Exploring New Models for Implementing Sustainable Integrated Health Access for People in Vulnerable Positions: Protocol for a Mixed Methods Multiple Case Study

Abstract

Background: Health care is a strongly universal right across European welfare states, however, social inequalities in health persist. Literature argues that healthcare organisation is an important but overlooked determinant of social inequalities in health, as health systems buffer or amplify structural and individual health determinants. The People-centred Coordination (PCC) model offers integrated health access to people with severe mental illness, through core groups of professionals from across health and social services.Objective: This study focuses on the vulnerable people with severe mental health problems and aims to analyse how the model can give people with severe mental illness more integrated access to health and social care. This can form a stepping-stone for the upscaling of the PCC model Methods: We conduct a five-year multiple case study of three municipalities in Denmark, where PPC is being implemented. In a one-year pilot study, we expect to gather quantitative registry data from the municipalities and the Central Denmark Region to explore the characteristics of people included in PCC. We will also collect qualitative data, including 21 hours of observations, 36 interviews with users, professionals and managers, and 3 focus groups across the three municipalities. In a subsequent, fouryear qualitative study, we aim to conduct 120 hours of observations, 120 interviews and 24 focus groups. In parallel with the qualitative study, we will facilitate a co-creation process to develop tools for sustaining integrated health access.Results: As of January 2024, we have completed the individual interviews with users of PCC and professionals and the focus groups. Individual interviews of managers will be conducted during the 1st quarter of 2024. The quantitative data is being collected.Conclusions: Inequality is one of the greatest challenges European societies face. Understanding new and innovative approaches to integrated care may provide valuable solutions to the challenges posed. Especially understanding and designing health and social care systems that meet the needs and abilities of those users requiring them most, is vitally important to tackle inequality.