Impact of integrated care on the use of emergency care among older people in Stockholm County

Abstract

Background In Sweden, health care is a regional responsibility and social care of older people is a municipal responsibility. The system is fragmented and the use of emergency care by older persons is rising. Better integration, coordination, and collaboration between health and social care providers is necessary to address the complex needs of an ageing population. Since 2006, Norrtälje municipality in Stockholm Region has integrated health and social care. This study aims to assess the impact of the integrated care system in Norrtälje on rates of emergency care visits, compared to the rest of Stockholm county. Methods A repeated cross-sectional study with an interrupted time series analysis compared the integrated care system in Norrtälje to a matched control from Stockholm county, using. population-based register data between 2000-2015 obtained from Stockholm Region’s administrative database of healthcare utilization and from the Longitudinal Integration database for Health Insurance and labour market studies from Statistics Sweden. Results There was no statistically significant difference in the post-intervention rates of emergency care visits in Norrtälje compared to the matched control. However, there was a decreasing trend in the rate of visits among females 65-79 years, those in lower income groups, those living alone and those born outside of Sweden. Conclusions The implementation of the integrated care system in Norrtälje had no statistically significant impact on the rate of emergency care visits among older persons compared to standard care. However, there was a reduced rate of visits among potentially vulnerable sub-groups. Further research is needed as the full implementation of the Norrtälje Model was completed as recently as 2016 and the full impact may not yet be realised. Key messages Bringing about change in the delivery of health and social care is complex and challenging. Thus, to observe differences in the utilisation of emergency care requires more time and resources. Innovation in the delivery of health and social care is needed to effectively manage and coordinate the ever changing needs of older persons with complex needs given the current fragmented services.

People living with dementia using eldercare in Sweden

“…Third, eldercare services in Sweden are publicly funded, organized by local municipalities, and provided almost exclusively by the public sector (Doheny et al, 2019;Peterson, 2017).…”

“…According to the Social Services Act (1982), all citizens aged 65 years and over have the right to claim public social services and help 'if their needs cannot be met in any other way' (Lagergren, 2002). The underlying principle is "equal access according to need" (Dahlberg et al, 2018;Doheny et al, 2019).…”