The path to integrated healthcare: Various Scandinavian strategies

Åhgren, Bengt

doi:10.1177/2053435414540606

Cited by 31 publications

(37 citation statements)

References 30 publications

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“…At the same time, positive experiences related to the personal continuity care are more holistic care, a higher adherence to treatment, lower risk for disengagement from treatment and smooth transition between hospital and community care. It is another important argument in prevention of the appearance of the "Bermuda triangle" in mental health care system where lack of holistic view of patient needs and poor coordination of different providers' tasks leads to the high risk of disengagement from treatment [1,25]. Lack of personal continuity increases the need of the patients to look after the continuity of care themselves, and to see that relevant information is conveyed to different actors.…”

Section: Results Related To Previous Findingsmentioning

confidence: 99%

Personal continuity versus specialisation of care approaches in mental healthcare: experiences of patients and clinicians—results of the qualitative study in five European countries

Klingemann

Welbel

Priebe

et al. 2019

Soc Psychiatry Psychiatr Epidemiol

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Background The current debate on organisation of the mental health care raises a question whether to prioritise specialisation of clinical teams or personal continuity of care. The article explores the experiences of patients and clinicians regarding specialisation (SC) and personal continuity (PCC) of care in five European countries. Methods Data were obtained via in-depth, semi-structured interviews with patients (N = 188) suffering from mental disorders (F20-49) and with clinicians (N = 63). A maximum variation sampling was applied to assume representation of patients and of clinicians with different characteristics. The qualitative data from each country were transcribed verbatim, coded and analysed through a thematic analysis method. Results Many positive experiences of patients and clinicians with the PCC approach relate to the high quality of therapeutic relationship and the smooth transition between hospital and community care. Many positive experiences of patients and clinicians with the SC approach relate to concepts of autonomy and choice and the higher adequacy of diagnosis and treatment. Clinicians stressed system aspects of providing mental health care: more effective management structure and higher professionalization of care within SC approach and the lower risk of disengagement from treatment and reduced need for coercion, restraint, forced medication or involuntary admission within PCC. Conclusions Neither the PCC, nor the SC approach meets the needs and expectations of all patients (and clinicians). Therefore, future reforms of mental health services should offer a free choice of either approach, considering that there is no evidence of differences in patient outcomes between PCC and SC approaches. Keywords Mental health care organisation • Functional system • Integrated system All authors declare that the submitted work has not been published before (neither in English nor in any other language) and that the work is not under consideration for publication elsewhere.

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Section: Results Related To Previous Findingsmentioning

confidence: 99%

Personal continuity versus specialisation of care approaches in mental healthcare: experiences of patients and clinicians—results of the qualitative study in five European countries

Klingemann

Welbel

Priebe

et al. 2019

Soc Psychiatry Psychiatr Epidemiol

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“…Concomitantly, it has been observed that public service provision is often affected by classical integration problems . Regarding health‐care, this is particularly salient since a well‐coordinated “supply chain” is widely viewed as an indispensable precondition for decent service provision (Ahgren ; Atun et al ; Nolte et al ). This is of particular relevance where system integration is needed to ensure the mere access to services.…”

Section: Health‐care Reforms and System Integration In A (Quasi‐)npm mentioning

confidence: 99%

Paradoxical Internationalization: Regulatory Reforms in the Mexican Health‐Care System through the Lens of European Experience

Bode

2018

Politics & Policy

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Over the recent past, Mexico has been exemplary in having launched regulatory reforms in order to modernize its health-care system, with major objectives being universal insurance coverage and less infrastructural fragmentation. In this article we argue that these reforms, widely inspired by the global New Public Management movement and its aftermath, take shape in a difficult encounter with both the traditional public administration model in Mexico and tensions endemic to the aforementioned reform movement as attempts to enhance system integration coincide with procedural disorganization. This results in a paradoxical internationalization of the Mexican health-care system due to which the above objectives may be difficult to achieve. To illustrate our argument, we examine the Mexican case through the lens of experience two European countries (Germany and Norway) in which reforms have affected the health-care system in a similar way.

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“…Similar to several Western countries [101112131415], Norway has implemented national reforms aiming to overcome challenges due to fragmentation of services for persons with long-term healthcare needs. The Norwegian Coordination reform was introduced in 2008 and implemented in 2012 [16].…”

Section: Introductionmentioning

confidence: 99%

“…These new coordinator roles represented a reinforcement of a long-term initiative: Since 2001, Norwegian health authorities have focused on individual care plans and patient coordinator roles held by clinicians to secure individualized and integrated care, with gradually stronger legal regulations [1120]. Research prior to the Coordination Reform has shown that implementation of patient coordinator roles for complex needs had been slow, that professionals were reluctant to take on such roles, and that the proportion of individual care plans relative to the estimated number of persons who qualify for such plans was low [11172526].…”

Section: Introductionmentioning

confidence: 99%

“…Research prior to the Coordination Reform has shown that implementation of patient coordinator roles for complex needs had been slow, that professionals were reluctant to take on such roles, and that the proportion of individual care plans relative to the estimated number of persons who qualify for such plans was low [11172526]. The Auditor General of Norway concluded in 2016 that, despite the extensive legislative efforts, the coordinator roles and individual care plans did not secure cohesive pathways for persons with complex or long-term needs according to the policy intentions [27].…”

Section: Introductionmentioning

confidence: 99%

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Policies Make Coherent Care Pathways a Personal Responsibility for Clinicians: A Discourse Analysis of Policy Documents about Coordinators in Hospitals

Høyem

Gammon²,

Berntsen

et al. 2018

Int J Integr Care

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Introduction:In response to increase of patients with complex conditions, policies prescribe measures for improving continuity of care. This study investigates policies introducing coordinator roles in Norwegian hospitals that have proven challenging to implement.Methods:This qualitative study of policy documents employed a discourse analysis inspired by Carol Bacchi’s ‘What‘s the problem represented to be?’. We analysed six legal documents (2011–2016) and selected parts of four whitepapers presenting the statutory patient care coordinator and contact physician roles in hospitals.Results:The ‘problem’ represented in the policies is lack of coherent pathways and lack of stable responsible professionals. Extended personal responsibility for clinical personnel as coordinators is the prescribed solution. Their duties are described in terms of ideals for coherent pathways across conditions and contexts. System measures to support and orchestrate the individual patient’s pathway (e.g. resources, infrastructure) are scarcely addressed.Conclusions and Discussion:We suggest that the policies’ construction of the ‘problem’ as a responsibility issue, result in that neither diversity of patients’ coordination needs, nor heterogeneity of hospital contexts regarding necessary system support for coordinators, is set on the agenda. Adoption of rhetoric from diagnosis-specific standardized pathways obscures unique challenges in creating coherent pathways for patients with complex needs.

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The path to integrated healthcare: Various Scandinavian strategies

Cited by 31 publications

References 30 publications

Personal continuity versus specialisation of care approaches in mental healthcare: experiences of patients and clinicians—results of the qualitative study in five European countries

Personal continuity versus specialisation of care approaches in mental healthcare: experiences of patients and clinicians—results of the qualitative study in five European countries

Paradoxical Internationalization: Regulatory Reforms in the Mexican Health‐Care System through the Lens of European Experience

Policies Make Coherent Care Pathways a Personal Responsibility for Clinicians: A Discourse Analysis of Policy Documents about Coordinators in Hospitals

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