Managing multimorbidity: Profiles of integrated care approaches targeting people with multiple chronic conditions in Europe

Abstract

In response to the growing populations of people with multiple chronic diseases, new models of care are currently being developed in European countries to better meet the needs of these people. This paper aims to describe the occurrence and characteristics of various types of integrated care practices in European countries that target people with multimorbidity. Data were analysed from multimorbidity care practices participating in the Innovating care for people with multiple chronic conditions (ICARE4EU) project, covering all 28EU Member States, Iceland, Norway and Switzerland. A total of 112 practices in 24 countries were included: 65 focus on patients with any combination of chronic diseases, 30 on patients with a specific chronic disease with all kinds of comorbidities and 17 on patients with a combination of specific chronic diseases. Practices that focus on a specific index disease or a combination of specific diseases are less extensive regarding the type, breadth and degree of integration than practices that focus on any combination of diseases. The latter type is more often seen in countries where more disciplines, e.g. community nurses, physiotherapists, social workers, work in the same primary care practice as the general practitioners. Non-disease specific practices put more emphasis on patient involvement and provide more comprehensive care, which are important preconditions for person-centered multimorbidity care.

Integrated Care Programs for People with Multimorbidity in European Countries: eHealth Adoption in Health Systems

“…Below, information on materials and methods is reported. A more detailed description of these aspects is provided elsewhere [52,65,66]. They were asked to identify existing integrated care initiatives at a national/regional/local level focusing on MM and to report the related information by filling in an online questionnaire for each eligible program, also with the collaboration of their expert network and program managers/leaders.…”

“…Different combinations/developments of these indicators/dimensions correspond to/measure different degrees in the strength of PC between countries. For this paper, we considered the overall strength of PC (iii) Level of (de)centralization of health system: this classification is based on WHO, Health System in Transition series (years from 2008 to 2013) [69], and it distinguished countries with centralized health systems (most of the responsibilities lie with the central government) vs. decentralized systems (management systems whose regulation, operation, and also cofunding are delegated to regional authorities or states), as level of decision making and executive powers in a country [52]. This classification was derived from descriptive data in countries' latest Health System Review (in 2013, i.e., year when the ICARE4EU project was initiated).…”

“…PC is indeed the first "entry-point" to the health system in many European countries, with a crucial role in coordinating patients throughout the different health settings [50], and a condition for its efficient work is the use of ICT. Living in countries with a strong PC system is in turn beneficial to people with MM [51], as the principles of PC-e.g., continuous, comprehensive, and coordinated care-may fit their needs in a better way [52,53].…”

“…Moreover, in countries where the responsibility for the provision of healthcare is decentralized, positive strategy documents regarding eHealth have been published by regional authorities [57]. Furthermore, different types of MM care practices may also be found in centralized and decentralized health systems [52]. Some authors also report that inequalities in ICT use are related not only to inequalities in individual social structures (e.g., sociodemographic, economic, and health variables) but also to macrosocial variables and welfare systems, e.g., economic, political, and social characteristics and public policies of the respective countries [58,59].…”

The multimorbidity epidemic: challenges for real-world research

“…It is apparent that a more integrated care response may be needed for people with multimorbidity. The concept, broadly defined and described in the literature, refers to an integration of interdisciplinary care across specializations that is incorporated into patients' routine primary care with shared decision-making that results in a single combined long-term treatment plan adapted to address patients (complex) multitude of health problem (Trivedi, 2017;Rijken et al, 2018). The care builds in different working dimensions such as the type of integration, the extent of services involved and the level of integration needed.…”