Last week, Barcelona was the host of the 16th International Conference on Integrated Care, a conference that brought together more than one thousand of health and social professionals in order to discuss the integration of services in response to the fragmented practice. Nick Goodwin, President of the International Foundation for Integrated Care (IFIC) in the Conference’s presentation video says that we often think about the integration of services as a mechanism for reducing unnecessary hospitalizations, or even to reduce costs of the waste caused by lack of coordination and inappropriate actions, but Goodwin points out that we should make no mistake: the main objective of this movement is to generate opportunities for care coordination in order to improve the experience and quality of life of patients, especially of those in need of complex health and social care.
Patient experience, the great challenge
The fragmentation of the care practice is a disgrace for everyone, but especially for elderly patients and, for this reason, most governments are engaging in service integration initiatives. Despite this, the progress is slow and the results are disappointing, because the systems are too fractioned with regards to budgets, access rights, circuits, professional cultures, institutions, public and private providers, etc.
As special guests, we had the opportunity to hear Don Redding from National Voices, a coalition of British health and social charities that promotes people-centred care, explaining the evaluation of the second year of the British’ Pioneering Program, with special reference to the list of "I declare" drawn from the experiences of many patients. We also listened to Angela Coulter from Nuffield Trust, an authority in assessing the patients’ perspective.
Have we found the ideal model?
At the Conference, more than 500 experiences from around the world were presented (many of them local), a spectrum that is so wide that does nothing more than to confirm that although everyone is trying, no one has yet found the Holy Grail. Each of the presentations (simultaneity prevented me from assisting in all but hope you’ll allow me to draw conclusions) showed that the strength of patient involvement and coordination between professionals and resources is always positive, at least from the perspective of those directly involved, including the patients. Despite the positive attitude that project leaders tend to radiate when comparing their projects’ data with previous situations, as John Wennberg explains in "Tracking Medicine", not even the best experiences of integration services have managed to be consistent and stable enough as to be replicated outside the environment that has prompted their creation. Perhaps that is the reason why, despite the thousand attendees seeking the ideal model, the truth is: what we have managed to confirm is that there are almost as many models as there are experiences.
Have we learned anything?
As this question is more modest than the previous one, the answer is slightly optimistic, now that after a quick glance over my notes, I dare to highlight some points that I believe, provided the projects observe them, can lead to an improvement to the current situation.
a) Patients and professionals:
- Projects ought to be defined after asking patients how they see things that affect them and how they prefer to live through their illness.
- The key to success is more a matter of tact and dignity than of circuits and technologies.
- Primary care and community services should be the leaders of multidisciplinary teams with well assigned functions, fairly distributed loads and sufficient resources in accordance with the proposed objectives.
- The individualized care plans developed jointly by all stakeholders, including patients, are the instrument that should facilitate care services coordination.
- One of the professionals, often the nurse, should be the patient’s referent, offering a one door service and this should be perceived by the patients themselves.
- The community nurse, often with the support of the social worker, is the piece that links the promotion self-care from home, the obtaining the highest possible level of independence, prevention of risk situations and coordination of all professionals involved in the individualized plan.
- We ought to resolve the differences regarding equal rights and access between social services and health services.
- The most successful initiatives are those that come from enthusiastic professionals who later receive the recognition of the above. For this reason, politicians and managers should be attentive to support and to and facilitate resources for those initiatives rigorously raised by the health and social professionals.
- The projects starting from above, with integrations or mergers, are often unsuccessful, especially if they forget to count on the collaboration of professionals and patients.
- Funding should seek capita models that are adjusted to complexity.
- We ought to fully integrate clinical systems and social information.
- Progress must be made at a “marathon” pace avoiding “sprinting”.