The Over 75 Service: Continuity of Integrated Care for Older People in a United Kingdom Primary Care Setting

Different Contexts, Similar Challenges. SUSTAIN’s Experiences with Improving Integrated Care in Europe

“…In SUSTAIN, we therefore used participatory implementation research to support local stakeholders to improve their existing ways of working. The paper by MacInnes et al [10] focusses on the improvement process of one specific integrated care initiative in the United Kingdom. SUSTAIN showed us that collaborative approaches, that use an iterative cycle of research, action, and reflection, are necessary to implement and improve integrated care successfully.…”

“…The project has generated lots of insights into and experiences with integrated care implementation and evaluation [7,8]. This special IJIC issue on SUSTAIN features six papers covering a variety of aspects of integrated care, including the implementation of activities to improve integrated care [9][10][11], the exploration of experiences of different stakeholders with integrated care, i.e. service users, informal carers, professionals, and managers [9,[11][12][13][14], and the evaluation of integrated care by means of a Patient Reported Outcome Measure (PREM) [14].…”

“…The papers by Stoop et al [11] and Lette et al [9] review all integrated care initiatives that participated in SUSTAIN, reflecting activities that were undertaken by the stakeholders of the initiatives to improve person-centredness and safety respectively. The paper by MacInnes et al [10] focusses on the improvement process of one specific integrated care initiative in the United Kingdom. The finding that there is a gap between managers' and professionals' views and those of users and informal carers on essential aspects of integrated care is a second lesson the SUSTAIN team learned.…”

Advancing integrated care evaluation in shifting contexts: Blending implementation research with case study design in Project SUSTAIN.

“…The two other elements, namely evidence-based interventions and the participatory implementation process (including stakeholder involvement), are more concerned with the intervention development and roll out and are reported elsewhere. (16,17,35) It is worth, however, mentioning brie y here some experiences with stakeholder involvement as they affected the methodology. In the face of universal health and social care resource constraints, considerable commitment was required for stakeholders not only to develop and implement the improvements with research teams at sites, but also to take part in interviews and assist with obtaining quantitative indicators.…”

“…Having reviewed the relative mertis of the EIT framework, the discussion moves on to a critique of case study design. One of the most commonly cited disadvantages of case studies is that ndings can lack generalisability and scienti c credibility because replication is di cult [35] . However, external validity can be stronger in multiple case study designs, which was the choice in SUSTAIN, and can be weak in more highly ranked randomised control trials.…”