally, 18 scientific contributions were selected, including studies from grey literature and experts’ suggestions. The analysis identified 175 items grouped in 12 categories.Conclusions:Most of the key factors reported in the literature derive from studies that developed their frameworks in specific contexts and/or for specific types of conditions. The identification and classification of the elements from this literature review provide a basis to develop a comprehensive framework enabling standardized descriptions and benchmarking of integrated care initiatives carried out in different contexts.

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Section: Resultsmentioning

confidence: 99%

The Core Dimensions of Integrated Care: A Literature Review to Support the Development of a Comprehensive Framework for Implementing Integrated Care

González-Ortiz¹,

Calciolari²,

Goodwin³

et al. 2018

International Journal of Integrated Care

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“…Most of these factors had been previously reported in the literature on implementation of integrated care [19212459], while some were new. It should be noted that, unlike England’s health system, where health care is provided by the National Health Service (NHS) and social care is provided by local governments, the Québec health system has combined health and social care since its inception in 1971.…”

Section: Discussionmentioning

confidence: 99%

“…Despite these benefits, however, routine use of integrated care models is far from optimal, and there is a big gap between the implementation of experimental projects and the implementation of integrated care models in any given territory. As of now, there are no consistent guidelines on implementing integrated care models in everyday practice [21], and the still-significant gap between research and practice reduces the impact of integrated care models in real life settings. This gap may result from the complexities of implementing an integrated care program [21].…”

Section: Introductionmentioning

confidence: 99%

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Providers’ Perspectives on the Implementation of Mandated Local Health Networks for Older People in Québec

Wankah

Couturier

Belzile

et al. 2018

International Journal of Integrated Care

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Introduction:In many countries, integrated care has been implemented to improve the quality, efficiency and patient experience of services. Understanding how integrated care is adopted in different settings may give insights into where, how and why different components of the organisational design work. The aim of this article is to understand how and why integrated care for older people has been implemented in different contexts from the perspective of providers.Theory and methods:The study uses an innovative composite framework for the implementation of integrated care models, which posits that structural, organisational, provider, innovation and patient factors influence implementation along six dimensions of integration. A qualitative multiple case study was done of three cases in Québec using document analysis and semi-structured interviews of 28 providers. Descriptive comparisons and thematic analysis were performed.Results:Providers considered that structural (government policy) and organisational (mergers) factors highly influenced the implementation of organisational and functional dimensions of integration, at the detriment of clinical integration. Provider, innovation and patient factors mildly or moderately influenced the implementation of integration.Conclusion:Structural and organisational factors were necessary conditions for the implementation of administrative components of integration, with great variability in the implementation of some clinical components.

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“…This said, people suffering from mental conditions face substantial barriers in negotiating health system compared with people without these conditions . Despite increased global efforts to achieve the ideal of comprehensive mental health care by integrating social and health services, success has been mixed . Paradoxically, integrated care initiatives have been plagued by fragmented approaches, across different contexts, health systems, cultural and governance structures, and definitions of key terms .…”

Section: Introductionmentioning

confidence: 99%

At the coalface of collaborative mental health care: A qualitative study of governance and power in district‐level service provision in South Africa

Rensburg

Khan

Wouters

et al. 2018

Health Planning & Management

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Globally, there is an urgency to address fragmented mental health systems, especially in low-to-middle income countries. State and non-state mental health service collaboration is a central strategy to strengthen care. The study was undertaken to analyse the power in governance processes of public mental health service provision. Semi-structured interviews were conducted with state and non-state actors in mental health care in a South African district. Transcriptions were thematically analysed using the Framework for Assessing Power in Collaborative Processes. Findings suggested that collaborative processes were significantly state-owned, in terms of funding models, administrative and legislative jurisdiction, and state hierarchical referral structure. No formal agreements were in place, elevating the importance of key network actors to bring less-endowed NGOs into the service network. Fragmentation between the Departments of Health and Social Development was telling in district forums. Resistance to power structures unfolded, some participants sidestepping traditional hierarchies to leverage funding and support. The paper highlights the complexities and different facets of power in integrated mental health care in a South African district, adding to growing literature on the social mechanisms that influence collaboration.

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Enablers and Barriers in Implementing Integrated Care

Cited by 101 publications

References 25 publications

The Core Dimensions of Integrated Care: A Literature Review to Support the Development of a Comprehensive Framework for Implementing Integrated Care

The Core Dimensions of Integrated Care: A Literature Review to Support the Development of a Comprehensive Framework for Implementing Integrated Care

Providers’ Perspectives on the Implementation of Mandated Local Health Networks for Older People in Québec

At the coalface of collaborative mental health care: A qualitative study of governance and power in district‐level service provision in South Africa

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